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Peterson De

Bio: Peterson De is an academic researcher. The author has contributed to research in topics: Cryptosporidium & Outbreak. The author has an hindex of 2, co-authored 2 publications receiving 2313 citations.

Papers
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Journal ArticleDOI
TL;DR: This massive outbreak of watery diarrhea among the residents of Milwaukee was caused by cryptosporidium oocysts that passed through the filtration system of one of the city's water-treatment plants, and water-quality standards and the testing of patients for cryptOSporidium were not adequate to detect this outbreak.
Abstract: Background Early in the spring of 1993 there was a widespread outbreak of acute watery diarrhea among the residents of Milwaukee. Methods We investigated the two Milwaukee water-treatment plants, gathered data from clinical laboratories on the results of tests for enteric pathogens, and examined ice made during the time of the outbreak for cryptosporidium oocysts. We surveyed residents with confirmed cryptosporidium infection and a sample of those with acute watery diarrhea consistent with cryptosporidium infection. To estimate the magnitude of the outbreak, we also conducted a survey using randomly selected telephone numbers in Milwaukee and four surrounding counties. Results There were marked increases in the turbidity of treated water at the city's southern water-treatment plant from March 23 until April 9, when the plant was shut down. Cryptosporidium oocysts were identified in water from ice made in southern Milwaukee during these weeks. The rates of isolation of other enteric pathogens remained stab...

2,040 citations

Journal ArticleDOI
TL;DR: The clinical and epidemiological features of visitors to the Milwaukee area in whom cryptosporidiosis developed, and a telephone survey of Milwaukee County households to evaluate the risk of recurrent illness and secondary transmission, merit further investigation.
Abstract: Contamination of the public water supply in Milwaukee during March and April 1993 resulted in a massive outbreak of cryptosporidium infection. We investigated the clinical and epidemiological features of visitors to the Milwaukee area in whom cryptosporidiosis developed, and we conducted a telephone survey of Milwaukee County households to evaluate the risk of recurrent illness and secondary transmission. Cryptosporidium infection during this outbreak generally seemed more severe than cases described in previous reports of large case series. The risk of secondary transmission within a household was low (5%) when the index case involved an adult. The recurrence of watery diarrhea after apparent recovery was a frequent occurrence among visitors with laboratory-confirmed cryptosporidium infection (39%) and among visitors and Milwaukee County residents with clinical infection (21%). The interval between the initial recovery and the onset of recurrence was prolonged (> or = 5 days) in 6%-8% of persons. This pattern of recurrence and its impact on transmission and our understanding of the pathophysiological mechanisms of cryptosporidium infection merit further investigation.

325 citations


Cited by
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Journal ArticleDOI
TL;DR: The SHSIP provides a well-detailed description of the proposed value-based models of care through the Patient-Centered Medical Home (PCMH) model, resulting in the statewide implementation of Accountable Health Communities (AHCs).
Abstract: Vision for Transformation Strengths: The SHSIP describes a holistic transformation plan and ensures connections between various plan components. The State’s Plan seeks to reward health care providers for better care, smarter spending, and healthier people through higher quality, instead of quantity of services by utilizing valuebased purchasing across public and private payers. The SHSIP provides a well-detailed description of the proposed value-based models of care through the Patient-Centered Medical Home (PCMH) model, resulting in the statewide implementation of Accountable Health Communities (AHCs). The SHSIP outlines a long-term vision of building and expanding the PCMH model into a Community Centered Health Homes (CCHHs) model, which will focus on prevention and collaboration with other communitybased organizations. Another strength identified is the amount of existing PCMHs operating within the State. The SHSIP provides a course of action to assist non-PCMH practices to become nationally certified, as well as, goals for a single, statewide PCMH model to be used by all providers and payers within the state. The implementation of the AHCs will be key in addressing social determinants of health within various communities and seems to align well with the PCMH goals. This focus on population and community health will enable the State to make a broader impact and support the long-term goal of moving towards a CCHH model. The focus on the improvement of clinical, behavioral, and oral health care within the urban, rural, and frontier communities is well aligned and consistent with the SIM goals and the overall Triple Aim initiative. Figure 18: Driver Diagram clearly shows how the State plans to achieve the Triple Aim by 2020.

1,627 citations

01 Jan 2011
TL;DR: This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations, including evidence-based recommendations supported by studies and experienced opinions based upon infection-control and engineering practices.
Abstract: The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.

1,478 citations

Journal Article
TL;DR: In this paper, the authors reported a total of 22 waterborne-disease outbreaks associated with drinking water and recreational lake water, which caused an estimated total of 2,567 persons to become ill. No deaths were reported.
Abstract: Problem/condition Since 1971, CDC and the U.S. Environmental Protection Agency have maintained a collaborative surveillance system for collecting and periodically reporting data that relate to occurrences and causes of waterborne-disease outbreaks (WBDOs). Reporting period covered This summary includes data for January 1995 through December 1996 and previously unreported outbreaks in 1994. Description of the system The surveillance system includes data about outbreaks associated with drinking water and recreational water. State, territorial, and local public health departments are primarily responsible for detecting and investigating WBDOs and for voluntarily reporting them to CDC on a standard form. Results For the period 1995-1996, 13 states reported a total of 22 outbreaks associated with drinking water. These outbreaks caused an estimated total of 2,567 persons to become ill. No deaths were reported. The microbe or chemical that caused the outbreak was identified for 14 (63.6%) of the 22 outbreaks. Giardia lamblia and Shigella sonnei each caused two (9.1%) of the 22 outbreaks; Escherichia coli O157:H7, Plesiomonas shigelloides, and a small round structured virus were implicated for one outbreak (4.5%) each. One of the two outbreaks of giardiasis involved the largest number of cases, with an estimated 1,449 ill persons. Seven outbreaks (31.8% of 22) of chemical poisoning, which involved a total of 90 persons, were reported. Copper and nitrite were associated with two outbreaks (9.1% of 22) each and sodium hydroxide, chlorine, and concentrated liquid soap with one outbreak (4.5%) each. Eleven (50.0%) of the 22 outbreaks were linked to well water, eight in noncommunity and three in community systems. Only three of the 10 outbreaks associated with community water systems were caused by problems at water treatment plants; the other seven resulted from problems in the water distribution systems and plumbing of individual facilities (e.g., a restaurant). Six of the seven outbreaks were associated with chemical contamination of the drinking water; the seventh outbreak was attributed to a small round structured virus. Four of the seven outbreaks occurred because of backflow or backsiphonage through a cross-connection, and two occurred because of high levels of copper that leached into water after the installation of new plumbing. For three of the four outbreaks caused by contamination from a cross-connection, an improperly installed vacuum breaker or a faulty backflow prevention device was identified; no protection against backsiphonage was found for the fourth outbreak. Thirty-seven outbreaks from 17 states were attributed to recreational water exposure and affected an estimated 9,129 persons, including 8,449 persons in two large outbreaks of cryptosporidiosis. Twenty-two (59.5%) of these 37 were outbreaks of gastroenteritis; nine (24.3%) were outbreaks of dermatitis; and six (16.2%) were single cases of primary amebic meningoencephalitis caused by Naegleria fowleri, all of which were fatal. The etiologic agent was identified for 33 (89.2%) of the 37 outbreaks. Six (27.3%) of the 22 outbreaks of gastroenteritis were caused by Cryptosporidium parvum and six (27.3%) by E. coli O157:H7. All of the latter were associated with unchlorinated water (i.e., in lakes) or inadequately chlorinated water (i.e., in a pool). Thirteen (59.1%) of these 22 outbreaks were associated with lake water, eight (36.4%) with swimming or wading pools, and one(4.5%) with a hot spring. Of the nine outbreaks of dermatitis, seven (77.8%) were outbreaks of Pseudomonas dermatitis associated with hot tubs, and two (22.2%) were lake-associated outbreaks of swimmer's itch caused by Schistosoma species. Interpretation WBDOs caused by E. coli O157:H7 were reported more frequently than in previous years and were associated primarily with recreational lake water. This finding suggests the need for better monitoring of water quality and identification of sources of

1,471 citations

Book
01 Jan 1998
TL;DR: In this paper, the authors present a special report of the Second Assessment Report (SAR) of the Intergovernmental Panel on Climate Change (IPCC), which has been published since mid-1995.
Abstract: The Intergovernmental Panel on Climate Change (IPCC) was jointly established by the World Meteorological Organization and the United Nations Environment Programme in 1988 to assess the scientific and technical literature on climate change, the potential impacts of changes in climate, and options for adaption to and mitigation of climate change. Since its inception, the IPCC has produced a series of Assessment Reports, Special Reports, Technical Papers, methodologies and other products which have become standard works of reference, widely used by policymakers, scientists and other experts. This Special Report, which has been produced by Working Group II of the IPCC, builds on the Working Group's contribution to the Second Assessment Report (SAR), and incorporates more recent information made available since mid-1995. It has been prepared in response to a request from the Subsidiary Body for Scientific and Technological Advice (SBSTA) of the UN Framework Convention on Climate Change (UNFCCC). It addresses an important question posed by the Conference of the Parties (COP) to the UNFCCC, namely, the degree to which human conditions and the natural environment are vulnerable to the potential effects of climate change. The report establishes a common base of information regarding the potential costs and benefits of climatic change, including the evaluation of uncertainties, to help the COP determine what adaptation and mitigation measures might be justified. The report consists of vulnerability assessments for 10 regions that comprise the Earth's entire land surface and adjoining coastal seas: Africa, Arid Western Asia (including the Middle East), Australasia, Europe, Latin America, North America, the Polar Regions (The Arctic and the Antarctic), Small Island States, Temperate Asia and Tropical Asia. It also includes several annexes that provide information about climate observations, climate projections, vegetation distribution projections and socioeconomic trends.

1,455 citations

Journal ArticleDOI
TL;DR: In this paper, the main groups of aquatic contaminants, their effects on human health, and approaches to mitigate pollution of freshwater resources are reviewed, particularly on inorganic and organic micropollutants including toxic metals and metalloids as well as a large variety of synthetic organic chemicals.
Abstract: Water quality issues are a major challenge that humanity is facing in the twenty-first century. Here, we review the main groups of aquatic contaminants, their effects on human health, and approaches to mitigate pollution of freshwater resources. Emphasis is placed on chemical pollution, particularly on inorganic and organic micropollutants including toxic metals and metalloids as well as a large variety of synthetic organic chemicals. Some aspects of waterborne diseases and the urgent need for improved sanitation in developing countries are also discussed. The review addresses current scientific advances to cope with the great diversity of pollutants. It is organized along the different temporal and spatial scales of global water pollution. Persistent organic pollutants (POPs) have affected water systems on a global scale for more than five decades; during that time geogenic pollutants, mining operations, and hazardous waste sites have been the most relevant sources of long-term regional and local water pollution. Agricultural chemicals and wastewater sources exert shorter-term effects on regional to local scales.

1,407 citations