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Globally, hepatitis A virus (HAV) is one of the most common agents of acute viral hepatitis and causes approximately 1.4 million cases and 90,000 deaths annually despite the existence of an effective vaccine. In 2019, federal, state, and local partners investigated a multi-state outbreak of HAV infections linked to fresh blackberries sourced from multiple suppliers in Michoacán, Mexico. A total of 20 individuals with outbreak-related HAV infection were reported in seven states, including 11 hospitalizations, and no deaths. The Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and Nebraska State and Douglas County Health Departments conducted a traceback investigation for fresh blackberries reportedly purchased by 16 ill persons. These individuals reported purchasing fresh blackberries from 11 points of service from September 16 through 29, 2019 and their clinical isolates assessed through next-generation sequencing and phylogenetic analysis were genetically similar. The traceback investigation did not reveal convergence on a common grower or packing house within Mexico, but all of the blackberries were harvested from growers in Michoacán, Mexico. FDA did not detect the pathogen after analyzing fresh blackberry samples from four distributors, one consumer, and from nine importers at the port of entry as a result of increased screening. Challenges included gaps in traceability practices and the inability to recover the pathogen from sample testing, which prohibited investigators from determining the source of the implicated blackberries. This multi-state outbreak illustrated the importance of food safety practices for fresh produce that may contribute to foodborne illness outbreaks.
相似文献Methods: After participating in the MPA, 1,631 subjects completed a questionnaire about rehabilitation efforts. The selection of items for this questionnaire was made according to our own prior research, interviews with problem drivers, and the diagnostic criteria for the MPA. Participants were asked when and from whom they obtained certain information and how relevant this information was for their success. In contrast to other studies, which used reoffense rates as a criterion for successful rehabilitation, we used a positive MPA result (positive, negative, or training) as the criterion for success.
Results: Just over half (52%) of the participants considered themselves optimally informed about the rehabilitation process. The others (47.4% of participants) judged the adequacy of information received as less than satisfactory. Offenders who did not partake in counseling before the MPA achieved a successful result only about half as often (37.1%) as those who did (70%) and were around 3 times as likely to have additional courses imposed upon them (21 vs. 7.6%). Of the offenders who received crucial and helpful information at an early stage, 62.4% attained a positive MPA at the first attempt (regardless of having attended any training courses). The success rate for the first attempt rose to 81% for offenders who were well informed at an early stage and participated in counseling before their first MPA.
Conclusion: The results clearly indicate that the provision of relevant information at an early stage combined with counseling has a beneficial influence on success rates for the rehabilitation process (an increase from 37.1 to 81%). As such, we recommend the introduction of obligatory license consultations, offered by MPA experts, involving a status assessment to customize offenders' rehabilitation and thereby provide more or less intensive guidance or coaching depending on offenders' characteristics throughout their progression through the MPA system. 相似文献