No abstract

SUMMARY Although rare, typhoid fever cases acquired in the United States continue to be reported. Detection and investigation of outbreaks in these domestically acquired cases offer opportunities to identify chronic carriers. We searched surveillance and laboratory databases for domestically acquired typhoid fever cases, used a space–time scan statistic to identify clusters, and classified clusters as outbreaks or non-outbreaks. From 1999 to 2010, domestically acquired cases accounted for 18% of 3373 reported typhoid fever cases; their isolates were less often multidrug-resistant (2% vs. 15%) compared to isolates from travel-associated cases. We identified 28 outbreaks and two possible outbreaks within 45 space–time clusters of ⩾2 domestically acquired cases, including three outbreaks involving ⩾2 molecular subtypes. The approach detected seven of the ten outbreaks published in the literature or reported to CDC. Although this approach did not definitively identify any previously unrecognized outbreaks, it showed the potential to detect outbreaks of typhoid fever that may escape detection by routine analysis of surveillance data. Sixteen outbreaks had been linked to a carrier. Every case of typhoid fever acquired in a non-endemic country warrants thorough investigation. Space–time scan statistics, together with shoe-leather epidemiology and molecular subtyping, may improve outbreak detection.

Medical records, poison center data, and CASPER household surveys were inexact but useful data sources to describe overall community health effects after a large-scale chemical spill. Analyzing multiple data sources could inform epidemiologic investigations of similar events.

In this study, we estimate the health benefits of more stringent alternative energy goals and the costs of reducing coal-fired power plant pollution in China projected in 2030. One of our two overarching alternative energy goals was to estimate the health benefits of complete elimination of coal energy, supplemented by natural gas and renewables. The second was a policy scenario similar to the U.S. 2013 Climate Action Plan (CAP), which played a pivotal role leading up to the 2015 Paris Climate Agreement. We used the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) model created by the International Institute for Applied Systems Analysis for our model simulations. We found that 17,137–24,220 premature deaths can be avoided if coal energy is completely replaced by alternative energy, and 8,693–9,281 premature deaths can be avoided if coal energy is replaced by alternatives in a CAP-like scenario. A CAP-like scenario using emission-controls in coal plants costs $11–18 per person. Reducing coal energy in China under a CAP-like scenario would free up $9.4 billion in the annual energy budget to spend on alternatives, whereas eliminating the cost of coal energy frees up $32 billion. This study's estimates show that more stringent alternative energy targets in China are worth the investment in terms of health.