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321
and 35.9-71.1 % in Asia. Between 1993 and 2010, globally, continued feeding for children with diarrhea appears to be unchanged (=0.15, p=0.82). Likewise, no significant improvements in continued feeding were observed in Latin America (= -0.10, p=0.78) or Sub-Saharan Africa (= -0.15, p=0.27). Prevalence of continued feeding in Asia appears to be increasing significantly at 0.25% increase rate per year (p=0.05). Sub-Saharan Africa has the highest diarrhea-associated mortality of any region in the world but has seen no improvements in continued feeding for children with diarrhea since 1993.These findings indicate the need for quantitative and qualitative research to understand barriers to continued feeding on the part of caregivers, and renewed efforts to promote continued feeding as a core component of diarrhea case management in settings where the burden of diarrhea is high. and the United States conducted a binational outbreak investigation to confirm this cluster and determine the etiology. We performed additional case-finding and classified GBS cases through interviews and medical record review. To investigate exposures, we reviewed disease surveillance data, performed C. jejuni stool culture, conducted a casecontrol study examining food and water exposures of cases with GBS or C. jejuni infection, and performed an environmental assessment of water systems. From May 4-July 21, 2011, 16 SLRC residents and 8 YC residents developed GBS, far exceeding the expected number of cases. Twentyone GBS patients (81%) reported antecedent diarrhea. Approximately two weeks before this cluster, weekly YC C. jejuni reports doubled compared with the 3 previous years. Though C. jejuni diagnostics were limited, 2 GBS patients had stool cultures yielding C. jejuni and 4 others had positive serologic or stool antigen tests. In the case-control study, all 7 GBS case-patients from YC traveled to SLRC during the exposure period versus 37% of 19 matched controls (mOR: 10.2; CI: 1.4-inf.). Few case-patients or controls (<20%) drank tap water, but >95% reported exposure through other routes. Case-patients consumed more washable, uncooked produce items than controls (Median: 7 vs. 5; P = 0.04). The SLRC municipal water system had a history of inadequate chlorination and pipe disruptions. Inadequately disinfected tap water contaminated with C. jejuni was the likely source of this first mainland North American outbreak of GBS. Improved water treatment practices were implemented and the institution of new epidemiological surveillance strategies in SLRC since this investigation will improve early detection of diarrheal outbreaks and facilitate public health actions.

1053
TRENDS IN ANTIBIOTIC RESISTANCE AND DIARRHEAL DISEASE EPIDEMIOLOGY IN A MILITARY POPULATION IN THE PERUVIAN AMAZON, 2003-2011 Kristen Heitzinger1, Ryan C. Maves2, Eric R. Hall2, Claudio Rocha2, Rene C. Guzman3, Franca R. Jones2, Drake H. Tilley2
1

University of Washington, Seattle, WA, United States, 2U.S. Naval Medical Research Unit - 6, Lima, Peru, 3Vargas Guerra Army Base, Iquitos, Peru

In Peru, where antibiotic use is unregulated, the effective treatment of diarrheal disease is often complicated by the development of antibiotic resistant organisms. We aimed to investigate the trends in diarrheal disease etiology and antibiotic resistance in a military population in the Peruvian Amazon in order to guide diarrhea treatment. From 2003 to 2011, diarrheal disease surveillance was conducted among personnel at the Vargas-Guerra Army Base in Iquitos, Peru. All individuals experiencing diarrhea were requested to present to the army health post where a stool sample was taken for culture. Diarrheagenic bacteria were isolated from 34.5% of the 638 cases. From the 215 samples in which a single bacterial pathogen was isolated, Shigella flexneri, Enterotoxigenic E. coli (ETEC) and Enteroinvasive E. coli (EIEC), were the most common pathogens and were identified in 47.0%, 30.2%, and 5.6% of samples, respectively. There were no trends in the prevalence of Shigella flexneri or EIEC over the study period, however, the prevalence of ETEC decreased significantly (Odds Ratio= 0.86, 95% CI=0.75, 0.97; p=0.02). Of 101 isolates of Shigella flexneri cultured, 95.0% demonstrated resistance to tetracycline, 89.1% to chloramphenicol, 84.2% to ampicillin, and 80.2% to cotrimoxazole. Resistance of Shigella flexneri to ciprofloxacin and azithromycin remained low (0% and 8.9%, respectively). There were no significant trends in resistance to any other antibiotics over time. These data demonstrate a high prevalence of Shigella flexneri and diarrheagenic E. coli among diarrhea cases in a military population in the Peruvian Amazon. Although antibiotic resistance to penicillins and sulfa antibiotics remains high in this population, more appropriate or less frequent use of certain antibiotics may have led to decreasing resistance.

1055
IDENTIFICATION AND CONFIRMATION THROUGH MULTIPLEX PCR OF THE SPECIES OF ARCOBACTER IN ISOLATES FROM HUMAN AND ANIMAL FECAL SAMPLES IN LIMA, PERU Rito Zerpa1, Maritza Puray-Chavez1, Carlos R. Sevilla1, Paolo A. Wong1, Percy Lezama2, Lilian Patio3, Jorge O. Alarcon1
Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Peru, 2Frigorifico La Colonial SAC, Callao, Peru, 3Instituto Nacional de Salud del Nio, Lima, Peru
1

1054
CLUSTER OF GUILLAIN-BARR SYNDROME DUE TO A WATERBORNE OUTBREAK OF CAMPYLOBACTER JEJUNI INFECTION -- SAN LUIS RIO COLORADO, SONORA, MEXICO AND YUMA, ARIZONA, UNITED STATES, 2011 Jos Alomia1, Brendan Jackson2
Sonora SubDirectorate of Epidemiological Intelligence, for the Binational GBS Investigation Team, Hermosillo, Mexico, 2Centers for Disease Control and Prevention, for the Binational GBS Investigation Team, Atlanta, GA, United States
1

A multiplex PCR was used to confirm the identity of isolates that are phenotypically suggestive of Arcobacter from human and animal stool samples in Lima, Peru. We evaluated 57 bacterial isolates from human fecal samples (3), pigs (52), lion (1) and rabbit (1), with the following phenotypic characteristics suggestive of Arcobacter: gram-negative rods, curve-shaped C or S, mobile, aerobic and microaerophilic, circular colonies 1 to 2mm in diameter at 18-24 hours of incubation in microaerophilic conditions on blood agar, non-hemolytic and lactose negative colonies on MacConkey agar, oxidase and catalase positive. The study of genotype was performed by multiplex PCR, as reported previously, using primers targeting the 16S and 23S rRNA genes for the detection of three species: A. butzleri, A. cryaerophilus, A. skirrowi, with a molecular weight of 401-bp, 257-bp, 641-bp, respectively. It was confirmed molecularly that Arcobacter was in 87.7% (50/57) of the isolates studied, 90% (45/50) of which corresponded to A. butzler, 8.0% (4/50) to A. cryaerophilus and 2% (2/50) to A. skirrowi. A proportion of 12.3% were negative with the primers used. Of the three human samples, two isolates corresponded to A. butzleri and one to A. cryaerophilus. The rabbit and lion isolates were A. butzleri. Of the pig isolates, 91.1% (41/45) A. butzler, 6.7% (3/45) were A. cryaerophilus, and 2.2% (1/45) A. skirrowi. The presence of A. butzler, A. cryaerophilus and A. skirrowi were confirmed in 87.7% of the total isolates of human, pig, rabbit and lion fecal samples. The remaining 12.3% of the isolates are likely composed of other species of Arcobacter.

From May 31-June 16, 2011, a cluster of 15 suspected cases of GuillainBarr Syndrome (GBS) which sometimes follows Campylobacter jejuni infection, was reported in San Luis Rio Colorado (SLRC), Sonora, Mexico and Yuma County (YC), Arizona. Epidemiological teams from Mexico

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Abstract Author Index

The number(s) following author name refers to the abstract number. Kuschner, Robert A. 418 Kushner, Adam L. 286 Kuzmin, Ivan 566 Kwak, Byung Hyung 676 Kwambai, Titus 271 Kwambana, Brenda 1419 Kwarteng, Alexander 522 Kwarteng, Anthony 1176 Kweza, Patience 1252 Kwiatkowski, Dominic 503, 999 Kwityn, Clifford 1034 Kwofie, Kofi D. 256 Kwon, Chang-hee 580 Kyabayinze, Daniel 463, 1307, 1309, 1020 Kyari, Fatima 1274 Kyebambe, Peterson S. 656 Kyelem, Carole G. 377 Kyelem, D. 483 Kyle, Dennis E. 431, 866, 867, 989 Kyobutungi, Catherine 1360 Larbi, Irene A. 1109 Larissa Aurore Tobola, Bouyoukou Hounkpatin 703 LaRocque, Regina C. 42, 43, 45, 1410, 41, 1041 Larrauri, Luis 446 Larsen, David 1180 Larsen, David A. 12, 468, 694, 1435 Larson, Erik 629 Larson, Nick 1213 Larson, Peter S. 915, 917 Larsson, Catherine 1011 Lasanajak, Yi 761 Laserson, Kayla 513, 514, 515, 952, 961, 453, 1403 Latourette, Matthew 1427 Lau, Colleen 118 Lau, Louis 1395 Lau, Rachel 862 Lauby-Secretan, Beatrice 141 Laucella, Susana A. 1153 Laufer, Miriam K. 871, 1438, 857, 857 Laurens, Matthew B. 5, 7, 1335 Laver, Susan M. L.. 1252 Law, Charity W. 1167 Lawal, Ismail 958 Lawrie, Alison 3 Lazo, John S. 537 Le, Binh 1209 Le, Christy 1002 Le, Huu Tho 246 Le, Minh Nhat 246 Le Bras, Jacques 862, 863, 863, 864, 868 Le Nagard, Herv 868 Ledermann, Jeremy P. 1377, 566 Lee, Angela 1357 Lee, Andrew H. 439 Lee, Bi-Yao 1119 Lee, Bruce Y. 127, 296 Lee, Ming-Chieh 877 Lee, Marcus C. S. 439 Lee, Patricia J. 683 Lee, Sue 548, 1269 Lee, Susan Shin-Jung 1119 Leed, Susan E. 683 Leeds, Janet M. 103 Leepitakrat, Surachai 578 Legac, Jenny 677 Legros, Mathieu 872 Lehane, Michael 71, 76 Leiby, David A. 905, 905 Leitner, Gabriel 797 Leitner, Wolfgang W. 611, 611 Lekpor, Cecilia E. 333 Lele, Albertine K. 337 Lemey, Philippe 17, 119 Lemma, Seblewengel 903 Lemnge, Martha M. 861 Lemos, Larissa S. 250 Lengeler, Christian 1328 Lenhart, Audrey 281, 724, 786 Lennon, Niall J. 429 Lennox, Gayle 1254 Leon, Juan S. 1255 Leontsini, Elli 774, 775, 963, 965 Leow, Kak S. 560 Lepore, Timothy 60 Lepore S.R., Timothy J. 59 Lerdprom, Rujira 877 Leroy, Didier 681, 986 Lesage, Pierre-Loup 1345 Lescano, Andrs G. 227, 259, 445, 640, 929, 1196, 1223 Lescuyer, Arlette 1451 Leshem, Eyal 829 Leslie, Toby 454, 461 Lesser, Adriane 1353 Lessler, Justin 1082 Letizia, Andrew 951 Leung, Daniel T. 42, 43, 45, 518, 1041, 1410 Leung, Zachary 1470 Leutner, Silke 980 Levens, Joshua 592 Levin, Joshua Z. 429 Levine, Jessica 54 Levine, Myron M. 236, 513, 515, 961, 1288, 514, 1059, 1060 Levine, Rebecca 563 Levy, Danielle 1275 Levy, Karen 1042 Levy, Michael Z. 275, 825 Lewallen, Susan 1268, 1271 Lewis, Kayla 1240 Lewis, Michael D. 981 Lezama, Percy 1055 Lhermitte-Vallarino, Nathaly 40 Li, Hongmin 1071 Li, Jianyong 24 Li, Jian 665 Li, Lixin 103 Li, Li 1104 Li, Qigui 840, 841 Li, Shanping 389 Li, Tao 189, 449 Li, Tiger 1099 Li, Xiangming 1461 Li, Yu 455 Li, Yuexin 834, 834 Liang, Ai Wei 110 Liang, Li 719 Liang, Song 960 Liang, Yousheng 532 Liao, Hua-Xin 632 Libraty, Daniel H. 15 Lichtner, Franz 1459 Lieberman, Marya 1240 Lieshout, L. V. 1434 Lietman, Tom M. 29 Lievens, Marc 188 Liles, W. C. 1449 Lilleb, Kristine 1278, 1279, 1280

A-471

L
LaBaer, Josh 41 Labb, Pierrick 1205 LaBeaud, A. Desiree 50, 423, 721 Laclette, Juan P. 98, 1076, 99 Lacoste, Maryjane 880 LaCrue, Alexis N. 431 Lafferty, Kevin 757 LaForce, Marc 1408 Lafosse, Elsie 47 Lafuente-Monasterio, Maria Jose 1325 Lage, Regina C. G. 529 Laguna-Torres, Victor A. 1135, 942, 1400 Lai, Chih-Yun 1394 Lakwo, Tom L. 520 Lal, Sham 340, 341 Lalji, Shabbir 546, 918 Lalloo, David 362, 1441 Lam, Felix 1345 Lam, Polo C. H.. 24 Lambert, Lynn 1423 Lamberton, Poppy H. L. 479 Lamine, Diakit Moussa 1337 Lammie, Patrick 482, 645 Lampah, Daniel A. 155, 1424 Lan, Nguyen T. P. 637 Lanata, Claudio F. 516, 941, 1248, 1258 Laney, Sandra J. 1489 Lang, Jean 110, 630 Lanou, Herman 292 Lantagne, Daniele S. 1252 Lanteri, Charlotte A. 837, 1063 Lantz, Chris 438 Laquer, Kari 176

Lilue, Jingtao 1499 Lim, Burton K. 53 Lim, Chang-kweng 1392 Lim, Jacqueline K. 1016, 1017 Lim, Kee-Chong 1035 Lim, Pharath 985 Lim, Yvonne A. L. 248 Lima, Aldo A. M. 517, 1049 Lima, Helena C. A. V. 19 Lima, Marcelo d. Lima. 265, 266 Nolia L. Lima. 517 Limbach, Keith 495 Limkittikul, Kriengsak 1016, 1017, 1101 Lin, Feng-Chang 363 Lin, Jingwen 978 Lin, Jessica T. 357, 689, 689, 889 Lin, Ren-Yong 449 Lin, Zhaoting 983 Linares-Perez, Nivaldo 944, 1249 Lindblade, Kim 485, 626, 938, 1124, 1125, 1243, 391 Lindh, Jenny 191, 214, 217 Lindo, John F. 1130 Lindquist, Susan 1297 Lindroth, Erica 67 Lindsay, Robbin 1090, 1287 Lindsay, Steve 191, 214, 217, 1220, 1388, 464, 1419 Lindsay, Thomas 1419 Lindsley, Craig W. 730 Lingam, Raghu 804 Linser, Paul 1362 Linthicum, Kenneth K. 211 Liomba, Mike 857, 857 Liong, Kek-Yee 983 Lipkin, W. Ian 1103 Lissandrin, Raffaella 448, 1067 Little, Kristen M. 485, 1124, 1125, 1478 Littrell, Megan 1021, 1299, 1300 Liu, Canhui 1113, 1487 Liu, Jenny 342, 684, 1174 Liu, Jie 512, 1380 Liu, Kun 1464 Liu, Lucy 60 Liu, Mingli 313, 663 Liu, Mingshun 625 Liu, Shiping 23 Liu, Xia 175 Liu, Yunhua 23 Liu, Yue 1027 Livengood, Jill A. 619, 1013, 1014 Liyanage, Jayantha 410 Llanos, Fernando 446 Llanos, Fiorella 1341 Llanos-Cuentas, Alejandro 885, 887, 1270, 1341 Llergo, Jose L. 1320 Llewellyn, Martin S. 981 Llins, Manuel 439 Lloyd, Bradley 790

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