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PubMed2004

Measles elimination in Canada.

To describe the progress and challenges in achieving measles elimination in Canada, we analyzed national data on measles cases for 1998-2001. To assess the status of measles elimination in Canada, we estimated the effective reproductive number, R. Measles elimination was defined as the interruption of endemic transmission and failure to reestablish endemic transmission after importation. Twelve isolated cases, 29 cases (72.4% were linked to 2 outbreaks), 199 cases (96.9% were linked to 4 outbreaks of 2, 6, 30, and 155 cases), and 34 cases (73.5% were linked to 8 outbreaks of 2, 2, 2, 2, 3, 3, 3, and 8 cases) were reported in 1998, 1999, 2000, and 2001, respectively. R ranged from 0.58 to 0.95. Multiple chains of transmission occurred in religious communities that actively oppose or resist immunization efforts. Epidemiological and virological evidence suggests that endemic transmission of measles has been mostly interrupted since 1998.

Adolescent↗
PubMed2004

Measles outbreak epidemiology in the United States, 1993-2001.

To evaluate the extent of measles virus circulation and populations at risk in the United States, we reviewed measles outbreaks during 1993-2001. A total of 120 measles outbreaks, constituting 1804 outbreak-related cases, were reported during this period. The maximum outbreak size decreased from 233 cases in 1993-1995 to 119 cases in 1996-1998 and 15 cases in 1999-2001. The maximum outbreak duration decreased from 127 days in 1993-1995 to 65 days in 1999-2001. The majority of outbreaks resulted from documented spread from an internationally imported case (42%) or had a strain of measles virus not endemic in the United States (12%). Outbreaks in which adults were the predominant age group affected accounted for 35% of all outbreaks, compared with 29% of outbreaks predominantly affecting preschool children, 30% predominantly affecting school-aged children and adolescents, and 6% with no predominant age group. The extremely limited size and duration of measles outbreaks indicates very high population immunity to measles and suggests that measles is no longer endemic in the United States.

Adolescent↗
PubMed2004

Has surveillance been adequate to detect endemic measles in the United States?

Evidence that endemic measles has been eliminated in the United States rests on the performance of the surveillance system. Information from national surveillance data allows us to evaluate the adequacy of national surveillance to detect the circulation of endemic measles. Sources of data include measles report dates, international importation status, and the size of chains of measles transmission. The proportion of chains of measles transmission that can be epidemiologically linked to international importations is high (62%), as would be expected if measles is no longer circulating; the number of imported cases, although lower than estimated expected values, is within a reasonable range of expectation. National surveillance detects even small outbreaks, so larger outbreaks that are the marker for endemic transmission would almost certainly be detected. Few unreported cases of measles are detected when health departments conduct careful investigations in response to reports of an index case. Surveillance appears to be adequate to support the contention that measles is no longer endemic in the United States.

Disease Notification↗
PubMed2006

Adequacy of surveillance to detect endemic rubella transmission in the United States.

BACKGROUND: Reported rubella cases in the United States are at the lowest numbers since the introduction of vaccine, suggesting that endemic transmission may have been interrupted. It is necessary to validate that the observed absence of rubella is due to the disappearance of disease rather than a failure of rubella surveillance. METHODS: Adequate rubella surveillance to detect ongoing transmission is characterized by evidence that rubella investigations are being conducted, detection of importations, and lack of spread from confirmed cases. We reviewed rubella surveillance data and activities from 5 sources: (1) data reported to the national surveillance system; (2) a survey of health departments and public health laboratories, including questions regarding any links between measles and rubella surveillance; (3) enhanced rubella surveillance activities in California and in New York City; (4) sentinel surveillance along the US-Mexico border; and (5) case detection in 8 large health maintenance organizations (HMOs). RESULTS: During 2002-2004, 35 cases of rubella were reported to the national system, including 12 (34%) imported cases. The 39 programs that responded to our survey reported conducting 1482 investigations for rubella; according to another national survey, 1921 investigations were conducted for measles. Forty-one laboratories responded to our survey and reported conducting 6428 tests for acute rubella. No previously undetected (or unreported) cases of rubella or congenital rubella syndrome were identified by our survey or reviews of surveillance in California, New York, and along the US-Mexico border, and no additional cases were detected in the HMO database. CONCLUSIONS: No previously unrecognized spread cases or outbreaks of rubella were detected. Surveillance in the United States is sufficiently sensitive to identify indigenous cases of rubella, if they were occurring, supporting the contention that rubella has been eliminated from the United States.

Disease Notification↗
PubMed2006

Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units.

BACKGROUND: Routine culturing of patients in intensive care units (ICUs) for methicillin-resistant Staphylococcus aureus (MRSA) identifies unrecognized carriers and facilitates timely isolation. However, the benefit of surveillance in detecting prevalent and incident carriers likely varies among ICUs. In addition, many assessments underestimate the incidence of acquisition by including prevalent carriers in the at-risk population. METHODS: We performed a retrospective cohort study using accurate at-risk populations to evaluate the range of benefit of admission and weekly surveillance cultures in detecting otherwise unrecognized MRSA in 12 ICUs in 5 states. RESULTS: We assessed 142 ICU-months. Among the 12 ICUs, the admission prevalence of imported MRSA was 5%-21%, with admission surveillance providing 30%-135% increases in rates of detection. The monthly hospital-associated incidence was 2%-6%, with weekly surveillance providing 7%-157% increases in detection. The common practice of reporting incidence using the total number of patients or total patient-days underestimated incidence by one-third. Surgical ICUs had lower MRSA importation but higher MRSA incidence. Overall, routine surveillance prevented the misclassification of 17% (unit range, 11%-29%) of "incident" carriers, compared with clinical cultures, and increased precaution days by 18% (unit range, 11%-91%). CONCLUSIONS: Routine surveillance significantly increases the detection of MRSA, but this benefit is not uniform across ICUs, even with high compliance and the use of correct denominators.

Academic Medical Centers↗
PubMed2003

Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience.

Telemedicine (TM) services a process in which expert medical advice from afar is provided using electronic signals to transfer the medical data from one site to another. As a pilot project to assess the efficacy of TM in developing countries like India, a telemedicine center was set up at the main hospital of Mahakumbh mela--a grand religious fair, at Prayag, a city in north India. The daily reporting of the in-patient and outpatient cases at the fair revealed a surge of diarrhea cases among the pilgrims at the fair. This information was communicated to the referral center at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), which, with the help of its microbiology department, conducted microbiological examinations of stool samples and rectal swabs of patients along with various water samples. Vibrio cholerae was isolated in 22.6% (7/31) of the samples. This information was immediately relayed to the Main Hospital at the fair online, and then to the health authorities, who took strict and prompt measures to improve hygiene. Subsequently, the number of diarrhea cases decreased considerably in a matter of a few days, and thus an epidemic disaster was averted, which could have created havoc in such a large gathering.

Aged↗
PubMed2004

Predicting super spreading events during the 2003 severe acute respiratory syndrome epidemics in Hong Kong and Singapore.

One of the intriguing characteristics of the 2003 severe acute respiratory syndrome (SARS) epidemics was the occurrence of super spreading events (SSEs). Here, the authors report the results of identifying the occurrence of SSEs in the Hong Kong and Singapore epidemics using mathematical and statistical analysis. Their predicted occurrence of SSEs agreed well with the reported occurrence of all seven super spreaders in the two cities. Additional unidentified SSEs were also found to exist. It was found that 71.1% and 74.8% of the infections were attributable to SSEs in Hong Kong and Singapore, respectively. There also seemed to be "synchronized" occurrences of infection peaks in both the community and the hospitals in Hong Kong. The results strongly suggested that the infection did not depend on the total number of symptomatic cases, with only a very small proportion of symptomatic individuals being shown to be infectious (i.e., able to infect other individuals). The authors found that the daily infection rate did not correlate with the daily total number of symptomatic cases but with the daily number of symptomatic cases who were not admitted to a hospital within 4 days of the onset of symptoms.

Adult↗
PubMed1997

HIV-related risk factors of blood donors in northern Thailand before and after knowing HIV test results.

BACKGROUND: The epidemic of Human Immunodeficiency Virus (HIV) infection led blood banks to initiate donation deferral criteria based on self-reported risk factors. However little information is available on the differences in reporting risk factors before and after HIV status is known. METHODS: Between April and July 1994, blood donors in a provincial hospital in northern. Thailand were interviewed at the time of donation, about their demographic characteristics and risk factors. All donors had agreed to learn their test results and were called back for post-test counselling and reinterview. RESULTS: HIV-positive blood donors were more likely to change from 'denying' to 'acknowledging' risk factors while HIV-negatives were more likely to change from 'acknowledging' to 'denying'. The differences between risk factors obtained before and after test results were known resulted in stronger, weaker or even opposite risk measures. CONCLUSION: The study results raise questions about the impact of the differences in reporting HIV-related risk factors by the donors on how effective donation deferral criteria can be developed.

Adult↗
PubMed1999

Trends in HIV and AIDS based on HIV/AIDS surveillance data in Japan.

BACKGROUND: In recent years a decline in the number of new AIDS cases has been observed in several industrialized countries. It is important to know whether these recent trends observed in North America and Europe are also occurring in Japan. METHODS: The number of people reported with HIV and AIDS by nationality, route of infection, and sex was calculated based on the HIV/AIDS surveillance data available in Japan through December 1997. The effect of reporting delay, which was defined as those HIV and AIDS cases reported in the calendar year following diagnosis, on the trends was examined. The coverage rate in reporting HIV cases was estimated as the ratio of the reported AIDS cases with prior report as an HIV-positive to the total number of reported AIDS cases. RESULTS: The cumulative number of reported cases of HIV among Japanese and non-Japanese residents of Japan up to the end of 1997 were 1,300 and 1,190, respectively. The cumulative number of reported cases of AIDS among Japanese and non-Japanese up to the end of 1997 were 758 and 298, respectively. The number of reported cases of HIV among Japanese was found to be still increasing, with the major contribution from male cases. The increasing trend in the number of reported AIDS cases among Japanese began to slow in 1996 and 1997. The number of reported cases of HIV among non-Japanese residents of Japan peaked in 1992, and has decreased since then, and remained constant after 1994. In contrast, the number of reported AIDS cases among these non-Japanese tended to increase gradually. There was a slight reporting delay for people with HIV and AIDS. The estimated coverage rate in reporting HIV cases tended to decrease in 1996 and 1997 (1/7.2, 1/10.2, respectively). We point out several reasons for this recent decline and suggest the possibility of an ostensible decline in the estimates. CONCLUSIONS: We suggest that the number of people with HIV among Japanese has continued to increase, and that the increase in the number of AIDS cases among Japanese is now slowing.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Barmah Forest virus epidemic on the south coast of New South Wales, Australia, 1994-1995: viruses, vectors, human cases, and environmental factors.

In 1995, the largest recorded outbreak of human disease resulting from infection with the mosquito transmitted alphavirus Barmah Forest (BF) virus occurred along the south coast of New South Wales, Australia. The virus was first isolated in early January from mosquitoes collected at Batemans Bay and predisposed the recognition of 135 human clinical cases. The cases of BF virus were identified initially from Batemans Bay during late January, and the majority (30%) of all cases came from this town. After 5 wk, all major centers on the south coast had clinical patients. Aedes vigilax (Skuse) were especially abundant at Batemans Bay, with levels up to 8 times greater than normal. This species yielded 111 isolates and appeared to be the major vector of BF virus. Attempts to examine if BF virus was maintained in the field by vertical transmission within Ae. vigilax populations were unsuccessful; no evidence of vertical transmission with BF virus, nor any other arbovirus, was found in > 17,000 adults emerging from field-collected larvae from the region following peak virus activity. In addition to BF virus, other viruses were recovered from field-collected adult mosquitoes, including Ross River (10 isolates), Edge Hill (21), and Stratford (10). Ae. vigilax again yielded the majority of these viral isolates. The BF virus outbreak appeared to be associated with several factors. A lack of recent BF virus activity in the region provided a highly susceptible human population, and unusual weather conditions of above average rainfall coupled with high tides resulted in extraordinarily large populations of Ae. vigilax.

Aedes↗
PubMedDate not supplied

Use of passive surveillance data to study temporal and spatial variation in the incidence of giardiasis and cryptosporidiosis.

OBJECTIVE: The goal of this study was to evaluate temporal and spatial variations in the reporting of cases of giardiasis and cryptosporidiosis to a passive surveillance system, and to assess the relationship of those variations to source of drinking water, adjusting for socioeconomic variables. METHODS: The authors analyzed temporal and spatial patterns for 4,058 cases of giardiasis and 230 cases of cryptosporidiosis reported to the Massachusetts Department of Public Health for 1993-1996. They linked each reported case to a database containing information on source of residential water supply and socioeconomic characteristics and evaluated the association between these factors and reporting rates using regression techniques. RESULTS: Reports of giardiasis and cryptosporidiosis were highest for the mixed unfiltered drinking water supply category. Reports of giardiasis were associated with income levels. Increases in reporting for both giardiasis and cryptosporidiosis were seen in summer to early fall. During a suspected outbreak of cryptosporidiosis n the city of Worcester in 1995, a significant increase in reported cases was also observed in the Boston metropolitan area. Following the suspected outbreak, weekly giardiasis rates increased slightly in Worcester and the Boston metropolitan area, while reporting of cryptosporidiosis increased dramatically. CONCLUSIONS: Consistently collected passive surveillance data have the potential to provide valuable information on the temporal variation of disease incidence as well as geographic factors. However, passive surveillance data, particularly in the initial period of surveillance, may be highly sensitive to patterns of diagnosis and reporting and should be interpreted with caution.

Adolescent↗
PubMedDate not supplied

Investigation of multistate foodborne disease outbreaks.

The U.S. food supply is characterized increasingly by centralized production and wide distribution of products, and more foodborne disease outbreaks are dispersed over broad geographic areas. Such outbreaks may present as a gradual, diffuse, and initially unapparent increase in sporadic cases. Recognition and reporting by clinicians and local public health officials and the ordering of laboratory tests by clinicians continue to be cornerstones of detecting all outbreaks. New methods--such as active laboratory-based surveillance, automated algorithms for detecting increases in infection rates, and molecular subtyping--facilitate detection of diffuse outbreaks. Routines have evolved for the investigation of multistate outbreaks; they are characterized by rapid communication between local, state, and federal public health officials; timely review of epidemiologic data by expert panels; collaboration on tracebacks with food safety regulatory agencies; and communication with the public and media. Rapid, efficient investigation of multistate outbreaks may result in control of acute public health emergencies, identification and correction of hazardous food production and processing practices, and consequent improvement in food safety.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Epidemiologic clues to bioterrorism.

Public health investigators have successfully carried out epidemiologic investigations of outbreaks of disease for many years. By far the majority of these outbreaks have occurred naturally. With the recent illnesses resulting from deliberate dissemination of B. anthracis on an unsuspecting population, public health investigation of diseases must now include consideration of bioterrorism as a potential cause of outbreaks of disease. The features of naturally occurring outbreaks have a certain amount of predictability in terms of consistency with previous occurrences, or at least biological plausibility. However, with a deliberately introduced outbreak or infection among a population, this predictability is minimized. In this paper, the authors propose some epidemiologic clues that highlight features of outbreaks that may be suggestive of bioterrorism. They also describe briefly the general process of involvement of agencies at various levels of government, public health and non-public health, depending on the extent of an outbreak or level of suspicion.

Anthrax↗
PubMed1999

Controlled management of public relations following a public health incident.

This paper describes the management of public relations following an outbreak of multidrug resistant TB at a London hospital. Eight patients were involved, all of the secondary cases occurred in HIV seropositive patients, and three cases died. The paper describes how the the Incident Committee undertook to recall contacts of the cases for screening, inform the general practitioners of all of the contacts about their patients' exposure, warn other organizations and professionals interested or involved in the management of HIV in the London area as to the nature of the incident, and establish a helpline, before informing a wider audience through the EPINET, Communicable Disease Report and national press.

AIDS-Related Opportunistic Infections↗
PubMed1996

Measles outbreaks in the United States, 1987 through 1990.

BACKGROUND: During 1989 and 1990 reported measles cases in the United States increased 6- to 9-fold over the annual mean of 3000 between 1985 and 1988. To evaluate recent epidemiology we summarized measles outbreaks. METHODS: Confirmed measles cases reported to the National Notifiable Disease Surveillance System during 1987 through 1990 were analyzed. An outbreak was defined as > or = 5 epidemiologically linked cases. RESULTS: There were 815 outbreaks, accounting for 94% of the 52,846 cases reported. Similar to 1985 and 1986, 3 patterns of measles transmission during outbreaks were identified: (1) predominantly among unvaccinated pre-school age children < 5 years of age (38% of outbreaks); (2) predominantly among vaccinated school age children 5 to 17 years of age (40%); and (3) predominantly among unvaccinated and vaccinated post-school age persons > or = 18 years of age (22%). Most outbreaks were small (median, 12 cases), but very large outbreaks occurred (maximum size, 10,670). Although school age outbreaks (58%) predominated during 1987 and 1988, preschool age (40%) and post-school age (23%) outbreaks were more important during 1989 and 1990. CONCLUSIONS: Recent epidemiology suggests that to achieve elimination of measles, ACIP recommendations must be fully implemented, including (1) routine administration of the first dose of measles vaccine from 12 to 15 months of age and (2) use of a routine two-dose schedule to prevent school age and post-school age outbreaks.

Adolescent↗