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PubMed2006

Epidemics of emerging animal diseases and food-borne infection problems over the last 5 years in Japan.

There have been several emerging animal diseases and food-borne infection problems occurring in Japan over the last 5 years. We describe brief pictures of these epidemics and our control activities. As acute contagious and/or emerging animal diseases, the foot and mouth disease (FMD) outbreak caused by the Pan-Asian topotype of the type O virus occurred in March 2000 after 92 years of FMD-free status. In 2004, four cases of the highly pathogenic avian influenza (HPAI), which was the first outbreak after 79 years, and caused by the H5N1 subtype, were identified. As part of the responses against these outbreaks, all the animals in the affected farms were destroyed, and movement control areas were established around the infected premises, and a nation-wide intensive survey for FMD and HPAI was performed. As for food-borne or feed-borne infections, the first bovine spongiform encephalopathy (BSE) was identified in September 2001 and 19 more cases have been reported until June 2005. A large outbreak of food-borne infection caused by low-fat milk contaminated with enterotoxin A produced by Staphylococcus aureus, involving more than 13,000 patients, occurred in 2000. In 2003, people who consumed uncooked liver and meat from wild boar and deer developed clinical signs of hepatitis caused by the hepatitis E virus. Pork is also suspected as natural source of virus transmission. Early detection of the first cases and rapid action in preventing and controlling the spread of infections are very important combined with proper risk communication about correct information of the diseases.

Animals↗

PubMed2005

Genetic characterization of Nipah virus, Bangladesh, 2004.

Until 2004, identification of Nipah virus (NV)-like outbreaks in Bangladesh was based on serology. We describe the genetic characterization of a new strain of NV isolated during outbreaks in Bangladesh (NV-B) in 2004, which confirms that NV was the etiologic agent responsible for these outbreaks.

Animals↗

PubMed1998

Hepatitis A vaccination of men who have sex with men--Atlanta, Georgia, 1996-1997.

Outbreaks of hepatitis A among men who have sex with men (MSM) are a recurring problem in many large cities in the industrialized world. Because MSM are at high risk for acquiring hepatitis A, in 1995 the Advisory Committee on Immunization Practices (ACIP) recommended that MSM be vaccinated against hepatitis A. These recommendations have not been implemented widely, even in outbreak settings. This report summarizes the investigation of an ongoing outbreak of hepatitis A among MSM in Atlanta, Georgia, and a public health vaccination campaign in response to the outbreak.

Adult↗

PubMed2004

Intensive investigation of bacterial foodborne disease outbreaks: proposed guidelines and tools for the collection of dose-response data by local health departments.

Local health departments that investigate foodborne disease outbreaks do not have adequate guidelines for collecting data that could be used to estimate dose-response relationships, a key component of hazard characterization in quantitative microbial risk assessment. To meet this need, criteria and a questionnaire template for the collection of appropriate dose-response data in the context of outbreaks were developed and applied in the investigation of a point-source outbreak linked to Salmonella serotype Enteritidis in a salmon entrée in February 2000. In this outbreak, the attack rate and risk of hospitalization increased with the amount of salmon entrée consumed, and detailed data were obtained on illness severity measures and host susceptibility factors. Local health departments might consider broadening investigations to include the collection of additional data when investigating outbreaks that have met a specific set of conditions. These data could provide information needed by federal regulatory agencies and other organizations for quantitative microbial risk assessment. Intensive investigations of outbreaks could prevent future illnesses by providing information needed to develop approaches to minimizing risk.

Chicago↗

PubMed2003

An outbreak of hypersensitivity pneumonitis at a metalworking plant: a longitudinal assessment of intervention effectiveness.

The authors describe a longitudinal assessment of intervention effectiveness in response to an outbreak of hypersensitivity pneumonitis (HP) at a metalworking facility. Thirty-five (29%) of the plant's 120 production workers were given a clinical diagnosis of HP during the two years of the investigation. Although quantitative exposure assessment tools were of limited utility, the investigators successfully used qualitative observations and the patients' return-to-work experiences to iteratively evaluate their exposure control recommendations. Recommended interventions included improving metalworking fluid management practices, enclosing selected metalworking fluid machining operations, eliminating mist cooling, exhausting two additional water-based industrial processes, increasing general dilution ventilation, and worker training. As of November 1999, 26 months into the outbreak, 51 percent (18) of the employees with a clinical diagnosis of hypersensitivity pneumonitis had been able to return to work. The symptom onset of the 35 workers who were given a clinical diagnosis of hypersensitivity pneumonitis during the two-year study period predated the implementation of the interventions. The collaboration of a multidisciplinary team appears to have allowed for successful intervention in this setting. A specific etiological agent(s) associated with the outbreak was not confirmed during the investigation. An acid fast isolate identified as being in the Mycobacterium chelonae group was detected in only one of the submitted metalworking fluid (MWF) sump samples. Longitudinally, there was a statistically significant difference in MWF sump bacteria (X(2) = 286.4, df = 17, p <.0001) and MWF sump fungi (X(2) = 28.1, df = 7, p <.0002). Measured oil mist air levels did not exceed the Occupational Safety and Health Administration's (OSHA's) permissible exposure limit (PEL), and in fact, did not exceed 0.5 mg/m(3).

Alveolitis, Extrinsic Allergic↗

PubMed2006

Incidence of dengue in a tertiary care centre--Kasturba Hospital, Manipal.

Dengue is the most important Arbovirus in the world in terms of occurrence and impact. It has been responsible for some devastating outbreaks and accounts for nearly 50-100 million cases of dengue fever and 2-5 lac cases of the dengue hemorrhagic fever worldwide. Dengue is caused by an arbovirus, which belongs to the Flaviviridae and is maintained in nature principally through biological transmission between susceptible vertebrate hosts by hematophagous arthropods. The incidence and global distribution of dengue has greatly increased in recent years and affects almost every country between the topics of Capricorn and Cancer. Although outbreaks of dengue fever has been occurring with regularity all over the country, and there have been 2 reported outbreaks in the neighboring district Mangalore in 1993 and 1996, there has been no reported outbreak in Manipal, which is what is responsible for the present study. In the study, out of the 100 clinically suspected cases of dengue, 44% tested positive for dengue IgM antibody, thus proving current dengue infection. Twenty six cases were from Shimoga district, which indicates increased dengue virus activity in this area and the possible endemicity in the region.

Antibodies, Viral↗

PubMed1993

Human immune responses to the Plasmodium falciparum ring-infected erythrocyte surface antigen (Pf155/RESA) after a decrease in malaria transmission in Madagascar.

A resurgence of falciparum malaria occurred in the central highlands of Madagascar in the 1980s and was responsible for an outbreak in 1986-1987. Since 1989, transmission has decreased dramatically. In April 1991, we investigated the humoral and cellular immune responses of 53 inhabitants of the village of Manarintsoa to six synthetic peptides that reproduced the major B and/or T cell epitopes of the Pfl 55/ring-infected erythrocyte surface antigen (RESA) of Plasmodium falciparum. The presence of RESA peptide-reactive T cells was assessed by lymphocyte proliferation assay as well as by detection of in vitro production of interferon-gamma and interleukin-2. The mean values of these cellular responses were low, and the results obtained in these three tests showed no correlation. Twenty-seven subjects presented with anti-RESA antibodies as detected by modified immunofluorescent assay, but the mean levels of anti-peptide antibodies were low. When compared with data obtained in January 1988 from the same subjects with three of the six peptides, the present data demonstrated a decrease in the response to these peptides in terms of both proliferative response and mean antibody titers. The mean values of anti-RESA antibodies remained unchanged. The fact that cellular and humoral responses to the major Pfl 55/RESA epitopes decreased but did not disappear probably reflects both the remainder of the acquired immunity resulting from the 1986-1987 malaria outbreak, and its conservation by the very low level of transmission since 1989.

Adolescent↗

PubMed1987

Campylobacter etiology in human gastroenteritis demonstrated by antibodies to acid extract antigen.

Campylobacter antibodies of the immunoglobulin G (IgG), IgM, and IgA classes were determined by enzyme immunoassay with acid glycine extract antigen in patients and controls involved in two Campylobacter outbreaks and in 266 unselected patients with acute enteritis. The assay showed a specificity of 99% for each immunoglobulin class in sera from 200 healthy blood donors. Elevated Campylobacter antibody titers were shown in 97% of stool culture-positive patients involved in the outbreaks. Rapid changes of IgA and IgM Campylobacter antibodies were typical of the early phase of serologic response in the outbreaks and thus offered the best diagnostic value in the serologic diagnosis of acute campylobacteriosis. In unselected patients with acute enteritis, the assay revealed elevated Campylobacter antibody titers in 37 patients, of whom only 12 had had positive Campylobacter stool cultures. In the sera of patients with other bacterial findings in addition to high titers of Campylobacter antibodies, no cross-reacting antibodies were found, but there was evidence of several mixed infections.

Acute Disease↗

PubMed2006

The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis.

Autoimmune progesterone dermatitis is a rare clinical condition in which patients display hypersensitivity to endogenous progesterone. It manifests as a cyclical cutaneous eruption that flares during the luteal phase of the menstrual cycle, when progesterone levels peak, and resolves partially or completely a few days after menses. Its cutaneous manifestations are variable and include urticaria, eczematous eruptions, vesiculopustular eruptions, fixed drug eruptions, stomatitis, erythema multiforme, and anaphylaxis. Autoimmune progesterone dermatitis has been diagnosed previously with intradermal skin testing or intramuscular progesterone challenge. Treatment of progesterone hypersensitivity generally consists of ovulation inhibition with pharmaceutical agents or oophorectomy; other therapies (eg, thalidomide) have also been used with success. We report a case of cyclical erythema multiforme (EM) induced by hypersensitivity to endogenous progesterone in a patient with a history of past oral contraceptive use. After herpes simplex virus was ruled out as an etiologic factor, a diagnosis of progesterone hypersensitivity was confirmed with intradermal skin testing. Results of subsequent patch testing with various progesterone derivatives were negative. The EM outbreaks were suppressed temporarily by continuous administration of Loestrin (ethinyl estradiol plus norethindrone), which also increased the responsiveness of the outbreaks to prednisone tapers.

Adult↗

PubMed2001

The statistical analysis of truncated data: application to the Sverdlovsk anthrax outbreak.

An outbreak of anthrax occurred in the city of Sverdlovsk in Russia in the spring of 1979. The outbreak was due to the inhalation of spores that were accidentally released from a military microbiology facility. In response to the outbreak a public health intervention was mounted that included distribution of antibiotics and vaccine. The objective of this paper is to develop and apply statistical methodology to analyse the Sverdlovsk outbreak, and in particular to estimate the incubation period of inhalational anthrax and the number of deaths that may have been prevented by the public health intervention. The data available for analysis from this common source epidemic are the incubation periods of reported deaths. The statistical problem is that incubation periods are truncated because some individuals may have had their deaths prevented by the public health interventions and thus are not included in the data. However, it is not known how many persons received the intervention or how efficacious was the intervention. A likelihood function is formulated that accounts for the effects of truncation. The likelihood is decomposed into a binomial likelihood with unknown sample size and a conditional likelihood for the incubation periods. The methods are extended to allow for a phase-in of the intervention over time. Assuming a lognormal model for the incubation period distribution, the median and mean incubation periods were estimated to be 11.0 and 14.2 days respectively. These estimates are longer than have been previously reported in the literature. The death toll from the Sverdlovsk anthrax outbreak could have been about 14% larger had there not been a public health intervention; however, the confidence intervals are wide (95% CI 0-61%). The sensitivity of the results to model assumptions and the parametric model for the incubation period distribution are investigated. The results are useful for determining how long antibiotic therapy should be continued in suspected anthrax cases and also for estimating the ultimate number of deaths in a new outbreak in the absence of any public health interventions.

Journal Article↗

PubMed1990

Cholera in Sarawak: a historical perspective (1873-1989).

Cholera has been in existence in Sarawak for many years and since 1873 many major epidemics have occurred. The epidemics usually occur during the dry months of May, June and July and the population affected are those in coastal areas. As in other outbreaks the areas affected were those which had poor environmental sanitation, poor water supply, poor refuse disposal and indiscriminate disposal of faeces. Malays are more affected as in Peninsular Malaysia outbreaks. The classical biotype was common prior to 1961. In later years the El Tor (biotype) has been responsible for most outbreaks.

Cholera↗

PubMed1995

Outbreak of HIV infection in a Scottish prison.

OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required.

Adult↗

PubMedDate not supplied

Outbreak of neonatal Klebsiella septicaemia: a review of antimicrobial sensitivities.

A 10-week prospective study was undertaken to document the antibiotic susceptibilities of klebsiella organisms which were responsible for an outbreak of septicaemia on the neonatal units of the University College Hospital, Ibadan, Nigeria. The thirty-nine isolates obtained comprised K. pneumoniae, 18 (46.2%), K. aerogenes, 17 (43.6%), K. edwardsii, 3 (7.7%), and K. oxytoca, 1(2.5%). All the strains were sensitive to ciprofloxacin and ofloxacin, but resistant to ampicillin. The percentage of qualitative sensitivities of the klebsiella species to other available drugs were 41% for ceftazidime, 36% for cefotaxime, 31% for ceftriazone, 23% for cefuroxime, 21% for gentamycin, and 15% for kanamycin. Quantitative sensitivities of the three most commonly isolated sub-types to netilmycin were 63%, 36%, and 33%, respectively. A comparison with a previous antibiotic susceptibility study still showed persistent resistance to the available aminoglycosides.

Ampicillin Resistance↗

PubMed2003

An epizootic of highly virulent feline calicivirus disease in a hospital setting in New England.

This article reports an outbreak of 24 cases of an unusually virulent feline calicivirus (FCV) infection in a small animal hospital. The circumstances and disease signs were very similar to those recently described in an outbreak of FCV hemorrhagic disease in Northern California (Vet. Microbiol. 73 (2000) 281). The virus entered the facility through shelter cats showing upper respiratory signs. Affected cats manifested high fever, anorexia, labored respirations, oral ulceration, facial and limb edema, icterus, and pancreatitis. The infection spread rapidly among the patients by contaminated animal caretakers and hospital equipment. One case of fomite transmission from an employee to a housecat was documented. Prior vaccination, even with multiple doses of FCV-F9-based live calicivirus vaccine, was not protective. Affected cats often required extensive supportive care for 7-10 days, and the overall mortality from death and euthanasia was 32%. The strain of FCV responsible for this outbreak was genetically and serologically distinct from the FCV strain responsible for a similar epizootic and the FCV-F9 strain contained in most vaccines. Outbreaks of this type are being reported with increasing frequency, and are often associated with the practice of treating sick shelter cats in private practices. Similar to the present epizootic, outbreaks of FCV hemorrhagic disease have been self-limiting, but require prompt application of strict quarantine, isolation, personnel sanitation, and disinfection procedures.

Animals↗

PubMed1999

Molecular typing methods to investigate transmission of Escherichia coli O157:H7 from cattle to humans.

The utility of phage typing, pulsed-field gel electrophoresis (PFGE), and plasmid profile analysis was compared, to differentiate between Canadian Escherichia coli O157:H7 strains of human (n = 27) and cattle (n = 24) origin. The diversity indices for phage typing, plasmid analysis and PFGE were 0.85, 0.69 and 0.93, respectively. PFGE and phage typing were also applied to study the role of direct transmission of E. coli O157:H7 from cattle to humans on isolates collected from two separate farm outbreaks. PFGE showed that more than one E. coli O157:H7 strain with varying PFGE DNA subtype profiles, may be responsible for an outbreak, and that more than one E. coli O157:H7 subtype may be circulating on a particular farm at any one time. To our knowledge, this is one of the first reports where PFGE typing was used to verify the direct transmission of E. coli O157:H7 from cattle to humans.

Animals↗

PubMed2003

Poliovirus detection in wastewater and stools following an immunization campaign in Havana, Cuba.

BACKGROUND: Recent outbreaks of poliomyelitis caused by vaccine-derived virus have raised concerns that vaccine-derived poliovirus may continue to circulate after eradication. In these outbreaks, the virus appears to have replicated for > or =2 years before detection. Early detection is critical for an effective response to these outbreaks. Although acute flaccid paralysis (AFP) surveillance will remain the standard for poliovirus detection, wastewater sampling could be a useful supplement. In this study, we evaluated the sensitivity of wastewater sampling by concurrently collecting stools from children aged < 3 years attending two neighbourhood clinics in Havana, Cuba, and wastewater from the same neighbourhoods. METHODS: Sample collection was begun during the third week after the national immunization campaign, continued weekly through the seventh week, and was repeated during weeks 15 and 19. Virus detection and titration were performed using both cell culture and polymerase chain reaction techniques. RESULTS: Wastewater sampling was found to be at least as sensitive as stool sampling under these conditions. Poliovirus was isolated from children through week 7, suggesting that viral shedding reached undetectable levels between weeks 8 and 14. The last virus-positive wastewater sample was collected during week 15. CONCLUSIONS: Wastewater sampling under the conditions studied can be a sensitive supplement to AFP surveillance. Similar studies under different conditions are needed to determine the role of wastewater sampling in post-eradication surveillance.

Child, Preschool↗

PubMed2002

Rapid response and strict control measures can contain a hospital outbreak of Norwalk-like virus.

Norwalk-like viruses (NLVs) are a major cause of sporadic gastroenteritis in the community and of large outbreaks of gastroenteritis in hospitals and other institutions. In January 2001, 38 staff and 20 patients on an acute elderly care ward became ill in an outbreak of gastrointestinal infection. Using reverse transcription polymerase chain reaction (RT-PCR) the causative agent was identified as NLV. No link was found between particular foods eaten and illness. At various times in the course of the outbreak a number of wards were implicated, but in hindsight the outbreak was confined to one ward. A prompt and rigorous response was successful in containing the spread of NLV infection to just one ward and stopping it in a few days.

Caliciviridae Infections↗

PubMed2004

Day care-related outbreaks of rhamnose-negative Shigella sonnei--six states, June 2001-March 2003.

During June 2001--March 2003, outbreaks of Shigella sonnei infections were reported in Delaware, Maryland, New Jersey, North Carolina, South Carolina, and Virginia. Five- to fortyfold increases in statewide shigellosis rates were observed during this period. These increases were attributed primarily to outbreaks in multiple day care settings that became prolonged and community wide. S. sonnei isolates from these states, as well as from New York City and Philadelphia, were similar genetically by pulsed-field gel electrophoresis (PFGE). Many of these isolates lacked the capacity to ferment rhamnose, which is unusual for S. sonnei. This report summarizes these outbreaks and describes the laboratory characteristics that link them. The findings underscore the importance of rapid and coordinated public health responses to isolated outbreaks of shigellosis.

Adolescent↗