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PubMed2005

[Accumulated occurrence of illnesses with Salmonella enteritidis in hospitals and nursing homes in the district Oberallgaeu, Bavaria, in July 2004].

We report on the investigation of a Salmonella enteritidis outbreak in hospitals and nursing homes in the district Oberallgaeu, Bavaria, in July 2004. Affected by this outbreak were hospital patients, inhabitants of nursing homes, kitchen coworkers and maintenance personnel. Within this outbreak six deaths were observed. A forensic medical investigation of four deaths revealed two cases of Salmonella enteritis as the primary cause of death, another cause of death was due to other causes and one cause of death remained unclear. The microbiological investigation of stool samples linked all positive samples to an outbreak during this period. The epidemiological outbreak curve pointed towards a foodborne transmission of the pathogen. The infection period could be limited to the weekend of the 3./4.7.2004. All affected institutions were supplied by a catering service with several sites. All tested food samples were negative for Salmonella enteritis. Epidemiological investigations revealed that a contaminated pudding was probably responsible for the outbreak.

Adult↗

PubMed1991

An outbreak of whooping cough in a highly vaccinated urban community.

In 1950 a whole-cell pertussis vaccine was introduced in Cape Town and was followed by a marked decline in reported whooping cough mortality and morbidity. This resulted in reduced awareness of whooping cough as a clinical problem and, in recent years, no routine diagnostic tests for Bordetella pertussis have been performed. An outbreak of whooping cough occurred in Cape Town between 1 June 1988, and 31 May 1989, with 292 children admitted to hospital for whooping cough during this period (hospital admission rate in children under 5 years of age = 187 per 100,000). In an investigation of 239 children attending four pre-primary schools in the city, the whooping cough attack rate was 33 per cent, while pertussis vaccine coverage was 95 per cent. In the latter part of the outbreak nasopharyngeal swabs and serology were performed in patients presenting to a children's hospital with suspected whooping cough. Bordetella pertussis was isolated from 3 out of 34 (9 per cent) children tested and the first isolate was serotyped as type 1,2,4. Available clinical and laboratory evidence indicated that the organism responsible for the outbreak was Bordetella pertussis. Coverage studies for pertussis vaccine in Cape Town indicated that between 81 and 93 per cent of children were fully immunized by 13 months of age. These findings suggest that, since its introduction, the whole-cell pertussis vaccine produced in South Africa has been highly effective in controlling whooping cough. However, it was not able to prevent a moderate scale outbreak, even in the presence of high vaccination levels.

Child↗

PubMed2000

Retrospective analysis of an outbreak of B virus infection in a colony of DeBrazza's monkeys (Cercopithecus neglectus).

In 1981, an outbreak of herpetic disease developed in a colony of DeBrazza's monkeys (Cercopithecus neglectus). In seven of eight infected animals, clinical signs of infection included vesicular and ulcerative lesions on the lips, tongue, and/or palate. Histologic examination of lesions revealed intranuclear inclusion bodies, and electron microscopy revealed nucleocapsids and virions with typical herpesvirus morphology. Although a virus was isolated that appeared similar to monkey B virus, techniques available at the time did not allow precise identification of the virus. Analysis of serum from one surviving monkey collected 12 years after the outbreak revealed a pattern of reactivity characteristic of B virus-positive serum on the basis of results of ELISA and western immunoblot analysis. Polymerase chain reaction analysis of archived paraffin-embedded tissue specimens and molecular analysis of the one viral isolate obtained from a DeBrazza's monkey indicated that the virus responsible for the outbreak was a new genotype of B virus. Testing of sera from lion-tailed macaques (Macaca silenus) housed in an adjacent cage at the same zoo indicated that these animals harbored this virus and, thus, were the likely source of the virus that infected the DeBrazza's monkeys. This study documents usefulness of archiving samples from disease outbreaks for later analysis. In addition, this incident underscores the importance of considering herpes B virus infection when outbreaks of disease having characteristics of herpetic infections develop in nonhuman primates kept at institutions that also house macaques.

Animals↗

PubMedDate not supplied

[Outbreak caused by Escherichia coli in Chalco, Mexico].

OBJECTIVE: To identify the etiologic agent responsible for a disease outbreak following an overflow of sewage water in Valle de Chalco, Mexico. MATERIAL AND METHODS: A retrospective cross-sectional study was carried out. Rectal samples were collected from the population of Chalco valley, who suffered from diarrhea and vomiting during a natural disaster that took place on May 31, 2000. The Instituto de Diagnóstico y Referencia Epidemiológicos (Epidemic Reference and Diagnosis Institute, InDRE, Ministry of Health), received 1521 rectal swab samples from diarrhea cases, to test for E. coli strains. Statistical analysis was performed to find a difference of proportions between cases and non-cases (chi-squared test). ETEC, EIEC, EPEC and EHEC pathogenic E. coli groups were hybridized by colony blot. RESULTS: Strains isolated were ETEC (62.2%), EIEC (0.84%), EPEC (0.84%), and EHEC non-O157:H7 (0.08%); there was no hybridization in 36.02% of E. coli strains. Other isolated microorganisms were Salmonella spp (0.45%) and Shigella spp (0.06%). CONCLUSIONS: Enterotoxigenic E. coli was the most likely etiologic agent. Sanitary control strategies should be targeted to preventing outbreaks caused by this pathogenic agent. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Adolescent↗

PubMed1997

General outbreaks of infectious intestinal disease associated with milk and dairy products in England and Wales: 1992 to 1996.

Twenty general outbreaks of food poisoning in England and Wales associated with the consumption of milk and dairy products were reported to the PHLS Communicable Disease Surveillance Centre between 1992 and 1996. A total of 600 people were ill and at least 45 people were admitted to hospital but no deaths were reported. Salmonella species were responsible for 11 outbreaks, Campylobacter species for five, Vero cytotoxin producing Escherichia coli O157 (VTEC) for three, and Cryptosporidium parvum for one. Outbreaks were associated with hotels (2 outbreaks), a psychogeriatric hospital, schools (3), a Royal Air Force base, a farm visit, an outdoor festival (2), and community outbreaks associated with milk supplied direct from farms (8). Milk was implicated in 16 outbreaks; 10 of which were associated with unpasteurised milk. Two outbreaks were associated with eating contaminated ice cream, and two with eating contaminated cheese. All these outbreaks could have been prevented by pasteurisation and simple hygienic measures.

Adult↗

PubMed1992

Reduction in morbidity due to diarrhea in nursing beef calves by use of an inactivated oil-adjuvanted rotavirus-Escherichia coli vaccine in the dam.

An outbreak of neonatal diarrhea occurred among beef calves (2000 animals) from one large Argentinian farm in 1985. Rotavirus was detected in 78% (106/136) and enterotoxigenic Escherichia coli in 1.5% of the samples (2/136) obtained from sick calves. In comparison rotavirus was identified in only 1.6% (1/63) of the samples from clinically healthy calves. The rotavirus strain responsible for the outbreak was characterized as serotype 6 belonging to group A. In the following three years the protective capacity of a combined rotavirus-E. coli inactivated vaccine administered to the dams during the last third of the gestation period was evaluated on this farm by comparison of morbidity due to diarrhea in calves from vaccinated vs. placebo cows within the same year. The morbidity due to diarrhea among calves from dams in the vaccinated and placebo groups was 34% and 77%, respectively in 1986; 23% and 47% in 1987, and 15% and 34%, in 1988. In 1987 morbidity of diarrhea in calves born from vaccinated heifers was 54% and 74% in calves from placebo heifers. In 1988 morbidity from diarrhea was 41% and 54%, respectively among calves in these two groups. In all experiments, calves from heifers showed significantly greater morbidity than calves from cows. Differences in diarrhea morbidity between the vaccinated and placebo groups were statistically significant (P less than 0.05). Additional studies showed that the diarrhea had a significant influence (P less than 0.05) on the average live weight of the calves at weaning (5 to 7 months) with an average weight loss of 7.8 kg per calf among the calves affected with diarrhea.

Adjuvants, Immunologic↗

PubMed2006

Public health professionals' perceptions toward provision of health protection in England: a survey of expectations of Primary Care Trusts and Health Protection Units in the delivery of health protection.

BACKGROUND: Effective health protection requires systematised responses with clear accountabilities. In England, Primary Care Trusts and the Health Protection Agency both have statutory responsibilities for health protection. A Memorandum of Understanding identifies responsibilities of both parties, but there is a potential lack of clarity about responsibility for specific health protection functions. We aimed to investigate professionals' perceptions of responsibility for different health protection functions, to inform future guidance for, and organisation of, health protection in England. METHODS: We sent a postal questionnaire to all health protection professionals in England from the following groups: (a) Directors of Public Health in Primary Care Trusts; (b) Directors of Health Protection Units within the Health Protection Agency; (c) Directors of Public Health in Strategic Health Authorities and; (d) Regional Directors of the Health Protection Agency RESULTS: The response rate exceeded 70%. Variations in perceptions of who should be, and who is, delivering health protection functions were observed within, and between, the professional groups (a)-(d). Concordance in views of which organisation should, and which does deliver was high (> or =90%) for 6 of 18 health protection functions, but much lower (< or =80%) for 6 other functions, including managing the implications of a case of meningitis out of hours, of landfill environmental contamination, vaccination in response to mumps outbreaks, nursing home infection control, monitoring sexually transmitted infections and immunisation training for primary care staff. The proportion of respondents reporting that they felt confident most or all of the time in the safe delivery of a health protection function was strongly correlated with the concordance (r = 0.65, P = 0.0038). CONCLUSION: Whilst we studied professionals' perceptions, rather than actual responses to incidents, our study suggests that there are important areas of health protection where consistent understanding of responsibility for delivery is lacking. There are opportunities to clarify the responsibility for health protection in England, perhaps learning from the approaches used for those health protection functions where we found consistent perceptions of accountability.

Administrative Personnel↗

PubMed1983

Atypical adult T-cell leukemia-lymphoma: diverse clinical manifestations of adult T-cell leukemia-lymphoma.

The diverse clinical manifestations of 10 cases of so-called adult T-cell leukemia-lymphoma (ATL)-related T-cell malignancies are described. These cases were anti-ATLA [antibody to ATL virus (ATLV)-associated antigen (ATLA)] positive, and tumor cells had the inducer/helper T-cell phenotype and expressed ATLA when cultured, indicating that these diseases are the same as typical ATL, even though their clinical diagnoses were different from ATL. Accordingly, they are called atypical ATL. Clinically, they could be divided into two subtypes, smoldering type and lymphoma type. In the smoldering type, the disease usually started with skin lesions and rarely with lung lesions. After a prodromal stage of several years, the disease progressed insidiously to the leukemic stage without additional manifestations. The flower cells characteristic of typical ATL were observed in only a small percentage of peripheral lymphoid cells. In two of the five patients the disease progressed to typical ATL after several years from onset. All five patients are alive with a long survival time, more than 6 yr in four, and had high titers of anti-ATLA, suggesting that anti-ATLA might have some role in regulating the proliferation of ATL cells in vivo. In the lymphoma type, morphological diagnosis was not always specific for discriminating ATL-related from ATL-unrelated T-cell lymphomas. Detection of anti-ATLA in the patient's serum and of ATLA in cultured tumor cells, examination of the sera of members of the patient's family for anti-ATLA, and observation of typical flower cells in the peripheral blood though the patients had neither lymphocytosis nor leukemic changes, seem to be useful for the discrimination, especially in an ATL-nonendemic area. Members of the family of a patient with anti-ATLA positive T-lymphoma in an ATL-nonendemic area were also anti-ATLA positive, indicating that healthy ATLV carriers in an ATL-nonendemic area exist as a family colony. This is responsible for sporadic outbreaks of ATL in an ATL-nonendemic area. In summary, the disease entity of ATL is considered, at present, to be a malignancy of inducer/helper T-cells transformed by ATLV or HTLV (human T-cell leukemia virus). In this sense, diverse clinical manifestations of ATL should be recognized as events of viral oncogenesis and host immune response.

Adult↗

PubMed2000

Development of a dose-response relationship for Escherichia coli O157:H7.

E. coli O157:H7 is an emerging food and waterborne pathogen. The development of acceptable guidelines for exposure to this organism based on quantitative microbial risk assessment requires a dose response curve. In this study, a prior animal study was used to develop a dose response relationship. The data was adequately fit by the beta-Poisson dose response relationship. This relationship was validated with reference to two outbreaks of this organism. It was found that the low dose extrapolation of the animal data using the beta-Poisson relationship provided estimates of risk concordant with those noted in the outbreaks. The fitted dose response relationship in conjunction with population estimates of the prevalence of E. coli O157:H7 illness indicates that the overall exposure is quite low in the US.

Animals↗

PubMed2000

An outbreak of Salmonella infection after a Chinese year-end party in central Taiwan.

An outbreak of food poisoning caused by Salmonella O7 serogroup C1 and O8 serogroup C2, occurred in Taichung City after a Chinese year-end buffet party with 127 attendees including employees, relatives and guests of the Psychiatry Department of Changhua Christian Hospital (CCH). Among the 114 attendees interviewed, 96 (84.2%) reported developing symptoms within 120 h after the dinner on February 4, 1999. The time of onset ranged from 2 h to 101 h after the dinner with an average of 20 +/- 16 h. The median and mode incubation periods were 17 h and 16 h, respectively. Salmonella C1 and C2 serogroups were isolated from the stool samples of 45 attendees. Based on the results of interview questionnaire, the most likely contaminated food was eel kabayaki (OR = 4.8, 95% CI:1.6-14.9, p < 0.01) followed by baked mussels (OR = 4.04, 95% CI:1.3-12.1, p = 0.01). However, this result could not be confirmed by food sample investigation due to the lack of leftover food. Possible techniques for the prevention of food-borne disease transmission, enhancement of communication about foodborne disease outbreaks within the health reporting system, and the reduction of response time during an outbreak of infection are required.

Adult↗

PubMed1953

Epidemiology of influenza.

The epidemiological pattern of influenza over the past century is outlined; its vagaries are ascribed to the plasticity of the influenza virus. In recent years it has been possible to carry out antigenic studies revealing variations in the strains of virus A, the agent in most major outbreaks. New antigenic variants may have a greater chance to emerge after periods of latency, since the exposed population will have less specific resistance to them. Work on the causation and spread of epidemics is reviewed; the conclusion these studies suggest is that two factors are involved-the existence of a "basic virus", as yet undetectable until activated, and responsible for multicentric outbreaks; and the element of "spread", which under favourable conditions carries the infection to susceptible groups, and results in extensive epidemics.

Disease Outbreaks↗

PubMed2001

Implication of milk and milk products in food-borne diseases in France and in different industrialised countries.

A study was carried out to estimate the proportion of diseases due to milk and milk products among food-borne diseases recorded in France and in other countries since 1980. Particular attention was given to whether the milk involved was heat-treated or not. Four etiologic agents were considered: Salmonella spp., Staphylococcus aureus, Listeria monocytogenes, and pathogenic Escherichia coli. An overview of food-borne disease annual reports from seven countries indicated that milk and milk products were implicated in 1-5% of the total bacterial outbreaks; however, details about the type of product and milk involved were usually not provided. When considering 60 outbreaks and four single cases described in the literature and implicating milk and milk products, confirmed or suspected food vehicles were distributed as follows: milk, 39.1%, cheese, 53.1%, other milk products, 7.8%. Overall, 32.8% of the food vehicles were made from pasteurised milk; 37.5% from raw milk; 10.9% from milk stated as "unpasteurised"; and 18.8% from unspecified milk. Salmonella spp. were responsible for 29 outbreaks, L. monocytogenes for 10 outbreaks and four well-documented single cases, pathogenic E. coli for 11 outbreaks, and S. aureus for 10 outbreaks. Analysis of unpublished data about food-borne disease outbreaks, listeriosis excluded, collected by the coordinator of the French surveillance system from 1992 to 1997, revealed 69 documented outbreaks for which milk and milk products were confirmed as the vehicle by the isolation of the etiologic agent. The food vehicles were distributed as follows: milk, 10%; cheese, 87%; others, 3%. UHT milk accounted for 1.5%, raw milk and raw milk products for 48%, and milk and milk products from unspecified milk for 50.5% of the 69 outbreaks. S. aureus was by far the most frequent pathogen associated with these outbreaks (85.5% of the outbreaks), followed by Salmonella (10.1%). This study demonstrates the limitations of the surveillance systems and the difficulties in estimating the contribution of milk and milk products to food-borne diseases. In particular, it was not possible to find out in many outbreaks what heat treatment, if any, the milk had undergone.

Animals↗

PubMed2006

[Influenza and travelling].

There is a risk for the traveler to acquire an exotic disease when traveling and to introduce it in non-endemic areas after returning. Influenza is a good example of such a disease. The incidence of flu in travelers is unknown. However, numerous outbreaks of flu have been reported in groups of travelers: package tours, pilgrims, elderly people, and travel by plane or cruise ships. Nowadays vaccination against flu is not recommended in travelers unless they belong to groups at risk for flu. Nonetheless vaccination against flu is difficult to apply to travelers due to problems in vaccine availability and inadequacy between vaccine strains and strains responsible for ongoing outbreaks in the opposite hemisphere. This vaccination seems important to travelers because flu may impair their vacation. In addition, it is also interesting for the community if it limits the spread of flu worldwide.

Adolescent↗

PubMed1973

Arbovirus studies in Luanda, Angola. 2. Virological and serological studies during an outbreak of dengue-like disease caused by the Chikungunya virus.

An outbreak of dengue-like disease was observed in Luanda, Angola, at the end of 1970 and beginning of 1971. Chikungunya virus was isolated from the blood of a patient with typical symptoms of dengue and from a pool of Aedes aegypti mosquitos. A survey for antibodies to arboviruses in the sera of persons living in Luanda showed that the Chikungunya virus was indeed responsible for the outbreak. The fact that this outbreak immediately preceded and continued concurrently with a yellow fever epidemic in Luanda shows that two arboviruses from different antigenic groups may circulate simultaneously in the same ecological area.

Aedes↗

PubMed2004

Impact of surveillance for vancomycin-resistant enterococci on controlling a bloodstream outbreak among patients with hematologic malignancy.

OBJECTIVE: To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia. DESIGN: Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated. SETTING: A tertiary-care cancer center with a high prevalence of VRE. PARTICIPANTS: All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible. RESULTS: Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study. CONCLUSION: Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.

Bacteremia↗

PubMed1975

Potential for in vivo acquisition of R plasmids by one strain of Vibrio cholerae biotype El tor.

The feces of five patients admitted to a hospital during an outbreak of cholera in Melbourne, Australia, in November 1972, were examined for the presence of tetracycline-resistant coliforms and tetracycline-resistant strains of Vibrio cholerae. Despite the abundance of tetracycline-resistant coliforms able to transfer this resistance to other strains of Escherichia coli, no tetracycline-resistant strains of V. cholerae were detected. In vitro transfer experiments using the V. cholerae strain responsible for the outbreak as recipient revealed that it was a particularly poor host for most R plasmids.

Cholera↗

PubMed1994

Faecal carriage and nosocomial spread of vancomycin-resistant Enterococcus faecium.

Eight clinical isolates of vancomycin-resistant Enterococcus faecium (VRE) were obtained from four renal and four other in-patients within an 11 week period during 1992. Characterisation of the isolates by restriction enzyme analysis with Sal I and rRNA gene restriction patterns (ribotyping) showed them to be clonally related. During the next 3 months an additional 14 VRE were isolated from hospital patients, nine of which were indistinguishable by ribotyping from the strain associated with the outbreak. An epidemiological survey was instigated in order to determine the level of carriage of this VRE. A total of 354 stool specimens was screened using a highly selective enrichment broth. VRE were detected in the stools of 11/73 (15%) of renal patients, 5/97 (5%) of other hospital patients and 3/184 (2%) of patients based in the community. Of the 25 stool isolates that were further characterised by ribotyping, 17 were indistinguishable from the outbreak strain. The remaining eight isolates gave seven different patterns. Patients harbouring the outbreak strain stayed in hospital significantly longer and had received more antibiotic treatment, for longer, than those patients from whom other VRE had been isolated. There was no significant difference in vancomycin or cephalosporin usage between the two groups of patients. Ribotyping showed there to be a number of clones of VRE carried by patients and that one of these clones was especially prevalent and has been responsible for the outbreak of infection in the renal unit. The technique also showed the presence of different VRE in general practice patients suggesting they are not just a hospital phenomenon.

Adult↗

PubMed2006

Outbreak of human listeriosis associated with tomme cheese in northwest Switzerland, 2005.

During an eight week period in spring 2005, 10 cases of listeriosis were reported in a small area of northwest Switzerland (150,000 inhabitants). Eight cases were in older immunocompromised patients who became ill with bacteraemia (three deaths), and two cases were in pregnant women who had septic abortion. All cases were due to a serotype 1/2a isolate with one of two pulsovars found by PFGE. Patient interviews quickly revealed that a locally made and distributed soft cheese (known as 'tomme') was the food source responsible for the outbreak. Samples of this cheese, and of butter made in the same factory, revealed Listeria monocytogenes sv 1/2a of the same pulsovar in amounts of 1000-10 000 and 10-100 cfu/g, respectively. The prompt suspension of production, the market recall of the product, and a public alert terminated the outbreak. However, two cases of febrile gastroenteritis due to the same strains were reported within 10 days of product recall. The restricted distribution area of the contaminated cheese and the collaboration of local physicians, medical microbiologists and food health services all contributed to a rapid and successful investigation. This small outbreak of listeriosis reinforces the need for a laboratory-based surveillance system with rapid typing, as well as collaboration between physicians and microbiologists.

Adult↗