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PubMed2002

Outbreaks of forest defoliating insects in Japan, 1950-2000.

In Japan, several forest-defoliating insects reach outbreak levels and cause serious defoliation. Stand mortality sometimes occurs after severe defoliation. However, in general, tree mortality caused by insect defoliation is low because of the prevailing moist climate in Japan. Evergreen conifers are more susceptible to tree mortality as a result of insect defoliation whereas deciduous broad-leaved trees are seldom killed. Insect defoliation occurs more frequently in man-made environments such as among shade trees, orchards, and plantations than in natural habitats. Outbreaks of some defoliators tend to occur in stands of a particular age: e.g. outbreaks of the pine caterpillar, Dendrolimus spectabilis Butler (Lepidoptera: Lasiocampidae) occur more frequently in young pine plantations. In contrast, defoliation caused by outbreaks of lepidopterous and hymenopterous pests in larch plantations is more frequent with stand maturation. There is a relationship between outbreaks of some defoliators and altitude above sea level. Most outbreaks of forest defoliators were terminated by insect pathogens that operated in a density-dependent fashion. Since the 1970s, Japan has been prosperous and can afford to buy timber from abroad. More recently, there has been an increasing demand for timber in Japan, that coincides with a huge demand internationally, so that the country will need to produce more timber locally in the future. The increasing pressure on the forestry industry to meet this demand will require more sophisticated methods of pest control coupled with more sustainable methods of silviculture.

Animals↗

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↗

PubMed1983

Use of electrophoresis of RNA from human rotavirus to establish the identity of strains involved in outbreaks in a tertiary care nursery.

During two nosocomial outbreaks in a tertiary care nursery, 22 of 102 infants had infections due to human rotavirus (HRV). The time sequence and proximity of the infected infants in the nursery rooms had suggested infant-to-infant spread of a single HRV strain in each outbreak. Polyacrylamide gel electrophoresis of virus permitted demonstration of four different HRV electropherotypes (strains) during the first outbreak period and seven during the second. One of the strains was detected during both outbreaks. All strains had fast-migrating RNA segments 10 and 11. Infant-to-infant spread of at least two different viruses apparently occurred in each outbreak period. Thus, electrophoretic analysis showed that infants in a tertiary care center can be infected with at least 10 different HRV strains within two months, that multiple HRV strains can spread independently and in parallel to different infants as part of a "single" outbreak, and that secondary spread of individual strains can be traced with considerable accuracy.

Cross Infection↗

PubMed1999

Two nursing home outbreaks of respiratory infection with Legionella sainthelensi.

OBJECTIVE: To describe outbreaks of infection caused by Legionella sainthelensi occurring in older residents of two nursing homes and to determine risk factors for the development of infection. DESIGN: Descriptive epidemiology and a case-control study. SETTING: Two nursing homes (140 beds and 254 beds in nursing homes A and B, respectively) located in southern Ontario, Canada, experiencing outbreaks of respiratory tract infection in July and August 1994. SUBJECTS: Case-residents of the two nursing homes who met clinical and laboratory criteria for Legionella infection. Control-residents were defined as those who were in the homes during the outbreaks and were asymptomatic. MEASUREMENTS: Active surveillance was conducted in both nursing homes to identify symptomatic residents. Residents with fever or respiratory tract symptoms had nasopharyngeal swabs taken for viral antigen detection and culture, urine for Legionella antigen detection, and acute and convalescent serology for viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella. Chest X-rays were performed, and an attempt was made to obtain blood and sputum cultures. Water samples from shower heads, faucets, and air conditioning units were collected for Legionella culture and polymerase chain reaction (PCR) assay. A case-control study was done to assess possible risk factors for legionellosis. RESULTS: Twenty-nine cases -- 17 in nursing home A; 12 in nursing home B - were identified. Four (14%) case-residents had documented pneumonia and four case-residents died. Univariate analysis revealed that a history of stroke (odds ratio (OR) 2.3 (95% CI, 1.0-5.3)), eating pureed food (OR 4.6 (95% CI, 1.6-12.7)), and having fluids administered with medication (OR 2.5 (95% CI, 1.0-5.9)) were significant risk factors. Cases were less likely to wear dentures (OR .4 (95% CI, .2-.9)) or to eat solid food (OR .3, (95% CI, .1-.6)). Only eating pureed food remained significant in a multivariable analysis (OR 4.6 (95% CI, 1.6-13.0, P = .01)). CONCLUSION: This report describes outbreaks of legionellosis in two nursing homes, representing the first reported outbreaks of infection caused by Legionella sainthelensi. The association with illness of dietary characteristics indicative of swallowing disorders suggests that aspiration was the most likely mode of infection. The diagnosis of legionellosis should be considered during outbreaks of respiratory infection in nursing homes.

Aged↗

PubMed1979

[Dimorphous Hansen's disease with outbreaks of Hansen reactions and visceral lesions].

The paper presents the case of a patient with borderline hanseniasis. After a long period of illness, he presented an outbreak with new lesions, that showed reactional tuberculoid aspects; he later presented lesions with clinical and histological aspects of Virchowian hanseniasis. This evolutional type is compatible with the pseudo-exacerbations outbreaks reported by Souza Lima. This patient also presented an Erythema Nodosum outbreak with cutaneous and visceral lesions, the latter occurring with great intensity in the liver parenchyma with clinical manifestations of icterus and hepatomegaly. The pathogenesis of the pseudo-exacerbations outbreaks is discussed, also the special situation of Borderline patients, subject to neurologic injuries during the pseudo-exacerbations outbreaks, and cutaneous, neurological and visceral lesions during the Erythema Nodosum Hansenicum outbreaks.

Erythema Nodosum↗

PubMed1993

[Clinical epidemiology of an outbreak of nosocomial infection caused by Staphylococcus aureus resistant to methicillin and aminoglycosides: efficacy of control measures. Comité de Control de Infecciones].

BACKGROUND: The appearance of outbreaks of nosocomial infections due to methicillin resistant Staphylococcus aureus (MRSA) is a current problem in Spain. The clinical and molecular epidemiology of these outbreaks as well as the efficacy of their control measures are a matter of controversy. METHODS: An outbreak of MRSA nosocomial infections in the Hospital Clínic i Provincial of Barcelona, a 953-bed University Hospital, with a total of 347 cases from September 1989 to October 1991 is described. The control measures used include prospective and continued surveillance of all MRSA isolations, identification of the reservoir, use of different types of isolation and control of nasal carriers among health care workers. The MRSA strains isolated were studied by standard microbiological procedures, phage-typing and extrachromosomal (plasmid) DNA analysis by means of restriction endonuclease analysis (REAP). RESULTS: From the Intensive Care Units, the outbreak extended to the medical and surgical wards. Seventy-one percent of the cases corresponded to infected patients and 29% to asymptomatic carrier patients. The MRSA strain responsible of the outbreak had a notable antibiotic multiple-resistance pattern. The studies performed showed that most of the strains belonged to phage group III and were lysed by phage 77. Plasmid DNA analysis showed that 95% of the strains isolated had a unique homogeneous profile. Despite the different control measures used, the MRSA infection has acquired a medium level endemic rate in the Hospital Clínic i Provincial. CONCLUSIONS: The introduction and spread of methicillin-resistant MRSA in a teaching hospital with more than 500-bed may be rapid and affecting large number of patients. Effective control measures carries multiple problems, which must be addressed with the collaboration of all hospital employees. The molecular typing techniques used (REAP) further identified that the outbreak is due to one single MRSA strain, with an epidemiologic behavior identical to the one showed by the epidemic strains previously described in the United Kingdom and Australia.

Aminoglycosides↗

PubMed2005

Nationwide outbreak of listeriosis due to contaminated meat.

We used molecular subtyping to investigate an outbreak of listeriosis involving residents of 24 US states. We defined a case as infection with Listeria monocytogenes serotype 4b yielding one of several closely related patterns when subtyped by pulsed-field gel electrophoresis. Patients infected with strains yielding different patterns were used as controls. A total of 108 cases were identified with 14 associated deaths and four miscarriages or stillbirths. A case-control study implicated meat frankfurters as the likely source of infection (OR 17.3, 95% CI 2.4-160). The outbreak ended abruptly following a manufacturer-issued recall, and the outbreak strain was later detected in low levels in the recalled product. A second strain was recovered at higher levels but was not associated with human illness. Our findings suggest that L. monocytogenes strains vary widely in virulence and confirm that large outbreaks can occur even when only low levels of contamination are detected in sampled food. Standardized molecular subtyping and coordinated, multi-jurisdiction investigations can greatly facilitate detection and control of listeriosis outbreaks.

Adolescent↗

PubMed2006

First general outbreak of Verocytotoxin-producing Escherichia coli O157 in Denmark.

This report describes the first general outbreak of verocytotoxin-producing E. coli (VTEC) in Denmark. Twenty five patients, 18 children and seven adults, with culture-confirmed VTEC O157:H- infection and indistinguishable pulsed-field gel electrophoresis DNA profiles, were identified during a six month period from September 2003 to March 2004. The outbreak strain possessed the virulence genes: eae, vtx1 and vtx2c. All patients but one presented with diarrhoea; none developed haemolytic uraemic syndrome. The outbreak was restricted to Copenhagen and surrounding areas. A case-control study including 11 cases and 55 matched controls revealed an association between VTEC O157:H- infection and shopping in a specific supermarket chain in Copenhagen and surrounding area, matched odds ratio (OR): 8.7 (95% confidence interval (CI): 1.1-71). After exclusion of three assumed secondary cases, only consumption of a particular kind of organic milk from a small dairy was associated with disease OR: 8.7 (95% CI 1.6-48). Environmental and microbiological investigations at the suspected dairy did not confirm the presence of the outbreak strain, but the outbreak stopped once the dairy was closed and thoroughly cleaned.

Animals↗

PubMed1994

A sudden outbreak of illness suggestive of mass hysteria in schoolchildren.

OBJECTIVE: To clarify factors contributing to mass illness of sudden onset by studying an outbreak that was apparently triggered by a gaseous odor and that involved a rapid, extensive response by school and fire officials. SETTING: Urban elementary school. MAIN OUTCOME MEASURE: A standardized student questionnaire was designed to identify potential illness predictors. DESIGN: Four weeks following the outbreak, public health officials distributed the questionnaire to all students in regular classes in grades 3 through 6 (N = 319), representing 46% of the estimated 680 students present the day of the outbreak. RESULTS: Seventy-seven percent of the students who completed the questionnaire reported that they experienced physical symptoms during the epidemic. A stepwise regression analysis demonstrated several independent variables that predicted the severity of illness, including the intensity of the odor smelled during the outbreak (P < .0001), becoming sick after the fire trucks arrived (P < .0001), and believing in an environmental cause for the illness (P < .002). CONCLUSIONS: These results indicate that both psychological and environmental factors, real or perceived, may contribute to sudden-onset epidemics of hysteria. Moreover, the response intervention of officials may influence the extent of such outbreaks. Early recognition of psychological causes and dispersion of groups at risk could reduce morbidity and associated health care costs.

Child↗

PubMed2006

A community-wide pertussis outbreak: an argument for universal booster vaccination.

BACKGROUND: Pertussis incidence has increased in the United States since 1980, punctuated by outbreaks that involve adults and adolescents. We investigated a community-wide outbreak and studied risk factors among adults to identify prevention and control opportunities. METHODS: We analyzed surveillance data, interviewed patients, visited outbreak sites, and conducted a case-control study of risk factors for first-in-household adult infection during a Jackson County, Oregon, outbreak in 2003. RESULTS: In Jackson County, 135 pertussis cases were reported; the incidence was 71 per 100 000 population compared with 0 to 1 per 100 000 population from 1995 through 2001. Case investigations identified 2658 close contacts (19.7 per case); 1050 (40%) received antibiotic prophylaxis. Older children and adolescents (aged 10-17 years) and adults (aged > or =18 years) accounted for 67% of cases. Five infants were hospitalized (192 hospitalizations per 100 000 infants) compared with 18 in the remainder of the state (33 per 100 000 infants). Many cases occurred among epidemiologically linked clusters of varied composition, such as jail inmates and employees, methamphetamine users, low-income housing residents, school students and employees, and employees in certain work settings. Adult patients were more likely than controls to live with children aged 6 to 10 years (odds ratio, 6.4; 95% confidence interval, 1.8-23.4) and less likely to report a complete childhood vaccination history (odds ratio, 0.1; 95% confidence interval, 0.003-0.9). CONCLUSION: The predominance of adolescent and adult cases, appearance of new clusters despite aggressive control efforts, clustering of cases in hard-to-reach populations, and absence of modifiable risk factors for adult disease in this outbreak all suggest that universal booster vaccination of adolescents and adults might offer the only effective means to prevent such events in the future.

Adolescent↗

PubMedDate not supplied

A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile.

BACKGROUND: Increased Clostridium difficile-associated disease (CDAD) in a hospital and an affiliated long-term care facility continued despite infection control measures. We investigated this outbreak to determine risk factors and transmission settings. METHODS: The CDAD cases were compared according to where the disease was likely acquired based on health care exposure and characterization of isolates from case patients, asymptomatic carriers, and the environment. Antimicrobial susceptibility testing, strain typing using pulsed-field gel electrophoresis, and toxinotyping were performed, and toxins A and B, binary toxin, and deletions in the tcdC gene were detected using polymerase chain reaction. Risk factors were examined in a case-control study, and overall antimicrobial use was compared at the hospital before and during the outbreak. RESULTS: Significant increases were observed in hospital-acquired (0.19 vs 0.86; P < .001) and long-term care facility-acquired (0.04 vs 0.31; P = .004) CDAD cases per 100 admissions as a result of transmission of a toxinotype III strain at the hospital and a toxinotype 0 strain at the long-term care facility. The toxinotype III strain was positive for binary toxin, an 18-base pair deletion in tcdC, and increased resistance to fluoroquinolones. Independent risk factors for CDAD included use of fluoroquinolones (odds ratio [OR], 3.22; P = .04), cephalosporins (OR, 5.19; P = .006), and proton pump inhibitors (OR, 5.02; P = .02). A significant increase in fluoroquinolone use at the hospital took place during the outbreak (185.5 defined daily doses per 1000 patient-days vs 200.9 defined daily doses per 1000 patient-days; P < .001). CONCLUSIONS: The hospital outbreak of CDAD was caused by transmission of a more virulent, fluoroquinolone-resistant strain of C difficile. More selective fluoroquinolone and proton pump inhibitor use may be important in controlling and preventing such outbreaks.

Adult↗

PubMed2003

Lake-associated outbreak of Escherichia coli O157:H7 in Clark County, Washington, August 1999.

CONTEXT: Escherichia coli O157:H7, one of hundreds of strains of the gram-negative bacterium E coli, has been implicated in numerous lake-borne outbreaks of infection during the past decade. In August 1999, several children who later became ill with E coli O157:H7 infection reported swimming in a lake in Clark County, Washington. The lake was closed and an investigation begun. OBJECTIVES: To identify the source of the outbreak and determine risk factors for infection with E coli O157:H7.Design, Setting, and Patients Two case-control studies were performed among residents of and visitors to Clark County in August 1999 by using community and campground-registrant control subjects. Main Outcome Measure Risk factors for infection with E coli O157:H7 among Clark County residents or visitors. RESULTS: We identified 37 case patients (including 29 primary-case patients) with a median age of 5 years (age range, 1-14 years for primary-case patients). Eight children were hospitalized, 3 with hemolytic uremic syndrome; none died. With analysis restricted to primary-case patients, illness was strongly associated with swimming in the lake (18 of 18 case patients vs 1 of 18 neighborhood-matched and age-matched control subjects; matched odds ratio undefined; P<.001). All primary-case patients were children younger than 15 years who swam in the lake. Illness was associated with placing the head underwater, getting lake water in the mouth, or swallowing lake water (26 of 27 case patients vs 43 of 62 control subjects; matched odds ratio = 11.5; P =.005). Cultures of lake water yielded E coli O157:H7 that matched the outbreak strain according to results of pulsed-field gel electrophoresis. CONCLUSIONS: To date, this is one of the largest documented outbreaks of E coli O157:H7 infection associated with unchlorinated recreational water and represents the first outbreak in which the strain was isolated from lake water. Guidelines are needed to decrease the risk of enteric illness associated with swimming in recreational lakes.

Adolescent↗

PubMed1999

Multinational outbreak of Salmonella enterica serotype Newport infections due to contaminated alfalfa sprouts.

CONTEXT: In December 1995, reported Salmonella enterica serotype Newport (SN) infections increased sharply in Oregon and British Columbia but not elsewhere in North America. Similar unexplained increases had been noted in 6 other states in the fall of 1995. OBJECTIVE: To determine the source of the outbreak(s). DESIGN: Case-control studies, environmental investigations, bacterial subtyping, and surveillance information review. SETTINGS: Oregon and British Columbia communities (winter 1995-1996) and Georgia, Oklahoma, Pennsylvania, Vermont, Virginia, and West Virginia (fall 1995). PARTICIPANTS: Oregon and British Columbia residents with culture-confirmed SN infections and onset from December 1, 1995, through February 29, 1996, and healthy community controls. MAIN OUTCOME MEASURES: Odds ratio (OR) of illness associated with exposures; distribution patterns and culture of alfalfa seeds and sprouts; subtyping of SN isolates. RESULTS: We identified 133 cases in Oregon and British Columbia; 124 (93%) occurred in patients older than 18 years; 87 (65%) were female. Case patients were more likely than community control subjects to report having eaten alfalfa sprouts in the 5 days preceding illness (41% [17/41] vs 4% [3/75]; OR, 17.0; 95% confidence interval, 4.3-96.0). Case isolates shared a distinctive pulsed-field gel electrophoresis (PFGE) pattern. The SN was grown from seeds and alfalfa sprouts. The distribution of 1 seed lot to multiple growers corresponded to the distribution of cases. Distribution of a second seed lot from the same European wholesaler corresponded to the location of the fall outbreak, which was characterized by a similar demographic profile. The PFGE pattern of fall outbreak isolates and confiscated sprouts and seeds was indistinguishable from the Oregon and British Columbia outbreak and differed from background isolates. CONCLUSIONS: The SN-contaminated alfalfa seeds were distributed to multiple growers across North America in 1995 and resulted in a protracted international outbreak scattered over many months. Current sprouting methods are inadequate to protect consumers from such events. Alfalfa sprouts may be an elusive but important vehicle for salmonellosis and other enteric infections.

Case-Control Studies↗

PubMedDate not supplied

Identification of a W variant outbreak of Mycobacterium tuberculosis via population-based molecular epidemiology.

CONTEXT: Typing of Mycobacterium tuberculosis could provide a more sensitive means of identifying outbreaks than use of conventional surveillance techniques alone. Variants of the New York City W strain of M tuberculosis were identified in New Jersey. OBJECTIVE: To describe the spread of the W family of M tuberculosis strains in New Jersey identified by molecular typing and surveillance data. DESIGN: Population-based cross-sectional study. SETTING AND SUBJECTS: All incident culture-positive tuberculosis cases reported in New Jersey from January 1996 to September 1998, for which the W family was defined by insertion sequence (IS) IS6110 DNA fingerprinting, polymorphic GC-rich repetitive sequence (PGRS) typing, spacer oligotyping (spoligotyping), and variable number tandem repeat (VNTR) analysis. MAIN OUTCOME MEASURE: Identification and characterization of W family clones supplemented by surveillance data. RESULTS: Isolates from 1207 cases were analyzed, of which 68 isolates (6%) belonged to the W family based on IS6110 and spoligotype hybridization patterns. The IS6110 hybridization patterns or fingerprints revealed that43 patients (designated group A) shared a unique banding motif not present in other W family isolates. Strains collected from the remaining 25 patients (designated group B), while related to W, displayed a variety of IS6110 patterns and did not share this motif. The PGRS and VNTR typing confirmed the division of the W family into groups A and B and again showed group A strains to be closely related and group B strains to be more diverse. The demographic characteristics of individuals from groups A and B were specific and defined. Group A patients were more likely than group B patients to be US born (91 % vs 24%, P<.001), black (76% vs 16%, P<.001), human immunodeficiency virus positive (40% vs 0%, P = .007), and residents of urban northeast New Jersey counties (P<.001). Patients with group B strains were primarily non-US born, of Asian descent, and more dispersed throughout New Jersey. No outbreak had been detected using conventional surveillance alone. CONCLUSIONS: The implementation of multiple molecular techniques in conjunction with surveillance data enabled us to identify a previously undetected outbreak in a defined geographical setting. The outbreak isolates comprise members of a distinct branch of the W family phylogenetic lineage. The use of molecular strain typing provides a proactive approach that may be used to initiate, and not just augment, traditional surveillance outbreak investigations.

Adult↗

PubMed1998

Association of hepatitis E virus with an outbreak of hepatitis at a military training camp in Nepal.

From 29 January 1995 to 15 March 1995, an outbreak of hepatitis occurred among 692 soldiers at an isolated training camp 25 km east of Kathmandu. Thirty-two cases occurred approximately 8 weeks after arrival of soldiers at the camp. To determine the etiology of the outbreak, patient sera were examined for evidence of infection with hepatitis A, B, C, and E viruses using commercially available enzyme-linked immunosorbent assay (ELISA) kits. The polymerase chain reaction (PCR) was used to detect hepatitis E virus (HEV) RNA. Evidence of recent infection (IgM to HEV and/or HEV RNA) was found in all but two patients, whereas none had evidence of recent infection with hepatitis A, B, or C viruses. Therefore, the outbreak was attributed to HEV. Fecally contaminated drinking water was suspected as the source of the outbreak. To determine the extent of HEV infections among those without clinical hepatitis, sera from the remaining soldiers were examined for markers of HEV infection. Evidence of past infection (IgG to HEV in the absence of IgM or HEV RNA) was found among 204 soldiers (prevalence = 30%), leaving 488 individuals susceptible to infection at the onset of the outbreak. Evidence of recent infection was found among another 83 individuals. We conclude that most exposed, susceptible soldiers sustained HEV infection without experiencing overt hepatitis. If the levels of virus inoculum and prior immunity in this population were typical, inapparent infection may be the usual adult response to virus exposure in an endemic area.

Adult↗

PubMed1990

Nosocomial outbreak of neonatal gastroenteritis caused by a new serotype 4, subtype 4B human rotavirus.

A nosocomial outbreak of rotavirus gastroenteritis involving 52 newborns occurred between June and September 1988 at the University Children's Hospital of Freiburg, Federal Republic of Germany. Stools from 27 representative patients were examined for rotavirus serotypes, using a monoclonal antibody-based enzyme-linked immunosorbent assay. The electropherotype was also examined by polyacrylamide gel electrophoresis of genomic RNA. As many as 18 patients were found to be infected by serotype 4, subtype 4B strain, and in all of them the same electropherotype was detected. Although rotavirus from the remaining nine patients could not be typed, the electropherotype in four was identical to that of the serotype 4, subtype 4B strain. Thus, most of the patients in the outbreak were infected by the same rotavirus strain. Retrospective epidemiological studies showed that the 4B strain began to circulate at the hospital in January 1988, whereas only rotavirus serotypes 1, 3, and 4A were detected in 1985-1987. The primary case of the outbreak was presumably a newborn with acute gastroenteritis, admitted to the hospital from a small maternity unit in the same urban area. During the outbreak, 12 of 44 healthy newborns in the nurseries of the Children's Hospital and other maternity hospitals were found to be asymptomatic rotavirus carriers, and in three of the newborns the same 4B strain was detected. This is the first reported outbreak caused by a serotype 4, subtype 4B strain.

Cross Infection↗

PubMed2005

Outbreak of acute gastroenteritis associated with group A rotavirus and genogroup I sapovirus among adults in a mental health care facility in Japan.

An outbreak of acute gastroenteritis consisting of 57 cases occurred in a mental health care facility in Takasaki city, Japan during 6th February and 27th March 2002. A total of 18 fecal specimens collected from 17 residents and one member of the medical staff during this outbreak were tested for the presence of viral enteropathogens by RT-PCR and latex agglutination. Group A rotavirus and sapovirus were detected in 5 out of 18 fecal specimens (55.6%). To our knowledge, this is the first finding of an outbreak of gastroenteritis associated with co-circulation of different kinds of viruses such as group A rotavirus and sapovirus. All of group A rotaviruses were typed further as P[4]G2 strains. Both rotavirus and sapovirus were subjected to molecular analysis by sequencing. It was noteworthy that all rotaviruses and sapoviruses had high homologies, respectively, to each other and sapoviruses presented a potential novel sapovirus genogroup I (GI) genotype, which was obviously different from any GI genotypes (GI-a, b, c, and d). The outbreak associated with these viruses spread gradually from dormitory to dormitory, suggesting a spread by person-to-person contact, although investigation on the route of transmission of the outbreak is lacking. The findings confirm the presence of group A rotavirus and sapovirus are important in acute gastroenteritis among adults in Japan.

Adult↗

PubMed2005

Outbreak of acute hemorrhagic conjunctivitis in French Guiana and West Indies caused by coxsackievirus A24 variant: phylogenetic analysis reveals Asian import.

An outbreak of acute hemorrhagic conjunctivitis occurred in French Guiana between April and July 2003, with approximately 6,000 cases in the two major cities Kourou and Cayenne. Since acute hemorrhagic conjunctivitis is not a notifiable disease in France, there was no registration of the number of cases. Therefore, these were estimated by comparing the consumption of antibiotic eye drops and ophthalmic ointments during 2002 and 2003. The outbreak rapidly spread into the Caribbean Islands, causing an outbreak in Guadeloupe in October. Viral isolates from conjunctival swabs of 16 patients were confirmed to be enterovirus by PCR directed to the 5' UTR of the genome. The isolates could not be neutralized by the Melnick intersecting pools, but were shown to be CV-A24 variant by limited sequencing within the VP1 and 3C regions of 12 strains. Phylogenetic analysis revealed that they were similar to the genotype III strains causing outbreaks in Korea 2002 and Malaysia 2003. The previous outbreak of conjunctivitis caused by CV-A24 in the Caribbean in the 1980s was also introduced from Asia, and disappeared after 3 years. This new introduction from Asia and its rapid spread into the Caribbean, where the infection disappeared after a few months, indicates that the CV-A24 variant has a different epidemiological pattern in this region compared to South East Asia, since it has not established an endemic infection. It had to be reintroduced from Asia, where it has been circulating since the 1970s.

Adult↗