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PubMed2006

[Molecular typing on Vibrio parahaemolyticus isolates from Hangzhou, China, during 2000-2002].

OBJECTIVE: To study the molecular epidemiology of Vibrio parahaemolyticus isolates from clinical and environmental samples collected in Hangzhou area during 2000 and 2002. METHODS: V. parahaemolyticus isolates from food-poisoning, sporadic diarrhea patients and seafood in market in Hangzhou during 2000 and 2002 were serotyped. From clinical isolates of serotype O3:K6 and environmental isolates of serotype O3:KUT, virulence genes, tdh and trh, were examined by PCR. Molecular typings [including ribotyping, random amplified polymorphic DNA analysis (RAPD), enterobacterial repetitive intergenic consensus PCR (ERIC-PCR)], were also performed. RESULTS: Among 13 food-poisoning outbreaks caused by V. parahaemolyticus, O3:K6 strains with tdh positive and trh negative were detected in 11 episodes (84.6%), and O4:K8 strains with tdh positive and trh negative were responsible for other 2 outbreaks (15.4%). In 34 V. parahaemolyticus isolates from sporadic diarrhea patients, O3:K6, O4:K8, and O1:KUT strains with tdh positive and trh negative were detected with proportions of 26.5% (9/34), 17.6% (6/34), and 38.2% (13/34), respectively, and other 6 strains were not able to be serotyped. Of 64 isolates from seafood in which both tdh and trh were negative except trh was positive in one O1:KUT strain, 37 belonged to 7 serotypes except O3:K6 or O4:K8, and 9 were not able to be serotyped. The fingprintings of ribotyping, ERIC-PCR, and RAPD showed that almost all of O3:K6 isolates from food-poisoning and sporadic diarrhea patients were genetically close to each other and there were obviously genetical difference between O3:K6 isolates from clinic and O3:KUT isolates from environment. CONCLUSION: There was a distinct serotype distribution between V. parahaemolyticus isolates from clinic patients and seafood. One group of close related V. parahaemolyticus O3:K6 strains with tdh positive and trh negative seemed to be prevailing in Hangzhou in those years.

China↗
PubMed1997

Transmission between HIV-infected patients of multidrug-resistant tuberculosis caused by Mycobacterium bovis.

OBJECTIVE: To investigate outbreaks of multidrug-resistant tuberculosis (TB) by using DNA fingerprint databases. DESIGN: Investigation of two outbreaks of multidrug-resistant TB in separate hospitals in Spain by restriction fragment length polymorphism (RFLP) and spoligotyping. Outbreak strains were compared with more than 1500 RFLPs of Mycobacterium tuberculosis complex strains isolated in Spain and 6000 RFLPs from 30 different countries. METHODS: Standardized IS6110 DNA fingerprinting and 'spoligotyping' was used to type multidrug-resistant isolates belonging to the M. tuberculosis complex amongst the outbreak cases. The DNA types were matched against DNA fingerprint databases in Spain and The Netherlands. RESULTS: The DNA typing analysis indicated that a single multidrug-resistant Mycobacterium bovis strain was responsible for a nosocomial outbreak in a hospital in Spain involving at least 16 HIV-infected patients with non-treatable to multidrug-resistant TB. Introduction of the fingerprint type of this strain to the international database revealed a single matching strain. This strain was also isolated from an HIV-infected patient in The Netherlands who had died from multidrug-resistant TB. This patient had previously been hospitalized in Spain, where a multidrug-resistant TB nosocomial outbreak involving 20 HIV-infected patients was ongoing. The strains causing this outbreak were also identified as M. bovis with an identical DNA pattern to those strains isolated in the Spanish hospital and the patient in The Netherlands. CONCLUSIONS: The use of centralized DNA databases can help to identify rapidly the origin and transmission routes of multidrug-resistant TB across international boundaries and the potential use of such an early warning surveillance system for investigation of nosocomial multidrug-resistant TB outbreaks between HIV-infected patients. To our knowledge this is the first report of transmission of multidrug-resistant M. bovis between hospitals.

Bacterial Typing Techniques↗
PubMed1979

Possible origin of the bluetongue epidemic in Cyprus, August 1977.

Possible origins of an epidemic of bluetongue in Cyprus in August 1977 have been analysed. First outbreaks occurred simultaneously in the south-east of the Famagusta district and on the north coast of the Kyrenia district respectively. Although the epidemic was due to type 4, which had been responsible for the previous outbreak in 1969, no evidence of persistance of virus could be found. Imports of domestic animals in the past year were not implicated since the imported cattle were introduced only to the southern part and not to the northern part of the island. Easterly, north-easterly and northerly winds during the period 11-14 August could have brought infected midges at a height of 0.5--1.5 km from Syria and Turkey, and such a movement would fit well the dates of the first outbreaks (20-25 August). Temperatures at a height of 1.5 km were 20-25 degrees C and at 0.5 km 30 35 degrees C, and with wind speeds 10-20 km h-1 the distance from Turkey and Syria would have been covered in 5-20 h. It follows that, in addition to surface winds, winds at all levels warm enough for flight should be taken into account when the possibility of disease spread by windborne midges is being assessed.

Animals↗
PubMed2000

Outbreak of hantavirus infection in the Four Corners region of the United States in the wake of the 1997-1998 El Nino-southern oscillation.

Hantavirus cardiopulmonary syndrome (HCPS), a rodent-borne zoonosis, has been endemic in the Americas for at least several decades. It is hypothesized that the 1991-1992 El Niño-southern oscillation (ENSO) caused increased precipitation that allowed an increase in rodent population densities, thereby increasing the possibility of transmission to humans. The result was a 1993-1994 outbreak of the disease in the Four Corners states of the southwestern United States. A second strong ENSO occurred in 1997-1998, after a period of considerable public education about the risks of hantavirus infection that began during the 1993-1994 outbreak. The caseload of HCPS increased 5-fold above baseline in the Four Corners states in 1998-1999. Regions that had received increased rainfall in 1998 were especially affected. A large majority of the 1998-1999 case patients reported indoor exposure to deer mice. Hantavirus outbreaks can occur in response to abiotic events, even in the face of extensive public education and awareness.

Animals↗
PubMed2000

Cellular immune responses persist and humoral responses decrease two decades after recovery from a single-source outbreak of hepatitis C.

As acute hepatitis C virus (HCV) infection is clinically inapparent in most cases, the immunologic correlates of recovery are not well defined. The cellular immune response is thought to contribute to the elimination of HCV-infected cells and a strong HCV-specific T-helper-cell (Th) response is associated with recovery from acute hepatitis C (ref. 2). However, diagnosis of resolved hepatitis C is based at present on the detection of HCV-specific antibodies and the absence of detectable HCV RNA, and detailed comparison of the humoral and cellular immune response has been hampered by the fact that patient cohorts as well as HCV strains are usually heterogeneous and that clinical data from acute-phase and long-term follow-up after infection generally are not available. We studied a cohort of women accidentally exposed to the same HCV strain of known sequence and found that circulating HCV-specific antibodies were undetectable in many patients 18-20 years after recovery, whereas HCV-specific helper and cytotoxic T-cell responses with an interferon (IFN)-gamma-producing (Tc1) phenotype persisted. The data indicate these HCV-specific CD4 + and CD8+ T cells are biomarkers for a prior HCV exposure and recovery. Because of undetectable antibodies against HCV, the incidence of self-limited HCV infections and recovery may be underestimated in the general population.

Antibody Specificity↗
PubMed2005

West Nile virus infection and serologic response among persons previously vaccinated against yellow fever and Japanese encephalitis viruses.

It is hypothesized that previous heterologous flaviviral exposure may modulate clinical illness among persons infected with West Nile virus (WNV). Little is known about the serological response in such persons. In summer 2003, a WNV outbreak occurred in Colorado, the location of the Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases (DVBID). DVBID employees, most previously vaccinated with yellow fever virus (YFV) or Japanese encephalitis virus (JEV) vaccines, were studied to determine whether previous vaccination affected symptom development among those subsequently infected with WNV during the outbreak, as well as their serological response. Serum samples collected in December 2003 and previously banked samples were tested using the plaque reduction neutralization test (PRNT) against WNV, Saint Louis encephalitis virus, dengue- 4 virus, JEV, and YFV. Specimens shown to have WNV antibody by PRNT were tested by IgM and IgG enzymelinked immunosorbent assays (ELISAs). Ten (9%) of 113 serosurvey participants had WNV neutralizing antibody titers in December 2003. PRNT titers from previous specimens showed that one of the ten had seroconverted to WNV before 2003. Of the remaining nine participants, seven reported illness in the summer of 2003, two of which were unvaccinated and five previously vaccinated. In the December 2003 specimens, five persons previously unvaccinated or vaccinated only against YFV had a fourfold or greater neutralizing titer with WNV than with other flaviviruses, whereas no persons previously vaccinated against JEV or JEV and YFV showed a similar difference in neutralizing titers. Eight of nine persons infected in 2003 had negative or indeterminate WNV MAC-ELISA results in the December 2003 sample; the ninth person was vaccinated against YFV one month previously, and was also YFV positive by MAC-ELISA. We conclude that previous flaviviral vaccination does not markedly affect the development of WNV fever and that the IgM antibody response in patients without neuroinvasive WNV disease is transient.

Adult↗
PubMed2002

Public health implications of campylobacter outbreaks in England and Wales, 1995-9: epidemiological and microbiological investigations.

Although campylobacter has been the most commonly recognized bacterial cause of gastrointestinal infection in England and Wales since 1981, there are few reported campylobacter outbreaks. Of the 2374 general outbreaks of infectious intestinal disease reported to CDSC between 1995 and 1999, for which an aetiological agent was identified, campylobacter accounted for only 50 (2%). Foodborne transmission was identified in 35 outbreaks and the majority took place in commercial catering establishments; waterborne transmission was responsible for a further four outbreaks. Isolates of Campylobacter jejuni were referred for typing from 25 outbreaks. In 13 outbreaks all isolates were the same subtype, as defined by serotype and phage type, while in the remainder more than one campylobacter subtype was involved.

Adolescent↗
PubMed2004

Vaccination as a control measure during the outbreak of foot-and-mouth disease in 2000 in Korea.

The Republic of Korea had been free from foot-and-mouth disease (FMD) for 66 years until 15 cases were confirmed between 24 March and 15 April in 2000. The FMD virus isolated in Korea was an O Pan Asia type, which was also responsible for the recent outbreaks in Japan and the U.K. Control measures including the stamping-out of infected animals on neighbouring farms, movement restrictions and emergency vaccination were implemented. The decision to vaccinate was made because the cattle affected were showing severe FMD lesions, there was significant possibility that a large amount of virus had already been shed and conditions at the time seemed to favour wind-borne spread. Also, because the spread was limited to cattle, it was assumed that the use of vaccinations would be more effective than if pigs had been affected. All susceptible animals within 10 km radius of the infected farms were vaccinated with inactivated, double-oil emulsion vaccines. Totals of 860,700 and 661,770 animals were vaccinated during the first and second round of booster vaccinations, and were completed within five months of the first outbreak. The government decided to adopt a let-live policy so that the vaccinated animals were not slaughtered. However, they were placed under movement restrictions and had to be identified and registered. Although there were concerns about the vaccinated animals becoming carriers, extensive serological surveillance using NSP ELISA found no evidence of FMD in the remaining vaccinated population. The use of emergency vaccinations in 2000 is regarded as being a major factor in limiting the spread of FMD and containing the outbreak within a month.

Animals↗
PubMed2005

Clinical review: SARS - lessons in disaster management.

Disaster management plans have traditionally been required to manage major traumatic events that create a large number of victims. Infectious diseases, whether they be natural (e.g. SARS [severe acute respiratory syndrome] and influenza) or the result of bioterrorism, have the potential to create a large influx of critically ill into our already strained hospital systems. With proper planning, hospitals, health care workers and our health care systems can be better prepared to deal with such an eventuality. This review explores the Toronto critical care experience of coping in the SARS outbreak disaster. Our health care system and, in particular, our critical care system were unprepared for this event, and as a result the impact that SARS had was worse than it could have been. Nonetheless, we were able to organize a response rapidly during the outbreak. By describing our successes and failures, we hope to help others to learn and avoid the problems we encountered as they develop their own disaster management plans in anticipation of similar future situations.

Communicable Disease Control↗
PubMed2005

Comparative analysis of Shigella boydii 18 foodborne outbreak isolate and related enteric bacteria: role of rpoS and adiA in acid stress response.

Shigella boydii CDPH (Chicago Department of Public Health) serotype 18 was implicated in an outbreak of foodborne illness in 1998. The suspected food vehicles were parsley and cilantro imported from Mexico used to prepare bean salad. Previous studies revealed that S. boydii CDPH serotype 18 can survive in bean salad, which contains organic acids and whose pH decreases over time. Acid challenge assays in acidified tryptic soy broth at pH 4.5, acidified Luria-Bertani broth at pH 4.5, and acidified M9 minimal salts medium at pH 2.5 containing amino acids, arginine, or glutamic acid were performed using S. boydii CDPH, S. boydii ATCC 35966, S. flexneri 3136, Escherichia coli O157:H7 dd8872, and E. coli O157:H7 dd642 to compare differences in acid tolerance. Differences in survival of exponential-phase cells were detected in acidified tryptic soy broth and Luria-Bertani broth at pH 4.5. In acidified minimal medium containing arginine, S. boydii strains were able to survive at pH 2.5. The arginine decarboxylase gene (adiA) present in S. boydii is involved in survival at extremely low pH. The discovery of adiA expression in S. boydii serotype 18 by use of an acidified minimal medium challenge and arginine decarboxylase biochemical assay is significant because arginine decarboxylase activity was thought to be unique to E. coli. Sequencing of the rpoS gene from the S. boydii outbreak strain indicates that it is 99% conserved compared with the E. coli K-12 rpoS gene and plays a vital role in survival under acidic conditions.

Acids↗
PubMedDate not supplied

Cholera in north Brazil: on the occurrence of strains of Vibrio cholerae O1 which fail to ferment sucrose during routine plating on thiosulphate-citrate-bile salt-sucrose agar (TCBS). A new problem in diagnosis and control?

The occurrence is recorded from a biochemical strain variant of Vibrio cholerae O1 originating from the municipality of Oiapoque, Amapá State, north Brazil and responsible for an epidemic outbreak of cholera in that region in August, 1994. The principal characteristic of the strain is its incapacity of break down sucrose on T.C.B.S. agar plates, and its delayed utilization of that sugar only after 48 hs. when cultivated in liquid medium. The strain spread rapidly in north Brazil, becoming responsible for most of the cases of cholera reported in Amazonian Brazil. The importance of this observation in laboratory diagnosis and the control of cholera is discussed.

Agar↗
PubMedDate not supplied

Proactive detection of cryptosporidiosis by clinical laboratories. Working Group on Waterborne Cryptosporidiosis.

Laboratories can play a critical and preemptive role as a community's first line of surveillance in detecting waterborne outbreaks when they are aware of increased numbers of stool specimens and suspect or identify Cryptosporidium as the cause of illness. In addition, strong working relationships between clinical laboratories and local or state public health laboratories or agencies can facilitate a meaningful and rapid response related to potential outbreaks. Clinical and public health laboratories potentially play a key role in adding to the limited knowledge of the endemicity and ultimately the natural history of Cryptosporidium. This article addresses the early detection of waterborne outbreaks of cryptosporidiosis and some strategies that could be used to determine endemic levels of Cryptosporidium infections unrelated to outbreaks: to detect Cryptosporidium outbreaks by causes other than potable waterborne sources, e.g., food, surface or recreational waters, pets or farm animals, or sexual contact; or to determine outbreak or endemic levels of other infectious diseases. Strategies for clinical laboratories, which include proactive external and internal planning and a brief overview of laboratory methodologies as they relate to the detection of waterborne cryptosporidiosis, are included.

Clinical Laboratory Techniques↗
PubMed1998

[History of the concept of quarantine].

Quarantine is a concept developed by society to protect against the outbreak of contagious diseases. From its original application in the favorable context of Medieval Europe, the quarantine concept has been driven by three main currents. The first involves the personification of epidemics. Although this personification had superstitious implications and led to many excesses, it did have the merit of establishing a concrete connection between travel and outbreak of disease. The second fundamental aspect of quarantining is the existence of a social organization capable of providing the necessary infrastructure for isolation. Specialized facilities are needed and laws must be made and enforced by competent officials. The last fundamental aspect of the development of the quarantine concept is the role of science. After a long process involving better medical knowledge and international negotiations, epidemic controls has largely outgrown the early stage involving essentially local control measures. In accordance with the development of these three currents, infected individuals have been branded as curse bearers, possible criminals, and innocent victims of natural contamination. While forced quarantine is no longer practiced, several recent examples of heated debates illustrate that strong emotional feelings are still present in societies threatened by epidemic disease outbreak. Since the major responsibility for disease control now rests in their hands, physicians must take these factors into account for management of possible future epidemic crises.

Cholera↗
PubMed2001

Tracing systems used during the epidemic of classical swine fever in the Netherlands, 1997-1998.

Any outbreak of an animal disease classified as a List A disease by the Office International des Epizooties, such as classical swine fever (CSF), has severe consequences for animal welfare, livestock production, exports of animals and animal products and the environment. Experience shows that early detection and response to a suspected disease outbreak will maximise the effectiveness of the emergency response actions and minimise the social, economic and environmental costs associated with the outbreak. The development and implementation of measures designed to minimise the risk of diseases entering a country or region has been the predominant animal health management strategy in most countries. However, even the strongest preventive management systems do not guarantee that outbreaks of animal diseases will not occur. Tracing, a procedure that begins with a known infected individual, herd or flock, and which traces all possible locational and interactive exposures in both directions, back towards the source and forward to contacts, is the backbone of disease emergency management. The authors provide an introduction to, and general overview of, tracking and tracing systems used during a recent epidemic of CSF in the Netherlands from 1997 to 1998.

Abattoirs↗
PubMed2004

[Meningococcal meningitis--familial outbreak].

Severe infections caused by Neisseria meningitidis, clinically appearing as meningitis or sepsis, are constantly noted in developed countries, including Poland. Because of rapid clinical course and mortality rate they continue to pose a serious clinical problem. Most cases are sporadic ones, caused by the contact with a healthy carrier of N. meningitidis. Familial and group outbreaks are rare, being responsible for about 1% of cases. However, in family members of patients with meningococcal infection the risk of developing the disease during the following week is about one hundred times higher than in the general population and they should receive an antibiotic prophylaxis. We describe a familial outbreak of meningococcal meningitis with typical clinical features, which appeared in two members of a family during the same day, with a case of acute pharyngitis most likely of the same etiology in the third person, a child. In that instance, practically simultaneous appearance of consecutive cases gave no time for prophylaxis. However, suspicion of meningococcal disease in the first patient contributed to the prompt hospitalization and diagnostics and proper treatment in the two following cases.

Adult↗
PubMed2003

The elderly and waterborne Cryptosporidium infection: gastroenteritis hospitalizations before and during the 1993 Milwaukee outbreak.

We used the Temporal Exposure Response Surfaces modeling technique to examine the association between gastroenteritis-related emergency room visits and hospitalizations in the elderly and drinking water turbidity before and during the 1993 Milwaukee waterborne Cryptosporidium outbreak. Before the outbreak, the rate of such events increased with age in the elderly (p</=0.001), suggesting that the elderly are at an increased risk. During the outbreak, strong associations between turbidity and gastroenteritis-related emergency room visits and hospitalizations occurred at temporal lags of 5-6 days (consistent with the Cryptosporidium incubation period). A pronounced second wave of these illnesses in the elderly peaked at 13 days. This wave represented approximately 40% of all excess cases in the elderly. Our findings suggest that the elderly had an increased risk of severe disease due to Cryptosporidium infection, with a shorter incubation period than has been previously reported in all adults and with a high risk for secondary person-to-person transmission.

Aged↗