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PubMed2000

The VP2 variable region of African and German isolates of infectious bursal disease virus: comparison with very virulent, "classical" virulent, and attenuated tissue culture-adapted strains.

11 African and two German IBDV strains isolated in the mid '80s from field outbreaks in vaccinated and unvaccinated chicken flocks displayed features of very virulent (vv) IBDV strains. The sequence data of the VP2 variable region and phylogenetic analysis confirm that these strains can be grouped within vv IBDV strains which appeared at the same time on the three continents Africa, Asia, and Europe. Strain Cu-1wt, responsible for severe IBD outbreaks in Germany 13 years earlier, showed some relatedness to these strains, but also significant differences at the genomic level, even though this strain has also features of the vv IBDV strains.

Africa↗

PubMed2002

Molecular epidemiology of Salmonella typhimurium isolates from human sporadic and outbreak cases.

The molecular epidemiology of a representative collection of sporadic foreign and domestically acquired Salmonella Typhimurium (S. Typhimurium) isolates from Norwegian patients in 1996-9 was studied by numerical analysis of pulsed-field gel electrophoresis (PFGE) profiles. Three subclusters (E5, F1 and G1) comprised 47% of the 102 sporadic isolates investigated and 45% of the domestically acquired isolates fell in subclusters E5 and F1. Distinct seasonal and geographic variations were evident for these strains which have been responsible for both local outbreaks (E5) and a national epidemic (F1) where salmonella-infected hedgehogs and birds constituted the suggested primary source of infection. Subcluster G1 was dominated by imported multi-resistant definitive type (DT) 104 isolates. All multi-resistant isolates contained integron-associated gene cassette-structures. This study presents valuable information on the relative significance, geographic distribution and antibiotic resistance features of distinct S. Typhimurium clones causing human salmonellosis among Norwegians.

Animals↗

PubMed2005

[Vibrio parahaemolyticus infections and algal intoxications as emergent public health problems in Chile].

There is interest in the paradigm that relates environmental sea changes to the emergence of diseases that affect both aquatic organisms in the sea and human beings. The emergence of Vibrio parahaemolyticus as an important cause of epidemic summer diarrhea in 2004 and 2005, confined mainly to the tenth region in Chile, could be a manifestation of this trend. This and other areas of the country have also experienced several outbreaks of paralytic shellfish poisoning (PSP), diarrheal shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP) caused by harmful algal blooms (HAB) of Alexandrium catenella, Dinophysis acuta and Pseudonitzchia species, respectively. The short historical record of these pathological phenomena in Chile suggests that they are increasing in frequency and expanding their geographical range. The V parahaemolyticus isolates responsible for the Chilean outbreaks correspond mainly to the pandemic strain O3:K6. HAB found in Chile and the intoxications caused by them have similar biological characteristics to those described in other areas of the world. The tenth region, the area where these problems are emerging, produces approximately 80-90% of the shellfish consumed in Chile and a large proportion of the shellfish that is exported. Prevention of these public health problems can be attained by developing policies that increase environmental surveillance for Vibrios and toxic algae, improve the epidemiological surveillance of acute diarrhea and algal intoxications after the ingestion of raw bivalves, and educate the population on the mode of transmission of these diseases. Scientific capacity and laboratories need to be developed to widen the limited knowledge of the biology of Vibrio and toxic algae and the environmental factors that favor their emergence as public health and economic problems in Chile.

Bacterial Toxins↗

PubMed2000

Bioterrorism and the importance of the public health laboratory.

Biological terrorism is a threat to the United States that public health laboratories cannot afford to ignore. With the ability to recognize unusual strains of organisms, or an increase in test requests or isolation of specific organisms, the public health laboratory can detect the beginning of an outbreak. The laboratory can also facilitate appropriate response measures with rapid diagnostic testing and by determining antibiotic resistance patterns. Public health laboratory personnel need to assess their capabilities, improve them where indicated, and know where to turn for assistance. As improvements in bioterrorism detection occur in the civilian sector, military laboratories must integrate with local, state, and federal health department systems. Laboratories are essential components in surveillance, recognition, and response for both bioterrorism and naturally occurring disease outbreaks.

Biological Warfare↗

PubMed2003

Identification and containment of an outbreak of SARS in a community hospital.

BACKGROUND: Severe acute respiratory syndrome (SARS) is continuing to spread around the world. All hospitals must be prepared to care for patients with SARS. Thus, it is important to understand the transmission of this disease in hospitals and to evaluate methods for its containment in health care institutions. We describe how we cared for the first 2 patients with SARS admitted to our 419-bed community hospital in Richmond Hill, Ont., and the response to a SARS outbreak within our institution. METHODS: We collected clinical and epidemiological data about patients and health care workers at our institution who during a 13-day period had a potential unprotected exposure to 2 patients whose signs and symptoms were subsequently identified as meeting the case definition for probable SARS. The index case at our hospital was a patient who was transferred to our intensive care unit (ICU) from a referral hospital on Mar. 16, 2003, where he had been in close proximity to the son of the individual with the first reported case of SARS in Toronto. After 13 days in the ICU, a diagnosis of probable SARS was reached for our index case. Immediately upon diagnosis of our index case, respiratory isolation and barrier precautions were instituted throughout our hospital and maintained for a period of 10 days, which is the estimated maximum incubation period reported for this disease. Aggressive surveillance measures among hospital staff, patients and visitors were also maintained during this time. RESULTS: During the surveillance period, 15 individuals (10 hospital staff, 3 patients and 2 visitors) were identified as meeting the case definition for probable or suspected SARS, in addition to our index case. All but 1 individual had had direct contact with a symptomatic patient with SARS during the period of unprotected exposure. No additional cases were identified after infection control precautions had been implemented for 8 days. No cases of secondary transmission were identified in the 21 days following the implementation of these precautions at our institution. INTERPRETATION: SARS can easily be spread by direct personal contact in the hospital setting. We found that the implementation of aggressive infection control measures is effective in preventing further transmission of this disease.

Adult↗

PubMed1994

Molecular epidemiology of Salmonella enteritidis.

Sixteen strains of Salmonella enteritidis isolated in 1991 from 13 unrelated poultry-associated sources, 7 strains from 2 community outbreaks, and 18 human sporadic isolates were investigated by phage typing, analysis of rRNA gene restriction patterns (ribotyping) and plasmid profiles. Four different phage types and 10 SphI patterns were found, whereas plasmids were identical in all but 4 isolates. Only one ribotype (RT A) occurred among both human and avian strains. This particular ribotype was also responsible for the two outbreaks investigated, suggesting that such strains may be of special significance for the increase of S. enteritidis infections.

Animals↗

PubMed1993

Tuberculosis symposium: emerging problems and promise.

Between 1985 and 1991, 39,000 cases of tuberculosis occurred in excess of those expected based on previous trends. Immigration from high-prevalence countries, coinfection with human immunodeficiency virus (HIV), and outbreaks in congregative facilities are most responsible for the increase. Coincident with the increase in tuberculosis, outbreaks of multidrug resistant (MDR) tuberculosis have occurred. Clinical and epidemiologic data support nosocomial transmission. MDR tuberculosis occurred late in the course of HIV infection and was refractory to treatment. Compounding the problems of rising incidence and increasing resistance was the sudden recognition of shortages of antituberculous drugs. The problems currently posed by tuberculosis require new approaches to diagnosis and rapid sensitivity testing as well as assuring an adequate supply of licensed drugs and development of new drugs. A number of steps have been taken by governmental agencies to assure that the challenge is met.

Drug Resistance, Microbial↗

PubMed2004

The role of the obstetrician-gynecologist in emerging infectious diseases: monkeypox and pregnancy.

Early in June 2003, the Centers for Disease Control and Prevention (CDC) announced yet another unique infectious disease outbreak, the first evidence of community-acquired monkeypox in the United States. By July 8, 2003, a total of 71 cases had been reported to CDC from 6 states. When emerging infectious diseases are reported in the United States, particularly when these reports receive widespread media attention, obstetrician-gynecologists may be called upon to rapidly respond to queries from their patients and to address certain infectious disease risks within their clinical practices. In addition, obstetrician-gynecologists may have specific concerns about the implications for an infectious disease outbreak, such as monkeypox, for pregnant women. Therefore, it is important that obstetrician-gynecologists know how to gather up-to-date and accurate information about infectious disease outbreaks and that they be familiar with the public health response system for responding to such outbreaks.

Communicable Diseases, Emerging↗

PubMed1999

Staphylinid (rove) beetle dermatitis outbreak in the American southwest?

An outbreak of a blistering disease was reported in a military unit training in the Arizona desert during heavy rain and flooding. In a unit of 249 personnel, 33 presented with dermatologic complaints, and 4 met stringent diagnostic criteria for dermatitis linearis. A fifth patient presented with symptoms and signs of "Nairobi eye." Staphylinid (rove) beetles related to the paederids, which have been responsible for vesicular dermatitis outbreaks in other parts of the world but not previously in the United States, were collected at the site. Reports in the antique scientific literature document paederids in the area after periodic floods. These findings suggest that rove beetle dermatitis should be added to the differential diagnosis of vesicular dermatitis in western North America.

Animals↗

PubMed2004

Limitations to successful investigation and reporting of foodborne outbreaks: an analysis of foodborne disease outbreaks in FoodNet catchment areas, 1998-1999.

To better understand factors associated with confirming the etiologic organism and identifying the food vehicle responsible for foodborne-disease outbreaks, we examined data from outbreaks reported in 1998 and 1999 through active surveillance by Foodborne Disease Active Surveillance Network (FoodNet) surveillance areas in 7 states. In 71% of these outbreaks, no confirmed etiology was identified, and in 46%, no suspected food vehicle was identified. Outbreaks involving > or =10 cases were significantly more likely to have their etiology identified than were smaller outbreaks. In two-thirds of outbreaks in which an etiology was not confirmed, no stool specimens were collected for laboratory testing; in 55% of these outbreaks, neither clinical specimens nor food samples were tested. If the etiology of and factors contributing to foodborne-disease outbreaks are to be understood, adequate resources must be available to allow specimens to be collected and tested and epidemiologic investigations to be conducted appropriately.

Disease Outbreaks↗

PubMedDate not supplied

Yaws in Papua New Guinea: extent of the problem and status of control programs.

Yaws was a significant health problem in Papua New Guinea until the nationwide total mass treatment campaign, which took place from 1953 to 1958. The number of cases reported annually fell to less than 300 during the 1960s. In the early 1970s outbreaks occurred in East New Britain and Bougainville but were effectively controlled. A larger outbreak in 1977-1978 on Karkar Island was more difficult to bring under control despite the clinical appearance of the cases, which were less florid than those seen in the 1950s. The latter outbreak raised questions about decreased response to penicillin, lack of ability to develop effective immunity, and increased susceptibility to yaws. Smaller outbreaks were reported in 1983 and 1984 in remote areas, but the current extent of yaws in Papua New Guinea is not fully known. Action is being taken to rectify this situation and to ensure that reports of yaws are fully investigated and that cases are properly managed.

Female↗

PubMed1990

Plasmid profile typing can be used to subdivide phage-type 49 of Salmonella typhimurium in outbreak investigations.

Plasmid profile typing has been used to subdivide phage-type 49 of Salmonella typhimurium, the most common phage type in humans in England and Wales since 1985. Twenty profile patterns have been identified in 350 strains examined. Four profile patterns have been identified in 143 isolates from patients infected in 33 epidemiologically unrelated incidents and two patterns have predominated, ST49:62 and ST49:62, 1. These patterns were also common amongst S. typhimurium phage-type 49 isolated from cattle and poultry; however ST49:62 was more common in bovines whereas ST49:62, 1 predominated in poultry. S. typhimurium phage-type 49 with a different profile pattern, ST49:62, 3, was responsible for a large outbreak in London in 1988 which was traced to mayonnaise made from eggs supplied by one producer. Plasmid profile typing can now be regarded as a method of supplementing phage typing in investigating outbreaks caused by this organism.

Animals↗

PubMed1994

Outbreak of Hantavirus pulmonary syndrome in the southwestern United States. Response of pathologists and other laboratorians.

During late spring and early summer of 1993, national and international media called worldwide attention to a cluster of deaths in the southwestern United States. These patients succumbed to a rapidly progressive severe respiratory distress syndrome. After notification of state and national health agencies in mid-May, a major effort was launched to determine the cause of this often fatal respiratory distress syndrome, to advise the public on safety measures, and to determine the method of spread of this "mystery illness." Within weeks of recognition of the early cases, the Centers for Disease Control and Prevention announced the probable agent, a Hantavirus. This report details the response of pathologists, medical technologists, and other laboratory scientists to this new viral epidemic, with emphasis on activities that occurred within New Mexico.

Adolescent↗

PubMed1980

Restriction endonucleases in identification of a genome type of adenovirus 19 associated with keratoconjunctivitis.

Adenovirus type 19 (Ad19) was first associated with disease in 1973 when several outbreaks of keratoconjunctivitis were reported from Europe and North America. We have examined Ad19 isolates by deoxyribonucleic acid restriction with BamHI, BglI, and SmaI restriction endonucleases. All keratoconjunctivitis-associated Ad19 isolates were identical but different from the Ad19 prototype. The total number of resolved restriction fragments of the Ad19 prototype genome was 31, only 17 of which migrated as the restriction fragments of keratoconjunctivitis-associated genomes. We conclude that two different genome types of Ad19 exist, one of which has been responsible for the recent outbreaks of keratoconjunctivitis.

Adenoviruses, Human↗

PubMed1992

Prophylactic oral acyclovir in outbreaks of primary herpes simplex virus type 1 infection in a closed community.

Oral acyclovir was given prophylactically to 37 children in the early stages of three outbreaks of herpes simplex virus type 1 (HSV-1) infection and the results were compared with those in untreated control subjects in two other outbreaks. The rates of seroconversion to HSV were significantly reduced in children treated with acyclovir compared with control subjects (91% vs 27%, P less than .001). The incidence of symptomatic disease was also significantly reduced (82% vs 0%, P less than .001). In some children receiving prophylactic acyclovir, anti-HSV antibody titers did not rise despite the presence of replicative HSV on throat swabs just before the start of treatment. Restriction endonuclease analysis of isolated HSV-DNA confirmed that one strain was responsible for the five outbreaks. No resistance to acyclovir was detected during the study, and no adverse effects of treatment were noted. In conclusion, short-term prophylactic acyclovir may limit the spread and reduce clinical manifestations of HSV infections in closed communities, although this use should be restricted to communities where severe symptoms are observed.

Acyclovir↗

PubMed2005

Implementation of the Hospital Emergency Incident Command System during an outbreak of severe acute respiratory syndrome (SARS) at a hospital in Taiwan, ROC.

We sought to describe the implementation of the Hospital Emergency Incident Command System (HEICS) at National Cheng Kung University Hospital (NCKUH) in Taiwan, ROC during the outbreak of severe acute respiratory syndrome (SARS) in early 2003. We administered a 14-question survey via structured interviews to individuals occupying activated HEICS leadership positions at NCKUH to identify the organization, structure, and function of the HEICS units and subunits they led and the job actions they performed from 25 March to 16 June 2003 Thirty-three of 38 persons (87%) occupying 39 of 44 (89%) activated HEICS leadership positions directly participated in the survey. The participants collectively reported: 1) the creation of four new HEICS unit leader positions and corresponding units during the outbreak, including the infection control officer (administrative section) and SARS assessment, isolation, and critical care unit leaders (operations section); 2) the creation of six new HEICS subunits, including functional areas for fever screening, SARS assessment, and resuscitation outside the hospital, and SARS patient care, SARS critical care, and employee isolation inside the hospital; and 3) the performance of new job actions related to infection control by all HEICS unit leaders. HEICS provides a flexible framework that seems to have assisted NCKUH in the organization of its emergency response to the SARS outbreak in Taiwan, ROC.

Cross-Sectional Studies↗

PubMed1992

Seroepidemiological characterization of a syphilis epidemic in the Republic of the Marshall Islands, formerly a yaws endemic area.

The annual numbers of reported cases of syphilis in the Republic of the Marshall Islands (RMI) increased from none in 1983 to more than 600 in 1989, suggesting a large outbreak of syphilis. Much of the increase resulted from expanded serological screening. The apparent outbreak of syphilis, therefore, may have been partly the result of increased surveillance or, since the RMI was formerly a yaws endemic area, possibly due to a resurgence of yaws. To address this problem and better characterize the epidemic, we analysed results from a 1989/90 Ministry of Health Services mass serological screening on Majuro Atoll, the main population centre. Serum specimens from 9160 people (86% of residents aged 15-44 years) on Majuro were screened with the rapid plasma reagin (RPR) card test; we repeated the RPR and performed a confirmatory microhaemagglutination assay for Treponema pallidum-specific antibodies (MHA-TP) on a sample of serum specimens. To estimate the seroprevalence of syphilis, we also tested a sample of RPR nonreactive specimens by MHA-TP. Among people less than 45 years of age, total (11.5%) and high-titre (5.2%) seropositivity rates were highest in the 20-24 year age group, as was MHA-TP seroprevalence (15.9%). These results suggested that a large outbreak of syphilis was responsible for the observed seroreactivity. Cumulative incidence modelling and comparisons with the results of a previous serosurvey conducted in 1985 suggested that the duration of the syphilis epidemic was approximately 10 years and that incidence had not increased appreciably since 1985.

Adolescent↗

PubMed2003

Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003.

BACKGROUND: An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People's Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province. METHODS: We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent. FINDINGS: SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province's capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world. INTERPRETATION: SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries.

China↗