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PubMed2000

The value of pyrolysis mass spectrometry to investigate nosocomial outbreaks caused by Serratia marcescens.

Simultaneous outbreaks of S. marcescens infection going on in the Neonatal Intensive Care Unit and the Surgical Department of the same hospital were investigated by pyrolysis mass spectrometry (PyMS). The PyMS analysis of the strains clearly demonstrated that the two outbreaks were caused by different strains. The 14 S. marcescens isolates from the first outbreak were closely related, with the exception of one environmental isolate, which did not harbour the ESBL plasmid, which was present in all other isolates. However, the phage type of all 14 isolates was the same. Among the 9 S. marcescens isolates from the second outbreak, PyMS clearly distinguished 3 that exhibited gentamicin resistance from the remaining 6 gentamicin-susceptible isolates. Phage typing was unhelpful in this case, as none of the isolates were typable. The PyMS typing of nosocomial outbreak strains can reach the level of discrimination approaching that achieved by molecular genetic analysis.

Bacterial Typing Techniques↗

PubMed2000

Serial outbreaks of food-borne disease in Blumenau, Brazil, caused by Salmonella enteritidis.

This work describes the epidemic profile of outbreaks of food infection caused by Salmonella enteritidis, serogroup D, in the city of Blumenau, Federal State of Santa Catarina, Brazil, during the period between February, 1994, and June, 1997. Ninety-six outbreaks were observed, and 79 (82%) were investigated, involving 7,802 people with signs and symptoms consistent with the infection. Most frequent symptoms were diarrhea (92%), abdominal pain (73%), fever (70%), vomiting (49%) and nausea (45%). Mayonnaise was the food most frequently associated with the outbreaks, being the responsible vehicle in almost two thirds of the cases investigated. The outbreaks most frequently occurred at home (60%), but the largest number of infections resulted from industrial kitchens (78%). The age group between 20 and 30 years was most affected. No relationships between the number of outbreaks and outside temperature or humidity were found. The attack rate showed no significant difference between men and women. Better attention to storage of food products at home and in industrial kitchens is needed to control this common gastrointestinal illness.

Adult↗

PubMed2003

Safety of community drinking-water and outbreaks of waterborne enteric disease: Israel, 1976-97.

Waterborne disease remains a major public health problem in many countries. We report findings on nearly three decades of waterborne disease in Israel and the part these diseases play in the total national burden of enteric disease. During the 1970s and 1980s, Israel's community water supplies were frequently of poor quality according to the microbiological standards at that time, and the country experienced many outbreaks of waterborne enteric disease. New regulations raised water quality standards and made chlorination of community water supplies mandatory, as well as imposing more stringent guidelines on maintaining water sources and distribution systems for both surface water and groundwater. This was followed by improved compliance and water quality, and a marked decline in the number of outbreaks of waterborne disease; no outbreaks were detected between 1992 and 1997. The incidence of waterborne salmonellosis, shigellosis, and typhoid declined markedly as proportions of the total burden of these diseases, but peaked during the time in which there were frequent outbreaks of waterborne disease (1980-85). Long-term trends in the total incidence of reported infectious enteric diseases from all sources, including typhoid, shigellosis, and viral hepatitis (all types) declined, while the total incidence of salmonellosis increased. Mandatory chlorination has had an important impact on improving water quality, in reducing outbreaks of waterborne disease in Israel, and reducing the total burden of enteric disease in the country.

Disease Outbreaks↗

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

Characterization of nine Pasteurella multocida isolates from avian cholera outbreaks in Indonesia.

Avian cholera outbreaks have been identified in Indonesia in recent years. Despite vaccination programs, outbreaks continue to occur. To date, there has been a lack of information on the characteristics of Pasteurella multocida isolates involved in these outbreaks. Hence, the objective of this study was to characterize Indonesian P. multocida isolates in poultry. During 1998-99, 20 field outbreaks were reported in Indonesia. Nine isolates of P. multocida were recovered from these field outbreaks. The isolates were compared with four vaccine strains that were used in Indonesia and designated PM-V1, PM-V2, PM-V3, and PM-V4. The isolates were characterized by biotype, capsular type, somatic serotype, restriction endonuclease analysis, plasmid presence, and antimicrobial susceptibility patterns. Of the nine Indonesian isolates, three were of capsular type A (A:1,3,13; A:1,3; and A:8). One isolate was of type B:2,3 and one isolate was of capsular type F. For three isolates, the capsular serogroup could not be identified. Plasmids the size of 2.3 kbp were present in three of the field isolates and two of the vaccine strains. One plasmid less than 2 kbp was isolated from the vaccine strain PM-V4. Eight distinct DNA profiles were obtained from digestion with the restriction endonuclease EcoRI, and seven distinct DNA profiles were obtained from digestion with the restriction endonuclease HindIII. All of the isolates were resistant to lincomycin and sulfadiazine and were susceptible to ampicillin and trimethoprim. Of the nine isolates, seven (78%) were susceptible to doxycycline and gentamicin and six (67%) were susceptible to enrofloxacin.

Ampicillin↗

PubMedDate not supplied

[Salmonella enteritidis outbreak in a home for the aged].

BACKGROUND: An outbreak of gastroenteritis caused by Salmonella Enteritidis (SE), phagotype 1, reported at a senior citizen living facility in Burgos on November 15, 1999 is discussed. The objective of the research of this outbreak was that of ascertaining the source of infection, the mechanism by which it was transmitted and to propose the suitable measures for preventing any recurrence of this problem. METHODS: An observational retrospective cohort study has been made by surveying 106 of a total of 119 residents and 9 employees at the center in question. The Relative Risk of being affected by this disorder has been estimated in terms of the intake of different foods. Logic Regression was employed for calculating the odds ratio adjusted by age, sex and by the intake of foods and wine. The concordance of the clinical diagnosis with the coproculture diagnosis was studied using the Cohen's Kappa index of agreement. RESULTS: A total of 42 individuals reported symptoms (37 residents and 5 employees). The clinical attack rate was 36.5%. Forty-five (45) of the 91 coprocultures performed (82 on residents and 9 on employees) were positive (41 in residents and 4 in employees). The attack rate for cases confirmed by coproculture was 49.5% among those investigated. Fried breaded milk and flour batter sweets was the food product implicated epidemiologically with the onset of the outbreak: RR 3.25 (C.I at 95% 1.10-9.59). The protective effect of the wine (Odds Ratio: 0.68) was not high enough to be statistically significant (p = 0.36). The Kappa index was 0.43 (p < 0.001), which reveals very little agreement between the clinical diagnosis and the coproculture diagnosis. CONCLUSIONS: Epidemiological evidence exists of the intake of fired breaded milk and flour batter sweets having been the mechanism for the transmission of the infection, and the food product in question having been stored at room temperature having been the determining contributing factor in the start of the outbreak. This reveals that the best way of preventing this type of outbreaks are clean habits and practices on the part of all those involved in the food-handling sector.

Aged↗

PubMed2001

Viral water contamination as the cause of aseptic meningitis outbreak in Belarus.

In the recent years Echovirus-30 associated outbreaks have taken place in different European countries. Aseptic meningitis caused by Echovirus-30 was the main diagnosis of a large outbreak in Belarus in Summer-Autumn, 1997, involving 460 patients. Echovirus-30 was detected in cerebrospinal fluid of the patients with aseptic meningitis. This serotype played the dominant role in the outbreak. Minor serotypes and mixtures of enteroviruses were detected in faeces and nasopharyngeal lavages. Investigation of environmental samples gave evidence of expressed viral contamination of drinking water and water sources (river and ground sources). River water sources were considerably contaminated with viruses. The incidence of virus isolation was 50%. After cleaning procedures, the incidence became two times lower, proving imperfect water purification and disinfection procedures. Sequence analysis of isolates from Belarus (isolates from water and patient's cerebrospinal fluid) showed the difference of 0.2%. The outbreak peculiarities such as high attack rate and wide-spread of the disease incidences, clinical form variability, isolation of outbreak strain from water and a good agreement between minor serotypes isolated from faeces and water samples as well as correlation in the dynamics of acute intestine infections, aseptic meningitis morbidity and bacterial water contamination can be considered as evidence of its water-borne. Echovirus-30 isolates from Belarus were very closely related to each other and to several European isolates. Sequence difference between isolates of 1994-1998 from European countries was found to be 4.3%. The data can point to the common primary source of enterovirus infection, connected to water and to the possibility of epidemic strain transmission from neighbouring states to the Republic of Belarus.

Disease Outbreaks↗

PubMed2001

Clonal relations among Salmonella enteritidis phage type 3 outbreak isolates traced by DNA fingerprinting.

Isolates of Salmonella enteritidis PT3, a rare phage type, were recovered from patients and strains were isolated from an outbreak of gastroenteritis that occurred during the summer of 1997 in North-East Sardinia, Italy. To investigate possible clonal involvement in the outbreak and to evaluate the capacity to discriminate among S. enteritidis PT3 strains, a number of molecular typing methods including ribotyping with a mixture of PstI and SphI (PS-ribotyping), PFGE with endonuclease XbaI and RAPD typing with four arbitrary primers was used. The typical XbaI endonuclease generated PFGE pattern also explained the prevalence of highly clonal S. enteritidis PT3 strains in the outbreak and adjacent areas. RAPD fingerprinting with primers OPA 4, OPB 15, OPB17 and P1254 exhibited a single but unique RAPD profile among the outbreak strains from various sources that differed significantly from control strains. The results of this study showed that when an appropriately chosen set of primers is employed, RAPD fingerprinting can be used as an alternative, rapid, highly reproducible technique for tracing the clonal relations of S. enteritidis PT3, and can be more discriminatory than PFGE. Furthermore, this study revealed the possibility of PT3 causing outbreak.

DNA Fingerprinting↗

PubMed2001

An outbreak of Norwalk-like viral gastroenteritis in a frequently penalized food service operation: a case for mandatory training of food handlers in safety and hygiene.

In 1999, in Toledo, Ohio, an outbreak of gastroenteritis occurred among people who had attended a Christmas dinner banquet and had eaten food prepared by a local caterer. Overall, 93 of the 137 attendees (67.9 percent) reported illness. Eight sought medical care, and one was hospitalized. Case-control studies revealed that the illness was associated with eating tossed salad (odds ratio [OR] = 2.5, 95 percent confidence interval [CI] = 1.02-6.26). Eleven of 12 stool specimens that were taken from ill people tested positive for a Norwalk-like virus (NLV) but were negative for E. coli O157:H7, Salmonella, and Shigella. The primary source of the outbreak was not determined, but an infected food handler may have played a role in the transmission of the virus. The catering facility had been cited frequently for food safety and hygiene violations. None of the personnel or food handlers at this facility had been appropriately trained in safe food-handling practices, nor had the personnel at another local caterer that had prepared food items suspected of causing a multistate outbreak of NLVs. In Toledo, food service operations with trained personnel/food handlers received better inspection reports than food service operations without trained personnel and were less likely to contribute to foodborne outbreaks. Training of personnel and food handlers may be important for preventing outbreaks.

Adolescent↗

PubMed2002

Practical lessons from the management of an outbreak of small round structured virus (Norwalk-like virus) gastroenteritis.

An outbreak of viral gastroenteritis caused illness in 92 people during October 2000. All the cases had an association with one hotel and 80% of cases identified had attended one of two buffet meals on 18th October 2000. Cohort analysis did not implicate any particular foodstuff in this outbreak. All bacteriological tests on food samples were negative. Small round structured virus (SRSV)/Norwalk-like virus (NLV) particles were seen by electron microscopy in 6 out of 27 stool samples submitted for analysis. This paper describes the outbreak and in particular the lessons learned from the management and control of it. These include practical points with regard to the outbreak control team, liaison with the microbiology laboratory, handling data, agreeing a case definition, and occupational health issues. All can be applied elsewhere by those responsible for managing outbreaks at a local level.

Caliciviridae Infections↗

PubMed2002

[Epidemiology on Norwalk virus-related gastroenteritis outbreaks among elderly persons living in nursing homes].

Person-to-person transmission of Norwalk virus(NV) is important factor for outbreaks in nursing homes in addition to foodborne and waterbone transmission. NV spread easily among residents and staffs through the care process and highly infectious contamination generated by vomitus and feces remains on the environmental surface. As a result, the outbreak continues for long period(a few weeks) compared with foodborne gastroenteritis outbreak in restaurant. For prevention and control of NV outbreak in nursing homes, it is necessary suitable efforts to break off the transmission routes; frequent handwashing, adequate measures against infectious materials such as stool and vomitus, cleaning with an appropriate germicidal product, and to minimize any mingling of residents and visitors until termination of the outbreak.

Aged↗

PubMed2002

General outbreaks of infectious intestinal disease linked with salad vegetables and fruit, England and Wales, 1992-2000.

Between 1992 and 2000, 1,518 foodborne general outbreaks of infectious intestinal disease (IID) were reported to the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC), of which 83 (5.5%) were associated with the consumption of salad vegetables or fruit (SVF). The pathogens most frequently reported were salmonellas (41.0%) and Norwalk-like virus (NLV) (15.7%). In total 3,438 people were affected; 69 were admitted to hospital and one person died. Most outbreaks were linked to commercial catering premises (67.5%). Three community outbreaks, of Salmonella enterica serovar Typhimurium Definitive Phage Type (DT) 104, S. Typhimurium DT 204b and Shigella sonnei infection, were found to be associated with lettuce contaminated at source, and these accounted for 501 (14.6%) cases. The latter two outbreaks were international, involving several European countries. This demonstrates how contamination of SVF during production/processing can result in major, geographically widespread, outbreaks of infection with serious public health consequences.

Disease Outbreaks↗

PubMed2001

An outbreak of dengue fever in rural areas of northern India.

During the past few decades, epidemics of dengue fever are causing concern in several South-East Asian countries including India. The rural areas of Hissar district of Haryana state, situated about 170 km North-West of Delhi, experienced an outbreak of febrile illness during July-August 1996. A total of 13 villages in eight affected primary health centres reported fever cases. The clinical, epidemiological and entomological findings indicated that the present episode was due to dengue fever. The aetiological agent of the current outbreak, the DEN-2 virus, was isolated from 12 acute-phase sera specimens. Though, in the recent past outbreaks have been reported from the rural areas of southern and western India, the present episode is the first outbreak being reported from the rural areas of northern India. The increasing frequency of dengue fever outbreaks in rural areas of various Indian states reflects the changing life style of the rural population as a result of urbanization process and calls for a suitable prevention and control policy based on strengthened surveillance, appropriate health education to the community coupled with proper training of health personnel.

Adolescent↗

PubMed2003

Outbreak of group A streptococcal pneumonia among Marine Corps recruits--California, November 1-December 20, 2002.

During November 1-December 20, 2002, a total of 163 Marine Corps personnel from the Marine Corps Recruit Depot (MCRD) in San Diego, California, including 160 new recruits, were admitted to the Naval Medical Center San Diego (NMCSD) for possible pneumonia. For 128 (79%) patients, pneumonia was confirmed by chest radiograph; of these 128 cases, 31 (24%) were definitely or probably caused by group A streptococci (GAS). This is the first outbreak of serious GAS-associated illness at a San Diego military training facility since the 1987 outbreak of rheumatic fever and the largest outbreak of GAS pneumonia in the United States since 1968. This report summarizes the results of the investigation of this outbreak, which indicate that GAS infection can occur among military recruit populations despite routine chemoprophylaxis administered to incoming recruits. Instituting routine surveillance for noninvasive GAS disease in military training facilities might prevent future invasive GAS outbreaks.

California↗

PubMed2003

[Outbreak of trichinellosis in the region of la Vera (Carceres, Spain) caused by Trichinella britovi].

OBJECTIVE: To describe the clinical and epidemiological aspects of a trichinellosis outbreak in the region of La Vera that took place during January and February 2002, related to the consumption of pork meat infected with Trichinella britovi. MATERIAL AND METHODS: When the first suspected case was discovered, the presumed infected meat was checked and all the people who might have eaten it were examined. An epidemiological interview and a clinic evaluation were carried out in each patient. RESULTS: We found 52 exposed people that had eaten the presumptive infected meat, 35 males and 17 females, with an age ranging from 2 to 86 years old. A confirmed positive diagnosis was established in 16 patients. The most frequent symptoms were: diarrhea (present in all the cases), fever, myalgia and facial edema. Eosinophilia was an early and characteristic analytic sign. All diagnosed cases were found to have positive serology, although this was not a required criterion to start medical treatment. Treatment was started once the clinical suspicion of trichinellosis was determined, based on compatible clinical signs and eosinophilia. There were no complications and none of the patients required hospitalization. The meat sample was claimed by the Health Authorities and destroyed, thus avoiding further extension of the outbreak. CONCLUSIONS: Sporadic outbreaks of trichinellosis have been described in Spain. In the present paper an outbreak caused by Trichinella britovi has been studied. Early diagnosis suspicion and its communication to the Health Authorities allowed the control of the outbreak and the identification of the contaminated meat. Treatment must be started after clinical suspicion and eosinophilia.

Adolescent↗

PubMed2003

Milkborne general outbreaks of infectious intestinal disease, England and Wales, 1992-2000.

From 1 January 1992 to 31 December 2000, 27 milkborne general outbreaks of infectious intestinal disease (IID) were reported to the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). These outbreaks represented a fraction (2%) of all outbreaks of foodborne origin (N = 1774) reported to CDSC, but were characterized by significant morbidity. Unpasteurized milk (52%) was the most commonly reported vehicle of infection in milkborne outbreaks, with milk sold as pasteurized accounting for the majority of the rest (37%). Salmonellas (37%), Vero cytotoxin-producing Escherichia coli (VTEC) O157 (33%) and campylobacters (26%) were the most commonly detected pathogens, and most outbreaks were linked to farms (67%). This report highlights the importance of VTEC O157 as a milkborne pathogen and the continued role of unpasteurized milk in human disease.

Animals↗

PubMed1992

Salivary antibody testing in a school outbreak of hepatitis A.

During a community-wide outbreak of hepatitis A in Gloucester, UK there was a high attack rate in children attending two city primary schools and a pre-school centre sharing the same site. In September 1990, saliva specimens were collected from 478 (85%) of the 562 children. The prevalence of antibody to hepatitis A virus (anti-HAV), as determined by saliva testing, was 29.6%; highest prevalences were seen in 5-6-year-olds and in children from that area of the city at the centre of the community-wide outbreak. The proportion of immune children with a history of clinical hepatitis varied with age from 1 in 42.7 of under-5-year-olds to 1 in 4.7 of 8-10-year-olds. Six children who received prophylaxis with human normal immune globulin (HNIG) because they were household contacts of cases subsequently became infected. Since there was evidence of transmission outside the school environment it is unlikely that a policy of universal prophylaxis within the schools would have stopped the outbreak. Mass prophylaxis in school outbreaks is only likely to be effective if most transmission is occurring at school and if the target population can be clearly defined. Salivary antibody testing is a simple, practical and acceptable procedure in young children. Salivary antibody surveys in conjunction with vaccination against hepatitis A should provide a cost-effective method for control of future outbreaks.

Age Factors↗

PubMed1992

An international foodborne outbreak of shigellosis associated with a commercial airline.

OBJECTIVE: To determine the source of an international outbreak of shigellosis associated with consumption of food served by a Minnesota-based airline. DESIGN: Cohort studies of players and staff of a Minnesota-based professional football team and passengers on flights with a confirmed case of outbreak-associated Shigella sonnei infection. SETTING: Community- and industry-based studies conducted from October through November 1988. PARTICIPANTS: Sixty-five football team players and staff, and 725 airline passengers in the cohort studies. RESULTS: Twenty-one (32%) of 65 football players and staff developed shigellosis that was associated with consumption of cold sandwiches prepared at the airline flight kitchen (relative risk [RR], 17.1; 95% confidence interval [Cl], 2.4 to 120; P < .001). Confirmed or probable shigellosis was identified among 240 passengers on 219 flights to 24 states, the District of Columbia, and four countries between September 14 and October 13. An outbreak-associated strain of S sonnei was isolated from football players and staff, airline passengers, and flight attendants. Thirty (4.1%) of 725 passengers on 13 flights with confirmed cases had confirmed or probable shigellosis. Illness was associated with consumption of cold food items served on the flights and prepared by hand at the airline flight kitchen (RR, 5.7; 95% Cl, 1.4 to 23.5; P < .01). CONCLUSIONS: This international outbreak of shigellosis was identified only because of the occurrence of an index outbreak involving a professional football team. Prevention of Shigella transmission in mass catering establishments may require reduction of hand contact in the preparation of cold food items or elimination of these items from menus.

Adult↗