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PubMedDate not supplied

A collaborative system-wide response to influenza outbreak management in Saskatoon Health Region.

OBJECTIVE: To describe the benefits of a regional, collaborative, system-wide approach to influenza outbreak management. PARTICIPANTS: Senior management representatives from affected parts of the Regional Health Authority. SETTING: Saskatoon Health Region. INTERVENTION: Public Health proactively engaged a broad-based, multidisciplinary planning/management group to minimize the effect of the influenza outbreak, and institute best practice in prevention and outbreak management system-wide for the future. OUTCOMES: Earlier recognition and faster resolution of influenza outbreaks, fewer outbreaks, reduced pressure on acute care, greater compliance with amantadine prophylaxis, and improved immunization rates in seniors and health care workers. CONCLUSION: While many of these interventions and best practices have been recommended by individual sectors, when Public Health takes a system-wide approach facilitated by regionalization, it results in optimized planning, co-ordination, evaluation and successful outcomes.

Amantadine↗

PubMed2003

A network-informed approach to investigating a tuberculosis outbreak: implications for enhancing contact investigations.

BACKGROUND: To elucidate networks of Mycobacterium tuberculosis transmission, it may be appropriate to characterize the types of relationships among tuberculosis (TB) cases and their contacts (with and without latent TB infection) in addition to relying on traditional efforts to distinguish 'close' from 'casual' contacts. SETTING: A TB outbreak in a US low incidence state. OBJECTIVE: To evaluate whether social network analysis can provide insights into transmission settings that might otherwise go unrecognized by routine practices. DESIGN: All adult outbreak-associated cases (n = 19) and a convenience sample of their contacts with and without latent TB infection (LTBI) (n = 26) were re-interviewed in 2001 using a structured questionnaire. Network analysis software was used to create diagrams illustrating important persons within the outbreak network, as well as types of activities TB cases engaged in with their contacts. RESULTS: Drug use and drug sharing were more commonly reported among cases and their infected contacts than among contacts without LTBI. TB cases central to the outbreak network used crack cocaine, uncovering the need to focus control efforts on specific sites and persons involved in illicit drug use. CONCLUSION: Outbreaks occur even in areas with low TB incidence, frequently among groups whose drug use or other illegal activities complicate control efforts. TB programs should consider the use of network analysis as a supplement to routine contact investigations to identify unrecognized patterns of M. tuberculosis transmission.

Adolescent↗

PubMed2004

Measles outbreak associated with an imported case in an infant--Alabama, 2002.

Local transmission of measles is rare in the United States. Since 1997, the majority of measles outbreaks have been caused by imported cases. During October 19-November 15, 2002, an outbreak of 13 confirmed cases of measles occurred, with exposure in Alabama; 11 cases were among day care attendees who had not yet been vaccinated for measles. This was the largest outbreak of measles in the United States since 1999. In response to this outbreak, the Alabama Department of Public Health (ADPH) and CDC conducted an epidemiologic investigation that determined the outbreak was initiated by an imported case in an infant aged 9 months who had returned recently from the Philippines. Health-care providers should continue to include measles in differential diagnoses for febrile rash illnesses in infants, particularly those with recent travel to areas where measles is endemic.

Adult↗

PubMed1992

Salmonella outbreak among railway and airline passengers.

A widespread outbreak by Salmonella infantis, infecting a total of 226 people, occurred in Finland at the beginning of August 1986. Of those infected, 107 were railway passengers, 91 were airline passengers and 28 were employed in a food processing establishment. The outbreak among the railway passengers was caused by egg sandwiches, the airline passengers were infected by a meal served on board and the catering employees by the breakfast served in the establishment. The outbreak was caused by food prepared in the establishment's kitchen. The employees' breakfasts had probably been contaminated by an employee who was a symptom-free Salmonella infantis carrier, and a number of the employees subsequently became infected, leading to widespread contamination of the food prepared in the establishment. The spread of the outbreak was further influenced by a heatwave at the time and by shortcomings in the cold storage facilities. The kitchen's hygiene supervision and the quality control of its output were reorganized after the outbreak.

Aircraft↗

PubMed1992

An outbreak of hepatitis A in Gloucester, UK.

During an outbreak of hepatitis A that occurred in Gloucester, UK between September 1989 and January 1991, 162 clinical cases were identified through notifications and laboratory reports, a monthly attack rate of 1.05 per 10,000 residents. The highest attack rate was seen in 5-14-year-olds. There were significant correlations between hepatitis A attack rates in the electoral wards of Gloucester and with the Jarman UPA 8 scores for the wards and with overcrowding, unemployment, under 5-year-olds and ethnic minority. The use of human normal immune globulin prophylaxis (HNIG) for household contacts was unsuccessful in ending the outbreak, partly because only one third of cases reported a household contact with recent hepatitis A. Our experience does not support the use of HNIG in stopping community-wide outbreaks of hepatitis A. Two public health campaigns were mounted during the outbreak; both were followed by a fall in the number of cases. Greater priority should be given to the implementation and evaluation of public health campaigns in future community-wide outbreaks of hepatitis A.

Adolescent↗

PubMed2003

Molecular diversity of noroviruses associated with outbreaks on cruise ships: comparison with strains circulating within the UK.

The molecular diversity of norovirus (NV) strains associated with 26 outbreaks of NV gastroenteritis has been determined. The outbreaks occurred on 14 cruise ships from seven cruise lines, during the period from 1998 to 2002. The ships cruised in seas worldwide, including the Mediterranean, the Baltic and the Caribbean. Genogroup I NVs were more common in the cruise ship setting than in hospitals, with 38% of the cruise ship outbreaks associated with genotype I NVs, as compared to < 10% in hospital and other semi-closed institutions in the UK. Outbreaks on cruise ships were more common in the period April to September, than in the winter. Two mixed genogroup I and II outbreaks were detected, which suggested contaminated food or water as the source of the infection.

Caliciviridae Infections↗

PubMed2004

Measles outbreak in a boarding school--Pennsylvania, 2003.

Measles has not been endemic in the United States since 1997, although limited outbreaks continue to be caused by imported cases. In 2003, CDC assisted in investigating the largest school outbreak of measles in the United States since 1998. The outbreak consisted of 11 laboratory-confirmed cases: nine cases in a boarding school in eastern Pennsylvania and two epidemiologically linked cases in New York City (NYC). This report summarizes the results of the outbreak investigation, which indicated that measles continues to be imported into the United States and that high coverage with 2 doses of measles-containing vaccine (MCV) among students was effective in limiting the size of the outbreak. Health-care providers should maintain a high index of suspicion for measles, especially in those who have traveled abroad recently, and recommendations for 2 doses of MCV in all school-aged children should be followed.

Adolescent↗

PubMed2004

Outbreak of aflatoxin poisoning--eastern and central provinces, Kenya, January-July 2004.

In May 2004, CDC Kenya, trainees of the CDC-supported Field Epidemiology and Laboratory Training Program (FELTP) in Kenya, the World Health Organization, and CDC were invited by the Kenya Ministry of Health (KMOH) to participate in the investigation of an outbreak of jaundice with a high case-fatality rate (CFR) in the districts of Makueni and Kitui, Eastern Province. Preliminary laboratory testing of food collected from the affected area revealed high levels of aflatoxin, suggesting that the outbreak was caused by aflatoxin poisoning, as was a previous outbreak in the same area in 1981. In the United States, aflatoxin concentrations are limited to 20 parts per billion (ppb), a level also adopted by Kenyan authorities. The 2004 outbreak resulted from widespread aflatoxin contamination of locally grown maize, which occurred during storage of the maize under damp conditions. Urgent replacement of the aflatoxin-contaminated maize with noncontaminated maize proved to be a critical intervention; however, as of July 21, a limited number of new cases continued to be detected. This report summarizes the preliminary results of the outbreak investigation. Aflatoxin poisoning likely will continue to be a public health problem until culturally appropriate storage methods for dry maize are implemented by the local population. In addition, enhanced surveillance for human aflatoxin poisoning and testing of commercially sold maize for aflatoxin levels will lead to long-term improvements in public health.

Adolescent↗

PubMedDate not supplied

Pediatric tuberculosis in Alberta First Nations (1991-2000): outbreaks and the protective effect of bacille Calmette-Guérin (BCG) vaccine.

BACKGROUND: The tuberculosis control strategy of vaccinating First Nations newborns with BCG (bacille Calmette-Guerin) is currently undergoing re-evaluation in Canada. Review of recent pediatric tuberculosis morbidity could inform this re-evaluation. METHODS: Potential source cases and pediatric cases of tuberculosis from Alberta First Nations were identified over the 10 years 1991-2000. The distribution of pediatric disease was described. The effect of BCG on tuberculosis morbidity in two large outbreaks was determined. RESULTS: A total of 57 potential source cases and 41 pediatric cases of tuberculosis were reported from 17 (41.5%) and 8 (19.5%) of the 41 on-reserve First Nation Community Health Centres, respectively. Three outbreaks traceable to three source cases accounted for 34 (18, 3, and 13, respectively) of the 41 (82.9%) pediatric cases. Each outbreak was spatially and temporally separate from the other. Each outbreak strain of Mycobacterium tuberculosis had a unique DNA fingerprint. In the largest outbreaks, disease-to-infection ratios (secondary case rates) were higher in newly infected unvaccinated versus vaccinated close pediatric contacts (12/13 [92.3%] versus 7/15 [46.7%], p=0.02), but the infection rate was almost certainly falsely high in the BCG vaccinated. One unvaccinated child had a brain tuberculoma in addition to primary pulmonary tuberculosis. CONCLUSION: For most Alberta First Nations communities, the spatial and temporal distribution of disease, and the meager impact on morbidity, challenge the rationale for continued use of BCG.

Adjuvants, Immunologic↗

PubMed2001

"Norwalk-like viruses". Public health consequences and outbreak management.

"Norwalk-like viruses" (NLVs) cause outbreaks of gastroenteritis and are spread frequently through contaminated food or water. Molecular diagnostics now enables detecting viruses in clinical and environmental specimens, linking of NLV strains causing outbreaks in multiple geographic locations, and tracing them to their sources in contaminated food or water. This report reviews recent advances in NLV detection and provides guidelines and recommendations for investigating NLV-related outbreaks, including specimen collection and disease prevention and control. This report also updates information provided in CDC's previously published, Viral Agents of Gastroenteritis: Public Health Importance and Outbreak Management (MMWR 1990;39 [No. RR-5]: 1-24). These CDC recommendations are intended for public health professionals who investigate outbreaks of acute gastroenteritis but could be useful in academic and research settings as well.

Caliciviridae Infections↗

PubMed2004

Tuberculosis, chickenpox and scabies outbreaks in an orphanage for children with HIV/AIDS in Jamaica.

OBJECTIVES: The aim of this study is to describe the investigation and management of outbreaks of acute tuberculosis, varicella zoster virus and scabies in a residential facility for children with HIV/AIDS. METHOD: A review of the results and management for diagnosed cases of acute TB (four between 2001 and 2002) as well as varicella zoster virus (15) and scabies (14) (concurrent in March--June 2003), in a residential facility housing 24 abandoned children with HIV/AIDS was conducted. Outbreak control methods and challenges are described The modified WHO criteria were used for TB diagnosis. The diagnoses of varicella and scabies were entirely clinical. RESULTS: Of the surviving 22 children, 12 (mean age 8 years 2 months) were female, and 10 (mean age 5 years 6 months) were male. Full immunization (primary series) was documented for 16 children, partial in one child, unknown status was documented in five children. One child had received varicella vaccine previously. Eleven (50%) children had been receiving antiretroviral triple therapy since 2002 (all in Centers for Diseases Control immunological categories 2-3). Two of the four children with tuberculosis died between 2001 and 2002; these were not on antiretroviral therapy--the 2 survivors are still on antiretroviral therapy. All staff mantoux test results were negative. Fifteen (68%) children developed chickenpox as well as three caregivers. The index case was a 13-year-old resident attending a nearby school with HIV negative children. This varicella outbreak went on to affect household members for the caregivers as well as other residential facilities nearby. Scabies affected 14 children (no caregivers); the index cases were most likely three new child residents who entered the institution in 2002 (from other homes) with histories of scabies infestation. Chickenpox and scabies dual infection occurred in seven (31%) of residents. No cases of herpes zoster, disseminated varicella infection or death because of varicella occurred Diagnosed cases of chickenpox were treated with oral acyclovir Knowledge about these disease outbreaks and their control was generally lacking. CONCLUSIONS: Improvement in immunization coverage for children and staff as well as educating staff about infectious disease outbreaks, is necessary for effective control. Appropriate screening for infection/disease for all susceptible persons is essential along with timely reporting of outbreaks/reportable diseases. There is need for increased awareness of acute opportunistic infections in children with HIV/AIDS living in close proximity.

AIDS-Related Opportunistic Infections↗

PubMed1992

Outbreak of invasive group A streptococcal infections in a nursing home. Lessons on prevention and control.

OBJECTIVE: Nine outbreaks of group A streptococcal (GAS) infections in nursing homes were reported to the Centers for Disease Control (Atlanta, Ga) during the past two winters. We conducted an intensive epidemiologic and laboratory investigation of one of these outbreaks to determine clinical characteristics, risk factors for transmission and infection, and methods of control and prevention. METHODS: Cases were detected using cultures and serologic tests. Matched case-control and retrospective cohort studies were performed to determine risk factors for infection. RESULTS: Between December 13, 1989, and January 31, 1990, 16 (20%) of 80 residents, and three (7%) of 45 staff, were infected with GAS. Eleven of the residents had invasive disease and four died. Isolates were available from four persons; all were serotype M-1, T-1. There was strong spatial clustering of cases within the nursing home; having a roommate with prior infection was the most important risk factor. Residents with preexisting decubiti had a reduced risk of infection, perhaps because of stricter infection control practices in their care. No evidence was found for common-source transmission of infection. No further cases occurred after improvement of infection control practices and administration of prophylactic antimicrobials to all residents and staff. CONCLUSIONS: Invasive GAS disease is increasing nationwide, and is a potentially serious problem in the growing and high-risk setting of nursing homes. These data suggest that, in this outbreak, a virulent GAS strain was introduced, with subsequent person-to-person transmission. Adherence to infection control practices can prevent or control GAS outbreaks. Prophylactic antimicrobials may be an effective adjunct to control severe or ongoing outbreaks.

Aged↗

PubMedDate not supplied

[Seasonal variations in the outbreaks in patients with multiple sclerosis].

INTRODUCTION: It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. AIMS: Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. PATIENTS AND METHODS: We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. RESULTS: We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. CONCLUSIONS: In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months.

Adult↗

PubMedDate not supplied

An outbreak of E. coli O157:H7 hemorrhagic colitis associated with unpasteurized gouda cheese.

BACKGROUND: A cluster of E. coli O157:H7 hemorrhagic colitis was identified in metro Edmonton, Alberta through notifiable disease surveillance in late 2002. METHODS: Environmental health officers collected food histories and clinical information from cases in the cluster. The provincial public health laboratory conducted pulsed field gel electrophoresis (PFGE) analysis on E. coli O157:H7 isolates from cluster cases. Public health and food regulatory agencies conducted an investigation when a food source (unpasteurized gouda cheese) was implicated. RESULTS: PFGE analysis revealed an "outbreak" profile in 13 cases. Onset dates for the outbreak cases ranged between October 2002 and February 2003. Two cases, aged 22 months and 4 years, developed hemolytic uremic syndrome as a result of their infection. Consumption of unpasteurized gouda cheese produced at a local dairy farm was reported by 12 of 13 outbreak cases in the 2 to 8 days prior to illness. E. coli O157:H7 was isolated from 2 of 26 cheese samples manufactured by the implicated producer. The cheese isolates had indistinguishable PFGE profiles as compared with outbreak case isolates. Implicated cheese was found to be contaminated with E. coli O157:H7 104 days after production, despite having met regulated microbiological and aging requirements. CONCLUSION: To our knowledge, this is the first confirmed outbreak of E. coli O157:H7 infection in Canada associated with raw milk hard cheese. A review of federal legislation vis-à-vis raw milk hard cheese may be in order.

Alberta↗

PubMed2004

[The role of the "infection control nurse (ICN)" in an outbreak].

The nosocomial infection and its expansion is a big problem for both customers and healthcare organizations. It is one of the most important tasks for the infection control team to prevent spreadng the hospital infection and to minimize its damage for clients and healthcare organizations. Japanese nurse association (JNA) has established the system of the certified nurses who finished authorized certification program in 15 areas including infection control in 1999. They are called "Certified Expert nurse (CEN)" and the number of CEN concerning about infection control (ICN) has reached 146 nurses in Japan in 2004. ICNs should have an ability to predict the possibility of an outbreak and to take measures to meet the situation, practically direct intervention and research for the outbreak. In this literature I have summarized the roles of ICN, introducing our experience of the scabies outbreak in our affiliated intermediate care facility for the senior citizens. It is important for ICN to research and analyze the outbreak, at the same time we have to feedback effectively to the healthcare stuffs to change their attitude and develop the system to discover the outbreak earlier by educating them.

Aged↗

PubMed2005

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal unit: control of an outbreak using a new ADSRRS technique.

Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (EPKP) strains are frequently implicated in outbreaks in neonatal units. From April 2002 to January 2003, 149 neonates were colonized/infected with EPKP in the Neonatal Clinic of the Teaching Hospital at the Medical University of Gdańsk, Poland. A novel assay based on suppression of PCR, ADSRRS-fingerprinting, was successfully evaluated for typing EPKP isolates. The results showed that the genotypes of all outbreak-related strains were identical, which suggested that the outbreak originated from a single clone. This conclusion was confirmed by using different methods--RAPD and PFGE. The outbreak was stopped by adopting improved hygiene and instituting outbreak control measures.

Anti-Bacterial Agents↗

PubMed1991

Identification of atypical rotaviruses in outbreaks of preweaning and postweaning diarrhea in Québec swine herds.

Intestinal contents of diarrheic pigs from 120 outbreaks of diarrhea were examined for the presence of atypical rotaviruses. Pigs involved in these outbreaks were aged two days to five weeks and samples collected over a period of one year originated from different regions of the province of Québec. Samples were analyzed by polyacrylamide gel electrophoresis (PAGE) for the presence of viral RNA and genome profiles were compared to those of porcine rotavirus A/OSU, B/Ohio and C/Cowden. Based on electropherotypes both typical (group A) and atypical (groups B and C) rotaviruses were identified. Rotaviruses could be demonstrated in 25.8% of outbreaks and together atypical rotaviruses accounted for 46.7% of rotavirus-positive outbreaks. Other common enteropathogens were often present in conjunction with rotaviruses in the preweaning and postweaning outbreaks studied.

Animals↗

PubMedDate not supplied

[Investigation of an outbreak of norovirus gastroenteritis in a geriatric hospital].

In aged-care facilities, gastroenteritis outbreaks are responsible for big trouble in the management of cares to the elderly. In November 2002, a gastroenteritis outbreak was observed in 5 of the 6 wards of the geriatric hospital La Charité, University Hospital of Saint-Etienne, France, with an attack rate of 38.5% in the elderly (70 infected from 182 patients) and of 26.0% in the nursing staff (40 infected from 154 agents). The outbreak lasted 30 days with a peak corresponding to 79.8% of the cases between the 11(th) and the 20(th) of November. The first cases were observed in the two short-term-care wards; then, the outbreak spread rapidly to 3 of the 4 long-term care units. Health care workers were contaminated later than the elderly (P < 0.001 by Kruskal-Wallis test). A self-administered questionnaire was documented by most of the nursing staff; the most frequently observed clinical symptoms in this population were nausea (82.5%), abdominal pain (80.0%), diarrhoea (70.5%), asthenia (67.5%) and vomiting (62.5%). Thirty-five percent of the health care workers ceased their work. The causative agent of the gastroenteritis was identified by RT-PCR in the stools of 5 aged persons as a norovirus close to the Lordsdale strain (genogroup II). These findings illustrate the respective role of elderly and health care workers in the spread of the gastroenteritis outbreak inside the geriatric hospital.

Adult↗