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PubMedDate not supplied

[Gastroenteritis outbreak associated with water consumption, possibly caused by Norwalk or Norwalk-like virus].

BACKGROUND: It is described an acute gastroenteritis outbreak of probable hydric transmission in Ontinyent (Valencia). It was declared on the 31st of January, 1992 and affected 3541 people according to the declaration done by the sanitary services who attended the patients. The clinical situation was characterized by the presence of profuse and watery diarrhoea, nausea, vomiting, abdominal pain and fever or febricula. METHODS: A preliminary study of the cases has been done, the information being treated with the classical method of descriptive epidemiology and a later study of the transversal observation type by means of a telephone inquiry. RESULTS: The results show that this outbreak affected approximately to a 30% of the population, and show the relation between consumption of water from the municipal water system and the outbreak, as well as the existence of a control population not affected for receiving a different water supply. CONCLUSION: Once rejected the bacterial origin for the results of the copro-cultivation done the analysis of the clinical and epidemiological characteristics of the outbreak, show a total agreement with the criteria described by Kaplan to characterize acute gastroenteritis outbreaks because of Norwalk-like virus.

Acute Disease↗

PubMed1995

Outbreaks of infectious intestinal disease associated with person to person spread in hotels and restaurants.

Twenty-eight outbreaks of infectious intestinal disease, reported as being transmitted mainly by the person to person route, were identified in association with retail catering premises, such as hotels, restaurants, and public houses, in England and Wales between 1992 and 1994. Five thousand and forty-eight people were at risk in these outbreaks and 1234 were affected. Most of the outbreaks (over 90%) occurred in hotels. Small round structured viruses were the most commonly detected pathogens. Diarrhoea and vomiting were common symptoms and most of the outbreaks occurred in the summer months. Control measures to contain infectious individuals and improved hygiene measures are necessary to contain such outbreaks.

Communicable Diseases↗

PubMed1995

Outbreak of leptospirosis with pulmonary involvement in north Andaman.

An outbreak of acute febrile illness with haemorrhagic manifestations and pulmonary involvement occurred in Diglipur of North Andaman during October-November 1993. Investigations were carried out to see whether leptospires were responsible for this outbreak. Serum samples were collected from suspected cases and tested for presence of antibodies to leptospires by microscopic agglutination test (MAT) using a battery of 19 antigens representing 16 serogroups. 66.7 per cent of the specimens showed significant titres of antibodies against leptospires, 18 of 23 paired sera (78.3%) showed sero-conversion or four-fold rise in antibody titres. The commonest serovar involved was Leptospira grippotyphosa followed by L. canicola and L. JEZ bratislava. In 7 patients L. grippotyphosa was the sole serovar against which antibodies were detected. Clinical and epidemiological observations of this outbreak were similar with that of earlier seasonal outbreaks of acute febrile illness with haemorrhagic manifestations occurring in the same area, indicating that the past outbreaks may also have been due to leptospires. This is the first report of pulmonary leptospirosis from India.

Disease Outbreaks↗

PubMed1995

Outbreaks of foodborne infectious intestinal disease in England and Wales: 1992 and 1993.

We have analysed data from the surveillance scheme of general foodborne outbreaks of infectious intestinal disease in England and Wales reported to, or otherwise identified by, the PHLS Communicable Disease Surveillance Centre in 1992 and 1993. Data were available about 458 outbreaks, 197 (43%) in commercial catering premises (restaurants, cafés, hotels, public houses, and canteens), 77 (17%) associated with food prepared in private houses, and 58 (13%) in hospitals and residential institutions. Salmonellas and Clostridium perfringens were responsible for 340 outbreaks (74%) and no pathogen was identified in 55 outbreaks (12%). Organisms associated with the highest mean attack rates were Staphylococcus aureus (66%) and C. perfringens (53%). Eleven thousand people were reported to be il and 362 were admitted to hospital. There were 15 deaths, 13 of which were associated with salmonellosis. A specified food was suspected to be the vehicle of infection in 204 outbreaks (45%). Possible contributory factors were identified in 277 (61%), most commonly inappropriate storage, cross contamination, and inadequate heat treatment. Reducing the incidence of food poisoning will depend on concerted action on farms, in abattoirs and food processing plants, in wholesale and retail outlets, and in kitchens.

Disease Outbreaks↗

PubMed1994

An outbreak of poliomyelitis in Andhra Pradesh (South India).

An outbreak of poliomyelitis that occurred in the year 1992 in Telangana region of Andhra Pradesh, South India was investigated to understand the reasons for persistence of poliomyelitis in the general population and for the outbreak in Andhra Pradesh in particular. The study comprised of a detailed investigation of epidemiological and clinical features, serology and vaccination status and a case control study to calculate vaccine efficacy by matched pair analysis. The outbreak occurred after a relative quiescence of 3 years. The age group of the patients ranged from 2 months to 5 years, 26.5% being infants and 70.2% being children between 1 and 5 years. The outbreak was mainly caused by Type 1 poliovirus. Vaccine efficacy was found to be 70%. Antibody response was not high in cases. Seventy six per cent of the children with poliomyelitis were unvaccinated. Ignorance of the mothers and family interference were the main causes for not vaccinating the children. The study indicates the need to increase the vaccination coverage and inclusion of children upto 5 years in the programme. Absence of vaccination is the major risk factor for the outbreak. The persistence of poliomyelitis in older children, low antibody response and suboptimal vaccine efficacy point out the problem of achieving control with OPV in tropical countries and suggest the need for alternate strategies. Better health education strategies need to be developed.

Child, Preschool↗

PubMed1993

Multistate outbreak of viral gastroenteritis related to consumption of oysters--Louisiana, Maryland, Mississippi and North Carolina, 1993.

On November 17, 1993, the state health departments of Louisiana, Maryland, and Mississippi notified CDC of several outbreaks of gastroenteritis occurring in their states since November 12. Preliminary epidemiologic investigations identified consumption of oysters as the primary risk factor for illness. On November 16, the Louisiana Department of Health and Hospitals (LDHH) had identified the Grand Pass and Cabbage Reef harvesting areas off the Louisiana coast as the source of oysters associated with outbreaks in Louisiana and Mississippi. Tagged oysters associated with outbreaks in Maryland were traced to the same oyster beds. The oysters harvested from these areas had been distributed throughout the United States. On November 18 and 19, the LDHH and CDC notified state epidemiologists of the potential for oyster-associated illness; outbreaks of oyster-associated gastroenteritis subsequently were identified in Florida and North Carolina. Collaborative investigations by state health officials, the Food and Drug Administration (FDA), and CDC were initiated to determine the magnitude and characteristics of the multistate outbreak, identify the etiologic agent, and trace the oysters. This report summarizes the preliminary findings of the ongoing investigation.

Acute Disease↗

PubMed1993

Outbreaks of Salmonella enteritidis gastroenteritis--California, 1993.

Foodborne infections cause an estimated 6.5 million cases of human illness and 9000 deaths annually in the United States. Salmonella is the most commonly reported cause of foodborne outbreaks, accounting for 28% of such outbreaks of known etiology and 45% of outbreak-associated cases during 1973-1987. During 1985-1992, state and territorial health departments reported 437 Salmonella enteritidis (SE) outbreaks (Table 1), which accounted for 15,162 cases of illness, 1734 hospitalizations, and 53 deaths. This report describes three SE outbreaks in California during a 4-month period in 1993.

California↗

PubMed1995

Investigation of an outbreak of typhoid fever in two settlements near Port Moresby.

From November 1985 to February 1986 two unplanned settlements near Port Moresby experienced a small person-to-person outbreak of typhoid fever, which included one death. Investigation showed that of the 20 individuals who were diagnosed as either ill, culture positive or a carrier, 15 were related by blood, marriage or through shared living quarters. The remaining 5 lived in the same house, but were not related to the larger group. Drinking water was contaminated with coliforms, but was not implicated. The outbreak resolved with no additional cases after February 1986. Outbreaks of this nature highlight the need for continuing public health education for local health officers in contact tracing, field testing and transportation of specimens, and epidemiological skills in ivestigating person-to-person outbreaks. They also make a strong case for public health laboratories equipped to perform rapid, comprehensive pathological examination of specimens collected during any outbreak of infectious illness.

Adolescent↗

PubMed1996

Effectiveness of vaccination at 6 to 11 months of age during an outbreak of measles.

HYPOTHESIS: Monovalent measles vaccine can be administered to children 6 to 11 months of age during an outbreak. Efficacy and effectiveness of this control measure still have to be assessed. METHODS: During and outbreak of measles, monovalent measles vaccine was administered as part of outbreak control to children aged 6 to 11 months. Active surveillance was used to detect cases of measles occurring during the following month. Children who did not develop measles were tested for measles antibody before their revaccination at 15 months of age. RESULTS: Of 81 children 6 to 11 months of age, 56 were vaccinated and two received immunoglobulins; the latter were excluded from the analysis. Measles occurred in 15 of the 79 children during and after the vaccination campaign, for an overall attack rate of 19%. The attack rate among unvaccinated children was 39% (9 of 23), compared with 11% (6 of 56) among those vaccinated (relative risk = 3.6, 95% confidence interval [CI] = 1.5 to 9.1). All of those who sustained measles in the vaccinated group developed the disease within 10 days after vaccination. The overall vaccine effectiveness was 73% (95% CI = 32% to 89%) when children were classified as vaccinated as soon as they were given measles vaccine. It rose to 96% (95% CI = 72% to 99%) when children were considered vaccinated 1 week postimmunization. Nineteen infants who were vaccinated and who did not develop measles during the outbreak were tested for measles antibody status at 15 months of age before revaccination. All had plaque reduction neutralizing antibody titers greater than 120. CONCLUSION: This study confirms that measles vaccination of infants aged 6 to 11 months is an effective intervention measure during measles outbreaks.

Antibodies, Viral↗

PubMed1996

The cost of a food-borne outbreak of hepatitis A in Denver, Colo.

BACKGROUND: In 1992, a food-borne outbreak of hepatitis A associated with a catering facility in Denver, Colo, resulted in 43 secondary cases of hepatitis A and the potential exposure of approximately 5000 patrons. OBJECTIVES: To assess (1) disease control costs, including state and local health department personnel costs, provision and administration of immune globulin, and cost of extra hepatitis A serologic tests performed; (2) business losses; and (3) cost of the cases' illnesses. METHODS: Cost data were collected from hospitals, health maintenance organizations, health departments, laboratories, the caterer's insurance company, and the catering facility involved in the outbreak. RESULTS: The total costs assessed in the outbreak from a societal perspective were $809,706. Disease control costs were $689,314, which included $450,397 for 16,293 immune globulin injections and $105,699 for 2777 hours of health department personnel time. The cases' medical costs were $46,064, or 7% of the disease control costs. CONCLUSIONS: The cases' medical costs and productivity losses were only a minor component of the total cost of this outbreak. The high cost of food-borne outbreaks should be taken into account in economic analyses of the vaccination of food handlers with inactivated hepatitis A vaccine.

Colorado↗

PubMedDate not supplied

[Foodborne diseases: a survey on working methods used by 6 Public Health Services in the Lombardy Region. 1. Outbreaks].

Since foodborne diseases, especially those caused by bacteria, have become an increasingly important public health problem, the Authors conducted a survey in order to evaluate the organization of, and the intervention carried out by, six Public Health Services in the Lombardia region, after reports of foodborne diseases outbreaks. Lack of correct methodology was detected, not to mention the usual omission of epidemic curves and attack rates. Besides, too many microbiological tests were made and it took too much time to take care of and to report the outbreaks to Regional and National Health Authorities. Forty-one outbreaks were examined: 415 cases occurred (AR: 28.7%), most of which home-made food-related. In 25 outbreaks the suspected food vehicles were eggs or fish, but only 5 of them were confirmed by laboratory tests. Salmonella enterica, either serovar Eenteritidis or group D, appeared responsible for 26 of the outbreaks [corrected].

Aged↗

PubMed1996

Evaluation of outbreaks of disease attributable to eastern equine encephalitis virus in horses.

OBJECTIVES: To evaluate outbreaks of disease attributable to eastern equine encephalitis virus (EEEV) in horses in Michigan, and the associated environmental patterns and weather conditions, so that factors could be identified that may have predisposed horses in specific areas of the state to infections with EEEV. DESIGN: Epidemiologic retrospective records analysis. ANIMALS: Data on EEEV vectors, wild-bird reservoir hosts, and incidental hosts, including horses and human beings, obtained from census reports and medical records compiled between 1942 and 1991. PROCEDURE: Patterns detected during outbreaks of disease attributable to EEEV infections in horses were compared to associated water drainage patterns, distributions of EEEV vectors, wild-bird reservoir and incidental hosts, and weather conditions. RESULTS: Michigan has all of the elements required to sustain EEEV on a state-wide basis. Outbreaks of disease attributable to EEEV in horses have recurred in a similar regional distribution in Michigan. Regions of Michigan that have specific patterns for water drainage, specific mosquito species, and areas with higher than expected amounts of precipitation have been associated with outbreaks of disease attributable to EEEV in horses. CLINICAL IMPLICATIONS: Evaluation of environmental patterns, weather conditions, and vector and reservoir host distributions may be useful to identify areas in Michigan and elsewhere in which horses and human beings are at increased risk for an outbreak of disease attributable to EEEV.

Animals↗

PubMed1996

Typing of Salmonella enterica serovar Saintpaul: an outbreak investigation.

During the summer of 1993 an outbreak of human salmonellosis caused by Salmonella serovar Saintpaul occurred in Denmark. A total of 35 isolates originating from pigs, turkeys and imported foodstuffs, and 10 human isolates were compared following their characterization by agglutination of the 0:5 factor, antibiogram typing, plasmid profiling, ribotyping and pulsed field gel electrophoresis, in order to identify the most probable source of infection. After typing, the source of the investigated outbreak remains obscure because so far no isolates with traits of the outbreak strain have been recovered from production animals. Presence of the 0:5 factor and absence of plasmids in human and porcine isolates pointed to pork as the source of infection, whereas human isolates and all Danish isolates from turkeys had the same ribotype, indicating that turkey was the infection source. A possible explanation for the failure to find isolates with traits of the outbreak strain could be the presence of a third, but so far unidentified, source. The present investigation illustrates the necessity of using more than one epidemiological typing method for outbreak investigation. This is especially important when the organism involved is relatively uncommon and little is known about its diversity and distribution.

Animals↗

PubMed1996

First report of field outbreaks of ergot-alkaloid toxicity in South Africa.

Outbreaks of clinical disease caused by the ingestion of ergotized Lolium rigidum (annual ryegrass), which resulted in a substantial loss in production, have been reported. A number of outbreaks of a hyperthermia syndrome in cattle, characterized by severe loss in milk production, loss of body mass and reduced fertility, are described. In one major outbreak in March to April 1994, a milling company reported that 2,646 dairy cows on 29 farms had developed clinical signs. In this outbreak, significant levels of ergotamine, ergosine, ergocornine and ergocryptine were found in the milled dairy rations fed to the affected cows. Barley screenings containing ergotized annual-ryegrass seed was identified as the toxic component and probable source of the ergot alkaloids in the ration. The clinical syndrome was reproduced experimentally by feeding suspected feed to a group of nine high-producing Ayrshire cows. An outbreak of gangrenous necrosis of the extremities in young cattle in the winter of 1987 was also suspected of having been caused by ergot alkaloids in grain screenings.

Animal Feed↗

PubMed1997

A college outbreak of group C meningococcal infection: how widely should investigation and prophylaxis extend?

Neisseria meningitidis group C type 2b, P1.2, P1.5 caused an outbreak of four cases, two of whom were members of an agricultural college in Devon, and two outside contacts of students who were documented carriers of the outbreak strain. The identification of the outbreak was made more difficult by the fact that none of the three cases first linked with the college was culture positive and indeed only one of these was actually a member of the college. Carriage of the outbreak strain was significantly associated with residence in college and enrollment on one particular course. The question was raised of whether in outbreaks of this type control measures should be extended beyond the confines of the affected institution.

Adolescent↗

PubMed1997

[Outbreak of meningitis caused by echovirus type 30].

OBJECTIVES: In the cold months of 1994-1995, we detected in our hospital an epidemic outbreak of acute enteroviral meningitis caused by echovirus type 30 (Echo 30). Until now, these outbreaks of viral epidemics had not been detected in Spain. PATIENTS AND METHODS: We reviewed retrospectively 46 clinical histories of patients who were admitted to our hospital between September 1994 and January 1995 with the diagnosis of acute lymphocytic meningitis, analyzing the clinical outbreak, epidemiological and laboratory characteristics, and how the outbreak spread. RESULTS: Regarding the patients, there was a prevalence in males, with an average age of 6 years and a range of 2 to 13 years of age. The most constant symptom was severe frontal headache, with signs of meningitis in only 50% of the cases. In the CSF, we found a predominance of PMN in the differential cell count in 63% of the cases, with the time of evolution before spinal puncture less than 24 hours in the majority of the patients. Viral cultures were performed on CSF, stool and throat scrapings in 16 patients with Echo 30 being isolated in 15 cases, which suggests 32.6% of the total cases. CONCLUSIONS: We detected in our environment an epidemic outbreak of viral meningitis caused by an agent not found previously in Spain, which presented epidemiological, clinical and laboratory characteristics similar to those reported in the literature. Its appearance during the cold months contrasts to what normally occurs.

Adolescent↗

PubMed1997

Outbreak of Salmonella infantis infection in a large animal veterinary teaching hospital.

During the past 11 years, there have been numerous reports of outbreaks of salmonellosis involving horses in veterinary teaching hospitals. Some of these outbreaks have been associated with Salmonella serotypes not commonly associated with infection of horses. Salmonella infantis is among the more common Salmonella serotypes isolated from human beings, and is an important pathogen in the broiler chicken industry. However, it was not commonly isolated from horses or cattle on a national basis between 1993 and 1995. In this report, we describe an outbreak of S infantis infection among large animals, primarily horses, in a veterinary teaching hospital and the control measures that were implemented. Factors that appeared to be key in control of this outbreak in this hospital included providing biosecurity training sessions for hospital personnel, adopting a standard operating procedure manual for biosecurity procedures, installing additional handwashing sinks throughout the facility, painting the interior of the facility with a nontoxic readily cleanable paint, replacing the dirt flooring in 4 stalls with concrete flooring, and removing noncleanable surfaces such as rubber stall mats, wooden hay storage bins, and open grain bins. Our experience with this outbreak suggests that although it is virtually impossible to eliminate Salmonella organisms from the environment, minimizing contamination is possible. Prevention of nosocomial infection must be approached in a multifaceted manner and care must be taken to search out covert sources of contamination, especially if standard intervention procedures do not prevent spread of the disease.

Animals↗

PubMedDate not supplied

[Effect of previous vaccination on the dynamics of measles outbreak].

BACKGROUND: The effectiveness of a vaccine should really be measured through controlled clinical testing. Ethical questions, however, prevent this from being possible. Orenstein suggests that one of the methods that could be used to estimate the effectiveness of a vaccine is the study of the epidemic outbreaks of the disease wherever possible. This paper examines the calculation of the effectiveness of vaccinations in the field and of the protective effects of a vaccination programme through the analysis of an epidemic outbreak of measles. METHODS: A retrospective cohort study. The covered population was a group of children born in the municipality of Aznalcollar (a town with 5,571 inhabitants falling under the Alfarafe-Seville Health Authority District) between two epidemic outbreaks of measles recorded there in 1986 and 1994. Those children who had not reached vaccination age at the start of the 1994 outbreak were excluded from the cohort as were those who had been previously exposed to the virus--the children born before and during the 1986 epidemic. The study included both children who had been vaccinated and children who had not. All the cases fulfilled the diagnostic criteria set. The vaccination history of all the children being monitored was reviewed. After calculating the infection rate in those who had been vaccinated and those who had not, the vaccination effectiveness and the indirect, total and average effects of the vaccination programme were calculated. RESULTS: The vaccination was effective in 91.5% of the children vaccinated. The vaccination programme led to a 78.9% reduction in the number of cases among the unvaccinated children, 98% among the children who had been vaccinated and 92% in the overall cohort studied, whose vaccination coverage was 66.4%. CONCLUSIONS: The effects of vaccination and vaccination effectiveness can and should be calculated by taking advantage of the epidemic outbreaks that take place wherever possible. It is recommended that vaccination coverage of the population be increased, thus enhancing the protective effects of the programme.

Adolescent↗