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PubMed2005

Investigation of a nosocomial outbreak of Acinetobacter baumannii producing PER-1 extended-spectrum beta-lactamase in an intensive care unit.

We investigated an outbreak of Acinetobacter baumannii in an adult intensive care unit of Kosin University Gospel Hospital in Busan, Republic of Korea. The outbreak involved 10 cases of infection by A. baumannii producing PER-1 extended-spectrum beta-lactamase over a seven-month period, and was caused by a single pulsed-field gel electrophoresis clone. The epidemic isolates were characterized by slight synergy between clavulanic acid and cefepime. Isoelectric focusing of crude bacterial extracts detected two nitrocefin-positive bands with pI values of 8.0 and 5.3. Polymerase chain reaction amplification and characterization of the amplicons by restriction analysis and direct sequencing indicated that the epidemic isolates carried a bla(PER-1) determinant. The epidemic isolates were characterized by a multidrug-resistant phenotype that remained unchanged over the outbreak, including penicillins, beta-lactam/beta-lactamase inhibitor, extended-spectrum cephalosporins and monobactams. Isolation of infected patients and appropriate carbapenem therapy were successful in ending the outbreak. Our report indicates that the bla(PER-1) resistance determinant may become an emerging therapeutic problem.

Acinetobacter Infections↗

PubMed2005

Unusual implication of biopsy forceps in outbreaks of Pseudomonas aeruginosa infections and pseudo-infections related to bronchoscopy.

Between January and April 2003, a sudden increase in positive respiratory tract specimens for Pseudomonas aeruginosa was observed in an intensive care unit of the University Teaching Hospital of Montpellier, France. Most of the strains were cultured from bronchoalveolar lavage fluid samples, suggesting that bronchoscopic procedures could be implicated. The relationships between isolates were investigated by antibiotyping and pulsed-field gel electrophoresis. Both phenotypic and molecular markers allowed identification of two consecutive nosocomial outbreaks of respiratory infections related to two different bronchoscopes. These two outbreaks implicated nine and seven patients, respectively. Four of these 16 patients had true infections and recovered with antibiotic therapy. Inspection of both bronchoscopes revealed a damaged internal channel caused by defective biopsy forceps. These defects led to improper cleaning and disinfection of the bronchoscopes despite adherence to all current reprocessing procedures. The two outbreaks were controlled after replacing the inner channels of the bronchoscopes and switching from use of re-usable to disposable biopsy forceps. These outbreaks emphasize the need to establish surveillance procedures for detecting contamination of bronchoscopes, and the importance of recording each endoscopic procedure to facilitate further investigations if needed.

Bronchoalveolar Lavage Fluid↗

PubMed2006

Epidemic outbreaks on structured populations.

Our chances to halt epidemic outbreaks rely on how accurately we represent the population structure underlying the disease spread. When analysing global epidemics this force us to consider metapopulation models taking into account intra- and inter-community interactions. Here I introduce and analyze a metapopulation model which accounts for several features observed in real outbreaks. First, I demonstrate that depending on the intra-community expected outbreak size and the fraction of social bridges the epidemic outbreaks die out or there is a finite probability to observe a global epidemics. Second, I show that the global scenario is characterized by resurgent epidemics, their number increasing with increasing the intra-community average distance between individuals. Finally, I present empirical data for the AIDS epidemics supporting the model predictions.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Diagnosis of Norovirus outbreaks by commercial ELISA or RT-PCR.

The IDEIA Norwalk-like virus (Dakocytomation Ltd., Ely, United Kingdom) and the Ridascreen Norwalk-like virus enzyme immunoassay (R-Biopharm AG, Darmstadt, Germany), were evaluated for the diagnosis of outbreaks of acute gastroenteritis. A panel of 158 fecal samples from 23 outbreaks, including confirmed rotavirus and astrovirus outbreaks, was used to determine the sensitivity and specificity of both ELISA kits relative to an RT-PCR protocol that was followed by Southern blot hybridization. Another panel consisted of 6 different genogroup I strains, 12 genogroup II strains and 1 genogroup IV strain and was used to determine the scope of the tests. Compared to the RT-PCR, sensitivities of 38% and 36% and specificities of 96% and 88% were found for the Dako kit and the Ridascreen kit, respectively. Two genogroup I strains, and one genogroup II strain were not detected by the Dako kit, while five genogroup I and five genogroup II strains were not detected by the Ridascreen kit. The sensitivity of both ELISA kits, and the scope of the Ridascreen are considered disappointing. However, the ELISA kits can be useful for a preliminary screening, provided that ELISA negative outbreaks will be re-tested by RT-PCR methods.

Blotting, Southern↗

PubMed2006

Congruent epidemic models for unstructured and structured populations: analytical reconstruction of a 2003 SARS outbreak.

Both the threat of bioterrorism and the natural emergence of contagious diseases underscore the importance of quantitatively understanding disease transmission in structured human populations. Over the last few years, researchers have advanced the mathematical theory of scale-free networks and used such theoretical advancements in pilot epidemic models. Scale-free contact networks are particularly interesting in the realm of mathematical epidemiology, primarily because these networks may allow meaningfully structured populations to be incorporated in epidemic models at moderate or intermediate levels of complexity. Moreover, a scale-free contact network with node degree correlation is in accord with the well-known preferred mixing concept. The present author describes a semi-empirical and deterministic epidemic modeling approach that (a) focuses on time-varying rates of disease transmission in both unstructured and structured populations and (b) employs probability density functions to characterize disease progression and outbreak controls. Given an epidemic curve for a historical outbreak, this modeling approach calls for Monte Carlo calculations (that define the average new infection rate) and solutions to integro-differential equations (that describe outbreak dynamics in an aggregate population or across all network connectivity classes). Numerical results are obtained for the 2003 SARS outbreak in Taiwan and the dynamical implications of time-varying transmission rates and scale-free contact networks are discussed in some detail.

Disease Outbreaks↗

PubMed2006

Rapid laboratory detection of meningococcal disease outbreaks caused by serogroup C Neisseria meningitidis.

Molecular subtyping is of significant importance to the recognition of outbreaks of meningococcal disease caused by serogroup C Neisseria meningitidis. We describe the application of multilocus variable number tandem repeat analysis (MLVA) for the molecular subtyping of N. meningitidis and compare its performance to that of pulsed-field gel electrophoresis (PFGE). For MLVA, a multiplex PCR assay targeting five variable number tandem repeat regions was developed and evaluated using a panel of sporadic and outbreak-associated serogroup C N. meningitidis isolates. MLVA was highly reproducible and provided results within 6 h. Overall, the discriminatory power of MLVA was equivalent to that of PFGE. The utilization of MLVA for subtyping N. meningitidis isolates provides a rapid and safer alternative to PFGE for identifying outbreaks of meningococcal disease. As such, it may provide public health officials with timely information that may minimize the spread of outbreak-related cases through prophylaxis.

Cluster Analysis↗

PubMed2005

Simulating the spatial dynamics of foot and mouth disease outbreaks in feral pigs and livestock in Queensland, Australia, using a susceptible-infected-recovered cellular automata model.

We describe an approach to modelling the spatio-temporal spread of foot and mouth disease through feral animal and unfenced livestock populations. We used a susceptible-infected-recovered model, implemented in a cellular automata framework, to assess the spread of FMD across two regions of Queensland, Australia. Following a sensitivity analysis on the infectious states, scenario analyses were conducted using feral pigs only as the susceptible population, and then with the addition of livestock, and initiated in the wet season and in the dry season. The results indicate that, depending on the season the outbreak is initiated, and without the implementation of control measures, an outbreak of Foot and Mouth Disease around Winton could continue unchecked, while an outbreak around Cape York may die out naturally. The approach explicitly incorporates the spatial relationships between the populations through which the disease spreads and provides a framework by which the spread of disease outbreaks can be explored through varying the model parameters. It highlights the emergence and importance of spatio-temporal patterns, something that previous modelling of FMD in feral animal and unfenced livestock populations has lacked.

Animals↗

PubMed2006

Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management.

With increased globalisation comes the likelihood that infectious disease appearing in one country will spread rapidly to another, severe acute respiratory syndrome (SARS) being a recent example. However, although SARS infected some 10,000 individuals, killing around 1000, it did not lead to the devastating health impact that many feared, but a rather disproportionate economic impact. The disproportionate scale and nature of this impact has caused concern that outbreaks of more serious disease could cause catastrophic impacts on the global economy. Understanding factors that led to the impact of SARS might help to deal with the possible impact and management of such other infectious disease outbreaks. In this respect, the role of risk--its perception, communication and management--is critical. This paper looks at the role that risk, and especially the perception of risk, its communication and management, played in driving the economic impact of SARS. It considers the public and public health response to SARS, the role of the media and official organisations, and proposes policy and research priorities for establishing a system to better deal with the next global infectious disease outbreak. It is concluded that the potential for the rapid spread of infectious disease is not necessarily a greater threat than it has always been, but the effect that an outbreak can have on the economy is, which requires further research and policy development.

Communicable Diseases↗

PubMed2006

Molecular epidemiology of multidrug-resistant Shigella dysenteriae type 1 causing dysentery outbreaks in Central African Republic, 2003-2004.

Shigella dysenteriae type 1 (Sd1) represents a particular threat in developing countries because of the severity of the infection and its epidemic potential. Antimicrobial susceptibility testing and molecular subtyping by pulsed-field gel electrophoresis (PFGE) and plasmid profiling (PP) of Sd1 isolates collected during two dysentery outbreaks (2013 and 445 cases of bloody diarrhoea) in Central African Republic (CAR) during the period 2003-2004 were reported. Eleven Sd1 comparison strains (CS) acquired by travellers or residents of Africa (n=10) or Asia (n=1) between 1993 and 2003 were also analysed. The 19 Sd1 isolates recovered from CAR outbreaks were multidrug resistant, although susceptible to quinolones and fluoroquinolones. Molecular subtyping by PFGE was more discriminatory than PP. The PFGE using XbaI and NotI restriction enzymes indicated that the two outbreaks were due to two different clones and also revealed a genetic diversity among the CS recovered from outbreak or sporadic cases between 1993 and 2003. This study was the result of a fruitful collaboration between field physicians and microbiologists. The data collected will serve as the basis for establishing long-term monitoring of Sd1 in CAR.

Anti-Bacterial Agents↗

PubMed2005

Two community hepatitis B outbreaks: an argument for vaccinating incarcerated persons.

Current recommendations have not resulted in routine vaccination of correctional facility inmates for hepatitis B. We investigated two hepatitis B outbreaks. Outbreak 1 involved 4 cases epidemiologically linked to persons who had been in jail. Outbreak 2 involved 48 community cases; 69% had a history of incarceration. Two-thirds of the cases in these outbreaks might have been prevented by a program of routine vaccination of local jail inmates. Priority should be given to developing and supporting practical programs to vaccinate the high-risk populations in correctional facilities against hepatitis B.

Adolescent↗

PubMed2004

Co-circulation of two genetically distinct viruses in an outbreak of African swine fever in Mozambique: no evidence for individual co-infection.

In 1998, domestic pigs originating from villages within a 40 km radius of Ulongwe in the northern Tete Province of Mozambique were held in a quarantine facility for a 3-month period prior to their importation into South Africa. Eight of a total of 25 pigs died within the first 3 weeks of quarantine of what appeared clinically and on post mortem examination to be African swine fever (ASF). Organs were collected and preserved in formol-glycerosaline and the presence of ASF virus in these specimens was confirmed by three independent polymerase chain reaction (PCR) tests. Two gene regions were characterised, namely the C-terminus end of the major immunodominant protein VP72 and the central variable region (CVR) of the 9RL open reading frame (ORF). Results confirmed the presence of two genetically distinct viruses circulating simultaneously within a single outbreak focus. However, despite the pigs being housed within the same facility, no evidence of co-infection was observed within individual animals. Comparison of the two 1998 virus variants with viruses causing historical outbreaks of the disease in Mozambique revealed that these viruses belong to two distinct genotypes which are unrelated to viruses causing outbreaks between 1960 and 1994. In addition, the CVR and p72 gene regions of one of the 1998 Mozambique virus variants (variant-40) was shown to be identical to the virus recovered from an ASF outbreak in Madagascar in the same year, whilst the other (variant-92) was identical to a 1988 pig isolate from Zambia.

African Swine Fever↗

PubMed2005

Characterization of H5N1 influenza A viruses isolated during the 2003-2004 influenza outbreaks in Japan.

In Japan, between the end of December 2003 and March 2004, four outbreaks of acute, highly transmissible and lethal disease occurred in birds in three prefectures separated by 150-450 km, involving three chicken farms and a group of chickens raised as pets. The cause of each outbreak was an H5N1 influenza A virus-the first highly pathogenic virus to be isolated from the outbreaks in Japan since 1925. The H5N1 virus was also isolated from dead crows, apparently infected by contact with virus-contaminated material. These H5N1 viruses were antigenically similar to each other, but could be differentiated from other H5 viruses, including those isolated from Hong Kong in 1997 and 2003, by use of a panel of monoclonal antibodies in hemagglutination inhibition assays. Genetically, the H5N1 viruses in Japan were closely related to each other in all genes and were genetically closely related to a single isolate of genotype V that was isolated in 2003 in the Guandong Province of mainland China (A/chicken/Shantou/4231/2003). The virulence of the index isolate (A/chicken/Yamaguchi/7/2004) was studied in chickens and mice. Chickens intravenously or intranasally inoculated with the isolate died within 1 or 3 days of inoculation, respectively. In mice, although this virus replicated well in the lung without prior adaptation and spread to the brain, the dose lethal to 50% of the mice was 5 x 10(5) 50% egg infectious doses (EID50), which is less pathogenic than the Hong Kong 1997 H5N1 viruses isolated from humans. Our findings indicate that the H5N1 viruses associated with the influenza outbreaks in chickens in Japan were genotypically closely related to an H5N1 virus isolated from chicken in China in 2003 (genotype V), but were different from those prevalent in southeastern Asia in 2003-2004 (i.e., genotype Z) and that these highly pathogenic viruses can be transmitted to crows, which are highly susceptible to these viruses.

Animals↗

PubMed2000

An outbreak of Legionella micdadei pneumonia in transplant patients: evaluation, molecular epidemiology, and control.

PURPOSE: To describe a nosocomial outbreak of Legionella micdadei pneumonia in transplant patients and to characterize the source of the outbreak and the control measures utilized. SUBJECTS AND METHODS: We performed retrospective Legionella micdadei serologic testing to enhance case finding in transplant patients with pneumonia that lacked a documented microbial etiology, as well as prospective environmental surveillance of water sites and testing for Legionella in clinical specimens. RESULTS: During a 3-month period, 12 cases of Legionella micdadei pneumonia were identified either by culture or serologic testing among 38 renal and cardiac transplant patients. Legionella micdadei isolates from hot water sources were found by pulsed-field gel electrophoresis to have a DNA banding pattern that was identical to the isolates from the first 3 culture-positive cases and from 2 cases that occurred 16 months later. CONCLUSIONS: Hospitals caring for organ transplant recipients and other immunosuppressed patients must be aware of the possibility of environmental sources of outbreaks of Legionella infection. A first-line screen with the Legionella urine antigen test will identify Legionella pneumophila serogroup 1. However, specific cultures in outbreak situations should be considered to identify other Legionella pneumophila serotypes and the nonpneumophila Legionella species.

Adult↗

PubMed2003

[Streptococcus pneumoniae transmission in a nursing home: analysis of an epidemic outbreak].

BACKGROUND AND OBJECTIVE: On the basis of an outbreak of pneumococcal pneumonia in a nursing home, we analyze causes and patterns of transmission and discuss preventive interventions carried out on the target population. PATIENTS AND METHOD: A retrospective cohort study was designed on 232 residents to identify risk factors associated with the outbreak. A descriptive study of those nasopharyngeal carriers of pneumococcus among nursing home workers was also carried out. RESULTS: Twenty cases of pneumococcal pneumonia were detected with 4 deaths; 13 cases were confirmed. Cases occurred on a close temporal aggregation form but they were quite disseminated spatially. Among the factors investigated, an older age was the only factor significantly associated (p = 0.02) with the risk of disease. In 4 workers, strains of Streptococcus pneumoniae were isolated from nasopharyngeal swabs; two of them corresponded to the serotype 3, as it was the strain isolated from the blood of a nursing home case. The number of new cases decreased dramatically after vaccination and/or chemoprophylaxis. CONCLUSIONS: Vaccination and chemoprophylaxis administered to nursing home residents seemed effective measures to halt the spread of this outbreak. Detection of the S. pneumoniae antigen by immunochromatographic tests in urine samples is a valuable tool for detecting an outbreak.

Aged↗

PubMed1984

Hospital outbreaks of cholera transmitted through close person-to-person contact.

Three hospital outbreaks of cholera which started in a children's infectious diseases ward in Dar es Salaam in 1977/78, 1981, and 1983 were controlled by bacteriological screening and isolation of infected patients, administration of antibacterial chemoprophylaxis to all at-risk patients and their accompanying relatives, and by reducing overcrowding. The outbreaks in 1981 and 1983 were caused by two distinct multiply antibiotic resistant E1 Tor Vibrio cholerae O1 strains. In these three outbreaks overcrowded conditions facilitated person-to-person transmission of cholera within the hospital. Cholera patients should be nursed separately and high standards of hospital hygiene should be maintained. This is one of the first reports of hospital outbreaks of cholera caused by multiply antibiotic resistant strains.

Adult↗

PubMed1984

Outbreak of paralytic poliomyelitis, Taiwan.

Taiwan had been free of major poliomyelitis outbreaks since 1975, but from May 29 to Oct 26, 1982, 1031 cases of type 1 paralytic poliomyelitis were reported to the Taiwan health authorities. Before the outbreak approximately 80% of infants had received at least 2 doses of trivalent oral poliovaccine (OPV) by their first birthday. Of the 86% of poliomyelitis patients whose vaccination status was known 65% had not had poliovaccine, 19% had received one dose, 8% had received two doses, and 8% had received three or more doses. Vaccine efficacy was calculated to be 82% after one dose, 96% after two doses, and 98% after three or more doses. Failure to vaccinate rather than vaccine failure was the most important risk factor in this outbreak. A child who had not had any vaccine was 80 times more likely to become a case than one who had received three or more doses of poliovaccine, independent of sanitation facilities at home. A child was 5 times more likely to become a case if he received water from non-municipal rather than municipal sources. Furthermore, for children who received municipal water, the risk was doubled if the family shared a toilet with at least one other family. This outbreak shows that major epidemics can occur in areas that have high overall community vaccination levels. Identification and vaccination of subpopulations with low coverage is essential for the control of poliomyelitis.

Adolescent↗

PubMed1986

Outbreak of paralytic poliomyelitis in Finland: widespread circulation of antigenically altered poliovirus type 3 in a vaccinated population.

An outbreak of 9 cases of paralytic poliomyelitis and 1 non-paralytic case occurred in Finland between August, 1984, and January, 1985, after two decades of freedom from the disease attributable to a successful immunisation programme. During the outbreak poliovirus type 3 was isolated from the patients, from about 15% of healthy persons tested, and from sewage water. At least 100 000 persons were estimated to have been infected. With 1.5 million extra doses of inactivated poliovirus vaccine to children under 18 years of age and an oral poliovirus vaccine campaign covering about 95% of the entire population in February-March, 1985, the outbreak was halted in February, 1985. Impaired herd immunity to the epidemic strain of poliovirus type 3, which differed from the type 3 vaccine strains in both immunological and molecular properties, was important in the emergence of this outbreak. The inactivated poliovaccine that had been used in the vaccination programme was relatively weakly immunogenic, especially as regards the type 3 component. Whether continuous antigenic variation of poliovirus type 3 has wider epidemiological implications is not known.

Adolescent↗

PubMed1994

Poliomyelitis outbreak in an unvaccinated community in The Netherlands, 1992-93.

An outbreak of poliomyelitis occurred in the Netherlands between September, 1992, and February, 1993, after 14 years without endemic cases. The outbreak was due to poliovirus type 3 and involved 71 patients, of whom 2 died and 59 had paralysis. The patients were aged between 10 days and 61 years (median 18 years). None of the patients had been vaccinated, and all but 1 belonged to a socially and geographically clustered group of people who refuse vaccination for religious reasons. Control measures were taken within 5 days of notification of the first patient and included a wide offer of vaccination with the trivalent oral poliovirus vaccine to the population at risk. Sequence analysis of the viral genome showed closest similarity (96.7%) with a strain isolated in India in 1992, indicating that the virus probably originates from the Indian subcontinent. The difference, however, is still too large to assume direct import. Extensive outbreak investigation at schools, in the environment, at virus diagnostic laboratories, and in the general population showed no evidence of widespread circulation of the epidemic virus outside the groups at risk and area where these groups live. As in the previous outbreak in 1978, the general population, including the majority of unvaccinated people who live dispersed in the population, seemed to be well-protected against poliomyelitis.

Adolescent↗