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PubMed1986

Lessons from the outbreak of food poisoning at Stanley Royd Hospital: what are health authorities doing now?

The committee of inquiry into the outbreak of food poisoning at Stanley Royd Hospital identified serious deficiencies in the management of the outbreak and urged all health authorities to learn from the incident and prepare adequate plans for dealing with any future outbreaks. A survey of district health authorities in England showed that most authorities do not yet have a written plan or that their plans are incomplete and inadequate. The appreciable resistance to such planning suggests that most health authorities would be unable to deal with outbreaks of food poisoning effectively and efficiently.

Disease Outbreaks↗

PubMed1989

Assessment of DNA fingerprinting for rapid identification of outbreaks of systemic candidiasis.

DNA fingerprinting was assessed as an improved typing system for Candida albicans aimed at speeding the implementation of cross infection control measures in outbreaks of systemic candidiasis. The study was carried out with 45 previously characterised isolates from five different outbreaks and with 96 unrelated isolates from a mixed control population. Sixteen different genotypes were produced. Results were obtainable within days, reproducibility was high, and there was good discrimination among different outbreaks. Compared with existing typing systems DNA fingerprinting provides a robust system that may be used rapidly to identify outbreaks of nosocomial candidiasis in laboratories with no specialist skill in typing C albicans.

Candida albicans↗

PubMed1989

Economic impact of a nationwide outbreak of salmonellosis: cost-benefit of early intervention.

The recognition and investigation of an outbreak of food poisoning in 1982 due to chocolate contaminated with Salmonella napoli enabled the food that carried the salmonella to be identified and four fifths of the implicated consignment of chocolate to be withdrawn. The economic benefits of prompt intervention in the outbreak have been assessed. The cost of the outbreak was over 0.5 pounds m. It is estimated that five deaths were prevented by the intervention and that 185 admissions to hospital and 29,000 cases of S napoli enteritis were avoided. This successful investigation yielded a 3.5-fold rate of return to the public sector and a 23.3-fold return to society on an investment in public health surveillance. A methodology is described that can be used to estimate the benefits of early intervention in outbreaks of foodborne illness and topics for further research are suggested. It is concluded that public health authorities and industry have much to gain by collaborating in the research into the design of cost effective programmes to prevent foodborne infections.

Cacao↗

PubMed2002

Increased stool sampling during a waterborne outbreak of cryptosporidiosis does not increase the detection of other faecal pathogens.

AIMS: To ascertain the effect of enhanced surveillance following an outbreak of waterborne cryptosporidiosis on the number of faecal specimens submitted to the local microbiology laboratory and the number positive for common enteric pathogens. The outbreak provided an opportunity to estimate the extent of routine under ascertainment of common enteric pathogens. METHOD: Retrospective search of the computerised microbiology system database for details of faecal examination requests for the period 26 April to 6 June in 1998 and 1999 (period of outbreak). RESULTS: Specimens were received from 378 community patients during the six week period 26 April to 6 June 1999. This was double that for the same period in 1998 (a non-outbreak year). Oocysts of Cryptosporidium parvum were detected in 59 patients, an eightfold increase compared with the same period in 1998. Despite the greater number of patients tested, the detection of other pathogens in patients with gastroenteritis was not altered when compared with the same period in the previous year. CONCLUSION: This study found no evidence of under ascertainment of gastrointestinal infection (common bacterial pathogens and rotavirus) by local general practitioners.

Adolescent↗

PubMed1993

Community wide outbreak of hepatitis A linked to children in day care centres and with increased transmission in young adult men in Florida 1988-9.

STUDY OBJECTIVE: To investigate a community wide outbreak of hepatitis A (HA). DESIGN: Description of the outbreak, with a case-control study to assess transmission. SETTING: A Florida county, USA, 1988-9. SUBJECTS: A total of 311 cases of HA. MEASUREMENTS AND MAIN RESULTS: A 13 month outbreak of HA is described. Most of the 311 cases (95%) were residents of a large metropolitan area (attack rate per 10,000 population (AR) = 3.7) and two smaller cities (AR = 61.5 and AR = 6.4). The ARs were greater for males than females and for residents aged 25-34 years (9.7) and < 5 years (8.3). Altogether 37% of cases were linked to day care centres, independent of the city of residence. A household case-control study showed an increased risk of HA in households in which a child attended a day care centre (p = 0.02), and centres that could take more than 50 children had an increased risk of HA introduction than smaller ones (p = 0.05). CONCLUSIONS: Day care centres were an important source of HA in the community, and the need for timely surveillance and immunoglobin prophylaxis is emphasised. Homosexual transmission may have played an important role in this outbreak.

Adolescent↗

PubMed1994

An outbreak of illness among schoolchildren in London: toxic poisoning not mass hysteria.

STUDY OBJECTIVE: To determine the cause of an outbreak of acute gastrointestinal illness that occurred shortly after lunch in children attending a school in London, UK. DESIGN: A questionnaire survey of children at the affected school was carried out on the day after the incident. Microbiological, environmental, and toxicological investigations were also undertaken. SETTING: A school in London, UK. PARTICIPANTS: Altogether 374/468 (80%) of the children who had eaten lunch at the school on the day of the incident completed a questionnaire. MAIN RESULTS: There was a significant association between illness and the consumption of raw cucumber (relative risk = 6.1; 95% confidence interval 2.2, 16). Microbiological investigation of the foods served at lunch did not show any pathogens and toxicological investigations suggested that the cucumbers were contaminated by a pesticide. CONCLUSIONS: Although the outbreak displayed several typical features of mass psychogenic illness, the most probable cause was a toxic chemical present in cucumber served at lunch. Those responsible for investigating outbreaks of illness should be aware of the possible toxicological causes and the appropriate modes of investigation. They should be wary of too readily attributing a psychogenic cause to unusual outbreaks of acute illness in schoolchildren.

Acute Disease↗

PubMed2006

The characterisation of a recent syphilis outbreak in Sheffield, UK, and an evaluation of contact tracing as a method of control.

OBJECTIVE: To explore the factors around and the success of contact-tracing in a recent major outbreak of infectious syphilis in Sheffield, and to evaluate the effectiveness of it, our hitherto standard strategy of control. METHOD: Retrospective chart review RESULTS: Over a period of 18 months, an outbreak of 21 cases was, on closer inspection, the result of several, discrete "micro" outbreaks in different groups. Two major patterns emerged, a relatively straightforward and more accessible cluster in heterosexual persons (a "spread" network), and more sporadic, "starburst" networks in men who have sex with men. CONCLUSION: Our traditional method of control, contact-tracing, was seen to be most effective in the spread network in heterosexuals. In the face of an apparent outbreak, clinicians should explore the nature and parameters of their local epidemic and engage a mixture of control methods. These may include, but not excusively so, contact-tracing to interrupt transmission by case-finding and by treatment.

Adult↗

PubMed2001

Surfing with spirochaetes: an ongoing syphilis outbreak in Brighton.

BACKGROUND/OBJECTIVES: There has been a recent shift in the epidemiology of early syphilis in the developed world with sporadic outbreaks on a historic low level of background disease. Here we describe an ongoing outbreak of syphilis in Brighton. METHODS: Data collected on all patients with a diagnosis of early infectious syphilis at Brighton GUM clinic. RESULTS: 30 cases of early syphilis were diagnosed over a 25 month period beginning in July 1999. 28 were homosexual or bisexual men, giving a rate of 134 cases per 100 000 homosexual men. The cases reported a median of three sexual contacts (range 1-50) in the preceding 6 months and 77% had concurrent regular and casual partners. 83% of contacts were casual and untraceable. Over one third (11) of these cases reported oral sex as their only risk factor for syphilis acquisition and were unaware of this transmission route. 70% were diagnosed with primary or secondary infection, the remaining 30% being asymptomatic with early latent infection. Eight of the cases were HIV positive and a further eight remain untested for HIV. At least one concurrent STI was found in 40% of cases. Regular outbreak control meetings, involving relevant healthcare professionals, were held to plan appropriate interventions. CONCLUSION: The high rate of casual and untraceable contacts in this outbreak suggest that alternative control measures are necessary, including on-site testing and further health education regarding the oral transmission of syphilis. Continued vigilance for syphilis is essential, especially in those patients who are HIV positive.

Adult↗

PubMed1991

Survey of field outbreaks of avian infectious laryngotracheitis in England and Wales.

Field outbreaks of infectious laryngotracheitis in commercial chicken flocks in England and Wales between 1985 and 1988 were investigated. Material from 49 outbreaks was submitted to Liverpool University, and virus was isolated from 17 of them. The results of a questionnaire on each outbreak are described. Generally, the disease was of moderate severity, and mainly affected laying flocks; it occurred in birds of a wide age range but most of the outbreaks were in birds between 10 and 20 weeks of age. The disease was not seen more frequently at any particular time of the year, and there was no evidence of a common source of infection. Three of the affected flocks had recently been moved and were beginning to lay; these stresses may have caused the re-excretion of latent virus.

Age Factors↗

PubMed1995

First recorded outbreak of equine viral arteritis in the United Kingdom.

Equine viral arteritis was diagnosed for the first time in the United Kingdom in 1993. The outbreak began on a non-thoroughbred stud in south Nottinghamshire and spread to five other premises through chilled semen used for artificial insemination and from acutely and subclinically infected mares returning home. The outbreak was contained on these six premises by means of voluntary movement restrictions. The most commonly observed clinical signs were typical: pyrexia with depression, and conjunctivitis with periorbital oedema; nasal discharge, and oedema of the distal limbs, prepuce and mammary glands were less common. The first mare to be covered by a recently imported stallion was the first animal to be affected. The mare was resident and no new mares had arrived on the stud during the previous five months. About 100 animals became infected during the outbreak, including three indigenous stallions. Equine arteritis virus was isolated from semen and heparinised blood samples and seroconversions were demonstrated by using the equine arteritis virus neutralisation test. Although the outbreak was contained, the free movement of animals within the European Union increases the possibility of infected stallions being introduced into the UK.

Animals↗

PubMed2006

[Assessment of two methods of antigenic detection by ELISA for the diagnosis of norovirus outbreaks].

INTRODUCTION: The aim of this study was to assess two ELISA techniques for the detection of outbreaks of norovirus. METHOD: One-hundred and sixty-five fecal samples from patients affected in 30 outbreaks were studied. RESULTS: On the basis of a specific consensus criterion between techniques for confirming outbreaks, the sensitivity and specificity was respectively 80% and 90% for RIDASCREEN, and 80% and 100% for IDEIA. CONCLUSION: These techniques could be useful for rapid detection of norovirus outbreaks in laboratories that lack molecular confirmation techniques.

Adult↗

PubMed1975

An outbreak of acute hemorrhagic conjunctivitis in Yugoslavia in 1973.

An outbreak of approximately 200 cases of acute hemorrhagic conjunctivitis is described in Prekmurje, a northern province in Yugoslavia. The epidemic was caused by enterovirus type 70, serologically identical with the causative agents of similar outbreaks in London and Japan. The origin of the outbreak could not be elucidated but a link was seen between this case and a small outbreak in Veenendaal in the Netherlands.

Acetates↗

PubMed1991

An outbreak of tuberculosis in a shelter for homeless men. A description of its evolution and control.

An outbreak of tuberculosis at a shelter for homeless men was studied in detail to further the understanding of the epidemiology of tuberculosis in this setting. The shelter provides evening accommodations for men aged 50 yr and older. The capacity is approximately 200 clients, and the client pool is approximately 1,000 men/yr. During a 6-wk period in December 1986 and January 1987, seven cases of tuberculosis were diagnosed in shelter clients. Nine cases were reported in clients during the preceding 12 months, and four cases in the year previous to that. The majority of outbreak cases were pulmonary tuberculosis, sputum smear positive. Drug resistance was rare. Phage typing of 15 Mycobacterium tuberculosis isolates revealed one predominant type and four other types. The goals of the control plan (and the steps taken to achieve them) were to render known infectious cases noninfectious (directly observed therapy); to find undiagnosed infectious cases (repetitive mass screenings); to protect exposed clients (repetitive tuberculin skin testing and isoniazid preventive therapy); and to make the shelter environment safe (exclude infectious, noncompliant clients and improve the shelter's ventilation system). Implementation of this plan rapidly terminated the outbreak; following the first mass screening in January 1987, at which six asymptomatic cases were detected, only five additional cases occurred in shelter clients during a 2-yr period of follow-up. The investigation suggested that the outbreak evolved during 1986 as a result of the presence at the shelter of an increasing number of men with undiagnosed infectious pulmonary tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗

PubMed1996

An outbreak of hepatitis A in an intensive care unit.

We describe an outbreak of hepatitis A that occurred in an Intensive Care Unit (ICU) in a regional hospital in North Queensland. Seven people were infected including two patients, two close contacts of the index patient and three ICU nursing staff. The index case was admitted with an overdose and multiple trauma; he was not suspected to be incubating hepatitis A. The outbreak was initiated as a result of inadequate precautions taken whilst handling the index patient's bile. Problems identified upon reviewing the outbreak were inadequate terminal cleaning of equipment, food consumption in the ICU and inadequate handwashing practices. Implementation and maintenance of standard infection control practices is vital if further outbreaks of hospital-acquired hepatitis A and other enteric infections are to be avoided. We also suggest that the inactivated hepatitis A vaccine be considered for ICU staff.

Adult↗

PubMed2001

An outbreak of toxoplasmosis in farmed mink (Mustela vison S.).

A large Wisconsin mink (Mustela vison) farm experienced an outbreak of toxoplasmosis in the spring of 1999 following an outbreak of canine distemper during the previous fall. Major clinical signs for pregnant females included reduced feed consumption, abortions, and stillborn kits; kits < or =3 weeks old experienced ataxia and mortality. Of 7,800 females, 1,976 (26%) lost their entire litter either from abortion or neonatal mortality. Kit mortality from 7 days to 3 weeks of age was 3,300, and overall kit mortality attributed to the toxoplasmosis outbreak was 10,408. Six neonatal mink kits, 12 3-week-old kits, and 2 adult female mink were submitted to the University of Minnesota Veterinary Diagnostic Laboratory for diagnostic workup. Gross postmortem lesions were limited to empty stomachs (12 of 12 kits) and pale livers (4 of 12 kits) for the 3-week-old kits. Major microscopic lesions included interstitial pneumonia, encephalitis, encephalomalacia, and myocarditis. Toxoplasmosis was diagnosed by microscopic lesions, microscopic lesion distribution, and the detection of Toxoplasma gondii tachyzoites by immunohistochemistry. This is the first detailed report of an outbreak of toxoplasmosis in mink in the United States.

Abortion, Veterinary↗

PubMed2003

Application of the Neospora caninum IgG avidity ELISA in assessment of chronic reproductive losses after an outbreak of neosporosis in a herd of beef cattle.

Point-source infections are most likely the cause for Neospora caninum-induced abortion outbreaks in cattle, whereas an increased annual abortion rate may be a consequence of vertical transmission. The aims of the present study were to examine the reproductive effects of neosporosis in a beef herd for 3 years, after a point-source outbreak and to use IgG avidity serology to examine the chronicity of infections and patterns of transmission. During the study, 76-78% of animals were seropositive for N. caninum. The pregnancy rate varied from 88% to 94%, without any reduction in the pregnancy rate of seropositive cows compared with seronegative cows. The annual abortion rate was 2.5-5.5%, and all but 1 abortion occurred in seropositive dams. The efficiency of vertical transmission was estimated to be 85%. Several calves, born to seronegative dams, were seropositive at 6-13 months of age, indicating a 22% mean annual rate of horizontal transmission. The mean avidity in seropositive cows increased from 30 during the initial outbreak to 74 after 3 years. The mode of IgG avidity was 21-40 during the initial abortion outbreak, 41-60 after 1 year, and 61-80 after 2 and 3 years. The results reveal high annual rates of both vertical and horizontal transmission of N. caninum in a herd of beef cows and provide further validation on the ability of the N. caninum IgG avidity ELISA to accurately assess the chronicity of infection.

Abortion, Veterinary↗

PubMed2006

A devastating outbreak of malignant catarrhal fever in a bison feedlot.

In early 2003, an outbreak of malignant catarrhal fever (MCF) occurred in a bison feedlot in southern Idaho. The outbreak resulted in a 51.2% (n = 825) mortality rate among bison, which had been exposed to sheep for 19 days. Diagnosis was made by detection of ovine herpesvirus 2 (sheep-associated MCF virus) DNA in tissues or peripheral blood by polymerase chain reaction (PCR), and by histological examination of tissue lesions. Peak losses occurred between 41 and 55 days postmean exposure time (PME), and reached a maximum of 41 head per day. No known cases of MCF were observed among the 177 head of bison that arrived in the lot 3 1/2 weeks after the departure of the sheep. Of the several thousand head of beef cattle in the lot during the outbreak, only a single case of MCF was identified. This outbreak illustrates the devastating impact the MCF virus can have on bison under certain exposure conditions, the high threat posed by adolescent lambs to susceptible species, the significantly greater susceptibility of bison than beef cattle to MCF, and the lack of horizontal transmission from clinically affected bison to herdmates.

Animals↗

PubMed2005

Providing care and facing death: nursing during Ebola outbreaks in central Africa.

Few studies have focused on describing the experiences of health care workers during rapid killing epidemics. In this article, the views and experiences of nurses during three outbreaks of Ebola hemorrhagic fever (EHF) in Central Africa are examined. These three outbreaks occurred in Kikwit, Democratic Republic of Congo (DRC, 1995); Gulu, Uganda (2000-2001); and Republic of Congo (ROC, 2003). Open-ended and semistructured interviews with individuals and small groups were conducted during the outbreaks in Uganda and ROC; data from DRC are extracted from published sources. Three key themes emerged from the interviews: (a) lack of protective gear, basic equipment, and other resources necessary to provide care, especially during the early phases of the outbreaks; (b) stigmatization by family, coworkers, and community; and (c) exceptional commitment to the nursing profession in a context where the lives of the health care workers were in jeopardy.

Altruism↗