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PubMedDate not supplied

[Outbreak of cryptosporidiosis in Guadarrama (Autonomous Community of Madrid)].

BACKGROUND: In spring of 1998, an acute gastroenteritis outbreak, which mainly affected preschool children, took place in Guadarrama (Community of Madrid, Spain). METHODS: A descriptive and analytical (cases and controls) study of the outbreak was done. Stool samples of the cases were taken to microbiological investigation. The tap water getting system of the municipality was inspected and samples were collected to microbiological analysis. RESULTS: Twenty one children from 0 to 5 years-old had liquid diarrhea which lasted more than five days. A significant statistical association was found within tap water consumption and gastroenteritis [OR = 5.73 (1.18-43.30); p < 0.05]. It did not have association with other variables investigated. Cryptosporidium parvum (Cp) oocysts were detected in stool samples of eight cases. Deficiencies were observed in the tap water getting and treatment system of the municipality but no oocysts were found in the analysis of the water. CONCLUSIONS: The results of the epidemiological investigation support that the source of the gastroenteritis outbreak was tap water, likely contaminated with Cp. While this parasite was not detected in the analysis of the water, it is explainable for the difficulties which this technique involves. In our review similar descriptions of outbreaks have not been found in Spain, but it seems that this reports are not infrequent in neighbour countries. Therefore, Cp should be borne in mind in diagnostic and management of these situations.

Case-Control Studies↗

PubMedDate not supplied

[Water-borne outbreak of serous meningitis caused by Echovirus-30 in Belarus].

In recent years outbreak of enterovirus infections caused by Echovirus-30 were rather frequently registered in different European countries. A major outbreak caused by this virus took place during the summer-autumn period of 1997 in the city of Gomel, Belarus. Sanitary epidemiological and molecular epidemiological studies made it possible to determine that the outbreak was water-borne. The sequence analysis of Echovirus-30 strains isolated from water and the cerebrospinal fluid of patients revealed a minor divergence between them (0.2%) indicative of their practical identity. The comparison of the Belorussian isolates with the strains isolated in Europe in 1994-1998 also showed a small percentage of differences in their genomes, which showed that the outbreak of Echovirus-30 infection was probably brought to Belarus from the territories of European countries.

Base Sequence↗

PubMed2000

Enterovirus 71: the virus, its infections and outbreaks.

Enterovirus 71 (EV71) was first recognized in 1974. Since then it has been implicated in 13 small and large outbreaks world-wide. Large outbreaks of hand, foot and mouth disease (HFMD), mostly benign, occurred in Japan in 1973 and 1978. Four outbreaks with brain stem encephalitis and significant numbers of deaths occurred in Bulgaria and Hungary in the late 1970's and in Malaysia and Taiwan in 1997 and 1998 respectively. During the latter two epidemics, pulmonary edema and hemorrhage often leading to quick deaths in children aged from 0.5 to 3 years old was first recognized. In Taiwan 78 deaths and over 100,000 cases of HFMD occurred. Coxsackie A16 cocirculated with EV 71, without however, causing any severe illnesses. The transmission of EV 71 was related to number of siblings in a household, rural residence and contact with cases of HFMD. Genotype analyses show that genotypes have changed with time in the United States and Japan. Recent isolates from Japan are similar to the isolates from Malaysia and Taiwan in 1997 and 1998, respectively. Even though genotype analysis has not identified specific sequences responsible for neurovirulence, the strains causing brain stem encephalitis and pulmonary edema in the Far East are similar and have arisen since 1997. Seroepidemiological studies in Taiwan suggest that children aged from 0.5 to 4 years old are most susceptible while the rest of the population are over 50% immune. Theoretically there is a pool of such susceptible subjects every few years. In prevention for another major outbreak, a simple, inactivated Salk type vaccine should be immediately prepared and made available.

Disease Outbreaks↗

PubMed2001

Practical evaluation of molecular subtyping and phage typing in outbreaks of infection due to Salmonella enterica serotype typhimurium.

Identification and control of food-poisoning outbreaks due to salmonellosis depend on prompt microbiological diagnosis and subtyping to identify the causative strain. In Australia, Salmonella enterica subspecies enterica serotype typhimurium (S. typhimurium) is responsible for 40-70% of cases of human salmonellosis. Phage typing is the usual method of subtyping S. typhimurium, but on its own, has limitations. We compared it with three molecular subtyping methods using 100 isolates of S. typhimurium, representing four different phage types (PT 1, 9, 126 and 135) and comprising 74 isolates from three presumed outbreaks, 25 isolates from sporadic cases of salmonellosis and S. typhimurium ATCC 10428 (phage type 126). The isolates were divided into 11 subtypes by IS200 restriction fragment length polymorphism (RFLP) typing, four each by ribotyping and pulsed-field gel electrophoresis (PFGE) and 17 distinct strains using a combination of phage and molecular typing. Isolates from two presumed outbreaks were resolved into multiple strains, possibly explaining the failure to identify a common source for either during the original investigations. IS200 RFLP analysis was the most discriminatory and reproducible typing method. Several strains were identifiable within and shared between phage types 1, 9 and 126. Phage and IS200 RFLP typing together, would provide improved definition of S. typhimurium outbreaks.

Bacterial Typing Techniques↗

PubMed2001

Family outbreaks of tuberculosis in South Moravia, a low incidence area of the Czech Republic.

OBJECTIVES: To identify suspected family outbreaks of tuberculosis in South Moravia, an area with the lowest notification rates in the Czech Republic. METHOD: The insertion sequence IS6110-based RFLP analysis of Mycobacterium tuberculosis was applied in isolates collected from 17 indigenous excretors giving the same family name and/or domicile. The fingerprints were matched with a database of 184 RFLP profiles of Czech M. tuberculosis isolates originating from remote localities. RESULTS: The RFLP analysis revealed uniform fingerprints in each of six indigenous outbreaks consisting of two to six family members or relatives. In three of them no matching case has been found in the Czech fingerprint database. The remaining three clusters showed identical patterns with RFLP profiles of 13 Czech M. tuberculosis strains originating from remote areas: five were from patients living in the immediate vicinity and eight were from distant regions. CONCLUSION: Different clustered genotypes of M. tuberculosis were identified in epidemiologically linked family outbreaks of tuberculosis, half of them indigenous and half matching fingerprints of strains from remote areas. It seems that family outbreaks may contribute to the continued occurrence of tuberculosis in South Moravia, which reports the lowest notification values in the Czech Republic.

Adolescent↗

PubMed2001

Influenza B virus outbreak on a cruise ship--Northern Europe, 2000.

During June 23-July 5, 2000, an outbreak of respiratory illnesses occurred on the MS Rotterdam (Holland America Line & Windstar Cruises) during a 12-day Baltic cruise from the United Kingdom to Germany via Russia. The ship carried 1311 passengers, primarily from the United States, and 506 crew members from many countries. Although results of rapid viral testing for influenza A and B viruses were negative, immunofluorescence staining and viral culture results implicated influenza B virus infection as the cause of the outbreak. This report summarizes the findings of the outbreak investigation conducted by the ship's medical department and describes the measures taken to control the outbreak. Travelers at high risk for complications of influenza who were not vaccinated with influenza vaccine during the preceding fall or winter should consider receiving influenza vaccine before travel with large tourist groups at any time of year or to certain regions of the world.

Disease Outbreaks↗

PubMed2001

Outbreak of syphilis among men who have sex with men--Southern California, 2000.

Syphilis is a sexually transmitted disease (STD) caused by infection with the spirochete Treponema pallidum, and like other genital ulcer diseases, syphilis enhances the transmission of human immunodeficiency virus (HIV). During the 1990s, syphilis occurred predominantly among heterosexual blacks in the South and in large cities. However, recent outbreaks of syphilis have occurred among men who have sex with men (MSM). A large syphilis outbreak occurred among MSM during January-July 2000 in southern California. During the outbreak period, the proportion of primary and secondary (P&S) syphilis cases among MSM increased to 51% from 26% for the same period in 1999. This report summarizes the findings of an investigation of this syphilis outbreak, which indicate a substantial increase in the number of syphilis cases among MSM, many of whom are HIV-positive. These data suggest that concern about HIV infection may be declining among MSM and emphasize the importance of strengthening efforts to prevent HIV infection in this population in the United States.

California↗

PubMed2001

An outbreak of food poisoning among children attending an international sports event in Johannesburg.

OBJECTIVES: To describe an outbreak of food poisoning at a major international sports event in Johannesburg and to determine the likely cause and source of the outbreak. DESIGN: A descriptive, case-control study. SETTING: An international sports event in Johannesburg. METHODS: A questionnaire survey of involved children was used to conduct a case-control study. Microbiological and chemical analysis of the implicated food was undertaken. Site visits to the premises involved in food preparation were conducted. RESULTS: A total of 578 children were involved. Of the 361 children who returned questionnaires, 134 were affected by an acute-onset emetic-type illness, while 53 children developed diarrhoea. Consumption of fruit juice was associated with acute illness, while diarrhoea was associated with the consumption of maize-meal porridge (pap) and chicken stew. Microbiological analysis revealed high bacterial loads in samples of the fruit juice and the presence of Shigella flexneri in the maize-meal porridge. Visits to the suppliers of the implicated foods revealed several deficiencies in terms of food hygiene precautions. CONCLUSION: The likely vehicles and causes of this outbreak are elucidated. Guidelines for monitoring the supply and distribution of food to future similar events should be established. Furthermore, hospitals should have protocols in place to deal with such outbreaks in a manner that facilitates epidemiological investigation.

Adolescent↗

PubMed2001

[Infection outbreaks caused by methicillin-resistant Staphylococcus aureus at Haukeland hospital].

BACKGROUND: Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) represent an increasing problem worldwide. MATERIAL AND METHODS: We report two outbreaks of methicillin-resistant S. aureus at Haukeland University Hospital during 1998-99. RESULTS: During the fall of 1998, four patients in the dermatological ward and three of their relatives were infected or colonised with MRSA. The strain was probably introduced by an eczematous patient who had recently arrived from Japan. Three patients became chronic carriers. The second outbreak involved three other hospital departments in July-August 1999. The index patient, a multitraumatised japanese tourist, died 16 days after admission. Two other patients were infected, one of them became a chronic carrier. According to official guidelines, neither of the index patients needed MRSA screening. Pulsed field gel-electrophoresis of the MRSA isolates revealed two different strains at the first outbreak, both probably introduced from the index patient, and one single strain at the second outbreak. Nasal swabs of staff were negative. INTERPRETATION: Physicians need to know that recommended guidelines regarding MRSA screening do not cover all types of risk situations. MRSA carriage among healthcare workers is probably not an important source of MRSA spread in hospitals. Measures to prevent cross infection between patients should be emphasised.

Adolescent↗

PubMed2001

Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome.

Outbreaks of rubella continue to occur in the United States despite widespread use of the measles-mumps-rubella (MMR) vaccine. Throughout the mid- to late-1990s, rubella outbreaks were characterized by increased numbers of cases among adults born in countries that do not have or have only recently instituted a national rubella vaccination program. To address this change in disease epidemiology, CDC's National Immunization Program (NIP) developed the following recommendations in conjunction with public health officials in the field. Public health officials should implement appropriate responses to reports of suspected rubella to determine if an outbreak exists, evaluate its scope, and implement appropriate control measures. Health-care providers should be aware of the need for rubella prevention and control among women of childbearing age and of the appropriate follow-up for pregnant women exposed to rubella. Comprehensive surveillance for congenital rubella syndrome should begin during a rubella outbreak.

Adolescent↗

PubMed2001

General outbreaks of infectious intestinal disease associated with fish and shellfish, England and Wales, 1992-1999.

Between 1992 and 1999 1425 foodborne general outbreaks of Infectious Intestinal Disease (IID) were reported to the PHLS Communicable Disease Surveillance Centre. Of these, 148 (10%) were associated with the consumption of fish and shellfish. Three main aetiologies were identified. Outbreaks associated with fish (47%) occurred more frequently in the summer months, and were linked with Scombrotoxic fish poisoning caused by the consumption of tuna that was improperly stored. Outbreaks associated with molluscs (36%) were associated with the consumption of oysters contaminated with viral pathogens, particularly in February. Outbreaks associated with the consumption of crustaceans (11%) often involved eating prawns that contained either salmonellas or viral pathogens. The maintenance of microbial quality from prior to capture/harvesting until the moment of consumption, based on a Hazard Analysis and Critical Control Point style approach, is essential if gastrointestinal illness associated with such produce is to be avoided.

Adolescent↗

PubMed2001

Influenza outbreak in a correctional facility.

The outbreak of influenza in a corrections facility occurred during August 2000. The outbreak progressed following introduction of the disease by a member of the public to the facility. Rapid diagnosis and typing of the influenza isolates was available, although two prisoners required hospital admission due to the severity of complications at the time of diagnosis. The group demonstrated rapid transmission of the virus by the respiratory route and probably by fomites. The identified infecting virus was A/Moscow-like, an H3N2 subtype typically associated with large outbreaks. Prevention of such outbreaks will involve either achieving high rates of vaccination within the risk groups, or rapid (possibly point of care) diagnosis with the institution of antiviral therapy within 48 hours of symptoms. Influenza control within institutions is feasible using such strategies, although it requires considerable planning to have such approaches in place during winter--a time when institutional staff absenteeism is typically high.

Disease Outbreaks↗

PubMed2001

[Collective outbreaks of foodborne infections and intoxications in Poland in 1985-1999].

In outbreaks of foodborne infections and intoxications in 1985-1999 in Poland among salmonellas S. Enteritidis amounted for 84.9% in 1986 and 97.8% in 1991-1992. In 1985-1999, among the total number of diseases in outbreaks most of the cases occurred after eating of the dishes made from eggs (over 50%). In 1987-1999, food prepared in private homes had the largest influence on the occurrence of the outbreaks (up to 65.4% of outbreaks). The private homes were also the most frequent places of the consumption of that food. Contamination of the ready-made dishes was found to be due to the raw materials, mainly eggs coming from private farms. In Poland and in neighboring countries Salmonella of animal's source determines the epidemiological situation of foodborne infections and intoxications.

Communicable Diseases↗

PubMed2001

Outbreak of paralytic poliomyelitis in the Chechen Republic in 1995.

An outbreak of poliomyelitis with 146 cases among children of whom six died occurred in the Chechen Republic in 1995. Sporadic cases of poliomyelitis have been reported in the neighbouring Ingush Republic. The outbreak lasted for five months (from May to September) and the maximum number of cases was registered in July. The age of the patients did not exceed 11 years, and more than 90% of the patients were children aged from one month to four years. The overwhelming majority of the patients had not been vaccinated in the routine OPV immunization programme. The outbreak was due to wild poliovirus type 1 belonging to genotype T previously known to circulate in the territory of the former Soviet Union (FSU). Chechen and Ingush isolates were very closely related to each other and to isolates from Central Asia, Tajikistan, 1994. Only a very distant relatedness of the Chechen and Ingush isolates was found with the strains isolated at about the same time outside the FSU (China 1994, Pakistan 1995). The presence of high numbers of non-vaccinated/poorly vaccinated persons and the poor sanitary and hygienic conditions for civilians due to the military conflict were factors that had a role in the outbreak.

Adolescent↗

PubMed2001

Outbreak of cryptosporidiosis linked with a farm event.

AIM: To investigate an outbreak of cryptosporidiosis linked to a two-day farm educational event in the Wellington region. Methods. The outbreak was investigated by carrying out a site visit and interviewing cases (or their parents) identified through notifications to Wellington Regional Public Health. RESULTS: Twenty confirmed cases were linked to the event. Nineteen were aged under seven years. The most likely route of infection was the hand-to-mouth transfer of the parasite after touching an infected animal. CONCLUSIONS: To our knowledge this is the first outbreak of cryptosporidiosis associated with a farm event reported in New Zealand. Farm animals, particularly calves, are likely to carry cryptosporidiosis and other microorganisms that are pathogenic in humans. This outbreak highlights the need for organisers of similar events to implement preventive measures such as hand washing facilities and reminders. Adults supervising young children should also be vigilant in enforcing hand washing following animal contact.

Adolescent↗

PubMed2001

Molecular comparison of toxigenic clinical & non-toxigenic environmental strains of Vibrio cholerae O1 Ogawa isolated during an outbreak of cholera in south India.

BACKGROUND & OBJECTIVES: While investigating a cholera outbreak in south India, toxigenic and nontoxigenic strains of Vibrio cholerae O1 were isolated from patients and from the environment, respectively. This study was performed to compare the genetic relatedness of the patient and environmental strains to determine clonal relationships among these strains and thereby determine the source of the cholera outbreak. METHODS: The 16 strains of V. cholerae isolated from hospitalized patients and 8 environmental V. cholerae strains isolated from the environment were phenotypically and genotypically characterized using a variety of standard techniques. RESULTS: Sixteen toxigenic clinical strains and 2 nontoxigenic environmental strains belonged to O1 serogroup, Ogawa serotype and El Tor biotype. The remaining 6 nontoxigenic environmental strains were classified as non-O1, non-O139 V. cholerae. The drug resistance pattern of the clinical and environmental strains of V. cholerae showed marked differences with the patient strains being resistant to more number of drugs as compared to the environmental strains. DNA fingerprinting of the strains showed considerable diversity between toxigenic clinical and nontoxigenic environmental O1 Ogawa isolates and between the O1 and non-O1, non-O139 isolates. INTERPRETATION & CONCLUSION: In this outbreak of cholera, the O1 strains of V. cholerae from clinical and environmental sources belonged to two different clones and the environmental strains could perhaps be the future cholera outbreak causing clones.

Animals↗

PubMed2002

[Outbreaks due to respiratory syncytial virus and influenzavirus A/H3N in institutionalized aged. Role of immunological status to influenza vaccine and possible implication of caregivers in the transmission].

OBJECTIVES: Report of epidemiological, clinical and virological data collected from the prospective surveillance of febrile episodes observed in aged residents of a long-stay care unit of 33 beds, at the University Hospital of Saint-Etienne, during the 1997-1998 winter season. METHODS: Systematic collection of clinical and biological data from febrile patients (> or = 38 degrees C) on a form, including virological findings obtained from a nasal swab and paired serum specimens. RESULTS: From 38 patients (37 of them having been vaccinated against influenza in October 1997), 18 febrile episodes were recorded in 16 subjects, including 3 respiratory syncytial virus infections and a late-occurring outbreak (March 1998) of influenza due to a A/H3N2 strain (15 cases, 14 of them virologically confirmed). No death was noted after the influenza outbreak. In 8 of the 9 tested patients with influenza, "protective" titres of antibodies directed towards the hemagglutinin of the vaccinal strain were present by radial hemolysis test three months before the beginning of the outbreak. During the influenza outbreak, the attack rate of symptomatic infection was 45.5% in elderly and 47.5% in healthcare workers (mainly unvaccinated). The occurrence of the first cases in the latter suggests their possible role in the transmission of the virus to the aged. CONCLUSION: This study underlines the epidemic circulation of multiple respiratory viruses during the same winter season in long-stay care facilities, the occurrence of clinical influenza infections in vaccinated patients exhibiting protective antibody titres and the role of unvaccinated healthcare workers in the propagation of influenza in institutionalised aged.

Adult↗

PubMed2001

Investigation of malaria outbreak in Bahraich district, Uttar Pradesh.

BACKGROUND & OBJECTIVES: Based on the reports of 139 fever related deaths in Jarwal primary health centre (PHC) of Bahraich district, Uttar Pradesh (UP) during April to September 1999, a study was undertaken to explore the possibility of outbreak of Plasmodium falciparum malaria in the area and reasons of outbreak. METHODS: The study was undertaken during September-October 1999 in Bahraich district, UP. The study included a parasitological and an entomological survey. Blood slides from fever cases were collected and examined following standard procedures for detection of species and stage of parasite. The resting adult mosquitoes were collected from human dwellings and cattle sheds from selected villages. Susceptibility status of Anopheles culicifacies to 4 per cent DDT and 0.05 per cent deltamethrin was determined under laboratory conditions following the WHO procedure. In vitro drug sensitivity of P. falciparum to chloroquine was also estimated. RESULTS: Overall slide positivity rate (SPR) was found to be 33.8 with a preponderance of P. falciparum (88.4%). There was an outbreak of Pf malaria in Jarwal and surrounding areas as well. Foci of P. falciparum malaria were found in Jarwal, Fakharpur and Hazoorpur PHCs around Kaisarganj PHC. In addition, P. falciparum cases, were also reported from Motipur and Tejwapur. INTERPRETATION & CONCLUSION: Poor surveillance of affected areas resulting in low annual parasite incidence (API), lack of insecticidal spray in the currently affected PHCs as the API was less than 2 and development of resistance in P. falciparum to chloroquine were found as the possible reasons for the outbreak. It is recommended that surveillance be strengthened in all PHCs of Bahraich district to contain further extension of malaria in northeastern UP.

Adolescent↗