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PubMed1992

Nosocomial outbreak of scabies.

Scabies is a common infestation caused by the human itch mite Sarcoptes scabiei. Small outbreaks in communities or hospitals are not uncommon, but are rarely documented. In this paper, we report on a nosocomial outbreak of scabies originating from a patient with Norwegian scabies at the Intensive Care Unit in Taiwan Provincial Tainan Hospital. Twenty-nine individuals including four inpatients and 25 hospital personnel were involved. The diagnosis was based on history, clinical findings or a positive skin scraping. Unfamiliarity with the clinical manifestations delayed the diagnosis and the highly contagious nature of Norwegian scabies precipitated this outbreak. Early initiation of effective control measures with extensive therapeutic and prophylactic treatment of all contacts resulted in successful eradication of the outbreak.

Aged↗

PubMed1992

First documented outbreak of dengue in the Peruvian Amazon region.

This article describes a classical dengue outbreak caused by dengue serotypes 1 and 4 that occurred from March to July 1990 in the city of Iquitos and surrounding areas of Loreto Department in the Peruvian Amazon. Epidemiologic data indicate that more than 150,000 persons may have been affected in Iquitos alone. Another dengue outbreak occurred in Tarapoto, a city in the neighboring department of San Martín. Laboratory data indicate that the same dengue serotypes were involved in both outbreaks. No cases of dengue hemorrhagic fever/shock syndrome appear to have occurred. Prior to this outbreak, no indigenous dengue cases had been documented in Peru.

Dengue↗

PubMed2003

Factors to consider when using vaccine to control an exotic disease outbreak.

Recent global events have dramatically increased the attention given to veterinary medical regulatory authorities' responsibility of protecting their country's agricultural interests from the threat of exotic disease outbreaks. A vaccine can be a valuable tool to help curb the spread of an exotic disease epidemic and/or lessen its economic impact. However, the decision on whether or not to use a vaccine during an outbreak may be complex and have far-reaching impacts. The decision must be approached in a logical and orderly fashion, taking into account the scientific, economic, political, and practical considerations that are unique to each individual disease outbreak. A decision-making process for the use of a vaccine developed for foot-and-mouth disease and its potential application to help decide on the use of vaccines in other exotic disease outbreaks is discussed.

Animal Diseases↗

PubMed2003

A gastroenteritis outbreak due to norovirus associated with a Colorado hotel.

Describing the system components of norovirus outbreaks is important in understanding how to prevent future outbreaks. Investigation of these components includes environmental, epidemiologic, and laboratory perspectives. This study describes how an investigation from these three perspectives was conducted and the significance of each component in understanding norovirus outbreaks. On May 23, 2000, members of a professional group attending two meetings at a local hotel in Englewood, Colorado, began to complain of gastrointestinal illness. Sixty-nine illnesses were reported among 133 attendees. Eight hotel employees also complained of illness. Staff from the Tri-County Health Department and the Centers for Disease Control and Prevention investigated the outbreak. Three stool specimens collected from ill attendees contained norovirus. While the epidemiologic component did not identify a specific vehicle of transmission, the environmental investigation revealed food-handling practices, food handler perceptions, and hotel policies that may have contributed to disease transmission.

Colorado↗

PubMed2004

Day care-related outbreaks of rhamnose-negative Shigella sonnei--six states, June 2001-March 2003.

During June 2001--March 2003, outbreaks of Shigella sonnei infections were reported in Delaware, Maryland, New Jersey, North Carolina, South Carolina, and Virginia. Five- to fortyfold increases in statewide shigellosis rates were observed during this period. These increases were attributed primarily to outbreaks in multiple day care settings that became prolonged and community wide. S. sonnei isolates from these states, as well as from New York City and Philadelphia, were similar genetically by pulsed-field gel electrophoresis (PFGE). Many of these isolates lacked the capacity to ferment rhamnose, which is unusual for S. sonnei. This report summarizes these outbreaks and describes the laboratory characteristics that link them. The findings underscore the importance of rapid and coordinated public health responses to isolated outbreaks of shigellosis.

Adolescent↗

PubMed2003

An outbreak of Methicillin-resistant Staphylococcus aureus cutaneous infection in a saturation diving facility.

We present a molecular epidemiological investigation of an outbreak of cutaneous tissue infection, which involved six divers during a 45 day saturation exposure dive. The cutaneous infection manifested as boils, foliculitis and small abscesses involving different body sites, including nose, external ear canal, necks, back, extremities, and buttocks. Staphylococcus aureus was consistently isolated from the skin lesions of affected divers. A study of the antibiogram revealed that all Staphylococcus aureus isolates were uniformly resistant to penicillin, oxacillin and erythromycin, but sensitive to clindamycin, tetracycline, trimethoprim-sulfamethoxazole, rifampin and vancomycin. Molecular typing by pulse field gel electrophoresis (PFGE) demonstrated that all the Methicillin-resistant Staphylococcus aureus (MRSA) isolates had an indistinguishable pulsed field gel electrophoresis pattern. The source of outbreak was identified as a colonized diver (diver D). Personal contact was most likely the mode of transmission among the six divers. Infection with MRSA should be suspected in outbreaks of boils that are not responding to standard antibiotic therapy among healthy divers and their close contacts. To our knowledge, this is the first report of Methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a saturation diving facility.

Adult↗

PubMed2004

Outbreak of measles amongst vaccinated children in a slum of Chandigarh.

BACKGROUND: An outbreak of measles was reported from a slum, UT, Chandigarh in April 2003. Similar outbreak was also reported in less than three years from the same and adjoining areas. The present study was conducted to investigate and assess various epidemiological features associated with measles outbreak. MATERIAL AND METHODS: Three cases of measles were admitted in Dept. of Paediatrics, Govt. Medical College & Hospital, Chandigarh and were reported to the Dept. of Community Medicine for an outbreak investigation. A trained team investigated the slum having a population of 25,000 and studied various features associated with epidemic between the period of April 22 to May 10, 2003. RESULTS: The study covered 484 houses having 1130 children. Among the children who developed measles 32.76% were vaccinated ones. In them attack rate was 3%. Attack rate in vaccinated children went on increasing as age increased. An overall attack rate of 5.13% (Peak incidence 6% in 1-4 years age group) was recorded. Among measles cases, one-fifth had post measles complications. As much as 32.76% children with measles had received measles vaccination in the past. Therefore something more than immunization by single dose of vaccine is required. Measles was reported to be higher amongst the children without Vitamin A supplementation (P < 0.001). CONCLUSION: There is need to store vaccine properly and to strengthen routine immunization coverage, Vitamin A supplementation and health infrastructure in underprivileged population. Serological studies among vaccinated children against measles should be undertaken to explore the possibility of second dose of measles in older children.

Adolescent↗

PubMed2004

Reactive arthritis following an outbreak of Campylobacter jejuni infection.

OBJECTIVE: To study the occurrence and the clinical picture of musculoskeletal (MSK) complications including reactive arthritis (ReA) following an outbreak of Campylobacter jejuni. METHODS: An outbreak of C. jejuni infection occurred in 2000 in Asikkala, Finland, during which 350 exposed subjects contacted the Municipal Health Centre (MHC). All primary care physicians in the MHC were advised to refer patients with acute MSK complications to the Rheumatism Foundation Hospital (RFH) for a specialist clinical examination, which was performed <or= 3 months after the onset of the outbreak. RESULTS: Fifteen subjects with acute MSK complaints (11 women, 4 men; mean age 58 yrs) were examined in the RFH, where the following MSK diagnoses were assessed: ReA (9 patients), reactive arthralgia (2). exacerbation of previous rheumatoid arthritis (3). and previous fibromyalgia (1). In the patients with ReA, all adults, the arthritis was oligoarticular in 6 patients and polyarticular in 3; one patient had monoarthritis. The most frequently affected joints were knees and ankles. Besides peripheral arthritis, one patient had clinical sacroiliitis. Of the ReA patients, the antigen HLA-B27 was positive in 33%, including the patient with sacroiliitis. At the clinical examination, 6 ReA patients had subsiding signs of synovitis, 2 had only arthralgia, and one was symptom-free. CONCLUSION: The frequency of ReA following an outbreak of C. jejuni was low: 2.6% (9 of 350). In the ReA patients, the clinical picture was mild, the primary outcome good, and the association with HLA-B27 not high.

Adolescent↗

PubMed2004

SARS preparedness. Revisiting the procedures to protect staff and help prevent or contain an outbreak.

Last year, more than 8,000 people worldwide contracted severe acute respiratory syndrome (SARS), leading to 774 deaths. Although transmission of the disease was quickly controlled, with the outbreak declared over by July, there is concern that SARS could in fact be a seasonal disease and that another outbreak could occur in 2004. In early January, Chinese health officials confirmed the first non-laboratory-related SARS case since the initial outbreak was contained. The threat of another outbreak underscores the importance of having a response plan in place to safeguard the health of your community and your staff. In this article, we discuss the latest information on the risks of acquiring SARS, review recent recommendations from the U.S. Centers for Disease Control and Prevention (CDC), discuss the role of hospital facility and clinical engineers in SARS preparations, and update ECRI's recommendations for infection control procedures during equipment servicing. (ECRI first addressed this issue in two June 2003 Health Devices Guidance Articles.) In two appendixes to the current article, we present CDC guidance on patient isolation in an airborne infection isolation room and offer a navigational guide to CDC's SARS Web site.

Cross Infection↗

PubMed2003

Large outbreak of infection with Escherichia coli O157 PT21/28 in Eccleston, Lancashire, due to cross contamination at a butcher's counter.

An outbreak of infection with Escherichia coli O157 Phage Type 21/28 occurred between the 23rd November 2001 and the 7th December 2001 in Eccleston, Lancashire. There were 30 confirmed cases (23 with positive faecal isolates and seven serologically positive). Eccleston is a village of approximately 5,000 inhabitants with a single medical practice where many of the cases were patients. Initial investigations identified the suspected source as a butcher's counter, operated as a franchise, in a supermarket in Eccleston. The butcher closed voluntarily on the 24th November. The median age of cases was 60 with a mean of 56 and a range of 2-91 years. Of the 30 confirmed cases, 22 were admitted to hospital. Two patients developed serious complications but all 30 made a full recovery. Microbiological investigations confirmed the butcher's counter as the source of the outbreak. The epidemiological evidence implicated cooked meats and microbiological evidence confirmed that contamination had occurred between raw and cooked meats. The deficiencies in meat hygiene practice that were identified could have led to the cross contamination. This outbreak illustrates the risk associated with the handling of raw and cooked meats in the same shop. Complete physical separation of raw and cooked meat operations reduces the risk of such outbreaks.

Disease Outbreaks↗

PubMed2003

Specialist vaccination advice and pockets of resistance to MMR vaccination: lessons from an outbreak of measles.

An outbreak of measles was associated with a private nursery school in north west London. Sixteen cases were identified of whom 13 were laboratory confirmed. The majority of cases were aged three years or younger. Older cases were siblings of younger cases. None of the cases had been vaccinated against measles. In the nursery school 33% of the children had not received MMR vaccination. Based on specialist advice from the Health Protection Agency the outbreak control team recommended that children with no history of MMR vaccination should have a first MMR dose as soon as possible and that children with one MMR dose should receive the second dose as soon as possible (minimum of one month between doses). Some parents had strong negative views about MMR and represented 'pockets of resistance' to vaccination advice. The specialist vaccination advice, which was different to national immunisation guidelines, also caused some confusion amongst other health professionals. With a decrease in MMR vaccination uptake and resulting increased potential for future measles outbreaks, clinicians should be aware of and understand specialist vaccination advice intended to deal with outbreaks.

Child↗

PubMedDate not supplied

Cryptosporidiosis outbreak in a recreational swimming pool in Minnesota.

On May 6, 1998, the Olmsted County Public Health Department initiated an investigation into an outbreak of diarrheal illness that had occurred among people who swam frequently at a local swimming pool. Interviews of swimmers and microbiological testing of stool samples and swimming pool filter material were conducted to determine the source of the outbreak. Twenty-six of 206 swimmers interviewed had illnesses that met the case definition. The most common symptoms were diarrhea (100 percent), abdominal cramps (81 percent), and nausea (77 percent). The median duration of symptoms was nine days. Four cases of cryptosporidiosis were confirmed by stool analysis. The outbreak was found to be associated with swimming at the pool. Public awareness-including an understanding that recreational water facilities should be avoided during diarrheal illness-and proper pool hygiene are vital in preventing cryptosporidiosis outbreaks. Health care providers also must consider testing specifically for cryptosporidiosis when a patient presents with persistent diarrhea.

Abdominal Pain↗

PubMed2004

Waterborne gastroenteritis outbreak in Albania.

Three different studies are reported concerning the environmental pollution caused by viruses in Albania. The first study describes an outbreak of gastroenteritis in the capital city, involving 2,722 children attending the Paediatric Unit of Tirana Hospital. The age group with the highest morbidity was 0-5 years, with 89.5%; no fatalities were recorded during the outbreak. Rotavirus was detected in 26/28 faecal samples by RT-PCR, although astrovirus, adenovirus and calicivirus were also present. The second study describes an outbreak of hepatitis A virus involving the city of Lac. Two hundred cases were recorded, with the highest incidence in the age-group 5-9 years. Phylogenetic analysis of the VP1/2A region showed the presence of a unique sequence: genotype IA. Rotavirus was identified in drinking-water samples collected during the outbreak. The third study describes the prevalence of HAV and HEV in 202 sera randomly collected from 12 different cities in Albania. HAV showed a high incidence (66.2%), whereas none was positive for HEV. The genomic analysis of the VP1/2A junction revealed the presence of only one genotype (IA) with few point mutations and just two amino acid substitutions at codons 22 and 34. Additionally, two potential antigenic variants were detected, the first at position 46 of VP3 and the second at position 23 of VP1.

Adolescent↗

PubMed2004

Outbreak of chickenpox in a Scottish prison.

An outbreak of chickenpox occurred in a Scottish prison in April 2003. Three clinical cases (one virologically confirmed) were identified, two prisoners and one staff member. All were male and aged between 30 and 45 years. A further six possible cases were identified. The source of the outbreak was likely to have been a prisoner's child who visited the prison with a chickenpox rash. The outbreak was point source in nature, and no secondary spread of infection occurred within the prison despite the crowded conditions, possibly reflecting high levels of natural immunity. The outbreak serves as a reminder of the prison environment and the vulnerability of the prison population to infectious disease, both because of the prison environment and the clinical characteristics of the prison population.

Adult↗

PubMed2004

[Trichinosis outbreak among Thai immigrant workers in the Hadera sub-district].

INTRODUCTION: Trichinosis also referred to as Trichinelliasis or Trichiniasis occurs sporadically in Israel and is not prevalent. Most reported cases have occurred in foreign born residents who were infected outside of Israel or in foreign workers who have eaten raw or undercooked meat. We report an outbreak of Trichinosis in Thai agricultural workers that occurred in February-March 2002. Of 120 workers in Moshav Sde Yitzchak, 30 became ill with thrichinosis. To the best of our knowledge, this is the largest outbreak of its kind reported in Israel. OBJECTIVES: To alert physicians in hospitals and clinics to consider the possibility of trichinosis in their differential diagnosis in light of the substantial population of foreign born workers in Israel, currently estimated at 238,000. We describe the outbreak and review the symptoms and signs of the disease, as well as the modes of transmission and treatment. RESULTS: Eosinophilia was found in 22 (73.3%) of the cases. The average CPK level in 27 of the cases was 1312. Antibodies to trichinella were positive in the 12 persons who agreed to be tested. CONCLUSION: The demographic changes in Israel over the past years should lead physicians to consider trichinosis in their differential diagnosis when presented with a patient with a suggestive history as well as compatible signs and symptoms. The physician has a legal obligation to report outbreaks of trichinosis to the District Health Office. Health education for at-risk populations is indicated.

Agriculture↗

PubMed1992

Food-borne outbreak of group A beta-hemolytic streptococcal pharyngitis.

An outbreak of pharyngitis due to group A beta-hemolytic streptococci type T 12 occurred at a military base. An epidemiologic investigation indicated that the outbreak was food borne. Consumption of boiled egg salad at lunch was significantly associated with the illness. Immediate institution of antibiotic therapy and isolation of the patients prevented secondary respiratory spread of the infection. No cases of poststreptococcal suppurative and nonsuppurative complications were found during a 6-week period after the outbreak. Medical personnel should be aware of the possibility of food-borne streptococcal pharyngitis. Regular health surveillance of food handlers and food preparation processes are important for prevention of such outbreaks.

Disease Outbreaks↗

PubMedDate not supplied

Syndromic surveillance of gastrointestinal illness using pharmacy over-the-counter sales. A retrospective study of waterborne outbreaks in Saskatchewan and Ontario.

OBJECTIVE: To ascertain if monitoring over-the-counter (OTC) drug sales could provide a timely syndromic surveillance method of detecting outbreaks of gastrointestinal illness. METHOD: This study evaluated the potential of a syndromic surveillance system by comparing retrospective pharmacy OTC sales of anti-nauseants and anti-diarrheals to emergency room visits and case numbers from two Canadian outbreaks related to water contamination by Cryptosporidium, and E.coli O157:H7 and Campylobacter. RESULTS: Local sales trends of weekly aggregate OTC products were comparable to the outbreak epidemic curves. Statistical control tests on the sales data indicated the start of the outbreak periods. CONCLUSIONS: An automated monitoring tool based on spatial and temporal trend analyses of daily OTC sales would provide supplemental community health information for public health officials that is timelier than currently available laboratory-based surveillance systems.

Antidiarrheals↗

PubMed2005

Serodiagnosis of dengue during an outbreak at a tertiary care hospital in Delhi.

Dengue, an important human arboviral infection, is endemic in many parts of India. Outbreaks are now reported quite frequently from different parts of the country. We report here findings of serological investigation of serum samples received during a recent outbreak of dengue infection in Delhi from September to November 2003. Acute phase serum samples from suspected cases of dengue infection (including dengue fever, dengue haemorrhagic fever and dengue shock syndrome) of duration 5 days, were tested for dengue specific IgM antibodies by enzyme linked immuno sorbant assay (ELISA). Of the 874 serum samples tested, 456 (52.3% ) were positive for dengue specific IgM antibodies. The maximum number of positive cases was reported in October, peaking in second and third week. Patients in the age group of 21-30 yr accounted for 34.2 per cent of positive cases. This outbreak was less severe as compared to the previous 1996 outbreak and showed a shift towards an older age group.

Adolescent↗