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PubMed2005

[Sequence analysis of Echovirus type 30 isolated from an aseptic meningitis outbreak in northern Jiangsu province in 2003].

OBJECTIVE: To determine the partial sequence of virus strains causing an aseptic meningitis outbreak in northern part of Jiangsu province in 2003 and to compare them with the same serotype strains isolated in other countries to better understand its genetic characteristics and hereditary trend of development. METHODS: Virus RNA was amplified using two sets of specific enteroviral 3' half of VP1 primers 012/011 and 040/011. Polymerase chain reaction (PCR) products were purified and sequenced. BLAST program was then used to perform on nucleotide and amino acid pairwise-alignment with all available sequences in NCBI database. Phylogenetic trees were drawed to compare with other enteroviral sequences using PHYLIP software. RESULTS: Under BLAST program, three sequences we submitted to GenBank were identically inferred as echovirus type 30, which had been identified by neutralization test in previous study. Phylogenetic analysis demonstrated that strains isolated from this outbreak were aggregated into a cluster, and the closest relationships with them were those isolated in 1999 and 2000. This phenomenon indicated that Echo30 from this outbreak was different from other strains in different epidemic area. CONCLUSION: 3' half of VP1 sequence could be used to quickly identify the serotype of isolated enterovirus. Strains isolated from this outbreak had the similar hereditary developing trend comparing with Echo30 strains isolated from other countries.

Base Sequence↗

PubMed2005

Environmental predictors of Ross River virus disease outbreaks in Queensland, Australia.

Ross River virus (RRV) disease is the most common mosquito-borne disease in Australia, with the majority of cases reported from Queensland. In this study we investigate the relationship between local RRV disease outbreaks and standardized rainfall and temperature data in Queensland. No one set of variables could be found to accurately predict RRV disease outbreaks across all of Queensland, although good predictive models could be developed for smaller regions. The variables identified as important in predicting RRV disease outbreaks differed between regions, and also between summer and autumn. This work highlights the sensitive relationship between virus prevalence, mosquito bionomics, and climate, illustrating that critical climatic factors differ depending on underlying environmental conditions. Identification of factors leading to RRV disease outbreaks will help local authorities identify periods of high risk, optimizing the provision of additional mosquito control measures.

Arbovirus Infections↗

PubMed2005

Outbreak of Shigella sonnei in a rural hotel in La Gomera, Canary Islands, Spain.

Shigella sonnei is a significant cause of gastroenteritis in both developing and industrialized countries. Knowledge of the diversity and antimicrobial susceptibility of the bacterium may be helpful in the management of both individual cases and outbreaks. This study was undertaken to evaluate the molecular epidemiology of an outbreak of diarrhea due to S. sonnei. The outbreak involved 14 of 28 (50%) tourists in a small rural hotel in La Gomera, Canary Islands, Spain. All of the S. sonnei isolates recovered had the same antimicrobial susceptibility and pulsed-field gel electrophoresis patterns, suggesting that the outbreak was produced by a single strain.

Adolescent↗

PubMed1992

[Outbreak of paratyphoid fever among Peruvian naval personnel].

A retrospective epidemiological study was conducted in connection with an outbreak of paratyphoid fever at a Peruvian naval installation in Callao. The study sought to determine the magnitude of the outbreak, the source of infection, the attack rates, the persistence of bacilli excretion, and the clinical picture of the disease. The source of Salmonella paratyphi B infection had been a meal of chicken and rice served to around 400 members of the naval police. Over a period of three weeks, 21 persons were hospitalized and 52 received outpatient treatment at the naval hospital. In addition, through a questionnaire it was revealed that 86 unreported cases of diarrhea related to the outbreak had occurred. The most common clinical manifestations were fever, headache, weakness, anorexia, abdominal pain, and diarrhea. The general attack rate was 39.8%. In a follow-up survey carried out 37 days after exposure, fecal cultures indicated that 8.5% of the persons affected continued to excrete the microorganism. The high rates of attack and transmission of S. paratyphi B in this outbreak point up the considerable pathogenicity and virulence of some strains of the microorganism and their impact on public health. It is suggested that preventive measures be taken at naval and other similar installations, including the education of workers who handle and prepare food, in order to ensure proper hygiene.

Adult↗

PubMed2005

A neonatal echovirus 11 outbreak in an obstetric clinic.

An echovirus 11 outbreak occurred among neonates in an obstetric clinic in November 2003. Thirteen neonates were transferred to our medical center, and all were found to have echovirus 11 infection. Viral studies were performed for 32 other infants born in the clinic during the same period, including 30 asymptomatic neonates and 2 febrile infants transferred to another hospital. Two of the asymptomatic infants had echovirus 11 isolated from rectal swabs. The first patient transferred to our medical center developed extensive hemorrhage and died 6 days later. Three family members of this infant were also proved to have echovirus 11 infections. One other infant had a fulminant course and had residual hepatic impairment. The other infants had no complications. Viral studies in the 24 nursery staff were all negative. This outbreak shows how a neonatal enterovirus outbreak can occur in a nursery, starting from an infected infant in the incubation period. Early recognition and prompt management of an outbreak is important to prevent further spread of the infection.

Antibodies, Viral↗

PubMed2005

PFGE-based epidemiological study of an outbreak of Candida tropicalis candiduria: the importance of medical waste as a reservoir of nosocomial infection.

Between November 2002 and March 2003, an outbreak of candiduria occurred in the surgical intensive care unit (SICU) of a university-affiliated hospital in South Korea. This outbreak affected 34 patients and was caused by Candida tropicalis. To determine the source of the epidemic and the risk factors, surveillance cultures from the SICU, genotyping of Candida isolates by pulsed-field gel electrophoresis (PFGE), and a case-control study were performed. The surveillance cultures revealed that 6 environmental samples related to the urine disposal route were positive for C. tropicalis. The PFGE analysis of genomic DNA demonstrated identical band patterns for all of the C. tropicalis isolates obtained from SICU patients and the 6 environmental samples during the outbreak period, while epidemiologically unrelated strains showed unique PFGE band patterns. Although no risk factors were identified by the case-control study, this epidemiological investigation involving the use of molecular techniques suggests that improper disposal of infectious medical waste led to the cross-transmission of a single clone that was responsible for the outbreak of C. tropicalis candiduria in this SICU. After implementing a better urine disposal system and thorough hand washing procedures, no further clusters of candiduria were detected in the SICU.

Candida tropicalis↗

PubMed2005

Late detection of a shigellosis outbreak in a school in Madrid.

Even though shigellosis in Spain is rare, an indigenous outbreak is occasionally detected. We describe an outbreak in a school in Madrid caused by person-to-person transmission of Shigella sonnei. After the detection of Shigella sonnei in a stool sample from a 3 year old girl, an investigation at her school was initiated. Questionnaires were distributed to the parents of 520 pupils attending the school. A case was defined as a school case if it was the first case in a child's household, and as a household case if other members of the household had fallen ill first. We identified 88 cases (60 pupils and 28 of their family members). The attack rate (AR) was 12% in the school and 32% in the families. There was a significant association between higher AR and lower age. The outbreak lasted for two months. The length and the shape of the epidemic curve of the 60 cases in pupils suggests person-to-person transmission. Shigella sonnei isolated from 5 different cases were typed by pulsed field gel electrophoresis (PFGE) and was found to be an identical strain. The prolonged duration of the outbreak was probably due to delayed detection, and stopped as soon as control measures were introduced.

Child↗

PubMed2005

Outbreaks of Escherichia coli O157:H7 associated with petting zoos--North Carolina, Florida, and Arizona, 2004 and 2005.

During 2004-2005, three outbreaks of Escherichia coli O157:H7 infections occurred among agricultural fair, festival, and petting zoo visitors in North Carolina, Florida, and Arizona. One hundred eight cases, including 15 cases of hemolytic uremic syndrome (HUS), were reported in the North Carolina outbreak; 63 cases, including seven HUS cases, were reported in the Florida outbreak; and two cases were reported in Arizona. No fatalities occurred. Illnesses primarily affected children who visited petting zoos at these events. This report summarizes findings from these outbreak investigations, which indicated the need for adequate control measures to reduce zoonotic transmission of E. coli O157:H7.

Adolescent↗

PubMed2005

Tsunami in South Asia: what is the risk of post-disaster infectious disease outbreaks?

The World Health Organization has warned that in the aftermath of the recent tsunami, infectious disease outbreaks will add to the heavy toll of the disaster itself, possibly even doubling the number of casualties. However, many experts believe the risks of infectious disease outbreaks following natural disasters have been overemphasised and have led to unnecessary and potentially harmful public health activities. This paper discusses the risk and prevention strategies of potential infectious diseases in the aftermath of the tsunami based on a literature review of previous similar disasters and current evidence. Infectious disease outbreaks, if any, will most likely be the consequence of post-tsunami camp situations involving large displaced populations rather than the tidal wave itself. Lessons have been learned from previous large-scale humanitarian crises about the provision of aid and the mitigation of epidemics. This paper examines the risk and preventive strategies of vector- and food/water-borne diseases, measles, acute respiratory infections and meningitis. Alert thresholds at which to trigger outbreak investigations, and standardised guidelines with regard to their control are outlined, based on the Sphere Project.

Communicable Diseases↗

PubMed1992

Ten years of kala-azar in west Bengal, Part I. Did post-kala-azar dermal leishmaniasis initiate the outbreak in 24-Parganas?

Following resurgence in Bihar of epidemic kala-azar, outbreaks of the disease were identified simultaneously in two separate foci about 500 km apart in West Bengal in 1980. While the outbreak in one of these foci, in northern West Bengal, was the result of a direct extension of the Bihar epidemic, the source of parasite in the other (in the village of Bandipur in the south of West Bengal) remained unknown until a case of nodulo-ulcerative post-kala-azar dermal leishmaniasis (PKDL) was located in the village. The continued presence of this case in the village from a time long before the outbreak aroused strong suspicion about its causal role. Laboratory-bred female Phlebotomus argentipes sandflies were allowed to feed on four cases of PKDL, including the case from Bandipur, to determine the transmission potential of these cases. Of a total of 400 flies in the experiment, 104 (26%) fed on the cases, and of these flies 44 died (31 within 48 hours of feeding). Of the surviving 60 flies, 32 developed promastigotes in the mid-gut. In view of the presence of the case of PKDL in the village prior to the outbreak and the availability of a susceptible human population and vectors, it is possible that the patient with PKDL was a source of Leishmania donovani parasites for the local focus. Furthermore, PKDL may act as a reservoir of parasites during inter-epidemic periods.

Animals↗

PubMed2005

Containing acute disease outbreak.

OBJECTIVE: The objectives of epidemiological surveillance and research of infectious diseases are to address disease prevention, identify outbreaks and monitor and evaluate control strategies. In this paper, we report on the development of a Geographical Information System (GIS) based on a novel Digital Ring Fence (DRiF) strategy for the containment of acute infectious diseases. METHOD: Data from probable cases are captured in a secure database. Postal codes of addresses facilitate precise mapping of the location of each probable case on a multi-layered GIS system. A digital ring fence is constructed around each location (hot-spot) using Non- Homogeneous Poisson Process (NHPP) modeling based on data of individuals coming into contact with each probable case. The radius of the DRiF gives the overall risk of infection from its epicenter, the probable case. By annotating the DRiF to a GIS, areas of population concentrations could be readily identified to direct outbreak containment efforts. RESULTS: Simulation studies have demonstrated that the DRiF strategy could provide a novel approach to containment of acute disease outbreaks. CONCLUSION: SARS has provided convincing evidence that the key to tackling acute infectious disease outbreaks lies in containment and making disease containment one step ahead of its spread. The DriF strategy achieves this by providing a zone to corral the spread of infection through person-to-person transmission. Other useful applications of the DriF technique include demarcating culling zone for the containment of bird flu infection and containment of person-to-person transmission should it occur.

Acute Disease↗

PubMed2005

Outbreak of cholera in & around Chandigarh during two successive years (2002, 2003).

BACKGROUND & OBJECTIVE: Outbreaks of cholera caused by Vibrio cholerae O1 Ogawa occurred in and around Chandigarh during two successive year 2002 and 2003. This study highlights the antibiotic sensitivity and phage typing pattern of V. cholerae isolates during 2002 and 2003. METHODS: Faecal specimens from acute gastroenteritis cases from July to September, 2002 and in the same month in 2003 were collected. Isolation and identification of pathogen was done according to standard methodology. Simultaneously water samples from the areas reporting the maximum number of cholera cases were also processed. Antibiotic susceptibility pattern of the isolates was studied and isolates were sent to National Institute of Cholera and Enteric Diseases (NICED), Kolkata for confirmation and phage typing. RESULTS: Of the 156 patients in 2002 and 125 in 2003, 59 and 40 isolates respectively were found to be positive for V. cholerae O1 serotype Ogawa biotype El tor. Of the 45 water samples tested in 2002, eight were found to be positive for V. cholerae O1 serotype Ogawa biotype El tor. None of the 52 water samples tested in 2003 was found to be positive for V. cholerae. Phage type 27 was found to be the predominant type for both the years. Majority of the clinical isolates were found to be resistant to more than two drugs. INTERPRETATION & CONCLUSION: The drug resistance in V. cholerae was on the rise during the subsequent outbreak. Phage 27 remained the predominant type in both the years. The major reason for the outbreak was traced to be contaminated water of the hand pumps in the affected area. Continuous surveillance of the outbreak is necessary to contain the spread of transmission.

Bacteriophage Typing↗

PubMedDate not supplied

The Global Public Health Intelligence Network and early warning outbreak detection: a Canadian contribution to global public health.

The recent SARS epidemic has renewed widespread concerns about the global transmission of infectious diseases. In this commentary, we explore novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area--the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. This commentary outlines the operation and development of GPHIN and compares it to ProMED-mail, another Internet-based approach to global health surveillance. We argue that GPHIN has created an important shift in the relationship of public health and news information. By exiting the pyramid of official reporting, GPHIN has created a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media's challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.

Canada↗

PubMed2006

Outbreak of E. coli O157 infection in the south west of the UK: risks from streams crossing seaside beaches.

In August 2004 seven cases of Escherichia coli O157 infection were identified in children on holiday in Cornwall, southwest England, all of whom had stayed at different sites in the area. Isolates from all seven cases were confirmed as E. coli serogroup O157 phage type 21/28. We carried out a case-control study among holidaymakers who visited the beach. A standardised questionnaire was administered by telephone to parents. They were asked where on the beach the children had played, whether they had had contact with the stream that flowed across the beach, and about their use of food outlets and sources of food eaten. Cases were more likely to have played in the stream than controls (OR [1.72- undefined]). The time spent in the stream by cases was twice spent there by controls. Cases and controls were equally exposed to other suspected risk factors. PFGE profiles for all the cases were indistinguishable. Increased numbers of coliforms were found in the stream prior to the outbreak. Cattle were found grazing upstream. We suggest that the vehicle of infection for an outbreak of acute gastrointestinal illness caused by E. coli O157 was a contaminated freshwater stream flowing across a seaside beach. The onset dates were consistent with a point source. Heavy rainfall in the days preceding the outbreak might have lead to faeces from the cattle potentially contaminated by E. coli O157 contaminating the stream, thereby leading to the outbreak. Control measures included fencing off the part of the stream in which children played, and putting up warning signs around the beach.

Bathing Beaches↗

PubMed2006

A gastroenteritis outbreak due to Norovirus infection in Xanthi, Northern Greece: management and public health consequences.

A gastroenteritis outbreak was observed in the town of Xanthi on Jan 28, 2005. A total of 709 patients (350 males and 359 females, mean age 23.8 +/- 19.95 years) visited the local hospital over a period of two weeks with symptoms of fever (22.3%), abdominal pain (78.6%), nausea (85.5%), vomiting (67.1%) and diarrhea (72.5%). PCR for Norovirus in randomly selected stool specimens examined was positive in all cases (8/8). No other pathogen was revealed. As 85.1% of the primary affected individuals had been using water from a single well (supplying approximately 40% of the 34,889 inhabitants), and water specimens from this well were found to carry a high bacterial load, the waterborne transmission of Norovirus was the main suspected cause of the outbreak. People were advised to consume bottled water and to wash their hands carefully especially after toilet use until the remission of the outbreak. Additionally, more chloride was added to the suspected well (10 ppm or 10 mg/l). Fourteen days later, the outbreak waned and all measures were withdrawn.

Adolescent↗

PubMed2006

An outbreak of Campylobacter jejuni associated with consumption of chicken, Copenhagen, 2005.

In May/June 2005 an outbreak of diarrhoeal illness occurred among company employees in Copenhagen. Cases were reported from seven of eight companies that received food from the same catering kitchen. Stool specimens from three patients from two companies were positive for Campylobacter jejuni. We performed a retrospective cohort study among employees exposed to canteen food in the three largest companies to identify the source of the outbreak and to prevent further spread. Using self-administered questionnaires we collected information on disease, days of canteen food eaten and food items consumed. The catering kitchen was inspected and food samples were taken. Questionnaires were returned by 295/348 (85%) employees. Of 247 employees who ate canteen food, 79 were cases, and the attack rate (AR) was 32%. Consuming canteen food on 25 May was associated with illness (AR 75/204, RR=3.2, 95%CI 1.3-8.2). Consumption of chicken salad on this day, but not other types of food, was associated with illness (AR=43/97, RR=2.3, 95%CI 1.3-4.1). Interviews with kitchen staff indicated the likelihood of cross-contamination from raw chicken to the chicken salad during storage. This is the first recognised major Campylobacter outbreak associated with contaminated chicken documented in Denmark. It is plausible that food handling practices contributed to transmission, and awareness of safe food handling and storage has since been raised among kitchen staff. The low number of positive specimens accrued in this outbreak suggests a general underascertainment of adult cases in the laboratory reporting system by a factor of 20.

Animals↗

PubMed2006

A regional outbreak of S. Typhimurium in Denmark and identification of the source using MLVA typing.

In Denmark, as part of the national laboratory-based surveillance system of human enteric infections, all S. Typhimurium isolates are currently sub-typed using phage typing, antibiogram typing, and pulsed-field gel electrophoresis (PFGE). However, the discriminatory ability of PFGE is not always high enough to discriminate within certain phage types, and it is not always possible to separate unrelated and related isolates. We have therefore applied multiple locus variable number of tandem repeats analysis (MLVA) for surveillance typing of S. Typhimurium since 2004. In May and June 2005, an outbreak with 26 cases of S. Typhimurium infection was identified by MLVA. The isolates were fully sensitive and had one of the most frequently occurring Danish phage types (DT12) and PFGE types. S. Typhimurium DT12 isolates from routine surveillance of animals and food were typed using MLVA and PFGE for comparison with the human isolates. The typing results revealed that an isolate from a pig herd and its corresponding slaughterhouse located in the same geographic region as the outbreak had the same PFGE and MLVA type as the human isolates. In contrast, all other DT12 isolates investigated, which had the same PFGE profile, had different MLVA types. The conclusion that the pig herd was the source of the human infections was supported by patient information, and pork from the herd stopped entering the market on 29 June. MLVA may contribute significantly to both surveillance and outbreak investigations of S. Typhimurium, as without MLVA typing this outbreak would not have been found nor its origin traced.

Denmark↗

PubMed2005

Early detection of rotavirus gastrointestinal illness outbreaks by multiple data sources and detection algorithms at a pediatric health system.

Using data from over 450,000 pediatric encounters three data sources were evaluated for their ability to support early detection of a yearly outbreak of rotavirus disease: 1) Laboratory studies ordered, 2) Diagnosis codes, and 3) Free text "reason for visit" strings categorized as Gastrointestinal syndrome by a support vector machine software classifier. We found that in this setting the categorized free text analyzed through simple control charts detected each outbreak within 10 days of their beginning as determined by laboratory detection of rotavirus antigen (the gold standard). Outbreak detection by laboratory studies was delayed an average of 14 days and by diagnosis codes by an average of 20 days. We conclude that categorized text may provide a valuable basis for real-time detection of disease outbreaks.

Algorithms↗