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PubMed2006

Accidental and intentional animal disease outbreaks: assessing the risk and preparing an effective response.

Intentional animal disease outbreaks are infrequent, if not rare, yet they carry the potential for disastrous consequences. Normal but accidental outbreaks are not uncommon and they must be handled efficiently, effectively and economically. And whatever its origin a disease will then follow its usual epidemiology. Therefore, the effectiveness in dealing with the normal, and the practice, experience and confidence gained, will significantly aid a country in how it minimises the cost of an intentional disease outbreak. The response is what determines the financial and economic costs of a disease outbreak. This paper provides an overview of the various threats, targets, and possible government responses, all of which is then expanded upon in detail in the other papers in this issue of the Review.

Animal Diseases↗

PubMed2006

Mumps in a boarding school: description of an outbreak and control measures.

BACKGROUND: The number of cases of mumps in the UK has increased during 2004-2005. Understanding why some people are more susceptible to mumps infection will help target vaccination and other control measures in the future. This paper describes a mumps outbreak in a boarding school in Scotland (October to November 2004). OBJECTIVES: To describe the characteristics of cases in a mumps outbreak; and to conduct a case-control study looking at the effect of previous measles-mumps-rubella (MMR) vaccination. DESIGN: Descriptive epidemiology. DATA SOURCES: Clinical, laboratory and surveillance data. SETTING: A private school with 600 boarding and day pupils. RESULTS: Fifty cases were notified to the public health department as having mumps. Twenty of the cases (40%) were confirmed virologically, all born between 1987-1991. A matched case-control study was conducted to explore the effect of prior MMR vaccination. Compared to no vaccine, MMR protected against mumps (odds ratio = 0.7), two doses offering best protection (odds ratio = 0.5), but the study was not large enough to detect a statistically significant difference. CONCLUSION: Some children and young people in the UK are currently incompletely vaccinated. This outbreak illustrates the potential of a mumps outbreak to disrupt the medical, educational and social life of a school. All children should be vaccinated with two doses of MMR vaccine before school entry. Children and young people born between 1979-1991 should be given the necessary additional dose(s) of MMR vaccine.

Adolescent↗

PubMed2006

Serological and entomological investigations of an outbreak of dengue fever in certain rural areas of Kanyakumari district, Tamil Nadu.

BACKGROUND AND OBJECTIVES: During the first week of July 2003, suspected cases of dengue fever were reported from three villages in Kanyakumari district in Tamil Nadu. Since the fever outbreak occurred for the first time in these villages, serological, virological and entomological investigations were carried out to confirm the aetiology of outbreak. METHODS: A total of 76 plasma samples were collected from suspected cases of dengue fever and screened for the presence of IgM antibodies by Pan Bio ELISA kit. Toxo-IFA system was used for the isolation of dengue virus from the plasma samples. Vector survey employing ovitraps and adult landing collection were carried out in the study villages. Pooled samples of Aedes mosquito were screened for dengue virus antigen by an in-house antigen capture ELISA test employing dengue virus specific monoclonal antibodies. RESULTS: Of the 76 samples tested, 15 (20%) were found positive for dengue virus specific IgM antibodies. Dengue virus serotype-3 was detected from a plasma sample by Toxo-IFA test using virus specific monoclonal antibodies. Entomological survey revealed the abundance of Aedes albopictus (Skuse) mosquitoes in the study area. One pool consisting of 12 Ae. albopictus males were found positive for dengue virus infection. INTERPRETATION AND CONCLUSION: Based on the IgM antibody capture ELISA results, it was evident that the current infection was caused by dengue virus in the affected areas. All the age groups were affected during this outbreak. Detection of dengue virus serotype-3 in plasma samples further confirmed the aetiology of this outbreak. The high prevalence of the mosquito vector Ae. albopictus (Skuse) was observed. Detection of dengue virus antigen in the male mosquitoes confirms that the virus is maintained in wild populations of Ae. albopictus in these areas.

Adolescent↗

PubMed2006

Outbreak of influenza amongst residential school students in Malaysia.

In the months of July and August 2003, an outbreak of acute respiratory illness caused by influenza A virus occurred among students in seven residential schools situated in the northern part (Perak) of Peninsular Malaysia. Out of 4989 students, aged 13 to 18 years (mean = 15.9), 1419 (28%) were effected by influenza-like illness. All patients were treated as outpatients except for 36 students who required admission for high fever, severe coughing and shortness of breath. Abnormal chest X-ray findings were noted for those that required inpatient management. Influenza A virus was isolated from 37 sputum specimens, 20 throat swabs and three nasal swab specimens from a total of 278 clinical samples obtained from 180 patients. Isolates from each of the outbreaks were sent to WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia for antigenic and genetic analysis. One school outbreak was due to influenza A (H1N1), A/New Caledonia/20/99-like virus while the other six school outbreaks were due to influenza A (H3N2) viruses which were A/Fujian/411/2002-like).

Adolescent↗

PubMed2006

Outbreaks of imipenem-resistant Acinetobacter baumannii producing carbapenemases in Korea.

Among 53 Acinetobacter baumannii isolates collected in 2004, nine imipenem-resistant isolates were obtained from clinical specimens taken from patients hospitalized in Busan, Korea. Nine carbapenemase-producing isolates were further investigated in order to determine the mechanisms underlying resistance. These isolates were then analyzed via antibiotic susceptibility testing, microbiological tests of carbapenemase activity, pI determination, transconjugation test, enterobacterial repetitive consensus (ERIC)-PCR, and DNA sequencing. One outbreak involved seven cases of infection by A. baumannii producing OXA-23 beta-lactamase, and was found to have been caused by a single ERIC-PCR clone. During the study period, the other outbreak involved two cases of infection by A. baumannii producing IMP-1 beta-lactamase. The two clones, one from each of the outbreaks, were characterized via a modified cloverleaf synergy test and an EDTA-disk synergy test. The isoelectric focusing of the crude bacterial extracts detected nitrocefin-positive bands with pI values of 6.65 (OXA-23) and 9.0 (IMP-1). The PCR amplification and characterization of the amplicons via direct sequencing showed that the clonal isolates harbored blaIMP-1 or blaOXA-23 determinants. The two clones were characterized by a multidrug resistance phenotype that remained unaltered throughout the outbreak. This resistance encompassed penicillins, extended-spectrum cephalosporins, carbapenems, monobactams, and aminoglycosides. These results appear to show that the imipenem resistance observed among nine Korean A. baumannii isolates could be attributed to the spread of an IMP-1- or OXA-23-producing clone. Our microbiological test of carbapenemase activity is a simple method for the screening of clinical isolates producing class D carbapenemase and/or class B metallo-beta-lactamase, in order both to determine their clinical impact and to prevent further spread.

Acinetobacter Infections↗

PubMed2006

A large food-borne outbreak of group A streptococcal pharyngitis in an industrial plant: potential for deliberate contamination.

Contamination of food with streptococci could present with unusual outbreaks that may be difficult to recognize in the early stages. This is demonstrated in a large food-borne outbreak of streptococcal pharyngitis that occurred in 2003 in a factory in Israel. The outbreak was reported to the public health services on July 2 and an epidemiologic investigation was initiated. Cases and controls were interviewed and throat swabs were taken. An estimated 212 cases occurred within the first 4 days, the peak occurring on the second day. There was a wave of secondary cases during an additional 11 days. The early signs were of a respiratory illness including sore throat, weakness and fever, with high absenteeism rates suggesting a respiratory illness. As part of a case-control study, cases and controls were interviewed and throat swabs taken. Illness was significantly associated with consumption of egg-mayonnaise salad (odds ratio 4.2, 95% confidence interval 1.4-12.6), suggesting an incubation period of 12-96 hours. The initial respiratory signs of food-borne streptococcal pharyngitis outbreaks could delay the identification of the vehicle of transmission. This could be particularly problematic in the event of deliberate contamination.

Bioterrorism↗

PubMed2006

Plasmid profiles and randomly amplified polymorphic DNA analysis of Salmonella enterica serotype Enteritidis strains from outbreaks and sporadic cases in Turkey.

The aim of the study was to investigate the characteristics of Salmonella serotype Enteritidis strains isolated from outbreaks and sporadic cases in Turkey by plasmid profiles and randomly amplified polymorphic DNA (RAPD) patterns. A total of 64 S. Enteritidis clinical strains were selected from the culture collection of the Enterobacteria Laboratory of Ankara University Medical School Department of Microbiology and Clinical Microbiology for molecular analysis using the plasmid profiles and RAPD method. Fifty-six isolates (88%) harbored one to four plasmids ranging in size from 2.5 to 100 kbp. 57 kbp plasmids were the most common plasmids, and forty-four strains (69%) carried 57 kbp plasmids alone or together with other plasmids. The outbreak strains carried the same plasmid profile: three plasmids sized 57, 40, 3.0 kbp. None of the strains analyzed displayed any RAPD bands with the primer OPB-17. By using primer p-1254, 42 strains (66%) were divided into fourteen RAPD patterns. Ten of the outbreak strains (77%) showed >80% similarity by cluster analysis program. Analysis of RAPD-PCR with primer p-1254 proved an easy, rapid and discriminative method complementing antibiogram and plasmid profiles in routine laboratories, and may contribute to the investigations of S. Enteritidis which still cause outbreaks in Turkey. This study presents the first report on S. Enteritidis isolates in Turkey investigated by plasmid profiles and RAPD methods.

Anti-Bacterial Agents↗

PubMed1991

Epidemiologic investigation on an outbreak of hepatitis C.

An outbreak of hepatitis in plasma donors occurred in a village of Hebei Province in the period of September to October 1985. The morbidity rate was 40.0% (26/65) in the plasma donors, which was significantly higher than that in whole blood donors (1/88) and in persons who were not blood donors (1/400). One to one paired survey was carried out, and the incidence was 46.4% (26/56) in the plasma donors, while there were no such outbreak in the control group. The distribution of cases showed positive correlation with the number of plasma donors from the production brigade. No secondary infection was found in their families. The peak of outbreak was about 2 months later than the peak of plasma donation. 26 cases of hepatitis in plasma donors all showed negative results for anti-HAV IgM, HBsAg, anti-HBC IgM, anti-CMV IgM and anti-EBV IgM. Sera of 25 cases were selected and sent to CDC, USA to confirm with Chiron C100 reagent. 24 cases were anti-HCV positive. This outbreak of hepatitis was demonstrated to be related to cross contamination during plasma donation.

Adult↗

PubMedDate not supplied

Evaluation of an intervention program in the control of an urban outbreak of shigellosis.

Community-wide outbreaks of shigellosis are a persistent public health problem. We evaluated the effect of a household-based intervention program on the control of an urban outbreak of S. sonnei gastroenteritis. During the intervention we attempted to contact all households with culture-confirmed S. sonnei and provide education in methods to prevent spread of Shigella. Subsequently we conducted a survey of intervention (n = 43) and nonintervention (n = 33) households. We also conducted a serosurvey of children three to five years of age. The number of new cases of S. sonnei infection declined steadily over several months after the intervention began. Members of the intervention households were more knowledgeable about handwashing (rate ratio [RR] 4.7, 95% confidence interval [CI] = 2.1-10.8) and others methods of S. sonnei transmission and control than members of nonintervention households. However, intervention households had higher attack rates of Shigella-associated diarrhea in susceptible household members (RR 1.4, 95% CI = 1.0-2.0). During the intervention we were able to contact only 25% of households by the eighth day after onset of diarrhea in the index case, when 90% of intrahousehold transmission of Shigella had already occurred. Two months after the outbreak ended, 42% of children in the outbreak community had elevated antibody titers against S. sonnei; an additional 19% had borderline elevated titers. The intervention program improved knowledge but may have occurred too late to prevent intrahousehold transmission of Shigella. Exhaustion of susceptible hosts, rather than the education program, likely accounted for the decline in shigellosis cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

[Epidemic outbreak of methicillin-resistant Staphylococcus aureus in a general hospital. Preliminary report].

The incidence of MRSA infections in Spain had remained in a low level through the years, being MRSA usually less than 1.5% of all S. aureus isolates. Since October 1988, we have detected in our hospital a MRSA outbreak. The epidemic started in the surgical wards, and spread through the rest of the institution. The incidence of cases was higher in the ICU's, areas that act as "multipliers" of the outbreak. In spite of standard control measures, the total number of patients with MRSA was 245 in April 1990. We studied prospectively a sample of 100 MRSA patients: thirty-six percent were colonized and 46% infected. The more common source of infection was the lower respiratory tract and primary bacteremia. The infection-related mortality was 30%. Our MRSA strain belong to phage type III, and shows a characteristic multiple antibiotic resistant pattern, the MRSA strain is sensitive to vancomycin, fusidic acid, phosphomycin and cotrimoxazole. Over the entire outbreak period, the MRSA strain developed resistance to rifampin, imipenem-cilastatin and ciprofloxacin. In spite of all control measures implemented, the outbreak can not have been totally controlled, and MRSA is now an endemic pathogen in our institution. Therefore, major changes in therapeutic approach to nosocomial infections have been since then introduced.

Adult↗

PubMed1991

A large outbreak of salmonellosis and its economic cost.

In the summer of 1989, a large outbreak of gastroenteritis occurred in persons attending a barbeque. An investigation was carried out to determine the cause, institute control measures, and to estimate the costs involved in the outbreak. Epidemiological investigation revealed that chicken served at the barbeque was the pecant food, which was confirmed by microbiological investigation. Prompt institution of control measures resulted in early containment of secondary spread. Nevertheless, the total cost of the outbreak amounted to 77,995 pounds. The economic impact of this outbreak was therefore considerable.

Diarrhea↗

PubMed1991

Update: surveillance of outbreaks--United States, 1990.

Although disease outbreaks are often preventable public health problems, no uniform national system exists in the United States for surveillance of outbreaks. In 1988, CDC's Epidemiology Program Office participated with the epidemiology programs in four states (Maryland, New York, Oklahoma, and Washington) in a 5-month trial of an electronic system for the timely surveillance of outbreaks (1). This report updates the initial trial by summarizing a pilot project of surveillance of outbreaks in nine states--Maryland, Mississippi, Missouri, New York, Oklahoma, Rhode Island, South Dakota, Vermont, and Washington.

Computer Communication Networks↗

PubMedDate not supplied

An outbreak of Campylobacter jejuni gastroenteritis linked to meltwater contamination of a municipal well.

A large outbreak of Campylobacter jujuni gastroenteritis attributed to contamination of an unchlorinated municipal water system was investigated. Unlike most previous summer outbreaks, this one began in early spring and was attributed to meltwater entering one or more municipal wells. 241 suspected cases were documented, but retrospective information from local health care workers suggested a much larger outbreak. 45 laboratory-confirmed cases participated in a case-control study which showed a significant association between infection and amount of town water consumed. Stool specimens from 29 patients were studied with detailed serotyping by the method of Lior, with eight known serotypes and one previously unknown one identified. It is concluded that intensive surveillance of water quality during periods of spring runoff is essential, and that timely reporting of disease outbreak patterns in emergency department settings is necessary to protect the public's health.

Campylobacter Infections↗

PubMedDate not supplied

Epidemiologic studies on infectious coryza outbreaks in northern New South Wales, Australia, using serotyping, biotyping, and chromosomal DNA restriction endonuclease analysis.

The epidemiology of 16 cases of infectious coryza, an upper respiratory tract disease of chickens caused by Haemophilus paragallinarum, was investigated in a retrospective study. The cases occurred over a 14-month period on 10 farms in northern New South Wales. The available field data indicated that the cases formed six unrelated outbreaks. The 16 isolates of H. paragallinarum were subjected to serotyping by the Page and Kume schemes and biotyping based on carbohydrate fermentation and antimicrobial drug-resistance patterns. As well, newer fingerprinting techniques--plasmid profiles, whole-cell protein profiles, immunoblots of whole-cell protein profiles and total DNA restriction endonuclease analysis (REA)--were evaluated. Antimicrobial biotyping and REA profile typing proved most useful, allowing the recognition of three groups among the isolates. The other techniques gave either limited or no subdivision among the isolates. The combined results of the laboratory study indicated that, rather than six unrelated outbreaks, the 16 isolates represented three pairs of related outbreaks. This study represents the first application of sensitive biotyping and fingerprinting techniques to outbreaks of infectious coryza. The results have established that farms can be repeatedly infected with a single strain of H. paragallinarum that re-emerges at intervals. This study also obtained the first detailed evidence that replacement stock are a major source of infectious coryza.

Animals↗

PubMed1990

Isolated malaria outbreak in Somalia: role of chloroquine-resistant Plasmodium falciparum demonstrated in Balcad epidemic.

A study was conducted in Balcad in December 1988 during a reported outbreak of malaria in order to investigate possible factors contributing to the outbreak. The slide positivity rate of 71% among fever patients, which was significantly higher than the usual rate, suggests the existence of a fresh malaria outbreak in the area. High parasite densities together with the pronounced malaria symptoms among both resident children and adult immigrants indicated little, if any, malaria experience in these patients. This outbreak could not be explained by gross climatic changes, e.g. unusual rainfalls. The in-vivo response of P. falciparum to the standard therapeutic regimen of chloroquine showed a high degree of resistance, with 31 of 36 patients showing resistance, including five RI responses and 26 RII-RIII responses. Micro in-vitro tests for chloroquine susceptibility showed resistance in 33 out of 37 isolates with a mean EC50 and EC99 of 1.50 and 10.97 X 10(-6) mol l-1 blood, respectively, indicative of a high degree of chloroquine resistance. All isolates tested against sulphadoxine/pyrimethamine showed a sensitive response. The frequent presence (78%) of detectable chloroquine levels prior to treatment did not apparently alter the in-vitro parasite growth. This is a sign of widespread use of this drug resulting in a high 'drug pressure' in the area. The proportion of sensitive parasites was inversely related to the pretreatment chloroquine concentration providing evidence of the selection of resistant parasites by the previous drug intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[An explosive outbreak of respiratory streptococcal infection with a droplet transmission mechanism].

The data obtained in the study of an explosive outbreak of acute respiratory diseases, tonsillitis and scarlet fever in one of schools in Moscow have made it possible to exclude the alimentary mechanism of its development and to demonstrate the role of the droplet mechanism of transmission in the appearance of its outbreak. The epidemiological analysis of the outbreak has permitted the formulation of the hypothesis on the conditions of the formation and spread of the epidemic variant of the infective agent; this hypothesis corresponds to the available data in literature on the qualitative changes of the infective agent in the course of the epidemic process. The study has shown that the prophylaxis of the explosive outbreaks of respiratory streptococcal infections must be ensured by the system of epidemiological surveillance with timely intervention into the epidemiological process at its early stages.

Adolescent↗

PubMedDate not supplied

Giardiasis outbreak from a chlorinated community water supply.

A giardiasis outbreak from a chlorinated, unfiltered surface water supply in Penticton, British Columbia (pop. 25,000) from June to August 1986 resulted in 362 laboratory-confirmed cases. A telephone survey estimated an attack rate of over 12%. A reservoir pond containing Giardia-infected beaver was implicated as the source. A case-control study with 65 cases did not find any significant associations. A retrospective case-finding survey of records from eight (out of 35) general physicians estimated that 1,500 physician visits occurred and produced an epidemic curve in close parallel with that from laboratory-confirmed and reported cases. Despite improvements on the reservoir, another outbreak occurred when this water source was reinstituted in October for several weeks, confirming our conclusion that it was the source of the first outbreak. Various options for reducing the risk of future outbreaks are being explored including full water treatment.

Animals↗

PubMed1990

[Evaluation of the medical and social cost of 2 trichinosis outbreaks in France in 1985].

Two outbreaks of trichinosis occurred in France in 1985 and 1,073 cases were identified. These outbreaks were related to the consumption of parasitized horse meat. The medical and social cost of these outbreaks have been estimated with a sample of 92 patients. The average medical cost was 1,200 FF by outpatient and 17,300 FF by hospitalized patient. For the 1,073 cases, the total cost of these 2 outbreaks is estimated to have been between 7 and 11 millions FF. Of this sum, the hospitalization fees exceeded 51% and the social cost was 36% (loss of productivity). Since October 1985, a decree of the French Ministry of Agriculture has imposed a parasitologic test on all horse carcasses slaughtered in France or imported. This examination costs under 5 FF (under $1) per carcass. This study shows that the systematic examination for trichinosis of horse meat carcasses should be continued and that more sensitive screening methods should be developed.

Adolescent↗