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PubMed1989

[A hepatitis A outbreak in a Granada district].

The aim of the present study was to define and characterize the occurrence of a hepatitis outbreak. A hepatitis outbreak developed from November 1987 and June 1988 in a peripheral district of the city of Granada. Sixty cases were diagnosed (59 confirmed and 1 probable). An increase in the incidence was observed during October, November and December. There were no sex differences in the specific attack rates and the mean age of cases was 7.14 years; the specific rates in the different age groups were higher in the 0-5 years and 6-10 years groups. The most common symptoms and signs were choluria, abdominal pain and jaundice. Anti-HVA IgM was positive in 83.3% of cases. Only 5 children required hospital admission, and the outcome of 83.3% of cases was known and favorable. The strategies adopted against the outbreak were to recommend hygienic measures in the households and school where cases had developed and to give nonspecific human immunoglobulins before or after exposure in the closed contacts of cases. We do not feel that these strategies have had a sizeable effect on the course of the outbreak.

Child↗

PubMedDate not supplied

An outbreak of acute infectious nonbacterial gastroenteritis in a high school in Maryland.

An outbreak of acute infectious nonbacterial gastroenteritis (AING) occurred in a high school in Maryland in 1984. Thirty-six percent of students surveyed met the case definition of gastroenteritis, as did 24 percent of school employees. Eating lunch in the cafeteria on January 30 was significantly associated with illness. After controlling for other food items consumed during the January 30 lunch, only the sandwiches were significantly associated with illness, but the source of the contamination was not identified. Four of 17 serum pairs from sick students and none of the 8 serum pairs from exposed controls (a nonsignificant difference) showed at least a 4-fold rise in antibody titre to Norwalk virus between acute- and convalescent-phase specimens. This outbreak of AING is believed to be the first to implicate epidemiologically sandwiches as vehicles of transmission. The outbreak highlights the need for investigators to look for a viral etiology in gastroenteritis outbreaks.

Adolescent↗

PubMed1988

[2 outbreaks of adenovirus 8 keratoconjunctivitis. Clinical, epidemiological and preventive approach].

Adenovirus 8 represents the main agent of Epidemic Keratoconjunctivitis (EKC) and outbreaks mainly occur in hospital wards, colleges and metallurgy industry. Adenovirus 8 conjunctivitis are generally severe lasting two to three weeks, and keratitis with persistent infiltrates may be observed for more than a year. There is no actual treatment of EKC and therefore preventive measures appear as essential to avoid and/or limit such outbreaks in hospital wards. We have observed two consecutive outbreaks of Adenovirus 8 EKC in the Ophthalmology Department of the University Hospital in Brest, France. One outbreak lasted from December 1st, 1983, to March 20, 1984, and the second from July 13, 1984, to November 6, 1984. All patients were selected on the basis of positive virus isolation and they were divided into three epidemiological groups: Group 1 concerned patients who came for EKC treatment at the Ophthalmology Department for the first time; Group 2 resembled either infected staff members or patients which came for EKC and which had already been at the Ophthalmology Department for less than a month with another disease; Group 3 corresponded to hospitalized patients which had contracted EKC during their stay in the ward. Virus isolations were attempted at the virus laboratory in Brest (Pr Chastel) using human diploid fibroblastic cells, MRC 5 strain (Bio-Mérieux, France) and virus isolates were identified by neutralisation tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoviridae Infections↗

PubMed1985

Control of a hospital outbreak of methicillin-resistant Staphylococcus aureus infections: value of an isolation unit.

An outbreak of methicillin- and gentamicin-resistant Staphylococcus aureus infections started in a university hospital after a patient, who was not known to be colonized, was admitted. During a 3-month period 15 surgical or geriatric patients and five staff were found to be infected or colonized by the epidemic strain in five surgical/orthopaedic wards, a geriatric ward, the intensive care unit and the isolation unit. Difficulties in controlling the outbreak arose when two patients who initially had negative bacteriological screening results were returned to general wards. Both patients were subsequently shown to be colonized and caused outbreaks which led to the further closure of two general wards. There was strong circumstantial evidence to suggest that physiotherapy staff were involved with the spread of the epidemic strain. Control of the outbreak was achieved by more strict isolation of 'negative' patient contacts as well as colonized/infected patients and increasing the level of staffing on the separate isolation unit.

Cross Infection↗

PubMed1985

Revisiting the Holy Cross football team hepatitis outbreak (1969) by serological analysis.

Clinical and biochemical data collected during the Holy Cross College football team hepatitis A outbreak in 1969 suggested that 32 team members had icteric hepatitis, 58 had anicteric illness, and only seven were not infected. Using a currently available radioimmunoassay, we tested stored serum samples obtained during the outbreak for IgM antibody to hepatitis A virus (IgM anti-HAV). Only individuals with icteric hepatitis were found to have IgM anti-HAV in serum; those with presumed anicteric illness were shown not to be infected with hepatitis A virus. The attack rate was thus only 34%, not 93% as originally reported, and the incidence of icteric illness in those infected was 100%, not 33%. This serological analysis of a classic outbreak of hepatitis A illustrates the utility and importance of IgM anti-HAV testing in seroepidemiologic investigations of hepatitis outbreaks.

Alanine Transaminase↗

PubMedDate not supplied

Continuing outbreak of hepatitis A linked with intravenous drug abuse in Multnomah County.

A communitywide outbreak of hepatitis A occurred in Portland, OR, from 1983 through 1986. At the peak of the outbreak, the age- and sex-specific annual incidence rate approached 400 cases per 100,000 population among men ages 25 to 34, the highest risk group. The community incidence rate was nearly 10 times the relevant national incidence rate. A review of the records concerning cases of hepatitis A reported in the last 6 months of 1985 revealed that about half the number of young adults whose cases were investigated during that time reported a history of intravenous (IV) drug use--a proportion about 50 times greater than expected among persons in that age range. A simultaneous epidemic of overdose deaths from heroin and a concomitant increase in hepatitis B incidence rates led to the suspicion that this was a drug-abuse-associated epidemic of hepatitis among new IV drug users. Control of this outbreak was difficult because the population most at risk was distrustful of public health officials. Increased surveillance in food service establishments and schools might have prevented outbreaks from a common source in the general population; however, an increase of sporadic cases in the nondrug-using population clearly occurred.

Adolescent↗

PubMed1988

Surveillance of food poisoning outbreaks in Thailand 1981-1986.

In the period of 1981-1986, eighteen outbreaks of food poisoning following ingestion of insecticide contaminated food were reported to the Division of Epidemiology, Ministry of Public Health. There were 678 individuals experiencing illness, of which 9 cases died. Out of 18 outbreaks, 16 involving 615 cases resulted from carbamate (Methomyl and Propoxur) intoxications. The remaining two outbreaks were caused by organophosphate (Coumaphos) and organochlorine (DDT). The case fatality rate was much higher with Coumaphos than Methomyl; and no death was reported among Propoxur and DDT victims. Desserts and beverages were found to be the main vehicles, and private home was the most common place for the outbreaks of food poisoning caused by ingestion of insecticide contaminated food.

Disease Outbreaks↗

PubMed1988

Disease outbreak investigations--objectives, methods and importance.

In South Africa approximately 100 disease outbreaks or epidemics requiring investigation and control can be anticipated each year. Outbreak investigations play a critical role in determining effective disease control strategies. The application of modern epidemiological methods to the study of disease outbreaks is discussed and problem-solving methodology, which has similarities to the approach used in clinical diagnostics, described. These methods were applied to the investigation of an outbreak of Legionnaire's disease at a Johannesburg teaching hospital.

Disease Outbreaks↗

PubMed1987

Epidemiological aspects of an outbreak of dengue fever/dengue haemorrhagic fever in Singapore.

A nation-wide outbreak of 260 cases of DF/DHF with 1 death occurred in Singapore from Apr-Sept 1986. The outbreak originated from 3 separate foci of transmission at the western, south-eastern and north-eastern parts of the island and then spread to other dengue receptive urban and suburban areas. The morbidity rate was highest in young male Chinese adults between 15 and 24 years of age. The outbreak was rapidly brought under control through destruction of adult Aedes mosquitoes, surveys and source reduction of larval breeding habitats, health education and to a certain extent law enforcement. The Aedes population was high in the main foci of transmission although the overall house index was only 1.1. Other factors which could have precipitated the outbreak included waning herd immunity of the human population and continuous introduction of dengue virus into the country.

Aedes↗

PubMed1985

Common plasmid encoding resistance to ampicillin, chloramphenicol, gentamicin, and trimethoprim-sulfadiazine in two serotypes of Salmonella isolated during an outbreak of equine salmonellosis.

An outbreak of equine salmonellosis occurred at the Veterinary Medical Teaching Hospital, University of California, Davis, between June 1981 and March 1982. Forty-four horses were infected with Salmonella saint-paul, a serotype rarely isolated from animals at the university before the outbreak. Unlike the isolates of S saint-paul obtained at the beginning of the outbreak, almost all strains isolated near the end were resistant to ampicillin, cephalothin, chloramphenicol, gentamicin, kanamycin, sulfadiazine, trimethoprim, and trimethoprim-sulfadiazine. A conjugal-resistance plasmid (R-plasmid) was responsible for resistance to these antimicrobics. This R-plasmid was identical to an R-plasmid of S krefeld, a serotype that had been isolated repeatedly throughout the hospital before, during, and after the outbreak involving S saint-paul. This finding prompted the suggestion that in vivo transfer of the R-plasmid had occurred. Whether the donor organism was S krefeld is unknown.

Ampicillin↗

PubMed1985

Outbreaks of group A streptococcal abscesses following diphtheria-tetanus toxoid-pertussis vaccination.

Two outbreaks of group A streptococcal abscesses following receipt of diphtheria-tetanus toxoid-pertussis (DTP) vaccine from different manufacturers were reported to the Centers for Disease Control (CDC) in 1982. The clustering of the immunization times of cases, the isolation of the same serotype of Streptococcus from all cases in each outbreak, and the absence of reported abscesses associated with receipt of the same lots of vaccine in other regions of the country, suggest that each outbreak was probably caused by contamination of a single 15-dose vial of vaccine. The preservative thimerosal was present within acceptable limits in unopened vials from the same lot of DTP vaccine in each outbreak. Challenge studies indicate that a strain of Streptococcus from one of the patients can survive up to 15 days in DTP vaccine at 4 degrees C. Contamination of vials during manufacturing would have required survival of streptococci for a minimum of 8 months. Preservatives in multidose vaccine vials do not prevent short-term bacterial contamination. Options to prevent further clusters of streptococcal abscesses are discussed. The only feasible and cost-effective preventive measure now available is careful attention to sterile technique when administering vaccine from multidose vials.

Abscess↗

PubMed1979

A field outbreak of suspected stachybotryotoxicosis in sheep.

An outbreak of mortality in a flock of mutton merino sheep in which 109 out of 568 sheep died in the south-western Cape Province, is described. It was characterized by haemorrhagic septicaemia, anaemia, leucocytopaenia and haemorrhagic tendencies. Mortalities followed unseasonal and heavy summer rain, extended over a period of 6 months and were associated with the uninterrupted consumption of sheep cubes processed on the farm severly fungus-infested wheat, barley and rye straw for a period of at least one month. The main clinical signs occurred in two phases: an elevated body temperature, listlessness, epistaxis and intermittent haemorrhagic diarrhoea during the first phase of the outbreak, and a progressively worsening anaemia, leucocytopaenia and less severe haemorrhagic tendencies and a terminally elevated body temperature during the second phase. The predominant autopsy findings were purpuric haemorrhage on serosal and mucosal surfaces and in most of the organs, enterorrhagia and severe pulmonary congestion and oedema during the first stage; anaemia was the predominant sign during the second stage - widespread haemorrhage still occurred but was less extensive. Pasteurella haemolytica was isolated from most of the animals autopsied during the first stage. Histologically the most salient features were atrophy and necrosis of the lymphoid tissue, aplastic anaemia and a markedly impaired inflammatory response. Extensive post-natal lamb mortalities, probably due to an Escherichia coli infection precipitated by the toxicosis, occurred during the outbreak. Toxigenic strains of Stachybotrys chartarum were isolated from the wheat and barley straw. Diethyl ether extracts of the wheat straw, sheep cubes and S. chartarum culture material elicited positive skin tests in rats following intradermal injection and the presence of 12,13-epoxytrichothecenes in these extracts were confirmed by thin layer chromatography. In feeding trials sheep cubes and wheat straw caused the death of 4/4 one-day-old Pekin ducklings and weanling Wistar rats in six and nine days, respectively. This is the first description of an outbreak of disease in sheep associated with the ingestion of S. chartarum-infested food components in the Republic of South Africa.

Animal Feed↗

PubMed1983

St. Louis encephalitis--Florida 1977. Patterns of a widespread outbreak.

From 8 August through 5 December 1977, 110 laboratory-documented cases (78 confirmed, 32 presumptive) of St. Louis encephalitis (SLE) occurred in 20 counties throughout central-south Florida. Most cases were initially identified through an active surveillance system involving repeated contact of hospital infection control officers. This outbreak had three characteristics that are unusual for SLE epidemics in the eastern United States: it lacked an urban focus, a disproportionate number of cases affected young males, and the epidemic period extended into December. There was no significant difference between attack rates for blacks and whites. Males were significantly more often affected than females. Because of the time required for laboratory confirmation of cases, most outbreak control measures were initiated after the outbreak was declining. Reporting of clinically suspected SLE cases to initiate epidemic mosquito control should improve the timeliness of control measures in future outbreaks.

Adolescent↗

PubMed1994

An outbreak of measles in Trafford.

In the autumn of 1993 an outbreak of measles occurred in Trafford, Greater Manchester, associated with two junior schools. Thirty-four cases were reported. Twenty-five of the 32 cases whose ages were known were aged between 7 and 11 years. The mean age was 8.6 years, and the median and modal age was 10. Two of the cases had received measles vaccine. Eighteen of the 19 cases who provided samples were confirmed as measles by laboratory tests. The incident showed that extensive resources are needed to investigate such outbreaks and implement control measures, and identified problems with the local child health computer system. The outbreak did, however, provide an opportunity to immunise children within the district who had not previously received measles vaccine. It is important for unprotected siblings of affected children to be vaccinated to prevent the secondary spread of infection, and all cases of measles should be notified promptly so that outbreaks can be identified.

Adolescent↗

PubMedDate not supplied

[Trichinosis outbreak in Purranque County, X Region, Chile. October-November, 1992].

An outbreak of trichinosis occurred in Purranque County, X Region, Chile, between october and november of 1992, which involved 36 persons. The incubation period, determined by the clinical picture and laboratory assays, fluctuated between 10 and 12 days. Myalgias (88.9%) and palpebral oedema (86.1%), were the most important symptoms, followed by fever (44.4%) and headache (33.3%). Eosinophils count ranged from two to 42% the first week, and this value raised to 55% the second week of the outbreak. Anti-Trichinella spiralis antibodies were determined by some serological tests such as: precipitin test (PT), bentonite flocculation test (BFT) and indirect hemagglutination test (IHAT) in sera from 28 patients at the beginning of the outbreak. PT was positive in 46.4% of the cases, followed by IHAT (21.4%) and BFT (3.6%). After 15 days, the three tests were performed in sera from 12 patients. At that time, the positivity was elevated in all of them: PT (100.0%), BFT (66.7%) and IHAT (91.7%). It is believed that the outbreak had its origin in infected pork meat that was consumed raw or insufficiently cooked without a previous veterinary inspection.

Adolescent↗

PubMed1995

Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis.

OBJECTIVE: Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis. DESIGN: Case series of tuberculosis in health care workers, January 1, 1989, through May 31, 1992. Antimicrobial susceptibility testing and restriction fragment length polymorphism analysis of M tuberculosis isolates. Longitudinal analysis of cumulative tuberculin skin test surveillance data. Assessment of infection control. The patients consisted of 361 health care workers who had either serial tuberculin skin tests or tuberculosis. RESULTS: Six health care workers, the largest number linked to one multidrug-resistant tuberculosis outbreak, had disease due to M tuberculosis that matched the outbreak strain from hospitalized patients. The two who were seropositive for human immunodeficiency virus died, one of tuberculous meningitis and the other of multiple causes including tuberculosis. The estimated risk of a skin test conversion was positively associated with time and increased by a factor of 8.3 (1979 to 1992). In 1992 the annual risk for workers in the lowest exposure occupational group was 2.4%. In comparison, nurses and housekeepers had relative risks of 8.0 (95% confidence interval, 3.2 to 20.3) and 9.4 (95% confidence interval, 2.7 to 32.3), respectively. Laboratory workers had a relative risk of 4.2 (95% confidence interval, 1.1 to 15.5). Tuberculosis admissions increased, but the hospital had inadequate ventilation to isolate tuberculosis patients effectively. There were lapses in infection control practices. CONCLUSIONS: Health care workers who were exposed during a hospital outbreak of multidrug-resistant tuberculosis had occupationally acquired active disease. The human immunodeficiency virus-infected health care workers with tuberculosis had severe disease and died. The risk of skin test conversion increased during the study period, and higher exposure occupations had elevated risk. Effective infection control is essential to prevent the transmission of tuberculosis to health care workers.

AIDS-Related Opportunistic Infections↗

PubMed1995

[Epidemic outbreak of shigellosis following water intake].

BACKGROUND: To describe the clinical, epidemiologic and microbiologic characteristics of an outbreak of shigellosis. METHODS: Twenty-six patients affected by shigellosis were studied. Upon identification of the outbreak, a questionnaire was carried out in relatives to determine the attack-rate. Studies of the isolated strains included biotype, antibiotype, and in 8 selected strains, plasmid and ribotyping profile. RESULTS: From September 23 to October 21 1991, 26 patients (42% males, 54% under the age of 14 years), 23 of whom drunk water from two nearby fountains were attended for acute gastroenteritis and positive stool culture with isolation of Shigella sonnei strains with identical biochemical pattern and sensitivity. Only 2 required hospital admission and all recovered well. Forty-five percent of the 80 individuals who had drunk water from the fountains were affected. The attack-rate was higher in children (67%) than in adults (27%) (p < 0.001). The plasmid profile was identical in the strains studied. The only discriminative endonuclease used for the ribotyping was Sal I, which allowed the strains corresponding to the outbreak to be differentiated from those used as controls. CONCLUSIONS: An outbreak of shigellosis due to water ingestion is herein reported. The usefulness of plasmid profile as an epidemiologic marker of Shigella is confirmed. Only one of the four enzymes used for the ribotyping was discriminative. A greater susceptibility to infection was observed in children.

Adolescent↗

PubMed1994

A multistate outbreak of Escherichia coli O157:H7-associated bloody diarrhea and hemolytic uremic syndrome from hamburgers. The Washington experience.

OBJECTIVE: To determine the source of and describe a large outbreak of Escherichia coli O157:H7 infections in Washington State. DESIGN: Case-control study; environmental investigation; provider-based surveillance for E coli O157:H7 infections. SETTING: Chain of fast-food restaurants, hospitals, physician offices, local laboratories, and local health departments. PARTICIPANTS: Patients with diarrhea and neighborhood controls. A case was defined as diarrhea with culture-confirmed E coli O157:H7 infection or postdiarrheal hemolytic uremic syndrome (HUS) occurring from December 1, 1992, through February 28, 1993, in a Washington State resident. Controls were age- and neighborhood-matched friends of the first 16 case patients. INTERVENTIONS: Announcement to the public; recall of implicated hamburger lots. MAIN OUTCOME MEASURE: Abatement of outbreak due to E coli O157:H7. RESULTS: Infection was associated with eating at a fast-food chain (chain A) in the 10 days before symptoms began. Twelve (75%) of 16 case patients but no controls had eaten at chain A (matched odds ratio undefined; lower 95% confidence interval, 3.5; P < .001). In total, 501 cases were reported, including 151 hospitalizations (31%), 45 cases of HUS (9%), and three deaths. Forty-eight patients (10%) had secondary infections. Of the remaining 453 patients (90%), 398 (86%) reported eating at a Washington chain A restaurant; 92% of them reported eating a regular hamburger. The pulsed-field gel electrophoresis pattern of the E coli O157:H7 strains isolated from all regular hamburger lots of a single production date shipped to Washington was identical to that of the strains isolated from patients. Ten (63%) of 16 regular hamburgers cooked according to chain A policy had internal temperatures below 60 degrees C. Public health action removed more than 250,000 potentially contaminated hamburgers, preventing an estimated 800 cases. CONCLUSIONS: This E coli O157:H7 outbreak, the largest reported, resulted from errors in meat processing and cooking. Public health surveillance through state-mandated reporting of E coli O157:H7 infection as is carried out in Washington State was critical for prompt outbreak recognition and control. Measures should be developed to reduce meat contamination. Consumers and food service workers should be educated about cooking hamburger meat thoroughly.

Adolescent↗