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PubMed1993

Scabies outbreak in an extended care unit--a positive outcome.

A recent outbreak of scabies occurred in an extended care unit attached to an acute care hospital. Seventy-eight residents and over 100 staff and family members were treated at a cost of more than $20,000. The protocol in use at that time was found to be inadequate for an outbreak situation because it was based on the assumption that all staff would have previous experience of this type of problem. Close liaison with the head nurse of the affected unit, the occupational health and safety department, the medical microbiologist and the infection control department has resulted in the development of a procedure that reflects all of the concerns that were raised during the outbreak. In addition, a policy was formulated to cover problems associated with contacting medical personnel in a timely manner. This outbreak has resulted in positive changes in procedures as well as improved communication in a wide variety of departments within the hospital.

Cross Infection↗

PubMed1993

Multiple drug resistant typhoid fever outbreak in Kashmir Valley.

We report the first ever report of multiple drug resistant salmonella typhi epidemic from Asia. The outbreak started in April 1988 and virtually ended by June 1988. The outbreak occurred in Baramullah town of Kashmir valley. In an epidemiological survey 230 cases were diagnosed as enteric fever. 46 cases (20%) were culture positive. A very rare multiple drug resistant strain of S. typhi was identified as phage type biotype II untypeable (UVS2). The strain was sensitive to Norfloxacin. This outbreak of S. typhi has many similarities with Mexico epidemic. Ingestion of contaminated water seems to be the possible cause for the outbreak.

Adolescent↗

PubMedDate not supplied

Evaluation of a method for detecting outbreaks of diseases in six states.

A new statistical method, developed for detection of changes in reporting, has proved useful in analysis of provisional data reported by state health departments to the National Notifiable Diseases Surveillance System (NNDSS). In this system, data from the current four-week period can be compared with data from the previous, same, and subsequent four-week periods from each of the preceding five years, and reports exceeding historical limits are highlighted in a horizontal bar graph. To evaluate the usefulness of this method at the state level, we applied it to weekly reports of seven notifiable diseases in six states over a four-month period. Participating state health departments investigated all events exceeding historical limits and reported known outbreaks that were not identified by the method. During the four-month period, the method identified 27 episodes of disease reports exceeding historical limits. Of these, 14 (52%) represented outbreaks. None was detectable by analysis of aggregate national surveillance data. Five outbreaks known to state health department officials were not identified by the method, because of increased disease activity during the baseline period or lack of timely provisional reporting of outbreak-related cases. Methods for detection of increases in reporting at the state level may identify events of public health importance that are obscured in aggregate national data and may supplement other local sources of information available to state health departments in the recognition of significant public health events.

Data Collection↗

PubMed1995

A school and community outbreak of influenza A.

In May 1995 a department of public health medicine was informed of an outbreak of respiratory and gastrointestinal illness in a local school. Eighty-three pupils and staff were affected out of a total of 247 people--an attack rate of 34%. The outbreak was investigated, control measures were instigated, and the outbreak subsided. Pupils and staff were surveyed and faecal specimens were collected. Blood specimens from a sample of pupils were examined serologically. No organisms were isolated from faecal specimens. Nine of the 18 blood specimens taken showed raised antibody titres against influenza A. This labour intensive investigation revealed a community outbreak of influenza A. Investigations in schools can be useful in community surveillance.

Antibodies, Viral↗

PubMed1995

Two outbreaks of type C and type D botulism in sheep and goats in south Africa.

Two outbreaks of botulism in sheep and goats are described; in one, 329 out of 900 sheep in a feedlot died within 9 d of the onset of the disease and in the other, 100 sheep and goats out of 330 succumbed over a period of about 3 weeks. Animals were found dead or died suddenly, without exhibiting clinical signs. Others stood with lowered heads and showed drooling of saliva or a stiff gait. Paresis and/or paralysis were frequent signs in the terminal stages of the disease. Gross lesions such as the accumulation of fluids in body cavities, pulmonary oedema, foam in the trachea, epicardial haemorrhages and congestion of the mucosa of the small intestine, suggestive of heart failure, were present in animals from both outbreaks. Botulism was confirmed via the mouse toxicity test, by the demonstration of Type C and Type D toxins in the feed and intestinal contents of sheep from the first outbreak and Type D toxin in intestinal contents of sheep from the second. The clinical signs and macropathology in the outbreaks of botulism in sheep and goats in South Africa may resemble "krimpsiekte" and cardiac glycoside and ionophore poisoning, as well as other conditions causing heart failure.

Animals↗

PubMed1995

Outbreaks of gastroenteritis due to Norwalk-like virus in two long-term care facilities for the elderly.

In February 1993, outbreaks of gastroenteritis due to Norwalk-like viruses occurred simultaneously among the elderly residents of two long-term care facilities. Facility A instituted infection control measures that included increased surveillance, reinforcement of handwashing, keeping symptomatic residents in their rooms and relieving symptomatic staff of their work duties until 48 h after resolution of their symptoms. Facility B instituted a more stringent set of control measures that included all those implemented by facility A plus the following: staff from affected units were not permitted to work on other units, affected units were closed to new admissions, enteric precautions were instituted for ill residents, residents were restricted to their own units and education was provided to staff and residents about gastroenteritis. Facility A had an attack rate of 9%; the attack rate for facility B was 11% (P = 0.38). The duration of the outbreak was 29 days in facility A and 24 days in facility B. The impact these infection control measures had on the course of the outbreaks is difficult to determine. However, it is doubtful that the more stringent measures implemented at facility B had any greater effect on the course of the outbreak. A better understanding of the precise mechanisms of viral transmission is required in order to determine the most appropriate control measures for gastroenteritis due to Norwalk-like viruses in long term care facilities.

Aged↗

PubMed1995

[Investigation of an outbreak of water-borne typhoid fever in Catalonia in 1994].

BACKGROUND: Typhoid fever incidence in Spain, and particularly in Catalonia has decreased significantly since 1985. Water borne outbreaks can affect large numbers of people. These two reasons make specially interesting to study all suspected typhoid fever outbreaks, like the one that happened in March 1994 in Bages county (Barcelona). METHODS: Epidemiological questionnaires were conducted to investigate the origin of the outbreak, the presence of related cases in the same area, and the household contacts of cases S. typhi isolates were characterized by serotyping, biotyping, phage-typing, ribotyping and pulsed field gel electrophoresis analysis of DNA. RESULTS: Nine cases were identified. All cases were treated with antibiotics, with clinical success. There were not secondary cases. The possible origin was a drinking fountain. All the strains had the same epidemiological marker patterns. CONCLUSIONS: Breaking of the sewer pipes near to the drinking fountain was probably the origin of the contamination. It can be concluded the importance of keeping a good epidemiological control system to investigate and prevent outbreaks. It is also important to control the drinking fountains to prevent its contamination. Finally it is necessary to highlight the utility of epidemiological markers to fully characterized the involved strains.

Adolescent↗

PubMed1996

[An outbreak of Streptococcus pyogenes infections in institutions for the mentally retarded in Greater Copenhagen 1995].

The largest reported outbreak of infections due to Streptococcus pyogenes, M-type 18, in recent years is described. Ninety persons at institutions for mentally retarded (73% residents) had infections due to the epidemic strain. Pharyngitis and scarlatina were the most common infections. Six patients died, five having a streptococcal toxic shock syndrome. During the outbreak an intensive surveillance was carried out together with improved infection control measures and prompt culturing of residents and employees before antimicrobial treatment. The primary outbreak was confined but a secondary outbreak could not be prevented. This was probably due to difficulties in implementing proper isolation precautions in this setting.

Adult↗

PubMed1996

Four outbreaks of Salmonella enteritidis phage type 4 food poisoning linked to a single baker.

An outbreak of gastrointestinal illness occurred among a party of diners at a hotel in South Yorkshire. A case control study identified a gateau, from an outside supplier, as the likeliest vehicle of infection. Further gateaux from the same baker's premises and other outlets were examined microbiologically. Three other outbreaks of food poisoning in neighbouring districts were recognised and found to be associated with gateaux supplied by the same baker. A total of 32 cases were identified. Stool specimens from 24 cases grew Salmonella enteritidis phage type (PT) 4. The same organism was also grown from gateau in the domestic refrigerator of the chef of one hotel, cheesecake made by the same baker, and a gateau and ingredients from the baker's premises. The isolates of S. enteritidis PT4 were all fully sensitive to antibiotics, and had the same plasmid and pulsed field gel electrophoresis profiles. It is most likely that cross contamination occurred from infected raw eggs on the baker's premises. The control measures instituted probably prevented two further outbreaks, and the baker now uses only pasteurised eggs. The benefits of close cooperation between different local and health authority districts in the investigation of the outbreaks are discussed.

Disease Outbreaks↗

PubMed1996

General outbreaks of vero cytotoxin producing Escherichia coli O157 in England and Wales from 1992 to 1994.

We have reviewed all general outbreaks of infection due to Vero cytotoxin producing Escherichia coli (VTEC) O157 reported in England and Wales from 1992 to 1994. One hundred and seventy-three people were affected in 18 outbreaks, compared with 76 people in seven outbreaks in the preceding three years (1989 to 1991). Outbreaks occurred throughout England and Wales. Thirty-eight per cent of cases were admitted to hospital, 21% developed haemolytic uraemic syndrome, and 3% died. VTEC O157 infection causes particular concern because of its serious complications--haemorrhagic colitis and haemolytic uraemic syndrome, its capacity to spread from person to person as well as by food and water, and its reservoir in dairy and beef cattle.

Adult↗

PubMed1996

Epidemiological investigation of an outbreak of enteric fever in a village in Maharashtra.

Four hundred fifteen fever cases occurred in village Katkalamba, in Nanded district, Maharashtra during November-December, 1995. Explosive nature of the outbreak, non involvement of infants, significantly higher incidence rate in the age group 1-14 years and clustering of almost all cases in the users of a particular well indicated it to be a water borne outbreak. Laboratory investigations in selected cases confirmed it to be an outbreak of enteric fever. Chemical and microbiological examination of water samples from the suspected wells gave evidence of faecal contamination of water. Circumstances under which the contamination occurred and the outbreak spread are discussed.

Adolescent↗

PubMedDate not supplied

[Epidemic outbreak of 81 cases of brucellosis following the consumption of fresh cheese without pasteurization].

BACKGROUND: In spite of the great effort that has been made in recent years in Castilla-La Mancha to control brucelosis, a lack of awareness on the part of producers and consumers leads to major epidemic outbreak, such as the one described below. METHODS: A description of the outbreak is described and a study is conducted of cases and controls to determine the factors which are responsible for the epidemic. Unadjusted and adjusted Odds Ratios (O.R.) are obtained together with their confidence intervals, for the main epidemiological factors studied. RESULTS: A total of 81 cases of brucelosis were recorded in a period of 25 weeks. All the cases occurred in the same borough or were in some way linked to it. In the case and controls study no differences were found with regard to age, sex, contact with livestock or the consumption of pasteurised milk or cheese. A strong link was established between the illness and the consumption of home-made cottage cheese prepared by a small-scale producer in the borough, (O.R. = 311.9; C.I. = 95% = 41.48-12735)., whose livestock turned out to be infected with Brucella Mellitensis. CONCLUSIONS: This outbreak showed that in Spain, there is a risk of contracting brucelosis by consuming non-pasteurised dairy products, particularly cheese, when these are not subjected to the normal sanitary and health controls. The benefits of epidemiological research in the search for cases and determining the factors responsible for the outbreak are also demonstrated. An intensification of controls, the cleansing of the herds and flocks and health education in general, are suitable instruments for controlling this zoonosis in Spain.

Adolescent↗

PubMed1997

Outbreaks of Escherichia coli O157:H7 infection and cryptosporidiosis associated with drinking unpasteurized apple cider--Connecticut and New York, October 1996.

In October 1996, unpasteurized apple cider or juice was associated with three outbreaks of gastrointestinal illness. In the Western United States, an outbreak of Escherichia coli O157:H7 infections associated with unpasteurized commercial apple juice caused illness in 66 persons and one death. In addition, one outbreak of apple cider-related E. coli O157:H7 infections and another of cider-related Cryptosporidium parvum infections occurred in the Northeast. Apple cider is a traditional beverage produced and consumed in the fall. Cider often is manufactured locally at small cider mills where apples are crushed in presses, and the cider frequently is not pasteurized before sale. This report summarizes the clinical and epidemiologic features of the two apple cider-related outbreaks, which suggest that current practices for producing apple cider may not be adequate to prevent microbial contamination.

Adolescent↗

PubMed1996

[Investigation of outbreaks of food-borne diseases].

Investigation of outbreaks of food-borne disease requires close cooperation between the health service and the food control authorities. The primary objective is to stop the outbreak and provide a basis for specific control and preventive measures. The investigation consists of the following steps: To confirm the existence of an outbreak and notify all authorities involved; to describe the outbreak according to the variables of time, place, person, and agent; to establish an interim diagnosis and identify the etiological agent responsible; to assemble all information and establish hypotheses about the source of infection using inspections, laboratory investigations, and pilot interviews; to test the hypotheses by laboratory-based methods and analytic epidemiological approaches; to eliminate the source of infection, implement preventive measures, and control that they are efficient; to report the results.

Disease Outbreaks↗

PubMed1996

Salmonella enteritidis outbreak in Thailand: study by random amplified polymorphic DNA (RAPD) analysis.

An outbreak of Salmonella enteritidis in Thailand was reported in 1990. The majority of isolates were found in chicken and human throughout the country. The continuation of a high rate of spreading which is presently continuing prompted us to investigate possible clonal involvement in the outbreak. One hundred and twenty five isolates of S. enteritidis which were isolated between 1990-1993 were clonally identified by the technique of Random Amplified Polymorphic DNA (RAPD) analysis. Eight profiles were found indicating the presence of 8 clones, designated no. 1-8. The predominant clone was profile no. 4 which was encountered in 93.6% of tested isolates while the rest of the profile comprised only 0.8-1.6%. The predominant clone was distributed mainly in isolates from chickens and humans which is suggestive that the profile no. 4 is the major clone involved in this outbreak and that chickens were the source of S. enteritidis infection. The information from the Microbiology Laboratory at Ramathibodi Hospital revealed that nearly 40% of S. enteritidis were isolated from blood specimens. This may reflect the invasiveness of S. enteritidis in Thailand. We concluded that the outbreak involved the single clone, RAPD profile no. 4 which may disperse dominantly during the epidemic.

Animals↗

PubMed1997

A coccidioidomycosis outbreak following the Northridge, Calif, earthquake.

OBJECTIVE: To describe a coccidioidomycosis outbreak in Ventura County following the January 1994 earthquake, centered in Northridge, Calif, and to identify factors that increased the risk for acquiring acute coccidioidomycosis infection. DESIGN: Epidemic investigation, population-based skin test survey, and case-control study. SETTING: Ventura County, California. RESULTS: In Ventura County, between January 24 and March 15, 1994, 203 outbreak-associated coccidioidomycosis cases, including 3 fatalities, were identified (attack rate [AR], 30 cases per 100,000 population). The majority of cases (56%) and the highest AR (114 per 100,000 population) occurred in the town of Simi Valley, a community located at the base of a mountain range that experienced numerous landslides associated with the earthquake. Disease onset for cases peaked 2 weeks after the earthquake. The AR was 2.8 times greater for persons 40 years of age and older than for younger persons (relative risk, 2.8; 95% confidence interval [CI], 2.1-3.7; P<.001). Environmental data indicated that large dust clouds, generated by landslides following the earthquake and strong aftershocks in the Santa Susana Mountains north of Simi Valley, were dispersed into nearby valleys by northeast winds. Simi Valley case-control study data indicated that physically being in a dust cloud (odds ratio, 3.0; 95% CI, 1.6-5.4; P<.001) and time spent in a dust cloud (P<.001) significantly increased the risk for being diagnosed with acute coccidioidomycosis. CONCLUSIONS: Both the location and timing of cases strongly suggest that the coccidioidomycosis outbreak in Ventura County was caused when arthrospores were spread in dust clouds generated by the earthquake. This is the first report of a coccidioidomycosis outbreak following an earthquake. Public and physician awareness, especially in endemic areas following similar dust cloud-generating events, may result in prevention and early recognition of acute coccidioidomycosis.

Acute Disease↗

PubMed1996

[Outbreak of Salmonella enteritidis food poisoning. Potential protective effect of alcoholic beverages].

BACKGROUND: On may 1994, a foodborne outbreak took place in Almazora (Castellón, Spain) after a meal with 116 persons. A sanitary study was made to find out the causes and control the outbreak. SUBJECTS AND METHODS: Inspection of the setting and a case-control study were carried out. Several foods and faecal specimens of 23 patients were investigated. We also study the effect of alcohol on the occurrence of the outbreak. RESULTS: A hundred people was interviewed (86%), 58 ill persons. Salmonella enteritidis was isolated from faeces and statistically implicated food (odds ratio = 75, IC 95 = 15.6-361), a sandwich with tuna, boiled eggs and vegetables. Among adults, epidemiological analysis showed a protective effect of alcohol, adjusted for age, sex and consumption of the implicated food (p = 0.007). CONCLUSIONS: In the study of foddborne outbreaks by Salmonella enteritidis simultaneous consumption of alcoholic drinks and foods should be taken into account to explain some exposed non-cases.

Adolescent↗

PubMed1997

[An outbreak of hepatitis A among intravenous drug addicts in Oslo 1995-96].

Intravenous drug abuse is a well-known risk factor for acquiring hepatitis A infection. Among drug abusers most cases are sporadic, but epidemic outbreaks may occur occasionally. In this article we describe an epidemic outbreak including 144 serologically proved cases of hepatitis A among intravenous heroin and amphetamine abusers in Oslo. The outbreak lasted for 11 months. 59 (41%) of the patients were admitted to hospital. One of them died and seven developed severe but reversible acute hepatitis. We also registered 26 cases of hepatitis A among close contacts, 14 of whom were associated with a nosocomial outbreak that affected nurses, fellow patients and relatives. We do not know how the hepatitis A virus was introduced into the abuser population, but the further spread was probably dominated by a combination of faecal-oral transmission and parenteral transmission secondary to sharing needles. Although we were unable to detect hepatitis A virus in confiscated drug samples by means of polymerase chain reaction we cannot exclude that some abusers were infected by injection of contaminated amphetamine.

Adult↗