Lymphocyte proliferative responsiveness in 31 patients after an outbreak of toxoplasmosis.
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Adolescent↗
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Salmonella and shigella surveillance in Hungary, 1972-1976. II. Shigella surveillance.
Shigellae were isolated from 32 399 persons in the bacteriological laboratories of the Public Health Stations between 1972-1976. The number of isolations ranged between 5325 and 8237 yearly. As S. dysenteriae and S. boydii serotypes occurred only in about 1.5% of all isolations, the epidemiological situation was determined by the incidence of S. flexneri and S. sonnei. Except in 1973, S. sonnei constituted the majority in every year. S. sonnei predominance, observed first in the western regions of the country, showed a gradual eastward spread and became characteristic of all localities in 1975-1976. The July-September peak of shigella isolations was associated with S. sonnei, as S. flexneri was distributed practically evenly in every season. The incidence of shigella isolations per 100 000 inhabitants was the lowest in the middle and the highest in the northern parts of the country. Sporadic cases were somewhat more frequent than epidemic outbreaks. Shigellae were isolated in 64.1% from patients and in 35.9% from asymptomatic excreters. The patient : excreter ratio was higher for S. sonnei (70.2 : 29.8) than for S. flexneri (54.6 : 45.4). In the survey period, 14 692 isolations were made in the course of 3278 epidemics; out of these, 11 171 cases were involved in 574 extensive outbreaks. S. sonnei was responsible mainly for school and nursery outbreaks, whereas S. flexneri dysentery predominated in mental wards and in homes for the aged and for mentally retarded children. The prevalent types of S. flexneri were (serological/phage type): 2a/69, 3a/5, 3a/19, 4a/81, 4a/89d and 6/85. The prevalent epidemiological subunits of S. sonnei were (phage/colicin type): 2/0, 2/6, 2/12, 3/12, 6/0, 7/0, 65/0, 65/6 and 65/12.
Adult↗
Molecular analysis of Pseudomonas aeruginosa: epidemiological investigation of mastitis outbreaks in Irish dairy herds.
Pseudomonas aeruginosa is a pathogen in both humans and animals. This bacterium, most often associated with respiratory infections in cystic fibrosis patients, was found to be the causative agent in bovine mastitis outbreaks among 11 Irish dairy herds. Epidemiological findings suggested that the infection was spread to all herds by teat wipes that had been contaminated with this organism. Two molecular-typing strategies were used in an attempt to determine the genomic relationship(s), if any, of the P. aeruginosa strains isolated from the various herds and to verify whether the same strain was responsible for each outbreak. Thirty-six isolates from the mastitis outbreaks were tested and compared to fourteen clinical isolates from Cork University Hospital. With one exception, all outbreak-linked strains produced identical patterns when ribotyped with ClaI and PvuII enzymes. Eight of the clinical isolates gave the same ClaI ribotype pattern as the mastitis-causing strains. However, PvuII proved more discriminatory, with only the outbreak isolates producing identical patterns. Similar results were obtained with RW3A-primed DNA amplification fingerprinting, with all outbreak isolates except one displaying the same fingerprint array. The clinical strains produced several fingerprint patterns, all of which were different from those of the mastitis-causing isolates. Fine-resolution DNA fingerprinting with a fluorescence-labelled RW3A primer also identified a number of low-molecular-weight polymorphisms that would have remained undetected by conventional methods. These data support the view that the same P. aeruginosa strain was responsible for the mastitis outbreaks in all 11 herds.
Animals↗
Anti-rotavirus G type-specific and isotype-specific antibodies in children with natural rotavirus infections.
Serum VP7 (G) type- and isotype-specific anti-rotavirus antibodies were assessed among children monitored longitudinally over one or two rotavirus seasons in day care centers. Seventy-five pairs of blood specimens from 63 children were tested for anti-rotavirus antibodies. Stool specimens were collected weekly and tested for rotavirus antigen. G typing of detected rotaviruses showed that seven outbreaks of G1 and one of G3 occurred during the two seasons. G type-specific responses to the outbreak strain occurred among 79% of infected children and 9% of children with infection not detected (P < .001). Of children infected with G1, 54% had a heterotypic response; they were older (P = .048) and had higher preexisting G1 antibody levels than children who had only homotypic responses (P = .012). Higher IgA, IgG, and homotypic antibody levels to the antigenic site C of the G1 and G3 VP7s correlated with protection against infection and illness, homotypic antibody independently of IgA or IgG titers.
Antibodies, Viral↗
Hepatitis A vaccination of men who have sex with men--Atlanta, Georgia, 1996-1997.
Outbreaks of hepatitis A among men who have sex with men (MSM) are a recurring problem in many large cities in the industrialized world. Because MSM are at high risk for acquiring hepatitis A, in 1995 the Advisory Committee on Immunization Practices (ACIP) recommended that MSM be vaccinated against hepatitis A. These recommendations have not been implemented widely, even in outbreak settings. This report summarizes the investigation of an ongoing outbreak of hepatitis A among MSM in Atlanta, Georgia, and a public health vaccination campaign in response to the outbreak.
Adult↗
Human immune responses to the Plasmodium falciparum ring-infected erythrocyte surface antigen (Pf155/RESA) after a decrease in malaria transmission in Madagascar.
A resurgence of falciparum malaria occurred in the central highlands of Madagascar in the 1980s and was responsible for an outbreak in 1986-1987. Since 1989, transmission has decreased dramatically. In April 1991, we investigated the humoral and cellular immune responses of 53 inhabitants of the village of Manarintsoa to six synthetic peptides that reproduced the major B and/or T cell epitopes of the Pfl 55/ring-infected erythrocyte surface antigen (RESA) of Plasmodium falciparum. The presence of RESA peptide-reactive T cells was assessed by lymphocyte proliferation assay as well as by detection of in vitro production of interferon-gamma and interleukin-2. The mean values of these cellular responses were low, and the results obtained in these three tests showed no correlation. Twenty-seven subjects presented with anti-RESA antibodies as detected by modified immunofluorescent assay, but the mean levels of anti-peptide antibodies were low. When compared with data obtained in January 1988 from the same subjects with three of the six peptides, the present data demonstrated a decrease in the response to these peptides in terms of both proliferative response and mean antibody titers. The mean values of anti-RESA antibodies remained unchanged. The fact that cellular and humoral responses to the major Pfl 55/RESA epitopes decreased but did not disappear probably reflects both the remainder of the acquired immunity resulting from the 1986-1987 malaria outbreak, and its conservation by the very low level of transmission since 1989.
Adolescent↗
Campylobacter etiology in human gastroenteritis demonstrated by antibodies to acid extract antigen.
Campylobacter antibodies of the immunoglobulin G (IgG), IgM, and IgA classes were determined by enzyme immunoassay with acid glycine extract antigen in patients and controls involved in two Campylobacter outbreaks and in 266 unselected patients with acute enteritis. The assay showed a specificity of 99% for each immunoglobulin class in sera from 200 healthy blood donors. Elevated Campylobacter antibody titers were shown in 97% of stool culture-positive patients involved in the outbreaks. Rapid changes of IgA and IgM Campylobacter antibodies were typical of the early phase of serologic response in the outbreaks and thus offered the best diagnostic value in the serologic diagnosis of acute campylobacteriosis. In unselected patients with acute enteritis, the assay revealed elevated Campylobacter antibody titers in 37 patients, of whom only 12 had had positive Campylobacter stool cultures. In the sera of patients with other bacterial findings in addition to high titers of Campylobacter antibodies, no cross-reacting antibodies were found, but there was evidence of several mixed infections.
Acute Disease↗
Cholera in Sarawak: a historical perspective (1873-1989).
Cholera has been in existence in Sarawak for many years and since 1873 many major epidemics have occurred. The epidemics usually occur during the dry months of May, June and July and the population affected are those in coastal areas. As in other outbreaks the areas affected were those which had poor environmental sanitation, poor water supply, poor refuse disposal and indiscriminate disposal of faeces. Malays are more affected as in Peninsular Malaysia outbreaks. The classical biotype was common prior to 1961. In later years the El Tor (biotype) has been responsible for most outbreaks.
Cholera↗
Outbreak of HIV infection in a Scottish prison.
OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required.
Adult↗
Outbreak of neonatal Klebsiella septicaemia: a review of antimicrobial sensitivities.
A 10-week prospective study was undertaken to document the antibiotic susceptibilities of klebsiella organisms which were responsible for an outbreak of septicaemia on the neonatal units of the University College Hospital, Ibadan, Nigeria. The thirty-nine isolates obtained comprised K. pneumoniae, 18 (46.2%), K. aerogenes, 17 (43.6%), K. edwardsii, 3 (7.7%), and K. oxytoca, 1(2.5%). All the strains were sensitive to ciprofloxacin and ofloxacin, but resistant to ampicillin. The percentage of qualitative sensitivities of the klebsiella species to other available drugs were 41% for ceftazidime, 36% for cefotaxime, 31% for ceftriazone, 23% for cefuroxime, 21% for gentamycin, and 15% for kanamycin. Quantitative sensitivities of the three most commonly isolated sub-types to netilmycin were 63%, 36%, and 33%, respectively. A comparison with a previous antibiotic susceptibility study still showed persistent resistance to the available aminoglycosides.
Ampicillin Resistance↗
Molecular typing methods to investigate transmission of Escherichia coli O157:H7 from cattle to humans.
The utility of phage typing, pulsed-field gel electrophoresis (PFGE), and plasmid profile analysis was compared, to differentiate between Canadian Escherichia coli O157:H7 strains of human (n = 27) and cattle (n = 24) origin. The diversity indices for phage typing, plasmid analysis and PFGE were 0.85, 0.69 and 0.93, respectively. PFGE and phage typing were also applied to study the role of direct transmission of E. coli O157:H7 from cattle to humans on isolates collected from two separate farm outbreaks. PFGE showed that more than one E. coli O157:H7 strain with varying PFGE DNA subtype profiles, may be responsible for an outbreak, and that more than one E. coli O157:H7 subtype may be circulating on a particular farm at any one time. To our knowledge, this is one of the first reports where PFGE typing was used to verify the direct transmission of E. coli O157:H7 from cattle to humans.
Animals↗
Patient-care directives and infection control: the potential conflict of interest during epidemics in long-term care facilities.
Patient-care directives in long-term care facilities ensure that the aggressiveness of diagnostic and therapeutic interventions accurately reflects the desires of the patient. The results of our investigation of two outbreaks of fatal respiratory illness in long-term care facilities illustrate how patient-care directives may have delayed response to the outbreaks. Despite a cluster of deaths in each facility, staff delayed collection of laboratory specimens until patients with no directives restricting the medical workup became ill. Directives focus on the needs of the individual patient and family, but when an outbreak occurs, they may conflict with community needs. The challenge for the infection control practitioner is to recognize when community needs outweigh individual desires so that appropriate laboratory investigations can identify the cause of the illness.
Advance Directives↗
Foodborne disease outbreaks of chemical etiology in Thailand, 1981-1987.
A study was conducted to determine the current situation of chemical foodborne outbreaks in Thailand for the period 1981-1987. Seventy-three outbreaks of chemical poisoning involving 1236 persons of whom 54 died were reported. Twenty outbreaks affecting 722 cases were caused by insecticide poisoning and methomyl was the most commonly recognized insecticide involved. Poisonous plants were responsible for 43 outbreaks with 420 cases. Mushroom poisoning was the most common entity (21 outbreaks, 211 cases), with plant seed poisoning next (9 outbreaks, 179 cases). There were 8 outbreaks following consumption of poisonous seafoods. Mussels were identified to be the vector in the outbreak of PSP. Horseshoe crabs which served as the vehicles for 4 outbreaks were also suspected to be associated with PSP. Puffer fish accounted for the remaining 3 outbreaks involving 6 cases of tetradotoxin poisoning. More complete reporting and more effort in outbreak investigations are needed for appropriate preventive and control measures.
Adolescent↗
Involvement of infants, children, and adults in a rotavirus gastroenteritis outbreak in a kibbutz in southern Israel.
An outbreak of acute gastroenteritis in a kibbutz in southern Israel, characterized by diarrhea, fever, vomiting, and abdominal pain, involved 32 kibbutz members of all ages. Nineteen percent of the children and 3.5% of the adults were ill. Transmission of the illness occurred in direct proportion to the degree of close contact, involving first infants, then mothers and nursery staff, and only later youngsters, adolescents, and fathers. Stool samples obtained from 32 kibbutz members with clinical illness and from 44 asymptomatic close contacts were examined for the presence of rotavirus antigen. Fifty-six percent of symptomatic members were positive for rotavirus antigen as compared with 4.5% of asymptomatic close contacts. Positivity of stool samples correlated inversely with the number of days elapsed after onset of illness until the sample was obtained. Serologic studies carried out on acute and convalescent sera of symptomatic and asymptomatic subjects further supported a rotavirus etiology for the outbreak. RNA profiles of stool sample extracts obtained by polyacrylamide gel electrophoresis and silver staining indicate that one electropherotype may have been responsible for the outbreak.
Adolescent↗
Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak.
Western Australia (WA) has been able to prevent methicillin-resistant Staphylococcus aureus (MRSA) strains from outside of the state from becoming established in its hospitals. Recently, a single-strain outbreak of MRSA occurred in a WA metropolitan teaching hospital following admission of an infected patient from a remote community. The strain responsible for the outbreak was unrelated to any imported strains and spread rapidly in the hospital. Screening of two remote communities in the region from which the index case came revealed that 42% of the people in one community and 24% in the other carried MRSA. Isolates were typed by resistance pattern, plasmid analysis, contour-clamped homogeneous electric field electrophoresis, bacteriophage pattern, and coagulase gene restriction fragment length polymorphism. It was found that of the people carrying MRSA, 39% in the former community and 17% in the latter community were carrying an MRSA strain which was indistinguishable from the strain that caused the hospital outbreak.
Cross Infection↗
Characterization of epidemic Neisseria meningitidis serogroup C strains in several Brazilian states.
Epidemic strains of the Neisseria meningitidis C:2b:P1.3 electrophoretic type 11 complex were responsible for an outbreak in Curitiba, Parana State, Brazil, from 1990 to 1991. Strains of this complex were also isolated in other Brazilian states and were responsible for a meningococcal disease epidemic in São Paulo State in 1990. Serotyping both with monoclonal antibodies and by multilocus enzyme electrophoresis was useful for typing these epidemic strains related to the increased incidence of meningococcal disease. The genetic similarity of members of the electrophoretic type 11 complex was confirmed by the ribotyping method by using EcoRI or ClaI endonuclease restriction enzymes.
Bacterial Typing Techniques↗
Clostridium difficile: an update on its epidemiology and role in hospital outbreaks in England and Wales.
Data from the surveillance system of general outbreaks of infectious intestinal disease and from laboratory reports collated by the Communicable Disease Surveillance Centre (CDSC) and requests for outbreak investigation by the PHLS Anaerobe Reference Unit were used to evaluate the current epidemiology of Clostridium difficile infection in England and Wales. Between January 1992 and December 1996, CDSC received 10,220 laboratory reports of C difficile isolation from patient's faeces and 26,873 of toxin in faeces. Over 75% of all reports were of people aged 64 years and over. The surveillance system captured a minimum data set on 694 hospital outbreaks of infectious intestinal disease. C. difficile was responsible for 109 (15%) outbreaks affecting 1625 people, of whom 1152 were found to have a C. difficile toxin producing strain. The median duration of outbreaks was 11 days. Fingerprinting by Pyrolysis Mass Spectrometry (PMS) was performed by the PHLS Anaerobe Reference Unit in 60 outbreaks, and typing by Polymerase Chain Reaction ribotyping (PCR) in 14.
Adolescent↗
Serotypes of Bacillus cereus from outbreaks of food poisoning and from routine foods.
A provisional serotyping scheme was used to type cultures of Bacillus cereus from 84 outbreaks of food poisoning in seven countries; 283 of the 337 (84%) cultures tested were typable. In 35 of the 61 outbreaks associated with a vomiting-type syndrome, foods, clinical specimens or both yielded H-serotype 1 only. Type 1 strains together with other sterotypes were isolated in seven outbreaks. In 14 outbreaks types 3, 4, 5, 8 or a mixture of serotypes were present. Untypable strains were isolated in five outbreaks. Two of the nine diarrhoeal-type outbreaks yielded serotype 1 only. Types 2, 6, 8, 9, 10 and a mixture of type 12 and an untypable strain appeared to be responsible for one outbreak each. Although 16 of the 18 recognized serotypes were present among cultures of B. cereus from various routine foods, only 156 of the 400 (39%) isolates tested were typable.
Australia↗