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PubMed2005

Archival study of a Finnish isolate from the 1988/89 rabies outbreak.

An archival brain sample from an infected dog taken during the 1988/89 rabies outbreak in Finland was investigated to confirm that it was infected with classical rabies virus (genotype 1). The first 400 base pairs of the virus nucleoprotein gene were then sequenced and used to undertake a phylogenetic comparison between this isolate and a panel of rabies virus sequences from the Baltic region. The Finnish dog isolate was identical to a virus isolated from a raccoon-dog also recorded during the 1988/89 outbreak and closely related to a third isolate from the Russian city of Pskov. The implications of these observations for the possible source of the Finnish outbreak are discussed.

Animals↗

PubMed2002

Nosocomial outbreak of multidrug-resistant tuberculosis caused by a strain of Mycobacterium tuberculosis W-Beijing family in St. Petersburg, Russia.

A molecular epidemiologic study of 35 Mycobacterium tuberculosis isolates from 19 patients was conducted to define a nosocomial outbreak of multidrug-resistant tuberculosis in St. Petersburg, Russia. IS 6110-restriction fragment length polymorphism (RFLP) fingerprinting, together with investigations to detect mutations conferring drug resistance, revealed relationships between the isolates and links between the cases. Three patients and a nurse exposed to active tuberculosis were proved to be involved in the outbreak; the source case was identified. The outbreak strain possessed a 17-band RFLP pattern and a spoligoprofile (signals 35-43) characteristic of the W-Beijing family as well as distinctive mutations in katG315, rpoB531, embB306 and rpsL43. This specific RFLP pattern has previously been identified among Mycobacterium tuberculosis W-Beijing strains isolated across the former Soviet Union and in the St. Petersburg area of Russia. The spread of multidrug-resistant strains of W-Beijing genotype in the general population and in hospital settings presents a serious threat for public health in Russia. Specific pathogenic properties of W-Beijing genotype strains, such as enhanced transmissibility and the ability to cause reinfection and to readily acquire drug resistance to major antituberculosis drugs, along with special features of host response, have yet to be investigated.

Adolescent↗

PubMed2002

Clinical study of an outbreak of Legionnaire's disease in Alcoy, Southeastern Spain.

The aim of this study was to identify the clinical features of Legionnaires' disease, sudden outbreaks of which demand a quick and flexible clinical approach, particularly with regard to diagnosis and therapy. A prospective and comparative study based on a clinical protocol was performed during an outbreak of Legionnaires' disease in Alcoy, Spain. The outbreak was environmental in origin, linked to cooling towers. Data about epidemiological and clinical features, blood chemistry values, radiological and microbiological findings, and characteristics related to the clinical course of Legionnaires' disease were obtained for 357 patients admitted to hospital with community-acquired pneumonia (177 with Legionella pneumonia). Patients with Legionnaires' disease were younger (mean age, 65.3+/-16.5 years) and more likely to be smokers compared with patients with other types of pneumonia (28.8% vs. 11.1%; P<0.01). Moreover, they had not been admitted to any hospital because of pneumonia in the previous year. Patients with Legionnaires' disease had higher fever, more severe headache, and less expectoration as well as lower sodium blood levels (mean, 132.6+/-4.8 mmol/l vs. 135.7 mmol/l; P<0.01). Radiological studies also showed that fewer patients with Legionnaires' disease had pleural effusion (9% vs. 19.4% of those with non- Legionella pneumonia). The presence of headache, high fever, hyponatremia, scanty or null expectoration, and current cigarette smoking provides physicians with important clues for a high suspicion of Legionella pneumonia before the results of confirmatory laboratory tests are available.

Adult↗

PubMed2005

Molecular analysis of noroviruses involved in acute gastroenteritis outbreaks in military units in Israel, 1999-2004.

The study presented here was conducted to determine the genetic properties of noroviruses (NoVs) identified between 1999 and 2004 in army recruits with acute gastroenteritis. Partial sequence analysis of the RNA-dependent RNA polymerase gene revealed the presence of two major sub-genogroups, all of which were related to genogroup II of NoV. Serological analysis using recombinant antigens confirmed this observation. Local strains associated with a 1999 outbreak were closely related to GII-6 strains, while those identified later were very closely related to GII-4 strains. GII-4 strains were also associated with an outbreak in civilian nursing homes in Israel in 2002 and samples from this outbreak were included in this study for comparison. This is the first report describing the molecular properties of NoV strains associated with diarrhea-related morbidity in Israel.

Acute Disease↗

PubMed2005

An outbreak of Q fever in an urban area in Israel.

Reported here is an outbreak of 21 cases of Q fever that were diagnosed during 5 months in the spring and summer of 2001 at Rambam Medical Center, Haifa, Israel. An epidemiological investigation and a case-control study were conducted to identify risk factors associated with acquisition of the disease in this outbreak. Patients were more likely than controls to live in Krayot (a large suburb of Haifa) (76.2% vs. 41.5%; p=0.005), to have more contact with animals (usually pets) (66.7% vs. 26.9%; p=0.007), and to consume more unpasteurized dairy products (23.8% vs. 0%; p=0.01). The Krayot suburb is an entirely urban area, but several livestock facilities are located in its close vicinity, and some of them have been reported to harbor Q fever. Although the patients did not recall having had direct contact with farm animals, the results suggest the presence of livestock facilities in such close proximity to a residential area may cause urban outbreaks of Q fever.

Adolescent↗

PubMed2006

Outbreak of Streptococcus equi subsp. zooepidemicus infections on the island of Gran Canaria associated with the consumption of inadequately pasteurized cheese.

Streptococcus equi subsp. zooepidemicus infections are infrequent in humans. A clinical and epidemiological study of a milk-borne outbreak caused by this organism is described. Fifteen patients (5 females, 10 males) with a median age of 70 years (range 47-86) were infected. Twelve (80%) had underlying diseases. Infection with S. equi subsp. zooepidemicus presented as primary bacteremia in six cases, as bacteremia associated with aortic aneurism in four cases, as septic arthritis in two cases, as pneumonia in two cases, and as meningitis in one case. Five (33.3%) patients died. A case-control study proved that consumption of inadequately pasteurized cheese of a specific brand was associated with S. equi subsp. zooepidemicus disease (OR=4.5; 95% CI 1.57-19.27; p<0.001). This outbreak serves as a reminder that S. equi subsp. zooepidemicus causes serious infections that are usually zoonoses. Identification of beta-hemolytic streptococci to the species level to detect contaminated foods of animal origin is important for preventing new food-borne outbreaks. For a precise characterization of the isolates, the application of molecular markers is recommended.

Aged↗

PubMed2001

Nosocomial outbreak of Clostridium difficile-associated diarrhoea due to a clindamycin-resistant enterotoxin A-negative strain.

A clindamycin-resistant toxin A-negative, toxin B-positive Clostridium difficile strain caused an outbreak among 24 hospitalized patients at the Department of Surgery, the Intensive Care unit, and the Department of Internal Medicine of an 800-bed academic hospital. Nineteen patients had undergone a surgical intervention and all 24 patients received at least one dose of antibiotics prior to the development of Clostridium difficile-associated diarrhoea. Twenty-seven episodes of Clostridium difficile-associated diarrhoea in 24 patients were categorized as mild (n=19), severe (n=7), or fatal (n=1). Relapses occurred in three patients. Nineteen of the 27 episodes required anti-Clostridium difficile treatment. Molecular typing performed by arbitrary primer polymerase chain reaction (PCR) and PCR amplification of rRNA intergenic spacer regions revealed that the outbreak strains recovered from culture were identical. The outbreak strain belonged to serogroup F and was resistant to erythromycin, clindamycin, and tetracycline, whereas susceptibility to chloramphenicol varied. No phenotypic activity of enterotoxin A was detected. A deletion of approximately 1.7 kb was found in the toxin A gene. Cytotoxin B had an unusual effect on cell culture assays that, at first, was not recognized as Clostridium difficile specific but could be neutralized with anti-Clostridium difficile B cytotoxin.

Adult↗

PubMed2003

Immediate control of a methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit.

An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) colonization occurred from November 2001 in the neonatal intensive care unit (NICU) of our hospital. Since the establishment of our NICU in 1991, some MRSA has been detected in NICU patients. For MRSA infection preventive measures, utilization of the following items was implemented: mupirocin ointment, diluted povidone iodine, methylrosaniline chloride, and disposable rubber gloves. Patients in whom MRSA was detected received intranasal administration of the mupirocin ointment three times daily and were bathed in, or their entire body was wiped with diluted povidone iodine once daily for the first 3 days in each week. In addition, they received an intraoral application of methylrosaniline chloride daily. All therapy was done until MRSA strains were undetectable for 3 continuous weeks. Genotypes of 13 MRSA strains isolated from eight inpatients and one mother were analyzed by pulsed-field gel electrophoresis (PFGE). All PFGE patterns were identical, except for one, which had one distinct migrating fragment. These data suggested that this MRSA outbreak was caused by the same strain, which was derived from the mother of a low-birth-weight infant born on October 30, 2001. Gradually, the number of inpatients carrying MRSA decreased, until finally MRSA was no longer observed, in April 2002. Fortunately, we controlled the MRSA outbreak immediately, and none of the inpatients developed severe MRSA infection. We think that in our NICU, which is isolated from other hospital wards, it is important to prevent the entrance of MRSA-carrying mothers.

Cross Infection↗

PubMed2005

Prediction of smallpox outbreak and evaluation of control-measure policy in Japan, using a mathematical model.

Since the September 1 terrorist attacks and moreover, since the anthrax exposure events in 2001 in the United States, bioterrorism attacks seem to be a real threat. Of course, the public health authorities in Japan have started to prepare control measures for such events. We report here our attempts, using a mathematical model, to estimate outbreak size and to examine the most effective measures; comparing ring vaccination (contact tracing, isolation, and vaccination among contacts) and mass vaccination of the susceptible population in the area. The basic framework of the mathematical model follows a model used in previous research. The initial susceptible population is assumed to be 30 million persons. Concerning the important parameters, such as the number of initial-exposure cases, R0 (infectious power, or natural history) and, the starting day of intervention after the initial exposure, we checked the robustness of our conclusions by sensitivity analysis. We found that mass vaccination is preferable to ring vaccination when the values for the initial-exposure cases and R0 are high and when the start of intervention by public health authorities is delayed. In the base-case situation, the mass vaccination strategy needs almost 30 million vaccine doses. On the other hand, though ring vaccination needs fewer doses, it needs fewer than 50,000 doses in the worst-case scenario, that with larger first exposure, higher R0, or later start of public health authority intervention. This mathematical model can measure the prevalence of an infectious disease and can evaluate control measures for it before an outbreak. Especially, it is useful for the planning of the outbreaks of emerging diseases such as severe acute respiratory syndrome (SARS) or for bioterrorism attacks involving such diseases as smallpox. In further research, we will have to take into account the population people vaccinated of for smallpox, who account for about 70% of the total population in Japan.

Disease Outbreaks↗

PubMed2005

Bacterial food-borne illness outbreaks in northern Taiwan, 1995-2001.

How to reduce the occurrence of food-borne illness has always been one issue of great importance in Taiwan's disease prevention and control efforts, and it is important to determine, from survey results, whether the pathogens in Taiwan are the same or different from those in other countries. Accordingly, data on 1171 food-borne illness outbreaks were collected from the Center for Disease Control (CDC) of the Department of Health in Taiwan. The patients and the cases were numbered according to the guidelines and definition of food poisoning given by the Department of Health in Taiwan. All rectal swabs for culture were collected from the CDC. During 1995 to 2001, 1171 outbreaks of food-borne illness, including 109,884 cases, were reported in northern Taiwan, of which 735 (62.8%) were caused by bacterial infection. Bacterial pathogens, particularly Vibrio parahaemolyticus (86.0%), Staphylococcus aureus (7.6%), and Salmonella spp. (4.9%) were the main etiologic agents. The responsible pathogens in Taiwan appeared to be quite different from those in Europe and the United States. It is important to establish a unique surveillance net of our own to prevent and control our situation of food-borne disease outbreaks effectively.

Bacterial Infections↗

PubMed2001

Hospital outbreak of MEN-1-derived extended spectrum beta-lactamase-producing Klebsiella pneumoniae.

An outbreak of Klebsiella pneumoniae resistant to broad spectrum cephalosporins occurred in a hospital in the Kinki area in Japan. During 18 months, from February 1998 to July 1999, 23 strains were isolated from 21 patients (10 with pneumonia, 4 with urinary tract infection, 1 with sepsis, 1 with vaginosis, 1 with a wound infection, and 1 with both pneumonia and sepsis; 3 patients showed noninfective colonization with K. pneumoniae) in seven wards, including the intensive care unit. MEN-1-derived gene was detected by polymerase chain reaction from the majority of the strains. Ninety-nine strains of K. pneumoniae were isolated during this period. The isolation rate of K. pneumoniae resistant to broad spectrum cephalosporins was 21%. We distinguished three clones by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA analysis, and one of them was isolated from 18 patients. The presence of an R-plasmid of more than 160 kb was confirmed by plasmid analysis, but it was not possible to obtain transconjugants from all strains. This outbreak of K. pneumoniae was immediately confirmed by genetic analysis, and it was promptly ended by the infection control procedures. This is the first hospital outbreak of MEN-1-producing K. pneumoniae in Japan.

Aged↗

PubMed2006

Long-term protective effect of post-exposure Havrix administration during viral hepatitis Type A outbreaks.

Administration of human normal immunoglobulin (HNIG) post-exposure has been routinely used in Slovakia for outbreak control of hepatitis A, but requires deep intramuscular injection, provides only short-lived protection and is a human blood product. The protective effect of post-exposure administration of an inactivated hepatitis A vaccine was evaluated during 10 outbreaks in Slovakia. Direct contacts of confirmed hepatitis A cases received either: a single dose of hepatitis A vaccine (n = 2171) or immunoglobulin (HNIG, n = 3837). In the HNIG group the number of hepatitis A confirmed cases dropped within the first 7 weeks, however the decrease was not as rapid or as marked as that observed in the vaccinated group where the number of hepatitis A cases dropped within the first 4 weeks after vaccination. Among contacts, 67 cases of hepatitis A were detected during the maximum incubation period of 45 days: 16 cases (0.7%) in the vaccine group and 51 cases (1.3%) in the HNIG group (p < 0.05). After two and three years respectively, 50 and 39 volunteers who had previously received one dose of hepatitis A vaccine received a booster dose and anti-HAV antibodies were measured. Differences in anti-HAV antibody GMCs before and after the booster were statistically significant. The longer time interval (3 years instead of 2) between primary vaccination and booster administration did not seem to impact the magnitude of the booster response. The results of this study show that active post-exposure immunisation with only one dose of inactivated vaccine confers high and long-term protection and effectively controls viral hepatitis A outbreaks.

Adolescent↗

PubMed2006

Outbreaks of avian influenza H6N2 viruses in chickens arose by a reassortment of H6N8 and H9N2 ostrich viruses.

The first recorded outbreak of avian influenza (AI) in South African chickens (low pathogenicity H6N2) occurred at Camperdown, KwaZulu/Natal Province (KZN) in June 2002. To determine the source of the outbreak, we defined the phylogenetic relationships between various H6N2 isolates, and the previously unpublished gene sequences of an H6N8 virus isolated in 1998 from ostriches in the Leeu Gamka region (A/Ostrich/South Africa/KK98/98). We demonstrated that two distinct genetic H6N2 lineages (sub-lineages I and II) circulated in the Camperdown area, which later spread to other regions. Sub-lineages I and II shared a recent common H6N2 ancestor, which arose from a reassortment event between two South African ostrich isolates A/Ostrich/South Africa/9508103/95 and (H9N2) A/Ostrich/South Africa/KK98/98 (H6N8). Furthermore, the H6N2 sub-lineage I viruses had several molecular genetic markers including a 22-amino acid stalk deletion in the neuraminidase (NA) protein gene, a predicted increased N-glycosylation, and a D144 mutation of the HA protein gene, all of which are associated with the adaptation of AI viruses to chickens. The H6N2 NS1 and PB1 genes shared recent common ancestors with those of contemporary Asian HPAI H5N1 viruses. Our results suggest that ostriches are potential mixing vessels for avian influenza viruses (AIV) outbreak strains and support other reports that H6 viruses are capable of forming stable lineages in chickens.

Animals↗

PubMed2003

Barbecued chicken causing a multi-state outbreak of Campylobacter jejuni enteritis.

BACKGROUND: Although the microbiological safety of food has improved, food-borne disease remains a significant cause of morbidity and mortality in Europe. PATIENTS AND METHODS: We investigated an outbreak of Campylobacter jejuni enteritis attributed to chicken meat, affecting five out of six people attending a private barbecue party in Germany. Patients fell ill in Germany, in Liechtenstein and in Austria. 80% of the cases had been exposed to barbecued chicken; the case that denied having eaten chicken was the party host, who also handled all the food. Three of four patients submitting stool specimens had culture-confirmed C. jejuni infection. RESULTS: The chicken meat was purchased in the Tyrol (Austria) and originated from a flock of 55600 chickens raised in Carinthia (Austria). Caecal swabs were obtained in 7 weeks later from 22 chicken at the incriminated farm: 18 of the 22 samples yielded C. jejuni. The same day, six carcasses out of 22000 slaughtered animals from the incriminated farm were tested and all six food samples yielded C. jejuni. Outbreak-associated human isolates yielded pulsed-field gel electrophoresis patterns indistinguishable from each other and from the meat isolates, but different from four human control strains and from 13 of 16 isolates from caecal swabs. CONCLUSION: Our data show that the outbreak clone had been colonizing the slaughterhouse and was cross-contaminating chickens there. The geographic mobility of people and food necessitates proper epidemiologic investigations to avoid overestimation of the proportion of sporadic occurrence of campylobacteriosis.

Adult↗

PubMed2000

A waterborne outbreak of gastroenteritis in the Golan Heights due to enterotoxigenic Escherichia coli.

BACKGROUND: Over a period of 4 days between May 18-21, 1998, a multifocal outbreak of diarrhea, involving 175 Israel Defence Force soldiers and at least 54 civilians, occurred in the Golan Heights. PATIENTS AND METHODS: Stool samples from 40 affected soldiers were collected for microbiological testing. In addition, a rapid PCR technique was employed for the direct detection of the heat-labile (LT) and heat-stable toxin (ST) genes of enterotoxigenic Escherichia coli (ETEC) in stool samples. RESULTS: All 40 stool specimens taken from patients with diarrhea was negative by culture. However, ETEC was detected in 16 stool specimens using the rapid PCR method. The epidemiological investigation found no association between the food items consumed prior to the onset of the outbreak and the attack rate of diarrhea. A review of the water distribution system revealed that all affected military posts and civilian communities were supplied by a common water pipeline. Water sampled from various points along the distribution system showed inadequate chlorination and high concentrations of E. coli. CONCLUSION: This report suggests that the involvement of ETEC in the etiology of waterborne diarrheal outbreaks may be underestimated, probably due to the difficulties involved in the laboratory identification of this enteropathogen. Adoption of our rapid method for the identification of ETEC, which is applicable to routine diagnostic laboratories, facilitates pathogen detection within hours, and allows early intervention in cases of widespread diarrheal epidemics.

Bacterial Toxins↗

PubMed1978

Outbreak of toxoplasmosis in a family and documentation of acquired retinochoroiditis.

An outbreak of toxoplasmosis in one household is described. It demonstrates the potential for a common source infection with Toxoplasma gondii to cause multiple cases. Six of seven members of a household investigated for toxoplasmosis demonstrated high antibody titers consistent with recent infection; five of these members (83%) were symptomatic. The most common manifestations were fever and lymphadenopathy, which developed from seven to 18 days (mean 11 days) after a common source ingestion of infected meat. Since inadequately cooked lamb, pork and beef are probably the most common sources of infection in the United States, outbreaks of multiple cases may occur more frequently than is generally appreciated. As more outbreaks of febrile illnesses are examined, especially in families and closed communities, it is likely that more common source epidemics of toxoplasmosis will be recognized. Retinochoroiditis is an unusual manifestation of adult acquired toxoplasmosis. In the index case in this epidemic the patient manifested vision threatening retinochoroiditis 129 days after infection with toxoplasmosis. He represents the ninth well-documented case of toxoplasma retinochoroiditis associated with adult acquired disease.

Adolescent↗

PubMed1981

Outbreak of acute pulmonary histoplasmosis in members of a wagon train.

In August 1980, an outbreak of acute pulmonary histoplasmosis occurred among participants in a wagon train as it traveled through eastern Tennessee. Of the 85 people on the train 69 (81 percent) had evidence of infection with Histoplasma capsulatum. Fifty-four people had symptomatic disease. The source of infection was traced to the site of a former winter blackbird roost in Charleston, Tennessee, that had been partially cleared five years earlier to make a park. Fourteen of 25 soil samples from this site were culture-positive for H. capsulatum. This is the first reported outbreak to involve a large migrant group. The outbreak is unusual in that exposure occurred without excavation, construction or tree-cutting at the site.

Adult↗

PubMed1986

A hospital outbreak of cholera in Maputo, Mozambique.

We describe a hospital outbreak of cholera in a children's paediatric unit. The outbreak began explosively and continued for four months with spread from person to person within the diarrhoea isolation unit. Overcrowded and unhygienic conditions in this unit facilitated transmission. The organism was multiply drug-resistant, the same strain having been isolated in another outbreak in the paediatric unit seven months previously. A high case fatality rate of 30.0% was recorded in infants infected in hospital.

Adolescent↗