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PubMedDate not supplied

An outbreak of nosocomial cholera in a 755-bed hospital.

From 30 October to 7 December 1984, an outbreak of nosocomial cholera involving 11 cases of biotype El Tor, serotype Inaba, took place in a 755-bed hospital in southern Thailand. The outbreak occurred primarily among patients admitted with severe illness. Of the 11 cases, 7 were children and 4 were adults. Most cases had mild symptoms of cholera and no case died in this outbreak. The first 2 cases occurred sporadically with a subsequent cluster of cases showing an explosive pattern. A case-control study found that a history of receiving liquid tube-fed diet was significantly more common among cholera cases than their matched controls, but it could not be determined how the diet was contaminated with cholera. Cases were also significantly more likely than controls to be on oral antacid medication which could increase risk of infection by neutralizing gastric acidity. No additional cases occurred after extensive implementation of control measures.

Adolescent↗

PubMedDate not supplied

An outbreak of suspected water-borne epidemic non-A non-B hepatitis in northern Botswana with a high prevalence of hepatitis B carriers and hepatitis delta markers among patients.

From June to December 1985 273 cases of hepatitis and jaundice were diagnosed in Maun, northern Botswana. It was known before the outbreak that most adults were immune to hepatitis A virus, most had markers indicating past infection with hepatitis B virus (HBV), there was a mean prevalence of 13.6% (57/418) HBsAg carriers, and a proportion of people had antibodies to hepatitis delta virus (HDV). There was evidence that faecal contamination of water supplies preceded the outbreak; the epidemic curve suggested that there was a major common source of infection; the disease appeared to have affected 1-2% of the population; 90.3% (214/237) patients for whom information is available were aged 20 years or older; the disease was generally mild and affected pregnant women most severely. 49 patients were admitted to hospital and at least 4/273 died. There were prevalences of 47% (28/60) HBsAg and 69% (37/54) anti-HDV reactors among patients bled 1-43 d after the onset of illness. The main features of the outbreak conformed to published descriptions of water-borne epidemic non-A non-B hepatitis and it is postulated that the disease was most severe in patients with active HBV infection and in those with HDV superinfection, so that such patients were disproportionately represented amongst those seeking medical attention.

Adolescent↗

PubMedDate not supplied

An outbreak of trichinosis in Lebanon.

In 1982 an outbreak of trichinosis occurred in an area of south Lebanon consisting of 4 villages, including 6440 persons. In 267 households, involving 2456 persons, typical clinical signs of Trichinella spiralis infection could be recognized among household members. Twenty-one of these households, including 193 persons, were randomly chosen for further studies. Nearly half of the household members (46%) had clinical symptoms consistent with acute trichinosis. 12 of 16 tested persons had high anti-Trichinella antibody titres (12 positive by indirect immunofluorescence (IIF) and 11 by enzyme-linked immunosorbent assay). Class-specific antibodies, IIF-immunoglobulin (Ig) G, IgM and IgA, were detected in most tested cases. Of the remaining 4 seronegative cases, 3 had a duration of clinical symptoms < or = 12 d. High peripheral eosinophilic counts (> 20%) were noted in 8 of 16 cases. In total, 15 of 16 cases were positive by one or more of these tests. The outbreak constituted one of the most extensive single outbreaks reported with a calculated > 1000 clinical cases. The cause was attributed to consumption of raw pork meat, an ingredient of kebbeh nayyeh, a favourite Lebanese dish.

Adolescent↗

PubMedDate not supplied

Poliomyelitis outbreak in Natal/KwaZulu, South Africa, 1987-1988. 2. Immunity aspects.

An extensive poliomyelitis outbreak due to type 1 poliovirus took place in Natal/KwaZulu, South Africa, in 1987-1988, causing 412 paralytic cases. This epidemic differed from a previously described outbreak in Gazankulu, South Africa, in 1982 in that it occurred against a background of relatively good immunity. Thus, only 12% of patients lacked antibodies to types 2 and 3, indicating lack of previous immunization, and 76% of healthy children sampled in the epidemic area had serological immunity to all 3 types of poliovirus. The occurrence of extensive outbreaks in relatively well-immunized communities emphasizes the need to maximize herd immunity and reduce reservoirs of infection in the gut and in the environment, which can be achieved only with oral polio vaccine.

Antibodies, Viral↗

PubMed1992

Parvovirus B19 outbreak in a children's ward.

Parvovirus B19 infection can cause severe complications in pregnant women, individuals with haemolytic anaemia, and those who are immunocompromised. In a hospital outbreak of this infection, a balance should be struck between protection of these individuals and the maintenance of medical services. The index case of an outbreak of parvovirus B19 infection among staff and patients of a paediatric ward was not identified. 58 members of staff were screened for B19 markers and 4 of the 6 susceptible men and 6 of the 24 susceptible women became infected (p = 0.05) as defined by serum IgM and viraemia. 1 of the 11 adults (10 members of staff and 1 parent) infected remained symptom-free. 12 immunocompromised patients were also assessed, and symptom-free infection developed in 2 of these. During the outbreak staff with symptoms were put on sick leave, immunocompromised patients (there were none with haemolytic anaemia) were given normal human immunoglobulin and nursed in single rooms by B19 IgG-positive, IgM-negative staff, and the ward was closed to B19 IgG-negative pregnant women. However, the limitation of spread of infection cannot be attributed with certainty to the measures taken.

Adult↗

PubMed1996

Serological and molecular analysis of serotype O foot-and-mouth disease virus isolated from disease outbreaks in India during 1987-91.

Foot-and-mouth disease virus (FMDV) type O outbreaks have been reported frequently in vaccinated cattle in India. Twenty-five field isolates, recovered from outbreaks in vaccinated and unvaccinated cattle between 1987 and 1991, were analyzed in relation to the vaccine strain (R2/75) by complement fixation, serum neutralization and partial nucleotide sequencing of the VP1 gene. These sequences were compared with the viral sequences in GenEMBL database. Although the Indian type O viruses were close to the European type O1 viruses, they constituted a separate group of type O FMDVs. One of the field viruses, isolated from an outbreak in vaccinated cattle and designated as BAK/90, showed significant serological and nucleotide sequence variations from the vaccine strain. Phylogenetic analysis showed that the BAK/90 and R2/75 viruses belong to separate subgroups. The other isolates were found to be serologically related to both the BAK/90 and the vaccine strain. The BAK/90 strain gave broader antigenic coverage, showed better immunogenicity, and yielded larger amounts of 146S particles in suspension cultures as compared with R2/75. Taken together, these results favour inclusion of the BAK/90 strain in the vaccine to provide adequate protection against the field variants of type O FMDV currently circulating in India.

Amino Acid Sequence↗

PubMed1987

An outbreak of Salmonella typhimurium gastroenteritis in a psychiatric hospital.

An outbreak of Salmonella typhimurium (phage type 12) infection involving 11 patients and 12 members of staff occurred in a psychiatric hospital in Merseyside during a 3-week period in September and October 1984. Bacteraemia did not occur in any patients, those affected having a mild self-limiting diarrhoea. The source of the organism remained unknown but the most probable means of transmission was by person to person contact. The outbreak was controlled by transferring affected patients to an isolation ward. Staff were encouraged to report gastrointestinal symptoms and remain off work until symptom free or until the results of cultures were known. The problems of managing the outbreak are discussed.

Cross Infection↗

PubMed1988

How to deal with a hospital outbreak of Legionnaires' disease.

The outbreak of Legionnaires' disease in Glasgow Royal Infirmary is discussed together with the problems such an outbreak poses to the microbiologist. The importance of early diagnosis is stressed. The outbreak was managed by a team drawn up from various disciplines within the hospital. Frank daily reports to the press, together with regular staff meetings with staff representatives helped to allay public anxiety. The subsequent maintenance and monitoring of the wet cooling tower required for the hospital ventilation system have resulted in considerable additional work for the microbiology department but especially for the hospital engineers.

Bacteriological Techniques↗

PubMed1989

An outbreak of acinetobacter septicaemia in a neonatal intensive care unit.

We describe an outbreak of Gram-negative septicaemia due to a rare, non-fermenting, aerobic organism, Acinetobacter calcoaceticus var. lwoffi. The outbreak occurred on a neonatal unit and was confined to babies who were receiving parenteral nutrition. Seven babies developed septicaemia within 24 hours. The source of the outbreak was never firmly established, but contamination of the parenteral nutrition fluid was considered most likely. All 7 babies recovered uneventfully after a week's course of intravenous ceftazidime. Thrombocytopenia was an unexpected feature of this infection.

Acinetobacter Infections↗

PubMed1991

An outbreak of Salmonella urbana infection in neonatal nurseries.

An outbreak of neonatal infection with Salmonella urbana in three neonatal wards of a teaching hospital in Bangkok, Thailand is described. The outbreak lasted for 5 days. Fifty-seven neonates had gastrointestinal infection, 37 had diarrhoea, and three had bacteraemia. The attack rates were 43% for infection, 29% for diarrhoea, and 2.3% for bacteraemia. Epidemiological evaluation suggested that a contaminated wash basin in the labour nursery was the source of infection. Delay in controlling this outbreak occurred because the staff assumed that person-to-person transmission was the mode of spread, thus ignoring epidemiological data that would have led to the identification of the source of infection.

Cross Infection↗

PubMed1991

Use of ciprofloxacin to control a Salmonella outbreak in a long-stay psychiatric hospital.

An outbreak of diarrhoea due to Salmonella virchow phage type 8 occurred in a major block of a large psychiatric hospital. The two other major blocks of the hospital remained unaffected. No source of infection was identified and the epidemiological investigations pointed to cross-infection as the mode of transmission. Infection control measures were implemented at an early stage but a total of 55 patients and four members of staff were affected. The disease was self-limiting and of short duration. During the course of the outbreak, Salmonella typhimurium phage type 66 also emerged as a pathogen and was isolated from the stools of symptomatic cases with diarrhoea. Owing to the size of the hospital, the lack of facilities for infection control, the nature of the patients' illnesses and an increasing number of affected patients, it was decided to treat all symptomatic and asymptomatic patients with oral ciprofloxacin 500 mg twice daily for 7 days. A quantitative stool culture for salmonellae was undertaken on days 3, 7, 10, 30, 60 and 90 from the start of treatment. All patients' and staff's stool cultures became negative on day 7 and remained negative for a period of 6 months during follow-up. We conclude that cross-infection outbreaks due to Salmonella spp. in psychiatric and geriatric hospitals can be controlled by isolation in a designated ward and supportive therapy, together with ciprofloxacin treatment.

Adult↗

PubMed1992

An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit.

An outbreak of infection due to Staphylococcus aureus phage-type 52, resistant only to penicillin, occurred in children's wards primarily in a neonatal intensive care unit. The outbreak involved 86 infants; the majority presented with conjunctivitis, wound infections, boils, omphalitis and otitis externa. Seven per cent of these infants (six of 86) also had septicaemia. In addition, 6% (five of 86) were colonized by this phage type and the most common site of carriage was the umbilicus. The outbreak was contained by eradication of nasal carriage among the staff members and also by standard infection control measures.

Bacteriophage Typing↗

PubMed1992

Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks.

During a 3-week period, nine babies in the neonatal unit of a large teaching hospital in Durban were infected or colonized with Klebsiella pneumoniae resistant to a range of antimicrobial agents including amikacin and cefotaxime. Resistance to cefotaxime was reduced by clavulanic acid in vitro suggesting production of extended-spectrum beta-lactamase activity. All the isolates had the same antibiotic resistance profile, belonged to the same serotype (K17), were non-typable with bacteriophages, and had identical plasmid profiles indicating that they belonged to the same strain. During a 1-day microbiological survey of the ward, the outbreak strain was isolated from the nose and hands of a doctor based in the nursery and from the hands of a nurse and the mother of an infected baby. The strain was also isolated from nine of 67 environmental samples. Investigation revealed that infection control practices which had been instituted following a previous outbreak in the nursery with multi-resistant methicillin-resistant Staphylococcus aureus (MRSA) were not being adhered to. The re-introduction and strict enforcement of these procedures under the supervision of an Infection Control Nurse resulted in the abrupt end of the outbreak.

Amikacin↗

PubMed1992

Outbreak of Mycoplasma pneumoniae infection among hospital personnel studied by a nucleic acid hybridization test.

An outbreak of Mycoplasma pneumoniae (MP) infection occurred during the period March-May 1989 among the personnel of the Accident and Emergency Department of the Kuopio University Hospital, Kuopio, Finland. The index patient was a young male orderly, who fell ill with severe pneumonia. His tracheal mucus sample proved to be strongly positive for MP when tested by a commercial DNA-RNA hybridization test (Gen-Probe). After the index patient two additional staff members (an orderly and a nurse) fell ill with pneumonia and 66 others showed symptoms of upper respiratory infection or fever. The most frequent symptoms were a sore throat, a cough, rhinitis and headaches. All 97 employees of the department were tested for the presence of MP in April-May 1989 using throat swabs as test material. Forty-three (44%) were found to be positive for MP by the 'Gen-Probe' test. Eight (19%) of the MP positive staff were completely asymptomatic. The MP positive staff were retested about 3 weeks later, whereupon 40 (93%) had become negative. Most of the persons involved in this outbreak suffered only from mild respiratory symptoms, suggesting that MP outbreaks like the present one may easily pass unnoticed.

Adult↗

PubMed1994

Outbreak of gentamicin, ciprofloxacin-resistant Pseudomonas aeruginosa in an intensive care unit, traced to contaminated quivers.

An outbreak of gentamicin, ciprofloxacin-resistant Pseudomonas aeruginosa in an intensive care unit, was investigated. The majority of isolates were from sputum and the organism was not isolated from any other patient in the hospital, except those admitted to the unit. A prospective study was set up, and the organism was found to be associated with contaminated quivers, used to store suction tubing between use on ventilated patients. Once the quivers were disinfected and changed between patients daily, the outbreak stopped. Suction of ventilated patients may be an important source of contamination of the respiratory tract with nosocomial pathogens. It is important that infection control teams regularly review procedures to ensure the correct practices are being followed, so that nosocomial outbreaks of infection may be prevented.

Ciprofloxacin↗

PubMed1994

Investigation of contaminated parenteral nutrition fluids associated with an outbreak of Serratia odorifera septicaemia.

An outbreak of fatal septicaemia caused by Serratia odorifera biotype 1 involved infants at several hospitals; the common vehicle of infection was contaminated parenteral nutrition fluid. The transfusate had been made up in a flexible film isolator system. The implicated organism was recovered from surfaces inside the isolator, despite routine decontamination procedures having been carried out shortly before. Our investigation into the origin of contamination revealed several shortcomings in the infusate compounding process. We noted deficiencies in cleaning and decontamination procedures, and in storage and sterility testing policies, but the origin and mechanism of the contamination were unclear. Withdrawal of parenteral nutrition products and revision of decontamination procedures terminated the outbreak. The efficacy of peracetic acid treatment of flexible film isolators, given the circumstances of this outbreak, may need further investigation. Regular training and assessment of admixture technicians is important.

Bacteremia↗

PubMed1993

A Flavobacterium meningosepticum outbreak among intensive care patients.

A Flavobacterium meningosepticum outbreak, involving 12 infected and 47 colonized intensive care patients during the months of February through July 1990, was investigated. F. meningosepticum was isolated from tap water and ice, but these environmental strains eventually proved to be distinct from those colonizing patients. A review of newly colonized patients' charts revealed that a common factor among the patients was daily changes of ventilator tubing pasteurized in the hospital's central sterile department. More than 90% of patients in the outbreak had been on ventilators that used the pasteurized tubing. An investigation of the pasteurization process found that two pasteurizer tanks had been operating at suboptimal temperatures (< 62 degrees C). Cultures of water from the tanks and droplets of water found in the pasteurized tubing grew species of Acinetobacter, Moraxella, and Pseudomonas but did not grow F. meningosepticum. After deficiencies in the pasteurization process were corrected, the outbreak terminated. Despite the failure to culture F. meningosepticum, an analysis of gram-negative bacillary isolates showed that the deficiency in the pasteurization process was a major contributor to colonization of ventilated patients by bacteria ubiquitous in tap water.

Central Supply, Hospital↗

PubMed1995

Pseudomonas aeruginosa outbreak in a neonatal intensive care unit: a possible link to contaminated hand lotion.

This article describes a prolonged outbreak of Pseudomonas aeruginosa. The attack rate of this outbreak was 8.5%, with no associated mortality. Hand lotion contaminated with P. aeruginosa was implicated in the transmission of organisms; removal of this hand lotion ended the outbreak. Contaminated hand lotion applied to clean hands of health care workers may have led to direct inoculation of infants at high risk for infection.

Cross Infection↗