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PubMed2004

[Legionella pneumophila pneumonia community epidemic outbreak in Barcelona: "The Barceloneta outbreak". Effect on the early diagnosis and treatment].

OBJECTIVE: Clinical and microbiological descriptive analysis of the outbreak of community legionnaire's disease recorded in the Barcelona's Barcelonesa neighborhood in November 2000. PATIENTS AND METHODS: Retrospective review of the epidemiological and clinical manifestations, as well as the evolution of the cases of Legionella pneumophila pneumonia associated with the outbreak and cared of in the Hospital del Mar. RESULTS: The 48 patients evaluated, all of them with confirmed diagnoses, represent 89% of the cases communicated. Seventy-five percent of patients showed some underlying disease, 54% had some criterion for severity, and mortality was 4%. In 81% of cases the detection of the antigen of Legionella pneumophila in urine was the diagnostic method. CONCLUSIONS: The detection in urine of the Legionella pneumophila antigen makes possible the early diagnosis of legionnaire's disease, particularly in epidemic outbreaks, which that facilitates the fast establishment of the adequate treatment and contributes to the reduction in mortality even in patients of high risk.

Adult↗
PubMed2000

Legionnaires' disease outbreak: Victoria's largest identified outbreak.

This paper describes and analyses some aspects of an outbreak of Legionnaires' disease in Victoria, commencing in late October 1998. In all, 18 cases caused by Legionella pneumophila serogroup 1 were notified within 10 days making this the largest outbreak in Victoria reported to that date. All cases had epidemiological links to an industrial estate in a northern Melbourne suburb. Extensive environmental sampling revealed Legionella bacteria in five cooling towers. Molecular sub-typing techniques were used to compare clinical and environmental isolates. Isolates from one tower had a pulsed-field gel electrophoresis pattern that was indistinguishable from clinical isolates from eight cases. Control of outbreaks caused by Legionella bacteria requires rapid, coordinated responses to linked cases of disease. The Legionella urinary antigen test facilitated a rapid public health response, and culture and molecular sub-typing of clinical specimens assisted in developing epidemiological links.

Adult↗
PubMed2000

An outbreak of hepatitis B associated with reusable subdermal electroencephalogram electrodes. Hepatitis B Outbreak Investigation Team.

BACKGROUND: In early 1996 an outbreak of hepatitis B was detected among patients who attended an electroencephalogram (EEG) clinic in Toronto operated by a neurologist. In this article we report the results of an investigation conducted to determine the extent and source of the outbreak. METHODS: Notifications were sent to 18 567 patients who had attended any of 6 EEG clinics operated by the neurologist between 1990 and 1996 asking them to see their physician to be tested for hepatitis B virus (HBV) infection; 2957 envelopes were returned. Of the remaining 15 610 patients, results of laboratory tests were available for 10 244 (65.6%). A detailed follow-up of patients with newly acquired hepatitis B and those with chronic infection (carriers) was conducted. Viral DNA sequencing was used to compare strains of available HBV isolates. RESULTS: A total of 75 patients were identified in whom hepatitis B developed between 1991 and 1996; all of them had had at least one EEG performed in which reusable subdermal electrodes had been used. No cases were detected among patients who participated only in sleep studies, for which disk electrodes had been used. The peak rate of HBV infection (18.2 cases per 1000 person-EEGs) occurred in 1995. One technician performed all of the EEGs at the clinics and was found to be positive for hepatitis B e antigen. DNA sequencing confirmed that the virus isolated from the technician was identical to the virus isolated in 4 cases of hepatitis B tested. Infection control procedures were found to be inadequate. INTERPRETATION: The hepatitis B outbreak was a result of a common source of infection, the technologist, and inadequate infection control practices. Reusable subdermal EEG electrodes were the likely vehicles of transmission. Health care workers should follow recommended infection control practices and be vaccinated against hepatitis B.

Cross Infection↗
PubMed2004

Syndrome and outbreak detection using chief-complaint data--experience of the Real-Time Outbreak and Disease Surveillance project.

This paper summarizes the experience of the Real-Time Outbreak and Disease Surveillance (RODS) project in collecting and analyzing free-text emergency department (ED) chief complaints. The technical approach involves real-time transmission of chief-complaint data as Health Level 7 messages from hospitals to a regional data center, where a Bayesian text classifier assigns each chief complaint to one of eight syndrome categories. Time-series algorithms analyze the syndrome data and generate alerts. Authorized public health users review the syndrome data by using Internet interfaces with timelines and maps. Deployments in Pennsylvania, Utah, Atlantic City, and Ohio have demonstrated feasibility of real-time collection of chief complaints. Retrospective experiments that measured case-classification accuracy demonstrated that the Bayesian classifier can discriminate between different syndrome presentations. Retrospective experiments that measured outbreak-detection accuracy determined that the classifier's performance was adequate to support accurate and timely detection of seasonal disease outbreaks. Prospective evaluation revealed that a cluster of carbon monoxide exposures was detected by RODS within 4 hours of the presentation of the first case to an emergency department.

Algorithms↗
PubMed1970

An airborne outbreak of smallpox in a German hospital and its significance with respect to other recent outbreaks in Europe.

Since 1960, smallpox has been introduced into 10 European countries on 28 separate occasions. Most commonly, the index case was infected in Asia and returned to Europe by air during the period December-May. Subsequent cases have occurred mainly among persons exposed by direct, face-to-face, contact in the household or hospital. Medical and hospital personnel, patients and visitors constituted approximately half of all cases in these outbreaks.In a recent outbreak in Meschede, Federal Republic of Germany, detailed epidemiological studies have clearly indicated that 17 of the cases were infected by virus particles disseminated by air over a considerable distance within a single hospital building. Several features believed to be of importance in this unusual pattern of transmission were common to a similar outbreak in the Federal Republic of Germany in 1961 in which airborne transmission also occurred. These features include a source case with extensive rash and cough, low relative humidity in the hospital and air currents which caused rapid dissemination of the virus. While airborne transmission of this sort is rarely observed in smallpox outbreak, it is important to recognize that it may occur under certain circumstances.Proper vaccination of travellers prior to their departure from their native countries and a regular programme for vaccination of medical and hospital personnel could have prevented at least half of the cases which occurred in Europe during the past decade. Although progress in the global smallpox eradication programme has been accompanied by a decreased frequency of importations into Europe, no country should relax its vigilance until smallpox has been eliminated everywhere.

Adolescent↗
PubMed2004

An outbreak of measles among unvaccinated young adults and measles seroprevalence study: implications for measles outbreak control in adult populations.

Measles incidence has declined significantly in the United States since the 1989-1991 resurgence. Several conditions, including pockets of underimmunization, international importation, and the inability to rapidly detect and contain cases, represent potential threats to this success. During the 1995-1996 winter holiday season, the Minnesota Department of Health investigated an outbreak of measles among unvaccinated young adults affiliated with a religious community. A total of 26 outbreak-associated cases of measles were identified; most case patients (65%) were 20-29 years of age (range, 18 months to 35 years). Although case patients had multiple opportunities to expose the general public, no subsequent transmission was identified despite extensive surveillance efforts. A measles seroprevalence survey of 508 Minnesota blood donors aged 20-39 years was conducted; 91% had serological evidence of immunity to measles. Our findings illustrate that high levels of population immunity can prevent transmission of measles, despite multiple opportunities for exposure.

Adolescent↗
PubMed1998

An outbreak of cyclosporiasis in Florida in 1995: a harbinger of multistate outbreaks in 1996 and 1997.

Before 1995, only one outbreak of cyclosporiasis had been reported in the United States. To identify risk factors for Cyclospora infection acquired in Florida in 1995, we conducted a matched case-control study (24 sporadic cases and 69 controls) and retrospective cohort studies of clusters of cases associated with two May social events (attack rates = 15.4% [8 of 52] and 54.5% [6 of 11]). In univariate analysis of data from the case-control study, consumption of fresh raspberries (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 1.1-31.7) and bare-handed contact with soil (OR = 5.4, 95% CI = 1.4-20.7) were associated with infection; soil contact was also implicated in multivariate analysis. For the events, mixed-fruit items that had only fresh raspberries and strawberries in common had elevated relative risks (3.7 and 4.2), but the confidence intervals overlapped 1.0. The raspberries eaten at the events and by sporadic case-patients were imported. Given the cumulative evidence of the three studies and the occurrence in 1996 and 1997 of outbreaks in North America associated with consumption of Guatemalan raspberries, food-borne transmission of Cyclospora was likely in 1995 in Florida as well.

Adolescent↗
PubMed1998

Molecular characterisation of Cryptosporidium parvum from two large suspected waterborne outbreaks. Outbreak Control Team South and West Devon 1995, Incident Management Team and Further Epidemiological and Microbiological Studies Subgroup North Thames 1997.

Polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) analysis of the Cryptosporidium parvum outer wall protein (COWP) gene was applied to specimens collected from 95 patients with cryptosporidiosis associated with two suspected waterborne outbreaks, 46 sporadic human cases and 62 infected livestock from other areas, and 12 patients infected with other gastrointestinal parasites. Ninety-six per cent of C. parvum isolates from patients linked to the two suspected waterborne outbreaks were of genotype 1; all the isolates from livestock were of genotype 2. Isolates from 59% of the sporadic human infections were of genotype 1 and 35% were of genotype 2. Specimens from two patients yielded both genotypes. Specimens from patients infected with other parasites yielded no amplicons.

Animals↗
PubMed2005

Are bark beetle outbreaks less synchronous than forest Lepidoptera outbreaks?

Comparisons of intraspecific spatial synchrony across multiple epidemic insect species can be useful for generating hypotheses about major determinants of population patterns at larger scales. The present study compares patterns of spatial synchrony in outbreaks of six epidemic bark beetle species in North America and Europe. Spatial synchrony among populations of the Eurasian spruce bark beetle Ips typographus was significantly higher than for the other bark beetle species. The spatial synchrony observed in epidemic bark beetles was also compared with previously published patterns of synchrony in outbreaks of defoliating forest Lepidoptera, revealing a marked difference between these two major insect groups. The bark beetles exhibited a generally lower degree of spatial synchrony than the Lepidoptera, possibly because bark beetles are synchronized by different weather variables that are acting on a smaller scale than those affecting the Lepidoptera, or because inherent differences in their dynamics leads to more cyclic oscillations and more synchronous spatial dynamics in the Lepidoptera.

Animals↗
PubMed1985

A rubella outbreak among dental students: description of the outbreak and analysis of control measures.

From February to April 1982, rubella was diagnosed in 17 Washington University dental students. The affected students represented 4.8% of all dental students and 21% of susceptible students. Because a high likelihood of rubella transmission was perceived, three adjacent university hospitals undertook an emergency program to ensure immunity to rubella in all personnel. The program reached 84.6% of all target personnel, but only 36% of physicians (p less than 0.001). We estimated that the program increased the level of rubella immunity from 92.2% to 98.1%, at a total cost of $140,274 of which $29,990 was in excess of ordinary expenditures. Our experience indicates that schools training health professionals face the possibility of rubella outbreaks unless they ensure rubella immunity in all students. The experience also supports the value of ongoing programs to ensure rubella immunity in hospital personnel. Without such programs, hospitals may be forced to undertake emergency programs that are likely to be disruptive and expensive and may have relatively little immediate measurable impact.

Antibodies, Viral↗
PubMed1996

An outbreak of hepatitis A associated with a bakery, New York, 1994: the 1968 "West Branch, Michigan' outbreak repeated.

In a community hepatitis A outbreak in the Rochester, New York area, 64 of 79 (81%) people with anti-hepatitis A IgM-antibodies and onset of symptoms from 9 April-31 May 1994, recalled eating food obtained from a retail buyer's club. Eleven (65%) of 17 households with cases contained club members compared with 7 (21%) of 34 neighbourhood-matched control-households (matched odds ratio 8.5; 95% CI 1.7-41.6). Club employees who ate sugar-glazed baked goods were at fourfold increased risk for hepatitis. The source of infection was an IgM-positive baker who contaminated baked goods while applying sugar glaze. Computer-generated purchase lists implicated 11-12 March and 21-24 March as the most likely dates when contamination occurred. This investigation demonstrates the importance of food workers adhering to established hygiene practices. Computer-generated commercial datasets can be useful in epidemiologic investigations.

Adolescent↗
PubMed2000

Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group.

From April through June 1997, 29 previously healthy children aged <6 years (median, 1.5 years) in Sarawak, Malaysia, died of rapidly progressive cardiorespiratory failure during an outbreak of hand, foot, and mouth disease caused primarily by enterovirus 71 (EV71). The case children were hospitalized after a short illness (median duration, 2 days) that usually included fever (in 100% of case children), oral ulcers (66%), and extremity rashes (62%). The illness rapidly progressed to include seizures (28%), flaccid limb weakness (17%), or cardiopulmonary symptoms (of 24 children, 17 had chest radiographs showing pulmonary edema, and 24 had echocardiograms showing left ventricular dysfunction), resulting in cardiopulmonary arrest soon after hospitalization (median time, 9 h). Cardiac tissue from 10 patients showed normal myocardium, but central nervous system tissue from 5 patients showed inflammatory changes. Brain-stem specimens from 2 patients were available, and both specimens showed extensive neuronal degeneration, inflammation, and necrosis, suggesting that a central nervous system infection was responsible for the disease, with the cardiopulmonary dysfunction being neurogenic in origin. EV71 and possibly an adenovirus, other enteroviruses, or unknown cofactors are likely responsible for this rapidly fatal disease.

Antigens, Viral↗
PubMed1991

[Food-borne outbreak of gastroenteritis caused by small round structured virus. 2. An outbreak associated with bakery product consumption].

In December 1989, an outbreak of gastroenteritis associated with cake consumption occurred in a day-care center with 60 children and 12 staff in Saitama prefecture. Children were served cakes at the Christmas party held in the day-care center and ate them with their families. Thirty-three of the 59 children (56%), 16 of the 74 families (22%) and 1 of the 10 staff (10%) eating the cakes became ill. Illness consisted primarily of nausea, vomiting, diarrhea and fever; the median incubation period was 31 hours. Bacteriological analysis of stool specimens did not reveal a causative agent. Small round structured viruses (SRSV) were detected in fecal specimens from 10 of the 17 ill children (59%) and 2 of the 6 ill families (33%) by electron microscopy. Cakes were purchased from a bakery where an employee who prepared the cake denied symptoms, and SRSV was not detected in the fecal specimen from the employee. Thus, it was not determined that the cake was contaminated by a food handler.

Adolescent↗
PubMed2004

Phylogenetic relationships among virulent Newcastle disease virus isolates from the 2002-2003 outbreak in California and other recent outbreaks in North America.

Isolates from the 2002-2003 virulent Newcastle disease virus (v-NDV) outbreak in southern California, Nevada, Arizona, and Texas in the United States were compared to each other along with recent v-NDV isolates from Mexico and Central America and reference avian paramyxovirus type 1 strains. Nucleotide sequencing and phylogenetic analyses were conducted on a 1,195-base genomic segment composing the 3' region of the matrix (M) protein gene and a 5' portion of the fusion (F) protein gene including the M-F intergenic region. This encompasses coding sequences for the nuclear localization signal of the M protein and the F protein cleavage activation site. A dibasic amino acid motif was present at the predicted F protein cleavage activation site in all v-NDVs, including the California 2002-2003, Arizona, Nevada, Texas, Mexico, and Central America isolates. Phylogenetic analyses demonstrated that the California 2002-2003, Arizona, Nevada, and Texas viruses were most closely related to isolates from Mexico and Central America. An isolate from Texas obtained during 2003 appeared to represent a separate introduction of v-NDV into the United States, as this virus was even more closely related to the Mexico 2000 isolates than the California, Arizona, and Nevada viruses. The close phylogenetic relationship between the recent 2002-2003 U.S. v-NDV isolates and those viruses from countries geographically close to the United States warrants continued surveillance of commercial and noncommercial poultry for early detection of highly virulent NDV.

Amino Acid Motifs↗
PubMed2000

Compliance with advice to boil drinking water during an outbreak of cryptosporidiosis. Outbreak Investigation Team.

All 2000 employees of a hospital in an area of the North Thames region where 300,000 households were advised to boil tap water before consumption during a large outbreak of cryptosporidiosis were surveyed about compliance with and adverse events linked to the boil water notice. Eighty-five per cent (408/479) of respondents who lived in the boil water area said that they used boiled water while the notice was in place, 72% (347) used bottled water, and 12% (59) did not continue to boil water for the whole 16 days. Although 88% believed that they were following the advice, 20% washed food that would be eaten raw in unboiled tap water and 57% used it to clean their teeth. If a boil water notice is applied for more than a few days it may be helpful to issue a detailed follow up letter.

Cryptosporidiosis↗