Showing papers on "Outbreak published in 1982"

Epidemiology of Nosocomial Infections Caused by Methicillin-Resistant Staphylococcus aureus

Abstract: Outbreaks of hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus are being recognized with increasing frequency in the United States. Two thirds of outbreaks have been centered in critical care units. Infected and colonized inpatients appear to be the major institutional reservoir, and transient carriage on the hands of hospital personnel appears to be the most important mechanism of serial patient-to-patient transmission. In over 85% of hospitals into which they have been introduced, methicillin-resistant strains of S. aureus have become established as endemic nosocomial pathogens. A program designed to control a widespread outbreak in a university hospital used three surveillance methods to identify the major institutional reservoir of colonized and infected inpatients. Daily clinical laboratory surveillance, monthly prospective microbiology surveys of high-risk inpatients, and the recognition of previously infected 38%, 31%, and 31% of new cases, respectively. After control measures were instituted, the prevalence (p less than 0.001) and the number of acquisitions (p less than 0.002) of methicillin-resistant S. aureus declined over a 12-month period.

The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis.

Abstract: Records of 642 outbreaks of acute gastroenteritis were reviewed to determine the proportion of outbreaks that were clinically and epidemiologically consistent with Norwalk-like virus infection. Using as our criteria stool cultures negative for bacterial pathogens, mean (or median) duration of illness 12-60 hours, vomiting in greater than or equal to 50 per cent of cases, and, if known, mean (or median) incubation period of 24-48 hours, we found that 23 per cent of waterborne outbreaks, 4 per cent of foodborne outbreaks, and 67 per cent, 60 per cent, and 28 per cent of outbreaks in nursing homes, in summer camps, and on cruise ships, respectively, satisfied the criteria for Norwalk-like pattern. Of 54 outbreaks that satisfied the criteria for Norwalk-like pattern, 14 were investigated for virus etiology. Ten of these (71 per cent) yielded serologic evidence of Norwalk-like virus infection. Norwalk-like viruses are probably an important cause of outbreaks of acute gastroenteritis. Investigation for Norwalk virus antibody in outbreaks that are clinically and epidemiologically consistent with Norwalk-like virus infection is likely to yield diagnostically useful results.

Endemic cholera in rural bangladesh, 1966–1980

Abstract: Since 1963, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), formerly the Cholera Research Laboratory, has maintained a field station in Matlab to treat patients from a surveillance population of 240,000 who have cholera and other diarrheal diseases. Since 1966, the authors have analyzed hospital records of 7141 surveillance-area patients culture-positive for v. cholerae 01 to relate the seasonality, age and sex distribution, and geographic trends with hypotheses concerning transmission, immunity, and risk groups. From this review, they have found that: 1) children 2-9 years old and adult women are most commonly hospitalized for cholera; 2) V. cholerae 01 emerges simultaneously throughout the area of surveillance, with the early cases being of different phage types; 3) three patients were hospitalized twice for cholera compared with 29 expected on the basis of life-table analysis (p less than 0.01), suggesting that immunity to severe disease conferred by previous illness may be stable and long-lasting; 4) no constant relationship was found between the times of onset or peaks of the yearly cholera epidemic and the times of onset or peaks of the monsoon rains or river water levels; and 5) an outbreak of multiply antibiotic-resistant V. cholerae 01 infection documented in 1979 raises questions about the dissemination of resistance plasmids, antibiotic-use patterns, and the need for other drugs in addition to tetracycline. While little progress has been made in understanding the mode of transmission of v. cholerae 01, and in identifying practices for prevention, fluid therapy in this area has decreased the case fatality rate significantly and provides guidance for similar programs elsewhere.

Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis.

Abstract: Outbreaks of Norwalk gastroenteritis, which may involve persons of all ages, occur during all seasons and in various locations. Waterborne, foodborne, and person-to-person modes of transmission have been described, and secondary person-to-person transmission is common. Outbreaks generally end in about 1 week; longer outbreaks occur only when new groups of susceptible persons are introduced, usually in the setting of a persistent common source of infection. The illness is generally mild and characterized by nausea, vomiting, diarrhea, and abdominal cramps. Vomiting is the predominant symptom among children, whereas diarrhea is commoner among adults. Forty-two percent of 74 outbreaks of acute nonbacterial gastroenteritis investigated by the Centers for Disease Control from 1976 to 1980 were attributed to the Norwalk virus. The rest resembled Norwalk outbreaks clinically and epidemiologically and were probably caused by 27-nm viral agents similar to the Norwalk virus.

Risk Factors for Disseminated or Fatal Histoplasmosis: Analysis of a Large Urban Outbreak

Abstract: An outbreak of histoplasmosis in Indianapolis involving 488 clinically recognized cases including 60 patients with disseminated or fatal infection permitted statistical analysis of risk factors. Being male, white, under 5 years of age, having chronic obstructive lung disease, and living near the presumed source of the outbreak were not risk factors for fatal or disseminated histoplasmosis. Age greater than 54 years and immunosuppression were the only risk factors for disseminated or fatal infection. Dissemination should be excluded in patients with histoplasmosis who are immunosuppressed or older than 54 years. Specific antifungal treatment is more likely to be required in those two groups rather than in patients without risk factors.

Listeriosis in Renal Transplant Recipients: Report of an Outbreak and Review of 102 Cases

Abstract: We observed six renal transplant recipients with listeriosis during a 10-week period in the autumn of 1979. Investigation of this outbreak established that the first four cases wer close contacts, all infected by Listeria monocytogenes serotype 1b. The source of infection and route of spread were not identified. A total of 102 renal transplant recipients with listeriosis have now been reported. The major manifestation of disease was meningitis in 50% of the patients, parenchymal disease of the central nervous system in 10%, both meningitis and parenchymal disease of the central nervous system in 9%, and primary bacteremia in 30%. The overall mortality rate was 26%. Pneumonia due to L. monocytogenes, a previously neglected finding, was present in seven patients (7%); five of the seven died. The route of transmission may sometimes be respiratory. Special techniques for isolation of L. monocytogenes from sputum are usually required but not complicated. We recommend that individual renal transplant patients with listeriosis be cared for with secretion and excretion precautions and that they be treated with ampicillin and gentamicin. We advocate the serotyping of all isolates and a careful case-control analysis of all epidemics, but we do not support the use of serologic testing or surveillance cultures.

An Outbreak Associated with a Municipal Water System

Abstract: An outbreak of gastroenteritis lasting for one week in August 1980 affected approximately 1,500 persons in a community in northern Georgia. Investigation included a telephone survey of the community, a survey of textile plant employees and junior high and high school students and staff, and a neighborhood door-to-door survey. An association between gastrointestinal illness and consumption of drinking water was shown for community residents, students, and school staff. Attack rates (0-68%) determined in 10 neighborhoods increased significantly (P less than 0.001) with proximity to a textile plant, the site of one of two known cross-connections between an industrial water system (which contained fecal coliform bacteria) and the community water system. A fourfold rise in titer of antibody to Norwalk virus was found in 12 of 19 serum pairs from patients. Norwalk virus illness associated with drinking water from a large municipal water system has not been documented previously. Norwalk virus may be an important cause of waterborne morbidity in the United States.

A Nosocomial Outbreak of Diarrheal Disease Due to Yersinia enterocolitica Serotype 0:5, Biotype 1

Abstract: An outbreak of diarrheal disease due to Yersinia enterocolitica serotype 0:5 , biotype 1, involved nine hospitalized patients. The possible source of this infection was two patients who were both hospitalized with a history of several weeks of intermittent diarrhea. Person-to-person contact was the probable mode of transmission of the disease. The present report describes the second known nosocomial outbreak of infection due to Y. enterocolitica, Serotype 0:5 of Y. enterocolitica is not commonly encountered, and its involvement in an outbreak of gastroenteritis has not been previously reported. The importance of the enrichment technique in the isolation of Y. enterocolitica is demonstrated.

An outbreak of acute nonbacterial gastroenteritis in a nursing home demonstration of person-to-person transmission by temporal clustering of cases

Abstract: An outbreak of acute nonbacterial gastroenteritis occurred among residents and staff in a nursing home in Baltimore, Maryland, in December 1980. A total of 101 residents and 69 staff members were surveyed by questionnaire. The attack rate (defined as acute onset of vomiting or two or more loose stools per 24 hours) was 46% in each group. Illness was brief and mild; no patients were hospitalized, and there were no deaths. Person-to-person transmission was documented by temporal clustering of cases (the demonstration of higher rate of illness among residents exposed to an ill roommate one or two days earlier than among those not similarly exposed; relative risk = 3.74), by a higher rate of illness among employees having daily contact with residents than among those without such contact (57% vs. 17%, p less than 0.01), and by secondary transmission to household contacts of ill employees (secondary attack rate = 33%). Three of 11 serum pairs from patients demonstrated a fourfold increase in antibody titer to the Norwalk virus between acute- and convalescent-phase specimens. The analysis of temporal clustering of cases was particularly useful in documenting person-to-person transmission in this outbreak and might be used for this purpose in other outbreaks caused by Norwalk or Norwalk-like viruses, as well as in outbreaks associated with other infectious organisms.

Impact of Influenza A in a Nursing Home

Abstract: Outbreaks of influenza A in the institutionalized elderly have been reported only rarely. Such an outbreak occurred in a nursing home in the period Dec 12, 1980, through Jan 21, 1981. Thirty (25%) of the 120 residents had onset of influenza-like illness during the outbreak. Influenza A/ Bangkok/79-like (H3N2) virus was isolated from throat swab specimens from five of eight acutely ill patients. Thirteen persons were hospitalized; nine persons died (case-fatality ratio, 30%). This outbreak documents that mortality associated with an influenza outbreak can be substantial in a closed population of the elderly. Because nursing home residents are an easily accessible high-risk population, control and prevention of influenza should be a high priority in nursing homes. (JAMA1982;247:1451-1453)

Directly transmitted viral and bacterial infections of man

Abstract: The origins of contemporary epidemiological theory can be traced back to the early part of the 20th century. Just prior to this period the mechanisms by which infectious disease agents spread within populations had been revealed by microbiological research, notably that of Pasteur and Koch, and this, together with a statistical familiarity with epidemiological data (particularly the geometry of the epidemic curve (Farr, 1840; Brownlee, 1906)), laid the groundwork for future developments.

Hospital outbreaks caused by Pseudomonas aeruginosa: importance of serogroup O11.

Abstract: Suspected outbreaks caused by pseudomonas aeruginosa in 19 hospitals and two motels were studied. On the basis of epidemiological analysis, serological typing, and antibiotic resistance patterns, 17 were classified as single-strain outbreaks. Six were classified as common-source outbreaks: of these, three were caused by contaminated urological instruments or solutions, two involved bathing in contaminated whirlpools, and one was caused by contaminated lens prostheses implanted during eye surgery. The ability of P. aeruginosa to survive or grow in wet environments was important in each of these six outbreaks. Eight outbreaks were classified as cross-infection. Two involved the urinary tract and were caused by antibiotic-resistant strains. Six involved the respiratory tract, but only one was caused by an antibiotic-resistant strain. In 2 of the 17 single-strain outbreaks, the exact mode of transmission could not be determined. One was an outbreak of pseudobacteremia in which patient blood cultures were contaminated with a single strain, presumably during collection of specimens or culture processing, P. aeruginosa serogroup O11 caused 9 of 17 (53%) single-strain outbreaks, a surprising finding since this serogroup represents only about 8% of endemic hospital isolates of this species. Serotyping was very useful in epidemiological analysis, but antibiotic susceptibility patterns were less useful.

An outbreak of cowpox in captive cheetahs: virological and epidemiological studies.

Abstract: This paper describes virological and epidemiological features of an infection which killed two of three affected cheetahs at Whipsnade Park in 1977. Two animals had profuse skin lesions and the third had an acute haemorrhagic pneumonia. The outbreak was shown to be caused by cowpox virus. Cowpox virus is believed to circulate in small wild animals, but the source of infection was not traced despite virological and serological tests on 93 captive and 102 wild animals. Sub-clinical infections did not occur in susceptible contact cheetahs. Immune globulin did not influence the outcome and smallpox vaccine does not take in cheetahs. Management of any future outbreak will rely on prompt diagnosis and segregation of infected animals.

Meningococcal disease in Scandinavia.

Abstract: Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) comprises with mutual borders and 22.3 million inhabitants an area where the socioeconomic and cultural conditions are similar. Epidemic diseases, such as meningococcal infection, might therefore be expected to be uniformly distributed. An epidemiological study in the 10-year period 1970-9 shows, however, remarkable differences in the incidence, age, and serogroup and type distribution, as well as in the general dynamics of the disease. Three epidemics, two caused by different serotypes of group B (Norway and Iceland) and one by group A (Finland) occurred within the observation period. The annual overall incidence was generally around 3/100 000 but increased from fivefold (Finland) to eightfold (northern Norway) during epidemics. The epidemic strains caused infection in over 3000 patients and the loss of at least 250 lives. The overall case fatality rate was 8.6% (range 4.1-13.7%). Men were more susceptible and had a worse prognosis than women of the same age group. The group A epidemic in Finland was influenced by a large vaccination campaign, but this possibility was not feasible in the two other epidemics.

An Institutional Outbreak of Hepatitis B Related to a Human Biting Carrier

Abstract: An outbreak of hepatitis B in a residential institution for the mentally retarded was studied. Initially one overt case of hepatitis was noted. A serologic screen of students and employees revealed a total of 12 individuals positive for hepatitis B surface antigen (HBsAg). Subtyping by radioimmunoassay subsequently demonstrated that the population of HBsAg-positive individuals could be subdivided into two groups, based on the HBsAg subtype: adw2 or ayw3. The five individuals with subtype adw2 all were carriers. The ayw3 group, in contrast, were acutely infected except for one carrier with persistent hepatitis B e antigen. Both the ayw3 carrier and several of the acutely infected individuals were aggressive biters. Human biting, a frequent occurrence in the classroom studied, was one probable mode of transmission in this outbreak. The resolution of the outbreak was achieved by rapid screening for HBsAg with subtyping of positive patients and careful observation of the setting for putative modes of transmission.

An outbreak of vulvovaginitis in goats caused by a caprine herpesvirus.

Abstract: A caprine herpesvirus related to infectious bovine rhinotracheitis virus but immunologically distinct from that virus was isolated from an outbreak of vulvovaginitis in a herd of Saanen goats. The morbidity rate was 52.5%, with 21 of 40 does showing clinical signs. The lesions healed rapidly with only two goats showing lesions two weeks after the disease was first detected. No effect on subsequent reproductive performance was observed. The mode of transmission of the virus was believed to be venereal.

The current outbreak of kaposi's sarcoma and opportunistic infections

Abstract: The data suggest that: The recent outbreak of KS and PCP is a single epidemic, that of immunosuppression among homosexual men and drug abusers. The public health significance of this epidemic is probably underestimated, and clinicians should be alert to more subtle indications of immunosuppression, such as nonfatal opportunistic infections, unexplained lymphadenopathy, or other tumors. Opportunities to clarify the relationships between the environment, immunology, cancer, and infections make this outbreak scientifically important. The sudden and highly focal occurrence of these illnesses among homosexual men and drug addicts suggests a potential for their prevention if risk factors or etiologic agent(s) can be identified. The staggering morbidity and mortality associated with this outbreak dictate immediate concerted efforts to identify risk factors.

An outbreak of gastroenteritis caused by both rotavirus and Shigella sonnei in a private school in Rio de Janeiro.

Abstract: In May 1980 an extensive outbreak of gastroenteritis occurred in a private school in the city of Rio de Janeiro. Examination of faeces and paired sera showed that this outbreak was caused by both rotavirus and a virulent strain of Shigella sonnei. In the first 19 stool samples collected seven (37%) had rotavirus only, six (32%) had Sh. sonnei only, while four (21%) had both agents. Examination of the second and third stool collections revealed only the presence of Sh. sonnei. The 18 paired sera showed seroconversion for rotavirus in four cases (22%) and in seven cases (39%) for Sh. sonnei. The overall attack rate of the disease was approximately 75%, the nursery and kindergarten having higher attack rates. Students in all grades became sick at the same time, and the unimodal curve of the onset dates of symptoms indicates a common source outbreak. Evidence suggested a contaminated water supply.

The Contagion of Great Power War Behavior, 1495-1975

Abstract: Hypotheses regarding short-term contagion in the outbreak of war involving the Great Powers were tested using war data for the modern Great Power system, 1495-1975. The analysis demonstrates the likelihood of initiation of a new war to be slightly greater during an ongoing war but not after its termination. Neither war's incidence-its seriousness along any or all of several dimensions-nor its frequency had any impact on the subsequent outbreak of war in the period immediately following.

Prevention of Rubella Transmission in Medical Facilities

Abstract: The widespread use of rubella vaccine in the United States has dramatically decreased the number of rubella cases and has prevented epidemics. Nevertheless, outbreaks of rubella continue to occur in medical facilities and have become important in the transmission of the disease. Control of outbreaks requires isolation of infectious patients, assignment of immune staff only to infectious patients, exclusion from work of infectious personnel, special follow-up of pregnant women and exposed persons, and the rapid vaccination of susceptible staff. Implementation of hospital rubella prevention programs is preferable to controlling an outbreak. The vaccination of all susceptible personnel provides the opportunity for preventing rubella outbreaks, disruption of hospital services, and fetal rubella infection. ( JAMA 1982;248:861-864)

A Foodborne Outbreak of Enterotoxigenic Escherichia coli Diarrhea

Abstract: AFTER the discovery that Escherichia coli could produce a pathogenic toxin,1 toxigenic Esch. coli was identified as a major cause of childhood diarrhea in the less-developed parts of the world2 , 3 and as the leading cause of travelers' diarrhea.4 , 5 Despite worldwide distribution,6 cases of diarrhea caused by toxigenic Esch. coli are rarely detected in the United States.7 Five outbreaks have been reported: three in nurseries8 9 10 and two after exposure to a common source.11 , 12 Apart from person-to-person transmission in nurseries, only water has been conclusively demonstrated as a vehicle of transmission.12 In this paper we describe a common-source outbreak of toxigenic Esch. . . .