Showing papers on "Outbreak published in 1998"
Journal Article•
TL;DR: In this paper, the authors reported a total of 22 waterborne-disease outbreaks associated with drinking water and recreational lake water, which caused an estimated total of 2,567 persons to become ill. No deaths were reported.
Abstract: Problem/condition Since 1971, CDC and the U.S. Environmental Protection Agency have maintained a collaborative surveillance system for collecting and periodically reporting data that relate to occurrences and causes of waterborne-disease outbreaks (WBDOs). Reporting period covered This summary includes data for January 1995 through December 1996 and previously unreported outbreaks in 1994. Description of the system The surveillance system includes data about outbreaks associated with drinking water and recreational water. State, territorial, and local public health departments are primarily responsible for detecting and investigating WBDOs and for voluntarily reporting them to CDC on a standard form. Results For the period 1995-1996, 13 states reported a total of 22 outbreaks associated with drinking water. These outbreaks caused an estimated total of 2,567 persons to become ill. No deaths were reported. The microbe or chemical that caused the outbreak was identified for 14 (63.6%) of the 22 outbreaks. Giardia lamblia and Shigella sonnei each caused two (9.1%) of the 22 outbreaks; Escherichia coli O157:H7, Plesiomonas shigelloides, and a small round structured virus were implicated for one outbreak (4.5%) each. One of the two outbreaks of giardiasis involved the largest number of cases, with an estimated 1,449 ill persons. Seven outbreaks (31.8% of 22) of chemical poisoning, which involved a total of 90 persons, were reported. Copper and nitrite were associated with two outbreaks (9.1% of 22) each and sodium hydroxide, chlorine, and concentrated liquid soap with one outbreak (4.5%) each. Eleven (50.0%) of the 22 outbreaks were linked to well water, eight in noncommunity and three in community systems. Only three of the 10 outbreaks associated with community water systems were caused by problems at water treatment plants; the other seven resulted from problems in the water distribution systems and plumbing of individual facilities (e.g., a restaurant). Six of the seven outbreaks were associated with chemical contamination of the drinking water; the seventh outbreak was attributed to a small round structured virus. Four of the seven outbreaks occurred because of backflow or backsiphonage through a cross-connection, and two occurred because of high levels of copper that leached into water after the installation of new plumbing. For three of the four outbreaks caused by contamination from a cross-connection, an improperly installed vacuum breaker or a faulty backflow prevention device was identified; no protection against backsiphonage was found for the fourth outbreak. Thirty-seven outbreaks from 17 states were attributed to recreational water exposure and affected an estimated 9,129 persons, including 8,449 persons in two large outbreaks of cryptosporidiosis. Twenty-two (59.5%) of these 37 were outbreaks of gastroenteritis; nine (24.3%) were outbreaks of dermatitis; and six (16.2%) were single cases of primary amebic meningoencephalitis caused by Naegleria fowleri, all of which were fatal. The etiologic agent was identified for 33 (89.2%) of the 37 outbreaks. Six (27.3%) of the 22 outbreaks of gastroenteritis were caused by Cryptosporidium parvum and six (27.3%) by E. coli O157:H7. All of the latter were associated with unchlorinated water (i.e., in lakes) or inadequately chlorinated water (i.e., in a pool). Thirteen (59.1%) of these 22 outbreaks were associated with lake water, eight (36.4%) with swimming or wading pools, and one(4.5%) with a hot spring. Of the nine outbreaks of dermatitis, seven (77.8%) were outbreaks of Pseudomonas dermatitis associated with hot tubs, and two (22.2%) were lake-associated outbreaks of swimmer's itch caused by Schistosoma species. Interpretation WBDOs caused by E. coli O157:H7 were reported more frequently than in previous years and were associated primarily with recreational lake water. This finding suggests the need for better monitoring of water quality and identification of sources of
1,471 citations
TL;DR: This outbreak was traced to two sources: a local Montana farm and six farms in Washington State that shipped under the same label and highlights the increasing importance of fresh produce as a vehicle in foodborne illness.
Abstract: In July 1995, 40 Montana residents were identified with laboratory-confirmed Escherichia coli O157:H7 infection; 52 residents had bloody diarrhea without laboratory confirmation. The median age of those with laboratory-confirmed cases was 42 years (range, 4- 86); 58% were female. Thirteen patients were hospitalized, and 1 developed hemolytic-uremic syndrome. A case-control study showed that 19 (70%) of 27 patients but only 8 (17%) of 46 controls reported eating purchased (not home-grown) leaf lettuce before illness (matched odds ratio, 25.3; 95% confidence interval, 3.9-1065.6). Pulsed-field gel electrophoresis identified a common strain among 22 of 23 isolates tested. Implicated lettuce was traced to two sources: a local Montana farm and six farms in Washington State that shipped under the same label. This outbreak highlights the increasing importance of fresh produce as a vehicle in foodborne illness. Sanitary growing and handling procedures are necessary to prevent these infections.
491 citations
TL;DR: Improved molecular techniques to detect NLVs demonstrate that most outbreaks of nonbacterial gastroenteritis in the United States appear to be associated with these viruses and that sequence analysis is a robust tool to help link or differentiate these outbreaks.
Abstract: Fecal specimens from 90 outbreaks of nonbacterial gastroenteritis reported to 33 state health departments from January 1996 to June 1997 were examined to determine the importance of and to characterize "Norwalk-like viruses" (NLVs) in these outbreaks. NLVs were detected by reverse transcription-polymerase chain reaction in specimens from 86 (96%) of 90 outbreaks. Outbreaks were most frequent in nursing homes and hospitals (43%), followed by restaurants or events with catered meals (26%); consumption of contaminated food was the most commonly identified mode of transmission (37%). Nucleotide sequence analysis showed great diversity between strains but also provided evidence indicating the emergence of a common, predominant strain. The application of improved molecular techniques to detect NLVs demonstrates that most outbreaks of nonbacterial gastroenteritis in the United States appear to be associated with these viruses and that sequence analysis is a robust tool to help link or differentiate these outbreaks.
482 citations
TL;DR: Antimicrobial susceptibility testing showed that A. baumannii outbreak strains were significantly more resistant to various broad-spectrum antimicrobial agents than sporadic strains, which may explain in part their propensity to cause prolonged outbreaks of nosocomial infection.
Abstract: Acinetobacter spp. are important nosocomial pathogens reported with increasing frequency in outbreaks of cross-infection during the past 2 decades. The majority of such outbreaks are caused by Acinetobacter baumannii. To investigate whether desiccation tolerance may be involved in the ability of certain strains of A. baumannii to cause hospital outbreaks, a blind study was carried out with 39 epidemiologically well-characterized clinical isolates of A. baumannii for which survival times were determined under simulated hospital conditions. The survival times on glass coverslips of 22 strains isolated from eight well-defined hospital outbreaks in a German metropolitan area were compared with the survival times of 17 sporadic strains not involved in outbreaks but rather isolated from inpatients in the same geographic area. All sporadic isolates have been shown by pulsed-field gel electrophoresis to represent different strain types. There was no statistically significant difference between the survival times of sporadic strains of A. baumannii and outbreak strains (27.2 versus 26.5 days, respectively; P ≤ 0.44) by the Wilcoxon-Mann-Whitney test. All investigated A. baumannii strains, irrespective of their areas of endemicity or epidemic occurrence, have the ability to survive for a long time on dry surfaces. Antimicrobial susceptibility testing showed that A. baumannii outbreak strains were significantly more resistant to various broad-spectrum antimicrobial agents than sporadic strains. Both desiccation tolerance and multidrug resistance may contribute to their maintenance in the hospital setting and may explain in part their propensity to cause prolonged outbreaks of nosocomial infection.
442 citations
TL;DR: In this outbreak of tuberculosis, the growth characteristics of the strain involved greatly exceeded those of other clinical isolates of M. tuberculosis, and the extensive transmission of tuberculosis may have been due to the increased virulence of the strains rather than to environmental factors or patient characteristics.
Abstract: Background and Methods From 1994 to 1996, there was a large outbreak of tuberculosis in a small, rural community with a population at low risk for tuberculosis Twenty-one patients with tuberculosis (15 with positive cultures) were identified; the DNA fingerprints of the 13 isolates available for testing were identical To determine the extent of transmission, we investigated both the close and casual contacts of the patients Using a mouse model, we also studied the virulence of the strain of Mycobacterium tuberculosis that caused the outbreak Results The index patient, in whom tuberculosis was diagnosed in 1995; the source patient, in whom the disease was diagnosed in 1994; and a patient in whom the disease was diagnosed in 1996 infected the other 18 persons In five, active disease developed after only brief, casual exposure There was extensive transmission from the three patients to both close and casual contacts Of the 429 contacts, 311 (72 percent) had positive skin tests, including 86 with docum
398 citations
TL;DR: RSV is an important pathogen in young children in tropical and developing countries and a frequent cause of hospital admission, and prevention of RSV infection by vaccination would have a significant impact on the incidence of ALRI in children in developing countries.
Abstract: Little is known about the epidemiology of respiratory syncytial virus (RSV) infection in tropical and developing countries; the data currently available have been reviewed. In most studies, RSV was found to be the predominant viral cause of acute lower respiratory tract infections (ALRI) in childhood, being responsible for 27-96% of hospitalised cases (mean 65%) in which a virus was found. RSV infection is seasonal in most countries; outbreaks occur most frequently in the cold season in areas with temperate and Mediterranean climates and in the wet season in tropical countries with seasonal rainfall. The situation on islands and in areas of the inner tropics with perennial high rainfall is less clear-cut. The age group mainly affected by RSV in developing countries is children under 6 months of age (mean 39% of hospital patients with RSV). RSV-ALRI is slightly more common in boys than in girls. Very little information is available about the mortality of children infected with RSV, the frequency of bacterial co-infection, or the incidence of further wheezing after RSV. Further studies on RSV should address these questions in more detail. RSV is an important pathogen ill young children in tropical and developing countries and a frequent cause of hospital admission. Prevention of RSV infection by vaccination would have a significant impact on the incidence of ALRI in children in developing countries.
351 citations
TL;DR: The characteristics of the predominant clones which are nowadays causing meningococcal disease in the world are summarized here and the importance of population genetics in interpreting the epidemiological data is illustrated.
Abstract: Under non-epidemic conditions, Neisseria meningitidis causes disease primarily in children under the age of 5 and the cases are sporadic without any evident relationship between them. Occasionally, localized outbreaks of meningococcal disease occur, and sometimes epidemic waves of disease may spread to several countries or even continents and constitute a pandemic. In the past 10 years or so, population genetic analyses have provided insights into the biology of the bacterium and the epidemiology of meningococcal disease, improving our understanding of the cause of epidemics. Through the application of molecular methods, and especially multilocus enzyme electrophoresis, to N. meningitidis strains of worldwide origin, it has been possible to identify virulent clones and provide a surveillance system to warn of meningococcal epidemics. The characteristics of the predominant clones which are nowadays causing meningococcal disease in the world are summarized here and the importance of population genetics in interpreting the epidemiological data is illustrated.
268 citations
TL;DR: Type 2 BVDV has been present in Ontario at least since 1981 without causing widespread outbreaks of severe acute BVD, which suggests that type 2 designation in itself does not imply enhanced virulence.
Abstract: In 1993, noncytopathic bovine viral diarrhea virus (BVDV) strains with enhanced virulence caused unprecedented outbreaks of severe acute bovine viral diarrhea (BVD) in dairy, beef, and veal herds in Ontario (Canada). Fever, pneumonia, diarrhea, and sudden death occurred in all age groups of cattle. Abortions often occurred in pregnant animals. Gross lesions in the alimentary tract were similar to those associated with mucosal disease, especially in animals .6 months of age. Cattle of all age groups had microscopic lesions in the alimentary tract similar to those seen with mucosal disease. The epidemic peaked in the summer of 1993, with 15% of all bovine accessions from diseased cattle presented to the diagnostic laboratory being associated with BVDV. The virus strains involved in the outbreak were analyzed using monoclonal and polyclonal anti- bodies and the polymerase chain reaction. The virus isolates from these outbreaks of severe disease were determined to be type 2 BVDV. Type 2 BVDV has been present in Ontario at least since 1981 without causing widespread outbreaks of severe acute BVD, which suggests that type 2 designation in itself does not imply enhanced virulence. Cattle properly vaccinated with type 1 BVDV vaccines appear to be protected from clinical disease. Bovine viral diarrhea (BVD) was originally de- scribed in 1946 16 in New York State as an acute, rarely fatal, highly contagious disease with fever, diarrhea, mucosal lesions, and leukopenia. Although initial re- ports described a clinically severe disease, acute BVD has since been considered a mild or subclinical disease of a few days duration, with negligible mortality at any age. 11,22 Occasionally, scattered outbreaks of se-
261 citations
TL;DR: The high prevalence of colonization with a virulent organism in an unvaccinated population contributed to the high attack rate in this outbreak of multidrug-resistant pneumococcal pneumonia among the residents and employees of a nursing home.
Abstract: Background Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings. Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States. In February 1996, there was an outbreak of multidrug-resistant pneumococcal pneumonia among the residents of a nursing home in rural Oklahoma. Methods We obtained nasopharyngeal swabs for culture from residents and employees. Streptococcus pneumoniae isolates were serotyped and compared by pulsed-field gel electrophoresis. A retrospective cohort study was conducted to identify factors associated with colonization and disease. Results Pneumonia developed in 11 of 84 residents (13 percent), 3 of whom died. Multidrug-resistant S. pneumoniae, serotype 23F, was isolated from blood and sputum from 7 of the 11 residents with pneumonia (64 percent) and from nasopharyngeal specimens from 17 of the 74 residents tested (23 percent) and 2 of the 69 employees tested (3 percent). All the serotype 23F iso...
260 citations
TL;DR: Preliminary results from the field investigations in 1997 suggest a new epidemiological pattern where a majority of secondary cases result from person-to-person transmission, and a clinically milder disease.
Abstract: Human monkeypox was first identified in 1970 in the Democratic Republic of the Congo. Extensive studies of this zoonotic infection in the 1970s and 1980s indicated a largely sporadic disease with a minority of cases resulting from person-to-person transmission, rarely beyond two generations. In August 1996, an unusually large outbreak of human monkeypox was reported, and cases continued through 1997 with peak incidence in August 1996, March 1997 and August 1997. Preliminary results from the field investigations in 1997 suggest a new epidemiological pattern where a majority of secondary cases result from person-to-person transmission, and a clinically milder disease. But there is preliminary laboratory evidence of a simultaneous outbreak of varicella in the same geographic region which will undoubtedly modify these preliminary results. Since smallpox was eradicated and vaccinia vaccination terminated in this region, the population of susceptible individuals has grown. The use of vaccination to protect the population at risk, however, must take into account HIV prevalence and the risk of generalized vaccinia when using vaccinia vaccine in populations where HIV is known to be present.
247 citations
TL;DR: Microbiological testing revealed evidence of R prowazeki infection in 76 (75%) patients, confirming that most cases of clinically-diagnosed sutama were epidemic typhus, and supporting the reliability of clinical diagnosis as a basis for the nationwide surveillance of the disease.
TL;DR: In this article, a review confirms a continuing risk of cryptosporidiosis from chlorinated water supplies in England and Wales, and reinforces governmental advice to water utilities that water treatment processes should be rigorously applied to ensure effective particle removal.
Abstract: Following the introduction of an improved surveillance system for infectious intestinal disease outbreaks in England and Wales, the Public Health Laboratory Service Communicable Disease Surveillance Centre received reports of 26 outbreaks between 1 January 1992 and 31 December 1995 in which there was evidence for waterborne transmission of infection. In these 26 outbreaks, 1756 laboratory confirmed cases were identified of whom 69 (4%) were admitted to hospital. In 19 outbreaks, illness was associated with the consumption of drinking water from public supplies (10 outbreaks) or private supplies (9 outbreaks). The largest outbreak consisted of 575 cases. In 4 of the remaining 7 outbreaks, illness was associated with exposure to swimming pool water. Cryptosporidium was identified as the probable causative organism in all 14 outbreaks associated with public water supplies and swimming pools. Campylobacter was responsible for most outbreaks associated with private water supplies. This review confirms a continuing risk of cryptosporidiosis from chlorinated water supplies in England and Wales, and reinforces governmental advice to water utilities that water treatment processes should be rigorously applied to ensure effective particle removal. High standards of surveillance are important for prompt recognition of outbreaks and institution of control measures. As microbiological evidence of water contamination may be absent or insufficient to implicate a particular water supply, a high standard of epidemiological investigation is recommended in all outbreaks of suspected waterborne disease.
TL;DR: NDV strains isolated from outbreaks during epizootics between 1992 and 1996 in Western European countries, were compared by restriction enzyme cleavage site mapping of the fusion (F) protein gene between nucleotides 334 and 1682 and by sequence analysis, revealing that NDV strains belong to two distinct genotypes.
Abstract: Newcastle disease virus (NDV) strains, isolated from outbreaks during epizootics between 1992 and 1996 in Western European countries, were compared by restriction enzyme cleavage site mapping of the fusion (F) protein gene between nucleotides 334 and 1682 and by sequence analysis between nucleotides 47 and 435 Both methods revealed that NDV strains responsible for these epizootics belong to two distinct genotypes Strains derived from sporadic cases in Denmark, Sweden, Switzerland and Austria were classified into genotype VI [6], the same group which caused outbreaks in the Middle East and Greece in the late 1960's and in Hungary in the early 1980's In contrast, viruses that caused epizootics in Germany, Belgium, The Netherlands, Spain and Italy could be classified into a novel genotype (provisionally termed VII), hitherto undetected in Europe It is possible that the genotype VII viruses originated in the Far East because they showed a high genetic similarity (97%) to NDV strains isolated from Indonesia in the late 1980's
TL;DR: The pathogen responsible for this new coral disease appeared on the Florida Reef Tract in June 1995 and was identified as a new species of Sphingomonas, which affected a wider variety of species, and destroyed tissue much more rapidly than other coral diseases.
Abstract: An unusual coral disease appeared on the Florida Reef Tract in June 1995. It was distinct in its microbiology, its pattern of tissue degradation, the species susceptible to it, and its regional distribution. Symptoms included a sharp line between healthy and diseased tissue, as occurs with other coral diseases, but the pathogen responsible for the new outbreak seemed more virulent, affected a wider variety of species, and destroyed tissue much more rapidly than these other ‘line’ or ‘band’ diseases. We have identified the pathogen responsible for this new disease as a new species of Sphingomonas.
TL;DR: An outbreak of 25 cases of Andes virus-associated hantavirus pulmonary syndrome was recognized in southern Chile from July 1997 through January 1998 and Epidemiologic studies suggested person-to-person transmission in two of three family clusters.
Abstract: An outbreak of 25 cases of Andes virus-associated hantavirus pulmonary syndrome (HPS) was recognized in southern Chile from July 1997 through January 1998. In addition to the HPS patients, three persons with mild hantaviral disease and one person with asymptomatic acute infection were identified. Epidemiologic studies suggested person-to-person transmission in two of three family clusters. Ecologic studies showed very high densities of several species of sigmodontine rodents in the area.
Journal Article•
TL;DR: One thousand nine hundred and nineteen general outbreaks of infectious intestinal disease in England and Wales were reported to the PHLS Communicable Disease Surveillance Centre between 1 January 1995 and 31 December 1996, compared with 1073 in the previous two years.
Abstract: One thousand nine hundred and nineteen general outbreaks of infectious intestinal disease in England and Wales were reported to the PHLS Communicable Disease Surveillance Centre (CDSC) between 1 January 1995 and 31 December 1996, compared with 1073 in the previous two years. A minimum data set was received for 1568 (82%) of the 1919 outbreaks. Over 40,000 people were affected and about 2% of those who were ill were admitted to hospital. Seventy-one deaths were reported. The duration of outbreaks varied between less than one day and 202 days (median six days) according to the pathogen. Small round structured virus (SRSV) (43%) and salmonellas (15%) were the most commonly reported pathogens. In almost a quarter of the outbreaks (24%) the aetiology was unknown. Over half the outbreaks (64%) were reported to be transmitted from person to person, most of which were due to SRSV and occurred in residential homes and hospitals. Twenty-two per cent of outbreaks were described as mainly foodborne, 51% of which were due to salmonellas. The number of outbreaks reported in each region ranged from 52 in Wales to 512 in Northern and Yorkshire.
TL;DR: Final analysis showed that the rillettes was the major vehicle of the outbreak but suggested that other brand A meat products could also have been involved.
Abstract: An outbreak of listeriosis involving 38 patients occurred in France between 18 June and 5 October 1993. The epidemic clone was characterized by serovar 4b, phagovar 2671:108:312, and DNA macrorestriction patterns 12 and 13. Thirty-one case-patients were materno-neonatal patients and 7 patients were nonpregnant adults. Preliminary analysis of a case-control study implicated a pork product, rillettes, of a particular brand (odds ratio, 18; 95% confidence interval, 2.2-208) as the vehicle of infection. Rillettes is a ready-to-eat food prepared with ham meat cooked with grease. The implicated lots of rillettes were recalled in mid-August, and the French authorities issued a warning to the general public. Microbiologic analysis of unopened plastic cans of rillettes confirmed the results of the case-control study 3 weeks after the recall. Final analysis showed that the rillettes was the major vehicle of the outbreak but suggested that other brand A meat products could also have been involved.
TL;DR: Outbreak investigations can help identify the source of ongoing outbreaks and prevent additional cases and provide epidemiologic training and foster cooperation between the clinical and public health communities.
Abstract: Outbreak investigations, an important and challenging component of epidemiology and public health, can help identify the source of ongoing outbreaks and prevent additional cases. Even when an outbreak is over, a thorough epidemiologic and environmental investigation often can increase our knowledge of a given disease and prevent future outbreaks. Finally, outbreak investigations provide epidemiologic training and foster cooperation between the clinical and public health communities.
TL;DR: The high mortality rates distinguish this coral disease as one of the most serious yet documented and regionally confined outbreaks of plague type II, which appeared on different reefs of sou Florida and the Florida Keys in 1996 and 1997.
Abstract: A coral disease characterized by a novel pattern of rapid tissue destruction first appeared on reefs of the middle Florida Keys in lune 1995. Between lune and October 1995 the disease infected 17 species of scleractinian corals and the hydrocoral Millepora alcicornis. Localized populations of Dichocoenia stokesi, the species most affected, revealed up to 38% mortality. Many colonies exhibited complete tissue loss within days as the disease moved across colonies at rates of up to 2 cm per 24 hr. Typically tissue loss was initiated at the base of the colony and moved upward. At times disease progression halted and colonies retained partial tissue resembling a cap on the top of an otherwise denuded colony. Laboratory cultures of samples from the disease line revealed a dominant bacterium that, when isolated and characterized using genetic and metabolic techniques, most closely matched the genus Sphingomonas. Pure laboratory cultures of the bacterium produced disease in freshly collected coral colonies incubated in laboratory aquaria. The disease that we call plague type II appeared on different reefs of sou Florida and the Florida Keys in 1996 and 1997. While coral mortality associated with each of the three outbreaks was regionally confined and did no! recur in subsequent years on the same reefs, the high mortality rates distinguish this disease as one of the most serious yet documented.
Journal Article•
TL;DR: A retrospective computerised analysis showed that the geographical distribution of cases was associated with a source in this area, and the probable cause of the outbreak was windborne spread of coxiella spores from farmland to the conurbation.
Abstract: The largest outbreak of the zoonotic disease Q fever recorded in the United Kingdom (UK) occurred in Birmingham in 1989. One hundred and forty-seven cases were identified, 125 of whom were males, and 130 of whom were between 16 and 64 years of age. Fewer cases of Asian ethnic origin were observed than expected (p < 0.01), and more smokers (p < 0.005). A case control study (26 cases and 52 matched controls) produced no evidence that direct contact with animals or animal products had caused the outbreak. The epidemic curve suggested a point source exposure in the week beginning 10 April. The home addresses of cases were clustered in a rectangle 11 miles (18.3 km) north/south by 4 miles (6.7 km) east/ west, and attack rates became lower towards the north. Directly south of this area were farms engaged in outdoor lambing and calving, a potent source of coxiella spores. A retrospective computerised analysis showed that the geographical distribution of cases was associated with a source in this area (p < 0.00001). On 11 April, unusual southerly gales of up to 78 mph (130 km/h) were recorded. The probable cause of the outbreak was windborne spread of coxiella spores from farmland to the conurbation
Journal Article•
TL;DR: Australia has a diversity of vectors and vector-borne human diseases, butMosquito-borne arboviruses are of greatest concern, but there are issues with other vector and pathogen systems.
Abstract: Australia has a diversity of vectors and vector-borne human diseases. Mosquito-borne arboviruses are of greatest concern, but there are issues with other vector and pathogen systems. Mosquitoes were responsible for more than 35,000 cases of Ross River virus during 1991-1997. Barmah Forest virus is increasing nationwide, and unidentified bunyaviruses suspected of causing illness have been isolated. Cases of Murray Valley encephalitis have occurred in 14 of the past 20 years in northern Australia. Dengue is a continuing problem for northern Queensland, with various serotypes being active. Japanese encephalitis has appeared in the Torres Strait Islands and threatens mainland Australia. Although malaria is eradicated, almost 1,000 cases are imported annually and occasional cases of local transmission occur. With ticks, paralysis in children occurs annually in eastern Australia. Tick typhus (Queensland Tick Typhus--Rickettsia australis) occurs down the east coast, and (Flinders Island Spotted Fever--Rickettsia honei) in Bass Strait and probably Tasmania. Lyme disease is reported but its presence is controversial. Fleas were responsible for a recent outbreak of murine typhus (Rickettsia typhi) in Western Australia. Mites cause scrub typhus (Orientia tsutsugamushi), and there was a recent fatality in the Northern Territory. Overall, resources for investigation and control of vector-borne disease have generally been meager. However, various avenues of basic and applied research have been pursued, and have included investigations into mosquito ecology, vector competence, disease epidemiology, and vector control. Disease surveillance programs vary between states, and mosquito control programs are organized and effective in only a few regions. There are concerns for import of vectors such as Aedes albopictus and export of pathogens such as Ross River virus; the former has occurred but the species has not become established, and the latter has occurred and has resulted in a major outbreak in the South Pacific. The predicted scenarios of increased temperature and rainfall with global warming are also causing concern for increases in vector-borne diseases, particularly the endemic arboviruses. Interest by health authorities is gravitating more towards epidemiological reporting and less towards public health action. In many respects, humans have much to do to get 'on top' of vectors and their pathogens 'down under' in Australia.
TL;DR: Consumption of raw milk remains a preventable cause of foodborne disease outbreaks and the legal status of intrastate raw milk sales for the period 1973 through 1995 is determined.
Abstract: OBJECTIVES: This study describes the epidemiology of raw milk-associated outbreaks reported to the Centers for Disease Control and Prevention from 1973 through 1992. METHODS: Surveillance data for each reported raw milk-associated outbreak were reviewed. A national survey was conducted to determine the legal status of intrastate raw milk sales for the period 1973 through 1995. RESULTS: Forty-six raw milk-associated outbreaks were reported during the study period; 40 outbreaks (87%) occurred in states where the intrastate sale of raw milk was legal. CONCLUSIONS: Consumption of raw milk remains a preventable cause of foodborne disease outbreaks.
TL;DR: In outbreak situations, colonized or infected patients and the inanimate environment, which can be secondarily contaminated, are the main reservoirs in the hospital setting for crosstransmission.
Abstract: In summary,Acinetobacter colonization or infection may originate from the patients' own flora under the pressure of antimicrobial selection, the hands of staff members, or contaminated equipment. Transmission ofAcinetobacter strains between patients occurs primarily via the hands of health care workers. In outbreak situations, colonized or infected patients and the inanimate environment, which can be secondarily contaminated, are the main reservoirs in the hospital setting for crosstransmission. However, colonized or infected patients seem to be the most important source of cross-contamination, as epidemic strains spread easily throughout different wards. Especially in prolonged outbreaks in which control efforts such as proper hand washing, glove changing, and restriction of antimicrobial agents are ineffective and specific sources such as contaminated equipment are not identified, the source of the epidemic strain is likely the patients' inanimate dry environment [45, 48]. In outbreak situations it is necessary that isolatedAcinetobacter strains are identified to the genomic species level and then typed before epidemiological conclusions can be drawn, becauseAcinetobacter spp. are ubiquitous organisms [3, 31].
TL;DR: Of 32 reported cheese-associated outbreaks, 11 attributed to manufacturing errors caused most of the illnesses and hospitalizations and all 58 deaths, suggesting that curing alone may not be a sufficient pathogen control step to eliminate Salmonella, Listeria, and E. coli O157:H7 from cheese.
TL;DR: The present study examined the extent to which this distribution reflected epidemic strain spread, as against the distribution of ESBL genes into unrelated strains, to imply a fluid situation, with resistance determinants being gained, modified or lost.
Abstract: Extended-spectrum beta-lactamases (ESBLs) are an increasing cause of resistance to oxyimino-aminothiazolyl cephalosporins, especially in klebsiellae. In a recent survey we detected ESBLs in 220 (23%) of 966 consecutive klebsiellae from 35 intensive care units (ICUs) in southern and western Europe. The present study examined the extent to which this distribution reflected epidemic strain spread, as against the distribution of ESBL genes into unrelated strains. All 220 ESBL producers were subjected to capsular serotyping and pulsed-field gel DNA electrophoresis (PFGE). Beta-Lactamases were typed for strains isolated on three or more occasions, with the emphasis on SHV enzymes, as these were commoner than TEM variants. Serotyping and PFGE typing defined 85 distinct strains, from 23 of the 35 participating centres. Of 14 centres that contributed five or more ESBL producers, all sent representatives of more than one strain, and two centres sent members of ten or more different strains in contributions of 17-21 ESBL-producing isolates. Nevertheless, epidemic strains-defined as those represented by three or more isolates-accounted for a majority (61%) of the collection. Fifty-two isolates of the same serotype K25 (occasionally acapsular) strain with SHV-4 beta-lactamase were recovered at two French hospitals and one in Belgium. This strain has been found by others in France, and has become particularly widespread. Another single strain was found in two separate Portuguese centres, and many individual hospitals had one or more epidemic strain(s), as well as a scatter of diverse ESBL producers. Major variation in antibiogram and plasmid profile was apparent within strains, with some intra-strain variation in beta-lactamase type. These data imply a fluid situation, with resistance determinants being gained, modified or lost. The endemicity of ESBL producers is disturbing since it limits the potential for control by blocking strain spread, while the diversity within strains is disturbing because it complicates the design of antibiotic policies even during 'single strain' outbreaks.
TL;DR: An outbreak of multidrug‐resistant tuberculosis (MDR‐TB), amongst HIV‐infected patients, spread from one hospital in Milan to another, is described, which is the largest nosocomial outbreak of MDR‐ TB reported in Europe.
Abstract: Objective:To describe an outbreak of multidrug-resistant tuberculosis (MDR-TB), amongst HIV-infected patients, spread from one hospital in Milan to another.Design:Descriptive epidemiological investigation and molecular typing.Methods:All cases identified by intensive case-finding were described in t
Journal Article•
TL;DR: Arboviruses continue to be major human pathogens in the Australian region and their activities over the past eight years are provided, and comments on new findings relevant to their respective ecologies are made.
Abstract: Arboviruses continue to be major human pathogens in the Australian region. This report provides a summary of the activities of these viruses over the past eight years, and comments on new findings relevant to their respective ecologies. Of particular interest and concern is the propensity of these viruses to spread. The examples discussed include the initiation of dengue epidemics in north Queensland by virus imported in viraemic travellers; the spread of Japanese encephalitis virus to the Australasian region and its probable enzootic establishment in the south-west of Papua New Guinea; the potential spread of Ross River virus to other countries, as demonstrated by the 1979-80 outbreak in the South Pacific, and the recent occurrence in military personnel from the United States of America after an exercise; and the recent spread of Barmah Forest virus into Western Australia.
TL;DR: The phenotypic and genotypic approaches to typing are reviewed here and the epidemiology of C. difficile-associated disease is elucidated in light of recent information.
Abstract: Clostridium difficile is normally a harmless environmental bacterium but, under certain circumstances, it can cause hospital outbreaks of disease. To understand the disease epidemiology, outbreaks have been investigated by many different methods. The phenotypic and genotypic approaches to typing are reviewed here and the epidemiology of C. difficile-associated disease is elucidated in light of recent information.
TL;DR: The epidemic strain of Salmonella typhimurium O:4-12 was regularly encountered as the etiologic agent of fatal salmonellosis among wild passerine birds, suggesting an epidemiologic link between the avian and human cases.
Abstract: In 1987, a nationwide outbreak of Salmonella typhimurium O:4-12 infection traced to contaminated chocolate bars occurred in Norway. In the 5 years after the outbreak, elevated numbers of sporadic cases caused by the epidemic strain of Salmonella were detected, followed by a decline in subsequent years. To characterize the epidemiology of this infection, the authors analyzed information concerning all sporadic cases reported in Norway from 1966 to 1996. Of the 153 patients infected by the outbreak strain, 43% were less than 5 years of age, and only three persons had acquired the infection abroad. In contrast, 46% of the cases attributable to other S. typhimurium O:4-12 variants and 90% of the total number of Salmonella infections were related to foreign travel. A distinct seasonality was observed: 76% of the cases appeared between January and April. At the same time of year, the epidemic strain was regularly encountered as the etiologic agent of fatal salmonellosis among wild passerine birds, suggesting an epidemiologic link between the avian and human cases. The strain was rarely isolated from other sources. From 1990 to 1992, the authors conducted a prospective case-control study of sporadic indigenous infections to identify risk factors and obtain guidance for preventive efforts. Forty-one case-patients, each matched by age, sex, and geographic area with two population controls, were enrolled. In conditional logistic regression analysis, the following environmental factors were independently related to an increased risk of infection: drinking untreated water, having direct contact with wild birds or their droppings, and eating snow, sand, or soil. Cases were also more likely than controls to report having antecedent or concurrent medical disorders. Forty-six percent of the study patients were hospitalized for their salmonellosis.
TL;DR: This is the first confirmation of the presence of this variety of C. neoformans var.gattii in Spain, with a peculiar ability to produce severe pulmonary and systemic disease in normal goats, particularly in the form of outbreaks of pneumonia in association with cachexia.
Abstract: Cryptococcus neoformans var. gattii is associated with Eucalyptus trees growing in various tropical and subtropical regions of the world. The identification of 13 autochthonous strains of C. neoformans var. gattii in Spain is reported. These strains were isolated from lung (10 samples), liver (1 sample), and brain (2 samples) tissue specimens from six goats suffering from predominantly severe pulmonary disease that were autopsied. The animals were members of five different herds of goats grazing in rural areas of the province of Caceres (Extremadura, Spain). Between 1990 and 1994, there were five outbreaks, in which between 2.5 and 12% of the goats were affected. Although respiratory symptoms (pneumonia) associated with cachexia were the predominant clinical picture in all outbreaks, brain and liver involvement was also documented in three of the five outbreaks. Biotyping was performed by culturing the isolates on l-canavanine-glycine-bromothymol blue medium and testing them for the assimilation of d-proline and d-tryptophan. Serotyping by agglutination tests confirmed the characterization of all strains as C. neoformans var. gattii serotype B. This is the first confirmation of the presence of this variety in Spain, with a peculiar ability to produce severe pulmonary and systemic disease in normal goats, particularly in the form of outbreaks of pneumonia in association with cachexia.