Showing papers on "Outbreak published in 2003"

Birds, Migration and Emerging Zoonoses: West Nile Virus, Lyme Disease, Influenza A and Enteropathogens

Abstract: Wild birds are important to public health because they carry emerging zoonotic pathogens, either as a reservoir host or by dispersing infected arthropod vectors. In addition, bird migration provides a mechanism for the establishment of new endemic foci of disease at great distances from where an infection was acquired. Birds are central to the epidemiology of West Nile virus (WNV) because they are the main amplifying host of the virus in nature. The initial spread of WNV in the U.S. along the eastern seaboard coincided with a major bird migration corridor. The subsequent rapid movement of the virus inland could have been facilitated by the elliptical migration routes used by many songbirds. A number of bird species can be infected with Borrelia burgdorferi, the etiologic agent of Lyme disease, but most are not competent to transmit the infection to Ixodes ticks. The major role birds play in the geographic expansion of Lyme disease is as dispersers of B. burgdorferi-infected ticks. Aquatic waterfowl are asymptomatic carriers of essentially all hemagglutinin and neuraminidase combinations of influenza A virus. Avian influenza strains do not usually replicate well in humans, but they can undergo genetic reassortment with human strains that co-infect pigs. This can result in new strains with a marked increase in virulence for humans. Wild birds can acquire enteropathogens, such as Salmonella and Campylobacter spp., by feeding on raw sewage and garbage, and can spread these agents to humans directly or by contaminating commercial poultry operations. Conversely, wild birds can acquire drug-resistant enteropathogens from farms and spread these strains along migration routes. Birds contribute to the global spread of emerging infectious diseases in a manner analogous to humans traveling on aircraft. A better understanding of avian migration patterns and infectious diseases of birds would be useful in helping to predict future outbreaks of infections due to emerging zoonotic pathogens.

Modelling vaccination strategies against foot-and-mouth disease

Abstract: Vaccination has proved a powerful defence against a range of infectious diseases of humans and animals. However, its potential to control major epidemics of foot-and-mouth disease (FMD) in livestock is contentious. Using an individual farm-based model, we consider either national prophylactic vaccination campaigns in advance of an outbreak, or combinations of reactive vaccination and culling strategies during an epidemic. Consistent with standard epidemiological theory, mass prophylactic vaccination could reduce greatly the potential for a major epidemic, while the targeting of high-risk farms increases efficiency. Given sufficient resources and preparation, a combination of reactive vaccination and culling might control ongoing epidemics. We also explore a reactive strategy, ‘predictive’ vaccination, which targets key spatial transmission loci and can reduce markedly the long tail that characterizes many FMD epidemics. These analyses have broader implications for the control of human and livestock infectious diseases in heterogeneous spatial landscapes.

Emergence and Global Spread of a Dengue Serotype 3, Subtype III Virus

Abstract: Over the past two decades, dengue virus serotype 3 (DENV-3) has caused unexpected epidemics of dengue hemorrhagic fever (DHF) in Sri Lanka, East Africa, and Latin America. We used a phylogenetic approach to evaluate the roles of virus evolution and transport in the emergence of these outbreaks. Isolates from these geographically distant epidemics are closely related and belong to DENV-3, subtype III, which originated in the Indian subcontinent. The emergence of DHF in Sri Lanka in 1989 correlated with the appearance there of a new DENV-3, subtype III variant. This variant likely spread from the Indian subcontinent into Africa in the 1980s and from Africa into Latin America in the mid-1990s. DENV-3, subtype III isolates from mild and severe disease outbreaks formed genetically distinct groups, which suggests a role for viral genetics in DHF.

Serotype-specific dengue virus circulation and dengue disease in bangkok, thailand from 1973 to 1999

Abstract: Dengue virus circulation and association with epidemics and severe dengue disease were studied in hospitalized children with suspected dengue at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, from 1973 to 1999. Dengue serology was performed on all patients and viral isolation attempted on laboratory-confirmed patients. Acute dengue was diagnosed in 15,569 children and virus isolated from 4,846. DEN-3 was the most frequent serotype in primary dengue (49% of all isolates), DEN-2 in secondary and in dengue hemorrhagic fever (37% and 35%, respectively). The predominant dengue serotype varied by year: DEN-1 from 1990-92, DEN-2 from 1973-86 and 1988-89; DEN-3 in 1987 and 1995-99; and DEN-4 from 1993-94. Only DEN-3 was associated with severe outbreak years. Our findings illustrate the uniqueness of each serotype in producing epidemics and severe disease and underscore the importance of long-term surveillance of dengue serotypes in understanding the epidemiology of these viruses.

Viral Gastroenteritis Outbreaks in Europe, 1995–2000

Abstract: To gain understanding of surveillance and epidemiology of viral gastroenteritis outbreaks in Europe, we compiled data from 10 surveillance systems in the Foodborne Viruses in Europe network. Established surveillance systems found Norovirus to be responsible for >85% (N=3,714) of all nonbacterial outbreaks of gastroenteritis reported from 1995 to 2000. However, the absolute number and population-based rates of viral gastroenteritis outbreaks differed markedly among European surveillance systems. A wide range of estimates of the importance of foodborne transmission were also found. We review these differences within the context of the sources of outbreak surveillance information, clinical definitions, and structures of the outbreak surveillance systems.

Clinical signs and epidemiology of classical swine fever: a review of new knowledge.

Abstract: Although classical swine fever (CSF) has been well known for decades and epidemics still occur, clinical diagnosis continues to cause problems for veterinary practitioners. This is due to the extensive differential diagnosis, further complicated by the emergence of new diseases such as porcine reproductive and respiratory syndrome (PRRS) and porcine dermatitis and nephropathy syndrome (PDNS). In addition, acute, chronic and prenatal courses of CSF have to be distinguished. As a cause of considerable economical losses within the EU, control of CSF requires knowledge of the primary outbreaks and spread of the disease. Genetic typing of CSF virus isolates has proved to be a potent method of supporting epidemiological investigations. Phylogenetic analysis of CSF virus strains and isolates originating from different continents has allowed three genetic groups and several subgroups within these groups to be distinguished. Whereas isolates belonging to group 3 seem to occur solely in Asia, all CSF virus isolates of the 1990s isolated in the EU belonged to one of the subgroups within group 2 (2.1, 2.2, or 2.3) and were clearly distinct from former CSF reference viruses, which belong to group 1. Within the EU, different strategies are followed for the eradication of CSF in domestic pigs and in wild boar. While a strict non-vaccination policy is followed for domestic pigs, eradication of the disease in wild boar is more complex, and oral immunisation together with special hunting strategies have been applied. Recently, marker vaccines with a companion discriminatory test designed to allow differentiation between vaccinated animals and animals having recovered from field virus infection have been developed. Preliminary studies indicated that the discriminatory tests had a reduced sensitivity and specificity. Further improvements are therefore necessary before marker vaccines can be considered for emergency use in EU Member States. Prevention of CSF remains the main objective within the EU.

Dead bird clusters as an early warning system for West Nile virus activity.

Abstract: An early warning system for West Nile virus (WNV) outbreaks could provide a basis for targeted public education and surveillance activities as well as more timely larval and adult mosquito control. We adapted the spatial scan statistic for prospective detection of infectious disease outbreaks, applied the results to data on dead birds reported from New York City in 2000, and reviewed its utility in providing an early warning of WNV activity in 2001. Prospective geographic cluster analysis of dead bird reports may provide early warning of increasing viral activity in birds and mosquitoes, allowing jurisdictions to triage limited mosquito-collection and laboratory resources and more effectively prevent human disease caused by the virus. This adaptation of the scan statistic could also be useful in other infectious disease surveillance systems, including those for bioterrorism.

Molecular Epidemiology of Human Enterovirus 71 Strains and Recent Outbreaks in the Asia-Pacific Region: Comparative Analysis of the VP1 and VP4 Genes

Abstract: This study provides a comprehensive overview of the molecular epidemiology of human enterovirus 71 (HEV71) in the Asia-Pacific region from 1997 through 2002. Phylogenetic analysis of the VP4 and VP1 genes of recent HEV71 strains indicates that several genogroups of the virus have been circulating in the Asia-Pacific region since 1997. The first of these recent outbreaks, described in Sarawak (Malaysian Borneo) in 1997, was caused by genogroup B3. This outbreak was followed by large outbreaks in Taiwan in 1998, caused by genogroup C2, and in Perth (Western Australia) in 1999, where viruses belonging to genogroups B3 and C2 cocirculated. Singapore, Taiwan, and Sarawak had HEV71 epidemics in 2000, caused predominantly by viruses belonging to genogroup B4; however, large numbers of fatalities were observed only in Taiwan. HEV71 was identified during an epidemic of hand, foot and mouth disease in Korea; that epidemic was found to be due to viruses constituting a new genogroup, C3.

The Interval between Successive Cases of an Infectious Disease

Abstract: The interval between successive cases of an infectious disease is determined by the time from infection to infectiousness, the duration of infectiousness, the time from infection to disease onset (incubation period), the duration of any extra-human phase of the infectious agent, and the proportion clinically affected among infected individuals. The interval is important in the interpretation of infectious disease surveillance and trend data, in the identification of outbreaks, and in the optimization of quarantine and contact tracing. This paper discusses the properties of these intervals, as measured between transmission events or between clinical onsets of successive infected individuals, noting the determinants of their ranges and frequency distributions, the circumstances under which secondary cases may arise before primaries, and under which the infection transmission interval will be different from the interval between clinical onsets of successive cases. It discusses the derivation of interval distribution statistics from descriptive data given in standard textbooks, with illustrations from published data on outbreaks, households, and epidemiologic tracing. Finally, it discusses the implications of such measures for studies of secondary attack rates, for the persistence of infection in human communities, for outbreak response, and for elimination or eradication programs.

Two epidemiologic patterns of norovirus outbreaks: surveillance in England and wales, 1992-2000.

Abstract: In the period 1992–2000, the Public Health Laboratory Service Communicable Disease Surveillance Centre collected standardized epidemiologic data on 1,877 general outbreaks of Norovirus (formerly “Norwalk-like virus”) infection in England and Wales. Seventy-nine percent of general outbreaks occurred in health-care institutions, i.e., hospitals (40%) and residential-care facilities (39%). When compared with outbreaks in other settings, those in health-care institutions were unique in exhibiting a winter peak (p<0.0001); these outbreaks were also associated with significantly higher death rates and prolonged duration but were smaller in size and less likely to be foodborne. These data suggest that Norovirus infection has considerable impact on the health service and the vulnerable populations residing in institutions such as hospitals and residential homes. A distinct outbreak pattern in health-care institutions suggests a combination of host, virologic, and environmental factors that mediate these divergent epidemiologic patterns.

A school outbreak of Norwalk-like virus: evidence for airborne transmission.

Abstract: An outbreak of gastroenteritis affected a school attended by children aged 4-11 years. Epidemiological features suggested this was due to Norwalk-like virus (NLV) and this was confirmed by polymerase chain reaction (PCR). Nucleotide sequence analysis of the PCR amplicons revealed identical strains in all five positive stool samples. Pupils were significantly more likely to become ill following an episode of vomiting within their classroom (adjusted odds ratio 4.1, 95% CI 1.8-9.3). The times from exposure to illness were consistent with direct infection from aerosolized viral particles where exposure to vomiting was high. Cleaning with quaternary ammonium preparations made no impact on the course of the outbreak. However, the outbreak stopped after the school closed for 4 days and was cleaned using chlorine-based agents. This study confirms the importance of vomiting in the transmission of NLV and provides evidence that direct infection with aerosolized viral particles occurs.

Update: Outbreak of severe acute respiratory syndrome - Worldwide, 2003

Abstract: CDC and the World Health Qrganization (WHO) are continuing to investigate the multicountry outbreak of unexplained atypical pneumonia referred to as severe acute respiratory syndrome (SARS). Pending development of confirmatory laboratory testing capacity, CDC's interim suspected SARS case definition is based on clinical criteria and epidemiologic linkage to other SARS cases or areas with community transmission of SARS. This case definition will be updated periodically as new information becomes available. Epidemiologic and laboratory investigations of SARS are ongoing. As of April 2, 2003, a total of 2,223 suspected and/or probable SARS cases have been reported to WHO from 16 countries, including the United States. The reported SARS cases include 78 deaths (case-fatality proportion: 3.5%). This report summarizes SARS cases among U.S. residents and surveillance and prevention activities in the United States.

Legionnaires' Disease Outbreak in Murcia, Spain

Abstract: An explosive outbreak of Legionnaires’ disease occurred in Murcia, Spain, in July 2001. More than 800 suspected cases were reported; 449 of these cases were confirmed, which made this the world’s largest outbreak of the disease reported to date. Dates of onset for confirmed cases ranged from June 26 to July 19 , with a case-fatality rate of 1%. The epidemic curve and geographic pattern from the 600 completed epidemiologic questionnaires indicated an outdoor point-source exposure in the northern part of the city. A case-control study matching 85 patients living outside the city of Murcia with two controls each was undertaken to identify the outbreak source; the epidemiologic investigation implicated the cooling towers at a city hospital. An environmental isolate from these towers with an identical molecular pattern as the clinical isolates was subsequently identified and supported that epidemiologic conclusion.

Applying network theory to epidemics: control measures for Mycoplasma pneumoniae outbreaks.

Abstract: We introduce a novel mathematical approach to investigating the spread and control of communicable infections in closed communities. Mycoplasma pneumoniae is a major cause of bacterial pneumonia in the United States. Outbreaks of illness attributable to mycoplasma commonly occur in closed or semi-closed communities. These outbreaks are difficult to contain because of delays in outbreak detection, the long incubation period of the bacterium, and an incomplete understanding of the effectiveness of infection control strategies. Our model explicitly captures the patterns of interactions among patients and caregivers in an institution with multiple wards. Analysis of this contact network predicts that, despite the relatively low prevalence of mycoplasma pneumonia found among caregivers, the patterns of caregiver activity and the extent to which they are protected against infection may be fundamental to the control and prevention of mycoplasma outbreaks. In particular, the most effective interventions are those that reduce the diversity of interactions between caregivers and patients. athematical modeling has a rich and growing tradition in epidemiology (1–3). Because experimental approaches to epidemic interventions are often impractical, and in some cases unethical, mathematical models can provide otherwise unobtainable insights on the spread and control of disease. Recently, considerable interest has been shown in the effect of contact networks on the spread of disease, and particularly in using the so-called percolation theory to model epidemics (4– 10). Agent-based simulation is also being used increasingly to help epidemiologic investigations (11). In this paper, we use both of these tools to assess the effects of epidemic interventions in closed health-care facilities. Mycoplasma pneumoniae is a major cause of bacterial pneumonia in the United States (12). This bacterium, the smallest self-replicating organism capable of cell-free existence, is spread both by direct contact between an infected person and a susceptible person, and by airborne droplets expelled when an infected person sneezes, coughs, or talks. Large, sustained outbreaks of M. pneumoniae have occurred in closed and semi-closed populations such as hospitals, psychiatric institutions, military and religious communities, and prisons (13–15). Public health officials and health-care providers struggle, often with little success, to control mycoplasma outbreaks because of the long incubation period of the organism, late detection of outbreaks, and an incomplete understanding of the effectiveness of various infection control strategies. Effective measures to control mycoplasma outbreaks are needed to limit the associated illness and substantial costs. Previous work has addressed candidate strategies, including infection control practices to prevent the exchange of respiratory droplets between patients and caregivers, cohorting members of the community who display symptoms of a respiratory infection, and antibiotic prophylaxis of asymptomatic members of the community (14–16). The costs of these strategies include curtailed social interactions because of cohorting, undesirable side effects or allergic reactions to prophylactic antibiotics, and a potential increase in the risk for infections caused by antibiotic-resistant bacteria. Studies of these control measures have been limited by incomplete information and participation. Using a network model approach, we show how data on interactions in real-world communities can be translated into graphs—mathematical representations of networks—and how to predict the course of an epidemic from the structure of a graph. We found that the assignment of caregivers to patient groups is more critical to the course of an epidemic than the cohorting of patients. Within our models, the most effective interventions are those that reduce the diversity of interactions that caregivers have with patients. For example, an institution with many wards can avoid a large outbreak by confining caregivers to work in only one or very few wards. The Model

Outbreak of Carbapenem-Resistant Acinetobacter baumannii Producing the OXA-23 Enzyme in Curitiba, Brazil

Abstract: Carbapenem-resistant Acinetobacter baumannii isolates were obtained from eight patients in two hospitals in Curitiba, Brazil. The isolates were multiresistant, belonged to a single strain, and produced the OXA-23 carbapenemase. Treatment options were limited, although the isolates were susceptible to polymyxin B in vitro. The strain contributed to the deaths of five patients.

Multistate outbreak of Monkeypox: Illinois, Indiana, and Wisconsin, 2003

Abstract: CDC has received reports of patients with a febrile rash illness who had close contact with pet prairie dogs and other animals. The Marshfield Clinic, Marshfield, Wisconsin, identified a virus morphologically consistent with a poxvirus by electron microscopy of skin lesion tissue from a patient, lymph node tissue from the patient's pet prairie dog, and isolates of virus from culture of these tissues. Additional laboratory testing at CDC indicated that the causative agent is a monkeypox virus, a member of the orthopoxvirus group. This report summarizes initial descriptive epidemiologic, clinical, and laboratory data, interim infection-control guidance, and new animal import regulations.

Molecular, Serological, and Virulence Characteristics of Vibrio parahaemolyticus Isolated from Environmental, Food, and Clinical Sources in North America and Asia

Abstract: Potential virulence attributes, serotypes, and ribotypes were determined for 178 pathogenic Vibrio parahaemolyticus isolates from clinical, environmental, and food sources on the Pacific, Atlantic, and Gulf Coasts of the United States and from clinical sources in Asia. The food and environmental isolates were generally from oysters, and they were defined as being pathogenic by using DNA probes to detect the presence of the thermostable direct hemolysin (tdh) gene. The clinical isolates from the United States were generally associated with oyster consumption, and most were obtained from outbreaks in Washington, Texas, and New York. Multiplex PCR was used to confirm the species identification and the presence of tdh and to test for the tdh-related hemolysin trh. Most of the environmental, food, and clinical isolates from the United States were positive for tdh, trh, and urease production. Outbreak-associated isolates from Texas, New York, and Asia were predominantly serotype O3:K6 and possessed only tdh. A total of 27 serotypes and 28 ribogroups were identified among the isolates, but the patterns of strain distribution differed between the serotypes and ribogroups. All but one of the O3:K6 isolates from Texas were in a different ribogroup from the O3:K6 isolates from New York or Asia. The O3:K6 serotype was not detected in any of the environmental and food isolates from the United States, and none of the food or environmental isolates belonged to any of the three ribogroups that contained all of the O3:K6 and related clinical isolates. The combination of serotyping and ribotyping showed that the Pacific Coast V. parahaemolyticus population appeared to be distinct from that of either the Atlantic Coast or Gulf Coast. The fact that certain serotypes and ribotypes contained both clinical and environmental isolates while many others contained only environmental isolates implies that certain serotypes or ribotypes are more relevant for human disease.

Avian Influenza in Hong Kong 1997–2002

Abstract: In 1997, a high-pathogenicity H5N1 avian influenza virus caused serious disease in both man and poultry in Hong Kong, China. Eighteen human cases of disease were recorded, six of which were fatal. This unique virus was eliminated through total depopulation of all poultry markets and chicken farms in December 1997. Other outbreaks of high-pathogenicity avian influenza (HPAI) caused by H5N1 viruses occurred in poultry in 2001 and 2002. These H5N1 viruses isolated had different internal gene constellations to those isolated in 1997. No new cases of infection or disease in man due to these or other H5N1 viruses have been reported. This paper provides an overview and chronology of the events in Hong Kong relating to avian influenza, covering the period from March 1997 to March 2002.

Enterovirus 71 outbreaks, Taiwan: Occurrence and recognition

Abstract: Enterovirus 71 (EV71) caused a large outbreak in Taiwan in 1998 with 78 deaths, and smaller outbreaks recurred in 2000 and 2001. The outbreak was recognized because of a large number of hand, foot, and mouth disease cases and the rapid deaths of children with the disease. Virologic and pathologic studies indicated that EV71 was the most important agent related to severe and fatal cases and that a neurogenic inflammatory response was involved in the pathogenesis of cardiopulmonary collapse resulting from fulminant EV71 infection. Seroepidemiologic study suggested that EV71 had circulated for at least 16 years and that the accumulation of susceptible hosts might have triggered the 1998 outbreak. However, a change in EV71 neurovirulence and host genetic susceptibility may also have affected the clinical outcome. The Taiwan outbreak shows that worldwide attention should be paid to such outbreaks, new antiviral drugs should be developed, and that vaccination of children under 5 years of age may be warranted.

Infectious Disease Outbreaks in Nursing Homes: An Unappreciated Hazard for Frail Elderly Persons

Abstract: The common occurrence and dire consequences of infectious disease outbreaks in nursing homes often go unrecognized and unappreciated. Nevertheless, these facilities provide an ideal environment for acquisition and spread of infection: susceptible residents who share sources of air, food, water, and health care in a crowded institutional setting. Moreover, visitors, staff, and residents constantly come and go, bringing in pathogens from both the hospital and the community. Outbreaks of respiratory and gastrointestinal infection predominate in this setting, but outbreaks of skin and soft-tissue infection and infections caused by antimicrobial-resistant bacteria also occur with some frequency.

Characterization of Waterborne Outbreak–associated Campylobacter jejuni, Walkerton, Ontario

Abstract: The Walkerton, Canada, waterborne outbreak of 2000 resulted from entry of Escherichia coli O157:H7 and Campylobacter spp. from neighboring farms into the town water supply. Isolates of Campylobacter jejuni and Campylobacter coli obtained from outbreak investigations were characterized by phenotypic and genotypic methods, including heat-stable and heat-labile serotyping, phage typing, biotyping, fla–restriction fragment length polymorphism (RFLP) typing, and pulsed-field gel electrophoresis. Two main outbreak strains were identified on the basis of heat-stable serotyping and fla-RFLP typing. These strains produced a limited number of types when tested by other methods. Isolates with types indistinguishable from, or similar to, the outbreak types were found only on one farm near the town of Walkerton, whereas cattle from other farms carried a variety of Campylobacter strains with different type characteristics. Results of these analyses confirmed results from epidemiologic studies and the utility of using several different typing and subtyping methods for completely characterizing bacterial populations.

Waterborne Outbreak of Gastroenteritis Associated with a Norovirus

Abstract: The Wyoming Department of Health investigated an outbreak of acute gastroenteritis among persons who dined at a tourist saloon in central Wyoming during October 2001. Human caliciviruses (HuCVs) were suspected as the etiological agent of the outbreak based on the incubation period, duration of illness, and symptoms observed in ill patrons. A retrospective cohort study demonstrated that ill patrons were 4.5 times more likely to have exposure to drinking water and/or ice than nonill patrons. No food items were associated with illness. An environmental investigation gave evidence that the saloon's groundwater was contaminated with sewage. Water from the saloon's only well was processed for viruses. The processed water sample and stool samples collected from three ill patrons were analyzed by reverse transcription-PCR (RT-PCR) for the presence of HuCV. All positive RT-PCR results were confirmed by sequence and phylogenetic analyses of cloned RT-PCR products. A genogroup I, subtype 3, HuCV stain was found to be present in the well water sample and two stool samples. In addition, a genogroup II, subtype 6, strain was detected in one stool sample. The identification of the same HuCV strain in both the well water and stool samples strongly suggests a link between exposure to well water and the outbreak of gastroenteritis. The presence of a genogroup II, subtype 6, strain in one of the stool samples suggests that multiple HuCV strains may have been involved in this outbreak. The laboratory isolation of HuCV strains from outbreak-associated drinking water is relatively novel in the United States. This investigation outlines the procedure for virus isolation and illustrates the utility of RT-PCR for the identification of HuCV in large volumes of water and stool samples obtained during outbreaks of acute nonbacterial gastroenteritis.

Evaluation of Pathogenic Potential of Avian Influenza Virus Serotype H9N2 in Chickens

Abstract: Recently seven isolates of avian influenza virus (AIV) serotype H9N2 recovered from an outbreak of AI were analyzed on the basis of their biological and molecular characteristics. All the isolates belonged to the low-pathogenicity group of AIV. To further evaluate their pathogenic potential in association with other organisms, an isolate was inoculated experimentally in chickens using different routes and subsequently challenged with infectious bronchitis virus, Ornithobacterium rhinotracheale or Escherichia coli. The virus isolation and seromonitoring data revealed a significant role of Escherichia coli in aggravating the clinical condition of the birds earlier infected with AIV (H9N2). The AIV-antigen was detected in lung, trachea, kidney, and cloacal bursa among the infected birds, using immunofluorescent antibody technique. In another experiment, chickens that were immunosuppressed chemically showed high mortality when challenged with AIV H9N2. The results indicated that this low pathogenicity AIV (H9N2) isolate could produce severe infection depending on the type of secondary opportunistic pathogens present under field conditions. This may explain the severity of infection with the present H9N2 outbreak in the field. A prolonged antibacterial therapy in flocks infected with AIV H9N2 and use of oil-based vaccine at an early age in new flocks has helped to control this infection and the disease.

Balanced polymorphism selected by genetic versus infectious human disease

Abstract: The polymorphisms within the human genome include several functional variants that cause debilitating inherited diseases. An elevated frequency of some of these deleterious mutations can be explained by a beneficial effect that confers a selective advantage owing to disease resistance in carriers of such mutations during an infectious disease outbreak. We here review plausible examples of balanced functional polymorphisms and their roles in the defense against pathogens. The genome organization of the chemokine receptor and HLA gene clusters and their influence on the HIV/AIDS epidemic provides compelling evidence for the interaction of infectious and genetic diseases in recent human history.

An outbreak of hepatitis A associated with consumption of raw blueberries.

Abstract: This report describes the epidemiology, investigation and control of a hepatitis A (HAV) outbreak in New Zealand Descriptive and analytical epidemiology, virology, product traceback and an orchard investigation were carried out A case-control study revealed that 56% of 39 cases had consumed raw blueberries, compared with 14% of 71 controls (odds ratio 76; 95% confidence intervals 26-224) Traceback of product through retailers and wholesalers implicated a single commercial orchard Hepatitis A virus was detected by reverse transcriptase polymerase chain reaction in faecal specimens from cases as well as a blueberry product from the orchard Presence of hepatitis A virus was confirmed by DNA hybridization and sequencing of PCR products Sanitary audit of the orchard revealed multiple opportunities for contamination of blueberries by pickers This outbreak highlights the need for food safety programmes in the berry fruit industry

A Multistate Outbreak of Salmonella enterica Serotype Newport Infection Linked to Mango Consumption: Impact of Water-Dip Disinfestation Technology

Abstract: Fresh produce increasingly is recognized as an important source of salmonellosis in the United States. In December 1999, the Centers for Disease Control and Prevention detected a nationwide increase in Salmonella serotype Newport (SN) infections that had occurred during the previous month. SN isolates recovered from patients in this cluster had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns (which identified the outbreak strain), suggesting a common source. Seventy-eight patients from 13 states were infected with the outbreak strain. Fifteen patients were hospitalized; 2 died. Among 28 patients enrolled in the matched case-control study, 14 (50%) reported they ate mangoes in the 5 days before illness onset, compared with 4 (10%) of the control subjects during the same period (matched odds ratio, 21.6; 95% confidence interval, 3.53- infinity; P=.0001). Traceback of the implicated mangoes led to a single Brazilian farm, where we identified hot water treatment as a possible point of contamination; this is a relatively new process to prevent importation of an agricultural pest, the Mediterranean fruit fly. This is the first reported outbreak of salmonellosis implicating mangoes. PFGE was critical to the timely recognition of this nationwide outbreak. This outbreak highlights the potential global health impact of foodborne diseases and newly implemented food processes.