An outbreak of mumps in the metropolitan area of Walsall, UK.

OBJECTIVE: To describe the epidemiology of excessive mumps cases during the year 2000, within the metropolitan area of Walsall, UK; to assess the impact of the mumps outbreak on morbidity; and to inform future communicable disease control strategy. METHODS: Demographic records, school attendance, uptake of the measles-mumps-rubella (MMR) vaccine, and mumps-associated admission to hospital, were reviewed for all Walsall residents diagnosed and notified with mumps during the year 2000. RESULTS: There were 200 mumps notifications in 2000 (76.6 per 100,000), representing the highest incidence in England. Only 91 of the notified cases were salivary antibody positive for mumps IgM, and 32 were negative, although 77 were not tested. Since 1990, annual totals have never previously exceeded 20. Over 90% of patients were <20 years old, with a peak age group of 10-14 years; 88% attended schools located within Walsall. The pattern of spread suggested that the outbreak proceeded through schools from north to south in the more deprived western half of the metropolitan area. Most cases (136, 68%) had received one (99, 49.5%) or two (37, 18.5%) doses of MMR vaccine; cases > or =20 years old had never received MMR. Six cases (aged 4-14 years) were admitted to hospital, all with a successful outcome, including one male with meningitis and one female with pancreatitis. Current uptake of the MMR vaccine at 24 months has dropped to below 90% in recent years, as in most parts of the UK. CONCLUSIONS: Future mumps outbreaks in schools, and among older age groups, can be predicted, since most older children and young adults have received only one dose of MMR vaccine or no vaccination at all. Primary vaccine failure is well described in mumps, and cases during outbreaks can include recipients of two MMR vaccine doses. It was fortunate that no severe morbidity was associated with this outbreak (prior to MMR, two to four mumps deaths occurred annually in England and Wales). Measures to restore the uptake of MMR to the previous levels of above 90-95% will be necessary to reduce the risk of the mumps virus circulating within communities. Older children are susceptible, and it may be advisable to ensure second-dose MMR uptake while they are still at or when they leave school, or when they enter college, university or the military.     

Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned

Background

Prevention of diarrhea has presented indomitable challenges. A preventive strategy that has received significant interest is zinc supplementation. Existing literature including quantitative meta-analyses and systematic reviews tend to show that zinc supplementation is beneficial however evidence to the contrary is augmenting. We therefore conducted an updated and comprehensive meta-analytical synthesis of the existing literature on the effect of zinc supplementation in prevention of diarrhea.

Methods

EMBASE^®, MEDLINE ^® and CINAHL^® databases were searched for published reviews and meta-analyses on the use of zinc supplementation for the prevention childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. Effect of zinc supplementation on the following five outcomes was studied: incidence of diarrhea, prevalence of diarrhea, incidence of persistent diarrhea, incidence of dysentery and incidence of mortality. The published RCTs were combined using random-effects meta-analyses, subgroup meta-analyses, meta-regression, cumulative meta-analyses and restricted meta-analyses to quantify and characterize the role of zinc supplementation with the afore stated outcomes.

Results

We found that zinc supplementation has a modest beneficial association (9% reduction) with incidence of diarrhea, a stronger beneficial association (19% reduction) with prevalence of diarrhea and occurrence of multiple diarrheal episodes (28% reduction) but there was significant unexplained heterogeneity across the studies for these associations. Age, continent of study origin, zinc salt and risk of bias contributed significantly to between studies heterogeneity. Zinc supplementation did not show statistically significant benefit in reducing the incidence of persistent diarrhea, dysentery or mortality. In most instances, the 95% prediction intervals for summary relative risk estimates straddled unity.

Conclusions

Demonstrable benefit of preventive zinc supplementation was observed against two of the five diarrhea-related outcomes but the prediction intervals straddled unity. Thus the evidence for a preventive benefit of zinc against diarrhea is inconclusive. Continued efforts are needed to better understand the sources of heterogeneity. The outcomes of zinc supplementation may be improved by identifying subgroups that need zinc supplementation.     

Epidemiological,prevention and control updates of yellow fever outbreak in Brazil

Yellow fever is an acute viral disease endemic to tropical countries, like Brazil, where, since the 1940 s, has no significant documented outbreaks similar to that observed between 2016/2018(2 045 confirmed cases and 677 deaths; caused by the sylvatic form).The principal manipulating factors inciting this change were absence of appropriate vaccination campaigns and increased urbanization population growth in forest areas, with prevalence of the virus in the species inhabiting of these areas.The 2016/2018 outbreaks exhibited incidence in areas with historically low or no yellow fever virus activity, triggering a surge in recorded deaths-mainly in the Southeastern states of Brazil.The Brazilian government aggressively responded, reforming the countries' prophylactic measures, including vaccine implementation-as of March, 2018, switching from the former double dose regimen of the vaccine, to a single dose protocol, deemed as adequate.Moreover, some states appropriated the fractionated dosage(1/5 of the standard dose), in foresight of potential vaccine shortages.To prevent the uprising of new sylvatic yellow fever cases in Brazil, it's obligatory the development of effective combative plans, including adaptation of prophylactic measures individually(use of repellents, protective clothing etc.), applicable vaccination campaigns in every endemic region, to raise awareness to locals and visitors alike.Notwithstanding these preventative strategies, the persistence of cases and the recent outbreaks in Brazil, highlight the possible ineffectiveness of combative measures.Based on these considerations, the objective of this review was to raise more awareness of the epidemiological impact of the disease in Brazil.     

A syphilis outbreak: recent trends in infectious syphilis in Birmingham, UK, in 2005 and control strategies

The objective of this study was to identify the demographic characteristics and sexual behaviour associated with primary, secondary and early latent syphilis in Birmingham and its epidemiologic and public health implications. All new patients diagnosed as having infectious syphilis in a genitourinary service in Birmingham in the period from January 2005 to December 2005 were studied retrospectively (history, physical examination, serology) to determine the stage of their disease. During the 12-month period, 69 new cases of primary, secondary and early latent syphilis were diagnosed. Patients were most commonly male (96%), aged between 20 and 44 years, symptomatic (84%) and were white men who had sex with men or Asian/Black Caribbean heterosexual men. Unemployment and having multiple partners were common in infected patients. Based on the results of this study, control measures are being undertaken, using enhanced surveillance, to focus on appropriate health promotion initiatives.     

Diphtheria outbreak in Norway: lessons learned

We describe an outbreak of diphtheria in Norway that occurred in 2008 and affected 3 unvaccinated family members. The epidemic caught the public health system off-guard on most levels; the diagnosis was distrusted due to its rarity, no diphtheria anti-toxin was available, and notification procedures were not rigorously followed.     

新型冠状病毒肺炎暴发期间儿科病房护理防控策略

2019年12月以来,新型冠状病毒肺炎（coronavirus disease-2019, COVID-19）迅速在国内外传播,受感染人群短期内大幅增加,不仅包括成年人,还包括不同年龄段儿童,甚至新生儿。儿童因免疫系统发育不成熟、抵抗力低下,成为COVID-19易感人群之一,尤其是COVID-19流行期间住院患儿更易受感染。因此,做好儿科病房疫情期间的防控工作,采取切实可行措施对于预防和控制儿童感染新型冠状病毒显得尤为重要。本文根据国家卫生部门关于COVID-19疫情最新管理规定,结合本医院COVID-19防控经验,从护理角度探讨综合性医院儿科病房感染防控措施,为国内其他医院儿科病房疫情防控与护理工作提供参考。     

Costs of dengue prevention and incremental cost of dengue outbreak control in Guantanamo, Cuba

Objective To assess the economic cost of routine Aedes aegypti control in an at‐risk environment without dengue endemicity and the incremental costs incurred during a sporadic outbreak. Methods The study was conducted in 2006 in the city of Guantanamo, Cuba. We took a societal perspective to calculate costs in months without dengue transmission (January–July) and during an outbreak (August–December). Data sources were bookkeeping records, direct observations and interviews. Results The total economic cost per inhabitant (p.i.) per month. (p.m.) increased from 2.76 USD in months without dengue transmission to 6.05 USD during an outbreak. In months without transmission, the routine Aedes control programme cost 1.67 USD p.i. p.m. Incremental costs during the outbreak were mainly incurred by the population and the primary/secondary level of the healthcare system, hardly by the vector control programme (1.64, 1.44 and 0.21 UDS increment p.i. p.m., respectively). The total cost for managing a hospitalized suspected dengue case was 296.60 USD (62.0% direct medical, 9.0% direct non‐medical and 29.0% indirect costs). In both periods, the main cost drivers for the Aedes control programme, the healthcare system and the community were the value of personnel and volunteer time or productivity losses. Conclusions Intensive efforts to keep A. aegypti infestation low entail important economic costs for society. When a dengue outbreak does occur eventually, costs increase sharply. In‐depth studies should assess which mix of activities and actors could maximize the effectiveness and cost‐effectiveness of routine Aedes control and dengue prevention.     

Filovirus outbreak detection and surveillance: lessons from Bundibugyo

The first outbreak of Ebola hemorrhagic fever (EHF) due to Bundibugyo ebolavirus occurred in Uganda from August to December 2007. During outbreak response and assessment, we identified 131 EHF cases (44 suspect, 31 probable, and 56 confirmed). Consistent with previous large filovirus outbreaks, a long temporal lag (approximately 3 months) occurred between initial EHF cases and the subsequent identification of Ebola virus and outbreak response, which allowed for prolonged person-to-person transmission of the virus. Although effective control measures for filovirus outbreaks, such as patient isolation and contact tracing, are well established, our observations from the Bundibugyo EHF outbreak demonstrate the need for improved filovirus surveillance, reporting, and diagnostics, in endemic locations in Africa.     

Combining prevention, treatment and care: lessons from South Africa

Over one million people in sub-Saharan Africa now access HIV treatment, and as the prognosis of life expectancy on antiretroviral therapy (ART) improves, the central question that arises for governments, civil society and the private sector must be: how will we pay for the healthcare costs?This paper critically evaluates the need to provide effective treatment, prevention and care for HIV over the long term. Compelling evidence and moral argument suggest that the right combination of treatment and prevention policies, bolstered by grassroots mobilization and effective treatment literacy campaigns, can prevent new infections, save lives and mitigate the impact of HIV/AIDS. South Africa's HIV epidemic and its antiretroviral roll-out provide instructive global templates. The scale of the epidemic, the political responses, the epidemiological evidence and the outcomes data are lessons for countries where there is only a low-level epidemic at present. The investment needed to provide universal ART in South Africa will be substantial, but the economic rationale to act now is compelling. Brazil and to a lesser extent Thailand have responded with increased urgency and foresight. When compared with South Africa, their successes lend further credence to the importance of augmenting HIV prevention efforts with widespread access to treatment and care. Despite the obstacles, important gains have been made in South Africa, with community level health facilities documenting noteworthy treatment and adherence results. Our example suggests that even after tragic mistakes have been made, collective action, evidence-informed programmes, and sustained investment can still save lives and mitigate the epidemic.     

Risk of respiratory infections in health care workers: lessons on infection control emerge from the SARS outbreak

Close proximity of persons together with handling of human secretions (eg respiratory secretions) make health care workers (HCW) particularly vulnerable to transmission of droplet-transmitted respiratory infections. This was tragically highlighted during the international outbreak of severe acute respiratory syndrome (SARS) in 2003 with attack rates of more than 50% in HCW. The purpose of this article is to review common airborne and droplet-transmitted bacterial and viral respiratory tract infections with regard to their impact on health care workers. Lessons need to be learned from the SARS epidemic. The three main strategies to prevent or control occupationally acquired infections are relatively simple and cost-effective-droplet and contact precautions and for some pathogens also vaccination. Enforced implementation of stringent droplet precautions during the SARS crisis should be maintained; and this will most likely have a major additional impact on other nosocomial infections. Employee health services should proactively and creatively devise delivery systems that enhance compliance with vaccination programs for all health care workers. Hospital surveillance should be expanded to all respiratory diseases to facilitate early detection of nosocomial outbreaks, and this should also include surveillance of all HCW. Integrated syndromic and virological surveillance systems set up during the SARS epidemic will also further our understanding of other respiratory infections in the hospital setting. Even if pursuing early diagnosis for unspecific respiratory illnesses is expensive, identification of the causative organism may reduce unnecessary isolation, contact tracing and anxiety, in particular during an outbreak situation. We have a duty to protect our health care workers.     

Investigation of an outbreak of Legionnaires' disease: Hereford, UK 2003

This report describes the investigation and control of a community outbreak of Legionnaires' disease in Hereford, UK, in November 2003. Outbreak investigation consisted of epidemiological survey, identification and environmental investigation of potential sources, microbiological analysis of clinical and environmental samples and mapping the location of potential sources and the movement and residence of cases. Each identified source was allocated a 'composite score' based on different zones of exposure and wind direction. Altogether, 28 cases were identified, with an overall case fatality rate of 7%. All cases had epidemiological links to Hereford city centre. The 'composite score' identified a cluster of cooling towers as being the most likely source of the outbreak. Environmental samples from one of the cooling towers in the cluster and clinical samples from two patients were positive for Legionella pneumophilia serogroup 1 and were indistinguishable by molecular sub-typing. In this outbreak, the use of microbiological, environmental and epidemiological techniques facilitated the rapid identification of a cooling tower as the source of this outbreak. This study illustrates the continuing importance of cooling towers as a source of Legionnaires' disease and the utility of obtaining and comparing both clinical and environmental samples.     

Rubella outbreak in a prenatal clinic: Management and prevention

An obstetrician and two staff members developed rubella and exposed 56 susceptible pregnant women in a large prenatal and family planning clinic. Two women (3.6%) developed rubella at 27 and 38 weeks' gestation and delivered uneventfully. Sixteen hundred clinic and hospital employees were tested, with 79% of the total and 48 of 59 (81.4%) OB/GYN personnel showing prior infection and/or immunity (HAI titer ? 1: 8). Of those susceptible, all obstetrical and most other personnel were vaccinated and removed from high risk areas until immune. Our management of a rubella outbreak and recommendations on hospital and clinic policy to avoid potential health problems are discussed.     

Influenza: prospect for prevention and control

Influenza is an emerging and re-emerging disease. Since the late 1930s influenza viruses have been isolated yearly from different parts of the world during epidemics and pandemics. The "epidemiologic success" of influenza is due largely to rapid and unpredictable antigenic changes (antigenic drift) among human influenza viruses, and the emergence of new subtypes (antigenic shift), mostly from reassortment between human and avian influenza viruses. Antigenic shifts were attributed to the global pandemic viruses of 1957 (H2N2 Asian flu) and 1968 (H3N2 Hong Kong flu). Concern over possible new pandemics has been heightened by recent reports of human infection in Asia in 1997 with avian viruses (H5N1) and in 1999 (H9N2) and isolation of human-avian reassorted viruses from pigs and humans in Europe. Influenza has a high rate of inapparent infection, short incubation and high infectivity; epidemics usually start abruptly and spread rapidly to neighboring communities and countries. Isolation and quarantine are often unsuccessful in preventing the spread of the infection. Although not perfect, immunization and chemoprophylaxis are highly effective at minimizing the spread of influenza and reducing morbidity and mortality, social disruption and economic loss. Plans for future influenza epidemics and pandemics require national and international programs to be in place for the monitoring of influenza activity, the dissemination and exchange of information and the provision and delivery of sufficient quantities of vaccines and antiviral agents. This paper reviews and discusses the antigenic variations of the influenza virus, potential influenza pandemics, protective efficacy of inactivated vaccines and antiviral agents and preparation for control of future epidemics and pandemics.     

Amyloid-beta immunotherapy for the prevention and treatment of Alzheimer disease: lessons from mice, monkeys, and humans

Alzheimer disease (AD), the most common form of dementia, is without an effective cure or preventive treatment. Recently, amyloid-beta protein (Abeta) has become a major therapeutic target. Many efforts are underway to either reduce the production of Abeta or enhance its clearance. In 1999, Schenk and colleagues first showed that active immunization with full-length Abeta lowered cerebral Abeta levels in transgenic mice. These findings have been confirmed and extended in various transgenic mouse models of AD using both active and passive Abeta immunization. Cognitive improvement also has been reported in association with active and passive Abeta vaccination in AD-like mouse models, even in the absence of significant reductions in cerebral Abeta loads. In 2004, the authors reported that active immunization with full-length Abeta in aged nonhuman primates, Caribbean vervets, reduced cerebral Abeta levels and gliosis. Proposed mechanisms of Abeta clearance by immunotherapy include disruption of Abeta aggregates, Abeta phagocytosis by microglia, neutralization of Abeta oligomers at the synapse, and increased efflux of Abeta from brain to blood. A phase IIa clinical trial was halted in 2002 because of the appearance of meningoencephalitis in approximately 6% of the AD patients. Although the exact cause of these adverse events is unknown, the immunogen, full-length Abeta1-42, may have been recognized as a self-antigen leading to an autoimmune response in some patients. Limited cognitive stabilization and apparent plaque clearance have been reported in subsets of patients who generated antibody titers. Currently, a passive immunization trial with a recombinant humanized monoclonal Abeta antibody is underway in humans. In the meantime, the authors are developing novel Abeta peptide immunogens for active immunization to target Abeta B cell epitope(s) and avoid Abeta-specific T-cell reactions in order to generate a safe and effective AD vaccine. The authors remain optimistic about the potential of such a vaccine for the prevention and treatment of AD.