Mass flea outbreak at a child care facility: case report.

Cat fleas, Ctenocephalides felis Bouchet, were collected at a Mississippi child care facility after reports of large numbers of adult fleas occurring on children and personnel. One building yielded 161 (99 percent) of the fleas collected. Urticarial lesions due to flea bites occurred on the legs of six children. Flea presence was due to cats occupying the crawl space. Fleas were eradicated by eliminating entry of cats and using residual insecticides throughout the facility.     

An outbreak of group a food-borne streptococcal pharyngitis

A food-borne outbreak of pharyngitis from group A streptococcus developed in people attending wedding banquets in the same restaurant on July 5–8,1986. Of the 300 people interviewed, 179 reported illness; pharyngeal swabs were taken from J 15 ill people; from 63 (53%) of them group A streptococci, belonging to serotype T28, M28, were isolated.Statistical analysis performed using chi-square and Cochran's test showed that a prawn horsd'oeuvre served on July 5 and squills or/and custard cake served on July 7 could have been a possible source of infection. Six people on the staff, 5 of whom belonged to the family of the restaurant manager, and the manager's three young daughters were colonized by the same group A serotype. A possible previous diffusion of the strain among the staff followed by contamination of the food was suspected.     

An outbreak of group A streptococcal infection in a maternity unit

An outbreak of group A streptococcal colonization among newborn infants in a maternity ward is described. The origin was probably a mother with an infected vaginal discharge and her baby with an omphalitis. Among 13 infants in one ward nine were colonized with group A streptococci and among 20 infants in a connecting ward one was colonized. T-typing revealed that three streptococcal types were involved. Six of the 10 colonized infants developed clinical infections mostly after discharge from the hospital. Control of the outbreak was achieved by closing the unit during one week. No prophylactic penicillin treatment was given to asymptomatic infant carriers.     

Role of acid-suppressing medications during a sustained outbreak of Salmonella enteritidis infection in a long-term care facility.

During an insidious outbreak of salmonellosis in a long-term care facility, residents who were treated with acid-suppressing medications were 8 times more likely than other residents to develop Salmonella infection. Among vulnerable populations, the risks and benefits of acid-suppressing medications should be considered carefully before use.     

A community outbreak of invasive and non-invasive group A beta-haemolytic streptococcal disease in a town in South Wales

An increase in the incidence of invasive and non-invasive infections caused by group A beta-haemolytic streptococci (GAS) was noted in and around the town of Glynneath (population approx. 4000) in West Glamorgan, South Wales between 1 January and 30 June 1995. A total of 133 cases was ascertained with 127 (96%) occurring between 1 March and 30 June 1995. Six patients had invasive disease (one died) and all presented at the peak of the outbreak. There were 127 non-invasive cases of whom 7 were hospitalized. The outbreak was investigated to determine its extent and whether it was caused by a single M-serotype of GAS. Serotyping showed that 13 different M-serotypes were involved with the M1 serotype predominating. The overall incidence of GAS invasive disease in West Glamorgan (population 365,000) increased sevenfold from a crude incidence of 0.5/10(5) per year in 1994 to 3.5/10(5) per year in 1995, but fell back to 0.75/10(5) per year in 1996. Eighty-two (80%) out of 102 individuals affected by GAS replied to a health questionnaire; sore throat was the commonest symptom reported (97%). Thirty-nine of these index cases identified at least one other member of their household who had experienced similar symptoms. The interval between the onset of illness in members of a single household was 0-83 days with a mean of 22 days. The mean duration of illness was 13.5 days and 61% of patients were treated with penicillin V for a mean duration of 9.3 days. Twenty-one per cent of GAS isolates were erythromycin-resistant and the M4 and M6 serotypes were especially resistant to erythromycin (87.5 and 100% resistance, respectively). Penicillin V failed to eradicate GAS from the throats of 25% of assessable patients. In this community, an outbreak of non-invasive disease caused by GAS was linked in time and place with an outbreak of serious invasive disease.     

A prolonged outbreak of streptococcal infection among workers at a meatplant

We describe an outbreak of skin sepsis due to an erythromycin-resistant strain of Streptococcus pyogenes in workers at a meat plant. The outbreak began among butchers in the boning room but subsequently spread to other groups of workers in the plant. Despite the introduction of additional control measures, the outbreak persisted for 7 months and affected 46/194 staff with ‘hands on’ occupations. Spread of infection from the plant to a retail butcher was documented.     

深圳市福田区一起聚集性传染性非典型肺炎发病的调查报告

深圳市福田区自2003年1月15日出现首例传染性非典型肺炎(SARS)病例以来,至今共报告SARS病例22例,除1例为医院感染病例外,其余21例均为社区感染病例.     

HIV as a chronic disease: Implications for long-term care at an AIDS-dedicated skilled nursing facility

Objective To describe the characteristics and outcomes of the first 3 years of admissions to a dedicated skilled nursing facility for people with acquired immunodeficiency syndrome (AIDS). Methods Systematic chart review of consecutive admissions to a 30-bed, AIDS-designated long-term care facility in New Haven, Connecticut, from October 1995 through December 1998. Results The facility has remained filled to 90% or more of its bed capacity since opening. Of 180 patients (representing 222 admissions), 69% were male; mean age was 41 years; 57% were injection drug users; 71% were admitted directly from a hospital. Leading reasons for admission were (1) the need for 24-hour nursing/medical supervision, (2) completion of acute medical treatment, and (3) terminal care. On admission, the median Karnofsky score was 40, and median CD4+ cell count was 24/mm³; 48% were diagnosed with serious neurologic disease, 44% with psychiatric illness; patients were receiving a median of 11 medications on admission. Of 202 completed admissions, 44% of patients died, 48% were discharged to the community, 8% were discharged to a hospital. Median length of stay was 59 days (range 1 to 1,353). Early (≤6 months) mortality was predicted by lower admission CD4+ count, impairments in activities of daily living, and the absence of a psychiatric history; long-term stay (>6 months) was predicted by total number of admission medications, neurologic disease, and dementia. Comparison of admissions from 1995 to 1996 to those in 1997 to 1998 indicated significantly decreased mortality rates and increased prevalence of psychiatric illness between the two periods (P<.01). Conclusions A dedicated skilled nursing facility for people with AIDS can fill an important service need for patients with advanced disease, acute convalescence, long-term care, and terminal care. The need for long-term care may continue to grow for patients who do not respond fully to current antiretroviral therapies and/or have significant neuropsychiatric comorbidities. This level of care may be increasingly important not only in reducing lengths of stay in the hospital, but also as a bridge to community-based residential options in the emerging chronic disease phase of the AIDS epidemic. Deceased. Supported in part by a Faculty Scholars Award to Dr. Selwyn from the Project on Death in America, Open Society Institute.     

Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial

OBJECTIVE: The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function. DESIGN: A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups. SETTING: A LTC facility, which included both assisted living (AL) and nursing home (NH) residents. PARTICIPANTS: Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility. INTERVENTION: After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise. MEASUREMENTS AND METHODS: Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used. RESULTS: There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0. CONCLUSION: Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.     

Nursing home outbreak of invasive group a streptococcal infections caused by 2 distinct strains.

OBJECTIVE: To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases. DESIGN: Outbreak investigation. SETTING: A 146-bed nursing home facility in northern Nevada. METHODS: We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices. RESULTS: Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts. CONCLUSIONS: Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.     

An outbreak of scabies in a long-term care facility: the role of misdiagnosis and the costs associated with control.

In August 2003, an outbreak of scabies was detected in a Canadian long-term care facility. The outbreak was likely associated with 2 index cases, 1 involving classic scabies and the other involving Norwegian scabies. The scabies control costs totaled CDN $200,000, and the facility received negative publicity for a short period after the outbreak.