Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare,England, 2018–2019

Healthcare-associated invasive group A Streptococcus (iGAS) outbreaks are common worldwide, but only England has reported outbreaks associated with home healthcare (HHC). We describe 10 outbreaks during 2018–2019 in England. A total of 96 iGAS cases (range 2–39 per outbreak) and 28 deaths (case-fatality rate 29%) occurred. Outbreak duration ranged from 3–517 days; median time between sequential cases was 20.5 days (range 1–225 days). Outbreak identification was difficult, but emm typing and whole-genome sequencing improved detection. Network analyses indicated multiple potential transmission routes. Screening of 366 HHC workers from 9 outbreaks identified group A Streptococcus carriage in just 1 worker. Outbreak control required multiple interventions, including improved infection control, equipment decontamination, and antimicrobial prophylaxis for staff. Transmission routes and effective interventions are not yet clear, and iGAS outbreaks likely are underrecognized. To improve patient safety and reduce deaths, public health agencies should be aware of HHC-associated iGAS.     

The epidemiology of varicella cases among children in Beijing's Fengtai District from 2008 to 2012

In recent years, the number of breakthrough cases of varicella (onset >42 days after vaccination) increased each year, and varicella outbreaks continue to occur in Beijing. Data from the Immunization Information System and the Infectious Disease Reporting System demonstrated that in Beijing's Fengtai District, the varicella breakthrough rate increased from 0.7% in 2008 to 2.5% in 2012 and showed an increased trend (P < 0.001). Among the varicella cases in children (age of 3–15 years), the number of breakthrough cases increased from 167 in 2008 to 622 in 2012, which was 45.2% (n = 1735) of the total child cases (n = 3842). From 2008 to 2012, a total of 62 outbreaks occurred; among the 787 affected child outbreak cases, 61% were vaccinated. Altogether, the results from this study indicated that 1-dose vaccination cannot sufficiently prevent the occurrence of breakthrough cases of varicella or control varicella outbreaks in Beijing's Fengtai District.     

北京市2014年外来就诊麻疹病例特征分析

目的 分析北京市外来就诊麻疹病例特征,探讨针对性防控策略和建议.方法 自北京市“麻疹监测信息报告管理系统” 截取2014年麻疹病例信息,采用描述性流行病学方法分析.结果 2014年北京市共报告麻疹病例3 328例,其中本市病例2 397例(72.0%),外来就诊病例931例(28.0%).分析显示外来就诊病例报告的时间高峰早于本市病例,而后者中有934例(39.0%)在发病前7～21 d均有医院暴露史.外来就诊病例以儿童为主,其中< 15岁占77.1%(718/931);病例报告医院集中于3家传染病专科医院(567人次,49.0%)和2家儿童专科医院(445人次,38.5%);病例来自24个省份,其中以河北省病例最多(705例,75.7%).分析712例有流行病学调查信息病例的就诊时症状,704例(98.9%)在来京就诊前已出皮疹,621例(87.2%)是在出皮疹后4 d内(处于麻疹传染期)前来就诊.结论 2014年北京市外来就诊麻疹病例数量增多,对北京市疫情造成一定影响,成为消除麻疹面临的又一严峻挑战.     

The association between family meals, TV viewing during meals, and fruit, vegetables, soda, and chips intake among Latino children

ObjectiveExamine the relationship of family meals to children's consumption of fruit and vegetables as well as soda and chips. Additionally, to assess the relationship between viewing TV during family meals and children's diet.DesignCross-sectional study that used a questionnaire completed by parents.SettingThirteen schools in San Diego, California.ParticipantsSeven hundred ninety-four children and their parents.AnalysisOrdinal regression assessed associations between children's intake of fruit, vegetables, soda, and chips with family meal frequency and TV viewing during family meals.ResultsChildren who consumed breakfast, lunch, or dinner with their family at least 4 days per week ate fruit and vegetables 5 or more times a week 84%, 85%, and 80%, respectively. Of those children who ate breakfast, lunch, or dinner with their family at least 4 days per week, 40%, 44%, and 43% consumed soda and chips 5 or more times a week, respectively. Children who ate breakfast with their families at least 4 times a week were more likely to consume fruit and vegetables, and children whose TV was never or rarely on during family meals were less likely to consume soda and chips (P = .04 and P < .001, respectively).ConclusionsInterventions geared at increasing the frequency of eating breakfast as a family and decreasing the amount of TV watched during family meals are needed, especially among acculturating Latino families.     

The Prevalence of Cryptosporidium spp. in Children,Taiz District,Yemen

Background

This is the first work done on cryptosporidiosis among the children in Taiz, Yemen.

Methods

A number of 712 samples were collected from children of different ages (ranging from 1 month to 12 years) from Dec 2006 to Aug 2007. The collected samples were examined by Sheather''s sugar floatation and Modified Ziehl- Neelsen stain as well as ELISA methods. The test results were statistically analyzed by SPSS software.

Results

The overall positive percentage was 43.7%. The higher incidence (36.2%) was occurred in males while the lowest incidence (32.7%) was observed in females (r=0.876; P=0.001). The correlation between infected cases and the type of drinking water was r =0.121. Among the cases examined by ELISA (92 cases), 26.1% were infected. The correlation between seropositivity and gender was r=0.652 (P=0.031).

Conclusion

Cryptosporidium spp. is a significant pathogen among children at Taiz. Fresh water supplies, education, eating habits and domestic animals are considered the main sources for transmission of cryptosporidiosis.     

Study on Vibrio cholerae infection in a small community in Calcutta

The presence of a high level of latent infection in an affected community was postulated as one of the conclusions of earlier studies undertaken during cholera epidemics. A small community, consisting of 59 persons, was investigated for 100 days to determine the prevalence and persistence of infection after the occurrence of 2 index cases of cholera. In the community 39 excretors (66.1%) were detected, the 2 index cases and 37 carriers. Excretion of Vibrio cholerae was detected as much as 100 days after the occurrence of the index cases. No subsequent case of clinical cholera occurred in the community. These observations show that incidence of infection can be very high and that infection can last for a long period after an index case even in the absence of overt disease.     

Aspects épidémiologiques de Staphylococcus aureus résistant à la méticilline dans un centre hospitalier de taille moyenne

Objective – The aim of this study was to assess the incidence of colonization/infection by methicillin-resistant Staphylococcus aureus (MRSA) in our hospital.Method – For two months, cases of MRSA colonization or infection were monitored prospectively. Antibiotic susceptibility patterns and molecular methods were used to type the isolated strains. Morbidity was determined from the incidence of patients colonized/infected by MRSA, according to the type of ward.Results – The overall incidence of patients colonized/infected by MRSA was 1.22%. Incidence depended on the type of ward; it was 1.56 per thousand days of hospitalization in short-term care wards, and 1.65 per thousand days of hospitalization in long-term care wards. MRSA skin colonization or wound infection was most frequently observed (53.1%). Chromosomal DNA macro restriction analysis, with SmaI by pulsed-field gel electrophoresis, revealed that some epidemic MRSA clones were widespread. Most of the 32 MRSA isolates (78.2%) were closely related, and among these strains, 96% displayed the same antibiotype. Community-acquired MRSA accounted for 25% of the MRSA colonization/infection cases. Nevertheless, when considering significant factors of persistent carriage, true community-acquired MRSA cases only accounted for 6.25% of all cases.Conclusion – Computer-triggered warnings in the patient's file, might contribute to the early detection of previously colonized or infected patients readmitted to the hospital.     

Clinical manifestations,complications and treatment of brucellosis: a retrospective evaluation of 480 patients

The aim of this study was to evaluate the clinical, laboratory findings, and therapeutic features of patients with brucellosis. The diagnosis was made by clinical findings, positive agglutination titer, and/or the isolation of Brucella species. Three hundred and twenty-two cases were acute, 121 sub-acute, 24 chronic, and 13 asymptomatic. Symptoms of patients were malaise in 432 (90%) patients, sweating in 405 (84.4%), arthralgia in 393 (81.9%), fever in 383 (79.8%), and back pain in 281 (58.5%). The most frequent findings were fever in 187 (39%) patients, hepatomegaly in 102 (21.3%), osteoarticular involvement in 91 (19%), splenomegaly in 68 (14.2%), nervous system involvement in 31 (6.5%) patients. Lymphocytosis was determined in 328 patients, anemia in 262 patients, thrombocytopenia in 35 patients, leukopenia in 37 patients, leukocytosis in 31 patients, and elevated erythrocyte sedimentation rate in 282 patients. Cultures were positive in 194 (45%) patients and all strains were identified as Brucella melitensis. Various treatment regimens were given to patients. No therapeutic failure was observed. The time to defervescence ranged from 2 to 15 days. Relapse occurred in 26 of the 480 patients (5.4%). There was no correlation between relapse and positive culture or complications. Brucellosis can present various clinical forms in endemic areas and mimics several diseases.     

Prevalence of Intestinal Parasites in Bakery Workers in Khorramabad,Lorestan Iran

Background

Food contamination may occur through production, processing, distribution and preparation. In Iran especially in Khorramabad, 33° 29'' 16" North, 48° 21'' 21" East, due to kind of nutrition, culture and economic status of people, bread is a part of the main meal and the consumption of bread is high. In this study, the bakery workers were studied for determining of intestinal parasites prevalence.

Methods

The study was carried out during September to November 2010 in Khorramabad. All the 278 bakeries and the bakery workers including 816 people were studied in a census method and their feces were examined for the presence of parasites by direct wet-mount, Lugol''s iodine solution, and formaldehyde-ether sedimentation, trichrome staining, and single round PCR (For discrimination of Entamoeba spp).

Results

Ninety-six (11.9%) stool specimens were positive for different intestinal parasites. Intestinal parasites included Giardia lamblia 3.7%, Entamoeba coli 5.5%, Blastocystis sp. 2.1%, Entamoeba dispar 0.4%, Hymenolepis nana 0.1%, and Blastocystis sp. 0.1%.

Conclusion

In order to reduce the contamination in these persons, some cases such as stool exam every three months with concentration methods, supervision and application of accurate health rules by health experts, training in transmission of parasites are recommended.     

Epidemiology of tetanus in the Marches Region of Italy, 1992-95.

Reported is the incidence of tetanus in the Marches Region of Italy for the period 1992-95. Data were obtained from both the regional public health committee''s notification forms for infectious diseases and from hospital clinical records. A total of 36 cases were examined, comprising 7 males (19.4%) and 29 females. The raw annual incidence was 6.3 per million population; the standardized incidence for females was four times greater than that for males (9.2 and 2.4 per million population annually, respectively). The patients'' ages varied from 31 years to 88 years (median, 73.5 years). The incidence among subjects older than 65 years was approximately ten times greater than that among younger individuals. Chronic wounds, such as trophic lesions, represented the site of tetanus infection in 14.3% of cases whose infection entry point was identified. Treatment of the 36 cases required a total of 1239 hospital days, of which 58.7% were in intensive care and 29.6% were in infectious diseases departments. The raw annual mortality rate for the period considered was 0.7 per million population; the case-fatality ratio was 11%. The results of our study confirm the limits of the current Italian immunization programmes, which exclude a large portion of the population from antitetanus protection.     

Genetic diversity of multidrug-resistant Mycobacterium tuberculosis isolates in Punjab,Pakistan

Pakistan ranks 5th among the world's highest tuberculosis (TB) burden countries and 6th among the countries with the highest prevalence of drug-resistant TB. However, insufficient data are available on the genetic structure of M. tuberculosis strains circulating in this country. The objective of this study was to explore the genetic diversity of multidrug-resistant M. tuberculosis isolates from Punjab, Pakistan with a combination of spoligotyping and 24-loci MIRU-VNTR typing.Among a total of 127 MDR isolates studies, 53 spoligotypes were obtained, split into 14 clusters (n = 88, 69.3%, 2–29 isolates per cluster) and 39 (30.7%) unique patterns. At the phylogenetic level, the most prevalent sublineage was CAS1_DELHI (n = 53, 41.7%), mostly represented by ST 1942 (n = 29, 22.8%), followed by T1 (n = 14, 11%) and Beijing (n = 10, 7.8%). The remaining nine sublineages (CAS, MANU2, EAI5, T2, LAM10_CAM, H1, X1, H4 and CAS2) involved altogether 24 (18.9%) isolates. Twenty-six (20.5%) isolates could not be assigned to any specific clade. MIRU-VNTR typing identified 123 (96.8%), 97 (76.4%) and 65 (51.2%) unique types with a tolerance of 0, 1, and 2 locus differences between the patterns.Upon combined spoligotyping and MIRU-VNTR typing analysis, 123 (96.8%), 108 (85%), and 91 (71.7%) unique types were identified if a tolerance of 0, 1, and 2 locus differences in the MIRU-VNTR patterns was assumed, respectively. Based on the clustering results, the transmission rate for MDR-TB cases under the study was calculated at 3.2%, 15%, and 28.3%.Overall, three clades, namely CAS1_DELHI, T1, and Beijing accounted for the majority of MDR-TB cases in Pakistan. Up to a third of the cases were clustered upon combined spoligotyping and MIRU-VNTR typing, suggesting a moderate level of active transmission.     

Epidemiological features of an outbreak of gastroenteritis/cholera in Katsina, Northern Nigeria.

In April 1982, Katsina, in Northern Nigeria, was affected by an outbreak of gastroenteritis associated with Vibrio cholerae serotype ''Ogawa'' and 662 patients were admitted to the Katsina General Hospital during a 16-week period. The outbreak affected all ages and both sexes and all parts of the town and its immediate surroundings except the Government Residential Area (GRA). The overall case fatality rate was 7.7%. Male specific case fatality and female specific case fatality rates were 9.7 and 6.2% respectively. ''Adults'' and those in the 11-20 and 21-30 age groups accounted for most of the cases. The epidemic curve was of a propagated and protracted nature. About 51.7% of all the patients spent between 2 and 5 days in the hospital. A similar pattern was observed for all age groups regardless of sex. Cholera vibrio ''Ogawa'', Shigella spp., Salmonella spp., Proteus spp. and Escherichia coli were isolated from 16 patients. All well-water samples obtained from the compounds of the cases were contaminated with MPN/100 ml index ranging from 540 to greater than 2400. All samples were positive for faecal coliforms. Salmonella spp., Shigella spp., Proteus spp. and non-O, group 1 (non-O 1) V. cholerae were isolated. Water sellers probably facilitated the spread of the outbreak.     

Severe acute respiratory syndrome, Beijing, 2003

The largest outbreak of severe acute respiratory syndrome (SARS) struck Beijing in spring 2003. Multiple importations of SARS to Beijing initiated transmission in several healthcare facilities. Beijing's outbreak began March 5; by late April, daily hospital admissions for SARS exceeded 100 for several days; 2,521 cases of probable SARS occurred. Attack rates were highest in those 20-39 years of age; 1% of cases occurred in children <10 years. The case-fatality rate was highest among patients >65 years (27.7% vs. 4.8% for those 20-64 years, p < 0.001). Healthcare workers accounted for 16% of probable cases. The proportion of case-patients without known contact to a SARS patient increased significantly in May. Implementation of early detection, isolation, contact tracing, quarantine, triage of case-patients to designated SARS hospitals, and community mobilization ended the outbreak.     

Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species,Japan, 2014–2020

To determine differences in clinical characteristics of patients with bacteremia caused by Corynebacterium striatum, C. jeikeium, and other species of Corynebacterium, we retrospectively reviewed medical records of patients in Japan who had Corynebacterium bacteremia during January 2014–May 2020. Of the 115 records evaluated, 60 (52%) were cases of true bacteremia and 55 (48%) were cases of contamination. Proportions of true bacteremia cases caused by C. striatum (70%) and by C. jeikeium (71%) were significantly higher than those caused by other species of Corynebacterium (9%). These 2 organisms were commonly detected in blood cultures of patients with hematologic malignancies and neutropenia. The mortality rates at 90 days were 34% (C. striatum), 30% (C. jeikeium), and 0 (other species). Given the high mortality rates, assessing true bacteremia when C. striatum or C. jeikeium is detected in blood cultures, especially in patients with hematologic malignancy, is warranted.     

Safar's Method for Treatment of Detachment of the Retina by Diathermy

Safar''s method aims at getting discrete areas of coagulation in the choroid without any injury to the retina. Larson produces areas of coagulation by surface cauterization with a small, ball-shaped electrode. Weve uses Larson''s method, and also the encircling method with a fine needle.The advantages of Safar''s method are: (a) The exact placing of the area of coagulation; (b) the possibility of using a more regular current; (c) less likelihood of the area of coagulation being too extensive; (d) the possibility of making large barrages without losing fluid and the eye becoming soft; (e) the avoidance of having to make a subsequent puncture to draw off the subretinal fluid.Technique.—(1) Nearly the same as Guist''s encircling method or the formation of barrages. (2) Instruments: Special isolated needles to avoid sparking and also to limit the depth of entry. Special ivory-headed retractors; glass retractors are also useful.Treatment.—(1) Previous to operation: rest in bed, with the use of Lindner''s Lochbrille. (2) Subsequent to operation: eight to fourteen days with both eyes bandaged. Wearing of the Lochbrille after the bandages have been removed.Scars.—Ideal scars about the size of optic disc, round, and stippled with small spots of pigment; the retina lies flat over these scars as seen by tracing the retinal vessels.Results. Up to 1932 (Safar''s).—Thirty-nine unselected cases: twenty-four reattachments, that is, more than 60% in recent cases of myopia, and after contusion more than 90%.     

Leptospirosis in Franche-Comté (FRANCE): Clinical,biological, and therapeutic data

Objectives and method

We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions.

Results

The median age was 42 years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50 years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7 days.

Conclusions

We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis.     

Fungal Endophthalmitis Outbreak after Cataract Surgery,South Korea, 2020

In November 2020, an unusual increase in fungal endophthalmitis cases after cataract surgery was reported to the Korea Disease Control and Prevention Agency, South Korea. We initiated an outbreak investigation to identify the cause. We identified 156 cases nationwide, 62 confirmed and 94 probable. Most case-patients were exposed during surgery to ocular viscoelastic devices (OVDs) from the same manufacturer (company A). We isolated Fusarium spp. from 50 confirmed cases. Molecular identification of 39 fungal isolates from clinical samples and 13 isolates from OVDs confirmed F. oxysporum caused the infections. The risk ratio for fungal endophthalmitis from company A’s OVDs was 86.0 (95% CI 27.4–256.9), much higher than risk from other manufacturers’ products. We determined this fungal endophthalmitis outbreak was caused by a contaminated lot of OVDs and recommended discontinued use of this product. Early recognition of outbreaks and joint responses from related government agencies can reduce risk for fungal endophthalmitis.     

Intestinal parasitic infection: prevalence,knowledge, attitude,and practices among schoolchildren in an urban area of Taiz city,Yemen

BackgroundIntestinal parasitic infections (IPIs) are regarded as one of the main public health problems and socio-economic issues adversely affecting the health of millions of people worldwide. Our study aimed to describe the knowledge, attitude, and practices of local urban schoolchildren in Taiz City towards intestinal parasitic infections.Methods and materialThis is a cross-sectional study conducted in Taiz, Yemen from March to May 2019. A total of 385 schoolchildren were selected using a random sampling technique from 7 primary schools. Wet-mount microscopic examination, formol-ether concentration techniques, and Lugols'' iodine were employed in parasite detection and cyst identification.ResultsOf the 385 schoolchildren examined for IPIs, 107 (27.8%) were positive for the presence of enteric parasites, some having multiple infections. The prevalence was slightly higher in males 46 (28.6%) than in females 61 (27.2%) but have no statistical difference (P = 0.77). Entamoeba histolytica/dispar was the most common infection with 16.4% of cases. A substantial percentage (40.5%) of the respondents displayed poor knowledge. The respondents also revealed inappropriate attitudes and practices that contribute to the prevalence of IPIs in the study.ConclusionsThe study revealed the prevalence of intestinal parasites among the schoolchildren in Taiz, Yemen, suggesting that IPIs remain a major public health problem. Entamoeba histolytica/dispar was the most prevalent intestinal parasites identified among the schoolchildren. Age, poor knowledge of the mode of transmission, prevention, and acquisition of IPIs, and poor habitual hygiene practices increase the risk of acquiring intestinal infections.