Nosocomial outbreak of scabies in a hospital in Spain

An outbreak of scabies occurred in a ward of a local hospital in Barbastro (Huesca, Spain), between November 2002 and January 2003. The outbreak was linked to a patient infested with mites when he was admitted to the ward on 1 November 2002. The first case had onset of symptoms on 5 November and the last one on 5 January 2003. Seventeen cases were reported: 11 healthcare workers (HCWs) and six patients. The outbreak was attributed to a delay in diagnosis, and lack of individual protection measures by caregivers. The use of short-sleeved coats is an habitual risk practice in this ward. Contact with fomites, animals, infested clothes or intimate contact with people other than their usual partners were dismissed as risk factors for the infestation. The different groups of caregivers in this ward presented a similar risk of becoming infested, and the mechanism of transmission was probably person to person contact. The implementation of specific guidelines for scabies prevention and treatment, as well as an active surveillance system, were fundamental to the control of this outbreak.     

Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo, 2003

This report describes the first reported outbreak of human monkeypox in the Republic of Congo. Eleven confirmed and probable monkeypox cases were observed during this outbreak, all were less than 18 years old, and most resided on the grounds of the Government Hospital in Impfondo. Molecular, virologic, and serologic, and diagnostic assays were used to detect evidence of monkeypox (or orthopox) virus infection in individuals with striking dermatologic and other clinical manifestations. The majority of cases in this outbreak experienced significant, symptomatic illnesses; there was one death, possibly involving secondary complications, and one instance of profound sequelae. Up to six sequential transmissions of monkeypox virus from person to person are hypothesized to have occurred, making this the longest uninterrupted chain of human monkeypox fully documented to date. The pattern of sustained human-to-human transmission observed during this outbreak may influence our current perception of the capacity for this zoonotic virus to adapt to humans.     

上气道咳嗽综合征患者Th1、Th2细胞表达水平研究

目的 探讨上气道咳嗽综合征(UACS)患者外周血辅助性T细胞(Th)亚群平衡偏移及其意义.方法 收集78例UACS患者(慢性扁桃体炎25例、鼻后滴流综合征17例、过敏性鼻炎36例),与40例健康体检者进行比较.以γ-干扰素(IFN-γ)代表Th1型细胞因子,白介素4(IL-4)代表Th2型细胞因子,ELISA法测定患者...     

An outbreak of shigellosis in a child care institution in Queluz,Portugal - 1995

The introduction of shigella into a child care centre carries a high risk of secondary spread from person to person within the centre. We report an outbreak of shigellosis in early 1995 that affected 99 children, 17 of their relations, and seven workers i     

An Epidemic of Non-A, Non-B Hepatitis in Japan

An epidemic of viral hepatitis was studied in the Okitsu area of Shimizu city in Japan from April 1980 to November 1981. One hundred thirty-six serum samples from patients with viral hepatitis were tested for hepatitis B virus, hepatitis A virus, Epstein-Barr virus, and cytomegalovirus infection. Immunoserological data showed the outbreak of viral hepatitis to be non-A, non-B hepatitis. Epidemiological investigations revealed that the mode of the outbreak was from person to person by close contact and the incubation period was from about 2 to 5 months.     

Gastro-enteritis outbreak among Nordic patients with psoriasis in a health centre in Gran Canaria, Spain: a cohort study

Background

Between November 2 and 10, 2002 several patients with psoriasis and personnel staying in the health centre in Gran Canaria, Spain fell ill with diarrhoea, vomiting or both. Patient original came from Norway, Sweden and Finland. The patient group was scheduled to stay until 8 November. A new group of patients were due to arrive from 7 November.

Methods

A retrospective cohort study was conducted to assess the extent of the outbreak, to identify the source and mode of transmission and to prevent similar problems in the following group.

Results

Altogether 41% (48/116) of persons staying at the centre fell ill. Norovirus infection was suspected based on clinical presentations and the fact that no bacteria were identified. Kaplan criteria were met. Five persons in this outbreak were hospitalised and the mean duration of diarrhoea was 3 days. The consequences of the illness were more severe compared to many other norovirus outbreaks, possibly because many of the cases suffered from chronic diseases and were treated with drugs reported to affect the immunity (methotrexate or steroids). During the two first days of the outbreak, the attack rate was higher in residents who had consumed dried fruit (adjusted RR = 3.1; 95% CI: 1.4–7.1) and strawberry jam (adjusted RR = 1.9; 95% CI: 0.9–4.1) than those who did not. In the following days, no association was found. The investigation suggests two modes of transmission: a common source for those who fell ill during the two first days of the outbreak and thereafter mainly person to person transmission. This is supported by a lower risk associated with the two food items at the end of the outbreak.

Conclusions

We believe that the food items were contaminated by foodhandlers who reported sick before the outbreak started. Control measures were successfully implemented; food buffets were banned, strict hygiene measures were implemented and sick personnel stayed at home >48 hours after last symptoms.     

上气道咳嗽综合征患者Th1、Th2细胞表达水平研究

目的探讨上气道咳嗽综合征（UACS）患者外周血辅助性T细胞（Th）亚群平衡偏移及其意义。方法收集78例UACS患者（慢性扁桃体炎25例、鼻后滴流综合征17例、过敏性鼻炎36例）,与40例健康体检者进行比较。以γ-干扰素（IFNγ-）代表Th1型细胞因子,白介素4（IL-4）代表Th2型细胞因子,ELISA法测定患者血清IL-27、IFN-γ、IL-4、肿瘤坏死因子α（TNF-α）浓度水平。结果正常组与UACS组之间比较,IL-27、IFN-γ、IL-4和TNF-α差异有统计学意义,正常组IL-27和IFN-γ浓度高于UACS组,差异有统计学意义,正常组IL-4和TNF-α浓度低于UACS组,且UACS组Th1/Th2比例失衡。结论 Th1、Th2细胞因子参与了UACS的发病,且Th1/Th2比例失衡可能是导致其发病的重要因素。     

A nosocomial outbreak of fluoroquinolone-resistant Streptococcus pneumoniae.

Over the course of a 20-month period, in a hospital respiratory ward in which ciprofloxacin was often used as empirical antimicrobial therapy for lower respiratory tract infections (LRTIs), 16 patients with chronic bronchitis developed nosocomial LRTIs caused by penicillin- and ciprofloxacin-resistant Streptococcus pneumoniae (serotype 23 F). The minimum inhibitory concentration (MIC) of ciprofloxacin for all isolates from the first 9 patients was 4 microg/mL, in association with a parC mutation. Isolates from the subsequent 7 patients all had a ciprofloxacin MIC of 16 microg/mL, in association with an additional mutation in gyrA. The MICs for this isolate were 8 microg/mL of levofloxacin (resistant), 2 microg/mL of moxifloxacin and gatifloxacin (intermediately resistant), and 0.12 microg/mL of gemifloxacin. This outbreak demonstrates the ability of S. pneumoniae to acquire multiple mutations that result in increasing levels of resistance to the fluoroquinolones and to be transmitted from person to person.     

The norovirus-epidemic in Berlin - clinic, epidemiology, and prevention

INTRODUCTION: During the winter 2002/2003, an increased number of outbreaks of acute gastroenteritis caused by norovirus was reported from Germany, some other European countries and the USA. In this study, the epidemiological and clinical features of the Berlin norovirus outbreak were investigated in order to identify the reasons for the spread of norovirus gastroenteritis and possible control measures. METHODS: Cases and spread of norovirus infection in eleven long-term care facilities and a university hospital in Berlin were monitored from October 2002 to February 2003. To investigate the symptomatology and routes of transmission, a retrospective and interview-based study of infected staff members was performed. RESULTS: Norovirus outbreaks in eleven long-term care facilities affected 314 patients (attack rate: 28.3 %, rate of hospitalisation: 20.7 %). 219 persons were affected in the hospital, during a period of four months. Sequence analysis revealed the circulation of Norovirus genogroup II (Grimsby-like viruses). The mean duration of symptoms was 69 hours. The duration of outbreaks on specific wards was negatively correlated with the time of returning to work (mean: 1.8 days) of the staff members after the disease. DISCUSSION: This report demonstrates the potential of norovirus to cause large outbreaks by person to person transmission. Spread by aerosols generated by vomiting and environmental contamination seem to be particular important in institutional settings. The duration of symptoms was longer than reported previously, reflecting a possible increased virulence. Besides this, the outbreak was facilitated by insufficient preventive measures.     

An outbreak of hepatitis A virus infection with a high case-fatality rate among injecting drug users

BACKGROUND/AIMS: In 2002, the first reported outbreak of hepatitis A virus (HAV) infection involving mostly intravenous drug users (IDU) occurred in Italy. We attempted a thorough evaluation of the outbreak, including epidemiological, clinical and virological analyses. METHODS: We conducted an epidemiological investigation, including a case-control study, to identify the source and the modes of HAV transmission. Hepatitis B and C (HCV) viruses and human immunodeficiency virus (HIV) coinfections were clinically analysed. Sequence analysis of the VP1/2A junction of the HAV isolates was also performed. RESULTS: Of the 47 symptomatic cases, 35 were IDUs. The only associated risk factor was contact (not related to injecting practices) with a jaundiced person (odds ratio: 5.8; 95% confidence interval: 1.3-29.9). Of the cases, 58% were anti-HCV positive and 4.7% anti-HIV positive. Three individuals died of acute liver failure: 2 were HCV-coinfected alcohol abusers, with underlying liver cirrhosis; 1 was HCV/HIV-coinfected. HAV-RNA was found in 15 of the 24 tested patients: genotype IB (8 cases) and IIIA (7 cases) were detected. CONCLUSIONS: HAV was probably transmitted through the fecal-oral route, although parenteral transmission cannot be excluded. The high fatality rate was probably due to severe underlying liver damage. The occurrence of this outbreak highlights the need for routine HAV vaccination for IDUs.     

A point-source norovirus outbreak caused by exposure to fomites

We investigated a norovirus outbreak (genotype GII.2) affecting 9 members of a soccer team. Illness was associated with touching a reusable grocery bag or consuming its packaged food contents (risk difference, 0.636; P?相似文献   

An outbreak of hepatitis B and D in butchers

This report documents an outbreak of hepatitis B (HB) and hepatitis D (HD) in a group of butcher shop employees. During the 13-month period from September 1983 to October 1984, 8 employees from 2 establishments developed acute HB. Epidemiological investigation suggested that the first case, who was also an intravenous drug user, was the source of infection for other employees. This person and 2 others were found to have concurrent HD. In November 1984 the wife of one of the infected butchers also developed HB.     

First reported outbreak of classical dengue fever at 1,700 meters above sea level in Guerrero State, Mexico, June 1988.

An outbreak of classical dengue fever occurred from March to August 1988 in the city of Taxco, Guerrero State, Mexico. Taxco is at an elevation of 1,700 meters above sea level, and this study represents the highest altitude at which an outbreak of dengue has been documented. An investigation was conducted to obtain serologic confirmation of dengue infection, determine the extent of the outbreak, and identify risk factors for dengue illness. Toxorhynchites cell lines were used for viral isolation, and hemagglutination inhibition was used to measure anti-dengue antibody titers. The case definition used in the investigation was any person with fever, headache, myalgias, and arthralgias, or rash or retroocular pain. Dengue virus type 1 was isolated from five acute cases. Of 1,686 persons living in the affected area, 42% (715) met the case definition. Large (200-liter) water containers were significantly associated with infection (relative risk = 1.7, 95% confidence interval 1.5-1.9). The effect of altitude on epidemic transmission is most likely modulated by seasonal temperatures. The epidemiologic and serologic confirmation of a dengue outbreak at 1,700 meters above sea level represents the capability of Aedes aegypti to adapt to new environments, and the potential for epidemic spread in cities at comparable altitudes or higher.     

Outbreak of hepatitis A in Korean military personnel

This report describes a hepatitis A outbreak among Korean military personnel. Each case of hepatitis A in this outbreak was defined as a person who had symptoms compatible with acute viral hepatitis A and had positive HAV IgM between May 2 and August 14, 2007 in Inje district, Gangwon, Korea. We tested 70 cases with symptoms for HAV IgM, and 67 cases showed positive results. They included 4 sergeants, 1 officer and 62 privates. A positive result for HAV IgG among asymptomatic military personnel was seen in 11.8% of cases. This epidemic occurred after a heavy rainfall in the military compound area where drinking water was supplied by the stream water. After the outbreak, the supply of drinking water was switched to a public water system. All of 178 military personnel who had no HAV IgG were vaccinated on July 26, 2007. The outbreak was resolved after the control measures were implemented.     

An outbreak of rubella among hospital personnel and measures taken against hospital infection--cost-benefits of the measure

There is no nationwide outbreak of rubella after 1992 in Japan, but a local outbreak remains. Recently, some cases of congenital rubella syndrome (CRS) were reported after a local outbreak. An outbreak of rubella among hospital personnel occurred in our hospital located on Tanegashima Island on March and April 2003 after a visit of one rubella patient. Fifteen employees, including 7 clerks, 6 nurses, one doctor, and one radiologist, experienced rubella. A total of 259 employees in our hospital employees were examined for anti rubella hemagglutination inhibition (HI) tests with informed consent and recommended to take rubella vaccines. Sixty-seven employees (26%) among 257 examined for tests were found susceptible to rubella, and 53 employees were vaccinated. After vaccination, the outbreak was stamped out immediately. There was no rubella patient infected from employee. Nine among the 15 infected employees had declared to have a history of rubella or rubella vaccines before onsets, suggesting interviews are not reliable. There were many susceptible persons and rubella patients among elderly women and male personnel; therefore, measures are needed for elderly personnel as well as younger employees. In addition, adequate measures should be taken to prevent CRS, because many female personnel capable of pregnancy work in hospitals. The cost of the rubella HI tests and vaccination was approximately yen 200,000 (about dollar 1,600). The absence due to illness per one person was 6 days, and the wage per one day was about yen 12,000 (about dollar 100) on the average. The overall cost required in the outbreak was estimated to be approximate yen 1,400,000 (about dollar 12,000). Considering that an outbreak of rubella causes not only a large amount of expenditure but also loss of hospital income, the investment to prevent a rubella outbreak is quite valuable in the management of a hospital.     

Health risks connected with the avian flu virus

The first human cases of infections with entire avian influenza strain were caused by subtype A/H5N1/ and occurred in 1997 in Hong Kong. Since this year until 27 March 2007 World Health Organization confirmed over 370 human cases of infections with avian influenza and almost 160 persons died due to this pathogen. At present there is known that person to person transmission of avian influenza virus is limited. Nevertheless, it is possible that with time virus will adapt to human sufficiently to be able to cause next influenza pandemic. Despite intensive studies and global influenza surveillance there is no possible to predict when pandemic will begin and what kind of virus will cause this outbreak.     

Transmission of tuberculosis (III)

Tuberculosis outbreak is defined as group infection more than 20 persons had been infected with tubercle bacilli in Japan, provided one person developed disease is counted as 6 persons had been infected. Outbreak is to be reported compulsory to the Ministry of Health, Welfare and Labor. A total of 365 outbreaks of tuberculosis have been reported in these 10 years during 1994 and 2004. Out of them, large scale outbreak more than 10 persons have developed disease were 41 (11.2%). Results of contact surveys has reported that 0.36% of newly registered smear positive cases had caused tuberculosis outbreak, 1.1% had resulted small scale group infection (5 to 19 persons had been infected), although majority of the bacteriology positive cases didn't infected even one person. To make clear the mode of airborne infection with tubercle bacilli more clearly, the author has discussed the results of quantitative model on droplet nucle infection by Riley RL and others, nosocomial infection of smallpox virus in Germany in 1970, the results of analysis of airflow at the sites of outbreaks at business office and middle school in Japan, and so on. Finally, the author has reviewed the development of research on annual risk of tuberculosis infection in Japan and discussed about the present problems of risk of tuberculosis infection in Japan.