Dysentery in Poland in 2000

The notified number of dysentery cases is still falling down since the year 1995 when bacteriological examination of feces for diagnostic purposes lost free of charge status obtained in 1928 under the legislation act of infectious disease investigation and obligatory registration. Only 121 dysentery cases were notified in the year 2000 (incidence 0.31/100,000 population), while 292 cases were notified in 1999 (incidence 0.76/100,000). No one death case was notified. Only 2 outbreaks (one due to S. flexneri 4a and one due to S. sonnei), both involving 26 patients, were notified in 2000, less than in 1999 when four outbreaks involving 146 patients were registered. In the year 2000, S. sonnei was the dominant etiological agent in 80% of notified dysentery cases and S. flexneri only in 20% of cases was the next. S. dysenteriae 3 was found only in one patient S. boydii in no one. All Shigella strains were susceptible to nitrofurans (ex.nifuroxaside), gentamicin, nalidixic acid, cefotaxime, and imipenem. Only two strains, including the one important from India, were susceptible to co-trimoxasole, but not to doxycycline.     

Dysentery in Poland in 2001

The notified number of dysentery cases is still very low, similar to the number reported in 2000. Only 128 cases were notified in the year 2001 (incidence 0.33/100,000 population) while 121 cases were notified in 2000 (incidence 0.31/100,000). No death due to dysentery was notified. The last three death cases were notified in 1999. Only one outbreak of foodborne infection due to S. sonnei involving 28 patients was registered, less than in 2000 when 2 outbreaks, one due to S. flexneri and one due to S. sonnei, and less than in 1999, when four outbreaks involving 146 patients were registered. S. sonnei remains the dominant etiological agent. It was isolated in 91% of notified dysentery cases and S. flexneri was isolated only in 10% of cases. S. dysenteriae and S. boydii were not found among persons examined bacteriologically by laboratory service of Epidemiological and Sanitary Stations. The external control of selective media used in 37 laboratories for routine bacteriological diagnosis of humans intestinal infections in the Sanitary--Epidemiological Stations (SSE) in Poland was performed. It was shown that the quality of the Mac Conkey medium was adequate for all 4 bacterial strains checked: S. sonnei, S. flexneri, S. Typhi and S. Enteritidis. All specimens of the SS medium were acceptable only for diagnosis of S. Enteritidis infections. The quality of media used in nearly 1/3 of SSE bacteriological laboratories was inadequate for diagnosis of S. flexneri infections and in some laboratories even not sufficient for diagnosis of infections due to S. Typhi and S. sonnei. In the period of low frequency of Shigella infections the external control of the quality of bacteriological media and laboratory procedures is needed and should be done regularly.     

Dysentery in Poland in 1999

The year 1999 was the consecutive year of decrease in the number of cases notified as dysentery. Only 292 cases were notified and incidence rate was 0.76/100,000 inhabitants, while in 1998, 555 cases (incidence rate 1.44/100,000) were notified. Three death cases of old persons in their 79, 85 and 88 were notified as dysentery, all three in one house of social care in Pomerania region. Half of the cases were sporadic ones but half was found in 4 institutional outbreaks. Three outbreaks were due to S. sonnei infection, and one to S. flexneri 4a. S. sonnei was the dominant aetiological agent in 80% of all dysentery cases and S. flexneri was the next (20%). S. boydii and S. dysentery were not isolated. All S. flexneri strains were susceptible to nitriofuran drugs (nitrofuroxaside), amoxycillin with clavulonic acid, cefalosporin, nalidixid acid and chloramphenicol, but were resistant to cotrimoxazole and tetracycline.     

Dysentery in Poland in 2003

The notified number of dysentery cases is the lowest in this century and even every year decreasing. Only 75 cases were notified in the year 2003 (incidence rate 0.20/100 000 population) while 220 cases were registered in 2002 (incidence 0.58/100 000 population). No one death case was notified. The last three death cases were notified in 1999. Only one outbreak of dysentery (due to S. flexneri 2a) was registered involving 23 patients/111 residents of Social Home for Mentally Disabled Men. Source of infection was probably one of residents who were infected during an outbreak of dysentery in the same institution four years earlier in 1999. The outbreak changed the overall etiology of dysentery cases in 2003: 52% was due to S. sonnei, but 46% was due to S. flexneri and 2% to S. dysenteriae 2, S. boydii were not found among persons examined bacteriologically by laboratory service of Epidemiological and Sanitary Service. The external quality control of procedures for selective investigation of Shigella infections in stool probe was done in 37 laboratories of Sanitary Epidemiological Stations with the use of control strain S. boydii 6. It was shown that in nearly all laboratories the strain was unable to grow on media SS and Hektoen after enrichment in the phosphate selenine--medium (SF) used by them. In the period of low frequency of Shigella infections the external control of the quality of bacteriological media and laboratory procedures is needed and should be done regularly.     

Infectious diseases in Poland in 1999

Improvement of epidemiological situation of infectious diseases was continued in Poland in 1999. The end of epidemics of measles, pertussis, mumps, scarlatine, chickenpox, and rubella was observed. In comparison with the number of cases of infectious diseases registered in 1998, decrease in the number of notified cases of salmonellosis, dysentery, meningitis, encephalitis, and hepatitis type B and A as well as increase in the number of influenza cases and trichinosis was noticed. In 1999, compared with 1998, among all notified deaths percentage of deaths attributed to infectious diseases (0.80%) and infectious diseases death rate (7.71 per 100,000) were slightly higher as an effect of the influenza deaths increase.     

Prevalence of giardiasis among primary school children

Summary This cross-sectional study was conducted to investigate the prevalence of intestinal parasites among primary school children in Northern Jordan. Stool specimens were collected from 1100 children of both sexes from urban and rural schools. A questionnaire covering relevant informations was completed for each child. Wet mount preparation, formaline-ether concentration technique, and trichrome stain were prepared for the recovery and identification of parasites. Giardia lamblia was observed in 396 (36%) of the stool specimens examined. The infection rates were higher in the younger age group where several of them had diarrhoea and reported variable symptoms. The infection rates declined with age and children were asymptomatic. Rates were higher in children from the rural areas, from low income families, and it was higher in boys than girls.
Contaminated drinking water is suspected to be the major potential source of infection. The importance of the asymptomatic cases and the epidemiological factors contributing to the transmission in these areas are discussed.     

Nosocomial infection due to rotavirus in infants in Alzahra Hospital, Isfahan, Iran

Rotavirus is one of the most common causes of acute diarrhoea during infancy, and the spread of this infection due to rotavirus in paediatric wards can cause acute diarrhoea during hospitalization, and, in turn, prolong hospitalization or rehospitalization. It is, therefore, important to evaluate the problem and to find an appropriate approach to decrease the rate of infection. The incidence of nosocomial infection due to rotavirus was studied in 80 children aged 3-24 months from November 2003 to April 2004 in the Alzahra Hospital, Isfahan, Iran. Rotavirus antigen was detected by latex aggulutation in stool samples obtained during hospitalization and up to 72 hours after discharge from the hospital. The prevalence of nosocomial infection due to rotavirus was 26.25%, which is a considerable prevalence compared to similar studies which reported a prevalence of 27.7%, 19.4%, and 14.6%. Overall, 15% of the 21 children with positive rotavirus antigen in their stools had acute diarrhoea during hospitalization and up to 72 hours after discharge (symptomatic nosocomial infection), and 11.25% of all children (n=80) studied had asymptomatic nosocomial infection. Regarding the low frequency of nosocomial infection due to rotavirus in other studies which have only studied symptomatic cases during hospitalization and reported a prevalence of 3.3 and 9%, it is suggested that the real estimation of nosocomial infection due to rotavirus in asymptomatic cases that might become symptomatic after discharge from hospital should also be considered. Due to the relatively high frequency of nosocomial infection in the Alzahra Hospital, it is necessary to follow stricter health issues, e.g. isolation of patients with diarrhoea and hand-washing before and after the examination of every patient.     

一起学校细菌性痢疾暴发疫情的病原追溯 和流行病学特征分析

摘要:目的　对学校发生的一起细菌性痢疾暴发疫情进行调查,并采用脉冲凝胶电泳（PFGE）方法对菌株进行同源性分析,为查找传染源、切断传播途径,提供参考依据。方法　开展现场流行病学调查,采用描述流行病学的方法对暴发原因进行分析,同时采集患者粪便、水样进行细菌学培养,运用PFGE对分离的菌株进行同源性分析。结果　此次暴发疫情的调查共发现病例60例,罹患率为10.12%,发病人群均为小学学生;从53例患者的粪便中共检出30例痢疾阳性病例,且菌群均为宋内志贺菌;水样检测发现2号水井及其旁边的水塘存在宋内志贺菌;对4份病例的粪便、2份水样进行PFGE分析,其结果显示,6份样本所检出菌株的电泳带型完全相同。结论　该事件是一起因饮用宋内志贺菌污染的水源而导致的细菌性痢疾暴发疫情。     

马鞍山、苏州两所医院5a以下急性腹泻患儿A组轮状病毒感染特征

目的 研究马鞍山和苏州两所医院5a以下急性腹泻患儿轮状病毒感染情况。方法 采用酶联免疫吸附试验对两市5a以下儿童的急性腹泻粪便标本1267份进行轮状病毒病原检测。结果 1267份标本中轮状病毒阳性378例，阳性率为29．83％。发病年龄主要在3a以下，流行季节高峰为11月份至次年1月份。结论 轮状病毒感染是两市5a以下儿童急性腹泻的主要致病原因之一。     

Dysentery in Poland in 2002

The notified number of dysentery cases was still very low, but a little higher than in 2001. Only 220 cases were notified in the year 2002 (incidence 0.58/100,000 population) while 128 cases were notified in 2001 (incidence 0.33/100,000). No one death case was notified. Four outbreaks of dysentery were observed: among them one foodborne infection due to S. sonnei involving 109 participants of a summer holiday camp for children from the poor families and one due to S. flexneri 2a involving 16 patients of psychiatric hospital were registered. S. sonnei remains the dominant etiological agent was isolated in 92% of notified dysentery cases and S. flexneri was isolated only in 8% of cases. S. dysenteriae and S. boydii were not found among persons examined bacteriologically by laboratory service of Epidemiological and Sanitary Service. Two tests of the external control of laboratory diagnosis were performed: one concerning the quality of the selective media used in the Sanitary-Epidemiological Stations (SSE) in Poland for routine bacteriological diagnosis of humans intestinal infections. It was shown that the specimens of the SS medium were acceptable only for diagnosis of S. enteritidis infections. In nearly 1/3 of SSE bacteriological laboratories was inefficient for diagnosis of S. flexneri infections and in some laboratories even not for diagnosis of infections due to S. typhi and S. sonnei. In another test the control strain of S. boydii 6 was send to SSE laboratories. The strain was properly diagnosed by all but two laboratories. Besides it was shown that the control strain was not able to grow on selective bacteriological media used for routine work. So there is a need to change the procedure used in those laboratories. In the period of low frequency of Shigella infections the external control of the quality of bacteriological media and laboratory procedures is needed and should be done regularly.     

Epidemiological situation of the selected infectious diseases in Poland in 1918-1939

In Poland, during twenty years between the first and the second world war modern methods and remedies were created and applied to save the society from biological extermination caused by the epidemics of acute infectious diseases that existed in the larger areas of the country and other diseases that could threaten the society when brought from abroad. Poland regained its independence in 1918 as a country completely destroyed by war and encompassed three partitioned sectors that differed in wealth, class consciousness, various infrastructure, legislation, epidemiological situation of infectious diseases and threats spreading from abroad. Infectious diseases such as typhus fever, typhoid fever, cholera, smallpox, dysentery and other diseases spreading by alimentary tracts caused the greatest epidemiological problem. The considerable number of smallpox cases was noted in 1920-1922. In the thirties only individual cases occurred. Since 1934 no fatal cases of smallpox were registered. In 1919, in Poland 219,688 cases and 18,641 typhus fever deaths were registered. Between 1930 and 1939 the annual number of cases ranged from 2000 to 4000. In Poland each year between the first and the second world war typhoid fever was a serious sanitary problem. The largest outbreak of dysentery occurred in Poland in 1920-1921 and comprised 64,000 cases, among them 10,000 deaths. Acute childhood diseases such as scarlet fever and diphtheria were in Poland endemic. Number of registered cases was variable.     

A national outbreak of Salmonella typhimurium DT 124 caused by contaminated salami sticks

An outbreak of Salmonella typhimurium DT 124 infection which affected 101 people in England in December 1987 and January 1988 was detected through surveillance of laboratory reports from medical microbiology laboratories of the NHS and PHLS. Within 1 week of noting the increase in reports, epidemiological and microbiological investigations identified a small German salami stick as the vehicle of infection and the product was withdrawn from sale. The epidemiological investigation highlighted the occurrence of a long incubation period, bloody diarrhoea. Prompt recognition and investigation of the outbreak prevented further cases of severe infection.     

Aetiology of diarrhoea in a birth cohort of children aged 0-2 year(s) in rural Mirzapur, Bangladesh

The incidence of aetiology-specific diarrhoea and the pathogenicity of infectious agents in a birth cohort (n=252) in rural Bangladesh were determined. Stool specimens or rectal swabs were collected from diarrhoeal cases over two years and routinely on a monthly basis. Stool samples from children with diarrhoea were compared with stool samples from children without diarrhoea to calculate rates of isolation and pathogenicity of agents. In total, 1750 stool specimens from diarrhoea patients and 5679 stool specimens from children without diarrhoea were tested. An infectious agent was identified in 58% of the stool specimens from diarrhoea patients and 21.6% of the stool specimens from children without diarrhoea. The most commonly-isolated pathogens from all specimens were enterotoxigenic Escherichia coli (ETEC), enteroadherent E. coli, Shigella, Campylobacter jejuni, Giardia, and rotavirus. ETEC (ST and LT-ST toxin), enterotoxigenic Bacteroides fragilis, Shigella, and rotavirus were associated more with disease than with asymptomatic infections. Aetiology-specific infections were associated with acute episodes. The isolated enteropathogens were essentially the same as those found in other tropical rural settings. Enterotoxigenic B. fragilis was also identified as a pathogen. Ongoing vaccine efforts focusing on Shigella, rotavirus, and ETEC would be useful.     

The frequency of culturing stools from adults with diarrhoea in Great Britain.

Utilizing the Office of Population Censuses and Surveys (OPCS) Omnibus Survey, it was possible to measure the frequency with which a stool culture was obtained following episodes of diarrhoea in adults. Interviewing over 8000 adults, over a 4-month period between October 1992 and January 1993, 633 persons (7.9%) reported one episode of diarrhoea in the previous month, and 5.4% of these individuals with diarrhoea reported that a stool had been requested for examination. No significant regional differences were observed with the sample size available. The estimate of the rate of diarrhoea in adults was just under one episode per person per year.     

Diagnosis of giardiasis using an enzyme-linked immunosorbent assay (ELISA) on formalin preserved stools

From a total of 162 children, three stool samples were collected from each child over a period of one week and preserved in formalin. Giardia lamblia was diagnosed by direct microscopy of formol-ether concentrates for each of the three samples. The first sample was also subjected to an ELISA test for detection of Giardia Iambia stool antigen in formalin preserved stool specimens. Microscopic examination revealed that 45 children were infected whereas ELISA detected 41 cases giving a sensitivity of 91.1% and a specificity of 99.1%. Predictive value of a positive test was 97.6% and that of a negative test was 96.7%. A significant correlation was present between mean optical density readings of ELISA and number of cysts present. No crossreactivity was observed ELISA is a simple, sensitive and specific test that can be applied in epidemiological studies for detection of Giardia lamblia coproantigen in formalin preserved stool specimens.     

Risk of infection associated with microbiological quality of public swimming pools in Bologna, Italy

Twelve public swimming pools in Bologna (Emilia-Romagna region, Italy) were investigated for the microbiological quality of water and surfaces of the pool edges, showers and changing rooms. At the same time a cross-sectional study was carried out on the health of 238 users (bathers) compared with 238 controls who practised sports other than swimming. Data regarding duration and frequency of exposure, behaviour and recent medical history were gathered by means of a questionnaire. All participants also underwent a medical examination. Compliance of the pool water to the microbiological standards set by Italian regulations was generally good; compliance was total when free chlorine residual was within the recommended limits. However, when analysis was extended to the various surfaces, potentially pathogenic bacteria such as P. aeruginosa and C. albicans were isolated. Eye burning and diarrhoea were the only declared symptoms and verrucas the only diagnosed disease showing statistically significant differences between bathers and controls. Verrucas tended to increase in proportion to exposure. Athlete's foot had a very high prevalence among both bathers (34 %) and controls (27.3%) and controls (27%). The environmental and epidemiological investigations both confirmed the risk of infection, mainly associated with the contamination of surfaces.     

细菌性痢疾与其他感染性腹泻的早期临床对比分析 FREE

目的 对比研究细菌性痢疾(简称菌痢)和其他感染性腹泻的流行病学及临床症候特点,以提高临床医生对二者的非细菌学简易鉴别能力。方法 对140例临床菌痢与349例其他感染性腹泻患者的流行病学和临床资料进行对比研究,同时再通过多因素分析筛选鉴别两者的相关因素。结果菌痢与其他感染性腹泻好发季节有所不同（P＜0.05）,前者夏季多发,后者秋季更为多见。菌痢患者发热、里急后重、黏液便、脓血便及左下腹压痛较其他感染性腹泻多见,而后者以恶心呕吐、水样便及稀便较多见,差异均有显著性（均P＜0.05）。二分类Logistic回归分析发现,发病季节、里急后重、发热、大便性状及左下腹压痛5个因素与菌痢的诊断密切相关。结论发热、里急后重、黏液便及左下腹压痛是临床诊断菌痢和其他感染性腹泻的主要鉴别点。     

一起细菌性痢疾暴发疫情的流行病学调查

目的:调查衢州市衢江区某乡两学校菌痢疫情暴发的原因和特点,为制定突发疫情防制对策提供科学依据。方法:采用现场流行病学调查资料进行统计分析。结果:两所学校共发病133例,罹患率为9.49%;男女发病比1.09∶1,初中男女罹患率差别有统计学意义;133例病例中3,3例从粪便中检测出福氏志贺氏菌(4a型)。结论:这是一起由福式志贺菌引起的细菌性痢疾暴发疫情。     

一起山洪暴发污染水源引起菌痢暴发疫情调查

目的了解某村细菌性痢疾暴发特点和规律,确定感染来源及传播途径,采取相应措施,控制疫情。方法对该村全体村民进行排查,对病人及密切接触者进行流行病学调查,同时开展水源及外环境调查,采集饮用水及病人粪便进行实验室检测。结果该村共发生菌痢病人82例,罹患率为19.52%,经流行病学调查发现患者均引用同一水源,外出不饮用此水源者不患病,实验室检测饮用水大肠杆菌严重超标,从病人粪便中检出宋内氏菌,外环境调查:出现病人前两天该地区普降几十年不遇的暴雨,雨水冲毁了蓄水池防护墙体,使源头水受到污染。结论本次疫情是由山洪爆发污染水源所致。     

Preferences for treatment of diarrhoea and dysentery in Kaengkhoi district, Saraburi province, Thailand

To estimate the proportion of cases missed in a passive surveillance study of diarrhoea and dysentery at health centres and hospitals in Kaengkhoi district, Saraburi province, Thailand, a community-based cluster survey of treatment-seeking behaviours was conducted during 21-23 June 2002. Interviews were conducted at 224 households among a study population of 78,744. The respondents reported where they sought care for diarrhoea and dysentery in children aged less than five years and adults aged over 15 years. Health centres or hospitals were the first treatment choice for 78% of children with dysentery (95% confidence interval [CI] 63-94%), 64% of children with diarrhoea (95% CI 54-74%), 61% of adults with dysentery (95% CI 40-82%), and 35% of adults with diarrhoea (95% CI 17-54%). A high degree of heterogeneity in responses resulted in a relatively large design effect (D=3.9) and poor intra-cluster correlation (rho=0.3). The community survey suggests that passive surveillance estimates of disease incidence will need to be interpreted with caution, since this method will miss nearly a quarter of dysentery cases in children and nearly two-thirds of diarrhoea cases in adults.