Helminth infections in British troops following an operation in Sierra Leone

One hundred and fifty-three British soldiers and 86 Royal Air Force (RAF) personnel were deployed on a hostage rescue operation in Sierra Leone. For 3 days they were exposed to various infection risks and 6 weeks later some of the soldiers presented with gastrointestinal complaints. Both groups were screened with structured questionnaires, blood investigations and (where indicated) faecal microscopy and charcoal culture for helminths. Definite and probable cases of helminth infection were treated with albendazole and all soldiers were screened again after 3 months. Among the soldiers investigated, 73/145 (50%) reported gastrointestinal symptoms and 70/139 (50%) had eosinophilia. Among these, 17/66 (26%) had hookworm infection, 6/66 (9%) had Strongyloides stercoralis infection and 1/66 (2%) had Giardia lamblia infection. Eosinophilia was most strongly associated with entering the enemy camp and being in the platoon that attacked the area around the camp latrines. Among RAF personnel, who were not involved in activities on the ground, 3/86 (3%) had borderline eosinophilia. Treatment of 105/153 (69%) soldiers with albendazole was well tolerated and, on follow-up screening 3 months later, 23/124 soldiers (19%) had gastrointestinal symptoms and 18/121 (15%) had eosinophilia. Faecal investigations and schistosomiasis serology tests were all negative at this stage.     

深圳某小学一起诺如病毒胃肠炎暴发疫情调查

目的 通过对一起诺如病毒感染性胃肠炎疫情调查处置,了解疫情发生发展特点,分析引起暴发的危险因素,为针对性防控措施提供依据。方法 采用描述性流行病学和回顾性队列分析疫情流行病学特征、传播方式及危险因素;对学校教室、食堂、饮水等开展卫生学调查,标本送实验室采用RT-PCR方法检测诺如病毒。结果 本次疫情共有病例20例,均发生在六（2）班,其中1例为该班班主任,班级学生罹患率为40.43%;主要临床症状为发热、恶心、呕吐,吃寿司是本次疫情危险因素,采集6份粪便/肛拭子标本检测,4份标本诺如病毒GⅡ4 Sydney-2012变异毒株阳性。结论 本次疫情为一起由GⅡ4 Sydney-2012变异毒株诺如病毒引起的胃肠炎爆发疫情,吃寿司可能是本次疫情的危险因素。     

江西省萍乡学院二次供水污染所致急性胃肠炎暴发调查

目的 查明萍乡学院急性胃肠炎暴发的原因、传播途径、危险因素,控制疫情蔓延。方法 根据病例定义开展搜索、个案调查,学校供水系统卫生状况调查,进行流行病学和卫生学分析,采集各种样本进行实验室检测。结果 共搜索到病例90例,症状以腹泻呕吐多见,全校罹患率为0.76%;东侧供水系统卫生状况差,消毒措施不到位;使用东侧供水系统与西侧供水系统相比,发病风险RR=6.47(95%CI:3.35~12.49);在病例样本、东侧供水系统水样、食堂从业人员样本中检出诺如病毒GII型、札如病毒阳性。结论 本次急性胃肠炎暴发主要是由于供水管路渗漏导致二次供水被札如病毒、诺如GII型病毒混合污染引起。     

Late recognition of SARS in nosocomial outbreak, Toronto

Late recognition of severe acute respiratory syndrome (SARS) was associated with no known SARS contact, hospitalization before the nosocomial outbreak was recognized, symptom onset while hospitalized, wards with SARS clusters, and postoperative status. SARS is difficult to recognize in hospitalized patients with a variety of underlying conditions in the absence of epidemiologic links.     

Comparison of survey methods in norovirus outbreak investigation, Oregon, USA, 2009

We compared data from an Internet-based survey and a telephone-based survey during a 2009 norovirus outbreak in Oregon. Survey initiation, timeliness of response, and attack rates were comparable, but participants were less likely to complete Internet questions. Internet-based surveys permit efficient data collection but should be designed to maximize complete responses.     

Respiratory infections during SARS outbreak, Hong Kong, 2003

The effect of community hygienic measures during the outbreak of severe acute respiratory syndrome in Hong Kong was studied by comparing the proportion of positive specimens of various respiratory viruses in 2003 with those from 1998 to 2002. Community hygienic measures significantly reduced the incidence of various respiratory viral infections.     

Molecular subtyping in cholera outbreak, Laos, 2010

A cholera outbreak in Laos in July 2010 involved 237 cases, including 4 deaths. Molecular subtyping indicated relatedness between the Vibrio cholerae isolates in this and in a 2007 outbreak, uncovering a clonal group of V. cholerae circulating in the Mekong basin. Our finding suggests the subtyping methods will affect this relatedness.     

Acute Health Effects Among Military Personnel Participating in the Cleanup of the Hebei Spirit Oil Spill, 2007, in Taean County,Korea

ObjectivesThis study was conducted to investigate acute health effects and its related factors among military personnel participating in the cleanup of the 2007 Hebei Spirit oil spill accident in Taean county, Korea.MethodsWe collected data on acute symptoms during the cleanup and their predictors using a self-administered questionnaire to 2624 military personnel. Self-reported symptoms included six neurologic symptoms, five respiratory symptoms, two dermatologic symptoms, three ophthalmic symptoms, and three general symptoms. Independent variables were demographic factors (gender, age, education level, and rank), health behavioral factors (smoking history and usage of the personal protective equipment such as masks and gloves), and occupational history such as where and for how long individuals participated in cleanup.ResultsThe duration of work days was significantly associated with 17 acute symptoms except for itchiness and red skin. Working in Taean county also increased the risk of most acute symptoms except headache and back pain. In regard to personal protective equipment, wearing masks was mainly related to the development of respiratory symptoms such as sore throat and wearing other protective equipment was related to the development of sore throat, back pain, headache, and cough. Military personnel younger than 25 years reported 4.66 times more hot flushing and 5.39 times more itchiness than those older than 25 years.ConclusionIt should be emphasized that for early-stage cleanup the number of workers should be minimized, sufficient personal protective equipment with approved quality for blocking noxious gas should be supplied, and systematic health care for the workers should be provided. Health effects could be diminished by providing adequate education regarding the appropriate use of protective equipment, especially to nonprofessionals such as residents and volunteers. To make disaster response expeditious, a national and regional preparedness plans and a professional response team for emergency environmental assessment and emergency action should be established beforehand to make prompt decisions.     

Ocular vaccinia infection in laboratory worker, Philadelphia, 2004

We report a case of ocular vaccinia infection in an unvaccinated laboratory worker. The patient was infected by a unique strain used in an experiment performed partly outside a biosafety cabinet. Vaccination should continue to be recommended, but laboratories with unvaccinated workers should also implement more stringent biosafety practices.     

Canine distemper outbreak in rhesus monkeys, China

Since 2006, canine distemper outbreaks have occurred in rhesus monkeys at a breeding farm in Guangxi, People's Republic of China. Approximately 10,000 animals were infected (25%-60% disease incidence); 5%-30% of infected animals died. The epidemic was controlled by vaccination. Amino acid sequence analysis of the virus indicated a unique strain.     

Questionnaire-based survey on structural quality of hospitals and nursing homes for the elderly,their staffing with infection control personal,and implementation of infection control measures in Germany

From January to May 2012, 1,860 hospitals throughout Germany received a questionnaire encompassing 77 items. Additionally, 300 outpatient care services and 310 nursing homes for elderly in Berlin also received a 10-item questionnaire asking on their implemented infection control practices. All questionnaires were anonymous. A total of 229 completed questionnaires from hospitals, 14 questionnaires from outpatient care services, and 16 questionnaires from nursing homes were eligible for further analysis.The lack of Infection Control physicians was identified as the largest issue. In hospitals sized 400–999 beds a gap of 71%, and in hospitals sized ≥1,000 beds a gap of 17% was reported. Depending on the number of hospital beds, 13–29% of hospitals sized ≥100 beds reported not havening one infection control nurse. Since based on the number of beds in larger institutions or in facilities caring for high-risk patients several infection control nurses may be required, the deficiency in infection control nurses may even be higher, particularly in secondary and tertiary care facilities. Furthermore, the analysis revealed that the legal requirements for surveillance and reporting of notifiable infectious diseases have not yet been implemented in 11% of the facilities. The implementation of antibiotic strategies did show significant gaps. However, deficiencies in the implemented measures for the prevention of surgical site infections were less frequent. Yet 12% of the participants did not have a dedicated infection control concept for their surgical services. Eight percent of hospitals were not prepared for an outbreak management and 10% did not have established regulations for wearing surgical scrubs. Deficiencies in waste disposal and the control of air-conditioning systems were also noted. Based on the results of this survey, conclusions on the optimal resource allocation for further improvement of patient safety may be drawn.While all participating nursing homes had some sort of infection control consultation, this only applied to 12 out of 16 outpatient nursing services. However, all 16 nursing services worked on the basis of an implemented infection control plan. Though legally binding hygiene recommendations have not yet been implemented for nursing homes, the necessity of infection control to assure patient safety has obviously been recognised throughout these services.     

Public health measures implemented during the SARS outbreak in Singapore, 2003

The SARS outbreak hit Singapore between March and May 2003. Public health control measures were applied along three fronts; prevention and control within healthcare settings, community and at the borders. Nosocomial spread composed majority of SARS cases in Singapore. To prevent infection within healthcare facilities, cases were centralized in a SARS-designated hospital, a no-visitors rule was applied and movement of patients and healthcare staff were restricted. For triaging purposes, fever clinics were established. A dedicated ambulance service was used to transport possible cases to the SARS-designated hospital. Hospitals were surveyed for fever clusters. The challenge was to identify cases with atypical presentation. Effective and safe discharge criteria were established from the lessons learnt. To prevent community spread, contacts of cases were stringently traced, quarantined in their homes and monitored daily. For prompt identification of a case and to reduce the time between onset of symptoms and isolation, the Infectious Diseases Act was amended. A large wholesale market closure resulted in massive quarantine thereby limiting the spread of infection. A mass education campaign was implemented in order to educate and raise awareness of the public. At all air, sea and land points-of-entry, exit and entry screening took place that resulted in zero importation and exportation of SARS cases after implementation of screening. Coordinated effort of the cross sectional inter-ministerial collaboration and strong coordination by the Task Force and commitment from different professionals made it possible to conquer the disease.     

High rates of malaria among US military members born in malaria-endemic countries, 2002-2010

To estimate malaria rates in association with birth country, we analyzed routine surveillance data for US military members. During 2002-2010, rates were 44× higher for those born in western Africa than for those born in the United States. Loss of natural immunity renders persons susceptible when visiting birth countries. Pretravel chemoprophylaxis should be emphasized.     

Distinguishing tuberculosis from nontuberculous mycobacteria lung disease, Oregon, USA

To determine whether tuberculosis (TB) and nontuberculous mycobacteria (NTM) infection patients could be distinguished from one another with limited information, we compared pulmonary TB and NTM patients during 2005-2006. Our finding that age, birthplace, and presence of chronic obstructive pulmonary disease could differentiate TB and NTM disease could assist tuberculosis control efforts.     

Clostridium difficile in Ready-to-Eat Salads, Scotland

Of 40 ready-to-eat salads, 3 (7.5%) were positive for Clostridium difficile by PCR. Two isolates were PCR ribotype 017 (toxin A–, B+), and 1 was PCR ribotype 001. Isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. Ready-to-eat salads may be potential sources for virulent C. difficile.     

Occupational health policies and practices related to tuberculosis in health care workers in KwaZulu-Natal,South Africa

Setting:

Three district hospitals in KwaZulu-Natal, South Africa, with specialized drug-resistant tuberculosis (TB) wards.

Objective:

To increase understanding of the implementation of occupational health (OH) and infection control (IC) guidelines for the prevention and control of TB among health care workers (HCWs).

Design:

An operational cross-sectional study conducted between July and September 2011, consisting of interviews with OH and IC nurses and chart review of OH medical records.

Results:

Although general national and provincial OH policies are in place, no specific OH policies exist for hospital settings. Two of three hospitals had a full-time OH nurse and all had a full-time IC nurse. All hospitals offered TB symptom screening; however, only 19% of HCWs were screened in 2010. TB incidence among HCWs was 1958 per 100 000 population in 2010. All hospitals offered HIV counseling and testing; however, only 22% of staff were tested across sites. Two hospitals offered isoniazid preventive therapy to HIV-positive staff and reassigned these staff to low TB risk areas.

Conclusions:

While OH policies and procedures are in place, implementation of these policies and procedures is inconsistent. This potentially places HCWs at risk of acquiring TB. These findings support the need for strengthening OH and IC services to prevent TB.     

Epidemic cholera in a crowded urban environment, Port-au-Prince, Haiti

We conducted a case-control study to investigate factors associated with epidemic cholera. Water treatment and handwashing may have been protective, highlighting the need for personal hygiene for cholera prevention in contaminated urban environments. We also found a diverse diet, a possible proxy for improved nutrition, was protective against cholera.     

The degrees of MD and ChM in British and Irish universities, 1953-70

About 80% of MBs who proceed to MD or ChM do so within 15 years of obtaining their primary medical qualification. Using this measurement as a yardstick, an attempt is made to draw a valid reflection of the award of these postgraduate degrees in the twenty university medical schools during the period 1953-70. London produced half as many MDs and ChMs as expected, Oxbridge considerably more and Scotland about half the expected ChMs.