Human botulism in Canada (1919-1973)

Since 1919, in Canada, 62 authenticated outbreaks of human botulism have affected 181 persons, with 83 deaths, a fatality rate of 46%. Among these, 41 outbreaks were bacteriologically determined (31 in one laboratory) as six type A, four type B, one both A and B, and 30 type E. About two thirds of the total outbreaks, cases and deaths involved Eskimos and Pacific coast Indians consuming raw marine mammal products and salmon eggs, respectively. Other parts of Canada recorded seven occurrences due to miscellaneous vehicles, three being type B. Since January 1961 there have been 38 outbreaks, involving 94 cases with 33 deaths. These include 18 outbreaks among Eskimos, affecting 51 persons (of whom 24 died) in Labrador, southern Baffin Island, northern Quebec, and the Mackenzie area. Also, putrid salmon eggs caused 15 outbreaks among Pacific coast Indians, totalling 35 cases, of whom only six died, the low fatality rate reflecting the introduction of type E botulinus antitoxin during 1961.     

Pasteurisation and the control of milkborne infection in Britain

Infections carried in milk, particularly salmonellosis and campylobacter enteritis, have continued to feature in Great Britain in recent years. Less commonly reported infections included an outbreak in 1984 in England due to Streptococcus zooepidemicus, in which 12 people, eight of whom died, were admitted to hospital. The implementation of legislation in 1983 requiring heat treatment of cows' milk for sale to the public reduced the incidence of milkborne infection in Scotland compared with previous years and compared with England and Wales, where, without legislative control, outbreaks continue to occur. Until compulsory pasteurisation is introduced throughout Britain and dairy farming communities can be persuaded to drink only heat treated milk outbreaks of milkborne infection will continue.     

Food-borne botulism in Canada, 1971-84

Sixty-one outbreaks of food-borne botulism involving a total of 122 cases, of which 21 were fatal, were recorded from 1971 to 1984 in Canada. Most occurred in northern Quebec, the Northwest Territories or British Columbia. Of the 122 victims 113 were native people, mostly Inuit. Most of the outbreaks (59%) were caused by raw, parboiled or “fermented” meats from marine mammals; fermented salmon eggs or fish accounted for 23% of the outbreaks. Three outbreaks were attributed to home-preserved foods, and one outbreak was attributed to a commercial product. The causative Clostridium botulinum type was determined in 58 of the outbreaks: the predominant type was E (in 52 outbreaks), followed by B (in 4) and A (in 2). Renewed educational efforts combined with a comprehensive immunization program would significantly improve the control of botulism in high-risk populations.     

2008-2010年福田区流感暴发疫情流行病学分析

目的 了解深圳市福田区2008-2010年流感暴发疫情特点,为开展流感防治工作提供依据.方法 对福田区2008-2010年流感暴发疫情处理资料进行描述性分析.结果 2008-2010年福田区共报告发生流感(疑似流感)暴发疫情100起,累计报告病例795例,其中甲型H1N1流感28起,A型流感18起,B型流感40起.平均罹患率为4.52%.首例发病至报告间隔时间平均为3.78 d.流感暴发疫情时间分布全年呈现两个发病高峰(3-6月和9月),甲型H1N1、A型和B型流感病毒全年交替出现,9月流感活动高峰期的优势毒株为甲型H1N1流感病毒.暴发疫情主要集中在小学,共报告63起,发病数521例,占发病总数的65.53%.结论 学校是易发生传染病暴发的场所,应重点加强学校卫生工作,预防控制流感暴发疫情的发生.     

Outbreak of type A botulism caused by a commercial food product in Taiwan: clinical and epidemiological investigations

In late September 1986, we found 7 patients from a printing factory in Chang-Hwa city who developed an endemic disease manifested by general malaise, ptosis, double vision, dysarthria, dysphagia, and proximal limb weakness. After clinical, epidemiological, microbiological, and toxicological investigations, an outbreak of botulism was confirmed 2 weeks later, Commercially canned peanuts made by an unlicensed cannery were identified as the vehicle of botulinum toxin transmission. Antitoxin was given to 2 patients who needed ventilator support. One of the 7 victims died from medical complications and the remaining 6 patients recovered. Several administrative problems exposed in this outbreak were the poor governmental supervision of canned food, the inadequate quantities of "orphan drugs" stored in this country, the inefficient system for recalling the problem products, and the delayed broadcasting of warnings to the public. Since commercially processed food is increasingly popular with modernization, the possibility of future botulism outbreaks should not be overlooked.     

深圳市2012年流感监测结果分析

目的通过对2012年深圳市流感监测结果进行分析,探索流感流行规律,为制定流感防治措施提供依据。方法收集全市哨点医院的流感样病例数据,病原学检测结果和暴发疫情资料进行分析。结果2012年深圳市的流感样病例占门诊急诊就诊总数百分比（ILI％）为4．15％,波动在3．16～5．56％之间。2012年全市哨点医院共采集ILI咽拭标本3776份,分离出474株流感病毒,阳性率为12．6％,其中264株季节H3亚型（55．7％）,150株B（Victoria,31．6％）亚型,55株B（Yamagata,11．6％）亚型,4株季节H1亚型（0．8％）,1株甲型H1N1亚型（0．2％）。2012年全市报告了87起ILI暴发疫情,流感PCR检测阳性74起,其中乙型23起（26．7％）,季节性甲型46起（53．5％）,季节性甲型和乙型混合感染5起（5．8％）。结论2012年深圳市流感活动较低,主要在上半年流行,3月初和6月初出现流行高峰。     

2009-2011年河北省食源性疾病暴发特点分析及控制策略

目的分析2009-2011年河北省食源性疾病暴发的流行病学特点,探讨其控制策略,为预防和控制食源性疾病暴发提供科学依据。方法对2009-2011年河北省食源性疾病暴发资料进行流行病学分析。结果 2009-2011年河北省共报告食源性疾病暴发39起,发病902人,死亡16人。呈现季节性高峰,家庭和集体食堂是发病的主要场所,细菌是主要的致病因素,毒素和化学物质是主要致死因素。结论建议加强食品安全监管,强化食源性疾病监测、报告、处置机制建设,做好公众宣传教育。     

Hepatitis B in general practice: epidemiology, clinical and serological features, and control

In an outbreak of hepatitis B virus infection in a south Wales village 31 cases were identified over 16 months. Spread of the infection was by sharing needles and by sexual contact. Twenty seven patients were known to have symptoms, of whom nine had an anicteric illness. Generally the illness was mild with no deaths, and there was only one chronic carrier. Two patients were only transiently positive for hepatitis B surface antigen. The outbreak was controlled by vigorous contact tracing and counselling. Despite an enormous increase in workload for the general practitioner and problems including disposal of contaminated needles, outbreaks of hepatitis B virus infection may adequately be treated in the community.     

Type A botulism from sauteed onions. Clinical and epidemiologic observations

Twenty-eight persons were hospitalized in Illinois with neurologic signs and symptoms compatible with botulism in October 1983. Twelve patients required ventilatory support, and 20 patients were treated with trivalent ABE antitoxin; one patient died while still in the hospital six months after onset of illness. Type A toxin and/or type A Clostridium botulinum were subsequently identified in specimens from 18 patients. Case-control studies implicated sauteed onions made from fresh raw onions and served on a patty-melt sandwich in a local restaurant as the vehicle of transmission. Although the original sauteed onions were not available for toxin testing, type A toxin was detected in washings from a wrapper in which a patty-melt sandwich was taken home by one of the ill persons. Also, type A C botulinum was cultured from five of 75 raw onions taken from the restaurant. This outbreak implicated an unusual vehicle for botulinal toxin that was initially not suspected and demonstrates the importance of considering all theoretically possible food items as potential vehicles for toxin until epidemiologic and laboratory data have been collected and analyzed.     

Hepatitis A outbreaks among illicit drug users and their contacts in Queensland, 1997.

OBJECTIVE: To describe five outbreaks of hepatitis A virus (HAV) infection associated with illicit drug use during a statewide outbreak of HAV infection in Queensland. DESIGN: Risk factor prevalence survey. PATIENTS AND SETTING: All 875 cases of HAV infection notified to Public Health Units in Queensland in the 12 months to 30 November 1997. MAIN OUTCOME MEASURE: Type and prevalence of illicit drug use. RESULTS: Risk factor assessment was completed for 804 cases (91.9%). We identified five outbreaks of HAV infection linked to illicit drug use. These outbreaks accounted for 24.6% (215/875) of all notified cases and 39% (190/482) of notified cases in the 15-34 years age group. The main type of illicit drug use in four of the five outbreaks was injecting drug use (74%; 118/160), while in the other outbreak it was sharing of smoking implements for marijuana (38%; 21/55). CONCLUSION: Illicit drug use may be an under-recognised risk factor for HAV infection, particularly in young people. Faecal-oral transmission through poor personal hygiene, including sharing of implements for smoking marijuana, is the most probable route of transmission in these drug-linked outbreaks. The role of contaminated drug and needle-sharing remains to be clarified.     

长沙市诺如病毒暴发疫情中GⅡ.2[P16]型全基因组分子进化特征分析

目的 对长沙市2020年急性胃肠炎暴发疫情中诺如病毒GⅡ.2[P16]型进行全基因组序列测定以及遗传进化特征分析。方法 采集2020年诺如病毒暴发疫情标本,采用逆转录聚合酶链反应（RT-PCR）方法扩增开放阅读框（ORF）1和ORF 2连接区进行分型鉴定。GⅡ.2[P16]型阳性标本在二代测序Miseq平台进行测序。测序结果进行序列比对及进化分析。结果 2020年本市共发生诺如病毒暴发疫情29起,共采集标本277份,阳性检出率为44.04%（122/277）。分型鉴定发现诺如病毒GⅡ.2[P16]型占比45.08%（55/122）。从疫情分布月份和机构来看,9—12月为暴发高峰,疫情发生在幼儿园和学校占比89.66%（26/29）。对53份GⅡ.2[P16]型ORF1和ORF2连接区序列进行进化树分析发现毒株处于多个分支,序列之间的同源性为98.5%~100%。对4株GⅡ.2[P16]型全基因组序列进行同源性比较发现毒株之间的同源性为98.5%~99.5%,与GⅡ.2[P16]2016-2017（KY771081）毒株同源性为97.9%~98.2%,进化树处于不同亚分支。RdRp区域氨基酸位点发生T396A和T464A突变,HBGA结合位点保守未发生突变。结论 长沙地区诺如病毒暴发疫情中以GⅡ.2[P16]型突变株传播为主,毒株由GⅡ.2[P16]2016-2017持续传播进化而来,并进化为另一个分支。本地区暴发的诺如病毒疫情主要发生在学校以及幼托机构,应持续加强对诺如病毒的监测。     

膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的临床研究

目的：观察膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的疗效。方法40例入选病例,随机分为逼尿肌注射组（A组）、逼尿肌联合三角区注射组（B组）,评估患者治疗前及治疗后4周的临床症状（平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数）及尿动力学指标（初始尿意膀胱容量、最大膀胱容量）和 OABSS 评分、QOL 评分情况。结果经过A型肉毒素注射治疗4周后,A组平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数以及OABSS评分, QOL评分、最大膀胱容量均较B组有明显改善（P＜0．05）。结论 A型肉毒素膀胱内注射治疗难治性膀胱过度活动症疗效好,无明显毒副作用,是治疗难治性膀胱过度活动的经济、有效的新方法;采用逼尿肌联合三角区部位的注射,症状缓解更为明显,值得进一步的研究及推广。     

Outbreak of chikungunya due to virus of Central/East African genotype in Malaysia

Chikungunya is an acute febrile illness caused by an alphavirus which is transmitted by infective Aedes mosquitoes. Two previous outbreaks of chikungunya in Malaysia were due to chikungunya virus of Asian genotype. The present outbreak involved two adjoining areas in the suburb of Ipoh city within the Kinta district of Perak, a state in the northern part of Peninsular Malaysia. Thirty seven residents in the main outbreak area and two patients in the secondary area were laboratory confirmed to be infected with the virus. The index case was a 44-year Indian man who visited Paramakudi, Tamil Naidu, India on 21st November 2006 and returned home on 30th of November 2006, and subsequently developed high fever and joint pain on the 3rd of December 2006. A number of chikungunya virus isolates were isolated from both patients and Aedes albopictus mosquitoes in the affected areas. Molecular study showed that the chikungunya virus causing the Kinta outbreak was of the Central/East African genotype which occurred for the first time in Malaysia.     

Cluster of Haemophilus influenzae type b infections in adults

Haemophilus influenzae type b commonly causes illness in young children, among whom transmission is known to occur. Most adults are believed to be immune to H influenzae type b and outbreaks of disease among adults appear to be uncommon. From July 14 to Aug 12, 1985, a cluster of six cases of acute febrile illness with cultures positive for H influenzae, biotype II (five cases) or untyped H influenzae (one case), occurred among adults in a nursing home and an adjoining hospital. All six case-patients had personal contact with at least one other case-patient. Among the 46 nursing home residents, men were more likely than women to become ill (44% vs 0%). This cluster of disease suggests that elderly adults may be more susceptible to H influenzae infection than is generally recognized and that outbreaks among adults may result from person-to-person transmission.     

An overview of type E botulism in China

The geographical distribution of C. botulinum type E and its associated disease, type E botulism in China, is different from that in other areas of the world. Cases of type E botulism generally arise in costal regions. In China, however, type E botuhsm is found primarily in the Qinghai-Tibet plateau of northwest China far from the ocean, at an altitude of approximately 4-5 kin. The foods most commonly associated with the disease are fermented grain and beans as well as raw meat A suspected outbreak of type E botulism poisoning in the central costal region of China in the 1990s prompted the collection and analysis of samples of mud, sand, and fish from the region. The toxin produced by type E botulinum was found in these samples. Surprisingly, though, upon further analysis, the strain isolated from the samples was identified not as type E C. botulinum, but as the neurotoxigenic bacterium Clostridiurn butyricurn.     

海南省一起流行性乙型脑炎暴发的调查分析

目的：为了寻找导致本次流行性乙型脑炎（乙脑）暴发的因素，以防止类似暴发疫情提供科学依据。方法：按疫情暴发调查方法，对病例进行个案调查和疫区处理，并采用ELISA和间接免疫荧光血清学方法检测所采集的患，疫区生猪静脉血以及对患粪便标本进行肠道病毒分离。结果：本次暴发疫情呈高度散发，年龄集中在10岁以下儿童，共有19例病例，2例死亡，病死率为10．53％，临床以轻型与普通型为主，表现为发热，头痛，呕吐等主要症状，实验室检测9份病例血清标本，间接免疫荧光法乙脑IgG抗体均阴性，IgM8例阳性，其中有6例用ELISA法检测乙脑IgM抗体阳性，双阳性符合率达到75％，2例生猪血标本未检出乙脑抗体，粪便培养不出肠道病毒，结论：儿童乙脑疫苗基础免疫空白是导致本次乙脑疫情暴发的主要原因。     

Outbreak of influenza amongst residential school students in Malaysia

In the months of July and August 2003, an outbreak of acute respiratory illness caused by influenza A virus occurred among students in seven residential schools situated in the northern part (Perak) of Peninsular Malaysia. Out of 4989 students, aged 13 to 18 years (mean = 15.9), 1419 (28%) were effected by influenza-like illness. All patients were treated as outpatients except for 36 students who required admission for high fever, severe coughing and shortness of breath. Abnormal chest X-ray findings were noted for those that required inpatient management. Influenza A virus was isolated from 37 sputum specimens, 20 throat swabs and three nasal swab specimens from a total of 278 clinical samples obtained from 180 patients. Isolates from each of the outbreaks were sent to WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia for antigenic and genetic analysis. One school outbreak was due to influenza A (H1N1), A/New Caledonia/20/99-like virus while the other six school outbreaks were due to influenza A (H3N2) viruses which were A/Fujian/411/2002-like).     

A review of botulism in China

The epidemiological characteristics and etiology of botulism in China, as well as the distribution of different types of Clostridium botulinum in China, are described. Through 1989, 15 provinces and autonomous regions reported the occurrence of botulism. There were 2861 cases involved in 745 outbreaks. Among the cases 421 died, with a case fatality of 14.7%. The main epidemiological characteristics of botulism in China are: (i) the major foods causing botulism are homemade fermented bean products which accounted for 62.6% of the cases; (ii) the incubation period is longer (3 h-54 days) than that described in the western literature (mostly 2-7 days); (iii) the peak occurrence is from February to May; (iv) the progression of symptoms and signs is slower than that of western cases. All types of C. botulinum, with the exception of type G, have been found in China. The distribution of various types of C. botulinum is significantly different between southern and northern China; this is related to the latitude and is correlated with the prevalence of this disease. Most of the botulism outbreaks occurred above 30 degrees north latitude in northern China and outbreaks rarely occurred below 30 degrees north latitude. Nationwide surveys showed that the average detection rate of C. botulinum spores in soil and foods in the northern parts of China was 14.8%, while it was only 2.5% in the south. C. botulinum types A, B, E, and F, which are involved in human botulism, were frequently found in the North, while types C and D, which are involved only in animal intoxication, were found more frequently in the south.     

Ocular findings in botulism type B.

In April 1977, fifty-nine persons became ill with type B botulism in a large, common-source outbreak. A combination of signs and symptoms that should make the clinician strongly suspect botulism was derived from the histories and ocular findings of these persons. Certain signs of third cranial nerve dysfunction reliably predicted in which patients ventilatory insufficiency would develop.     

Type B botulism outbreak caused by a commercial food product. West Virginia and Pennsylvania, 1973

In the week of May 7, 1973, seven persons contracted botulism after eating together. The most common symptoms were vomiting, constipation, dry mouth, dysphagia, and dysphonia. All were treated with trivalent botulinal antitoxin, and none died. Serum specimens obtained from all seven patients were negative for botulinal toxin, but stool specimens from three patients were positive for type B toxin. Electromyographic studies performed on five patients documented the neurophysiologic abnormalities of botulism. Commercially canned peppers in oil were implicated epidemiologically, and type B toxin was identified in leftover peppers. The processor voluntarily recalled the pepper product, and no further cases were reported.