Genomic epidemiology of a protracted hospital outbreak caused by multidrug-resistant Acinetobacter baumannii in Birmingham, England.

PubMed

Halachev, Mihail R; Chan, Jacqueline Z-M; Constantinidou, Chrystala I; Cumley, Nicola; Bradley, Craig; Smith-Banks, Matthew; Oppenheim, Beryl; Pallen, Mark J

2014-01-01

Multidrug-resistant Acinetobacter baumannii commonly causes hospital outbreaks. However, within an outbreak, it can be difficult to identify the routes of cross-infection rapidly and accurately enough to inform infection control. Here, we describe a protracted hospital outbreak of multidrug-resistant A. baumannii, in which whole-genome sequencing (WGS) was used to obtain a high-resolution view of the relationships between isolates. To delineate and investigate the outbreak, we attempted to genome-sequence 114 isolates that had been assigned to the A. baumannii complex by the Vitek2 system and obtained informative draft genome sequences from 102 of them. Genomes were mapped against an outbreak reference sequence to identify single nucleotide variants (SNVs). We found that the pulsotype 27 outbreak strain was distinct from all other genome-sequenced strains. Seventy-four isolates from 49 patients could be assigned to the pulsotype 27 outbreak on the basis of genomic similarity, while WGS allowed 18 isolates to be ruled out of the outbreak. Among the pulsotype 27 outbreak isolates, we identified 31 SNVs and seven major genotypic clusters. In two patients, we documented within-host diversity, including mixtures of unrelated strains and within-strain clouds of SNV diversity. By combining WGS and epidemiological data, we reconstructed potential transmission events that linked all but 10 of the patients and confirmed links between clinical and environmental isolates. Identification of a contaminated bed and a burns theatre as sources of transmission led to enhanced environmental decontamination procedures. WGS is now poised to make an impact on hospital infection prevention and control, delivering cost-effective identification of routes of infection within a clinically relevant timeframe and allowing infection control teams to track, and even prevent, the spread of drug-resistant hospital pathogens.

The public health response to the re-emergence of syphilis in Wales, UK.

PubMed

Thomas, D Rh; Cann, K F; Evans, M R; Roderick, J; Browning, M; Birley, H D L; Curley, W; Clark, P; Northey, G; Caple, S; Lyons, M

2011-09-01

During the 1990s, cases of infectious syphilis were uncommon in Wales. In 2002, an outbreak occurred in a sexual network of men who have sex with men (MSM) attending a sauna. A multidisciplinary outbreak control team was convened to raise awareness of the outbreak among MSM and health professionals, assess the extent of outbreak, and initiate surveillance measures. It is likely that early intensive control efforts dampened the epidemic curve. However, since 2006 the number of cases has increased steadily to a peak of four cases per 100,000 population in 2008. The majority of cases continue to occur in MSM (81% in 2009) and in those attending genitourinary (GU) medicine clinics in south east Wales (76%). Traditional sexual networks such as saunas, bars/clubs and cruising grounds remain frequently reported, but Internet-based networks are assuming increasing importance. Public health interventions have been sustained, using traditional partner notification, health promotion initiatives, and more innovative Internet network tracing methods.

The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014.

PubMed

Rostrup, Morten; Edwards, Jeffrey K; Abukalish, Mohamed; Ezzabi, Masoud; Some, David; Ritter, Helga; Menge, Tom; Abdelrahman, Ahmed; Rootwelt, Rebecca; Janssens, Bart; Lind, Kyrre; Paasma, Raido; Hovda, Knut Erik

2016-01-01

Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports. In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival. Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in these challenging contexts.

Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014.

PubMed

Severi, E; Verhoef, L; Thornton, L; Guzman-Herrador, B R; Faber, M; Sundqvist, L; Rimhanen-Finne, R; Roque-Afonso, A M; Ngui, S L; Allerberger, F; Baumann-Popczyk, A; Muller, L; Parmakova, K; Alfonsi, V; Tavoschi, L; Vennema, H; Fitzgerald, M; Myrmel, M; Gertler, M; Ederth, J; Kontio, M; Vanbockstael, C; Mandal, S; Sadkowska-Todys, M; Tosti, M E; Schimmer, B; O Gorman, J; Stene-Johansen, K; Wenzel, J J; Jones, G; Balogun, K; Ciccaglione, A R; O' Connor, L; Vold, L; Takkinen, J; Rizzo, C

2015-07-23

In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.

Outbreak of novel influenza A (H1N1-2009) linked to a dance club.

PubMed

Chan, Pei Pei; Subramony, Hariharan; Lai, Florence Y L; Tien, Wee Siong; Tan, Boon Hian; Solhan, Suhana; Han, Hwi Kwang; Foong, Bok Huay; James, Lyn; Ooi, Peng Lim

2010-04-01

This paper describes the epidemiology and control of a community outbreak of novel influenza A (H1N1-2009) originating from a dance club in Singapore between June and July 2009. Cases of novel influenza A (H1N1-2009) were confirmed using in-house probe-based real-time polymerase chain reaction (PCR). Contact tracing teams from the Singapore Ministry of Health obtained epidemiological information from all cases via telephone. A total of 48 cases were identified in this outbreak, of which 36 (75%) cases were patrons and dance club staff, and 12 (25%) cases were household members and social contacts. Mathematical modelling showed that this outbreak had a reproductive number of 1.9 to 2.1, which was similar to values calculated from outbreaks in naïve populations in other countries. This transmission risk occurred within an enclosed space with patrons engaged in intimate social activities, suggesting that dance clubs are places conducive for the spread of the virus.

The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014

PubMed Central

Rostrup, Morten; Edwards, Jeffrey K.; Abukalish, Mohamed; Ezzabi, Masoud; Some, David; Ritter, Helga; Menge, Tom; Abdelrahman, Ahmed; Rootwelt, Rebecca; Janssens, Bart; Lind, Kyrre; Paasma, Raido; Hovda, Knut Erik

2016-01-01

Background Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. Methods Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports. Findings In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival. Interpretation Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in these challenging contexts. PMID:27030969

Anthrax Outbreaks in Bangladesh, 2009–2010

PubMed Central

Chakraborty, Apurba; Khan, Salah Uddin; Hasnat, Mohammed Abul; Parveen, Shahana; Islam, M. Saiful; Mikolon, Andrea; Chakraborty, Ranjit Kumar; Ahmed, Be-Nazir; Ara, Khorsed; Haider, Najmul; Zaki, Sherif R.; Hoffmaster, Alex R.; Rahman, Mahmudur; Luby, Stephen P.; Hossain, M. Jahangir

2012-01-01

During August 2009–October 2010, a multidisciplinary team investigated 14 outbreaks of animal and human anthrax in Bangladesh to identify the etiology, pathway of transmission, and social, behavioral, and cultural factors that led to these outbreaks. The team identified 140 animal cases of anthrax and 273 human cases of cutaneous anthrax. Ninety one percent of persons in whom cutaneous anthrax developed had history of butchering sick animals, handling raw meat, contact with animal skin, or were present at slaughtering sites. Each year, Bacillus anthracis of identical genotypes were isolated from animal and human cases. Inadequate livestock vaccination coverage, lack of awareness of the risk of anthrax transmission from animal to humans, social norms and poverty contributed to these outbreaks. Addressing these challenges and adopting a joint animal and human health approach could contribute to detecting and preventing such outbreaks in the future. PMID:22492157

Selection of population controls for a Salmonella case-control study in the UK using a market research panel and web-survey provides time and resource savings.

PubMed

Mook, P; Kanagarajah, S; Maguire, H; Adak, G K; Dabrera, G; Waldram, A; Freeman, R; Charlett, A; Oliver, I

2016-04-01

Timely recruitment of population controls in infectious disease outbreak investigations is challenging. We evaluated the timeliness and cost of using a market research panel as a sampling frame for recruiting controls in a case-control study during an outbreak of Salmonella Mikawasima in the UK in 2013. We deployed a web-survey by email to targeted members of a market research panel (panel controls) in parallel to the outbreak control team interviewing randomly selected public health staff by telephone and completing paper-based questionnaires (staff controls). Recruitment and completion of exposure history web-surveys for panel controls (n = 123) took 14 h compared to 15 days for staff controls (n = 82). The average staff-time cost per questionnaire for staff controls was £13·13 compared to an invoiced cost of £3·60 per panel control. Differences in the distribution of some exposures existed between these control groups but case-control studies using each group found that illness was associated with consumption of chicken outside of the home and chicken from local butchers. Recruiting market research panel controls offers time and resource savings. More rapid investigations would enable more prompt implementation of control measures. We recommend that this method of recruiting controls is considered in future investigations and assessed further to better understand strengths and limitations.

What is the utility of using syndromic surveillance systems during large subnational infectious gastrointestinal disease outbreaks? An observational study using case studies from the past 5 years in England.

PubMed

Todkill, D; Elliot, A J; Morbey, R; Harris, J; Hawker, J; Edeghere, O; Smith, G E

2016-08-01

Syndromic surveillance systems in England have demonstrated utility in the early identification of seasonal gastrointestinal illness (GI) tracking its spatio-temporal distribution and enabling early public health action. There would be additional public health utility if syndromic surveillance systems could detect or track subnational infectious disease outbreaks. To investigate using syndromic surveillance for this purpose we retrospectively identified eight large GI outbreaks between 2009 and 2014 (four randomly and four purposively sampled). We then examined syndromic surveillance information prospectively collected by the Real-time Syndromic Surveillance team within Public Health England for evidence of possible outbreak-related changes. None of the outbreaks were identified contemporaneously and no alerts were made to relevant public health teams. Retrospectively, two of the outbreaks - which happened at similar times and in proximal geographical locations - demonstrated changes in the local trends of relevant syndromic indicators and exhibited a clustering of statistical alarms, but did not warrant alerting local health protection teams. Our suite of syndromic surveillance systems may be more suited to their original purposes than as means of detecting or monitoring localized, subnational GI outbreaks. This should, however, be considered in the context of this study's limitations; further prospective work is needed to fully explore the use of syndromic surveillance for this purpose. Provided geographical coverage is sufficient, syndromic surveillance systems could be able to provide reassurance of no or minor excess healthcare systems usage during localized GI incidents.

The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda.

PubMed

de Vries, Daniel H; Rwemisisi, Jude T; Musinguzi, Laban K; Benoni, Turinawe E; Muhangi, Denis; de Groot, Marije; Kaawa-Mafigiri, David; Pool, Robert

2016-02-16

A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest ("the first mile"). In this paper we document how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. We ask to what extent the community became a resource for early detection, and identify problems encountered with community health worker and social mobilization strategies. Analysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper's authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish. All informants were chosen through non-probability sampling sampling. Our data illustrate the lack of credibility, from an emic perspective, of biomedical explanations which ignore local understandings. These explanations were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community--in particular its belief in amayembe spirits--fuelled historical distrust of the external health system and engendered community-level resistance to early detection. Given the available anthropological knowledge of a previous outbreak in Northern Uganda, it is surprising that so little serious effort was made this time round to take local sensibilities and culture into account. The "first mile" problem is not only a question of using local resources for early detection, but also of making use of the contextual cultural knowledge that has already been collected and is readily available. Despite remarkable technological innovations, outbreak control remains contingent upon human interaction and openness to cultural difference.

Scrum kidney: epidemic pyoderma caused by a nephritogenic Streptococcus pyogenes in a rugby team.

PubMed

Ludlam, H; Cookson, B

1986-08-09

In December, 1984, an outbreak of pyoderma affected five scrum players in the St Thomas' Hospital rugby team. The causative organism, Streptococcus pyogenes, was acquired during a match against a team experiencing an outbreak of impetigo, and was transmitted to two front row players of another team a week later, and to two girlfriends of affected St Thomas' players a month later. The strain was M-type 49, tetracycline-resistant, and virulent. It caused salpingitis in a girlfriend and acute glomerulonephritis in one rugby player. No case of subclinical glomerulonephritis was detected in eight patients with pyoderma. Screening of the St Thomas' Hospital team revealed four further cases of non-streptococcal skin infection, with evidence for contemporaneous spread of Staphylococcus aureus. Teams should not field players with sepsis, and it may be advisable to apply a skin antiseptic to traumatised skin after the match.

Working practices and success of infection prevention and control teams: a scoping study.

PubMed

Hale, R; Powell, T; Drey, N S; Gould, D J

2015-02-01

Little research has been undertaken on how infection prevention and control (IPC) teams operate and how their effectiveness is assessed. This review aimed to explore how IPC teams embed IPC throughout hospitals, balance outbreak management with strategic aspects of IPC work (e.g. education), and how IPC team performance is measured. A scoping exercise was performed combining literature searches, evidence synthesis, and intelligence from expert advisers. Eleven publications were identified. One paper quantified how IPC nurses spend their time, two described daily activities of IPC teams, five described initiatives to embed IPC across organizations following legislation since 1999 in the UK or changes in the delivery of healthcare, and three explored the contribution of IPC intermediaries (link nurses and champions). Eight publications reported research findings. The others reported how IPC teams are embedding IPC practice in UK hospitals. In conclusion, there is scope for research to explore different models of IPC team-working and effectiveness, and cost-effectiveness. Other topics that need addressing are the willingness and ability of ward staff to assume increased responsibility for IPC and the effectiveness of intermediaries. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Detecting the Norovirus Season in Sweden Using Search Engine Data – Meeting the Needs of Hospital Infection Control Teams

PubMed Central

Edelstein, Michael; Wallensten, Anders; Zetterqvist, Inga; Hulth, Anette

2014-01-01

Norovirus outbreaks severely disrupt healthcare systems. We evaluated whether Websök, an internet-based surveillance system using search engine data, improved norovirus surveillance and response in Sweden. We compared Websök users' characteristics with the general population, cross-correlated weekly Websök searches with laboratory notifications between 2006 and 2013, compared the time Websök and laboratory data crossed the epidemic threshold and surveyed infection control teams about their perception and use of Websök. Users of Websök were not representative of the general population. Websök correlated with laboratory data (b = 0.88-0.89) and gave an earlier signal to the onset of the norovirus season compared with laboratory-based surveillance. 17/21 (81%) infection control teams answered the survey, of which 11 (65%) believed Websök could help with infection control plans. Websök is a low-resource, easily replicable system that detects the norovirus season as reliably as laboratory data, but earlier. Using Websök in routine surveillance can help infection control teams prepare for the yearly norovirus season. PMID:24955857

Detecting the norovirus season in Sweden using search engine data--meeting the needs of hospital infection control teams.

PubMed

Edelstein, Michael; Wallensten, Anders; Zetterqvist, Inga; Hulth, Anette

2014-01-01

Norovirus outbreaks severely disrupt healthcare systems. We evaluated whether Websök, an internet-based surveillance system using search engine data, improved norovirus surveillance and response in Sweden. We compared Websök users' characteristics with the general population, cross-correlated weekly Websök searches with laboratory notifications between 2006 and 2013, compared the time Websök and laboratory data crossed the epidemic threshold and surveyed infection control teams about their perception and use of Websök. Users of Websök were not representative of the general population. Websök correlated with laboratory data (b = 0.88-0.89) and gave an earlier signal to the onset of the norovirus season compared with laboratory-based surveillance. 17/21 (81%) infection control teams answered the survey, of which 11 (65%) believed Websök could help with infection control plans. Websök is a low-resource, easily replicable system that detects the norovirus season as reliably as laboratory data, but earlier. Using Websök in routine surveillance can help infection control teams prepare for the yearly norovirus season.

The outbreak of SARS at Tan Tock Seng Hospital--relating epidemiology to control.

PubMed

Chen, Mark I C; Leo, Yee-Sin; Ang, Brenda S P; Heng, Bee-Hoon; Choo, Philip

2006-05-01

The outbreak of severe acute respiratory syndrome (SARS) began after the index case was admitted on 1 March 2003. We profile the cases suspected to have acquired the infection in Tan Tock Seng Hospital (TTSH), focussing on major transmission foci, and also describe and discuss the impact of our outbreak control measures. Using the World Health Organization (WHO) case definitions for probable SARS adapted to the local context, we studied all cases documented to have passed through TTSH less than 10 days prior to the onset of fever. Key data were collected in liaison with clinicians and through a team of onsite epidemiologists. There were 105 secondary cases in TTSH. Healthcare staff (57.1%) formed the majority, followed by visitors (30.5%) and inpatients (12.4%). The earliest case had onset of fever on 4 March 2003, and the last case, on 5 April 2003. Eighty-nine per cent had exposures to 7 wards which had cases of SARS that were not isolated on admission. In 3 of these wards, major outbreaks resulted, each with more than 20 secondary cases. Attack rates amongst ward-based staff ranged from 0% to 32.5%. Of 13 inpatients infected, only 4 (30.8%) had been in the same room or cubicle as the index case for the ward. The outbreak of SARS at TTSH showed the challenges of dealing with an emerging infectious disease with efficient nosocomial spread. Super-spreading events and initial delays in outbreak response led to widespread dissemination of the outbreak to multiple wards.

Outbreak of invasive group A streptococcus: investigations using agar settle plates detect perineal shedding from a healthcare worker.

PubMed

Mahida, N; Prescott, K; Yates, C; Spencer, F; Weston, V; Boswell, T

2018-03-29

Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings. Transmission to patients is sometimes linked to colonized healthcare workers (HCWs) and/or a contaminated environment. To describe the investigation and control of an outbreak of healthcare-associated GAS on an elderly care medical ward, over six months. Four patients developed septicaemia due to GAS infection without a clinically obvious site of infection. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, HCW screening and environmental sampling using both swabs and settle plates. Immediate control measures included source isolation and additional cleaning of the ward environment with a chlorine disinfectant and hydrogen peroxide. Prospective patient screening identified one additional patient with throat GAS carriage. Settle plate positivity for GAS was strongly associated with the presence of one individual HCW on the ward, who was subsequently found to have GAS perineal carriage. Contamination of a fabric-upholstered chair in an office adjacent to the ward, used by the HCW, was also detected. In total, three asymptomatic HCWs had throat GAS carriage and one HCW had both perineal and throat carriage. All isolates were typed as emm 28. This is the first outbreak report demonstrating the use of settle plates in a GAS outbreak investigation on a medical ward, to identify the likely source of the outbreak. Based on this report we recommend that both throat and perineal sites should be sampled if HCW screening is undertaken during an outbreak of GAS. Fabric, soft furnishings should be excluded from clinical areas as well as any adjacent offices because pathogenic bacteria such as GAS may contaminate this environment. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The RAPIDD ebola forecasting challenge: Synthesis and lessons learnt.

PubMed

Viboud, Cécile; Sun, Kaiyuan; Gaffey, Robert; Ajelli, Marco; Fumanelli, Laura; Merler, Stefano; Zhang, Qian; Chowell, Gerardo; Simonsen, Lone; Vespignani, Alessandro

2018-03-01

Infectious disease forecasting is gaining traction in the public health community; however, limited systematic comparisons of model performance exist. Here we present the results of a synthetic forecasting challenge inspired by the West African Ebola crisis in 2014-2015 and involving 16 international academic teams and US government agencies, and compare the predictive performance of 8 independent modeling approaches. Challenge participants were invited to predict 140 epidemiological targets across 5 different time points of 4 synthetic Ebola outbreaks, each involving different levels of interventions and "fog of war" in outbreak data made available for predictions. Prediction targets included 1-4 week-ahead case incidences, outbreak size, peak timing, and several natural history parameters. With respect to weekly case incidence targets, ensemble predictions based on a Bayesian average of the 8 participating models outperformed any individual model and did substantially better than a null auto-regressive model. There was no relationship between model complexity and prediction accuracy; however, the top performing models for short-term weekly incidence were reactive models with few parameters, fitted to a short and recent part of the outbreak. Individual model outputs and ensemble predictions improved with data accuracy and availability; by the second time point, just before the peak of the epidemic, estimates of final size were within 20% of the target. The 4th challenge scenario - mirroring an uncontrolled Ebola outbreak with substantial data reporting noise - was poorly predicted by all modeling teams. Overall, this synthetic forecasting challenge provided a deep understanding of model performance under controlled data and epidemiological conditions. We recommend such "peace time" forecasting challenges as key elements to improve coordination and inspire collaboration between modeling groups ahead of the next pandemic threat, and to assess model forecasting accuracy for a variety of known and hypothetical pathogens. Published by Elsevier B.V.

Waterborne outbreak of cryptosporidiosis in the South East of Ireland: weighing up the evidence.

PubMed

Mahon, M; Doyle, S

2017-11-01

In late Spring 2012, 12 cases of cryptosporidiosis in a town in the South East of Ireland were notified to the regional Department of Public Health. The purpose of this paper is to describe the outbreak and the investigative process which led to the conclusion that the source was a public drinking water supply. Outbreak and incident control teams were convened to investigate and control the outbreak. Eleven cases were speciated as Cryptosporidium parvum. GP60 analysis demonstrated that 10 were C. parvum IIaA20G3R1, indicating that the cases were linked. The public water supply was the only common risk factor identified. Increased water sampling identified Cryptosporidium muris/andersoni in the treated water at one of two water treatment plants (Water Treatment Plant, WTP A) for the supply, and on the network. C. parvum was subsequently identified in raw water from WTP A. The Health Service Executive (HSE) concluded that this outbreak was "probably associated with water" produced at WTP A based on (1) descriptive epidemiological evidence suggesting water-related illness and excluding other obvious explanations; and (2) water treatment failure at WTP A. WTP A was closed to facilitate an upgrade. No boil water notice was required as a supplementary supply was available. The upgrade was completed and the incident closed in 2013.

Outbreak of measles in a non-immunizing population, Alberta 2013.

PubMed

Kershaw, T; Suttorp, V; Simmonds, K; St Jean, T

2014-06-12

An outbreak of measles was declared in southern Alberta on October 18, 2013, after a case had been reported to the local public health unit in a non-immunized teenager with recent travel to the Netherlands. The teenager had had contact with a large number of unimmunized people while infectious; therefore, the risk of spread was high. The potential for an outbreak of measles in this area had been identified by the lead Medical Officer of Health for South Zone, and planning for an outbreak had begun in August 2013. Several public health measures were implemented to control the outbreak: mass immunization clinics; an outbreak dose of measles mumps and rubella (MMR) vaccine for infants 6-12 months old; communication within the affected and surrounding communities; a dedicated measles hotline; a Mobile Measles Assessment Team; and a Measles Assessment Centre. A total of 42 confirmed cases were identified during the outbreak between October 16 and November 25. Just over half the cases were male (52.4%). The average age was 12 (range < 1 to 24 years) and the median age 13 years. There was one hospitalization, and no deaths occurred. All cases were unimmunized. Cases were located in five communities immediately surrounding Lethbridge. All but two cases were epidemiologically linked within 10 households. The planning that occurred before the outbreak was essential in containing the outbreak to 10 households. To prevent future outbreaks of measles, exploring strategies for increasing immunization coverage rates in unimmunized populations is essential. When immunization acceptance is not uniform, other public health strategies should be planned for and implemented in order to prevent additional spread.

An international foodborne outbreak of shigellosis associated with a commercial airline.

PubMed

Hedberg, C W; Levine, W C; White, K E; Carlson, R H; Winsor, D K; Cameron, D N; MacDonald, K L; Osterholm, M T

1992-12-09

To determine the source of an international outbreak of shigellosis associated with consumption of food served by a Minnesota-based airline. Cohort studies of players and staff of a Minnesota-based professional football team and passengers on flights with a confirmed case of outbreak-associated Shigella sonnei infection. Community- and industry-based studies conducted from October through November 1988. Sixty-five football team players and staff, and 725 airline passengers in the cohort studies. Twenty-one (32%) of 65 football players and staff developed shigellosis that was associated with consumption of cold sandwiches prepared at the airline flight kitchen (relative risk [RR], 17.1; 95% confidence interval [Cl], 2.4 to 120; P < .001). Confirmed or probable shigellosis was identified among 240 passengers on 219 flights to 24 states, the District of Columbia, and four countries between September 14 and October 13. An outbreak-associated strain of S sonnei was isolated from football players and staff, airline passengers, and flight attendants. Thirty (4.1%) of 725 passengers on 13 flights with confirmed cases had confirmed or probable shigellosis. Illness was associated with consumption of cold food items served on the flights and prepared by hand at the airline flight kitchen (RR, 5.7; 95% Cl, 1.4 to 23.5; P < .01). This international outbreak of shigellosis was identified only because of the occurrence of an index outbreak involving a professional football team. Prevention of Shigella transmission in mass catering establishments may require reduction of hand contact in the preparation of cold food items or elimination of these items from menus.

Ebola and Marburg virus diseases in Africa: increased risk of outbreaks in previously unaffected areas?

PubMed

Changula, Katendi; Kajihara, Masahiro; Mweene, Aaron S; Takada, Ayato

2014-09-01

Filoviral hemorrhagic fever (FHF) is caused by ebolaviruses and marburgviruses, which both belong to the family Filoviridae. Egyptian fruit bats (Rousettus aegyptiacus) are the most likely natural reservoir for marburgviruses and entry into caves and mines that they stay in has often been associated with outbreaks of MVD. On the other hand, the natural reservoir for ebola viruses remains elusive; however, handling of wild animal carcasses has been associated with some outbreaks of EVD. In the last two decades, there has been an increase in the incidence of FHF outbreaks in Africa, some being caused by a newly found virus and some occurring in previously unaffected areas such as Guinea, Liberia and Sierra Leone, in which the most recent EVD outbreak occurred in 2014. Indeed, the predicted geographic distribution of filoviruses and their potential reservoirs in Africa includes many countries in which FHF has not been reported. To minimize the risk of virus dissemination in previously unaffected areas, there is a need for increased investment in health infrastructure in African countries, policies to facilitate collaboration between health authorities from different countries, implementation of outbreak control measures by relevant multi-disciplinary teams and education of the populations at risk. © 2014 The Societies and Wiley Publishing Asia Pty Ltd.

Public health action and mass chemoprophylaxis in response to a small meningococcal infection outbreak at a nursery in the West Midlands, England.

PubMed

Stewart, Antony; Coetzee, Nic; Knapper, Elizabeth; Rajanaidu, Subhadra; Iqbal, Zafar; Duggal, Harsh

2013-03-01

Meningococcal infection is fatal in 10% of cases, and age-specific attack rates are highest in infancy. A nursery outbreak was declared just before a bank holiday weekend in August 2010, when two children attending the same nursery were confirmed to have meningococcal infection. Although such outbreaks are rare, they generate considerable public alarm and are challenging to manage and control. This report describes the investigation and public health response to the outbreak. Both cases had relatively mild disease and were confirmed as having serogroup B infection. Chemoprophylaxis and advice were given to most of the 146 children and 30 staff at the nursery. Within 28 hours of declaring the outbreak, over 95% of parents received information, advice and prescriptions for their children. GPs were also given information and the after-hours service provided continuity over the weekend. No further cases were identified and the outbreak was closed four weeks after being declared. Considerable logistical challenges were involved in providing timely advice and chemoprophylaxis to the entire nursery and staff one day before a bank holiday weekend. The speed of the public health response and implementation of preventive measures was crucial in providing assurance to parents and staff, and reducing their anxiety. The decision to provide on-site prescribing at the nursery (coupled with information sessions and individual counselling) proved to be a key implementation-success factor. Effective coordination and management by the outbreak control team was able to rapidly provide leadership, delegate tasks, identify gaps, allocate resources and ensure a proactive media response. A number of useful lessons were learnt and recommendations were made for future local practice.

Outcome of strict implementation of infection prevention control measures during an outbreak of Middle East respiratory syndrome.

PubMed

El Bushra, Hassan E; Al Arbash, Hussain A; Mohammed, Mutaz; Abdalla, Osman; Abdallah, Mohamed N; Al-Mayahi, Zayid K; Assiri, Abdallah M; BinSaeed, Abdulaziz A

2017-05-01

The objective of this retrospective cohort study was to assess the impact of implementation of different levels of infection prevention and control (IPC) measures during an outbreak of Middle East respiratory syndrome (MERS) in a large tertiary hospital in Saudi Arabia. The setting was an emergency room (ER) in a large tertiary hospital and included primary and secondary MERS patients. Rapid response teams conducted repeated assessments of IPC and monitored implementation of corrective measures using a detailed structured checklist. We ascertained the epidemiologic link between patients and calculated the secondary attack rate per 10,000 patients visiting the ER (SAR/10,000) in 3 phases of the outbreak. In phase I, 6 primary cases gave rise to 48 secondary cases over 4 generations, including a case that resulted in 9 cases in the first generation of secondary cases and 21 cases over a chain of 4 generations. During the second and third phases, the number of secondary cases sharply dropped to 18 cases and 1 case, respectively, from a comparable number of primary cases. The SAR/10,000 dropped from 75 (95% confidence interval [CI], 55-99) in phase I to 29 (95% CI, 17-46) and 3 (95% CI, 0-17) in phases II and III, respectively. The study demonstrated salient evidence that proper institution of IPC measures during management of an outbreak of MERS could remarkably change the course of the outbreak. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

National outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to mixed salad leaves, United Kingdom, 2016.

PubMed

Gobin, Maya; Hawker, Jeremy; Cleary, Paul; Inns, Thomas; Gardiner, Daniel; Mikhail, Amy; McCormick, Jacquelyn; Elson, Richard; Ready, Derren; Dallman, Tim; Roddick, Iain; Hall, Ian; Willis, Caroline; Crook, Paul; Godbole, Gauri; Tubin-Delic, Drazenka; Oliver, Isabel

2018-05-01

We investigated a large outbreak of Escherichia coli O157 in the United Kingdom (UK) with 165 cases between 31 May and 29 July 2016. No linked cases were reported in other countries. Cases were predominately female (n = 128) and adult (n = 150), 66 attended hospital and nine had features of haemorrhagic uraemic syndrome. A series of epidemiological studies (case-control, case-case, ingredients-based and venue-based studies) and supply chain investigations implicated mixed salad leaves from Supplier A as the likely outbreak vehicle. Whole genome sequencing (WGS) indicated a link with strains from the Mediterranean and informed the outbreak control team to request that Supplier A cease distributing salad leaves imported from Italy. Microbiological tests of samples of salad leaves from Supplier A were negative. We were unable to confirm the source of contamination or the contaminated constituent leaf although our evidence pointed to red batavia received from Italy as the most likely vehicle. Variations in Shiga toxin-producing E. coli surveillance and diagnosis may have prevented detection of cases outside the UK and highlights a need for greater standardisation. WGS was useful in targeting investigations, but greater coverage across Europe is needed to maximise its potential.

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach.

PubMed

Edmunds, Kelly L; Elrahman, Samira Abd; Bell, Diana J; Brainard, Julii; Dervisevic, Samir; Fedha, Tsimbiri P; Few, Roger; Howard, Guy; Lake, Iain; Maes, Peter; Matofari, Joseph; Minnigh, Harvey; Mohamedani, Ahmed A; Montgomery, Maggie; Morter, Sarah; Muchiri, Edward; Mudau, Lutendo S; Mutua, Benedict M; Ndambuki, Julius M; Pond, Katherine; Sobsey, Mark D; van der Es, Mike; Zeitoun, Mark; Hunter, Paul R

2016-06-01

To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.

Innovative Technological Approach to Ebola Virus Disease Outbreak Response in Nigeria Using the Open Data Kit and Form Hub Technology.

PubMed

Tom-Aba, Daniel; Olaleye, Adeniyi; Olayinka, Adebola Tolulope; Nguku, Patrick; Waziri, Ndadilnasiya; Adewuyi, Peter; Adeoye, Olawunmi; Oladele, Saliu; Adeseye, Aderonke; Oguntimehin, Olukayode; Shuaib, Faisal

2015-01-01

The recent outbreak of Ebola Virus Disease (EVD) in West Africa has ravaged many lives. Effective containment of this outbreak relies on prompt and effective coordination and communication across various interventions; early detection and response being critical to successful control. The use of information and communications technology (ICT) in active surveillance has proved to be effective but its use in Ebola outbreak response has been limited. Due to the need for timeliness in reporting and communication for early discovery of new EVD cases and promptness in response; it became imperative to empower the response team members with technologies and solutions which would enable smooth and rapid data flow. The Open Data Kit and Form Hub technology were used in combination with the Dashboard technology and ArcGIS mapping for follow up of contacts, identification of cases, case investigation and management and also for strategic planning during the response. A remarkable improvement was recorded in the reporting of daily follow-up of contacts after the deployment of the integrated real time technology. The turnaround time between identification of symptomatic contacts and evacuation to the isolation facility and also for receipt of laboratory results was reduced and informed decisions could be taken by all concerned. Accountability in contact tracing was ensured by the use of a GPS enabled device. The use of innovative technologies in the response of the EVD outbreak in Nigeria contributed significantly to the prompt control of the outbreak and containment of the disease by providing a valuable platform for early warning and guiding early actions.

Innovative Technological Approach to Ebola Virus Disease Outbreak Response in Nigeria Using the Open Data Kit and Form Hub Technology

PubMed Central

Nguku, Patrick; Waziri, Ndadilnasiya; Adewuyi, Peter; Adeoye, Olawunmi; Adeseye, Aderonke; Oguntimehin, Olukayode; Shuaib, Faisal

2015-01-01

The recent outbreak of Ebola Virus Disease (EVD) in West Africa has ravaged many lives. Effective containment of this outbreak relies on prompt and effective coordination and communication across various interventions; early detection and response being critical to successful control. The use of information and communications technology (ICT) in active surveillance has proved to be effective but its use in Ebola outbreak response has been limited. Due to the need for timeliness in reporting and communication for early discovery of new EVD cases and promptness in response; it became imperative to empower the response team members with technologies and solutions which would enable smooth and rapid data flow. The Open Data Kit and Form Hub technology were used in combination with the Dashboard technology and ArcGIS mapping for follow up of contacts, identification of cases, case investigation and management and also for strategic planning during the response. A remarkable improvement was recorded in the reporting of daily follow-up of contacts after the deployment of the integrated real time technology. The turnaround time between identification of symptomatic contacts and evacuation to the isolation facility and also for receipt of laboratory results was reduced and informed decisions could be taken by all concerned. Accountability in contact tracing was ensured by the use of a GPS enabled device. The use of innovative technologies in the response of the EVD outbreak in Nigeria contributed significantly to the prompt control of the outbreak and containment of the disease by providing a valuable platform for early warning and guiding early actions. PMID:26115402

Community-based survey during rabies outbreaks in Rangjung town, Trashigang, eastern Bhutan, 2016.

PubMed

Tenzin, Tenzin; Namgyal, Jamyang; Letho, Sangay

2017-04-17

Rabies is a highly fatal disease transmitted through the bite of a rabid animal. Human deaths can be prevented by prompt administering of rabies vaccine and rabies immunoglobulin following the exposure. An assessment of community knowledge, awareness and practices on rabies is important during outbreak to understand their preparedness and target educational messages and response activities by the rapid response team. A rabies outbreak has occurred in Rangjung town, eastern Bhutan on 4 October 2016. A rapid response team was activated to investigate outbreak and to establish a control program. A community-based questionnaire survey was conducted from 20 to 21 October 2016 to assess the community knowledge of rabies to guide outbreak preparedness and also target educational messages and response activities by the RRT. A total of 67 respondents were interviewed, of which 61% were female and 39% male. All the respondents have heard of rabies (100%), have knowledge on source of rabies (dog) and its mode of transmission in animals and humans. Most (61%) respondents were aware and also indicated that they would wash the animal bite wound with soap and water and seek medical care on the same day of exposure (100%). Majority (94%) of the respondents have indicated that they would report to the government agencies if they see any suspected rabid dogs in the community and suggested various control measures for dog population management and rabies in Rangjung including neutering procedure and mass dog vaccination. Although only few (10%) of the respondents households owned dogs and cats, but 50% of them have indicated that their dogs were allowed to roam outside the home premises posing risk of contracting rabies through rabid dog bites. Although this study indicates a high level of knowledge and awareness on rabies among the community, there exists some knowledge gaps about rabies and therefore, an awareness education should be focused on the source of rabies and rabies virus transmission route to reduce public concern on nonexposure events thereby reducing the cost on unnecessary postexposure treatment.

Outbreak of Salmonella enteritidis PT14b gastroenteritis at a restaurant in England: the use of molecular typing to achieve a successful prosecution.

PubMed

Chatt, C; Nicholds-Trainor, D; Scrivener, A; Suleman, S; Harvey, M; Dallman, T; Hawker, J; Sibal, B

2017-10-01

To describe an outbreak of Salmonella enteritidis phage type (PT) 14b in people who had eaten at a restaurant, and the investigation and subsequent prosecution of the food business operator (FBO). The local health protection team and environmental health department formed an outbreak control team to investigate the outbreak. Epidemiological, microbiological, and environmental investigations were undertaken. Epidemiological investigations involved case finding and interviews. Microbiological investigation: stool samples from the suspected cases and environmental samples from the implicated food business were investigated. Salmonella isolates obtained were subjected to multiple locus variable-number tandem repeat analysis (MLVA) profiling and whole genome sequencing. In addition, adenosine triphosphate (ATP) hygiene swab tests were used to verify the quality of cleaning procedures and data loggers were used to determine the water temperature of the mechanical dishwasher. Fifteen cases of illness where the causative agent was shown to be S. enteritidis PT14b were identified, all of whom had eaten at the same restaurant. S. enteritidis PT14b was also identified from three of the 11 food and environmental samples taken at the restaurant and found to have the same MLVA profile as the cases. A case for prosecution was built and the FBO was successfully prosecuted in July 2015. This investigation highlighted that the use of molecular typing as part of thorough epidemiological, microbiological, and environmental investigations can present a robust case for prosecution against restaurants which pose a risk to public health. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Aseptic meningitis outbreak associated with echovirus 30 among high school football players--Los Angeles County, California, 2014.

PubMed

Croker, Curtis; Civen, Rachel; Keough, Kathleen; Ngo, Van; Marutani, Amy; Schwartz, Benjamin

2015-01-02

On August 4, 2014, the Acute Communicable Disease Control Program of the Los Angeles County Department of Public Health received a report of three aseptic meningitis cases among football players at a county high school. An investigation was conducted to determine the extent of the outbreak, identify potential exposures, and recommend control measures. An outbreak-associated aseptic meningitis case was defined as an illness of any team or family member with onset during July 28-August 11 with 1) cerebrospinal fluid pleocytosis and negative bacterial culture or 2) an emergency department visit with headache, fever, and stiff neck. Ten cases were identified; nine in males, and one in a female; patient ages ranged from 13 to 17 years. All the patients sought care at an emergency department, and five were hospitalized, resulting in 12 total hospital days. All 10 patients have recovered. Eight patients were football players, and two were siblings of football players. The most affected subgroup was the junior varsity football team, with seven cases out of 57 players (attack rate = 12.3%); the relative risk for aseptic meningitis was higher among players who were linemen than among those who were not linemen (relative risk = 5.4 [p = 0.03]). Of the 10 patients, eight tested positive by polymerase chain reaction for enterovirus, and two were not tested. Echovirus testing was performed at the California Viral and Rickettsial Disease Laboratory. Of the eight specimens testing positive for enterovirus, seven tested positive for echovirus 30, and one specimen could not be typed because of insufficient quantity.

Taste and Safety: Is the Exceptional Cuisine Offered by High End Restaurants Paralleled by High Standards of Food Safety?

PubMed Central

Kanagarajah, Sanch; Mook, Piers; Crook, Paul; Awofisayo-Okuyelu, Adedoyin; McCarthy, Noel

2016-01-01

Introduction: Restaurant guides such as the Good Food Guide Top 50 create a hierarchy focussing on taste and sophistication. Safety is not explicitly included. We used restaurant associated outbreaks to assess evidence for safety. Methods: All foodborne disease outbreaks in England reported to the national database from 2000 to 2014 were used to compare the Top 50 restaurants (2015) to other registered food businesses using the Public Health England (PHE) outbreak database. Health Protection Teams were also contacted to identify any outbreaks not reported to the national database. Among Good Food Guide Top 50 restaurants, regression analysis estimated the association between outbreak occurrence and position on the list. Results: Four outbreaks were reported to the PHE national outbreak database among the Top 50 giving a rate 39 times higher (95% CI 14.5–103.2) than other registered food businesses. Eight outbreaks among the 44 English restaurants in the Top 50 were identified by direct contact with local Health Protection Teams. For every ten places higher ranked, Top 50 restaurants were 66% more likely to have an outbreak (Odds Ratio 1.66, 95% CI 0.89–3.13). Discussion: Top 50 restaurants were substantially more likely to have had reported outbreaks from 2000-2014 than other food premises, and there was a trend for higher rating position to be associated with higher probability of reported outbreaks. Our findings, that eating at some of these restaurants may pose an increased risk to health compared to other dining out, raises the question of whether food guides should consider aspects of food safety alongside the clearly important complementary focus on taste and other aspects of the dining experience. PMID:27617168

Establishment of CDC Global Rapid Response Team to Ensure Global Health Security.

PubMed

Stehling-Ariza, Tasha; Lefevre, Adrienne; Calles, Dinorah; Djawe, Kpandja; Garfield, Richard; Gerber, Michael; Ghiselli, Margherita; Giese, Coralie; Greiner, Ashley L; Hoffman, Adela; Miller, Leigh Ann; Moorhouse, Lisa; Navarro-Colorado, Carlos; Walsh, James; Bugli, Dante; Shahpar, Cyrus

2017-12-01

The 2014-2016 Ebola virus disease epidemic in West Africa highlighted challenges faced by the global response to a large public health emergency. Consequently, the US Centers for Disease Control and Prevention established the Global Rapid Response Team (GRRT) to strengthen emergency response capacity to global health threats, thereby ensuring global health security. Dedicated GRRT staff can be rapidly mobilized for extended missions, improving partner coordination and the continuity of response operations. A large, agencywide roster of surge staff enables rapid mobilization of qualified responders with wide-ranging experience and expertise. Team members are offered emergency response training, technical training, foreign language training, and responder readiness support. Recent response missions illustrate the breadth of support the team provides. GRRT serves as a model for other countries and is committed to strengthening emergency response capacity to respond to outbreaks and emergencies worldwide, thereby enhancing global health security.

Outbreak of mumps in a school setting, United Kingdom, 2013.

PubMed

Aasheim, Erlend T; Inns, Thomas; Trindall, Amy; Emmett, Lynsey; Brown, Kevin E; Williams, Chris J; Reacher, Mark

2014-01-01

Effective protection against mumps can be achieved through 2 doses of the measles-mumps-rubella (MMR) vaccine. However, outbreaks of mumps have recently been described among populations with high vaccination coverage, including 2 doses of MMR. Here we describe an outbreak at a school in the East of England, UK. The school was attended by 540 pupils aged 10-19 years and had 170 staff. In total, 28 cases of mumps (24 pupils and 4 staff) were identified during 10 January to 16 March 2013. Vaccination status was known in 25 of the cases, and among these 21 (84.0%) had a documented history of 2 doses of MMR while the remaining had a history of one dose (2/25 cases, 8.0%) or no doses (2/25, 8.0%) of MMR. An outbreak control team recommended that MMR vaccine should be offered to all pupils whose parents consented to it, regardless of previous vaccination status. Additional MMR vaccines were administered to 103 pupils, including 76 (73.8%) third doses of MMR. Offering an additional dose of MMR appeared to be acceptable to parents, and we found it feasible to administer the intervention in a timely manner with resources from the local Public Health Centre (Primary Care Trust). An additional dose of MMR to all individuals at risk can be considered as an acceptable control measure for mumps outbreaks in schools even if the vaccination coverage is high. However, further evidence on the effectiveness, acceptability, and safety of this intervention is needed.

Investigation of an outbreak of cutaneous anthrax in Banlu village, Lianyungang, China, 2012

PubMed Central

Liang-liang, Cui; Li, LI; Ming-lei, Zhang; Fang, Qi; Liang, Ying; Chang-jun, Bao

2012-01-01

Objective After notification of a suspected case of anthrax following the slaughtering of a sick cow in Banlu village, an area that has not had any anthrax cases for decades, we aimed to confirm the outbreak, determine the transmission mechanism and implement control measures. Methods The outbreak response team interviewed all people that had contact with the sick cow. Three types of cases’ specimens were collected and tested by blood smear, real-time polymerase chain reaction (PCR) and the gold colloid method. Traceback of potentially contaminated meat and cattle were conducted. Results There were five confirmed and three probable cases verified among 17 people who had contact with the sick cow – an attack rate of 47%. The incubation period ranged from one to eight days with a median of two days. All eight cases had lesions. All were native residents of Banlu village aged between 21 and 48 years. Five male cases were professional butchers; two females and one male were temporary assistants. The sick cow’s meat and hide, as well as all cattle processed at the same time, were recalled. Hypochlorite was used to disinfect the contaminated environments, butchering facilities and the contacts’ personal effects. Conclusion This outbreak was caused by anthrax bacillus transmitted to contacts from the tissues of the sick cow. Control of the outbreak was managed by recalling all potentially infected meat and disinfecting the slaughter house and the suspected cases’ personal effects and environment. PMID:23908932

Quarantine after an international biological weapons attack: medical and public health requirements for containment.

PubMed

Oren, Meir

2004-11-01

The world now faces the dreadful possibility of biological weapons attacks by terrorists. Healthcare systems would have to cope with such emergencies should all preemptive measures fail. Information gained from the Global Mercury exercise and the SARS outbreak has shown that containing an outbreak at the start is more effective than reacting to it once it has spread and that containment should be treated both nationally and internationally. On the national level this entails developing rapid and effective methods to detect and identify infected cases, and implementing isolation and control measures to lower the risk of further transmission of the disease while assuring the safety of medical teams and laboratory workers. Strategic contingency plans should incorporate well-defined procedures for hospitalization and isolation of patients, providing regional backup of medical personnel and equipment and maintaining close cooperation between the various bodies in the healthcare system. Quarantine is an effective containment measure, especially if voluntarily imposed. Modern communication systems can help by sending professional teams timely instructions and providing the public with information to reduce panic and stress during quarantine procedures. Informing the public poses a dilemma: finding a balance between giving advance warning of an imminent epidemic outbreak and ascertaining the likelihood of its occurrence. Containment of international bioterrorist attacks depends entirely on close international cooperation to implement national and international strategic contingency plans with free exchange of information and recognition of procedures.

[Control of human African trypanosomiasis: back to square one].

PubMed

Jannin, J; Louis, F J; Lucas, P; Simarro, P P

2001-01-01

The natural history of sleeping sickness is cyclic. The first epidemic outbreak in the 19th century devastated the population and resolved spontaneously for lack of victims. Intensive development during the colonial period and the movement of population that it spawned led to another epidemic in the early 1920s that reached such severe proportions that drastic steps had to be taken. At that time, Jamot was given complete political, administrative, and financial freedom to combat the disease. This program led to the development of the mobile team concept and so-called vertically structured vector control strategy and was so successful that sleeping sickness ceased to be considered as a major public health problem at the beginning of the 1960s. In the ensuing years sleeping sickness was largely neglected. Monitoring the disease required specialized teams that were no longer considered as cost-effective. One by one the measures that had been implemented to control the disease disappeared, thus setting the scene for a new outbreak grew. In 1995, the incidence of sleeping sickness reached the same levels as in the 1920s. The current situation is a classic example of a neglected disease with a paucity of competent specialists, diagnostic tests, effective drugs, and operational facilities. It was not until 2001 that new hope appeared thanks to a combined public- and private-sector initiative allowing restructuring of treatment teams, renovation of facilities, free distribution of drugs, and research to develop new therapeutic agents. Also thanks to the PATTEC initiative, the governments of the African affected nations are showing new in interest in sleeping sickness. However the battle is far from won and much effort will be required. Time is running out and the stakes are high.

Nurses' experience with vancomycin-resistant enterococci (VRE).

PubMed

Mitchell, Ann; Cummins, Teresa; Spearing, Natalie; Adams, June; Gilroy, Lisa

2002-01-01

The emergence and spread of resistant organisms, in particular vancomycin-resistant enterococci (VRE), is an issue facing all staff in acute hospitals. This study explored how nurses coped with the responsibility of halting further spread of this organism during an outbreak. VRE-positive patients were cohorted with nurses who cared for them in an endeavour to contain the spread of VRE. The majority of nurses found the situation extremely stressful because of the need to act as 'gatekeepers' responsible for educating and monitoring the practices of staff and visitors. The nurses reported that they felt they were inadequately supported, were blamed for the outbreak, and that they had an increased workload as they took on duties of other staff. The results reinforce the need for a multidisciplinary team approach to education and control of VRE, more support for nursing staff cohorted with VRE-positive patients, and stringent adherence to infection control measures by all hospital staff.

Infectious Diseases Associated With Organized Sports and Outbreak Control.

PubMed

Davies, H Dele; Jackson, Mary Anne; Rice, Stephen G

2017-10-01

Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete's primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports-related infections, and the implementation of preventive interventions. Copyright © 2017 by the American Academy of Pediatrics.

Successful infection control for a vancomycin-intermediate Staphylococcus aureus outbreak in an advanced emergency medical service centre.

PubMed

Sakai, Y; Qin, L; Miura, M; Masunaga, K; Tanamachi, C; Iwahashi, J; Kida, Y; Takasu, O; Sakamoto, T; Watanabe, H

2016-04-01

A vancomycin-intermediate Staphylococcus aureus (VISA) (vancomycin minimum inhibitory concentration: 4mg/L) outbreak occurred in an advanced emergency medical service centre [hereafter referred to as the intensive care unit (ICU)] between 2013 and 2014. Our objective was to evaluate the infection control measures that were successful. Seventeen VISA strains were isolated from the sputum of 15 inpatients and the skin of two inpatients. Fourteen VISA strains were recognized as colonization. However, three VISA strains were isolated from the sputum of three inpatients with pneumonia. Environmental cultures were performed and VISA strains were detected in five of 65 sites. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) was performed on 21 VISA strains. Molecular typing including PFGE and MLST showed that the patterns of 19 VISA strains were identical and those of the other two VISA strains were possibly related. This meant that a horizontal transmission of VISA strains had occurred in the ICU. In August 2013, the infection control team began interventions. However, new inpatients with VISA strains continued to appear. Therefore, in October 2013, the ICU was partially closed in order to try to prevent further horizontal transmission, and existing inpatients with the VISA strain were isolated. Although new cases quickly dissipated after the partial closure, it took approximately five months to eradicate the VISA outbreak. Our data suggest that despite the employment of various other infection control measures, partial closure of the ICU was essential in terminating this VISA outbreak. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

A One Health, participatory epidemiology assessment of anthrax (Bacillus anthracis) management in Western Uganda.

PubMed

Coffin, Jeanne L; Monje, Fred; Asiimwe-Karimu, Grace; Amuguni, Hellen Janetrix; Odoch, Terence

2015-03-01

Sporadic anthrax outbreaks have occurred in and around Uganda's Queen Elizabeth National Park (QENP) for years, affecting wildlife, domestic animals, and humans. Reported outbreaks (2004-2005 and 2010) in QENP collectively killed over 500 wild animals and over 400 domestic animals. A 2011 outbreak in Sheema district temporarily froze local markets while killing two humans and seven bovines. One Health is multidisciplinary at its core, yet studies sometimes focus on the effects of animals on human health to the detriment of investigating the surrounding ecological and cultural contexts. Participatory methods connect problems - such as disease - to their context. A multidisciplinary team used participatory epidemiology and conventional structured questionnaires to investigate the impacts of anthrax on human livelihoods and the related perceptions of conservation, public health, and veterinary health efforts in the QENP area. Proximities to previous anthrax outbreaks and to QENP were treated as risk factors in the collection and evaluation of data. Participants' feedback indicates that anthrax prevalence may be greater than officially reported. Community member perceptions about anthrax and other diseases appear to be more closely related to their proximity to QENP than their proximity to anthrax outbreaks. Neither risk factor had a strong effect on knowledge of disease, nor any effect on behaviors associated with disease response or control. Instead, participants reported that social pressures, the economics of poverty, and the lack of health and veterinary infrastructure highly influenced responses to disease. The complex connections between the social needs and the economic context of these communities seem to be undermining current anthrax control and education measures. This livelihood-based decision-making may be unlikely to respond to educational intervention alone. This study provides a strong base for further research and for improvements in effective disease control. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach

PubMed Central

Edmunds, Kelly L; Elrahman, Samira Abd; Bell, Diana J; Brainard, Julii; Dervisevic, Samir; Fedha, Tsimbiri P; Few, Roger; Howard, Guy; Lake, Iain; Maes, Peter; Matofari, Joseph; Minnigh, Harvey; Mohamedani, Ahmed A; Montgomery, Maggie; Morter, Sarah; Muchiri, Edward; Mudau, Lutendo S; Mutua, Benedict M; Ndambuki, Julius M; Pond, Katherine; Sobsey, Mark D; van der Es, Mike; Zeitoun, Mark

2016-01-01

Abstract Objective To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. Methods A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. Findings The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. Conclusion The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease. PMID:27274594

An outbreak of invasive group A streptococcal infection among elderly patients receiving care from a district nursing team, October 2013 – May 2014

PubMed Central

Iyanger, Nalini; Cleary, Vivien; Lamagni, Theresa

2015-01-01

Between October 2013 and April 2014 five elderly patients living within a 2 square mile radius, were admitted to local hospitals with severe group A streptococcal cellulitis and septicaemia. Molecular typing confirmed four patients for whom typing results were available to have the same emm gene sequence type, emm st89. An outbreak investigation was launched and identified that each patient had received care interventions from a district nursing team at their home or local health clinic in the 7 days prior to onset of symptoms. PMID:28989424

Epidemiological and laboratory characterization of a yellow fever outbreak in northern Uganda, October 2010-January 2011.

PubMed

Wamala, Joseph F; Malimbo, Mugagga; Okot, Charles L; Atai-Omoruto, Ann D; Tenywa, Emmanuel; Miller, Jeffrey R; Balinandi, Stephen; Shoemaker, Trevor; Oyoo, Charles; Omony, Emmanuel O; Kagirita, Atek; Musenero, Monica M; Makumbi, Issa; Nanyunja, Miriam; Lutwama, Julius J; Downing, Robert; Mbonye, Anthony K

2012-07-01

In November 2010, following reports of an outbreak of a fatal, febrile, hemorrhagic illness in northern Uganda, the Uganda Ministry of Health established multisector teams to respond to the outbreak. This was a case-series investigation in which the response teams conducted epidemiological and laboratory investigations on suspect cases. The cases identified were line-listed and a data analysis was undertaken regularly to guide the outbreak response. Overall, 181 cases met the yellow fever (YF) suspected case definition; there were 45 deaths (case fatality rate 24.9%). Only 13 (7.5%) of the suspected YF cases were laboratory confirmed, and molecular sequencing revealed 92% homology to the YF virus strain Couma (Ethiopia), East African genotype. Suspected YF cases had fever (100%) and unexplained bleeding (97.8%), but jaundice was rare (11.6%). The overall attack rate was 13 cases/100000 population, and the attack rate was higher for males than females and increased with age. The index clusters were linked to economic activities undertaken by males around forests. This was the largest YF outbreak ever reported in Uganda. The wide geographical case dispersion as well as the male and older age preponderance suggests transmission during the outbreak was largely sylvatic and related to occupational activities around forests. Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Outbreak of syphilis in men who have sex with men living in rural North Wales (UK) associated with the use of social media.

PubMed

Thomas, Daniel Rh; Williams, Christopher J; Andrady, Ushan; Anderson, Valerie; Humphreys, Sioned; Midgley, Claire M; Fina, Laia; Craine, Noel; Porter-Jones, Gary; Wilde, Alison; Whiteside, Chris

2016-08-01

To describe an outbreak of infectious syphilis in rural North Wales and the control measures implemented. Following reports of an increase of syphilis in North Wales, a multidisciplinary Outbreak Control Team (OCT) was established. A multilevel prevention and control response was initiated, including: active case surveillance, partner notification and treatment, sexual network analysis, awareness raising with professionals and affected communities, point-of-care syphilis testing at a sauna and a health promotion campaign targeting users of men who have sex with men (MSM) social network mobile phone applications (apps). Four cases of infectious syphilis were diagnosed in clinics in North Wales per 100 000 population in 2013 compared with a mean of one case per 100 000 in the preceding decade. Diagnosed cases peaked in January 2014, declining in the first half of 2014. Initial cases were clustered in the westerly rural counties of North Wales and were predominantly white men, self-reporting as MSM (median age: 34 years, range: 17-61). Point-of-care testing at a sauna did not identity further new infections, suggesting that the cluster was relatively focused and had probably been detected early. The use of apps to find sexual partners was a feature of the network affected. A health promotion campaign, initiated by the OCT, targeting men using MSM apps reached 92% of the 755 men messaged. The outbreak was successfully controlled. However, it is difficult to determine which of the interventions implemented were most effective. Future outbreaks should be used as an opportunity to evaluate interventions using apps. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

[Healthcare-Associated Infection Control with Awareness of Patient Safety].

PubMed

Murakami, Nobuo

2016-03-01

In order to provide safe and secure medical care for patients, health care-associated infections (HAI) must not occur. HAI should be considered as incidents, and countermeasures should be viewed as a patient safety management itself. Healthcare-associated infection control (HAIC) is practiced by the infection control team (ICT), which is based on multidisciplinary cooperation. Team members have to recognize that it is the most important to make use of the expertise of each discipline. In addition, all members must try to respond quickly, to help the clinic staff. Visualized rapid information provision and sharing, environmental improvement, outbreak factor analysis, hand hygiene compliance rate improvement, proper antibiotic use (Antimicrobial Stewardship Program: ASP), and regional cooperation & leadership comprise the role of the ICT in the flagship hospital. Regarding this role, we present our hospital's efforts and the outcomes. In conclusion, for medical practice quality improvement, healthcare-associated infection control should be conducted thoroughly along with an awareness of patient safety.

Epidemiology, surveillance and control of Nipah virus infections in Malaysia.

PubMed

Chua, K B

2010-12-01

The outbreak of Nipah virus, affecting pigs and pig-farm workers, was first noted in September 1998 in the north-western part of peninsular Malaysia. By March 1999, the outbreak had spread to other pig-farming areas of the country, inclusive of the neighbouring country, Singapore. A total of 283 human cases of viral encephalitis with 109 deaths were recorded in Malaysia from 29 September 1998 to December 1999. During the outbreak period, a number of surveillances under three broad groups; Surveillance in Human Health Sector, Surveillance in Animal Health Sector, and Surveillance for the Reservoir Hosts, were carried out to determine the prevalence, risk of virus infections and transmission in human and swine populations as well as the source and reservoir hosts of Nipah virus. Surveillance data showed that the virus spread rapidly among pigs within infected farms and transmission was attributed to direct contact with infective excretions and secretions. The spread of the virus among pig farms within and between states of peninsular Malaysia was due to movement of pigs. The transmission of the virus to humans was through close contact with infected pigs. Human to human transmission was considered a rare event though the Nipah virus could be isolated from saliva, urine, nasal and pharyngeal secretions of patients. Field investigations identified fruitbats of the Pteropid species as the natural reservoir hosts of the viruses. The outbreak was effectively brought under control following the discovery of the virus and institution of correct control measures through a combined effort of multi-ministerial and multidisciplinary teams working in close co-operation and collaboration with other international agencies.

Rapid assessment of Ebola infection prevention and control needs--six districts, Sierra Leone, October 2014.

PubMed

Pathmanathan, Ishani; O'Connor, Katherine A; Adams, Monica L; Rao, Carol Y; Kilmarx, Peter H; Park, Benjamin J; Mermin, Jonathan; Kargbo, Brima; Wurie, Alie H; Clarke, Kevin R

2014-12-12

As of October 31, 2014, the Sierra Leone Ministry of Health and Sanitation had reported 3,854 laboratory-confirmed cases of Ebola virus disease (Ebola) since the outbreak began in May 2014; 199 (5.2%) of these cases were among health care workers. Ebola infection prevention and control (IPC) measures are essential to interrupt Ebola virus transmission and protect the health workforce, a population that is disproportionately affected by Ebola because of its increased risk of exposure yet is essential to patient care required for outbreak control and maintenance of the country's health system at large. To rapidly identify existing IPC resources and high priority outbreak response needs, an assessment by CDC Ebola Response Team members was conducted in six of the 14 districts in Sierra Leone, consisting of health facility observations and structured interviews with key informants in facilities and government district health management offices. Health system gaps were identified in all six districts, including shortages or absence of trained health care staff, personal protective equipment (PPE), safe patient transport, and standardized IPC protocols. Based on rapid assessment findings and key stakeholder input, priority IPC actions were recommended. Progress has since been made in developing standard operating procedures, increasing laboratory and Ebola treatment capacity and training the health workforce. However, further system strengthening is needed. In particular, a successful Ebola outbreak response in Sierra Leone will require an increase in coordinated and comprehensive district-level IPC support to prevent ongoing Ebola virus transmission in household, patient transport, and health facility settings.

Outbreak of extended-spectrum β-lactamase-producing Escherichia coli transmitted through breast milk sharing in a neonatal intensive care unit.

PubMed

Nakamura, K; Kaneko, M; Abe, Y; Yamamoto, N; Mori, H; Yoshida, A; Ohashi, K; Miura, S; Yang, T T; Momoi, N; Kanemitsu, K

2016-01-01

Routine surveillance in a neonatal intensive care unit (NICU) showed an increased detection of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) in August 2012, following nearly a year without detection. To describe the investigation and interventions by a hospital infection control team of an outbreak of ESBL-E. coli in a NICU. Six neonates with positive cultures of ESBL-E. coli (five with respiratory colonization, one with a urinary tract infection), control infants who were negative for ESBL-E. coli during the study period, and mothers who donated their breast milk were included. A case-control study was performed to identify possible risk factors for positive ESBL-E. coli cultures and molecular typing of isolated strains by pulsed-field gel electrophoresis. The odds ratio for ESBL-E. coli infection after receiving shared unpasteurized breast milk during the study period was 49.17 (95% confidence interval: 6.02-354.68; P < 0.05). The pulsed-field gel electrophoresis pattern showed that all strains were identical, and the same pathogen was detected in freshly expressed milk of a particular donor. After ceasing the breast milk sharing, the outbreak was successfully terminated. This outbreak indicates that contamination of milk packs can result in transmission of a drug-resistant pathogen to newborn infants. Providers of human breast milk need to be aware of the necessity for low-temperature pasteurization and bacterial cultures, which should be conducted before and after freezing, before prescribing to infants. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Time delays in the response to the Neisseria meningitidis serogroup C outbreak in Nigeria - 2017.

PubMed

Hassan, Assad; Mustapha, G U; Lawal, Bola B; Na'uzo, Aliyu M; Ismail, Raji; Womi-Eteng Oboma, Eteng; Oyebanji, Oyeronke; Agenyi, Jeremiah; Thomas, Chima; Balogun, Muhammad Shakir; Dalhat, Mahmood M; Nguku, Patrick; Ihekweazu, Chikwe

2018-01-01

Nigeria reports high rates of mortality linked with recurring meningococcal meningitis outbreaks within the African meningitis belt. Few studies have thoroughly described the response to these outbreaks to provide strong and actionable public health messages. We describe how time delays affected the response to the 2016/2017 meningococcal meningitis outbreak in Nigeria. Using data from Nigeria Centre for Disease Control (NCDC), National Primary Health Care Development Agency (NPHCDA), World Health Organisation (WHO), and situation reports of rapid response teams, we calculated attack and death rates of reported suspected meningococcal meningitis cases per week in Zamfara, Sokoto and Yobe states respectively, between epidemiological week 49 in 2016 and epidemiological week 25 in 2017. We identified when alert and epidemic thresholds were crossed and determined when the outbreak was detected and notified in each state. We examined response activities to the outbreak. There were 12,535 suspected meningococcal meningitis cases and 877 deaths (CFR: 7.0%) in the three states. It took an average time of three weeks before the outbreaks were detected and notified to NCDC. Four weeks after receiving notification, an integrated response coordinating centre was set up by NCDC and requests for vaccines were sent to International Coordinating Group (ICG) on vaccine provision. While it took ICG one week to approve the requests, it took an average of two weeks for approximately 41% of requested vaccines to arrive. On the average, it took nine weeks from the date the epidemic threshold was crossed to commencement of reactive vaccination in the three states. There were delays in detection and notification of the outbreak, in coordinating response activities, in requesting for vaccines and their arrival from ICG, and in initiating reactive vaccination. Reducing these delays in future outbreaks could help decrease the morbidity and mortality linked with meningococcal meningitis outbreaks.

Infectious diseases in competitive sports.

PubMed

Goodman, R A; Thacker, S B; Solomon, S L; Osterholm, M T; Hughes, J M

1994-03-16

Participation in competitive sports is popular and widely encouraged throughout the United States. Reports of infectious disease outbreaks among competitive athletes and recent publicity regarding infectious disease concerns in sports underscore the need to better characterize the occurrence of these problems. To identify reports of infectious diseases in sports, we performed a comprehensive search of the medical literature (MEDLINE) and newspaper databases in two on-line services (NEXIS and DIALOG PAPERS). Articles selected from the literature review included those describing cases or outbreaks of disease in which exposure to an infectious agent was likely to have occurred during training for competitive sports or during actual competition. Articles from the newspaper review included reports of outbreaks, exposures, or preventive measures that directly or indirectly involved teams or spectators. The literature review identified 38 reports of infectious disease outbreaks or other instances of transmission through person-to-person (24 reports), common-source (nine reports), or airborne (five reports) routes; the newspaper search identified 28 reports. Infectious agents included predominantly viruses but also a variety of fungi and gram-positive and gram-negative bacteria. Our findings indicate that strategies to prevent transmission of infectious diseases in sports must recognize risks at three levels: the individual athlete, the team, and spectators or others who may become exposed to infectious diseases as a result of sports-related activities. Team physicians and others who are responsible for the health of athletes should be especially familiar with the features of infectious diseases that occur in sports and measures for the prevention of these problems.

Controlling the last known cluster of Ebola virus disease - Liberia, January-February 2015.

PubMed

Nyenswah, Tolbert; Fallah, Mosoka; Sieh, Sonpon; Kollie, Karsor; Badio, Moses; Gray, Alvin; Dilah, Priscilla; Shannon, Marnijina; Duwor, Stanley; Ihekweazu, Chikwe; Cordier-Lassalle, Thierry; Cordier-Lasalle, Thierry; Shinde, Shivam A; Hamblion, Esther; Davies-Wayne, Gloria; Ratnesh, Murugan; Dye, Christopher; Yoder, Jonathan S; McElroy, Peter; Hoots, Brooke; Christie, Athalia; Vertefeuille, John; Olsen, Sonja J; Laney, A Scott; Neal, Joyce J; Yaemsiri, Sirin; Navin, Thomas R; Coulter, Stewart; Pordell, Paran; Lo, Terrence; Kinkade, Carl; Mahoney, Frank

2015-05-15

As one of the three West African countries highly affected by the 2014-2015 Ebola virus disease (Ebola) epidemic, Liberia reported approximately 10,000 cases. The Ebola epidemic in Liberia was marked by intense urban transmission, multiple community outbreaks with source cases occurring in patients coming from the urban areas, and outbreaks in health care facilities (HCFs). This report, based on data from routine case investigations and contact tracing, describes efforts to stop the last known chain of Ebola transmission in Liberia. The index patient became ill on December 29, 2014, and the last of 21 associated cases was in a patient admitted into an Ebola treatment unit (ETU) on February 18, 2015. The chain of transmission was stopped because of early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the health care system; and rapid isolation of symptomatic contacts. In addition, a "sector" approach, which divided Montserrado County into geographic units, facilitated the ability of response teams to rapidly respond to community needs. In the final stages of the outbreak, intensive coordination among partners and engagement of community leaders were needed to stop transmission in densely populated Montserrado County. A companion report describes the efforts to enhance infection prevention and control efforts in HCFs. After February 19, no additional clusters of Ebola cases have been detected in Liberia. On May 9, the World Health Organization declared the end of the Ebola outbreak in Liberia.

A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013.

PubMed

O'Connor, L; Ward, M; Bennett, D; Mulhall, R; O'Lorcain, P; Cunney, R; McDermott, R; Neville, E; Heslin, J; FitzGerald, R; Meyler, K; Conlon, M; Clarke, A; Corcoran, B; Fitzpatrick, G; O'Connor, B; Flanagan, P; O'Flanagan, D; Cotter, S

2015-05-28

Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7–2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.

Guatemala's ministry of health rapid response team manuals.

PubMed

Hernandez, Luis; Hanson, Kimberly M; Martel, Lise D

2014-01-01

The function of public health rapid response teams (RRTs) is to quickly identify, investigate, and control an outbreak before it can spread. The Central America Regional Office in Guatemala provided assistance to the Guatemalan Ministry of Health and Social Assistance (MSPAS) to develop RRT manuals at the district and regional levels. The manuals are divided into 4 sections: background, activity lists, standard operating procedures, and annexes. The manuals outline Guatemala's RRT members' responsibilities and will be tested in the near future through tabletop exercises. The development of the manuals is a concrete and significant step toward the attainment of Guatemala's IHR goals and should be integrated into a larger emergency management system to promote "a world safe and secure from global health threats posed by infectious diseases."

Outbreak of Salmonella enterica serotype I 4,5,12:i:- infections: the challenges of hypothesis generation and microwave cooking.

PubMed

Mody, R K; Meyer, S; Trees, E; White, P L; Nguyen, T; Sowadsky, R; Henao, O L; Lafon, P C; Austin, J; Azzam, I; Griffin, P M; Tauxe, R V; Smith, K; Williams, I T

2014-05-01

We investigated an outbreak of 396 Salmonella enterica serotype I 4,5,12:i:- infections to determine the source. After 7 weeks of extensive hypothesis-generation interviews, no refined hypothesis was formed. Nevertheless, a case-control study was initiated. Subsequently, an iterative hypothesis-generation approach used by a single interviewing team identified brand A not-ready-to-eat frozen pot pies as a likely vehicle. The case-control study, modified to assess this new hypothesis, along with product testing indicated that the turkey variety of pot pies was responsible. Review of product labels identified inconsistent language regarding preparation, and the cooking instructions included undefined microwave wattage categories. Surveys found that most patients did not follow the product's cooking instructions and did not know their oven's wattage. The manufacturer voluntarily recalled pot pies and improved the product's cooking instructions. This investigation highlights the value of careful hypothesis-generation and the risks posed by frozen not-ready-to-eat microwavable foods.

Control of Aedes aegypti larvae in household water containers by Chinese cat fish.

PubMed

Wu, N; Wang, S S; Han, G X; Xu, R M; Tang, G K; Qian, C

1987-01-01

In 1980-81 an outbreak of dengue fever occurred in Guangdong province and in Guangxi-Zhuang autonomous region in the central-southern part of China. Subsequently, a nationwide survey indicated that the vector of the disease, Aedes aegypti, was confined to the coastal strip of Guangdong and Guangxi-Zhuang. Since the first case in the outbreak occurred in Guangxi-Zhuang, a community-based programme to control A. aegypti was set up in eight fishing villages of this region where the mosquito was breeding in household water containers. The principal method of control was use of the indigenous edible fish Clarias fuscus (Chinese cat fish), which is highly larvivorous and tolerant of harsh environmental conditions. Each container was stocked with a young fish, which could survive there for periods of up to a year. A team of primary medical personnel (barefoot doctors) made sure that the programme was correctly implemented. The programme was monitored from 1981 to 1985 in three of the villages, and the results indicated that the Breteau index remained at a low level throughout this period.

Control of Aedes aegypti larvae in household water containers by Chinese cat fish

PubMed Central

Neng, Wu; Shusen, Wang; Guangxin, Han; Rongman, Xu; Guangkun, Tang; Chen, Qian

1987-01-01

In 1980-81 an outbreak of dengue fever occurred in Guangdong province and in Guangxi-Zhuang autonomous region in the central-southern part of China. Subsequently, a nationwide survey indicated that the vector of the disease, Aedes aegypti, was confined to the coastal strip of Guangdong and Guangxi-Zhuang. Since the first case in the outbreak occurred in Guangxi-Zhuang, a community-based programme to control A. aegypti was set up in eight fishing villages of this region where the mosquito was breeding in household water containers. The principal method of control was use of the indigenous edible fish Clarias fuscus (Chinese cat fish), which is highly larvivorous and tolerant of harsh environmental conditions. Each container was stocked with a young fish, which could survive there for periods of up to a year. A team of primary medical personnel (barefoot doctors) made sure that the programme was correctly implemented. The programme was monitored from 1981 to 1985 in three of the villages, and the results indicated that the Breteau index remained at a low level throughout this period. PMID:3500803

Development and evaluation of a real-time RT-PCR assay for the detection of Ebola virus (Zaire) during an Ebola outbreak in Guinea in 2014-2015.

PubMed

Dedkov, V G; Magassouba, N' F; Safonova, M V; Deviatkin, A A; Dolgova, A S; Pyankov, O V; Sergeev, A A; Utkin, D V; Odinokov, G N; Safronov, V A; Agafonov, A P; Maleev, V V; Shipulin, G A

2016-02-01

In early February 2014, an outbreak of the Ebola virus disease caused by Zaire ebolavirus (EBOV) occurred in Guinea; cases were also recorded in other West African countries with a combined population of approximately 25 million. A rapid, sensitive and inexpensive method for detecting EBOV is needed to effectively control such outbreak. Here, we report a real-time reverse-transcription PCR assay for Z. ebolavirus detection used by the Specialized Anti-epidemic Team of the Russian Federation during the Ebola virus disease prevention mission in the Republic of Guinea. The analytical sensitivity of the assay is 5 × 10(2) viral particles per ml, and high specificity is demonstrated using representative sampling of viral, bacterial and human nucleic acids. This assay can be applied successfully for detecting the West African strains of Z. ebolavirus as well as on strains isolated in the Democratic Republic of the Congo in 2014. Copyright © 2015 Elsevier B.V. All rights reserved.

Creating student sleuths: how a team of graduate students helped solve an outbreak of Salmonella Heidelberg infections associated with kosher broiled chicken livers.

PubMed

Hanson, Heather; Hancock, W Thane; Harrison, Cassandra; Kornstein, Laura; Waechter, HaeNa; Reddy, Vasudha; Luker, John; Malavet, Michelle; Huth, Paula; Gieraltowski, Laura; Balter, Sharon

2014-08-01

Since 2009, the New York City Department of Health and Mental Hygiene (DOHMH) has received FoodCORE funding to hire graduate students to conduct in-depth food exposure interviews of salmonellosis case patients. In 2011, an increase in the number of Salmonella Heidelberg infections with pulsed-field gel electrophoresis Xba I pattern JF6X01.0022 among observant Jewish communities in New York and New Jersey was investigated. As this pattern is common nationwide, some cases identified were not associated with the outbreak. To reduce the number of background cases, DOHMH focused on the community initially identified in the outbreak and defined a case as a person infected with the outbreak strain of Salmonella Heidelberg with illness onset from 1 April to 17 November 2011 and who consumed a kosher diet, spoke Yiddish, or self-identified as Jewish. Nationally, 190 individuals were infected with the outbreak strain of Salmonella Heidelberg; 63 New York City residents met the DOHMH case definition. In October 2011, the graduate students (Team Salmonella) interviewed three case patients who reported eating broiled chicken livers. Laboratory testing of chicken liver samples revealed the outbreak strain of Salmonella Heidelberg. Although they were only partially cooked, the livers appeared fully cooked, and consumers and retail establishment food handlers did not cook them thoroughly before eating or using them in a ready-to-eat spread. This investigation highlighted the need to prevent further illnesses from partially cooked chicken products. Removing background cases helped to focus the investigation. Training graduate students to collect exposure information can be a highly effective model for conducting foodborne disease surveillance and outbreak investigations for local and state departments of public health.

Network visualization for outbreak response: Mapping the Ebola Virus Disease (EVD) chains of transmission in N'Zérékoré, Guinea.

PubMed

Valencia, C; Bah, H; Fatoumata, B; Rodier, G; Diallo, B; Koné, M; Giese, C; Conde, L; Malano, E; Mollet, T; Jansa, J; Coulombier, D; Sudre, B

2017-03-01

During the 2014-2015 Ebola Virus Disease (EVD) outbreak in N'Zérékoré, Forested Guinea, modes of transmission remained unexamined for a number of new cases. We used network visualization to investigate EVD transmission chains (TC) in seven sub-prefectures of N'Zérékoré in order to adapt outbreak response. Between August 2014 and February 2015, the EVD outbreak response team including the World Health Organization (WHO) and local health authorities routinely collected information among new cases regarding hospital visits, cases within a household, participation in burials, as well as dates of symptom onset, serial intervals (SI) and exposure to EVD. SI's were defined as the interval between symptom onset in an index case and symptom onset in a secondary case infected by that index case. Cases who reported hospital visits, contact with a case in the household or participating in burials were attributed to these exposures. We identified seven TC (two urban and five rural) gathering characteristics of 109 probable/confirmed cases. Overall, 61% (66 cases, SI range: 7-20 days) were household related, 32% (35 cases, SI range 8-30 days) were household or burial related and 7% (8 cases, SI range: 4-20 days) were hospital-related. In the urban chains (18 cases, SI range: 7-20 days), 12 cases were household related and 6 cases were hospital related, none where household or burial related. In the rural chains (84 cases, SI range: 7-30 days), 60% (50 cases) were household related, 1% (1 case) was hospital related and 39% (34 cases) were household or burial related. No cases reported multiple exposures. Network visualization during field response is crucial in enhancing local control strategies, refining outbreak response and aiding rapid response teams in insuring psychosocial and socio-economic recovery. Urban settings need to focus on reducing hospital EVD transmission whereas rural settings should focus on raising awareness of transmission within a household and safeguarding EVD burials. Copyright © 2016. Published by Elsevier Ltd.

Public health foodborne illness case study during a Special Operations Forces deployment to South America.

PubMed

McCown, Michael; Grzeszak, Benjamin

2010-01-01

Although many public health articles have been published detailing foodborne illness outbreaks, a medical literature search revealed no articles that detail a case study or a specific response of a deployed U.S. military unit to a potential foodborne illness. This article describes a recent public health case study of a U.S. Special Operations Forces (SOF) team sickened while deployed to South America. It highlights public health factors which may affect U.S. personnel deployed or serving overseas and may serve as a guide for a deployed SOF medic to reference in response to a potential food- or waterborne illness outbreak. Eight food samples and five water samples were collected. The food samples were obtained from the host nation kitchen that provided food to the SOF team. The water samples were collected from the kitchen as well as from multiple sites on the host nation base. These samples were packaged in sterile containers, stored at appropriate temperatures, and submitted to a U.S. Army diagnostic laboratory for analysis. Laboratory results confirmed the presence of elevated aerobic plate counts (APCs) in the food prepared by the host nation and consumed by the SOF team. High APCs in food are the primary indicator of improper sanitation of food preparation surfaces and utensils. This case study concluded that poor kitchen sanitation, improper food storage, preparation, and/or holding were the probable conditions that led to the team?s symptoms. These results emphasize the importance of ensuring safe food and water for U.S. personnel serving overseas, especially in a deployment or combat setting. Contaminated food and/or water will negatively impact the health and availability of forces, which may lead to mission failure. The SOF medic must respond to potential outbreaks and be able to (1) critically inspect food preparation areas and accurately advise commanders in order to correct deficiencies and (2) perform food/water surveillance testing consistently throughout a deployment and at any time in response to a potential outbreak.

CE: Inside an Ebola Treatment Unit: A Nurse's Report.

PubMed

Wilson, Deborah

2015-12-01

In December 2013, the first cases of the most recent outbreak of Ebola virus disease (formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Liberia for five weeks. This article describes her experiences there. It provides some background, outlines the practices and teams involved, and aims to convey a sense of what it's like to work during an Ebola outbreak and to put a human face on this devastating epidemic.

Public health incident management: Logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

PubMed

Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

2015-01-01

Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

Public health incident management: logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

PubMed

Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

2015-01-01

Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

Outbreak of Legionnaires' disease on a cruise ship: lessons for international surveillance and control.

PubMed

Regan, C M; McCann, B; Syed, Q; Christie, P; Joseph, C; Colligan, J; McGaffin, A

2003-06-01

A sporadic case of Legionnaires' disease was linked to travel on a cruise ship. Investigation identified two further cases of Legionnaires' Disease and one case of non-pneumonic Legionella infection. An Incident Team confirmed the source to be the ship's water system and control measures were instituted that included pasteurisation, super chlorination and chlorine dioxide dosing. The Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC), through the European Surveillance Scheme for Travel Associated Legionnaires' Disease, identified three previous cases associated with the same ship's water system including one fatality. Lessons for the international surveillance and control of Legionnaires' disease on cruise ships are discussed.

Guatemala’s Ministry of Health Rapid Response Team Manuals

PubMed Central

Hernandez, Luis; Hanson, Kimberly M.; Martel, Lise D.

2017-01-01

The function of public health rapid response teams (RRTs) is to quickly identify, investigate, and control an outbreak before it can spread. The Central America Regional Office in Guatemala provided assistance to the Guatemalan Ministry of Health and Social Assistance (MSPAS) to develop RRT manuals at the district and regional levels. The manuals are divided into 4 sections: background, activity lists, standard operating procedures, and annexes. The manuals outline Guatemala’s RRT members’ responsibilities and will be tested in the near future through tabletop exercises. The development of the manuals is a concrete and significant step toward the attainment of Guatemala’s IHR goals and should be integrated into a larger emergency management system to promote “a world safe and secure from global health threats posed by infectious diseases.” PMID:25254918

Invasive Group A Streptococcal Infection in High School Football Players, New York City, 2003

PubMed Central

Lee, Elsie; Bambino, Maribeth; Ackelsberg, Joel; Weiss, Don; Sathyakumar, Chiminyan; Kornblum, John; Barbot, Oxiris; Johnson, Dwight; Kaplan, Edward L.; Layton, Marcelle

2005-01-01

After being notified that 2 high school football teammates were hospitalized with confirmed or suspected invasive group A streptococcal infections, we conducted an investigation of possible spread among other team members. This investigation highlights a need for guidelines on management of streptococcal and other infectious disease outbreaks in team sport settings. PMID:15705342

Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?

PubMed

Thiam, Sylla; Delamou, Alexandre; Camara, Soriba; Carter, Jane; Lama, Eugene Kaman; Ndiaye, Bara; Nyagero, Josephat; Nduba, John; Ngom, Mor

2015-01-01

The Ebola outbreak emerged in a remote corner of Guinea in December 2013, and spread into Liberia and Sierra Leone in the context of weak health systems. In this paper, we report on the main challenges faced by frontline health services and by communities including their perceptions and views on the current Ebola response in the Prefectures of Coyah and Forecariah in Guinea. A cross-sectional study was conducted in December 2014 using mixed approaches: (i) Desk review; (ii) Interviews; and (iii) Direct observation. Almost one year after the beginning of the Ebola virus disease outbreak in West Africa, the perceptions of stakeholders and the observed reality were that the level of preparedness in the two health districts was low. The study identified poor coordination mechanisms, inadequate training of human resources and lack of equipment and supplies to field teams and health facilities as key elements that affected the response. The situation was worsened by the inadequate communication strategy, misconceptions around the disease, ignorance of local culture and customs and lack of involvement of local communities in the control strategies, within the context of poor socioeconomic development. As a result distrust developed between communities and those seeking to control the epidemic and largely contributed to the reluctance of the communities to participate and contribute to the effort. There is a need to rethink the way disease control interventions in the context of an emergency such as Ebola virus disease are designed, planned and implemented in low income countries.

Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?

PubMed Central

Thiam, Sylla; Delamou, Alexandre; Camara, Soriba; Carter, Jane; Lama, Eugene Kaman; Ndiaye, Bara; Nyagero, Josephat; Nduba, John; Ngom, Mor

2015-01-01

Introduction The Ebola outbreak emerged in a remote corner of Guinea in December 2013, and spread into Liberia and Sierra Leone in the context of weak health systems. In this paper, we report on the main challenges faced by frontline health services and by communities including their perceptions and views on the current Ebola response in the Prefectures of Coyah and Forecariah in Guinea. Methods A cross-sectional study was conducted in December 2014 using mixed approaches: (i) Desk review; (ii) Interviews; and (iii) Direct observation. Results Almost one year after the beginning of the Ebola virus disease outbreak in West Africa, the perceptions of stakeholders and the observed reality were that the level of preparedness in the two health districts was low. The study identified poor coordination mechanisms, inadequate training of human resources and lack of equipment and supplies to field teams and health facilities as key elements that affected the response. The situation was worsened by the inadequate communication strategy, misconceptions around the disease, ignorance of local culture and customs and lack of involvement of local communities in the control strategies, within the context of poor socioeconomic development. As a result distrust developed between communities and those seeking to control the epidemic and largely contributed to the reluctance of the communities to participate and contribute to the effort. Conclusion There is a need to rethink the way disease control interventions in the context of an emergency such as Ebola virus disease are designed, planned and implemented in low income countries. PMID:26740850

Social ecological analysis of an outbreak of pufferfish egg poisoning in a coastal area of Bangladesh.

PubMed

Islam, M Saiful; Luby, Stephen P; Rahman, Mahmudur; Parveen, Shahana; Homaira, Nusrat; Begum, Nur Har; Dawlat Khan, A K M; Sultana, Rebeca; Akhter, Shammi; Gurley, Emily S

2011-09-01

Recurrent outbreaks of marine pufferfish poisoning in Bangladesh highlight the need to understand the context in which the outbreaks occurred. In a recent outbreak investigation, a multidisciplinary team conducted a mixed-method study to identify the demography and clinical manifestation of the victims and to explore different uses of pufferfish, and local buying, selling, and processing practices. The outbreak primarily affected a low income household where an elderly woman collected and cooked pufferfish egg curry. Nine persons consumed the curry, and symptoms developed in 6 (67%) of these persons. Symptoms included vomiting, diarrhea, paresis, and tingling sensation; 2 (22%) persons died. The unstable income of the affected family, food crisis, and the public disposal of unsafe pufferfish byproducts all contributed to the outbreak. A multi-level intervention should be developed and disseminated with the participation of target communities to discourage unsafe discarding of pufferfish scraps and to improve the community knowledge about the risk of consuming pufferfish.

Social Ecological Analysis of an Outbreak of Pufferfish Egg Poisoning in a Coastal Area of Bangladesh

PubMed Central

Islam, M. Saiful; Luby, Stephen P.; Rahman, Mahmudur; Parveen, Shahana; Homaira, Nusrat; Begum, Nur Har; Dawlat Khan, A. K. M.; Sultana, Rebeca; Akhter, Shammi; Gurley, Emily S.

2011-01-01

Recurrent outbreaks of marine pufferfish poisoning in Bangladesh highlight the need to understand the context in which the outbreaks occurred. In a recent outbreak investigation, a multidisciplinary team conducted a mixed-method study to identify the demography and clinical manifestation of the victims and to explore different uses of pufferfish, and local buying, selling, and processing practices. The outbreak primarily affected a low income household where an elderly woman collected and cooked pufferfish egg curry. Nine persons consumed the curry, and symptoms developed in 6 (67%) of these persons. Symptoms included vomiting, diarrhea, paresis, and tingling sensation; 2 (22%) persons died. The unstable income of the affected family, food crisis, and the public disposal of unsafe pufferfish byproducts all contributed to the outbreak. A multi-level intervention should be developed and disseminated with the participation of target communities to discourage unsafe discarding of pufferfish scraps and to improve the community knowledge about the risk of consuming pufferfish. PMID:21896811

OUTBREAK OF TINEA GLADIATORUM IN WRESTLERS IN TEHRAN (IRAN)

PubMed Central

Bassiri-Jahromi, Shahindokht; Khaksar, Ali Asghar

2008-01-01

Background: In recent years, skin diseases in wrestling have finally received the attention they deserve. Outbreaks of tinea corporis are often associated with sports involving extensive bodily contact; such sports include wrestling. Tinea corporis gladiatorum is primarily caused by Trichophyton tonsurans, infecting wrestlers at alarming rates. The management of skin infections in wrestlers and other athletes in sports involving skin-to-skin contact entails numerous challenges, from making an accurate diagnosis to determining eligibility for playing the sports. To control outbreaks, we conducted an epidemiologic investigation. The purpose of this article is to determine the prevalence of tinea corporis gladiatorum in wrestlers in Tehran, Iran. Materials and Methods: A study of dermatophytosis was carried out during the period of March 2004 to December 2005 on 612 mycological proven cases of dermatophytosis found in male wrestlers in Tehran. Mycological examination consisted of culturing of pathologic material followed by direct microscopic observation. Diagnosis was based on macroscopic and microscopic characteristics of the colonies. Results: T. tonsurans was the predominant dermatophyte, accounting for >90% of all tinea corporis gladiatorum isolates during the 2 year analysis. Tinea corporis gladiatorum was found to be more frequent in individuals between the ages of 10 and 20 years of age (72.7%). Wrestlers with tinea corporis gladiatorum were predominantly from wrestling clubs in southern and southeastern Tehran. Transmission of tinea corporis is primarily through skin-to-skin contact. Conclusion: Rapid identification and treatment of tinea corporis gladiatorum is required to minimize the disruption of team practices and competitions. Infection with dermatophytes can disqualify a wrestler from competing in matches, and thus, vigilant surveillance and rapid initiation of treatment is important to prevent the suspension of team practices and competitions. PMID:19882012

[Surveillance of infection events in neonatal intensive care].

PubMed

Decembrino, L; Perrini, S; Stronati, M

2010-06-01

Nosocomial infections are one of the major causes of morbidity and mortality in the newborn intensive care unit (NICU). They result in prolonged hospital stays and increased hospital costs. Neonates are susceptible hosts because of prematurity of organ systems, immaturity of immune system, low birth weight and the use of invasive devices. Most infections are endemic others can occur during outbreaks. As advances in medical technology improve mortality in the tiniest of infants, it is imperative that health care providers identify effective interventions to minimize the risks of nosocomial infections in the NICU. Recommended infection control and prevention strategies are: hand washing promotion, decreased use of invasive procedures, limited antitibiotic exposure, environmental hygiene. In this context infection surveillance is the first step to recognize and analyze problems, to effectively target infection control measures and feedback. Any suspicion of an outbreak should lead to a review of general infection control procedures to prevent the spread of the pathogens as quickly as possible. A multidisciplinary approach can be an effective means of developing a plan of action to apply prolonged and strict adherence to isolation precautions', to detect potential reservoirs or source of infections, to educate every member of the patient care team and to review NICU protocols.

Cross-border outbreak of extensively drug-resistant tuberculosis linked to a university in Romania.

PubMed

Popovici, O; Monk, Ph; Chemtob, D; Chiotan, D; Freidlin, P J; Groenheit, R; Haanperä, M; Homorodean, D; Mansjö, M; Robinson, E; Rorman, E; Smith, G; Soini, H; Van Der Werf, M J

2018-05-01

Extensively drug-resistant (XDR) tuberculosis (TB) poses a threat to public health due to its complicated, expensive and often unsuccessful treatment. A cluster of three XDR TB cases was detected among foreign medical students of a Romanian university. The contact investigations included tuberculin skin testing or interferon gamma release assay, chest X-ray, sputum smear microscopy, culture, drug susceptibility testing, genotyping and whole-genome sequencing (WGS), and were addressed to students, personnel of the university, family members or other close contacts of the cases. These investigations increased the total number of cases to seven. All confirmed cases shared a very similar WGS profile. Two more cases were epidemiologically linked, but no laboratory confirmation exists. Despite all the efforts done, the source of the outbreak was not identified, but the transmission was controlled. The investigation was conducted by a team including epidemiologists and microbiologists from five countries (Finland, Israel, Romania, Sweden and the UK) and from the European Centre for Disease Prevention and Control. Our report shows how countries can collaborate to control the spread of XDR TB by exchanging information about cases and their contacts to enable identification of additional cases and transmission and to perform the source investigation.

Integrated sequence and immunology filovirus database at Los Alamos

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yusim, Karina; Yoon, Hyejin; Foley, Brian

The Ebola outbreak of 2013–15 infected more than 28,000 people and claimed more lives than all previous filovirus outbreaks combined. Governmental agencies, clinical teams, and the world scientific community pulled together in a multifaceted response ranging from prevention and disease control, to evaluating vaccines and therapeutics in human trials. We report that as this epidemic is finally coming to a close, refocusing on long-term prevention strategies becomes paramount. Given the very real threat of future filovirus outbreaks, and the inherent uncertainty of the next outbreak virus and geographic location, it is prudent to consider the extent and implications of knownmore » natural diversity in advancing vaccines and therapeutic approaches. To facilitate such consideration, we have updated and enhanced the content of the filovirus portion of Los Alamos Hemorrhagic Fever Viruses Database. We have integrated and performed baseline analysis of all family Filoviridae sequences deposited into GenBank, with associated immune response data, and metadata, and we have added new computational tools with web-interfaces to assist users with analysis. Here, we (i) describe the main features of updated database, (ii) provide integrated views and some basic analyses summarizing evolutionary patterns as they relate to geo-temporal data captured in the database and (iii) highlight the most conserved regions in the proteome that may be useful for a T cell vaccine strategy.« less

Integrated sequence and immunology filovirus database at Los Alamos

PubMed Central

Yoon, Hyejin; Foley, Brian; Feng, Shihai; Macke, Jennifer; Dimitrijevic, Mira; Abfalterer, Werner; Szinger, James; Fischer, Will; Kuiken, Carla; Korber, Bette

2016-01-01

The Ebola outbreak of 2013–15 infected more than 28 000 people and claimed more lives than all previous filovirus outbreaks combined. Governmental agencies, clinical teams, and the world scientific community pulled together in a multifaceted response ranging from prevention and disease control, to evaluating vaccines and therapeutics in human trials. As this epidemic is finally coming to a close, refocusing on long-term prevention strategies becomes paramount. Given the very real threat of future filovirus outbreaks, and the inherent uncertainty of the next outbreak virus and geographic location, it is prudent to consider the extent and implications of known natural diversity in advancing vaccines and therapeutic approaches. To facilitate such consideration, we have updated and enhanced the content of the filovirus portion of Los Alamos Hemorrhagic Fever Viruses Database. We have integrated and performed baseline analysis of all family Filoviridae sequences deposited into GenBank, with associated immune response data, and metadata, and we have added new computational tools with web-interfaces to assist users with analysis. Here, we (i) describe the main features of updated database, (ii) provide integrated views and some basic analyses summarizing evolutionary patterns as they relate to geo-temporal data captured in the database and (iii) highlight the most conserved regions in the proteome that may be useful for a T cell vaccine strategy. Database URL: www.hfv.lanl.gov PMID:27103629

Integrated sequence and immunology filovirus database at Los Alamos

DOE PAGES

Yusim, Karina; Yoon, Hyejin; Foley, Brian; ...

2016-01-01

The Ebola outbreak of 2013–15 infected more than 28,000 people and claimed more lives than all previous filovirus outbreaks combined. Governmental agencies, clinical teams, and the world scientific community pulled together in a multifaceted response ranging from prevention and disease control, to evaluating vaccines and therapeutics in human trials. We report that as this epidemic is finally coming to a close, refocusing on long-term prevention strategies becomes paramount. Given the very real threat of future filovirus outbreaks, and the inherent uncertainty of the next outbreak virus and geographic location, it is prudent to consider the extent and implications of knownmore » natural diversity in advancing vaccines and therapeutic approaches. To facilitate such consideration, we have updated and enhanced the content of the filovirus portion of Los Alamos Hemorrhagic Fever Viruses Database. We have integrated and performed baseline analysis of all family Filoviridae sequences deposited into GenBank, with associated immune response data, and metadata, and we have added new computational tools with web-interfaces to assist users with analysis. Here, we (i) describe the main features of updated database, (ii) provide integrated views and some basic analyses summarizing evolutionary patterns as they relate to geo-temporal data captured in the database and (iii) highlight the most conserved regions in the proteome that may be useful for a T cell vaccine strategy.« less

Modeling Man-Made Epidemics

DTIC Science & Technology

2002-03-01

ment.” He studied a 1995 Ebola Hemmoragic Fever (EHF) outbreak in the Democratic Republic of the Congo. Armed with the data from the EHF outbreak...contain three infantry men (plus a fire-team leader). For this model we are dealing with the reinforced infantry bat - 15 talion, the largest homogeneous...realistic model will be a daunting but neccessary task. The issue will be getting the right combination of individuals working on the project. At a

Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome.

PubMed

Lin, Y C; Dong, S L; Yeh, Y H; Wu, Y S; Lan, G Y; Liu, C M; Chu, T C

2005-07-01

The World Health Organization classified Taiwan as a serious epidemic-stricken area when the extent of severe acute respiratory syndrome (SARS) in Taiwan became clear. As of 11 July 2003, 671 probable SARS cases had been identified in Taiwan and 7 healthcare workers had died from the disease. Radiographers were easily infected by SARS because they had close contact with suspected or probable cases while conducting chest X-ray examinations. Three radiographers had been infected by the end of May 2003. Because of the impact of SARS on the Radiology Department, the department established a SARS emergency infection control team and re-designed the department's infection-control and emergency-management procedures based on the concept of risk-grade protection. This effort included installing a radiographic room at the fever-screening station, re-allocating human resources in the Radiology Department, training the department staff in infection control, and drafting new operational procedures for radiographers conducting X-ray examinations on SARS patients. The goal of this program was to reduce the infection rate and distribute materials efficiently in the department. This article introduces the emergency-management procedure of the Radiology Department during the SARS outbreak and the infection-protection experience of the department staff.

[Western area surge for controlling Ebola hemorrhagic fever outbreak in Sierra Leone and evaluation of its effect].

PubMed

Chen, Yong; Wu, Dan; Zhang, Wenyi; Chen, Zeliang; Chang, Guohui; Tian, Shuguang; Yang, Ruifu; Liu, Chao

2015-10-01

To investigate the Western Area Surge (WAS) program in the Ebola outbreak of Sierra Leone, and to analyze its implementing effect. The subject of this study was 3,813 laboratory confirmed Ebola hemorrhagic fever (EHF) cases reported in Sierra Leone from November 19, 2014 through January 27, 2015, a period before and after the implementation of the WAS program. To analyze and make conclusions according to the working experience of China Mobile Laboratory Reponses Team in the fight of Ebola outbreak, using WHO published EHF case definition to make diagnosis and compare the number of bed numbers, confirmed EHF cases, samples tested, and positive rates before and after implementation of WAS program. From the implementation of WAS program on 17th December 2014 to half a month later, the total numbers of Ebola holding and treatment centers increased from 640 to 960, six additional laboratories were established. On January, 2015, another two laboratories from America and The Netherlands were established. The numbers of samples tested one month before and after WAS program were 7,891 and 9,783, respectively, with an increase of 24.0 percent, while the positive rate of Ebola virus decreased from 22.2% (1,752/7,891) to 11.0% (1,077/9,783). The positive rate of blood samples decreased from 39.6% (248/626) in the month before WAS program to 27.4% (131/478) (χ2=17.93, P<0.001) in the mother after WAS program, the positive rate of blood samples 22.7% (103/454) to 10% (62/609) (χ2=31.03, P<0.001), accordingly. After 3 weeks of WAS program, in addition to Western Area, another four hotspots in Sierra Leone had also reported a significant decrease of the numbers of confirmed EVD cases. Forty-two days after implementation of WAS program, the daily number of laboratory confirmed EHF cases decreased from 63 to 10. WAS program played a vital role in controlling the EHF outbreak rapidly in Sierra Leone. It could also provide guidance for the control similar large infectious diseases outbreak in the future.

An account of the Ebola virus disease outbreak in Nigeria: implications and lessons learnt.

PubMed

Otu, Akaninyene; Ameh, Soter; Osifo-Dawodu, Egbe; Alade, Enoma; Ekuri, Susan; Idris, Jide

2017-07-10

The 2014 Ebola virus disease (EVD) outbreak remains unprecedented both in the number of cases, deaths and geographic scope. The first case of EVD was confirmed in Lagos Nigeria on 23 July 2014 and spread to involve 19 laboratory-confirmed EVD cases. The EVD cases were not limited to Lagos State as Rivers State recorded 2 confirmed cases of EVD with 1 out of the 2 dying. Swift implementation of public health measures were sufficient to forestall a country -wide spread of this dreaded disease. This exploratory formative research describes the events of the Nigeria Ebola crisis in 2014. This research was implemented through key informant in-depth interviews involving 15 stakeholders in the EVD outbreak in Nigeria by a team of two or three interviewers. Most of the interviews were conducted face-to-face at the various offices of the respondents and others were via the telephone. The interviews which lasted an hour on average were conducted in English, digitally recorded and notes were also taken. This study elucidated the public health response to the Ebola outbreak led by Lagos State Government in conjunction with the Federal Ministry of Health. The principal strategy was an incident management approach which saw them identify and successfully follow up 894 contacts. The infected EVD cases were quarantined and treated. The Nigerian private sector and international organizations made significant contributions to the control efforts. Public health enlightenment programmes using multimodal communication strategies were rapidly deployed. Water and sanitary facilities were provided in many public schools in Lagos. The 2014 Ebola outbreak in Nigeria was effectively controlled using the incident management approach with massive support provided by the private sector and international community. Eight of the confirmed cases of EVD in Nigeria eventually died (case fatality rate of 42.1%) and twelve were nursed back to good health. On October 20 2014 Nigeria was declared fee of EVD by the World Health Organization. The Nigerian EVD experience provides valuable insights to guide reforms of African health systems in preparation for future infectious diseases outbreaks.

An Explosive Epidemic of DENV-3 in Cairns, Australia

PubMed Central

Ritchie, Scott A.; Pyke, Alyssa T.; Hall-Mendelin, Sonja; Day, Andrew; Mores, Christopher N.; Christofferson, Rebecca C.; Gubler, Duane J.; Bennett, Shannon N.; van den Hurk, Andrew F.

2013-01-01

From November 2008-May 2009 Cairns Queensland Australia was struck by an explosive epidemic of DENV-3 that exceeded the capacity of highly skilled dengue control team to control it. We describe the environmental, virological and entomological factors associated with this outbreak to better understand the circumstances leading to its occurrence. Patient interviews, serological results and viral sequencing strongly suggest that the imported index case was infected in Kalimantan, Indonesia. A delay in notification of 27 days from importation of the index case until Queensland Health was notified of dengue transmission allowed the virus to amplify and spread unchecked through November 2008. Unseasonably warm weather, with daily mean temperatures exceeding 30°C, occurred in late November and would have shortened the extrinsic incubation period of the virus and enhanced transmission. Analysis of case movements early in the outbreak indicated that the total incubation period was as low as 9–11 days. This was supported by laboratory vector competence studies that found transmission by Aedes aegypti occurred within 5 days post exposure at 28°C. Effective vector competence rates calculated from these transmission studies indicate that early transmission contributed to the explosive dengue transmission observed in this outbreak. Collections from BG sentinel traps and double sticky ovitraps showed that large populations of the vector Ae. aegypti occurred in the transmission areas from November – December 2008. Finally, the seasonal movement of people around the Christmas holiday season enhanced the spread of DENV-3. These results suggest that a strain of DENV-3 with an unusually rapid transmission cycle was able to outpace vector control efforts, especially those reliant upon delayed action control such as lethal ovitraps. PMID:23874522

Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina--multiple states, August-September, 2005.

PubMed

2005-09-30

On August 29, 2005, Hurricane Katrina struck states along the Gulf Coast of the United States. In the days after the hurricane struck, approximately 750 evacuation centers were established in at least 18 states to accommodate more than 200,000 evacuees. State and local health departments, with assistance from CDC, initiated enhanced infectious disease surveillance and outbreak response activities, implemented by teams of public health and rescue workers, including military personnel. Outbreak monitoring included direct reporting of conditions of public health significance to public health agencies; daily contact between CDC and local public health officials; canvassing of reports from CDC, public health departments, and news media for potential infectious disease outbreaks; and investigation of reports of infectious disease with outbreak potential. This report summarizes infectious disease and dermatologic conditions reported during the first 3 weeks after the hurricane, before effective local surveillance was fully implemented. One outbreak of norovirus was reported among evacuees in Texas; no other outbreaks requiring unusual mobilization of public health resources were reported among evacuees or rescue workers.

Surface Sampling and Detection Investigations at the CDC

NASA Astrophysics Data System (ADS)

Rose, L. J.; Coulliette, A. D.

2015-03-01

The Environmental and Applied Microbiology Team is tasked with investigating disease outbreaks in healthcare settings. We will summarize and discuss applied research endeavors to understand and optimize sampling and detection of microorganisms.

Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening

PubMed Central

Condell, Orla; Wasunna, Christine; Kpaka, Jonathan; Zwizwai, Ruth; Nuha, Mahmood; Fallah, Mosoka; Freeman, Maxwell; Harris, Victoria; Miller, Mark; Baller, April; Massaquoi, Moses; Katawera, Victoria; Saindon, John; Bemah, Philip; Hamblion, Esther; Castle, Evelyn; Williams, Desmond; Gasasira, Alex; Nyenswah, Tolbert

2018-01-01

The 2014–16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64–100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region. PMID:29304039

Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening.

PubMed

Raftery, Philomena; Condell, Orla; Wasunna, Christine; Kpaka, Jonathan; Zwizwai, Ruth; Nuha, Mahmood; Fallah, Mosoka; Freeman, Maxwell; Harris, Victoria; Miller, Mark; Baller, April; Massaquoi, Moses; Katawera, Victoria; Saindon, John; Bemah, Philip; Hamblion, Esther; Castle, Evelyn; Williams, Desmond; Gasasira, Alex; Nyenswah, Tolbert

2018-01-01

The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64-100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.

Use of a Diagonal Approach to Health System Strengthening and Measles Elimination after a Large Nationwide Outbreak in Mongolia.

PubMed

Hagan, José E; Greiner, Ashley; Luvsansharav, Ulzii-Orshikh; Lake, Jason; Lee, Christopher; Pastore, Roberta; Takashima, Yoshihiro; Sarankhuu, Amarzaya; Demberelsuren, Sodbayar; Smith, Rachel; Park, Benjamin; Goodson, James L

2017-12-01

Measles is a highly transmissible infectious disease that causes serious illness and death worldwide. Efforts to eliminate measles through achieving high immunization coverage, well-performing surveillance systems, and rapid and effective outbreak response mechanisms while strategically engaging and strengthening health systems have been termed a diagonal approach. In March 2015, a large nationwide measles epidemic occurred in Mongolia, 1 year after verification of measles elimination in this country. A multidisciplinary team conducted an outbreak investigation that included a broad health system assessment, organized around the Global Health Security Agenda framework of Prevent-Detect-Respond, to provide recommendations for evidence-based interventions to interrupt the epidemic and strengthen the overall health system to prevent future outbreaks of measles and other epidemic-prone infectious threats. This investigation demonstrated the value of evaluating elements of the broader health system in investigating measles outbreaks and the need for using a diagonal approach to achieving sustainable measles elimination.

Lessons from the Ebola Outbreak: Action Items for Emerging Infectious Disease Preparedness and Response.

PubMed

Jacobsen, Kathryn H; Aguirre, A Alonso; Bailey, Charles L; Baranova, Ancha V; Crooks, Andrew T; Croitoru, Arie; Delamater, Paul L; Gupta, Jhumka; Kehn-Hall, Kylene; Narayanan, Aarthi; Pierobon, Mariaelena; Rowan, Katherine E; Schwebach, J Reid; Seshaiyer, Padmanabhan; Sklarew, Dann M; Stefanidis, Anthony; Agouris, Peggy

2016-03-01

As the Ebola outbreak in West Africa wanes, it is time for the international scientific community to reflect on how to improve the detection of and coordinated response to future epidemics. Our interdisciplinary team identified key lessons learned from the Ebola outbreak that can be clustered into three areas: environmental conditions related to early warning systems, host characteristics related to public health, and agent issues that can be addressed through the laboratory sciences. In particular, we need to increase zoonotic surveillance activities, implement more effective ecological health interventions, expand prediction modeling, support medical and public health systems in order to improve local and international responses to epidemics, improve risk communication, better understand the role of social media in outbreak awareness and response, produce better diagnostic tools, create better therapeutic medications, and design better vaccines. This list highlights research priorities and policy actions the global community can take now to be better prepared for future emerging infectious disease outbreaks that threaten global public health and security.

Field Epidemiology and Laboratory Training Programs in West Africa as a model for sustainable partnerships in animal and human health.

PubMed

Becker, Karen M; Ohuabunwo, Chima; Ndjakani, Yassa; Nguku, Patrick; Nsubuga, Peter; Mukanga, David; Wurapa, Frederick

2012-09-01

The concept of animal and human health experts working together toward a healthier world has been endorsed, but challenges remain in identifying concrete actions to move this one health concept from vision to action. In 2008, as a result of avian influenza outbreaks in West Africa, international donor support led to a unique opportunity to invest in Field Epidemiology and Laboratory Training Programs (FELTPs) in the region that engaged the animal and human health sectors to strengthen the capacity for prevention and control of zoonotic diseases. The FELTPs mixed 25% to 35% classroom and 65% to 75% field-based training and service for cohorts of physicians, veterinarians, and laboratory scientists. They typically consisted of a 2-year course leading to a master's degree in field epidemiology and public health laboratory management for midlevel public health leaders and competency-based short courses for frontline public health surveillance workers. Trainees and graduates work in multidisciplinary teams to conduct surveillance, outbreak investigations, and epidemiological studies for disease control locally and across borders. Critical outcomes of these programs include development of a cadre of public health leaders with core skills in integrated disease surveillance, outbreak investigation, vaccination campaigns, laboratory diagnostic testing, and epidemiological studies that address priority public health problems. A key challenge exists in identifying ways to successfully scale up and transform this innovative donor-driven program into a sustainable multisectoral one health workforce capacity development model.

Cholera outbreaks in Malawi in 1998-2012: social and cultural challenges in prevention and control.

PubMed

Msyamboza, Kelias Phiri; Kagoli, Mathew; M'bang'ombe, Maurice; Chipeta, Sikhona; Masuku, Humphrey Dzanjo

2014-06-11

Cholera still remains a significant cause of morbidity and mortality in developing countries, although comprehensive surveillance data to inform policy and strategies are scarce. A desk review of the national cholera database and zonal and districts reports was conducted. Interviews were conducted with district health management teams, health workers, and participants in communities in six districts affected by cholera in 2011/2012 to obtain data on water, sanitation, and sociocultural issues. From 1998 to 2012, cholera outbreaks occurred every year in Malawi, with the highest number of cases and deaths reported in 2001/2002 (33,546 cases, 968 deaths; case fatality rate [CFR] 2.3%). In 2011/2012, cholera outbreak was widespread in the southern region, affecting 10 out of 13 districts, where 1,806 cases and 38 deaths (CFR 2.1%) were reported. Unsafe water sources, lack of maintenance of broken boreholes, frequent breakdown of piped water supply, low coverage of pit latrines (range 40%-60%), lack of hand washing facilities (< 5%), salty borehole water, fishermen staying on Lake Chilwa, cross-border Malawi-Mozambique disease spread, and sociocultural issues were some of the causes of the persistent cholera outbreaks in Malawi. Despite improvements in safe drinking water and sanitation, cholera is still a major public health problem. Introduction of a community-led total sanitation approach, use of social and cultural information in community mobilization strategies, and introduction of an oral cholera vaccine could help to eliminate cholera in Malawi.

The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines.

PubMed

White, L C J; Lanza, S; Middleton, J; Hewitt, K; Freire-Moran, L; Edge, C; Nicholls, M; Rajan-Iyer, J; Cassell, J A

2016-11-01

Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.

An outbreak of Salmonella Enteritidis phage type 34a infection associated with a Chinese restaurant in Suffolk, United Kingdom

PubMed Central

Badrinath, Padmanabhan; Sundkvist, Torbjorn; Mahgoub, Hamid; Kent, Richard

2004-01-01

Background On 30th July 2002, the Suffolk Communicable Disease Control Team received notifications of gastrointestinal illness due to Salmonella Enteritidis in subjects who had eaten food from a Chinese restaurant on 27th July. An Outbreak Control Team was formed resulting in extensive epidemiological, microbiological and environmental investigations. Methods Attempts were made to contact everybody who ate food from the restaurant on 27th July and a standard case definition was adopted. Using a pre-designed proforma information was gathered from both sick and well subjects. Food specific attack rates were calculated and two-tailed Fisher's exact test was used to test the difference between type of food consumed and the health status. Using a retrospective cohort design univariate Relative Risks and 95% Confidence Intervals were calculated for specific food items. Results Data was gathered on 52 people of whom 38 developed gastrointestinal symptoms; 16 male and 22 female. The mean age was 27 years. The mean incubation period was 30 hours with a range of 6 to 90 hours. Food attack rates were significantly higher for egg, special and chicken fried rice. Relative risk and the Confidence interval for these food items were 1.97 (1.11–3.48), 1.56 (1.23–1.97) and 1.48 (1.20–1.83) respectively. Interviews with the chef revealed that many eggs were used in the preparation of egg-fried rice, which was left at room temperature for seven hours and was used in the preparation of the other two rice dishes. Of the 31 submitted stool specimens 28 tested positive for S Enteritidis phage type 34a and one for S Enteritidis phage type 4. Conclusion In the absence of left over food available for microbiological examination, epidemiological investigation strongly suggested the eggs used in the preparation of the egg-fried rice as the vehicle for this outbreak. This investigation highlights the importance of safe practices in cooking and handling of eggs in restaurants. PMID:15341665

A national outbreak of Salmonella enteritidis infections from ice cream. The Investigation Team.

PubMed

Hennessy, T W; Hedberg, C W; Slutsker, L; White, K E; Besser-Wiek, J M; Moen, M E; Feldman, J; Coleman, W W; Edmonson, L M; MacDonald, K L; Osterholm, M T

1996-05-16

In September 1994, the Minnesota Department of Health detected an increase in the number of reports of Salmonella enteritidis infections. After a case-control study implicated a nationally distributed brand of ice cream (Schwan's) in the outbreak, the product was recalled and further epidemiologic and microbiologic investigations were conducted. We defined an outbreak-associated case of S. enteritidis infection as one in which S. enteritidis was cultured from a person who became ill in September or October 1994. We established national surveillance and surveyed customers of the implicated manufacturer. The steps involved in the manufacture of ice cream associated with cases of S. enteritidis infection were compared with those of products not known to be associated with infection matched for the date of manufacture. Cultures for bacteria were obtained from ice cream samples, the ice cream plant, and tanker trailers that had transported the ice cream base (premix) to the plant. We estimate that S. enteritidis gastroenteritis developed in 224,000 persons in the United States after they ate Schwan's ice cream. The attack rate for consumers was 6.6 percent. Ice cream associated with infection contained a higher percentage of premix that had been transported by tanker that had carried nonpasteurized eggs immediately before (P = 0.02). S. enteritidis was isolated from 8 of 226 ice cream products (3 percent), but not from environmental samples obtained from the ice cream plant (n = 157) or tanker trailers (n = 204). This nationwide outbreak of salmonellosis was most likely the result of contamination of pasteurized ice cream premix during transport in tanker trailers that had previously carried nonpasteurized liquid eggs containing S. enteritidis. To prevent further outbreaks, food products not destined for repasteurization should be transported in dedicated containers.

Invasive group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regulation.

PubMed

Beaudoin, Amanda L; Torso, Lauren; Richards, Katherine; Said, Maria; Van Beneden, Chris; Longenberger, Allison; Ostroff, Stephen; Wendt, Joyanna; Dooling, Kathleen; Wise, Matthew; Blythe, David; Wilson, Lucy; Moll, Mària; Perz, Joseph F

2014-07-01

Liposuction is one of the most common cosmetic surgery procedures in the United States. Tumescent liposuction, in which crystalloid fluids, lidocaine, and epinephrine are infused subcutaneously before cannula-assisted aspiration of fat, can be performed without intravenous or general anesthesia, often at outpatient facilities. However, some of these facilities are not subject to state or federal regulation and may not adhere to appropriate infection control practices. To describe an outbreak of severe group A Streptococcus (GAS) infections among persons undergoing tumescent liposuction at 2 outpatient cosmetic surgery facilities not subject to state or federal regulation. Outbreak investigation (including cohort analysis of at-risk patients), interviews using a standardized questionnaire, medical record review, facility assessment, and laboratory analysis of GAS isolates. Patients undergoing liposuction at 2 outpatient facilities, one in Maryland and the other in Pennsylvania, between July 1 and September 14, 2012. Confirmed invasive GAS infections (isolation of GAS from a normally sterile site or wound of a patient with necrotizing fasciitis or streptococcal toxic shock syndrome), suspected GAS infections (inflamed surgical site and either purulent discharge or fever and chills in a patient with no alternative diagnosis), postsurgical symptoms and patient-reported experiences related to his or her procedure, and emm types, T-antigen types, and antimicrobial susceptibility of GAS isolates. We identified 4 confirmed cases and 9 suspected cases, including 1 death (overall attack rate, 20% [13 of 66]). One instance of likely secondary GAS transmission to a household member occurred. All confirmed case patients had necrotizing fasciitis and had undergone surgical debridement. Procedures linked to illness were performed by a single surgical team that traveled between the 2 locations; 2 team members (1 of whom reported recent cellulitis) were colonized with a GAS strain that was indistinguishable by laboratory analysis of the isolates from the case patients. Facility assessments and patient reports indicated substandard infection control, including errors in equipment sterilization and infection prevention training. This outbreak of severe GAS infections was likely caused by transmission from colonized health care workers to patients during liposuction procedures. Additional oversight of outpatient cosmetic surgery facilities is needed to assure that they maintain appropriate infection control practices and other patient protections.

Infection surveillance after a natural disaster: lessons learnt from the Great East Japan Earthquake of 2011.

PubMed

Iwata, Osuke; Oki, Tomoharu; Ishiki, Aiko; Shimanuki, Masaaki; Fuchimukai, Toru; Chosa, Toru; Chida, Shoichi; Nakamura, Yasuhide; Shima, Hiroji; Kanno, Michihiro; Matsuishi, Toyojiro; Ishiki, Mikihito; Urabe, Daisaku

2013-10-01

On 11 March 2011, the Great East Japan Earthquake produced a catastrophic tsunami that devastated the city of Rikuzen-Takata and left it without an effective health infrastructure and at increased risk of outbreaks of disease. On 2 May 2011, a disease-surveillance team was formed of volunteers who were clinicians or members of Rikuzen-Takata's municipal government. The team's main goal was to detect the early signs of disease outbreaks. Seven weeks after the tsunami, 16 support teams were providing primary health care in Rikuzen-Takata but the chain of command between them was poor and 70% of the city's surviving citizens remained in evacuation centres. The communication tools that were available were generally inadequate. The surveillance team collected data from the city's clinics by using a simple reporting form that could be completed without adding greatly to the workloads of clinicians. The summary findings were reported daily to clinics. The team also collaborated with public health nurses in rebuilding communication networks. Public health nurses alerted evacuation centres to epidemics of communicable disease. Modern health-care systems are highly vulnerable to the loss of advanced technological tools. The initiation--or re-establishment--of disease surveillance following a natural disaster can therefore prove challenging even in a developed country. Surveillance should be promptly initiated after a disaster by (i) developing a surveillance system that is tailored to the local setting, (ii) establishing a support team network, and (iii) integrating the resources that remain--or soon become--locally available.

[Clinical management of patients and deceased during the Ebola outbreak from October to December 2003 in Republic of Congo].

PubMed

Boumandouki, P; Formenty, P; Epelboin, A; Campbell, P; Atsangandoko, C; Allarangar, Y; Leroy, E M; Kone, M L; Molamou, A; Dinga-Longa, O; Salemo, A; Kounkou, R Y; Mombouli, V; Ibara, J R; Gaturuku, P; Nkunku, S; Lucht, A; Feldmann, H

2005-09-01

Outbreaks of Ebola virus hemorrhagic fever (EVHF) have been reported since 2001 in the Cuvette Ouest department, a forested area located in the Western North of Congo. At the end of October 2003 a new alarm came from this department which was quickly confirmed as being an epidemic of EVHF. The outbreak response was organized by the ministry of health with the assistance of an international team under the aegis of WHO. The case management of suspect cases was done in an isolation ward set up at the hospital; when patients refused to go to the ward for care they were isolated in their house according to a protocol "transmission risks reduction at home". Safe burials were performed by specialized teams which respected the major aspects of the funeral to allow the process of mourning of the families. An active surveillance system was set up in order to organize the detection of new cases and the follow-up of their contacts. A case definition was adopted. From October 11 to December 2, 2003, 35 cases including 29 deaths were reported, 16 cases were laboratory confirmed. The first four cases had been exposed to monkey meat (Cercopithecus nictitans). The epidemic spread was due to family transmission. The population interpretation of the disease, in particular questions around wizards and evil-minded persons, is a factor which must be taken into account by the medical teams during communication meetings for behavioral change of the populations. The case management of patient in isolation wards to prevent the transmission of the virus in the community remains the most effective means to dam up Ebola virus hemorrhagic fever outbreaks. The good perception by the community of the safe funerary procedures is an important aspect in the establishment of confidence relations with the local population.

Decreasing influenza impact in lodges: 1997-2000 Calgary Regional Health Authority.

PubMed

McLeod, L; Lau, W W

2001-01-01

Influenza causes high morbidity and hospitalization rates in residents of seniors lodges, I causing increased pressure on emergency departments and hospital beds every winter. This quasi-experimental study assessed the prevention of influenza outbreaks and their consequences in Calgary lodges. A multidisciplinary team worked to improve communication between health professionals, increase resident and staff immunization coverage, obtain weights and creatinines prior to influenza season, and facilitate amantadine prophylaxis during influenza A outbreaks. We had an increase in standing orders for amantadine and up to 56% of residents from one lodge had documented creatinine levels. Amantadine was administered to residents within two days of outbreak notification. Influenza morbidity in lodge outbreaks decreased from a rate of 37% to 9% over the three years and hospitalization rates decreased from 9% to 1%. We recommend that other regions consider a similar approach to decreasing influenza morbidity and hospitalization in lodge residents.

INVESTIGATION OF MEASLES OUTBREAK IN A DISTRICT OF BALOCHISTAN PROVINCE, PAKISTAN.

PubMed

Saeed, Abid; Butt, Zahid Ahmad; Malik, Tabinda

2015-01-01

Measles is a communicable viral disease which is a major public health problem and a leading cause of morbidity and mortality in the developing countries including Pakistan with implications for outbreaks. An outbreak was reported from Ibrahim Khan Village of Manzari union council (UC), Pishin District by medical officer during polio campaign on 15th April 2014. A team was sent to investigate the outbreak and suggest control measures. Rapid assessment of outbreak was done by collecting data from house-to-house from April 16th-20th, 2014. Case was defined as "a person of any age, resident of village Ibrahim Khan village with non-vesicular maculopapular rash and fever along with one of the symptoms of cough, coryza and conjunctivitis from April 4th-20th, 2014". Routine immunization (RI) was assessed through recall and immunization cards and BCG scars were checked. Line list was developed and data was analyzed. Fifty-five cases (attack rate = 11.27%) including 4 deaths (Case Fatality Rates = 7.27%) were found. Mean age of children was 47 months (4-132 Months). Age-group 0-5 years was most affected (n = 48, 87.27%). Along-with maculopapular rash and fever. Other predominant symptoms were: coryza (n = 52, 95%), conjunctivitis (n = 51, 92%) and pneumonia (n = 42, 77%). RI status assessment showed that none of these children had been immunized. About 56.36% of the respondents were unaware about RI, 16.36% mentioned that vaccinator had not visited their homes, 14.54% reported that health facility is far away and 12.72% reported that even if they could get access to a health facility, the vaccines were not available. Functionalization of EPI centre, vaccinations of all children and mass education was strongly recommended. Surveillance system for vaccine preventable diseases (VPDs) should be strengthened to prevent such outbreaks. Outreach activity must be carried out regularly to reach scattered population.

Performance of district disaster management teams after undergoing an operational level planners' training in Uganda.

PubMed

Orach, Christopher Garimol; Mayega, Roy William; Woboya, Vincent; William, Bazeyo

2013-06-01

Uganda is vulnerable to several natural, man-made and a hybrid of disasters including drought, famine, floods, warfare, and disease outbreaks. We assessed the district disaster team's performance, roles and experiences following the training. The disasters most commonly experienced by the district teams were epidemics of diseases in humans (7 of 12), animals (epizoonotics) (3 of 12) and crops (3 of 12); hailstorms and floods (3 of 12). The capabilities viewed most useful for management of disasters were provision of health care services (9/12) and response management (8 of 12). The capability domains most often consulted during the disasters were general response management (31%), health services (29%) and water and sanitation (17%). The skills areas perceived to be vital following the training were response to epidemics 10/12, disaster management planning 8/12, hazards and vulnerability analysis 7/12 and principles of disaster planning 7/12 respectively. Main challenges mentioned by district teams were inadequacy of finance and logistics, lack of commitment by key partners towards disaster preparedness and response. The most common disaster experienced disasters related to outbreaks of diseases in man, animals and crops. The most frequently applied capabilities were response management and provision of emergency health services. The activities most frequently implemented following disaster management teams training were conducting planning meetings, refinement of plans and dissemination of skills gained. The main challenges were related to limited budget allocations and legal frameworks for disaster management that should be addressed by both central and local governments.

Foodborne Illness Outbreak Investigation in a High-Profile Sports Club.

PubMed

Cavanagh, Kwendy; Johnstone, Travers; Huhtinen, Essi; Najjar, Zeina; Lorentzos, Peter; Shadbolt, Craig; Shields, John; Gupta, Leena

2017-12-01

A foodborne illness outbreak involving an elite sports team was investigated by a public health unit in Sydney, Australia. An epidemiological association was established between gastrointestinal illness and the consumption of food supplied by an external caterer, with a lamb meal most strongly associated with illness. Genetically identical Salmonella isolates were identified from clinical specimens, residual food items, and an environmental swab taken from the catering premises. The training schedule and other club operations were significantly affected by this outbreak. Increased susceptibility due to regular shared activities and the potential for significant impact upon performance indicates that sports clubs must ensure that food suppliers comply with the highest standards of hygiene. Collaboration with public health authorities assists in source identification and prevention of further transmission.

Outbreak column 17: Situational Awareness for healthcare outbreaks

PubMed Central

2015-01-01

Outbreak column 17 introduces the utility of Situation Awareness (SA) for outbreak management. For any given time period, an individual or team’s SA involves a perception of what is going on, meaning derived from the perception and a prediction of what is likely to happen next. The individual or team’s SA informs, but is separate to, both the decisions and actions that follow. The accuracy and completeness of an individual or team’s SA will therefore impact on the effectiveness of decisions and actions taken. SA was developed by the aviation industry and is utilised in situations which, like outbreaks, have dynamic, i.e. continuously changing problem spaces, and wherein a loss of SA is likely to lead to both poor decision-making and actions with potentially fatal consequences. The potential benefits of using SA for outbreaks are discussed and include: (1) retrospectively to identify if poor decision-making was a result of a poor SA; (2) prospectively to identify where the system is weakest; and (3) as a teaching tool to improve the skills of individuals and teams in developing a shared understanding of the here and now. PMID:28989433

Hepatitis A outbreak in Ba subdivision, Fiji, October-December 2013.

PubMed

Getahun, Aneley; Rafai, Eric; Tolosa, Maria Ximena; Dawainavesi, Akanisi; Tabua, Anaseini Maisema; Tabua, Josefa

2015-01-01

A cluster of suspected hepatitis A cases was notified to the Fiji Ministry of Health on 22 October 2013. An outbreak investigation team was mobilized to confirm the existence of an outbreak of hepatitis A and advise appropriate public health interventions. A case definition for the outbreak investigation was established, and standardized data collection tools were used to collect information on clinical presentation and risk factors. An environmental assessment was also conducted. There were 160 clinical cases of hepatitis A of which 15 were laboratory-confirmed. The attack rate was 349 per 10,000 population in the Nukuloa nursing zone; there were no reported deaths. Residents of the Nukuloa settlement were 6.6 times more likely to present with symptomatic hepatitis A infection (95% confidence interval: 3.8-12.6) compared with residents of another village with a different water supply. This is the first significant hepatitis A outbreak documented in Ba subdivision and possibly in Fiji. Enhanced surveillance of hepatitis A may reveal other clusters in the country. Improving the primary water source dramatically reduced the occurance of disease in the affected community and adjacent areas.

Echovirus 30 meningitis epidemic followed by an outbreak-specific RT-qPCR.

PubMed

Österback, Riikka; Kalliokoski, Teemu; Lähdesmäki, Tuire; Peltola, Ville; Ruuskanen, Olli; Waris, Matti

2015-08-01

An outbreak of enteroviral aseptic meningitis emerged in Southwestern Finland in August 2009. The same enterovirus reappeared with increasing incidence of meningitis in other parts of Finland in 2010. To identify the incidence and molecular epidemiology of enteroviral meningitis outbreak. The causative agent was identified as echovirus 30 (E-30) by sequencing partial viral protein 1 capsid genome, and a virus type-specific RT-qPCR was set up for sensitive detection of the virus in cerebrospinal fluid specimens. Enterovirus positive CSF specimens were subjected to the E-30-specific assay to investigate this unusual occurrence of aseptic meningitis and facilitate case confirmation during the outbreaks between August 2009 and September 2010. E-30 was detected in 106 (72%) enterovirus positive cerebrospinal fluid specimens. All the meningitis cases in 2009 and most of them in 2010 were among adolescents and several were members of sport teams. Between August 2009 and September 2010, E-30 caused an extensive outbreak with two peaks in Finland. Type-specific RT-PCR allowed rapid diagnostic follow-up of the epidemic. Copyright © 2015 Elsevier B.V. All rights reserved.

[Respiratory syncytial virus outbreak in a tertiary hospital Neonatal Intensive Care Unit].

PubMed

Moreno Parejo, Carlos; Morillo García, Aurea; Lozano Domínguez, Carmen; Carreño Ochoa, Concepción; Aznar Martín, Javier; Conde Herrera, Manuel

2016-09-01

Investigation and control of a respiratory syncytial virus (RSV) outbreak that affected the Neonatal Intensive Care Unit (NICU) of a university hospital from October to December 2012. Cohort study of children admitted to the NICU. The infection attack rate was calculated. A descriptive analysis of the cases and a multivariate analysis was performed using the variables that were shown to be risk factors for RSV infection. Preventive measures taken were: contact isolation; hand hygiene training and observation; exclusivity of a health team of nurses and physicians for positive cases, restrictions on visitor numbers; surveillance RSV testing, and palivizumab prophylaxis. The outbreak had three epidemic waves and 20 positive cases out of a total of 48 children admitted. The overall attack rate was 42%. Half of positive cases were children, with a median age of 36 days (p25=22, p75=58). The independent risk factors for RSV infection were birth weight below 1000 grams (OR=23.5; P=.002) and to have another nosocomial infection the week before the diagnosis of RSV infection (OR=19.98; P=.016). It was an outbreak with a high number of cases, due to the delay in notification, prolonged RSV carrier status, and low adherence to hand hygiene practice, which favoured the cross-transmission of infection. The most effective preventive measures were direct observation of hand hygiene and supervision of isolation measures. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Review: Evaluation of Foot-and-Mouth Disease Control Using Fault Tree Analysis.

PubMed

Isoda, N; Kadohira, M; Sekiguchi, S; Schuppers, M; Stärk, K D C

2015-06-01

An outbreak of foot-and-mouth disease (FMD) causes huge economic losses and animal welfare problems. Although much can be learnt from past FMD outbreaks, several countries are not satisfied with their degree of contingency planning and aiming at more assurance that their control measures will be effective. The purpose of the present article was to develop a generic fault tree framework for the control of an FMD outbreak as a basis for systematic improvement and refinement of control activities and general preparedness. Fault trees are typically used in engineering to document pathways that can lead to an undesired event, that is, ineffective FMD control. The fault tree method allows risk managers to identify immature parts of the control system and to analyse the events or steps that will most probably delay rapid and effective disease control during a real outbreak. The present developed fault tree is generic and can be tailored to fit the specific needs of countries. For instance, the specific fault tree for the 2001 FMD outbreak in the UK was refined based on control weaknesses discussed in peer-reviewed articles. Furthermore, the specific fault tree based on the 2001 outbreak was applied to the subsequent FMD outbreak in 2007 to assess the refinement of control measures following the earlier, major outbreak. The FMD fault tree can assist risk managers to develop more refined and adequate control activities against FMD outbreaks and to find optimum strategies for rapid control. Further application using the current tree will be one of the basic measures for FMD control worldwide. © 2013 Blackwell Verlag GmbH.

Rapid response to Ebola outbreaks in remote areas - Liberia, July-November 2014.

PubMed

Kateh, Francis; Nagbe, Thomas; Kieta, Abraham; Barskey, Albert; Gasasira, Alex Ntale; Driscoll, Anne; Tucker, Anthony; Christie, Athalia; Karmo, Ben; Scott, Colleen; Bowah, Collin; Barradas, Danielle; Blackley, David; Dweh, Emmanuel; Warren, Felicia; Mahoney, Frank; Kassay, Gabriel; Calvert, Geoffrey M; Castro, Georgina; Logan, Gorbee; Appiah, Grace; Kirking, Hannah; Koon, Hawa; Papowitz, Heather; Walke, Henry; Cole, Isaac B; Montgomery, Joel; Neatherlin, John; Tappero, Jordan W; Hagan, Jose E; Forrester, Joseph; Woodring, Joseph; Mott, Joshua; Attfield, Kathleen; DeCock, Kevin; Lindblade, Kim A; Powell, Krista; Yeoman, Kristin; Adams, Laura; Broyles, Laura N; Slutsker, Laurence; Larway, Lawrence; Belcher, Lisa; Cooper, Lorraine; Santos, Marjorie; Westercamp, Matthew; Weinberg, Meghan Pearce; Massoudi, Mehran; Dea, Monica; Patel, Monita; Hennessey, Morgan; Fomba, Moses; Lubogo, Mutaawe; Maxwell, Nikki; Moonan, Patrick; Arzoaquoi, Sampson; Gee, Samuel; Zayzay, Samuel; Pillai, Satish; Williams, Seymour; Zarecki, Shauna Mettee; Yett, Sheldon; James, Stephen; Grube, Steven; Gupta, Sundeep; Nelson, Thelma; Malibiche, Theophil; Frank, Wilmont; Smith, Wilmot; Nyenswah, Tolbert

2015-02-27

West Africa is experiencing its first epidemic of Ebola virus disease (Ebola). As of February 9, Liberia has reported 8,864 Ebola cases, of which 3,147 were laboratory-confirmed. Beginning in August 2014, the Liberia Ministry of Health and Social Welfare (MOHSW), supported by CDC, the World Health Organization (WHO), and others, began systematically investigating and responding to Ebola outbreaks in remote areas. Because many of these areas lacked mobile telephone service, easy road access, and basic infrastructure, flexible and targeted interventions often were required. Development of a national strategy for the Rapid Isolation and Treatment of Ebola (RITE) began in early October. The strategy focuses on enhancing capacity of county health teams (CHT) to investigate outbreaks in remote areas and lead tailored responses through effective and efficient coordination of technical and operational assistance from the MOHSW central level and international partners. To measure improvements in response indicators and outcomes over time, data from investigations of 12 of 15 outbreaks in remote areas with illness onset dates of index cases during July 16-November 20, 2014, were analyzed. The times to initial outbreak alerts and durations of the outbreaks declined over that period while the proportions of patients who were isolated and treated increased. At the same time, the case-fatality rate in each outbreak declined. Implementation of strategies, such as RITE, to rapidly respond to rural outbreaks of Ebola through coordinated and tailored responses can successfully reduce transmission and improve outcomes.

Update on Zika Virus

PubMed Central

Toresdahl, Brett G.; Asif, Irfan M.

2016-01-01

As public health experts work to contain the outbreak of Zika virus in South America and minimize the devastating prenatal complications, the international sports community prepares for the 2016 Summer Olympic and Paralympic Games in Rio de Janeiro, Brazil. Athletes have publicly expressed concern regarding the health risks of competition in Zika-endemic areas.33 Ensuring the safety of the athletes during training and competition is the primary role of the team physician. Special consideration is needed for sports teams preparing for travel to areas affected by Zika virus. PMID:27436751

Estimating the effectiveness of early control measures through school absenteeism surveillance in observed outbreaks at rural schools in Hubei, China.

PubMed

Fan, Yunzhou; Yang, Mei; Jiang, Hongbo; Wang, Ying; Yang, Wenwen; Zhang, Zhixia; Yan, Weirong; Diwan, Vinod K; Xu, Biao; Dong, Hengjin; Palm, Lars; Liu, Li; Nie, Shaofa

2014-01-01

School absenteeism is a common data source in syndromic surveillance, which allows for the detection of outbreaks at an early stage. Previous studies focused on its correlation with other data sources. In this study, we evaluated the effectiveness of control measures based on early warning signals from school absenteeism surveillance in rural Chinese schools. A school absenteeism surveillance system was established in all 17 primary schools in 3 adjacent towns in the Chinese region of Hubei. Three outbreaks (varicella, mumps, and influenza-like illness) were detected and controlled successfully from April 1, 2012, to January 15, 2014. An impulse susceptible-exposed-infectious-recovered model was used to fit the epidemics of these three outbreaks. Moreover, it simulated the potential epidemics under interventions resulting from traditional surveillance signals. The effectiveness of the absenteeism-based control measures was evaluated by comparing the simulated datasets. The school absenteeism system generated 52 signals. Three outbreaks were verified through epidemiological investigation. Compared to traditional surveillance, the school absenteeism system generated simultaneous signals for the varicella outbreak, but 3 days in advance for the mumps outbreak and 2-4 days in advance for the influenza-like illness outbreak. The estimated excess protection rates of control measures based on early signals were 0.0%, 19.0-44.1%, and 29.0-37.0% for the three outbreaks, respectively. Although not all outbreak control measures can benefit from early signals through school absenteeism surveillance, the effectiveness of early signal-based interventions is obvious. School absenteeism surveillance plays an important role in reducing outbreak spread.

Entomologic investigations during an outbreak of West Nile virus disease in Maricopa County, Arizona, 2010.

PubMed

Godsey, Marvin S; Burkhalter, Kristen; Young, Ginger; Delorey, Mark; Smith, Kirk; Townsend, John; Levy, Craig; Mutebi, John-Paul

2012-12-01

Entomologic investigations were conducted during an intense outbreak of West Nile virus (WNV) disease in Maricopa County, Arizona during July 31-August 9, 2010. The investigations compared the East Valley outbreak area, and a demographically similar control area in northwestern metropolitan Phoenix where no human cases were reported. Five mosquito species were identified in each area, and species composition was similar in both areas. Significantly more Culex quinquefasciatus females were collected by gravid traps at Outbreak sites (22.2 per trap night) than at control sites (8.9 per trap night), indicating higher Cx. quinquefasciatus abundance in the outbreak area. Twenty-eight WNV TaqMan reverse transcription-polymerase chain reaction-positive mosquito pools were identified, including 24 of Cx. quinquefasciatus, 3 of Psorophora columbiae, and 1 of Culex sp. However, Cx. quinquefasciatus WNV infection rates did not differ between outbreak and control sites. At outbreak sites, 30 of 39 engorged Cx. quinquefasciatus had fed on birds, 8 of 39 on humans, and 1 of 39 on a lizard. At control sites, 20 of 20 identified blood meals were from birds. Data suggest that Cx. quinquefasciatus was the primary enzootic and epidemic vector of this outbreak. The most important parameters in the outbreak were vector abundance and blood meal analysis, which suggested more frequent contact between Cx. quinquefasciatus and human hosts in the outbreak area compared with the control area.

Entomologic Investigations during an Outbreak of West Nile Virus Disease in Maricopa County, Arizona, 2010

PubMed Central

Godsey, Marvin S.; Burkhalter, Kristen; Young, Ginger; Delorey, Mark; Smith, Kirk; Townsend, John; Levy, Craig; Mutebi, John-Paul

2012-01-01

Entomologic investigations were conducted during an intense outbreak of West Nile virus (WNV) disease in Maricopa County, Arizona during July 31–August 9, 2010. The investigations compared the East Valley outbreak area, and a demographically similar control area in northwestern metropolitan Phoenix where no human cases were reported. Five mosquito species were identified in each area, and species composition was similar in both areas. Significantly more Culex quinquefasciatus females were collected by gravid traps at Outbreak sites (22.2 per trap night) than at control sites (8.9 per trap night), indicating higher Cx. quinquefasciatus abundance in the outbreak area. Twenty-eight WNV TaqMan reverse transcription-polymerase chain reaction–positive mosquito pools were identified, including 24 of Cx. quinquefasciatus, 3 of Psorophora columbiae, and 1 of Culex sp. However, Cx. quinquefasciatus WNV infection rates did not differ between outbreak and control sites. At outbreak sites, 30 of 39 engorged Cx. quinquefasciatus had fed on birds, 8 of 39 on humans, and 1 of 39 on a lizard. At control sites, 20 of 20 identified blood meals were from birds. Data suggest that Cx. quinquefasciatus was the primary enzootic and epidemic vector of this outbreak. The most important parameters in the outbreak were vector abundance and blood meal analysis, which suggested more frequent contact between Cx. quinquefasciatus and human hosts in the outbreak area compared with the control area. PMID:23109372

Societal impact of dengue outbreaks: Stakeholder perceptions and related implications. A qualitative study in Brazil, 2015

PubMed Central

Rodrigues, Mariana; Davis, Ben; Besson, Marie-Hélène; Audureau, Etienne; Saba, Joseph

2017-01-01

Background The growing burden of dengue in many countries worldwide and the difficulty of preventing outbreaks have increased the urgency to identify alternative public health management strategies and effective approaches to control and prevent dengue outbreaks. The objectives of this study were to understand the impact of dengue outbreak on different stakeholders in Brazil, to explore their perceptions of approaches used by governmental authorities to control and prevent dengue outbreaks and to define the challenges and implications of preventing future outbreaks. Methods In 2015, a qualitative study was conducted in two urban states in Brazil: São Paulo, which was experiencing an outbreak in 2015, and Rio de Janeiro, which experienced outbreaks in 2011 and 2012. Face-to-face interviews using a semi-structured questionnaire were conducted with nine different categories of stakeholders: health workers (physicians, nurses), hospital administrators, municipal government representatives, community members and leaders, school administrators, business leaders and vector control managers. Interviews were focused on the following areas: impact of the dengue outbreak, perceptions of control measures implemented by governmental authorities during outbreaks and challenges in preventing future dengue outbreaks. Results A total of 40 stakeholders were included in the study. Health workers and community members reported longer waiting times at hospitals due to the increased number of patients receiving care for dengue-related symptoms. Health workers and hospital administrators reported that there were no major interruptions in access to care. Overall financial impact of dengue outbreaks on households was greatest for low-income families. Despite prevention and control campaigns implemented between outbreak periods, various stakeholders reported that dengue prevention and control efforts performed by municipal authorities remained insufficient, suggesting that efforts should be reinforced and better coordinated by governmental authorities, particularly during outbreak periods. Conclusion The study shows that a dengue outbreak has a multisectorial impact in the medical, societal, economic and political sectors. The study provides useful insights and knowledge in different stakeholder populations that could guide local authorities and government officials in planning, designing and initiating public health programs. Research focused on a better understanding of how communities and political authorities respond to dengue outbreaks is a necessary component for designing and implementing plans to decrease the incidence and impact of dengue outbreaks in Brazil. PMID:28278157

An outbreak of tinea gladiatorum in Lanzarote.

PubMed

Pique, E; Copado, R; Cabrera, A; Olivares, M; Fariña, M C; Escalonilla, P; Soriano, M L; Requena, L

1999-01-01

Canary Islands wrestling is a variant of the sport played exclusively in that region, and is associated with close participant contact. An outbreak of a fungal infection, so-called tinea gladiatorum, amongst such wrestlers in Lanzarote, one island in the archipelago is now described. 102 wrestlers from the eight teams on the island were examined; some of the clubs are 50 km apart; 45 wrestlers (44.1% of those examined) were noted to be affected. To our knowledge, this is the largest reported series of patients with tinea gladiatorum and the only one to demonstrate such infection in a variety of geographical locations.

Variable global strategies for avian influenza outbreak control and eradication

USDA-ARS?s Scientific Manuscript database

Since 1959, 40 epizootics of high pathogenicity avian influenza (HPAI) have occurred with 35 outbreaks using stamping-out programs exclusively, leading to rapid eradication, and five outbreaks having also used vaccination as a control tool. The majority of the recent outbreaks of H5N1 HPAI have occu...

Estimating the Effectiveness of Early Control Measures through School Absenteeism Surveillance in Observed Outbreaks at Rural Schools in Hubei, China

PubMed Central

Fan, Yunzhou; Yang, Mei; Jiang, Hongbo; Wang, Ying; Yang, Wenwen; Zhang, Zhixia; Yan, Weirong; Diwan, Vinod K.; Xu, Biao; Dong, Hengjin; Palm, Lars; Liu, Li; Nie, Shaofa

2014-01-01

Background School absenteeism is a common data source in syndromic surveillance, which allows for the detection of outbreaks at an early stage. Previous studies focused on its correlation with other data sources. In this study, we evaluated the effectiveness of control measures based on early warning signals from school absenteeism surveillance in rural Chinese schools. Methods A school absenteeism surveillance system was established in all 17 primary schools in 3 adjacent towns in the Chinese region of Hubei. Three outbreaks (varicella, mumps, and influenza-like illness) were detected and controlled successfully from April 1, 2012, to January 15, 2014. An impulse susceptible-exposed-infectious-recovered model was used to fit the epidemics of these three outbreaks. Moreover, it simulated the potential epidemics under interventions resulting from traditional surveillance signals. The effectiveness of the absenteeism-based control measures was evaluated by comparing the simulated datasets. Results The school absenteeism system generated 52 signals. Three outbreaks were verified through epidemiological investigation. Compared to traditional surveillance, the school absenteeism system generated simultaneous signals for the varicella outbreak, but 3 days in advance for the mumps outbreak and 2–4 days in advance for the influenza-like illness outbreak. The estimated excess protection rates of control measures based on early signals were 0.0%, 19.0–44.1%, and 29.0–37.0% for the three outbreaks, respectively. Conclusions Although not all outbreak control measures can benefit from early signals through school absenteeism surveillance, the effectiveness of early signal-based interventions is obvious. School absenteeism surveillance plays an important role in reducing outbreak spread. PMID:25250786

[Measures taken by a university hospital for the prevention and control of the 2009 H1N1 influenza].

PubMed

Hayashi, Jun; Murata, Masayuki; Furusyo, Norihiro; Hoshina, Takayuki; Shimono, Nobuyuki

2010-09-01

After extensive discussion with the Fukuoka City government of measures for the prevention and control of the 2009 H1N1 influenza pandemic, Kyushu University Hospital organized the infection control teams of 39 hospitals in the Fukuoka City area in preparation for a possible outbreak. A facility was set up at Kyushu University Hospital for the screening of outpatients with fever, and those with influenza and an underlying disease or severe symptoms were admitted to the hospital. 37 (22%) of the 171 outpatients with fever were infected with the new strain of influenza, confirmed by rapid influenza antigen test and PCR: Of these 37 patients, 17 (45.9%) were negative by influenza antigen test. Other 37 patients (5 adults, 32 children) were admitted, all of whom were successfully treated with neuraminidase inhibitors and discharged with no aftereffects.

The Global Outbreak Alert and Response Network

PubMed Central

Mackenzie, John S.; Drury, Patrick; Arthur, Ray R.; Ryan, Michael J.; Grein, Thomas; Slattery, Raphael; Suri, Sameera; Domingo, Christine Tiffany; Bejtullahu, Armand

2014-01-01

The Global Outbreak Alert and Response Network (GOARN) was established in 2000 as a network of technical institutions, research institutes, universities, international health organisations and technical networks willing to contribute and participate in internationally coordinated responses to infectious disease outbreaks. It reflected a recognition of the need to strengthen and coordinate rapid mobilisation of experts in responding to international outbreaks and to overcome the sometimes chaotic and fragmented operations characterising previous responses. The network partners agreed that the World Health Organization would coordinate the network and provide a secretariat, which would also function as the operational support team. The network has evolved to comprise 153 institutions/technical partners and 37 additional networks, the latter encompassing a further 355 members and has been directly involved in 137 missions to 79 countries, territories or areas. Future challenges will include supporting countries to achieve the capacity to detect and respond to outbreaks of international concern, as required by the International Health Regulations (2005). GOARN's increasing regional focus and expanding geographic composition will be central to meeting these challenges. The paper summarises some of network's achievements over the past 13 years and presents some of the future challenges. PMID:25186571

The global outbreak alert and response network.

PubMed

Mackenzie, John S; Drury, Patrick; Arthur, Ray R; Ryan, Michael J; Grein, Thomas; Slattery, Raphael; Suri, Sameera; Domingo, Christine Tiffany; Bejtullahu, Armand

2014-01-01

The Global Outbreak Alert and Response Network (GOARN) was established in 2000 as a network of technical institutions, research institutes, universities, international health organisations and technical networks willing to contribute and participate in internationally coordinated responses to infectious disease outbreaks. It reflected a recognition of the need to strengthen and coordinate rapid mobilisation of experts in responding to international outbreaks and to overcome the sometimes chaotic and fragmented operations characterising previous responses. The network partners agreed that the World Health Organization would coordinate the network and provide a secretariat, which would also function as the operational support team. The network has evolved to comprise 153 institutions/technical partners and 37 additional networks, the latter encompassing a further 355 members and has been directly involved in 137 missions to 79 countries, territories or areas. Future challenges will include supporting countries to achieve the capacity to detect and respond to outbreaks of international concern, as required by the International Health Regulations (2005). GOARN's increasing regional focus and expanding geographic composition will be central to meeting these challenges. The paper summarises some of network's achievements over the past 13 years and presents some of the future challenges.

Hepatitis A outbreak in Ba subdivision, Fiji, October–December 2013

PubMed Central

Rafai, Eric; Tolosa, Maria Ximena; Dawainavesi, Akanisi; Tabua, Anaseini Maisema; Tabua, Josefa

2015-01-01

Objective A cluster of suspected hepatitis A cases was notified to the Fiji Ministry of Health on 22 October 2013. An outbreak investigation team was mobilized to confirm the existence of an outbreak of hepatitis A and advise appropriate public health interventions. Methods A case definition for the outbreak investigation was established, and standardized data collection tools were used to collect information on clinical presentation and risk factors. An environmental assessment was also conducted. Results There were 160 clinical cases of hepatitis A of which 15 were laboratory-confirmed. The attack rate was 349 per 10 000 population in the Nukuloa nursing zone; there were no reported deaths. Residents of the Nukuloa settlement were 6.6 times more likely to present with symptomatic hepatitis A infection (95% confidence interval: 3.8–12.6) compared with residents of another village with a different water supply. Discussion This is the first significant hepatitis A outbreak documented in Ba subdivision and possibly in Fiji. Enhanced surveillance of hepatitis A may reveal other clusters in the country. Improving the primary water source dramatically reduced the occurance of disease in the affected community and adjacent areas. PMID:26306214

Post-tsunami outbreaks of influenza in evacuation centers in Miyagi Prefecture, Japan.

PubMed

Hatta, Masumitsu; Endo, Shiro; Tokuda, Koichi; Kunishima, Hiroyuki; Arai, Kazuaki; Yano, Hisakazu; Ishibashi, Noriomi; Aoyagi, Tetsuji; Yamada, Mitsuhiro; Inomata, Shinya; Kanamori, Hajime; Gu, Yoshiaki; Kitagawa, Miho; Hirakata, Yoichi; Kaku, Mitsuo

2012-01-01

We describe 2 post-tsunami outbreaks of influenza A in evacuation centers in Miyagi Prefecture, Japan, in 2011. Although containment of the outbreak was challenging in the evacuation settings, prompt implementation of a systemic approach with a bundle of control measures was important to control the influenza outbreaks.

Role of data aggregation in biosurveillance detection strategies with applications from ESSENCE.

PubMed

Burkom, Howard S; Elbert, Y; Feldman, A; Lin, J

2004-09-24

Syndromic surveillance systems are used to monitor daily electronic data streams for anomalous counts of features of varying specificity. The monitored quantities might be counts of clinical diagnoses, sales of over-the-counter influenza remedies, school absenteeism among a given age group, and so forth. Basic data-aggregation decisions for these systems include determining which records to count and how to group them in space and time. This paper discusses the application of spatial and temporal data-aggregation strategies for multiple data streams to alerting algorithms appropriate to the surveillance region and public health threat of interest. Such a strategy was applied and evaluated for a complex, authentic, multisource, multiregion environment, including >2 years of data records from a system-evaluation exercise for the Defense Advanced Research Project Agency (DARPA). Multivariate and multiple univariate statistical process control methods were adapted and applied to the DARPA data collection. Comparative parametric analyses based on temporal aggregation were used to optimize the performance of these algorithms for timely detection of a set of outbreaks identified in the data by a team of epidemiologists. The sensitivity and timeliness of the most promising detection methods were tested at empirically calculated thresholds corresponding to multiple practical false-alert rates. Even at the strictest false-alert rate, all but one of the outbreaks were detected by the best method, and the best methods achieved a 1-day median time before alert over the set of test outbreaks. These results indicate that a biosurveillance system can provide a substantial alerting-timeliness advantage over traditional public health monitoring for certain outbreaks. Comparative analyses of individual algorithm results indicate further achievable improvement in sensitivity and specificity.

Control of Ebola virus disease - firestone district, liberia, 2014.

PubMed

Reaves, Erik J; Mabande, Lyndon G; Thoroughman, Douglas A; Arwady, M Allison; Montgomery, Joel M

2014-10-24

On March 30, 2014, the Ministry of Health and Social Welfare (MOHSW) of Liberia alerted health officials at Firestone Liberia, Inc. (Firestone) of the first known case of Ebola virus disease (Ebola) inside the Firestone rubber tree plantation of Liberia. The patient, who was the wife of a Firestone employee, had cared for a family member with confirmed Ebola in Lofa County, the epicenter of the Ebola outbreak in Liberia during March-April 2014. To prevent a large outbreak among Firestone's 8,500 employees, their dependents, and the surrounding population, the company responded by 1) establishing an incident management system, 2) instituting procedures for the early recognition and isolation of Ebola patients, 3) enforcing adherence to standard Ebola infection control guidelines, and 4) providing differing levels of management for contacts depending on their exposure, including options for voluntary quarantine in the home or in dedicated facilities. In addition, Firestone created multidisciplinary teams to oversee the outbreak response, address case detection, manage cases in a dedicated unit, and reintegrate convalescent patients into the community. The company also created a robust risk communication, prevention, and social mobilization campaign to boost community awareness of Ebola and how to prevent transmission. During August 1-September 23, a period of intense Ebola transmission in the surrounding areas, 71 cases of Ebola were diagnosed among the approximately 80,000 Liberians for whom Firestone provides health care (cumulative incidence = 0.09%). Fifty-seven (80%) of the cases were laboratory confirmed; 39 (68%) of these cases were fatal. Aspects of Firestone's response appear to have minimized the spread of Ebola in the local population and might be successfully implemented elsewhere to limit the spread of Ebola and prevent transmission to health care workers (HCWs).

How can patients and their physicians contribute to an outbreak investigation? Experiences from a nationwide listeriosis outbreak in Switzerland.

PubMed

Kiefer, Sabine; Kling, Kerstin; Stephan, Roger; Bratschi, Martin W; Jost, Marianne; Bless, Philipp Justus; Schmutz, Claudia; Mäusezahl, Daniel; Wyss, Kaspar; Mäusezahl-Feuz, Mirjam; Hatz, Christoph

2016-01-01

Gathering patient information to contain an outbreak of Listeria monocytogenes is difficult because of the patients' severe illness or death. Extending the range of interviewees to acquire epidemiological data can thus be important to maximise information. We built the current analysis on a case-case outbreak investigation conducted during a Swiss listeriosis outbreak between 30 January and 11 May 2014, including 31 patients with confirmed L. monocytogenes infection. We interviewed treating physicians and patients or their next of kin to gather information on clinical aspects, eating habits and food consumption. We compared the different information sources with regards to their potential to provide specific, complete and rapid information on the affected population and their food consumption history. We obtained a 100% response rate among physicians, providing detailed information on the affected population by describing health status, underlying conditions, and signs and symptoms. Detailed information on food history could not be obtained from physicians, making the information vague and unspecific. Less than 50% of patients could be interviewed, limiting our information base. Nevertheless, patient information on the food history was sufficiently detailed and helped to identify the outbreak source CONCLUSIONS: Outbreak investigation teams confronted with limited information from patients and with small numbers of cases can enhance information on the affected population and the outbreak source by combining information from physicians and patients. Physicians provided comprehensive information on signs and symptoms, underlying conditions and the general health status. Patients remain vital to provide detailed information on the food consumption history.

Control Measures Used during Lymphogranuloma Venereum Outbreak, Europe

PubMed Central

Hulscher, Marlies E.J.L.; Vos, Dieuwke; van de Laar, Marita J.W.; Fenton, Kevin A.; van Steenbergen, Jim E.; van der Meer, Jos W.M.; Grol, Richard P.T.M.

2008-01-01

To assess the response to the reemergence of lymphogranuloma venereum, we conducted a cross-sectional survey by administering a structured questionnaire to representatives from 26 European countries. Responses were received from 18 countries. The ability to respond quickly and the measures used for outbreak detection and control varied. Evidence-based criteria were not consistently used to develop recommendations. We did not develop criteria to determine the effectiveness of the recommendations. The degree of preparedness for an unexpected outbreak, as well as the ability of countries to respond quickly to alerts, varied, which indicates weaknesses in the ability to control an outbreak. More guidance is needed to implement and evaluate control measures used during international outbreaks. PMID:18394274

The challenges of detecting and responding to a Lassa fever outbreak in an Ebola-affected setting.

PubMed

Hamblion, E L; Raftery, P; Wendland, A; Dweh, E; Williams, G S; George, R N C; Soro, L; Katawera, V; Clement, P; Gasasira, A N; Musa, E; Nagbe, T K

2018-01-01

Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein. In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken. From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases. The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Infection surveillance after a natural disaster: lessons learnt from the Great East Japan Earthquake of 2011

PubMed Central

Oki, Tomoharu; Ishiki, Aiko; Shimanuki, Masaaki; Fuchimukai, Toru; Chosa, Toru; Chida, Shoichi; Nakamura, Yasuhide; Shima, Hiroji; Kanno, Michihiro; Matsuishi, Toyojiro; Ishiki, Mikihito; Urabe, Daisaku

2013-01-01

Abstract Problem On 11 March 2011, the Great East Japan Earthquake produced a catastrophic tsunami that devastated the city of Rikuzen-Takata and left it without an effective health infrastructure and at increased risk of outbreaks of disease. Approach On 2 May 2011, a disease-surveillance team was formed of volunteers who were clinicians or members of Rikuzen-Takata’s municipal government. The team’s main goal was to detect the early signs of disease outbreaks. Local setting Seven weeks after the tsunami, 16 support teams were providing primary health care in Rikuzen-Takata but the chain of command between them was poor and 70% of the city’s surviving citizens remained in evacuation centres. The communication tools that were available were generally inadequate. Relevant changes The surveillance team collected data from the city’s clinics by using a simple reporting form that could be completed without adding greatly to the workloads of clinicians. The summary findings were reported daily to clinics. The team also collaborated with public health nurses in rebuilding communication networks. Public health nurses alerted evacuation centres to epidemics of communicable disease. Lessons learnt Modern health-care systems are highly vulnerable to the loss of advanced technological tools. The initiation – or re-establishment – of disease surveillance following a natural disaster can therefore prove challenging even in a developed country. Surveillance should be promptly initiated after a disaster by (i) developing a surveillance system that is tailored to the local setting, (ii) establishing a support team network, and (iii) integrating the resources that remain – or soon become – locally available. PMID:24115802

Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review.

PubMed

French, C E; Coope, C; Conway, L; Higgins, J P T; McCulloch, J; Okoli, G; Patel, B C; Oliver, I

2017-01-01

In recent years, infections with carbapenemase-producing Enterobacteriaceae (CPE) have been increasing globally and present a major public health challenge. To review the international literature: (i) to describe CPE outbreaks in acute hospital settings globally; and (ii) to identify the control measures used during these outbreaks and report on their effectiveness. A systematic search of MEDLINE and EMBASE databases, abstract lists for key conferences and reference lists of key reviews was undertaken, and information on unpublished outbreaks was sought for 2000-2015. Where relevant, risk of bias was assessed using the Newcastle-Ottawa scale. A narrative synthesis of the evidence was conducted. Ninety-eight outbreaks were eligible. These occurred worldwide, with 53 reports from Europe. The number of cases (CPE infection or colonization) involved in outbreaks varied widely, from two to 803. In the vast majority of outbreaks, multi-component infection control measures were used, commonly including: patient screening; contact precautions (e.g. gowns, gloves); handwashing interventions; staff education or monitoring; enhanced environmental cleaning/decontamination; cohorting of patients and/or staff; and patient isolation. Seven studies were identified as providing the best-available evidence on the effectiveness of control measures. These demonstrated that CPE outbreaks can be controlled successfully using a range of appropriate, commonly used, infection control measures. However, risk of bias was considered relatively high for these studies. The findings indicate that CPE outbreaks can be controlled using combinations of existing measures. However, the quality of the evidence base is weak and further high-quality research is needed, particularly on the effectiveness of individual infection control measures. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Results of routine restaurant inspections can predict outbreaks of foodborne illness: the Seattle-King County experience.

PubMed Central

Irwin, K; Ballard, J; Grendon, J; Kobayashi, J

1989-01-01

To analyze the association between the results of routine inspections and foodborne outbreaks in restaurants, we conducted a matched case-control study using available data from Seattle-King County, Washington. Case restaurants were facilities with a reported foodborne outbreak between January 1, 1986 and March 31, 1987 (N = 28). Two control restaurants with no reported outbreaks during this period were matched to each case restaurant on county health district and date of routine inspection (N = 56). Data from the routine inspection that preceded the outbreak (for case restaurants) or the date-matched routine inspection (for control restaurants) were abstracted from computerized inspection records. Case restaurants had a significantly lower mean inspection score (83.8 on a 0 to 100 point scale) than control restaurants (90.9). Restaurants with poor inspection scores and violations of proper temperature controls of potentially hazardous foods were, respectively, five and ten times more likely to have outbreaks than restaurants with better results. Although this study demonstrates that Seattle-King County's routine inspection form can successfully identify restaurants at increased risk of foodborne outbreaks, it also illustrates that more emphasis on regulation and education is needed to prevent outbreaks in restaurants with poor inspection results. PMID:2705592

Update on Zika Virus: Considerations for the Traveling Athlete.

PubMed

Toresdahl, Brett G; Asif, Irfan M

2016-09-01

As public health experts work to contain the outbreak of Zika virus in South America and minimize the devastating prenatal complications, the international sports community prepares for the 2016 Summer Olympic and Paralympic Games in Rio de Janeiro, Brazil. Athletes have publicly expressed concern regarding the health risks of competition in Zika-endemic areas.(33) Ensuring the safety of the athletes during training and competition is the primary role of the team physician. Special consideration is needed for sports teams preparing for travel to areas affected by Zika virus. © 2016 The Author(s).

Revelations of an overt water contamination.

PubMed

Singh, Gurpreet; Kaushik, S K; Mukherji, S

2017-07-01

Contaminated water sources are major cause of water borne diseases of public health importance. Usually, contamination is suspected after an increase in patient load. Two health teams investigated the episode. First team conducted sanitary survey, and second team undertook water safety and morbidity survey. On-site testing was carried out from source till consumer end. Investigation was also undertaken to identify factors which masked the situation. Prevention and control measures included super chlorination, provision of alternate drinking water sources, awareness campaign, layout of new water pipeline bypassing place of contamination, repair of sewers, flushing and cleaning of water pipelines, and repeated water sampling and testing. Multiple sources of drinking water supply were detected. Water samples from consumer end showed 18 coliforms per 100 ml. Sewer cross connection with active leakage in water pipeline was found and this was confirmed by earth excavation. Water safety and morbidity survey found majority of households receiving contaminated water supply. This survey found no significant difference among households receiving contaminated water supply and those receiving clean water. Average proportion of household members with episode of loose motions, pain abdomen, vomiting, fever, and eye conditions was significantly more among households receiving contaminated water. The present study documents detailed methodology of investigation and control measures to be instituted on receipt of contaminated water samples. Effective surveillance mechanisms for drinking water supplies such as routine testing of water samples can identify water contamination at an early stage and prevent an impending outbreak.

Clostridium difficile outbreak in Costa Rica: control actions and associated factors.

PubMed

Wong-McClure, Roy A; Guevara-Rodríguez, Moraima; Abarca-Gómez, Leandra; Solano-Chinchilla, Antonio; Marchena-Picado, Margarita; O'Shea, Michele; Badilla-Vargas, Xiomara

2012-12-01

To describe interventions implemented during a nosocomial outbreak of Clostridium difficile in a general hospital in Costa Rica from December 2009 to April 2010 in order to achieve outbreak control and the factors determined to be associated with C. difficile infection. Laboratory-confirmed cases of C. difficile were analyzed to describe the outbreak pattern and intervention measures implemented. Cases were selected and recruited in a case-control study. Controls were selected from the same services and time period as the cases. Evaluated exposures included underlying medical conditions and treatments administered before the onset of symptoms. The mean ages in case and control groups were 62.3 and 55.3 years, respectively. Control measures included a hand-hygiene campaign, deep disinfection of hospital surfaces, strict isolation of cases, use of personal protection equipment, and restriction of antibiotic use. The adjusted attributable risks associated with the outbreak were diabetes [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.5-7.7], chronic renal failure (OR 9.0, 95% CI 1.5-53.0), and prescribing ceftazidime (OR 33.3, 95% CI 2.9-385.5) and cefotaxime (OR 20.4, 95% CI 6.9-60.3). Timely implementation of control measures resulted in reduced infection transmission and successful control of the outbreak. Conditions associated with C. difficile infection were similar to those found in previously described outbreaks of this bacterium.

Is hand hygiene frequency associated with the onset of outbreaks in pediatric long-term care?

PubMed

Cohen, Bevin; Murray, Meghan; Jia, Haomiao; Jackson, Olivia; Saiman, Lisa; Neu, Natalie; Hutcheon, Gordon; Larson, Elaine

2016-12-01

Studies in adult long-term care facilities (LTCFs) have shown a correlation between hand hygiene (HH) and viral outbreak reduction, but no such studies have been conducted in pediatric LTCFs where the epidemiology of viral pathogens is different. We compared electronically monitored facility-wide HH frequency in the weeks immediately prior to outbreaks of acute respiratory or gastrointestinal infections versus control weeks in a 137-bed pediatric LTCF from October 2012-August 2015. Control weeks were the 8-14 day (control 1) and 15-21 day (control 2) periods prior to the onset of each outbreak. There was no difference in HH frequency in the weeks leading up to the outbreaks versus control weeks (odds ratio [OR], 1.0; 95% confidence interval CI, 1.00-1.001 using control 1 and OR, 1.0; 95% CI, 1.00-1.001 using control 2). Our findings differed from those in adult LTFCs, possibly because of the greater contact between residents and staff in the pediatric setting, increased susceptibility to viral pathogens because of immunologic immaturity, or differences in the types of pathogens prevalent in each setting. Although HH may be important for limiting the number of residents infected during outbreaks, we found no association between HH frequency and subsequent outbreak onset. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Development of mobile laboratory for viral haemorrhagic fever detection in Africa.

PubMed

Weidmann, Manfred; Faye, Ousmane; Faye, Oumar; Abd El Wahed, Ahmed; Patel, Pranav; Batejat, Christophe; Manugerra, Jean Claude; Adjami, Aimee; Niedrig, Matthias; Hufert, Frank T; Sall, Amadou A

2018-06-15

In order to enable local response to viral haemorrhagic fever outbreaks a mobile laboratory transportable on commercial flights was developed. The development progressed from use of mobile real time RT-PCR to mobile Recombinase Polymerase Amplification (RT-RPA). The various stages of the mobile laboratory development are described. A brief overview of its deployments, which culminated in the first on site detection of Ebola virus disease (EVD) in March 2014 and a successful use in a campaign to roll back EVD cases in Conakry in the West-Africa Ebola virus outbreak are described. The developed mobile laboratory successfully enabled local teams to perform rapid viral haemorrhagic fever disgnostics.

Cluster of HIV Infections Attributed to Unsafe Injection Practices--Cambodia, December 1, 2014-February 28, 2015.

PubMed

Vun, Mean Chhi; Galang, Romeo R; Fujita, Masami; Killam, William; Gokhale, Runa; Pitman, John; Selenic, Dejana; Mam, Sovatha; Mom, Chandara; Fontenille, Didier; Rouet, Francois; Vonthanak, Saphonn

2016-02-19

In December 2014, local health authorities in Battambang province in northwest Cambodia reported 30 cases of human immunodeficiency virus (HIV) infection in a rural commune (district subdivision) where only four cases had been reported during the preceding year. The majority of cases occurred in residents of Roka commune. The Cambodian National Center for HIV/AIDS (acquired immunodeficiency syndrome), Dermatology and Sexually Transmitted Diseases (NCHADS) investigated the outbreak in collaboration with the University of Health Sciences in Phnom Penh and members of the Roka Cluster Investigation Team. By February 28, 2015, NCHADS had confirmed 242 cases of HIV infection among the 8,893 commune residents, an infection rate of 2.7%. Molecular investigation of the HIV strains present in this outbreak indicated that the majority of cases were linked to a single HIV strain that spread quickly within this community. An NCHADS case-control study identified medical injections and infusions as the most likely modes of transmission. In response to this outbreak, the Government of Cambodia has taken measures to encourage safe injection practices by licensed medical professionals, ban unlicensed medical practitioners, increase local capacity for HIV testing and counseling, and expand access to HIV treatment in Battambang province. Measures to reduce the demand for unnecessary medical injections and the provision of unsafe injections are needed. Estimates of national HIV incidence and prevalence might need to be adjusted to account for unsafe injection as a risk exposure.

Outbreak of Drug-Resistant Mycobacterium tuberculosis Among Homeless People in Atlanta, Georgia, 2008-2015

PubMed Central

VanderEnde, Daniel S.; Holland, David P.; Haddad, Maryam B.; Yarn, Benjamin; Yamin, Aliya S.; Mohamed, Omar; Sales, Rose-Marie F.; DiMiceli, Lauren E.; Burns-Grant, Gail; Reaves, Erik J.; Gardner, Tracie J.; Ray, Susan M.

2017-01-01

Objectives: Our objective was to describe and determine the factors contributing to a recent drug-resistant tuberculosis (TB) outbreak in Georgia. Methods: We defined an outbreak case as TB diagnosed from March 2008 through December 2015 in a person residing in Georgia at the time of diagnosis and for whom (1) the genotype of the Mycobacterium tuberculosis isolate was consistent with the outbreak strain or (2) TB was diagnosed clinically without a genotyped isolate available and connections were established to another outbreak-associated patient. To determine factors contributing to transmission, we interviewed patients and reviewed health records, homeless facility overnight rosters, and local jail booking records. We also assessed infection control measures in the 6 homeless facilities involved in the outbreak. Results: Of 110 outbreak cases in Georgia, 86 (78%) were culture confirmed and isoniazid resistant, 41 (37%) occurred in people with human immunodeficiency virus coinfection (8 of whom were receiving antiretroviral treatment at the time of TB diagnosis), and 10 (9%) resulted in TB-related deaths. All but 8 outbreak-associated patients had stayed overnight or volunteered extensively in a homeless facility; all these facilities lacked infection control measures. At least 9 and up to 36 TB cases outside Georgia could be linked to this outbreak. Conclusions: This article highlights the ongoing potential for long-lasting and far-reaching TB outbreaks, particularly among populations with untreated human immunodeficiency virus infection, mental illness, substance abuse, and homelessness. To prevent and control TB outbreaks, health departments should work with overnight homeless facilities to implement infection control measures and maintain searchable overnight rosters. PMID:28257261

Increase in outbreaks of gastroenteritis linked to bathing water in Finland in summer 2014

PubMed Central

Kauppinen, Ari; Al-Hello, Haider; Zacheus, Outi; Kilponen, Jaana; Maunula, Leena; Huusko, Sari; Lappalainen, Maija; Miettinen, Ilkka; Blomqvist, Soile; Rimhanen-Finne, Ruska

2017-01-01

An increased number of suspected outbreaks of gastroenteritis linked to bathing water were reported to the Finnish food- and waterborne outbreak (FWO) registry in July and August 2014. The investigation reports were assessed by a national outbreak investigation panel. Eight confirmed outbreaks were identified among the 15 suspected outbreaks linked to bathing water that had been reported to the FWO registry. According to the outbreak investigation reports, 1,453 persons fell ill during these outbreaks. Epidemiological and microbiological data revealed noroviruses as the main causative agents. During the outbreaks, exceptionally warm weather had boosted the use of beaches. Six of eight outbreaks occurred at small lakes; for those, the investigation strongly suggested that the beach users were the source of contamination. In one of those eight outbreaks, an external source of contamination was identified and elevated levels of faecal indicator bacteria (FIB) were noted in water. In the remaining outbreaks, FIB analyses were insufficient to describe the hygienic quality of the water. Restrictions against bathing proved effective in controlling the outbreaks. In spring 2015, the National Institute for Health and Welfare (THL) and the National Supervisory Authority for Welfare and Health (Valvira) published guidelines for outbreak control to prevent bathing water outbreaks. PMID:28251888

Use of palivizumab with other infection control measures to control respiratory syncytial virus outbreaks in neonatal care units.

PubMed

Hammoud, Majeda S; Al-Taiar, Abdullah; Raina, Aditiya; Elsori, Dalal; Al-Qabandi, Sarah; Al-Essa, Mazen

2016-10-01

No guidelines exist on the use of palivizumab during outbreaks of Respiratory Syncytial Virus (RSV) in Neonatal Intensive Care Units (NICUs). We aimed to describe an outbreak of RSV in NICU settings and the role of palivizumab in controlling the outbreak. The index case was a 30-day-old premature infant. During the outbreak, 13 cases of RSV were confirmed by RT-PCR. All infants in the NICU received palivizumab after RSV diagnosis. Of the 13 cases, seven were male; and the median (interquartile) of birth weight was 1585 (IQR: 1480-1705) g. All cases were premature under 34-weeks-gestation. Age at onset of disease varies between 10 and 160 days. Only four cases occurred after administering palivizumab and applying other infection control measures. During nosocomial outbreaks of RSV, administration of palivizumab to all infants in NICU appears to be rational and may help contain outbreaks. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done?

PubMed Central

Mwesawina, Maurice; Baluku, Yosia; Kanyanda, Setiala S. E.; Orach, Christopher Garimoi

2016-01-01

Introduction Cross-border cholera outbreaks are a major public health problem in Sub-Saharan Africa contributing to the high annual reported cholera cases and deaths. These outbreaks affect all categories of people and are challenging to prevent and control. This article describes lessons learnt during the cross-border cholera outbreak control in Eastern and Southern Africa sub-regions using the case of Uganda-DRC and Malawi-Mozambique borders and makes recommendations for future outbreak prevention and control. Materials and Methods We reviewed weekly surveillance data, outbreak response reports and documented experiences on the management of the most recent cross-border cholera outbreaks in Eastern and Southern Africa sub-regions, namely in Uganda and Malawi respectively. Uganda-Democratic Republic of Congo and Malawi-Mozambique borders were selected because the countries sharing these borders reported high cholera disease burden to WHO. Results A total of 603 cross-border cholera cases with 5 deaths were recorded in Malawi and Uganda in 2015. Uganda recorded 118 cases with 2 deaths and CFR of 1.7%. The under-fives and school going children were the most affected age groups contributing 24.2% and 36.4% of all patients seen along Malawi-Mozambique and Uganda-DRC borders, respectively. These outbreaks lasted for over 3 months and spread to new areas leading to 60 cases with 3 deaths, CRF of 5%, and 102 cases 0 deaths in Malawi and Uganda, respectively. Factors contributing to these outbreaks were: poor sanitation and hygiene, use of contaminated water, floods and rampant cross-border movements. The outbreak control efforts mainly involved unilateral measures implemented by only one of the affected countries. Conclusions Cross-border cholera outbreaks contribute to the high annual reported cholera burden in Sub-Saharan Africa yet they remain silent, marginalized and poorly identified by cholera actors (governments and international agencies). The under-fives and the school going children were the most affected age groups. To successfully prevent and control these outbreaks, guidelines and strategies should be reviewed to assign clear roles and responsibilities to cholera actors on collaboration, prevention, detection, monitoring and control of these epidemics. PMID:27258124

Outbreaks attributed to fresh leafy vegetables, United States, 1973–2012

PubMed Central

HERMAN, K. M.; HALL, A. J.; GOULD, L. H.

2015-01-01

SUMMARY Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20 003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing Escherichia coli (STEC) (18%), and Salmonella (11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation. PMID:25697407

Outbreaks attributed to fresh leafy vegetables, United States, 1973-2012.

PubMed

Herman, K M; Hall, A J; Gould, L H

2015-10-01

Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20 003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing Escherichia coli (STEC) (18%), and Salmonella (11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation.

Incorporating risk communication into highly pathogenic avian influenza preparedness and response efforts.

PubMed

Voss, Shauna J; Malladi, Sasidhar; Sampedro, Fernando; Snider, Tim; Goldsmith, Timothy; Hueston, William D; Lauer, Dale C; Halvorson, David A

2012-12-01

A highly pathogenic avian influenza (HPAI) outbreak in the United States will initiate a federal emergency response effort that will consist of disease control and eradication efforts, including quarantine and movement control measures. These movement control measures will not only apply to live animals but also to animal products. However, with current egg industry "just-in-time" production practices, limited storage is available to hold eggs. As a result, stop movement orders can have significant unintended negative consequences, including severe disruptions to the food supply chain. Because stakeholders' perceptions of risk vary, waiting to initiate communication efforts until an HPAI event occurs can hinder disease control efforts, including the willingness of producers to comply with the response, and also can affect consumers' demand for the product. A public-private-academic partnership was formed to assess actual risks involved in the movement of egg industry products during an HPAI event through product specific, proactive risk assessments. The risk analysis process engaged a broad representation of stakeholders and promoted effective risk management and communication strategies before an HPAI outbreak event. This multidisciplinary team used the risk assessments in the development of the United States Department of Agriculture, Highly Pathogenic Avian Influenza Secure Egg Supply Plan, a comprehensive response plan that strives to maintain continuity of business. The collaborative approach that was used demonstrates how a proactive risk communication strategy that involves many different stakeholders can be valuable in the development of a foreign animal disease response plan and build working relationships, trust, and understanding.

Outbreak detection and evaluation of a school-based influenza-like-illness syndromic surveillance in Tianjin, China.

PubMed

Xu, Wenti; Chen, Tianmu; Dong, Xiaochun; Kong, Mei; Lv, Xiuzhi; Li, Lin

2017-01-01

School-based influenza-like-illness (ILI) syndromic surveillance can be an important part of influenza community surveillance by providing early warnings for outbreaks and leading to a fast response. From September 2012 to December 2014, syndromic surveillance of ILI was carried out in 4 county-level schools. The cumulative sum methods(CUSUM) was used to detect abnormal signals. A susceptible-exposed-infectious/asymptomatic-recovered (SEIAR) model was fit to the influenza outbreak without control measures and compared with the actual influenza outbreak to evaluate the effectiveness of early control efforts. The ILI incidence rates in 2014 (14.51%) was higher than the incidence in 2013 (5.27%) and 2012 (3.59%). Ten school influenza outbreaks were detected by CUSUM. Each outbreak had high transmissibility with a median Runc of 4.62. The interventions in each outbreak had high effectiveness and all Rcon were 0. The early intervention had high effectiveness within the school-based ILI syndromic surveillance. Syndromic surveillance within schools can play an important role in controlling influenza outbreaks.

[Prompt control of an imported carbapenem-resistant Acinetobacter baumanii outbreak in a French intensive care unit].

PubMed

Guth, C; Cavalli, Z; Pernod, C; Lhopital, C; Wey, Pf; Gerome, P; Turc, J

2016-01-01

to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit. Careful review of the contact's and carrier's files and outbreak management procedures. An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions. restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.

School Public Relations and the SARS Epidemic in Toronto: An Interview with Brian Woodland.

ERIC Educational Resources Information Center

Partlow, Michelle Chaplin

2003-01-01

In an interview, a school district director of communication shares his experiences about the Severe Acute Respiratory Syndrome (SARS) outbreak in Ontario and offers timely advice for practitioners, including a proactive communications team and coordination of information with state and local health, police, and fire departments. (MLF)

Are staff management practices and inspection risk ratings associated with foodborne disease outbreaks in the catering industry in England and Wales?

PubMed

Jones, Sarah L; Parry, Sharon M; O'Brien, Sarah J; Palmer, Stephen R

2008-03-01

Despite structured enforcement of food hygiene requirements known to prevent foodborne disease outbreaks, catering businesses continue to be the most common setting for outbreaks in the United Kingdom. In a matched case control study of catering businesses, 148 businesses associated with outbreaks were compared with 148 control businesses. Hazard analysis critical control point systems and/or formal food hygiene training qualifications were not protective. Food hygiene inspection scores were not useful in predicting which catering businesses were associated with outbreaks. Businesses associated with outbreaks were more likely to be larger small and medium-sized enterprises (SMEs) or to serve Chinese cuisine and less likely to have the owner or manager working in the kitchen, but when size of the SME was taken into account these two differences were no longer significant. In larger businesses, case businesses were more likely to be hotels and were more commonly associated with viral foodborne outbreaks, but there was no explanation within the data for this association.

Lessons learned from Ebola Vaccine R&D during a public health emergency.

PubMed

Kieny, Marie-Paule

2018-02-16

In spite of a complete lack of Research and Development (R&D) preparedness, the 2013-2016 West-Africa Ebola experience demonstrated that it is possible to compress R&D timelines to less than a single year, from a more usual decade or longer. This is mostly to be credited to an unprecedented collaborative effort building on the availability of a small number of candidate diagnostic tests, drugs and vaccines that could be moved rapidly into the clinical phase evaluation. The World Health Organization (WHO) led international consultations and activities - including the organization of a successful Ebola vaccine efficacy trial in Guinea - as a contribution to the unprecedented global efforts to control the Ebola epidemic. Since 2015, WHO expert teams and partners are implementing a novel R&D model for emerging infectious pathogens which are the most likely to cause severe outbreaks in the future, and for which no or only few medical countermeasures are available: the WHO R&D Blueprint. The objective for the Blueprint is the fostering of a R&D environment which is prepared for quickly and effectively responding to outbreaks due to emerging infectious disease.

Control fast or control smart: When should invading pathogens be controlled?

PubMed

Thompson, Robin N; Gilligan, Christopher A; Cunniffe, Nik J

2018-02-01

The intuitive response to an invading pathogen is to start disease management as rapidly as possible, since this would be expected to minimise the future impacts of disease. However, since more spread data become available as an outbreak unfolds, processes underpinning pathogen transmission can almost always be characterised more precisely later in epidemics. This allows the future progression of any outbreak to be forecast more accurately, and so enables control interventions to be targeted more precisely. There is also the chance that the outbreak might die out without any intervention whatsoever, making prophylactic control unnecessary. Optimal decision-making involves continuously balancing these potential benefits of waiting against the possible costs of further spread. We introduce a generic, extensible data-driven algorithm based on parameter estimation and outbreak simulation for making decisions in real-time concerning when and how to control an invading pathogen. The Control Smart Algorithm (CSA) resolves the trade-off between the competing advantages of controlling as soon as possible and controlling later when more information has become available. We show-using a generic mathematical model representing the transmission of a pathogen of agricultural animals or plants through a population of farms or fields-how the CSA allows the timing and level of deployment of vaccination or chemical control to be optimised. In particular, the algorithm outperforms simpler strategies such as intervening when the outbreak size reaches a pre-specified threshold, or controlling when the outbreak has persisted for a threshold length of time. This remains the case even if the simpler methods are fully optimised in advance. Our work highlights the potential benefits of giving careful consideration to the question of when to start disease management during emerging outbreaks, and provides a concrete framework to allow policy-makers to make this decision.

[Critical role of clinical laboratories in hospital infection control].

PubMed

Yagi, Tetsuya

2010-11-01

The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections.

Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England.

PubMed

Hewitt, K A; Nalabanda, A; Cassell, J A

2015-05-01

Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.

The World Health Organization Global Health Emergency Workforce: What Role Will the United States Play?

PubMed

Burkle, Frederick M

2016-08-01

During the May 2016 World Health Assembly of 194 member states, the World Health Organization (WHO) announced the process of developing and launching emergency medical teams as a critical component of the global health workforce concept. Over 64 countries have either launched or are in the development stages of vetting accredited teams, both international and national, to provide surge support to national health systems through WHO Regional Organizations and the delivery of emergency clinical care to sudden-onset disasters and outbreak-affected populations. To date, the United States has not yet committed to adopting the emergency medical team concept in funding and registering an international field hospital level team. This article discusses future options available for health-related nongovernmental organizations and the required educational and training requirements for health care provider accreditation. (Disaster Med Public Health Preparedness. 2016;10:531-535).

A large outbreak of mumps in the postvaccine era.

PubMed

Wharton, M; Cochi, S L; Hutcheson, R H; Bistowish, J M; Schaffner, W

1988-12-01

During a county-wide mumps outbreak in Nashville, Tennessee, 332 cases of mumps were identified at a public high school (attack rate, 18.8%). A pep rally 17 d before the peak of the outbreak at a single public high school may have provided an opportunity for point-source exposure. A case-control study demonstrated that vaccine efficacy was 75% (we used provider-verified records and excluded students with a history of mumps disease). Although school records were nonuniform, mumps immunization status was correct, compared with provider-verified records, in at least 85% of both cases and controls. Parental reports were much less reliable. The cost of the outbreak was estimated at $154/case. Receiving mumps vaccine at a vaccine clinic held after the outbreak had peaked was associated with a decrease in risk of mumps disease. Thus, these clinics may have a role in the control of such outbreaks.

The potential of targeted antibody prophylaxis in SARS outbreak control: a mathematic analysis.

PubMed

Bogaards, Johannes Antonie; Putter, Hein; Jan Weverling, Gerrit; Ter Meulen, Jan; Goudsmit, Jaap

2007-03-01

Severe acute respiratory syndrome (SARS) coronavirus-like viruses continue to circulate in animal reservoirs. If new mutants of SARS coronavirus do initiate another epidemic, administration of prophylactic antibodies to risk groups may supplement the stringent isolation procedures that contained the first SARS outbreak. We developed a mathematical model to investigate the effects of hospital admission and targeted antibody prophylaxis on the reproduction number R, defined as the number of secondary cases generated by an index case, during different SARS outbreak scenarios. Assuming a basic reproduction number R(0)=3, admission of patients to hospital within 4.3 days of symptom onset is necessary to achieve outbreak control without the need to further reduce community-based transmission. Control may be enhanced by providing pre-exposure prophylaxis to contacts of hospitalized patients, and through contact tracing and provision of post-exposure prophylaxis. Antibody prophylaxis may also be employed to reduce R below one and thereby restrict outbreak size and duration. Patient isolation alone can be sufficient to control SARS outbreaks provided that the time from onset to admission is short. Antibody prophylaxis as supplemental measure generally allows for containment of higher R(0) values and restricts both the size and duration of an outbreak.

Surveillance and Outbreak Response Management System (SORMAS) to support the control of the Ebola virus disease outbreak in West Africa.

PubMed

Fähnrich, C; Denecke, K; Adeoye, O O; Benzler, J; Claus, H; Kirchner, G; Mall, S; Richter, R; Schapranow, M P; Schwarz, N; Tom-Aba, D; Uflacker, M; Poggensee, G; Krause, G

2015-03-26

In the context of controlling the current outbreak of Ebola virus disease (EVD), the World Health Organization claimed that 'critical determinant of epidemic size appears to be the speed of implementation of rigorous control measures', i.e. immediate follow-up of contact persons during 21 days after exposure, isolation and treatment of cases, decontamination, and safe burials. We developed the Surveillance and Outbreak Response Management System (SORMAS) to improve efficiency and timeliness of these measures. We used the Design Thinking methodology to systematically analyse experiences from field workers and the Ebola Emergency Operations Centre (EOC) after successful control of the EVD outbreak in Nigeria. We developed a process model with seven personas representing the procedures of EVD outbreak control. The SORMAS system architecture combines latest In-Memory Database (IMDB) technology via SAP HANA (in-memory, relational database management system), enabling interactive data analyses, and established SAP cloud tools, such as SAP Afaria (a mobile device management software). The user interface consists of specific front-ends for smartphones and tablet devices, which are independent from physical configurations. SORMAS allows real-time, bidirectional information exchange between field workers and the EOC, ensures supervision of contact follow-up, automated status reports, and GPS tracking. SORMAS may become a platform for outbreak management and improved routine surveillance of any infectious disease. Furthermore, the SORMAS process model may serve as framework for EVD outbreak modeling.

Early detection and control of an Acinetobacter baumannii multi-resistant outbreak in a hospital in Quito, Ecuador.

PubMed

Cartelle Gestal, Monica; Zurita, Jeannete; Gualpa, Gabriela; Gonzalez, Cecibel; Paz Y Mino, Ariane

2016-12-30

Acinetobacter baumannii (ABA) is an important opportunistic pathogen associated with high mortality rates in intensive care units (ICUs). An outbreak in the ICU of a secondary-level hospital in Quito, Ecuador, occurred during April and May 2015 and was successfully controlled. Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) and repetitive element palindromic (REP)-PCR was conducted on all isolates recovered from patients, as well as environmental samples, to confirm the presence of an outbreak. A case-control study was conducted by comparing the clinical histories of the affected patients and of control patients present in the ICU during the outbreak period who did not present a positive culture for ABA. Five patients were infected and two were colonized with the same clonal strain of ABA, which was also identified on the stethoscope and a monitor associated with an isolation room. Statistical analysis of case histories did not identify any additional risk factors, but the outbreak was initiated by one patient in the isolation room of the ICU who was infected with the outbreak strain. All patients who ocupied that room after the index case tested positive for at least one culture of ABA. The outbreak strain was found on the stethoscope, and a subclone was found on the monitor of that room. Having access to basic equipment will enable well-trained professionals to rapidly detect and initiate the control process of an outbreak, saving lives and money spent on nosocomial infection treatments.

Evaluating the effects of common control measures for influenza A (H1N1) outbreak at school in China: A modeling study.

PubMed

Chen, Tianmu; Huang, Yuanxiu; Liu, Ruchun; Xie, Zhi; Chen, Shuilian; Hu, Guoqing

2017-01-01

Influenza A (H1N1) outbreaks have become common at schools in China since 2009. However, the effects of common countermeasures for school influenza outbreak have not been quantified so far, including isolation, vaccination, antivirus and school closure. We conducted a mathematically modeling study to address this unsolved issue. We collected data of all small-scale school outbreaks caused by influenza A that occurred in Changsha city between January 2009 and December 2013. Two outbreaks (one was in 2009 and the other one was in 2013) were used for simulating the effects of single and combined use of common measures, including isolation (Iso), therapeutics (T), prophylactics (P), vaccinating 70% of susceptible individuals prior to the outbreak (VP70), vaccinating 70% of susceptible individuals every day during the outbreak (VD70) and school closure of one week (S1w). A susceptible-exposed-infectious/asymptomatic-recovered (SEIR) model was developed to implement the simulations based on the natural history of influenza A. When no control measures are taken, the influenza is expected to spread quickly at school for the selected outbreak in 2013; the outbreak would last 56 days, and the total attack rate (TAR) would reach up to 46.32% (95% CI: 46.12-46.52). Of all single control measures, VP70 is most effective to control the epidemic (TAR = 8.68%), followed by VP50, VD70, VD50 and Iso. The use of VP70 with any other measure can reduce TAR to 3.37-14.04% and showed better effects than any other combination of two kinds of measures. The best two-measure combination is 'S1w+VP70' (TAR = 3.37%, DO = 41 days). All combinations of three kinds of measures were not satisfactory when Vp70 and VD70 were excluded. The most effective three-intervention combination was 'Iso+S1w+VP70' (with TAR = 3.23%). When VP70 or VD70 is included, the combinations of four or five kinds of interventions are very effective, reducing TAR to lower than 5%. But the TAR of combination of 'T+P+Iso+S1w' is 23.20%. Similar simulation results were observed for the selected outbreak in 2009. Vaccinating no less than 70% of individuals prior to the outbreak and isolation are recommended as single measures to control H1N1outbreak at school. The combination of VP70+S1w can achieve very good control for school outbreak.

Scabies: Prevention and Control

MedlinePlus

... and General Public. Contact Us Parasites Home Prevention & Control Recommend on Facebook Tweet Share Compartir When a ... avoid outbreaks. Institutional outbreaks can be difficult to control and require a rapid, aggressive, and sustained response. ...

Ebola virus disease in Africa: epidemiology and nosocomial transmission.

PubMed

Shears, P; O'Dempsey, T J D

2015-05-01

The 2014 Ebola outbreak in West Africa, primarily affecting Guinea, Sierra Leone, and Liberia, has exceeded all previous Ebola outbreaks in the number of cases and in international response. There have been 20 significant outbreaks of Ebola virus disease in Sub-Saharan Africa prior to the 2014 outbreak, the largest being that in Uganda in 2000, with 425 cases and a mortality of 53%. Since the first outbreaks in Sudan and Zaire in 1976, transmission within health facilities has been of major concern, affecting healthcare workers and acting as amplifiers of spread into the community. The lack of resources for infection control and personal protective equipment are the main reasons for nosocomial transmission. Local strategies to improve infection control, and a greater understanding of local community views on the disease, have helped to bring outbreaks under control. Recommendations from previous outbreaks include improved disease surveillance to enable more rapid health responses, the wider availability of personal protective equipment, and greater international preparedness. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Trends of major disease outbreaks in the African region, 2003-2007.

PubMed

Kebede, Senait; Duales, Sambe; Yokouide, Allarangar; Alemu, Wondimagegnehu

2010-03-01

Communicable disease outbreaks cause millions of deaths throughout Sub-Saharan Africa each year. Most of the diseases causing epidemics in the region have been nearly eradicated or brought under control in other parts of the world. In recent years, considerable effort has been directed toward public health initiatives and strategies with a potential for significant impact in the fight against infectious diseases. In 1998, the World Health Organization African Regional Office (WHO/AFRO) launched the Integrated Disease Surveillance and Response (IDSR) strategy aimed at mitigating the impact of communicable diseases, including epidemic-prone diseases, through improving surveillance, laboratory confirmation and appropriate and timely public health interventions. Over the past decade, WHO and its partners have been providing technical and financial resources to African countries to strengthen epidemic preparedness and response (EPR) activities. This review examined the major epidemics reported to WHO/AFRO from 2003 to 2007. we conduct a review of documents and reports obtained from WHO/AFRO, WHO inter-country team, and partners and held meeting and discussions with key stakeholders to elicit the experiences of local, regional and international efforts against these epidemics to evaluate the lessons learned and to stimulate discussion on the future course for enhancing EPR. The most commonly reported epidemic outbreaks in Africa include: cholera, dysentery, malaria and hemorrhagic fevers (e.g. Ebola, Rift Valley fever, Crimean-Congo fever and yellow fever). The cyclic meningococcal meningitis outbreak that affects countries along the "meningitis belt" (spanning Sub-Saharan Africa from Senegal and The Gambia to Kenya and Ethiopia) accounts for other major epidemics in the region. The reporting of disease outbreaks to WHO/AFRO has improved since the launch of the IDSR strategy in 1998. Although the epidemic trends for cholera showed a decline in case fatality rate (CFR) suggesting improvement in detection and quality of response by the health sector, the number of countries affected has increased. Major epidemic diseases continue to occur in most countries in the region. Among the major challenges to overcome are: poor coordination of EPR, weak public health infrastructure, lack of trained workers and inconsistent supply of diagnostic, treatment and prevention commodities. To successfully reduce the levels of morbidity and mortality resulting from epidemic outbreaks, urgent and long-term investments are needed to strengthen capacities for early detection and timely and effective response. Effective advocacy, collaboration and resource mobilization efforts involving local health officials, governments and the international community are critically needed to reduce the heavy burden of disease outbreaks on African populations.

Population control methods in stochastic extinction and outbreak scenarios.

PubMed

Segura, Juan; Hilker, Frank M; Franco, Daniel

2017-01-01

Adaptive limiter control (ALC) and adaptive threshold harvesting (ATH) are two related control methods that have been shown to stabilize fluctuating populations. Large variations in population abundance can threaten the constancy and the persistence stability of ecological populations, which may impede the success and efficiency of managing natural resources. Here, we consider population models that include biological mechanisms characteristic for causing extinctions on the one hand and pest outbreaks on the other hand. These models include Allee effects and the impact of natural enemies (as is typical of forest defoliating insects). We study the impacts of noise and different levels of biological parameters in three extinction and two outbreak scenarios. Our results show that ALC and ATH have an effect on extinction and outbreak risks only for sufficiently large control intensities. Moreover, there is a clear disparity between the two control methods: in the extinction scenarios, ALC can be effective and ATH can be counterproductive, whereas in the outbreak scenarios the situation is reversed, with ATH being effective and ALC being potentially counterproductive.

Epidemiologic, Virologic, and Host Genetic Factors of Norovirus Outbreaks in Long-term Care Facilities

PubMed Central

Costantini, Veronica P.; Cooper, Emilie M.; Hardaker, Hope L.; Lee, Lore E.; Bierhoff, Marieke; Biggs, Christianne; Cieslak, Paul R.; Hall, Aron J.; Vinjé, Jan

2018-01-01

Background In the Unites States, long-term care facilities (LTCFs) are the most common setting for norovirus outbreaks. These outbreaks provide a unique opportunity to better characterize the viral and host characteristics of norovirus disease. Methods We enrolled 43 LTCFs prospectively to study the epidemiology, virology, and genetic host factors of naturally occurring norovirus outbreaks. Acute and convalescent stool, serum, and saliva samples from cases, exposed and nonexposed controls were collected. Norovirus infection was confirmed using quantitative polymerase chain reaction testing of stool samples or 4-fold increase in serum antibody titers. The presence of histo-blood group antigens (secretor, ABO, and Lewis type) was determined in saliva. Results Sixty-two cases, 34 exposed controls, and 18 nonexposed controls from 10 norovirus outbreaks were enrolled. Forty-six percent of acute, 27% of convalescent case, and 11% of control stool samples tested norovirus positive. Outbreak genotypes were GII.4 (Den Haag, n = 3; New Orleans, n = 4; and Sydney, n = 2) and GI.1 (n = 1). Viral load in GII.4 Sydney outbreaks was significantly higher than in outbreaks caused by other genotypes; cases and controls shed similar amounts of virus. Forty-seven percent of cases shed virus for ≥21 days. Symptomatic infections with GII.4 Den Haag and GII.4 New Orleans were detected among nonsecretor individuals. Conclusions Almost half of all symptomatic individuals shed virus for at least 21 days. Viral load was highest in GII.4 viruses that most recently emerged; these viruses also infect the nonsecretor population. These findings will help to guide development of targeted prevention and control measures in the elderly. PMID:26508509

Large outbreak caused by methicillin resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital--from outbreak control to outbreak prevention.

PubMed

Grönthal, Thomas; Moodley, Arshnee; Nykäsenoja, Suvi; Junnila, Jouni; Guardabassi, Luca; Thomson, Katariina; Rantala, Merja

2014-01-01

The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP) ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 - January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented. Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing. Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3-17.0, P = 0.0003), antimicrobial treatment (OR = 3.8, CI95% 1.0-13.9, P = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1-1.6, P = 0.0007) or in the surgery ward (OR = 1.1, CI95% 1.0-1.3, P = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission. Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring MRSP. Rigorous control measures were needed to control the outbreak. We recommend the implementation of a search-and-isolate policy to reduce the burden of MRSP.

Outbreak of multidrug-resistant Escherichia coli sequence type 131 in a neonatal intensive care unit: efficient active surveillance prevented fatal outcome.

PubMed

Silwedel, C; Vogel, U; Claus, H; Glaser, K; Speer, C P; Wirbelauer, J

2016-06-01

Outbreaks of infections with multidrug-resistant bacteria in neonatal intensive care units (NICUs) pose a major threat, especially to extremely preterm infants. This study describes a 35-day outbreak of multidrug-resistant Escherichia coli (E. coli) in a tertiary-level NICU in Germany. To underline the importance of surveillance policies in the particularly vulnerable cohort of preterm infants and to describe the efficacy of outbreak control strategies. Data were collected retrospectively from medical reports. Infants and environment were tested for E. coli. The outbreak affected a total of 13 infants between 25(+1) and 35(+0) weeks of gestation with seven infants showing signs of infection. The outbreak strain was identified as E. coli sequence type 131. Environmental screening provided no evidence for an environmental source. Through colonization surveillance and immediate and adequate treatment of potentially infected preterm infants, no fatalities occurred. Outbreak control was achieved by strict contact precautions, enhanced screening and temporary relocation of the NICU. Relocation and reconstruction improved the NICU's structural layout, focusing on isolation capacities. Follow-up indicated carriage for several months in some infants. Routine surveillance allowed early detection of the outbreak. The identification of carriers of the outbreak strain was successfully used to direct antibiotic treatment in case of infection. Enhanced hygienic measures and ward relocation were instrumental in controlling the outbreak. Copyright © 2016. Published by Elsevier Ltd.

DISEASE OUTBREAKS CAUSED BY DRINKING WATER

EPA Science Inventory

Thirty-two waterborne disease outbreaks were reported to the Centers for Disease Control (CDC) and the Environmental Protection Agency in 1981. The outbreaks occurred in 17 states and involved 4430 cases. This was only 64% of the number of outbreaks that were reported in 1980 and...

Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada.

PubMed

Mahmud, Salaheddin M; Thompson, Laura H; Nowicki, Deborah L; Plourde, Pierre J

2013-11-01

Outbreaks of influenza-like illness (ILI) are common in long-term care facilities (LTCFs) and result in significant morbidity and mortality among residents. We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents' death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Of a total of 154 reported outbreaks, most (N=80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Influenza-like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks. © 2012 John Wiley & Sons Ltd.

A six-month Serratia marcescens outbreak in a Neonatal Intensive Care Unit.

PubMed

Morillo, Áurea; González, Verónica; Aguayo, Josefa; Carreño, Concepción; Torres, María José; Jarana, Daniel; Artacho, María José; Jiménez, Francisco; Conde, Manuel; Aznar, Javier

2016-12-01

To investigate a Serratia marcescens (S. marcescens) outbreak in a Neonatal Unit in a tertiary university hospital. Descriptive study of children admitted to the Unit with S. marcescens infection from November 2012 to March 2013. Conventional microbiological methods for clinical and environmental samples were used. The clonal relationship between all available isolates was established by molecular methods. A multidisciplinary team was formed, and preventive measures were taken. S. marcescens was isolated from 18 children. The overall attack rate was 12%, and the case fatality rate in the Intensive Care Unit was 23.5%. The most prevalent types of infections were pneumonia (6), conjunctivitis (6), and bloodstream infection (5). Clinical isolates and environmental isolates obtained from an incubator belonged to a unique clone. The clonal relationship between all S. marcescens strains helped us to identify the possible source of the outbreak. Isolation of S. marcescens from stored water in a container, and from the surface of an incubator after cleaning, suggests a possible environmental source as the outbreak origin, which has been perpetuated due to a failure of cleaning methods in the Unit. The strict hygiene and cleaning measures were the main factors that contributed to the end of the outbreak. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Measles outbreak response decision-making under uncertainty: a retrospective analysis.

PubMed

Fonnesbeck, Christopher J; Shea, Katriona; Carran, Spencer; Cassio de Moraes, Jose; Gregory, Christopher; Goodson, James L; Ferrari, Matthew J

2018-03-01

Resurgent outbreaks of vaccine-preventable diseases that have previously been controlled or eliminated have been observed in many settings. Reactive vaccination campaigns may successfully control outbreaks but must necessarily be implemented in the face of considerable uncertainty. Real-time surveillance may provide critical information about at-risk population and optimal vaccination targets, but may itself be limited by the specificity of disease confirmation. We propose an integrated modelling approach that synthesizes historical demographic and vaccination data with real-time outbreak surveillance via a dynamic transmission model and an age-specific disease confirmation model. We apply this framework to data from the 1996-1997 measles outbreak in São Paulo, Brazil. To simulate the information available to decision-makers, we truncated the surveillance data to what would have been available at 1 or 2 months prior to the realized interventions. We use the model, fitted to real-time observations, to evaluate the likelihood that candidate age-targeted interventions could control the outbreak. Using only data available prior to the interventions, we estimate that a significant excess of susceptible adults would prevent child-targeted campaigns from controlling the outbreak and that failing to account for age-specific confirmation rates would underestimate the importance of adult-targeted vaccination. © 2018 The Author(s).

Mass poisoning after consumption of a hawksbill turtle, Federated States of Micronesia, 2010.

PubMed

Pavlin, Boris I; Musto, Jennie; Pretrick, Moses; Sarofalpiy, Joannes; Sappa, Perpetua; Shapucy, Siana; Kool, Jacobus

2015-01-01

Marine turtles of all species are capable of being toxic. On 17 October 2010, health authorities in the Federated States of Micronesia were notified of the sudden death of three children and the sickening of approximately 20 other people on Murilo Atoll in Chuuk State. The illnesses were suspected to be the result of mass consumption of a hawksbill turtle (Eretmochelys imbricata). An investigation team was assembled to confirm the cause of the outbreak, describe the epidemiology of cases and provide recommendations for control. We conducted chart reviews, interviewed key informants, collected samples for laboratory analysis, performed environmental investigations and conducted a cohort study. Four children and two adults died in the outbreak and 95 others were sickened; 84% of those who ate the turtle became ill (n = 101). The relative risk for developing illness after consuming the turtle was 11.1 (95% confidence inteval: 4.8-25.9); there was a dose-dependent relationship between amount of turtle meat consumed and risk of illness. Environmental and epidemiological investigations revealed no alternative explanation for the mass illness. Laboratory testing failed to identify a causative agent. We concluded that turtle poisoning (also called chelonitoxism) was the cause of the outbreak on Murilo. The range of illness described in this investigation is consistent with previously reported cases of chelonitoxism. This devastating incident highlights the dangers, particularly to children, of consuming turtle meat. Future incidents are certain to occur unless action is taken to alter turtle-eating behaviour in coastal communities throughout the world.

Mass poisoning after consumption of a hawksbill turtle, Federated States of Micronesia, 2010

PubMed Central

Musto, Jennie; Pretrick, Moses; Sarofalpiy, Joannes; Sappa, Perpetua; Shapucy, Siana; Kool, Jacobus

2015-01-01

Background Marine turtles of all species are capable of being toxic. On 17 October 2010, health authorities in the Federated States of Micronesia were notified of the sudden death of three children and the sickening of approximately 20 other people on Murilo Atoll in Chuuk State. The illnesses were suspected to be the result of mass consumption of a hawksbill turtle (Eretmochelys imbricata). An investigation team was assembled to confirm the cause of the outbreak, describe the epidemiology of cases and provide recommendations for control. Methods We conducted chart reviews, interviewed key informants, collected samples for laboratory analysis, performed environmental investigations and conducted a cohort study. Results Four children and two adults died in the outbreak and 95 others were sickened; 84% of those who ate the turtle became ill (n = 101). The relative risk for developing illness after consuming the turtle was 11.1 (95% confidence inteval: 4.8–25.9); there was a dose-dependent relationship between amount of turtle meat consumed and risk of illness. Environmental and epidemiological investigations revealed no alternative explanation for the mass illness. Laboratory testing failed to identify a causative agent. Conclusion We concluded that turtle poisoning (also called chelonitoxism) was the cause of the outbreak on Murilo. The range of illness described in this investigation is consistent with previously reported cases of chelonitoxism. This devastating incident highlights the dangers, particularly to children, of consuming turtle meat. Future incidents are certain to occur unless action is taken to alter turtle-eating behaviour in coastal communities throughout the world. PMID:26045970

Auditing the management of vaccine-preventable disease outbreaks: the need for a tool.

PubMed

Torner, Nuria; Carnicer-Pont, Dolors; Castilla, Jesus; Cayla, Joan; Godoy, Pere; Dominguez, Angela

2011-01-13

Public health activities, especially infectious disease control, depend on effective teamwork. We present the results of a pilot audit questionnaire aimed at assessing the quality of public health services in the management of VPD outbreaks. Audit questionnaire with three main areas indicators (structure, process and results) was developed. Guidelines were set and each indicator was assessed by three auditors. Differences in indicator scores according to median size of outbreaks were determined by ANOVA (significance at p≤0.05). Of 154 outbreaks; eighteen indicators had a satisfactory mean score, indicator "updated guidelines" and "timely reporting" had a poor mean score (2.84±106 and 2.44±1.67, respectively). Statistically significant differences were found according to outbreak size, in the indicators "availability of guidelines/protocol updated less than 3 years ago" (p = 0.03) and "days needed for outbreak control" (p = 0.04). Improving availability of updated guidelines, enhancing timely reporting and adequate recording of control procedures taken is needed to allow for management assessment and improvement.

The economic cost of measles: Healthcare, public health and societal costs of the 2012-13 outbreak in Merseyside, UK.

PubMed

Ghebrehewet, Sam; Thorrington, Dominic; Farmer, Siobhan; Kearney, James; Blissett, Deidre; McLeod, Hugh; Keenan, Alex

2016-04-04

Measles is a highly contagious vaccine-preventable infection that caused large outbreaks in England in 2012 and 2013 in areas which failed to achieve herd protection levels (95%) consistently. We sought to quantify the economic costs associated with the 2012-13 Merseyside measles outbreak, relative to the cost of extending preventative vaccination to secure herd protection. A costing model based on a critical literature review was developed. A workshop and interviews were held with key stakeholders in the Merseyside outbreak to understand the pathway of a measles case and then quantify healthcare activity and costs for the main NHS providers and public health team incurred during the initial four month period to May 2012. These data were used to model the total costs of the full outbreak to August 2013, comprising those to healthcare providers for patient treatment, public health and societal productivity losses. The modelled total cost of the full outbreak was compared to the cost of extending the preventative vaccination programme to achieve herd protection. The Merseyside outbreak included 2458 reported cases. The estimated cost of the outbreak was £ 4.4m (sensitivity analysis £ 3.9 m to £ 5.2m) comprising 15% (£ 0.7 m) NHS patient treatment costs, 40% (£ 1.8m) public health costs and 44% (£ 2.0m) for societal productivity losses. In comparison, over the previous five years in Cheshire and Merseyside a further 11,793 MMR vaccinations would have been needed to achieve herd protection at an estimated cost of £ 182,909 (4% of the total cost of the measles outbreak). Failure to consistently reach MMR uptake levels of 95% across all localities and sectors (achieve herd protection) risks comparatively higher economic costs associated with the containment (including healthcare costs) and implementation of effective public health management of outbreaks. Commissioned by the Cheshire and Merseyside Public Health England Centre. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

An assessment of the ability of routine restaurant inspections to predict food-borne outbreaks in Miami-Dade County, Florida.

PubMed Central

Cruz, M A; Katz, D J; Suarez, J A

2001-01-01

OBJECTIVES: This study sought to determine the usefulness of restaurant inspections in predicting food-borne outbreaks in Miami-Dade County, Fla. METHODS: Inspection reports of restaurants with outbreaks in 1995 (cases; n = 51) were compared with those of randomly selected restaurants that had no reported outbreaks (controls; n = 76). RESULTS: Cases and controls did not differ by overall inspection outcome or mean number of critical violations. Only 1 critical violation--evidence of vermin--was associated with outbreaks (odds ratio = 3.3; 95% confidence interval = 1.1, 13.1). CONCLUSIONS: Results of restaurant inspections in Miami-Dade County did not predict outbreaks. If these findings are representative of the situation in other jurisdictions, inspection practices may need to be updated. PMID:11344897

A Participatory System for Preventing Pandemics of Animal Origins: Pilot Study of the Participatory One Health Disease Detection (PODD) System

PubMed Central

Yano, Terdsak; Phornwisetsirikun, Somphorn; Susumpow, Patipat; Visrutaratna, Surasing; Chanachai, Karoon; Phetra, Polawat; Chaisowwong, Warangkhana; Trakarnsirinont, Pairat; Hemwan, Phonpat; Kaewpinta, Boontuan; Singhapreecha, Charuk; Kreausukon, Khwanchai; Charoenpanyanet, Arisara ; Robert, Chongchit Sripun; Robert, Lamar; Rodtian, Pranee; Mahasing, Suteerat; Laiya, Ekkachai; Pattamakaew, Sakulrat; Tankitiyanon, Taweesart; Sansamur, Chalutwan

2018-01-01

Background Aiming for early disease detection and prompt outbreak control, digital technology with a participatory One Health approach was used to create a novel disease surveillance system called Participatory One Health Disease Detection (PODD). PODD is a community-owned surveillance system that collects data from volunteer reporters; identifies disease outbreak automatically; and notifies the local governments (LGs), surrounding villages, and relevant authorities. This system provides a direct and immediate benefit to the communities by empowering them to protect themselves. Objective The objective of this study was to determine the effectiveness of the PODD system for the rapid detection and control of disease outbreaks. Methods The system was piloted in 74 LGs in Chiang Mai, Thailand, with the participation of 296 volunteer reporters. The volunteers and LGs were key participants in the piloting of the PODD system. Volunteers monitored animal and human diseases, as well as environmental problems, in their communities and reported these events via the PODD mobile phone app. LGs were responsible for outbreak control and provided support to the volunteers. Outcome mapping was used to evaluate the performance of the LGs and volunteers. Results LGs were categorized into one of the 3 groups based on performance: A (good), B (fair), and C (poor), with the majority (46%,34/74) categorized into group B. Volunteers were similarly categorized into 4 performance groups (A-D), again with group A showing the best performance, with the majority categorized into groups B and C. After 16 months of implementation, 1029 abnormal events had been reported and confirmed to be true reports. The majority of abnormal reports were sick or dead animals (404/1029, 39.26%), followed by zoonoses and other human diseases (129/1029, 12.54%). Many potentially devastating animal disease outbreaks were detected and successfully controlled, including 26 chicken high mortality outbreaks, 4 cattle disease outbreaks, 3 pig disease outbreaks, and 3 fish disease outbreaks. In all cases, the communities and animal authorities cooperated to apply community contingency plans to control these outbreaks, and community volunteers continued to monitor the abnormal events for 3 weeks after each outbreak was controlled. Conclusions By design, PODD initially targeted only animal diseases that potentially could emerge into human pandemics (eg, avian influenza) and then, in response to community needs, expanded to cover human health and environmental health issues. PMID:29563079

A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management.

PubMed Central

Rooney, Roisin M.; Cramer, Elaine H.; Mantha, Stacey; Nichols, Gordon; Bartram, Jamie K.; Farber, Jeffrey M.; Benembarek, Peter K.

2004-01-01

OBJECTIVE: Foodborne disease outbreaks on ships are of concern because of their potentially serious health consequences for passengers and crew and high costs to the industry. The authors conducted a review of outbreaks of foodborne diseases associated with passenger ships in the framework of a World Health Organization project on setting guidelines for ship sanitation. METHODS: The authors reviewed data on 50 outbreaks of foodborne disease associated with passenger ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and food vehicles were collected. RESULTS: The findings of this review show that the majority of reported outbreaks were associated with cruise ships and that almost 10,000 people were affected. Salmonella spp were most frequently associated with outbreaks. Foodborne outbreaks due to enterotoxigenic E. coli spp, Shigella spp, noroviruses (formally called Norwalk-like viruses), Vibrio spp, Staphylococcus aureus, Clostridium perfringens, Cyclospora sp, and Trichinella sp also occurred on ships. Factors associated with the outbreaks reviewed include inadequate temperature control, infected food handlers, contaminated raw ingredients, cross-contamination, inadequate heat treatment, and onshore excursions. Seafood was the most common food vehicle implicated in outbreaks. CONCLUSIONS: Many ship-associated outbreaks could have been prevented if measures had been taken to ensure adequate temperature control, avoidance of cross-contamination, reliable food sources, adequate heat treatment, and exclusion of infected food handlers from work. PMID:15219800

A review of outbreaks of foodborne disease associated with passenger ships: evidence for risk management.

PubMed

Rooney, Roisin M; Cramer, Elaine H; Mantha, Stacey; Nichols, Gordon; Bartram, Jamie K; Farber, Jeffrey M; Benembarek, Peter K

2004-01-01

Foodborne disease outbreaks on ships are of concern because of their potentially serious health consequences for passengers and crew and high costs to the industry. The authors conducted a review of outbreaks of foodborne diseases associated with passenger ships in the framework of a World Health Organization project on setting guidelines for ship sanitation. The authors reviewed data on 50 outbreaks of foodborne disease associated with passenger ships. For each outbreak, data on pathogens/toxins, type of ship, factors contributing to outbreaks, mortality and morbidity, and food vehicles were collected. The findings of this review show that the majority of reported outbreaks were associated with cruise ships and that almost 10,000 people were affected. Salmonella spp were most frequently associated with outbreaks. Foodborne outbreaks due to enterotoxigenic E. coli spp, Shigella spp, noroviruses (formally called Norwalk-like viruses), Vibrio spp, Staphylococcus aureus, Clostridium perfringens, Cyclospora sp, and Trichinella sp also occurred on ships. Factors associated with the outbreaks reviewed include inadequate temperature control, infected food handlers, contaminated raw ingredients, cross-contamination, inadequate heat treatment, and onshore excursions. Seafood was the most common food vehicle implicated in outbreaks. Many ship-associated outbreaks could have been prevented if measures had been taken to ensure adequate temperature control, avoidance of cross-contamination, reliable food sources, adequate heat treatment, and exclusion of infected food handlers from work.

Challenges with controlling varicella in prison settings: Experience of California, 2010–2011

PubMed Central

Leung, Jessica; Lopez, Adriana S.; Tootell, Elena; Baumrind, Nikki; Mohle-Boetani, Janet; Leistikow, Bruce; Harriman, Kathleen H.; Preas, Christopher P.; Cosentino, Giorgio; Bialek, Stephanie R.; Marin, Mona

2015-01-01

We describe the epidemiology of varicella in one state prison in California during 2010–2011, control measures implemented, and associated costs. Eleven varicella cases were reported, 9 associated with 2 outbreaks. One outbreak consisted of 3 cases and the second consisted of 6 cases with 2 generations of spread. Among exposed inmates serologically tested, 98% (643/656) were VZV sero-positive. The outbreaks resulted in >1,000 inmates exposed, 444 staff exposures, and >$160,000 in costs. We documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary for managing cases and outbreaks. PMID:25201912

A local outbreak of dengue caused by an imported case in Dongguan China

PubMed Central

2012-01-01

Background Dengue, a mosquito-borne febrile viral disease, is found in tropical and sub-tropical regions around the world. Since the first occurrence of dengue was confirmed in Guangdong, China in 1978, dengue outbreaks have been reported sequentially in different provinces in South China transmitted by.peridomestic Ae. albopictus mosquitoes, diplaying Ae. aegypti, a fully domestic vector that transmits dengue worldwide. Rapid and uncontrolled urbanization is a characteristic change in developing countries, which impacts greatly on vector habitat, human lifestyle and transmission dynamics on dengue epidemics. In September 2010, an outbreak of dengue was detected in Dongguan, a city in Guangdong province characterized by its fast urbanization. An investigation was initiated to identify the cause, to describe the epidemical characteristics of the outbreak, and to implement control measures to stop the outbreak. This is the first report of dengue outbreak in Dongguan, even though dengue cases were documented before in this city. Methods Epidemiological data were obtained from local Center of Disease Control and prevention (CDC). Laboratory tests such as real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR), the virus cDNA sequencing, and Enzyme-Linked immunosorbent assay (ELISA) were employed to identify the virus infection and molecular phylogenetic analysis was performed with MEGA5. The febrile cases were reported every day by the fever surveillance system. Vector control measures including insecticidal fogging and elimination of habitats of Ae. albopictus were used to control the dengue outbreak. Results The epidemiological studies results showed that this dengue outbreak was initiated by an imported case from Southeast Asia. The outbreak was characterized by 31 cases reported with an attack rate of 50.63 out of a population of 100,000. Ae. albopictus was the only vector species responsible for the outbreak. The virus cDNA sequencing analysis showed that the virus responsible for the outbreak was Dengue Virus serotype-1 (DENV-1). Conclusions Several characterized points of urbanization contributed to this outbreak of dengue in Dongguan: the residents are highly concentrated; the residents' life habits helped to form the habitats of Ae. albopictus and contributed to the high Breteau Index; the self-constructed houses lacks of mosquito prevention facilities. This report has reaffirmed the importance of a surveillance system for infectious diseases control and aroused the awareness of an imported case causing the epidemic of an infectious disease in urbanized region. PMID:22276682

Estimating Costs Associated with a Community Outbreak of Meningococcal Disease in a Colombian Caribbean City

PubMed Central

Pinzón-Redondo, Hernando; Coronell-Rodriguez, Wilfrido; Díaz-Martinez, Inés; Guzmán-Corena, Ángel; Constenla, Dagna

2014-01-01

ABSTRACT Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$ (2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50% of the cases died; 50% of the cases were reported to have meningitis (3/6); 33% were diagnosed with meningococcaemia and myocarditis (2/6); 50% of the cases had bacteraemia (3/6); 66% of the cases had a culture specimen positive for Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$ 4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak. PMID:25395916

Estimating costs associated with a community outbreak of meningococcal disease in a colombian Caribbean city.

PubMed

Pinzón-Redondo, Hernando; Coronell-Rodriguez, Wilfrido; Díaz-Martinez, Inés; Guzmán-Corena, Angel; Constenla, Dagna; Alvis-Guzmán, Nelson

2014-09-01

Meningococcal disease is a serious and potentially life-threatening infection that is caused by the bacterium Neisseria meningitidis (N. meningitidis), and it can cause meningitis, meningococcaemia outbreaks and epidemics. The disease is fatal in 9-12% of cases and with a death rate of up to 40% among patients with meningococcaemia. The objective of this study was to estimate the costs of a meningococcal outbreak that occurred in a Caribbean city of Colombia. We contacted experts involved in the outbreak and asked them specific questions about the diagnosis and treatment for meningococcal cases during the outbreak. Estimates of costs of the outbreak were also based on extensive review of medical records available during the outbreak. The costs associated with the outbreak were divided into the cost of the disease response phase and the cost of the disease surveillance phase. The costs associated with the outbreak control and surveillance were expressed in US$ (2011) as cost per 1,000 inhabitants. The average age of patients was 4.6 years (SD 3.5); 50% of the cases died; 50% of the cases were reported to have meningitis (3/6); 33% were diagnosed with meningococcaemia and myocarditis (2/6); 50% of the cases had bacteraemia (3/6); 66% of the cases had a culture specimen positive for Neisseria meningitidis; 5 of the 6 cases had RT-PCR positive for N. meningitidis. All N. meningitidis were serogroup B; 50 doses of ceftriaxone were administered as prophylaxis. Vaccine was not available at the time. The costs associated with control of the outbreak were estimated at US$ 0.8 per 1,000 inhabitants, disease surveillance at US$ 4.1 per 1,000 inhabitants, and healthcare costs at US$ 5.1 per 1,000 inhabitants. The costs associated with meningococcal outbreaks are substantial, and the outbreaks should be prevented. The mass chemoprophylaxis implemented helped control the outbreak.

Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review.

PubMed

Chan, J Hy; Law, C K; Hamblion, E; Fung, H; Rudge, J

2017-04-01

Hand, foot, and mouth disease continues to cause seasonal epidemics in the Asia-Pacific Region. Since the current Enterovirus 71 vaccines do not provide cross-protection for all Enterovirus species that cause hand, foot, and mouth disease, there is an urgent need to identify appropriate detection tools and best practice to prevent its transmission and to effectively control its outbreaks. This systematic review aimed to identify characteristics of outbreak and assess the impact and effectiveness of detection tools and public health preventive measures to interrupt transmission. The findings will be used to recommend policy on the most effective responses and interventions in Hong Kong to effectively minimise and contain the spread of the disease within childcare facilities. We searched the following databases for primary studies written in Chinese or English: MEDLINE, EMBASE, Global Health, WHO Western Pacific Region Index Medicus database, China National Knowledge Infrastructure Databases, and Chinese Scientific Journals Database. Studies conducted during or retrospective to outbreaks of hand, foot, and mouth disease caused by Enterovirus 71 from 1980 to 2012 within childcare facilities and with a study population of 0 to 6 years old were included. Sixteen studies conducted on outbreaks in China showed that hand, foot, and mouth disease spread rapidly within the facility, with an outbreak length of 4 to 46 days, especially in those with delayed notification (after 24 hours) of clustered outbreak (with five or more cases discovered within the facility) to the local Center for Disease Control and Prevention and delayed implementation of a control response. The number of classes affected ranged from 1 to 13, and the attack rate for children ranged from 0.97% to 28.18%. Communication between key stakeholders about outbreak confirmation, risk assessment, and surveillance should be improved. Effective communication facilitates timely notification (within 24 hours) of clustered outbreaks to a local Center for Disease Control and Prevention. Timely implementation of a control response is effective in minimising incidence and length of an outbreak in childcare facilities. The government should provide incentives for childcare facilities to train infection control specialists who can serve as the first contact, knowledge, and communication points, as well as facilitate exchange of information and provision of support across stakeholders during a communicable disease epidemic.

Risk Factors for Mycobacterium abscessus subsp. bolletii infection after laparoscopic surgery during an outbreak in Brazil.

PubMed

Baruque Villar, Gabriela; de Mello Freitas, Felipe Teixeira; Pais Ramos, Jesus; Dias Campos, Carlos Eduardo; de Souza Caldas, Paulo Cesar; Santos Bordalo, Fernanda; Amorim Ramos, Tatyana Costa; do Nascimento Pereira, Vívian; Cordeiro-Santos, Marcelo; Abdalla Santos, Joao Hugo; Coelho Motta, Glauco; Gomes, Suzie Marie; Mendes de Souza, Verena Maria; de Araujo, Wildo Navegantes

2015-01-01

OBJECTIVE To identify risk factors related to Mycobacterium abscessus subsp. bolletii infection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases. DESIGN A retrospective cohort study. SETTING A private hospital in Manaus, Brazil. PATIENTS A cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team. METHODS We collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables with P≤0.2 in the bivariate analysis in a logistic regression model. Additionally, we reviewed the procedures for reprocessing the laparoscopic surgery equipment, and the strains obtained with culture were identified by molecular methods. RESULTS We recorded 60 (27%) cases of infection. After multivariate analysis, the duration of surgery beyond 1 hour (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2-4.5), not to have been the first operated patient on a given day (OR, 2.7; 95% CI, 1.4-5.2), and the use of permanent trocar (OR, 2.2; 95% CI, 1.1-4.2) were associated with infection. We observed that the surgical team attempted to sterilize the equipment in glutaraldehyde solution when sanitary authorities had already prohibited it. Eleven strains presented 100% DNA identity with a single strain, known as BRA100 clone. CONCLUSIONS Because contaminated material can act as vehicle for infection, ensuring adequate sterilization processing of video-assisted surgery equipment was crucial to stopping this single clonal outbreak of nonturbeculous mycobacteria in Brazil.

Foodborne outbreak simulation to teach field epidemiology: the Moroccan Field Epidemiology Training Program.

PubMed

Jroundi, Imane; Belarbi, Abdellatif

2016-11-01

Morocco in 2010 launched a new field epidemiology training program to enhance the skills of health professionals in charge of epidemiological surveillance and to investigate outbreaks; including foodborne diseases that represent a very substantial burden of disease. To apply an active learning method to teach outbreak investigation within a controled environment for field epidemiology trainees program at the Moroccan National school of public Health. A scenario describing digestive symptoms evoking a restaurant-associated foodborne outbreak that would affect the school staff was designed for the residents to investigate, to assess their organizational capacity and application of all stages of epidemiological investigation. Nine Residents applied study design, database management and statistical analysis to investigate the foodborne outbreak, to estimate attack rates, classify cases and controls, to identify the contaminated foods and pathogens and to issue preventive recommendations for the control and the prevention of further transmission. The overall resident's satisfaction of the learning method was 67%. A simulation of an outbreak investigation within an academic setting is an active learning method to be used in the curriculum for introducing the residents on field epidemiology program to the principles and practices of outbreak investigation before their implication in a real situation.

[Study on the efficacy of quarantine during outbreaks of acute hemorrhagic conjunctivitis outbreaks at schools through the susceptive-infective-quarantine-removal model].

PubMed

Chen, Tian-mu; Liu, Ru-chun

2013-01-01

To assess the efficacy of quarantine for acute hemorrhagic conjunctivitis (AHC) outbreaks control in schools, by using the Compartment Model. Through combining the characters of both AHC and compartment model, we built a susceptive-infective-removal (SIR) model suited for AHC outbreaks control in schools, and then quarantine was added into the model to develop a susceptive-infective-quarantine-removal (SIQR) model. An outbreak of AHC in Changsha in 2011 was employed as a sample to assess the effect of quarantine for the prevention and control of AHC. Basic reproduction number (λ0) of the AHC outbreak without intervention was 6.80, thus the transmission speed of the disease became quite fast. If no intervention had been adopted, almost all the students, faculties and staff members would have been infected within 23 days, and the accumulative cases would become 738, with the total attack rate (TAR) as 99.73%. The peak of the outbreak was at Sep. 11th and the number of new cases was 126 on that day. The efficacy would have been different if quarantine forces had been taken at different time and differently. The bigger and earlier the quarantine force had been adopted, the lower morbidity peak and the smaller TAR would have been appeared, with better efficacy of outbreak control. If the quarantine rate had been taken at the level of 90% on the sixth day, the accumulative case would have been reduced to 132 and the TAR had become 17.84% consequently. Quarantine program could be used as a main intervention approach to be employed for ACH outbreak at schools.

Why has the Ebola outbreak in West Africa been so challenging to control?

PubMed Central

Semalulu, T; Wong, G; Kobinger, G; Huston, P

2014-01-01

West Africa is in the midst of the largest Ebola outbreak ever; there have been over 1000 deaths and many new cases are reported each day. The World Health Organization (WHO) declared it an outbreak in March 2014 and on August 6, 2014 the WHO declared the outbreak a public health emergency of international concern. Based on the number of deaths and total number of cases reported to the WHO as of August 11, 2014, the current outbreak has an overall mortality rate of 55%. Outbreak control measures against Ebola virus disease are effective. Why then, has this outbreak been so challenging to control? Ebola is transmitted through bodily fluids and immediately attacks the immune system, then progressively attacks the major organs and the lining of blood vessels. Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas. This has been made more challenging by the fact that health care workers are at risk of contracting Ebola virus disease. Treatment to date has been supportive, not curative and outbreak control strategies have been met with distrust due to fear and misinformation. However, important progress is being made. The international response to Ebola is gaining momentum, communication strategies have been developed to address the fear and mistrust, and promising treatments are under development, including a combination of three monoclonal antibodies that has been administered to two American Ebola infected health care workers. The National Microbiology Laboratory of the Public Health Agency of Canada (PHAC) has been supporting laboratory diagnostic efforts in West Africa and PHAC has been working with the provinces and territories and key stakeholders to ensure Canada is prepared for a potential Ebola importation. PMID:29769855

Why has the Ebola outbreak in West Africa been so challenging to control?

PubMed

Semalulu, T; Wong, G; Kobinger, G; Huston, P

2014-08-14

West Africa is in the midst of the largest Ebola outbreak ever; there have been over 1000 deaths and many new cases are reported each day. The World Health Organization (WHO) declared it an outbreak in March 2014 and on August 6, 2014 the WHO declared the outbreak a public health emergency of international concern. Based on the number of deaths and total number of cases reported to the WHO as of August 11, 2014, the current outbreak has an overall mortality rate of 55%. Outbreak control measures against Ebola virus disease are effective. Why then, has this outbreak been so challenging to control? Ebola is transmitted through bodily fluids and immediately attacks the immune system, then progressively attacks the major organs and the lining of blood vessels. Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas. This has been made more challenging by the fact that health care workers are at risk of contracting Ebola virus disease. Treatment to date has been supportive, not curative and outbreak control strategies have been met with distrust due to fear and misinformation. However, important progress is being made. The international response to Ebola is gaining momentum, communication strategies have been developed to address the fear and mistrust, and promising treatments are under development, including a combination of three monoclonal antibodies that has been administered to two American Ebola infected health care workers. The National Microbiology Laboratory of the Public Health Agency of Canada (PHAC) has been supporting laboratory diagnostic efforts in West Africa and PHAC has been working with the provinces and territories and key stakeholders to ensure Canada is prepared for a potential Ebola importation.

Evaluating the effects of common control measures for influenza A (H1N1) outbreak at school in China: A modeling study

PubMed Central

Liu, Ruchun; Xie, Zhi; Chen, Shuilian; Hu, Guoqing

2017-01-01

Background Influenza A (H1N1) outbreaks have become common at schools in China since 2009. However, the effects of common countermeasures for school influenza outbreak have not been quantified so far, including isolation, vaccination, antivirus and school closure. We conducted a mathematically modeling study to address this unsolved issue. Methods We collected data of all small-scale school outbreaks caused by influenza A that occurred in Changsha city between January 2009 and December 2013. Two outbreaks (one was in 2009 and the other one was in 2013) were used for simulating the effects of single and combined use of common measures, including isolation (Iso), therapeutics (T), prophylactics (P), vaccinating 70% of susceptible individuals prior to the outbreak (VP70), vaccinating 70% of susceptible individuals every day during the outbreak (VD70) and school closure of one week (S1w). A susceptible—exposed—infectious/asymptomatic—recovered (SEIR) model was developed to implement the simulations based on the natural history of influenza A. Results When no control measures are taken, the influenza is expected to spread quickly at school for the selected outbreak in 2013; the outbreak would last 56 days, and the total attack rate (TAR) would reach up to 46.32% (95% CI: 46.12–46.52). Of all single control measures, VP70 is most effective to control the epidemic (TAR = 8.68%), followed by VP50, VD70, VD50 and Iso. The use of VP70 with any other measure can reduce TAR to 3.37–14.04% and showed better effects than any other combination of two kinds of measures. The best two-measure combination is ‘S1w+VP70’ (TAR = 3.37%, DO = 41 days). All combinations of three kinds of measures were not satisfactory when Vp70 and VD70 were excluded. The most effective three-intervention combination was ‘Iso+S1w+VP70’ (with TAR = 3.23%). When VP70 or VD70 is included, the combinations of four or five kinds of interventions are very effective, reducing TAR to lower than 5%. But the TAR of combination of ‘T+P+Iso+S1w’ is 23.20%. Similar simulation results were observed for the selected outbreak in 2009. Conclusion Vaccinating no less than 70% of individuals prior to the outbreak and isolation are recommended as single measures to control H1N1outbreak at school. The combination of VP70+S1w can achieve very good control for school outbreak. PMID:28542360

A review of nosocomial Salmonella outbreaks: infection control interventions found effective.

PubMed

Lee, M B; Greig, J D

2013-03-01

To review nosocomial salmonellosis outbreaks to identify: mode of transmission; morbidity and mortality patterns; and recommendations for control and prevention. Documented nosocomial salmonellosis outbreaks in hospitals published from January 1995 to November 2011, written in the English language, were systematically reviewed. The study methodology incorporated steps from the PRISMA statement for a high quality review process. Computer-aided searches of Scopus, CAB Global Health and CINAHL(®), the Cumulative Index to Nursing and Allied Health Literature were completed to identify relevant outbreak reports written in English. To validate the electronic search methodology, bibliographies and reference lists of relevant review articles were hand-searched. Public health and government websites were searched for nosocomial salmonellosis. Fifty-two relevant reports were identified. The most frequently reported routes of transmission were food 31/52 (59.6%) and person-to-person transmission 7/52 (13.5%). Actions taken during the outbreak to control transmission included improvements to: 1) infection control practices (41.8% of actions); isolation or cohorting patients, hand hygiene practices, and enhancing cleaning and disinfection in patient care areas; and 2) food handling practices (24.4% of actions); reviewing food preparation practices, enhancing cleaning and sanitation of the kitchen, and controlling food temperatures. Investigators made recommendations retrospectively in outbreak reports to provide direction to health centees but these recommendations were not statistically evaluated for effectiveness. More emphasis should be placed on improving food handling practices, such as training food workers, monitoring food temperatures, and not using raw foods of animal origin, to prevent nosocomial salmonellosis outbreaks in hospitals because almost 60% of the outbreaks were foodborne. Copyright © 2013 The Royal Institute of Public Health. All rights reserved.

An Outbreak of Cryptosporidium parvum across England & Scotland Associated with Consumption of Fresh Pre-Cut Salad Leaves, May 2012

PubMed Central

McKerr, Caoimhe; Adak, Goutam K.; Nichols, Gordon; Gorton, Russell; Chalmers, Rachel M.; Kafatos, George; Cosford, Paul; Charlett, Andre; Reacher, Mark; Pollock, Kevin G.; Alexander, Claire L.; Morton, Stephen

2015-01-01

Background We report a widespread foodborne outbreak of Cryptosporidium parvum in England and Scotland in May 2012. Cases were more common in female adults, and had no history of foreign travel. Over 300 excess cases were identified during the period of the outbreak. Speciation and microbiological typing revealed the outbreak strain to be C. parvum gp60 subtype IIaA15G2R1. Methods Hypothesis generation questionnaires were administered and an unmatched case control study was undertaken to test the hypotheses raised. Cases and controls were interviewed by telephone. Controls were selected using sequential digit dialling. Information was gathered on demographics, foods consumed and retailers where foods were purchased. Results Seventy-four laboratory confirmed cases and 74 controls were included in analyses. Infection was found to be strongly associated with the consumption of pre-cut mixed salad leaves sold by a single retailer. This is the largest documented outbreak of cryptosporidiosis attributed to a food vehicle. PMID:26017538

An Outbreak of Cryptosporidium parvum across England & Scotland Associated with Consumption of Fresh Pre-Cut Salad Leaves, May 2012.

PubMed

McKerr, Caoimhe; Adak, Goutam K; Nichols, Gordon; Gorton, Russell; Chalmers, Rachel M; Kafatos, George; Cosford, Paul; Charlett, Andre; Reacher, Mark; Pollock, Kevin G; Alexander, Claire L; Morton, Stephen

2015-01-01

We report a widespread foodborne outbreak of Cryptosporidium parvum in England and Scotland in May 2012. Cases were more common in female adults, and had no history of foreign travel. Over 300 excess cases were identified during the period of the outbreak. Speciation and microbiological typing revealed the outbreak strain to be C. parvum gp60 subtype IIaA15G2R1. Hypothesis generation questionnaires were administered and an unmatched case control study was undertaken to test the hypotheses raised. Cases and controls were interviewed by telephone. Controls were selected using sequential digit dialling. Information was gathered on demographics, foods consumed and retailers where foods were purchased. Seventy-four laboratory confirmed cases and 74 controls were included in analyses. Infection was found to be strongly associated with the consumption of pre-cut mixed salad leaves sold by a single retailer. This is the largest documented outbreak of cryptosporidiosis attributed to a food vehicle.

An outbreak of human parainfluenza virus 3 infection in an outpatient hematopoietic stem cell transplantation clinic.

PubMed

Sydnor, Emily R M; Greer, Amy; Budd, Alicia P; Pehar, Miriana; Munshaw, Supriya; Neofytos, Dionissios; Perl, Trish M; Valsamakis, Alexandra

2012-09-01

Parainfluenza viruses cause respiratory tract infections in adults and children, with peak activity during the spring and summer months. Human parainfluenza virus type 3 (hPIV-3) can contribute to significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Automated surveillance software was used to identify an hPIV-3 outbreak in an HSCT clinic. Active surveillance for respiratory illness and infection control measures were instituted. A retrospective molecular investigation of outbreak viral strains was performed by direct sequencing. Twelve of 196 HSCT recipients attending the clinic during the outbreak period had hPIV-3; one of these patients died. Sequencing demonstrated highly related strains in 9 of 10 patients studied. Despite the ongoing presence of hPIV-3 outside the inpatient/outpatient care continuum clinic, only 2 cases were observed after institution of respiratory season infection control measures. This investigation demonstrates the utility of surveillance software in the identification of respiratory virus outbreaks and the importance of rapid implementation of infection control/prevention measures for containment of outbreaks. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Nosocomial outbreak of extensively drug-resistant Pseudomonas aeruginosa associated with aromatherapy.

PubMed

Mayr, Astrid; Hinterberger, Guido; Lorenz, Ingo H; Kreidl, Peter; Mutschlechner, Wolfgang; Lass-Flörl, Cornelia

2017-04-01

An increase of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) in various clinical specimens among intensive care unit patients (n = 7) initiated an outbreak investigation consisting of patient data analyses, control of adherence to infection control guidelines, microbiologic surveys, and molecular-based studies. XDR-PA was detected in a jointly used aroma-oil nursing bottle for aromatherapy. We implemented the restriction of oil sharing among patients. Hence, the outbreak was controlled successfully. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Economic costs of outbreaks of acute viral gastroenteritis due to norovirus in Catalonia (Spain), 2010-2011.

PubMed

Navas, Encarna; Torner, Nuria; Broner, Sonia; Godoy, Pere; Martínez, Ana; Bartolomé, Rosa; Domínguez, Angela

2015-10-01

To determine the direct and indirect costs of outbreaks of acute viral gastroenteritis (AVG) due to norovirus in closed institutions (hospitals, social health centers or nursing homes) and the community in Catalonia in 2010-11. Information on outbreaks were gathered from the reports made by epidemiological surveillance units. Direct costs (medical visits, hospital stays, drug treatment, sample processing, transport, diagnostic tests, monitoring and control of the outbreaks investigated) and indirect costs (lost productivity due to work absenteeism, caregivers time and working hours lost due to medical visits) were calculated. Twenty-seven outbreaks affecting 816 people in closed institutions and 74 outbreaks affecting 1,940 people in the community were detected. The direct and indirect costs of outbreaks were € 131,997.36 (€ 4,888.79 per outbreak) in closed institutions and € 260,557.16 (€ 3,521.04 per outbreak) in community outbreaks. The cost per case was € 161.76 in outbreaks in closed institutions and € 134.31 in community outbreaks. The main costs were surveillance unit monitoring (€ 116,652.93), laboratory diagnoses (€ 119,950.95), transport of samples (€ 69,970.90), medical visits (€ 25,250.50) and hospitalization (€ 13,400.00). The cost of outbreaks of acute viral gastroenteritis due to norovirus obtained in this study was influenced by the number of people affected and the severity of the outbreak, which determined hospitalizations and work absenteeism. Urgent reporting of outbreaks would allow the implementation of control measures that could reduce the numbers affected and the duration of the illness and thus the costs derived from them.

Emerging zoonoses: responsible communication with the media--lessons learned and future perspectives.

PubMed

Tabbaa, D

2010-11-01

Emerging zoonotic disease outbreaks are inevitable and often unpredictable events. The environment surrounding an outbreak is unique in public health, and outbreaks are frequently marked by uncertainty, confusion and a sense of urgency. Good communication at this time, generally through the media, is essential, but examples unfortunately abound of communication failures that have delayed outbreak control, undermined public trust and compliance, and unnecessarily prolonged economic, social and political turmoil. With this paper we hope to disseminate the idea that communication expertise has become as essential to outbreak control as epidemiological training and laboratory analysis. The paper presents the best practices for communicating with the public and discusses future aspects of communicating through the mass media during an outbreak. Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control

PubMed Central

Stamm, Lola V.

2015-01-01

Ebola virus disease (EVD) is a life-threatening zoonosis caused by infection with the Ebola virus. Since the first reported EVD outbreak in the Democratic Republic of the Congo, several small outbreaks have been reported in central Africa with about 2,400 cases occurring between 1976 and 2013. The 2013–2015 EVD outbreak in west Africa is the first documented outbreak in this region and the largest ever with over 27,000 cases and more than 11,000 deaths. Although EVD transmission rates have recently decreased in west Africa, this crisis continues to threaten global health and security, particularly since infected travelers could spread EVD to other resource-limited areas of the world. Because vaccines and drugs are not yet licensed for EVD, outbreak control is dependent on the use of non-pharmaceutical interventions (e.g., infection control practices, isolation of EVD cases, contact tracing with follow-up and quarantine, sanitary burial, health education). However, delays in diagnosing and reporting EVD cases in less accessible rural areas continue to hamper control efforts. New advances in rapid diagnostics for identifying presumptive EVD cases and in mobile-based technologies for communicating critical health-related information should facilitate deployment of an early response to prevent the amplification of sporadic EVD cases into large-scale outbreaks. PMID:26175026

Building-level analyses to prospectively detect influenza outbreaks in long-term care facilities: New York City, 2013-2014.

PubMed

Levin-Rector, Alison; Nivin, Beth; Yeung, Alice; Fine, Annie D; Greene, Sharon K

2015-08-01

Timely outbreak detection is necessary to successfully control influenza in long-term care facilities (LTCFs) and other institutions. To supplement nosocomial outbreak reports, calls from infection control staff, and active laboratory surveillance, the New York City (NYC) Department of Health and Mental Hygiene implemented an automated building-level analysis to proactively identify LTCFs with laboratory-confirmed influenza activity. Geocoded addresses of LTCFs in NYC were compared with geocoded residential addresses for all case-patients with laboratory-confirmed influenza reported through passive surveillance. An automated daily analysis used the geocoded building identification number, approximate text matching, and key-word searches to identify influenza in residents of LTCFs for review and follow-up by surveillance coordinators. Our aim was to determine whether the building analysis improved prospective outbreak detection during the 2013-2014 influenza season. Of 119 outbreaks identified in LTCFs, 109 (92%) were ever detected by the building analysis, and 55 (46%) were first detected by the building analysis. Of the 5,953 LTCF staff and residents who received antiviral prophylaxis during the 2013-2014 season, 929 (16%) were at LTCFs where outbreaks were initially detected by the building analysis. A novel building-level analysis improved influenza outbreak identification in LTCFs in NYC, prompting timely infection control measures. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Measles outbreak in Venezuela: a new challenge to postelimination surveillance and control?

PubMed

Sarmiento, Héctor; Cobo, Oswaldo Barrezueta; Morice, Ana; Zapata, Roger; Benitez, María Victoria; Castillo-Solórzano, Carlos

2011-09-01

The circulation of wild measles virus was interrupted in Venezuela in February 2007 after the catch-up vaccination (1994) and monitoring (1998) and in response to the measles outbreak in 2001. Traditionally, the routine coverage with measles-mumps-rubella vaccine does not exceed 85%. In February 2006, a measles outbreak started by importation in the State Miranda; this extended to 7 states and lasted 50 weeks with an intermediate period of 17 weeks without reported cases. New cases were reported in the States Guarico and Amazon. The pattern of circulation of the silent period was determined through the use of retrospective search for measles; this showed that 57% of suspected cases did not enter the surveillance system. Molecular epidemiology made it possible to identify B3 as only genotype, which also circulated in Spain. The epidemiological and clinical characteristics of measles have been modified; these determine outbreaks identified late, of slow expansion, silent, and with limited case-fatality, compared with classical outbreaks. The outbreak spread by that behavior was not recognized and the classical control measures did not result. The beginning of a broader and intense vaccination was delayed, partly by weaknesses in the sensitivity of the system. It is crucial to recognize the new behavior of measles and the effectiveness of the classical control measures, and especially to establish criteria for interruption of the circulation to control an outbreak in this stage of elimination.

Healthcare-associated outbreaks due to Mucorales and other uncommon fungi.

PubMed

Davoudi, Setareh; Graviss, Linda S; Kontoyiannis, Dimitrios P

2015-07-01

Healthcare-associated outbreaks of fungal infections, especially with uncommon and emerging fungi, have become more frequent in the past decade. Here, we reviewed the history and definition of healthcare-associated outbreaks of uncommon fungal infections and discussed the principles of investigating, containing and treatment of these outbreaks. In case of these uncommon diseases, occurrence of two or more cases in a short period is considered as an outbreak. Contaminated medical devices and hospital environment are the major sources of these outbreaks. Care must be taken to differentiate a real infection from colonization or contamination. Defining and identifying cases, describing epidemiologic feature of cases, finding and controlling the source of the outbreak, treating patients, and managing asymptomatic exposed patients are main steps for outbreak elimination. These fungal outbreaks are not only difficult to detect but also hard to treat. Early initiation of appropriate antifungal therapy is strongly associated with improved outcomes in infected patients. Choice of antifungal drugs should be made based on spectrum, pharmacodynamic and pharmacokinetic characteristics and adverse effects of available drugs. Combination antifungal therapy and surgical intervention may be also helpful in selected cases. A multidisciplinary approach and close collaboration between all key partners are necessary for successful control of fungal outbreaks. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

Operational practices associated with foodborne disease outbreaks in the catering industry in England and Wales.

PubMed

Jones, Sarah L; Parry, Sharon M; O'Brien, Sarah J; Palmer, Stephen R

2008-08-01

Catering businesses continue to be the most common setting for foodborne disease outbreaks. In a study of catering businesses in England and Wales, operational practices relating to the supply, preparation, and service of food in 88 businesses associated with outbreaks were compared with those practices at 88 control businesses. Operational practices did not differ significantly between case and control businesses but larger small medium-size enterprise (SME) businesses were more likely to be associated with foodborne disease outbreaks than were micro-SME businesses. Businesses associated with outbreaks of Salmonella infection were less likely to use local or national suppliers but instead used regional suppliers, especially for eggs. This practice was the only significantly independent operational practice associated with outbreaks of Salmonella infection. Regional egg suppliers also were more likely to be used by businesses associated with outbreaks attributed to food vehicles containing eggs. Businesses associated with egg-associated outbreaks were less likely to use eggs produced under an approved quality assurance scheme, suggesting that the underlying risk associated with using regional suppliers may relate to the use of contaminated eggs.

Challenges with controlling varicella in prison settings: experience of California, 2010 to 2011.

PubMed

Leung, Jessica; Lopez, Adriana S; Tootell, Elena; Baumrind, Nikki; Mohle-Boetani, Janet; Leistikow, Bruce; Harriman, Kathleen H; Preas, Christopher P; Cosentino, Giorgio; Bialek, Stephanie R; Marin, Mona

2014-10-01

This article describes the epidemiology of varicella in one state prison in California during 2010 and 2011, control measures implemented, and associated costs. Eleven varicella cases were reported, of which nine were associated with two outbreaks. One outbreak consisted of three cases and the second consisted of six cases with two generations of spread. Among exposed inmates serologically tested, 98% (643/656) were varicella-zoster virus seropositive. The outbreaks resulted in > 1,000 inmates exposed, 444 staff exposures, and > $160,000 in costs. The authors documented the challenges and costs associated with controlling and managing varicella in a prison setting. A screening policy for evidence of varicella immunity for incoming inmates and staff and vaccination of susceptible persons has the potential to mitigate the impact of future outbreaks and reduce resources necessary to manage cases and outbreaks. © The Author(s) 2014.

Clostridium difficile associated infection, diarrhea and colitis

PubMed Central

Hookman, Perry; Barkin, Jamie S

2009-01-01

A new, hypervirulent strain of Clostridium difficile, called NAP1/BI/027, has been implicated in C. difficile outbreaks associated with increased morbidity and mortality since the early 2000s. The epidemic strain is resistant to fluoroquinolones in vitro, which was infrequent prior to 2001. The name of this strain reflects its characteristics, demonstrated by different typing methods: pulsed-field gel electrophoresis (NAP1), restriction endonuclease analysis (BI) and polymerase chain reaction (027). In 2004 and 2005, the US Centers for Disease Control and Prevention (CDC) emphasized that the risk of C. difficile-associated diarrhea (CDAD) is increased, not only by the usual factors, including antibiotic exposure, but also gastrointestinal surgery/manipulation, prolonged length of stay in a healthcare setting, serious underlying illness, immune-compromising conditions, and aging. Patients on proton pump inhibitors (PPIs) have an elevated risk, as do peripartum women and heart transplant recipients. Before 2002, toxic megacolon in C. difficile-associated colitis (CDAC), was rare, but its incidence has increased dramatically. Up to two-thirds of hospitalized patients may be infected with C. difficile. Asymptomatic carriers admitted to healthcare facilities can transmit the organism to other susceptible patients, thereby becoming vectors. Fulminant colitis is reported more frequently during outbreaks of C. difficile infection in patients with inflammatory bowel disease (IBD). C. difficile infection with IBD carries a higher mortality than without underlying IBD. This article reviews the latest information on C. difficile infection, including presentation, vulnerable hosts and choice of antibiotics, alternative therapies, and probiotics and immunotherapy. We review contact precautions for patients with known or suspected C. difficile-associated disease. Healthcare institutions require accurate and rapid diagnosis for early detection of possible outbreaks, to initiate specific therapy and implement effective control measures. A comprehensive C. difficile infection control management rapid response team (RRT) is recommended for each health care facility. A communication network between RRTs is recommended, in coordination with each country’s department of health. Our aim is to convey a comprehensive source of information and to guide healthcare professionals in the difficult decisions that they face when caring for these oftentimes very ill patients. PMID:19340897

Large Outbreak Caused by Methicillin Resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention

PubMed Central

Grönthal, Thomas; Moodley, Arshnee; Nykäsenoja, Suvi; Junnila, Jouni; Guardabassi, Luca; Thomson, Katariina; Rantala, Merja

2014-01-01

Introduction The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP) ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 – January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented. Methods Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing. Results Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3–17.0, P = 0.0003), antimicrobial treatment (OR = 3.8, CI95% 1.0–13.9, P = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1–1.6, P = 0.0007) or in the surgery ward (OR = 1.1, CI95% 1.0–1.3, P = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission. Conclusion Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring MRSP. Rigorous control measures were needed to control the outbreak. We recommend the implementation of a search-and-isolate policy to reduce the burden of MRSP. PMID:25333798

Performance of statistical process control methods for regional surgical site infection surveillance: a 10-year multicentre pilot study.

PubMed

Baker, Arthur W; Haridy, Salah; Salem, Joseph; Ilieş, Iulian; Ergai, Awatef O; Samareh, Aven; Andrianas, Nicholas; Benneyan, James C; Sexton, Daniel J; Anderson, Deverick J

2017-11-24

Traditional strategies for surveillance of surgical site infections (SSI) have multiple limitations, including delayed and incomplete outbreak detection. Statistical process control (SPC) methods address these deficiencies by combining longitudinal analysis with graphical presentation of data. We performed a pilot study within a large network of community hospitals to evaluate performance of SPC methods for detecting SSI outbreaks. We applied conventional Shewhart and exponentially weighted moving average (EWMA) SPC charts to 10 previously investigated SSI outbreaks that occurred from 2003 to 2013. We compared the results of SPC surveillance to the results of traditional SSI surveillance methods. Then, we analysed the performance of modified SPC charts constructed with different outbreak detection rules, EWMA smoothing factors and baseline SSI rate calculations. Conventional Shewhart and EWMA SPC charts both detected 8 of the 10 SSI outbreaks analysed, in each case prior to the date of traditional detection. Among detected outbreaks, conventional Shewhart chart detection occurred a median of 12 months prior to outbreak onset and 22 months prior to traditional detection. Conventional EWMA chart detection occurred a median of 7 months prior to outbreak onset and 14 months prior to traditional detection. Modified Shewhart and EWMA charts additionally detected several outbreaks earlier than conventional SPC charts. Shewhart and SPC charts had low false-positive rates when used to analyse separate control hospital SSI data. Our findings illustrate the potential usefulness and feasibility of real-time SPC surveillance of SSI to rapidly identify outbreaks and improve patient safety. Further study is needed to optimise SPC chart selection and calculation, statistical outbreak detection rules and the process for reacting to signals of potential outbreaks. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementing systems thinking for infection prevention: The cessation of repeated scabies outbreaks in a respiratory care ward.

PubMed

Chuang, Sheuwen; Howley, Peter P; Lin, Shih-Hua

2015-05-01

Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals; however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. No nosocomial scabies have been reported for more than 1975 days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270 days and 180 days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

EpideMiology and control measures of outBreaks due to Antibiotic-Resistant orGanisms in EurOpe (EMBARGO): a systematic review protocol

PubMed Central

Nithya, Babu Rajendran; Gladstone, Beryl Primrose; Rodríguez-Baño, Jesús; Sifakis, Frangiscos; Voss, Andreas; Carmeli, Yehuda; Burkert, Francesco Robert; Gkolia, Panagiota; Tacconelli, Evelina

2017-01-01

Introduction Improving our understanding of outbreaks due to antibiotic-resistant bacteria (ARB) and their control is critical in the current public health scenario. The threat of outbreaks due to ARB requires multifaceted efforts. However, a global overview of epidemiological characteristics of outbreaks due to ARB and effective infection control measures is missing. In this paper, we describe the protocol of a systematic review aimed at mapping and characterising the epidemiological aspects of outbreaks due to ARB and infection control measures in European countries. Methods and analysis The databases MEDLINE, Web of Knowledge and Cochrane library will be searched using a 3-step search strategy. Selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. All study designs will be included if they report an outbreak and define the microbiological methods used for microorganism identification. The target bacteria will be methicillin-resistant and vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, ceftazidime-resistant and carbapenem-resistant Acinetobacter baumannii, ceftazidime-resistant and carbapenem-resistant Pseudomonas aeruginosa, ciprofloxacin-resistant Escherichia coli, extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae, carbapenem-resistant and carbapenamase-producing Enterobacteriaceae. Data will be extracted using a tailored pilot tested form and the quality of reporting will be assessed using the ORION (Outbreak Reports and Intervention Studies Of Nosocomial infections) tool. Data will be synthesised and reported by the type of ARB, setting and country. Infection control measures and bundles of measures will be described. The effectiveness will be reported as defined by the authors. Regression analysis will be used to define independent factors associated with outbreaks' control. Heterogeneity between studies will be assessed by forest plots and I² statistics. Ethics and dissemination Ethical approval is not applicable for this study. Findings will be disseminated through journal publication and conference presentations and talks. PMID:28057656

Infection prevention and control of the Ebola outbreak in Liberia, 2014-2015: key challenges and successes.

PubMed

Cooper, Catherine; Fisher, Dale; Gupta, Neil; MaCauley, Rose; Pessoa-Silva, Carmem L

2016-01-05

Prior to the 2014-2015 Ebola outbreak, infection prevention and control (IPC) activities in Liberian healthcare facilities were basic. There was no national IPC guidance, nor dedicated staff at any level of government or healthcare facility (HCF) to ensure the implementation of best practices. Efforts to improve IPC early in the outbreak were ad hoc and messaging was inconsistent. In September 2014, at the height of the outbreak, the national IPC Task Force was established with a Ministry of Health (MoH) mandate to coordinate IPC response activities. A steering group of the Task Force, including representatives of the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), supported MoH leadership in implementing standardized messaging and IPC training for the health workforce. This structure, and the activities implemented under this structure, played a crucial role in the implementation of IPC practices and successful containment of the outbreak. Moving forward, a nationwide culture of IPC needs to be maintained through this governance structure in Liberia's health system to prevent and respond to future outbreaks.

Is case-chaos methodology an appropriate alternative to conventional case-control studies for investigating outbreaks?

PubMed

Edelstein, Michael; Wallensten, Anders; Kühlmann-Berenzon, Sharon

2014-08-15

Case-chaos methodology is a proposed alternative to case-control studies that simulates controls by randomly reshuffling the exposures of cases. We evaluated the method using data on outbreaks in Sweden. We identified 5 case-control studies from foodborne illness outbreaks that occurred between 2005 and 2012. Using case-chaos methodology, we calculated odds ratios 1,000 times for each exposure. We used the median as the point estimate and the 2.5th and 97.5th percentiles as the confidence interval. We compared case-chaos matched odds ratios with their respective case-control odds ratios in terms of statistical significance. Using Spearman's correlation, we estimated the correlation between matched odds ratios and the proportion of cases exposed to each exposure and quantified the relationship between the 2 using a normal linear mixed model. Each case-control study identified an outbreak vehicle (odds ratios = 4.9-45). Case-chaos methodology identified the outbreak vehicle 3 out of 5 times. It identified significant associations in 22 of 113 exposures that were not associated with outcome and 5 of 18 exposures that were significantly associated with outcome. Log matched odds ratios correlated with their respective proportion of cases exposed (Spearman ρ = 0.91) and increased significantly with the proportion of cases exposed (b = 0.054). Case-chaos methodology missed the outbreak source 2 of 5 times and identified spurious associations between a number of exposures and outcome. Measures of association correlated with the proportion of cases exposed. We recommended against using case-chaos analysis during outbreak investigations. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Two Linked Enteroinvasive Escherichia coli Outbreaks, Nottingham, UK, June 2014

PubMed Central

MacGregor, Vanessa; Robbins, Vivienne; Bayliss, Laura; Chattaway, Marie Anne; Dallman, Tim; Ready, Derren; Aird, Heather; Puleston, Richard; Hawker, Jeremy

2016-01-01

Enteroinvasive Escherichia coli (EIEC) outbreaks are uncommon in Europe. In June 2014, two EIEC outbreaks occurred in Nottingham, UK, within 2 days; outbreak A was linked to a takeaway restaurant and outbreak B to a wedding party. We conducted 2 analytical studies: a case–control study for outbreak A and a cohort study for outbreak B. We tested microbiological and environmental samples, including by using whole-genome sequencing. For both outbreaks combined, we identified 157 probable case-patients; 27 were laboratory-confirmed as EIEC O96:H19–positive. Combined epidemiologic, microbiological, and environmental findings implicated lettuce as the vehicle of infection in outbreak A, but the source of the organism remained unknown. Whole-genome sequencing identified the same organism in cases from both outbreaks, but no epidemiologic link was confirmed. These outbreaks highlight that EIEC has the capacity to cause large and severe gastrointestinal disease outbreaks and should be considered as a potential pathogen in foodborne outbreaks in Europe. PMID:27314432

Two Linked Enteroinvasive Escherichia coli Outbreaks, Nottingham, UK, June 2014.

PubMed

Newitt, Sophie; MacGregor, Vanessa; Robbins, Vivienne; Bayliss, Laura; Chattaway, Marie Anne; Dallman, Tim; Ready, Derren; Aird, Heather; Puleston, Richard; Hawker, Jeremy

2016-07-01

Enteroinvasive Escherichia coli (EIEC) outbreaks are uncommon in Europe. In June 2014, two EIEC outbreaks occurred in Nottingham, UK, within 2 days; outbreak A was linked to a takeaway restaurant and outbreak B to a wedding party. We conducted 2 analytical studies: a case-control study for outbreak A and a cohort study for outbreak B. We tested microbiological and environmental samples, including by using whole-genome sequencing. For both outbreaks combined, we identified 157 probable case-patients; 27 were laboratory-confirmed as EIEC O96:H19-positive. Combined epidemiologic, microbiological, and environmental findings implicated lettuce as the vehicle of infection in outbreak A, but the source of the organism remained unknown. Whole-genome sequencing identified the same organism in cases from both outbreaks, but no epidemiologic link was confirmed. These outbreaks highlight that EIEC has the capacity to cause large and severe gastrointestinal disease outbreaks and should be considered as a potential pathogen in foodborne outbreaks in Europe.

75 FR 34146 - Draft Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Draft Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings AGENCY... and comment on the Draft Guideline for the Prevention and Control of Norovirus Gastroenteritis...

Systematic review of outbreaks of Pneumocystis jirovecii pneumonia: evidence that P. jirovecii is a transmissible organism and the implications for healthcare infection control.

PubMed

Yiannakis, E P; Boswell, T C

2016-05-01

Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity and mortality in immunocompromised patients. Several nosocomial outbreaks of PCP have been reported in human-immunodeficiency-virus-negative, immunocompromised patients. The primary route of P. jirovecii transmission has yet to be proven; however, these outbreaks of infection suggest either interhuman transmission or a common environmental source. To identify and evaluate all published clusters and outbreaks of PCP. The main objective was to compare the epidemiology of the outbreaks, with a particular focus on the evidence for different modes of transmission. PubMed and EMBASE were searched to identify all English-language articles describing PCP outbreaks or clusters between 1980 and March 2015. Data were extracted on the outbreak setting, features of the outbreak, application of molecular typing, results of epidemiological assessment and environmental sampling. Thirty outbreaks described in 29 articles were identified. Twenty-five (83%) of these outbreaks were described in patients who had undergone solid organ transplantation, primarily renal transplantation. All studies described a defined cohort of patients who shared some nosocomial facilities, including both inpatient and outpatient areas. Genotyping was undertaken in 16 (47%) studies. Cases with an identical genotype were demonstrated in all these studies. The findings of this review raise a number of concerns regarding the public health and infection control implications of infection with PCP. The evidence presented for nosocomial acquisition and possible person-to-person transmission of infection suggests the need for formal infection control policies. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

[Comparison of Flu Outbreak Reporting Standards Based on Transmission Dynamics Model].

PubMed

Yang, Guo-jing; Yi, Qing-jie; Li, Qin; Zeng, Qing

2016-05-01

To compare the current two flu outbreak reporting standards for the purpose of better prevention and control of flu outbreaks. A susceptible-exposed-infectious/asymptomatic-removed (SEIAR) model without interventions was set up first, followed by a model with interventions based on real situation. Simulated interventions were developed based on the two reporting standards, and evaluated by estimated duration of outbreaks, cumulative new cases, cumulative morbidity rates, decline in percentage of morbidity rates, and cumulative secondary cases. The basic reproductive number of the outbreak was estimated as 8. 2. The simulation produced similar results as the real situation. The effect of interventions based on reporting standard one (10 accumulated new cases in a week) was better than that of interventions based on reporting standard two (30 accumulated new cases in a week). The reporting standard one (10 accumulated new cases in a week) is more effective for prevention and control of flu outbreaks.

Salmonella Weltevreden food poisoning in a tea garden of Assam: An outbreak investigation.

PubMed

Saikia, L; Sharma, A; Nath, R; Choudhury, G; Borah, A K

2015-01-01

Salmonella enterica serovar Weltevreden has been a rare cause of acute gastroenteritis occurring worldwide. Here, we report an outbreak of food poisoning in a tea garden. To determine the aetiological agent and risk factors responsible for the outbreak and to take necessary steps for prevention of future outbreaks. Affected area was visited by a team of microbiologists for collecting stool samples/rectal swabs from affected patients. Samples were processed by culture followed by confirmation of the isolates biochemically, automated bacterial identification system, conventional serotyping and molecular typing. Water samples were also processed for detection of faecal contamination. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to the Clinical Laboratory Standard Institute guidelines. The isolates were confirmed as S. enterica subspecies enterica serovar Weltevreden. They were found sensitive to ampicillin, amoxycillin-clavulanic acid, ciprofloxacin, ofloxacin, norfloxacin, cefotaxime, ceftriaxone, co-trimoxazole and doxycycline. Water samples showed high-level faecal contamination. Source of outbreak was found to be drinking water contaminated with dead livestock. House to house visit was made for early diagnosis and treatment of the cases, awareness campaigning and chlorination of drinking water. This report emphasises the geographical distribution of this organism in Assam. As S. Weltevreden is widely distributed in domestic animals, people should be made aware of immediate reporting of any unusual death among the livestock and their safe disposal which can significantly reduce the incidence of non-typhoidal salmonellosis in the country.

Epidemiological Data Management during an Outbreak of Ebola Virus Disease: Key Issues and Observations from Sierra Leone.

PubMed

Owada, Kei; Eckmanns, Tim; Kamara, Kande-Bure O'Bai; Olu, Olushayo Oluseun

2016-01-01

Sierra Leone experienced intense transmission of Ebola virus disease (EVD) from May 2014 to November 2015 during which a total of 8,704 confirmed cases and over 3,589 confirmed deaths were reported. Our field observation showed many issues in the EVD data management system, which may have contributed to the magnitude and long duration of the outbreak. In this perspective article, we explain the key issues with EVD data management in the field, and the resulting obstacles in analyzing key epidemiological indicators during the outbreak response work. Our observation showed that, during the latter part of the EVD outbreak, surveillance and data management improved at all levels in the country as compared to the earlier stage. We identified incomplete filling and late arrival of the case investigation forms at data management centers, difficulties in detecting double entries and merging identified double entries in the database, and lack of clear process of how death of confirmed cases in holding, treatment, and community care centers are reported to the data centers as some of challenges to effective data management. Furthermore, there was no consolidated database that captured and linked all data sources in a structured way. We propose development of a new application tool easily adaptable to new occurrences, regular data harmonization meetings between national and district data management teams, and establishment of a data quality audit system to assure good quality data as ways to improve EVD data management during future outbreaks.

An international point source outbreak of typhoid fever: a European collaborative investigation*

PubMed Central

Stanwell-Smith, R. E.; Ward, L. R.

1986-01-01

A point source outbreak of Salmonella typhi, degraded Vi-strain 22, affecting 32 British visitors to Kos, Greece, in 1983 was attributed by a case—control study to the consumption of a salad at one hotel. This represents the first major outbreak of typhoid fever in which a salad has been identified as the vehicle. The source of the infection was probably a carrier in the hotel staff. The investigation demonstrates the importance of national surveillance, international cooperation, and epidemiological methods in the investigation and control of major outbreaks of infection. PMID:3488842

Epidemiology of restaurant-associated foodborne disease outbreaks, United States, 1998-2013.

PubMed

Angelo, K M; Nisler, A L; Hall, A J; Brown, L G; Gould, L H

2017-02-01

Although contamination of food can occur at any point from farm to table, restaurant food workers are a common source of foodborne illness. We describe the characteristics of restaurant-associated foodborne disease outbreaks and explore the role of food workers by analysing outbreaks associated with restaurants from 1998 to 2013 reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. We identified 9788 restaurant-associated outbreaks. The median annual number of outbreaks was 620 (interquartile range 618-629). In 3072 outbreaks with a single confirmed aetiology reported, norovirus caused the largest number of outbreaks (1425, 46%). Of outbreaks with a single food reported and a confirmed aetiology, fish (254 outbreaks, 34%) was most commonly implicated, and these outbreaks were commonly caused by scombroid toxin (219 outbreaks, 86% of fish outbreaks). Most outbreaks (79%) occurred at sit-down establishments. The most commonly reported contributing factors were those related to food handling and preparation practices in the restaurant (2955 outbreaks, 61%). Food workers contributed to 2415 (25%) outbreaks. Knowledge of the foods, aetiologies, and contributing factors that result in foodborne disease restaurant outbreaks can help guide efforts to prevent foodborne illness.

Epidemiological characterization of a nosocomial outbreak of extended spectrum β-lactamase Escherichia coli ST-131 confirms the clinical value of core genome multilocus sequence typing.

PubMed

Woksepp, Hanna; Ryberg, Anna; Berglind, Linda; Schön, Thomas; Söderman, Jan

2017-12-01

Enhanced precision of epidemiological typing in clinically suspected nosocomial outbreaks is crucial. Our aim was to investigate whether single nucleotide polymorphism (SNP) analysis and core genome (cg) multilocus sequence typing (MLST) of whole genome sequencing (WGS) data would more reliably identify a nosocomial outbreak, compared to earlier molecular typing methods. Sixteen isolates from a nosocomial outbreak of ESBL E. coli ST-131 in southeastern Sweden and three control strains were subjected to WGS. Sequences were explored by SNP analysis and cgMLST. cgMLST clearly differentiated between the outbreak isolates and the control isolates (>1400 differences). All clinically identified outbreak isolates showed close clustering (≥2 allele differences), except for two isolates (>50 allele differences). These data confirmed that the isolates with >50 differing genes did not belong to the nosocomial outbreak. The number of SNPs within the outbreak was ≤7, whereas the two discrepant isolates had >700 SNPs. Two of the ESBL E. coli ST-131 isolates did not belong to the clinically identified outbreak. Our results illustrate the power of WGS in terms of resolution, which may avoid overestimation of patients belonging to outbreaks as judged from epidemiological data and previously employed molecular methods with lower discriminatory ability. © 2017 APMIS. Published by John Wiley & Sons Ltd.

Perceptions of vulnerability to a future outbreak: a study of horse managers affected by the first Australian equine influenza outbreak

PubMed Central

2013-01-01

Background A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated with horse managers’ perceived vulnerability to a future equine influenza outbreak. Results Of the 200 respondents, 31.9% perceived themselves to be very vulnerable, 36.6% vulnerable and 31.4% not vulnerable to a future outbreak of equine influenza. Multivariable logistic regression modelling revealed that managers involved in horse racing and those on rural horse premises perceived themselves to have low levels of vulnerability. Managers of horse premises that experienced infection in their horses in 2007 and those seeking infection control information from specific sources reported increased levels of perceived vulnerability to a future outbreak. Conclusion Different groups across the horse industry perceived differing levels of vulnerability to a future outbreak. Increased vulnerability contributes to favourable infection control behaviour and hence these findings are important for understanding uptake of recommended infection control measures. Future biosecurity communication strategies should be delivered through information sources suitable for the horse racing and rural sectors. PMID:23902718

Perceptions of vulnerability to a future outbreak: a study of horse managers affected by the first Australian equine influenza outbreak.

PubMed

Schemann, Kathrin; Firestone, Simon M; Taylor, Melanie R; Toribio, Jenny-Ann L M L; Ward, Michael P; Dhand, Navneet K

2013-07-31

A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated with horse managers' perceived vulnerability to a future equine influenza outbreak. Of the 200 respondents, 31.9% perceived themselves to be very vulnerable, 36.6% vulnerable and 31.4% not vulnerable to a future outbreak of equine influenza. Multivariable logistic regression modelling revealed that managers involved in horse racing and those on rural horse premises perceived themselves to have low levels of vulnerability. Managers of horse premises that experienced infection in their horses in 2007 and those seeking infection control information from specific sources reported increased levels of perceived vulnerability to a future outbreak. Different groups across the horse industry perceived differing levels of vulnerability to a future outbreak. Increased vulnerability contributes to favourable infection control behaviour and hence these findings are important for understanding uptake of recommended infection control measures. Future biosecurity communication strategies should be delivered through information sources suitable for the horse racing and rural sectors.

Cost of dengue outbreaks: literature review and country case studies

PubMed Central

2013-01-01

Background Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Methods Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Results Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems. The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control; surveillance; information, education and communication; direct medical and indirect costs), as percentage of total costs, differed across the respective countries. Resources used for dengue disease control and treatment were country specific. Conclusions The evidence so far collected further confirms the methodological challenges in this field: 1) to define technically dengue outbreaks (what do we measure?) and 2) to measure accurately the costs in prospective field studies (how do we measure?). Currently, consensus on the technical definition of an outbreak is sought through the International Research Consortium on Dengue Risk Assessment, Management and Surveillance (IDAMS). Best practice guidelines should be further developed, also to improve the quality and comparability of cost study findings. Modelling the costs of dengue outbreaks and validating these models through field studies should guide further research. PMID:24195519

Cost of dengue outbreaks: literature review and country case studies.

PubMed

Stahl, Hans-Christian; Butenschoen, Vicki Marie; Tran, Hien Tinh; Gozzer, Ernesto; Skewes, Ronald; Mahendradhata, Yodi; Runge-Ranzinger, Silvia; Kroeger, Axel; Farlow, Andrew

2013-11-06

Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save--through early response activities--resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems.The country case studies--conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control; surveillance; information, education and communication; direct medical and indirect costs), as percentage of total costs, differed across the respective countries. Resources used for dengue disease control and treatment were country specific. The evidence so far collected further confirms the methodological challenges in this field: 1) to define technically dengue outbreaks (what do we measure?) and 2) to measure accurately the costs in prospective field studies (how do we measure?). Currently, consensus on the technical definition of an outbreak is sought through the International Research Consortium on Dengue Risk Assessment, Management and Surveillance (IDAMS). Best practice guidelines should be further developed, also to improve the quality and comparability of cost study findings. Modelling the costs of dengue outbreaks and validating these models through field studies should guide further research.

Transmission patterns of smallpox: systematic review of natural outbreaks in Europe and North America since World War II.

PubMed

Bhatnagar, Vibha; Stoto, Michael A; Morton, Sally C; Boer, Rob; Bozzette, Samuel A

2006-05-05

Because smallpox (variola major) may be used as a biological weapon, we reviewed outbreaks in post-World War II Europe and North America in order to understand smallpox transmission patterns. A systematic review was used to identify papers from the National Library of Medicine, Embase, Biosis, Cochrane Library, Defense Technical Information Center, WorldCat, and reference lists of included publications. Two authors reviewed selected papers for smallpox outbreaks. 51 relevant outbreaks were identified from 1,389 publications. The median for the effective first generation reproduction rate (initial R) was 2 (range 0-38). The majority outbreaks were small (less than 5 cases) and contained within one generation. Outbreaks with few hospitalized patients had low initial R values (median of 1) and were prolonged if not initially recognized (median of 3 generations); outbreaks with mostly hospitalized patients had higher initial R values (median 12) and were shorter (median of 3 generations). Index cases with an atypical presentation of smallpox were less likely to have been diagnosed with smallpox; outbreaks in which the index case was not correctly diagnosed were larger (median of 27.5 cases) and longer (median of 3 generations) compared to outbreaks in which the index case was correctly diagnosed (median of 3 cases and 1 generation). Patterns of spread during Smallpox outbreaks varied with circumstances, but early detection and implementation of control measures is a most important influence on the magnitude of outbreaks. The majority of outbreaks studied in Europe and North America were controlled within a few generations if detected early.

Molecular Analysis of an Outbreak of Lethal Postpartum Sepsis Caused by Streptococcus pyogenes

PubMed Central

Turner, Claire E.; Dryden, Matthew; Holden, Matthew T. G.; Davies, Frances J.; Lawrenson, Richard A.; Farzaneh, Leili; Bentley, Stephen D.; Efstratiou, Androulla

2013-01-01

Sepsis is now the leading direct cause of maternal death in the United Kingdom, and Streptococcus pyogenes is the leading pathogen. We combined conventional and genomic analyses to define the duration and scale of a lethal outbreak. Two postpartum deaths caused by S. pyogenes occurred within 24 h; one was characterized by bacteremia and shock and the other by hemorrhagic pneumonia. The women gave birth within minutes of each other in the same maternity unit 2 days earlier. Seven additional infections in health care and household contacts were subsequently detected and treated. All cluster-associated S. pyogenes isolates were genotype emm1 and were initially indistinguishable from other United Kingdom emm1 isolates. Sequencing of the virulence gene sic revealed that all outbreak isolates had the same unique sic type. Genome sequencing confirmed that the cluster was caused by a unique S. pyogenes clone. Transmission between patients occurred on a single day and was associated with casual contact only. A single isolate from one patient demonstrated a sequence change in sic consistent with longer infection duration. Transmission to health care workers was traced to single clinical contacts with index cases. The last case was detected 18 days after the first case. Following enhanced surveillance, the outbreak isolate was not detected again. Mutations in bacterial regulatory genes played no detectable role in this outbreak, illustrating the intrinsic ability of emm1 S. pyogenes to spread while retaining virulence. This fast-moving outbreak highlights the potential of S. pyogenes to cause a range of diseases in the puerperium with rapid transmission, underlining the importance of immediate recognition and response by clinical infection and occupational health teams. PMID:23616448

Outbreak of toxic anterior segment syndrome following cataract surgery associated with impurities in autoclave steam moisture.

PubMed

Hellinger, Walter C; Hasan, Saiyid A; Bacalis, Laura P; Thornblom, Deborah M; Beckmann, Susan C; Blackmore, Carina; Forster, Terri S; Tirey, Jason F; Ross, Mary J; Nilson, Christian D; Mamalis, Nick; Crook, Julia E; Bendel, Rick E; Shetty, Rajesh; Stewart, Michael W; Bolling, James P; Edelhauser, Henry F

2006-03-01

Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002. Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography. During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations. Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.

Review of Avian Influenza Outbreaks in South Korea from 1996 to 2014.

PubMed

Mo, In-Pil; Bae, Yeon-Ji; Lee, Seung-Baek; Mo, Jong-Suk; Oh, Kwang-Hyun; Shin, Jeong-Hwa; Kang, Hyun-Mi; Lee, Youn-Jeong

2016-05-01

Since the first outbreak of low pathogenic avian influenza (LPAI) in 1996, outbreaks of LPAI have become more common in Korea, leading to the development of a nationwide mass vaccination program in 2007. In the case of highly pathogenic avian influenza (HPAI), four outbreaks took place in 2003-04, 2006-07, 2008, and 2010-11; a fifth outbreak began in 2014 and was ongoing at the time of this writing. The length of the four previous outbreaks varied, ranging from 42 days (2008) to 139 days (2010-11). The number of cases reported by farmers that were subsequently confirmed as HPAI also varied, from seven cases in 2006-07 to 53 in 2010-11. The number of farms affected by the outbreaks varied, from a low of 286 (2006-07) with depopulation of 6,473,000 birds, to a high of 1500 farms (2008) with depopulation of 10,200,000 birds. Government compensation for bird depopulation ranged from $253 million to $683 million in the five outbreaks. Despite the damage caused by the five HPAI outbreaks, efficient control strategies have yet to be established. Meanwhile, the situation in the field worsens. Analysis of the five HPAI outbreaks revealed horizontal farm-to-farm transmission as the main factor effecting major economic losses. However, horizontal transmission could not be efficiently prevented because of insufficient transparency within the poultry industry, especially within the duck industry, which is reluctant to report suspicious cases early. Moreover, the experiences and expertise garnered in previous outbreaks has yet to be effectively applied to the management of new outbreaks. Considering the magnitude of the economic damage caused by avian influenza and the increasing likelihood of its endemicity, careful and quantitative analysis of outbreaks and the establishment of control policies are urgently needed.

Limits to Forecasting Precision for Outbreaks of Directly Transmitted Diseases

PubMed Central

Drake, John M

2006-01-01

Background Early warning systems for outbreaks of infectious diseases are an important application of the ecological theory of epidemics. A key variable predicted by early warning systems is the final outbreak size. However, for directly transmitted diseases, the stochastic contact process by which outbreaks develop entails fundamental limits to the precision with which the final size can be predicted. Methods and Findings I studied how the expected final outbreak size and the coefficient of variation in the final size of outbreaks scale with control effectiveness and the rate of infectious contacts in the simple stochastic epidemic. As examples, I parameterized this model with data on observed ranges for the basic reproductive ratio (R 0) of nine directly transmitted diseases. I also present results from a new model, the simple stochastic epidemic with delayed-onset intervention, in which an initially supercritical outbreak (R 0 > 1) is brought under control after a delay. Conclusion The coefficient of variation of final outbreak size in the subcritical case (R 0 < 1) will be greater than one for any outbreak in which the removal rate is less than approximately 2.41 times the rate of infectious contacts, implying that for many transmissible diseases precise forecasts of the final outbreak size will be unattainable. In the delayed-onset model, the coefficient of variation (CV) was generally large (CV > 1) and increased with the delay between the start of the epidemic and intervention, and with the average outbreak size. These results suggest that early warning systems for infectious diseases should not focus exclusively on predicting outbreak size but should consider other characteristics of outbreaks such as the timing of disease emergence. PMID:16435887

Dengue Contingency Planning: From Research to Policy and Practice.

PubMed

Runge-Ranzinger, Silvia; Kroeger, Axel; Olliaro, Piero; McCall, Philip J; Sánchez Tejeda, Gustavo; Lloyd, Linda S; Hakim, Lokman; Bowman, Leigh R; Horstick, Olaf; Coelho, Giovanini

2016-09-01

Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan.

South African Ebola diagnostic response in Sierra Leone: A modular high biosafety field laboratory

PubMed Central

Jansen van Vuren, Petrus; Meier, Gunther H.; le Roux, Chantel; Conteh, Ousman S.; Kemp, Alan; Fourie, Cardia; Naidoo, Prabha; Naicker, Serisha; Ohaebosim, Phumza; Storm, Nadia; Hellferscee, Orienka; Ming Sun, Lisa K.; Mogodi, Busisiwe; Prabdial-Sing, Nishi; du Plessis, Desiree; Greyling, Deidre; Loubser, Shayne; Goosen, Mark; McCulloch, Stewart D.; Scott, Terence P.; Moerdyk, Alexandra; Dlamini, Wesley; Konneh, Kelfala; Kamara, Idrissa L.; Sowa, Dauda; Sorie, Samuel; Kargbo, Brima; Madhi, Shabir A.

2017-01-01

Background In August 2014, the National Institute for Communicable Diseases (NICD) in South Africa established a modular high-biosafety field Ebola diagnostic laboratory (SA FEDL) near Freetown, Sierra Leone in response to the rapidly increasing number of Ebola virus disease (EVD) cases. Methods and findings The SA FEDL operated in the Western Area of Sierra Leone, which remained a “hotspot” of the EVD epidemic for months. The FEDL was the only diagnostic capacity available to respond to the overwhelming demand for rapid EVD laboratory diagnosis for several weeks in the initial stages of the EVD crisis in the capital of Sierra Leone. Furthermore, the NICD set out to establish local capacity amongst Sierra Leonean nationals in all aspects of the FEDL functions from the outset. This led to the successful hand-over of the FEDL to the Sierra Leone Ministry of Health and Sanitation in March 2015. Between 25 August 2014 and 22 June 2016, the laboratory tested 11,250 specimens mostly from the Western Urban and Western Rural regions of Sierra Leone, of which 2,379 (21.14%) tested positive for Ebola virus RNA. Conclusions The bio-safety standards and the portability of the SA FEDL, offered a cost-effective and practical alternative for the rapid deployment of a field-operated high biocontainment facility. The SA FEDL teams demonstrated that it is highly beneficial to train the national staff in the course of formidable disease outbreak and accomplished their full integration into all operational and diagnostic aspects of the laboratory. This initiative contributed to the international efforts in bringing the EVD outbreak under control in Sierra Leone, as well as capacitating local African scientists and technologists to respond to diagnostic needs that might be required in future outbreaks of highly contagious pathogens. PMID:28628619

South African Ebola diagnostic response in Sierra Leone: A modular high biosafety field laboratory.

PubMed

Paweska, Janusz T; Jansen van Vuren, Petrus; Meier, Gunther H; le Roux, Chantel; Conteh, Ousman S; Kemp, Alan; Fourie, Cardia; Naidoo, Prabha; Naicker, Serisha; Ohaebosim, Phumza; Storm, Nadia; Hellferscee, Orienka; Ming Sun, Lisa K; Mogodi, Busisiwe; Prabdial-Sing, Nishi; du Plessis, Desiree; Greyling, Deidre; Loubser, Shayne; Goosen, Mark; McCulloch, Stewart D; Scott, Terence P; Moerdyk, Alexandra; Dlamini, Wesley; Konneh, Kelfala; Kamara, Idrissa L; Sowa, Dauda; Sorie, Samuel; Kargbo, Brima; Madhi, Shabir A

2017-06-01

In August 2014, the National Institute for Communicable Diseases (NICD) in South Africa established a modular high-biosafety field Ebola diagnostic laboratory (SA FEDL) near Freetown, Sierra Leone in response to the rapidly increasing number of Ebola virus disease (EVD) cases. The SA FEDL operated in the Western Area of Sierra Leone, which remained a "hotspot" of the EVD epidemic for months. The FEDL was the only diagnostic capacity available to respond to the overwhelming demand for rapid EVD laboratory diagnosis for several weeks in the initial stages of the EVD crisis in the capital of Sierra Leone. Furthermore, the NICD set out to establish local capacity amongst Sierra Leonean nationals in all aspects of the FEDL functions from the outset. This led to the successful hand-over of the FEDL to the Sierra Leone Ministry of Health and Sanitation in March 2015. Between 25 August 2014 and 22 June 2016, the laboratory tested 11,250 specimens mostly from the Western Urban and Western Rural regions of Sierra Leone, of which 2,379 (21.14%) tested positive for Ebola virus RNA. The bio-safety standards and the portability of the SA FEDL, offered a cost-effective and practical alternative for the rapid deployment of a field-operated high biocontainment facility. The SA FEDL teams demonstrated that it is highly beneficial to train the national staff in the course of formidable disease outbreak and accomplished their full integration into all operational and diagnostic aspects of the laboratory. This initiative contributed to the international efforts in bringing the EVD outbreak under control in Sierra Leone, as well as capacitating local African scientists and technologists to respond to diagnostic needs that might be required in future outbreaks of highly contagious pathogens.

The economic burden of a Salmonella Thompson outbreak caused by smoked salmon in the Netherlands, 2012-2013.

PubMed

Suijkerbuijk, Anita W M; Bouwknegt, Martijn; Mangen, Marie-Josee J; de Wit, G Ardine; van Pelt, Wilfrid; Bijkerk, Paul; Friesema, Ingrid H M

2017-04-01

In 2012, the Netherlands experienced the most extensive food-related outbreak of Salmonella ever recorded. It was caused by smoked salmon contaminated with Salmonella Thompson during processing. In total, 1149 cases of salmonellosis were laboratory confirmed and reported to RIVM. Twenty percent of cases was hospitalised and four cases were reported to be fatal. The purpose of this study was to estimate total costs of the Salmonella Thompson outbreak. Data from a case-control study were used to estimate the cost-of-illness of reported cases (i.e. healthcare costs, patient costs and production losses). Outbreak control costs were estimated based on interviews with staff from health authorities. Using the Dutch foodborne disease burden and cost-of-illness model, we estimated the number of underestimated cases and the associated cost-of-illness. The estimated number of cases, including reported and underestimated cases was 21 123. Adjusted for underestimation, the total cost-of-illness would be €6.8 million (95% CI €2.5-€16.7 million) with productivity losses being the main cost driver. Adding outbreak control costs, the total outbreak costs are estimated at €7.5 million. In the Netherlands, measures are taken to reduce salmonella concentrations in food, but detection of contamination during food processing remains difficult. As shown, Salmonella outbreaks have the potential for a relatively high disease and economic burden for society. Early warning and close cooperation between the industry, health authorities and laboratories is essential for rapid detection, control of outbreaks, and to reduce disease and economic burden. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

A decrease in the number of cases of necrotizing enterocolitis associated with the enhancement of infection prevention and control measures during a Staphylococcus aureus outbreak in a neonatal intensive care unit.

PubMed

Lemyre, Brigitte; Xiu, Wenlong; Bouali, Nicole Rouvinez; Brintnell, Janet; Janigan, Jo-Anne; Suh, Kathryn N; Barrowman, Nicholas

2012-01-01

Most cases of necrotizing enterocolitis (NEC) are sporadic, but outbreaks in hospital settings suggest an infectious cause. Our neonatal intensive care unit (NICU) experienced an outbreak of methicillin-sensitive Staphylococcus aureus (MSSA). We aimed to assess whether the enhancement of infection prevention and control measures would be associated with a reduction in the number of cases of NEC. Retrospective chart review. A 24-bed, university-affiliated, inborn level 3 NICU. Infants of less than 30 weeks gestation or birth weight ≤ 1,500 g admitted to the NICU between January 2007 and December 2008 were considered at risk of NEC. All cases of NEC were reviewed. Infection prevention and control measures, including hand hygiene education, were enhanced during the outbreak. Avoidance of overcapacity in the NICU was reinforced, environmental services (ES) measures were enhanced, and ES hours were increased. Two hundred eighty-two at-risk infants were admitted during the study. Their gestational age and birth weight (mean ± SD) were 28.2 ± 2.7 weeks and 1,031 ± 290 g, respectively. The proportion of NEC was 18/110 (16.4%) before the outbreak, 1/54 (1.8%) during the outbreak, and 4/118 (3.4%) after the outbreak. After adjustment for gestational age, birth weight, gender, and singleton versus multiple births, the proportion was lower in the postoutbreak period than in the preoutbreak period (P < .002). Although this observational study cannot establish a causal relationship, there was a significant decrease in the incidence of NEC following implementation of enhanced infection prevention and control measures to manage an MSSA outbreak.

Major outbreaks of the Douglas-fir tussock moth in Oregon and California.

Treesearch

Boyd E. Wickman; Richard R. Mason; C.G. Thompson

1973-01-01

Case histories of five tussock moth outbreaks that occurred in California and Oregon between 1935 and 1965 are discussed. Information is given on the size and duration of the outbreaks, the presence of natural control agents and the damage caused. Most of the outbreaks were eventually treated with DDT. However, enough information was available from untreated portions...

Cost analysis of an outbreak of Clostridium difficile infection ribotype 027 in a Dutch tertiary care centre.

PubMed

van Beurden, Y H; Bomers, M K; van der Werff, S D; Pompe, E A P M; Spiering, S; Vandenbroucke-Grauls, C M J E; Mulder, C J J

2017-04-01

The economic impact of Clostridium difficile infection (CDI) on the healthcare system is significant. From May 2013 to May 2014, an outbreak of C. difficile ribotype 027 occurred in a Dutch tertiary care hospital, involving 72 patients. The primary aim of this study was to provide insight into the financial burden that this CDI outbreak brought upon this hospital. A retrospective analysis was performed to estimate the costs of a one-year-long C. difficile ribotype 027 outbreak. Medical charts were reviewed for patient data. In addition, all costs associated with the outbreak control measures were collected. The attributable costs of the whole outbreak were estimated to be €1,222,376. The main contributing factor was missed revenue due to increased length of stay of CDI patients and closure of beds to enable contact isolation of CDI patients (36%). A second important cost component was extra surveillance and activities of the Department of Medical Microbiology and Infection Control (25%). To the authors' knowledge, this is the first study to provide insight into the attributable costs of CDI in an outbreak setting, and to delineate the major cost items. It is clear that the economic consequences of CDI are significant. The high costs associated with a CDI outbreak should help to justify the use of additional resources for CDI prevention and control. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Outbreaks in Health Care Settings.

PubMed

Sood, Geeta; Perl, Trish M

2016-09-01

Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. Copyright © 2016 Elsevier Inc. All rights reserved.

An outbreak of scarlet fever in a primary school.

PubMed

Lamden, K H

2011-04-01

Scarlet fever, due to infection with an erythrogenic toxin-producing Group A streptococcus, is an uncommon and generally mild illness, although serious sequelae do occur. In March 2009, 57 of the 126 (45%) pupils in a primary school in Lancashire, UK developed scarlet fever over a 4-week period. Infection was transmitted via direct contact between pupils, particularly among the youngest pupils. A significant degree of transmission also occurred between siblings. The median number of days absent from school was 3 (range 1-10 days). No children were hospitalised. Control measures, including hygiene advice to the school and exclusion of pupils for 24h while initiating penicillin treatment, were ineffective. The outbreak occurred against a background of an unusually high incidence of invasive Group A streptococcal infection. While there are national guidelines for the control of invasive disease, none exist for the control of scarlet fever outbreaks. This prolonged outbreak of scarlet fever highlights the need for an evidence based approach to outbreak management.

Outbreaks attributed to pork in the United States, 1998-2015.

PubMed

Self, J L; Luna-Gierke, R E; Fothergill, A; Holt, K G; Vieira, A R

2017-10-01

Each year in the United States, an estimated 525 000 infections, 2900 hospitalizations, and 82 deaths are attributed to consumption of pork. We analyzed the epidemiology of outbreaks attributed to pork in the United States reported to the Centers for Disease Control and Prevention (CDC) 1998-2015. During that period, 288 outbreaks were attributed to pork, resulting in 6372 illnesses, 443 hospitalizations, and four deaths. The frequency of outbreaks attributed to pork decreased by 37% during this period, consistent with a decline in total foodborne outbreaks. However, outbreaks attributed to pork increased by 73% in 2015 (19 outbreaks) compared with the previous 3 years (average of 11 outbreaks per year), without a similar increase in total foodborne outbreaks. Most (>99%) of these outbreaks occurred among people exposed in the same state. The most frequent etiology shifted from Staphylococcus aureus toxin during 1998-2001 (19%) to Salmonella during 2012-2015 (46%). Outbreaks associated with ham decreased from eight outbreaks per year during 1998-2001, to one per year during 2012-2015 (P < 0·01). Additional efforts are necessary to reduce outbreaks and sporadic illnesses associated with pork products.

Results of Survey Regarding Prevalence of Adventitial Infections in Mice and Rats at Biomedical Research Facilities.

PubMed

Marx, James O; Gaertner, Diane J; Smith, Abigail L

2017-09-01

Control of rodent adventitial infections in biomedical research facilities is of extreme importance in assuring both animal welfare and high-quality research results. Sixty-three U.S. institutions participated in a survey reporting the methods used to detect and control these infections and the prevalence of outbreaks from 1 January 2014 through 31 December 2015. These results were then compared with the results of 2 similar surveys published in 1998 and 2008. The results of the current survey demonstrated that the rate of viral outbreaks in mouse colonies was decreasing, particularly in barrier facilities, whereas the prevalence of parasitic outbreaks has remained constant. These results will help our profession focus its efforts in the control of adventitial rodent disease outbreaks to the areas of the greatest needs.

Modeling Classical Swine Fever Outbreak-Related Outcomes

PubMed Central

Yadav, Shankar; Olynk Widmar, Nicole J.; Weng, Hsin-Yi

2016-01-01

The study was carried out to estimate classical swine fever (CSF) outbreak-related outcomes, such as epidemic duration and number of infected, vaccinated, and depopulated premises, using defined most likely CSF outbreak scenarios. Risk metrics were established using empirical data to select the most likely CSF outbreak scenarios in Indiana. These scenarios were simulated using a stochastic between-premises disease spread model to estimate outbreak-related outcomes. A total of 19 single-site (i.e., with one index premises at the onset of an outbreak) and 15 multiple-site (i.e., with more than one index premises at the onset of an outbreak) outbreak scenarios of CSF were selected using the risk metrics. The number of index premises in the multiple-site outbreak scenarios ranged from 4 to 32. The multiple-site outbreak scenarios were further classified into clustered (N = 6) and non-clustered (N = 9) groups. The estimated median (5th, 95th percentiles) epidemic duration (days) was 224 (24, 343) in the single-site and was 190 (157, 251) and 210 (167, 302) in the clustered and non-clustered multiple-site outbreak scenarios, respectively. The median (5th, 95th percentiles) number of infected premises was 323 (0, 488) in the single-site outbreak scenarios and was 529 (395, 662) and 465 (295, 640) in the clustered and non-clustered multiple-site outbreak scenarios, respectively. Both the number and spatial distributions of the index premises affected the outcome estimates. The results also showed the importance of implementing vaccinations to accommodate depopulation in the CSF outbreak controls. The use of routinely collected surveillance data in the risk metrics and disease spread model allows end users to generate timely outbreak-related information based on the initial outbreak’s characteristics. Swine producers can use this information to make an informed decision on the management of swine operations and continuity of business, so that potential losses could be minimized during a CSF outbreak. Government authorities might use the information to make emergency preparedness plans for CSF outbreak control. PMID:26870741

Listeriosis Outbreaks and Associated Food Vehicles, United States, 1998–2008

PubMed Central

Cartwright, Emily J.; Jackson, Kelly A.; Johnson, Shacara D.; Graves, Lewis M.; Mahon, Barbara E.

2013-01-01

Listeria monocytogenes, a bacterial foodborne pathogen, can cause meningitis, bacteremia, and complications during pregnancy. This report summarizes listeriosis outbreaks reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 1998–2008. The study period includes the advent of PulseNet (a national molecular subtyping network for outbreak detection) in 1998 and the Listeria Initiative (enhanced surveillance for outbreak investigation) in 2004. Twenty-four confirmed listeriosis outbreaks were reported during 1998–2008, resulting in 359 illnesses, 215 hospitalizations, and 38 deaths. Outbreaks earlier in the study period were generally larger and longer. Serotype 4b caused the largest number of outbreaks and outbreak-associated cases. Ready-to-eat meats caused more early outbreaks, and novel vehicles (i.e., sprouts, taco/nacho salad) were associated with outbreaks later in the study period. These changes may reflect the effect of PulseNet and the Listeria Initiative and regulatory initiatives designed to prevent contamination in ready-to-eat meat and poultry products. PMID:23260661

Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis

PubMed Central

Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

2016-01-01

Objectives To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Setting and participants Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Design and outcome measures Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Results Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI −1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI −8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Conclusions Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure. PMID:27381211

Evaluation of the use of oseltamivir prophylaxis in the control of influenza outbreaks in long-term care facilities in Alberta, Canada: a retrospective provincial database analysis.

PubMed

Ye, Ming; Jacobs, Angela; Khan, Muhammad Naeem; Jaipaul, Joy; Oda, Joanna; Johnson, Marcia; Doroshenko, Alexander

2016-07-05

To evaluate the impact of oseltamivir prophylaxis in the management and control of influenza outbreaks in long-term care facilities in Alberta, Canada. Long-term care facilities where 127 influenza outbreaks were reported to public health authorities in Alberta, Canada, during two influenza seasons from 2013 to 2015. Using routinely collected surveillance and administrative data, we examined the association between decision-making time for oseltamivir recommendation as prophylaxis strategy for influenza outbreaks in long-term care facilities (explanatory variable) and the duration of an influenza outbreak, the postprophylaxis risk of influenza-like illness and hospitalisation among residents of long-term care facilities in Alberta (outcome variables) using multivariable linear and Poisson regression models. Oseltamivir prophylaxis decision-making time was positively associated with the postintervention duration of an outbreak, with a 1-day delay in making decision on oseltamivir prophylaxis associated with 2.22 (95% CI 1.37 to 3.06) more days of the duration of an outbreak after controlling for potential confounding effect of the number of residents at risk at intervention, outbreak progression time, prevalence of influenza-like illness during outbreak progression, facility location, presence of mixed strain and based on optimal timing of oseltamivir prophylaxis. Although not statistically significant, a 1-day delay in making decision on oseltamivir prophylaxis was associated with a 5% (95% CI -1% to 11%) increase in the postintervention risk of influenza-like illness, and a 6% (95% CI -8% to 22%) increase in the postintervention risk of hospitalisation after controlling for the same potential confounders. Our study demonstrated benefits of using oseltamivir prophylaxis to shorten the duration of influenza outbreaks; however, there were no significant differences in the influenza-like illness and hospitalisation risk occurring after the intervention. Surveillance data may offer means of rapid evaluation of oseltamivir prophylaxis in long-term care facilities as a public health measure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Post-earthquake outbreak of rotavirus gastroenteritis in Kashmir (India): an epidemiological analysis.

PubMed

Karmakar, Somenath; Rathore, Abhilakh Singh; Kadri, Syed Manzoor; Dutt, Som; Khare, Shashi; Lal, Shiv

2008-10-01

An earthquake struck Kashmir on 8 October 2005. A central team of public health specialists was sent to Kashmir to assess the public health measures required following the earthquake, and to assist in institution of public health measures. Epidemiological and environmental investigation in Tangdar block (Kupwara district) and Uri Tehsil (Baramula district). Visits to villages affected by the earthquake, rehabilitation camps and health care, examination of cases with acute diarrhoeal disease (ADD), environmental observations, collection of clinical samples from ADD cases and environmental samples from drinking water sources, and laboratory methods. In total, 1783 cases of ADD were reported between 14 October and 17 December 2005 in Tangdar (population 65000). The overall attack rate was 20% in children under 4 years of age. Twelve cases of ADD with loose motions without blood were studied, and 11 rectal swabs and one stool sample were processed. No bacterial enteropathogens could be isolated, but three of the 12 samples yielded rotavirus antigen on enzyme-linked immunosorbent assay. Twelve of 13 (92.3%) water samples, collected from various stream or tap water (source: spring/stream) sources, were unsatisfactory (P=0.001) using the H(2)S strip method compared with other sources (well/mineral water). All eight water sources in Tangdar block were unsatisfactory, indicated by blackening of H(2)S filter paper strips. Following the earthquake, drinking stream water or tap water without boiling or chlorination may have led to a common source water-borne outbreak of rotavirus gastroenteritis. Other contributing factors were: overcrowding; poor sanitation; open-air defaecation; poor hygiene; and living in makeshift camps near streams. Person-to-person transmission may also have contributed to perpetuation of the outbreak. Following the establishment of medical camps and information, education and communication regarding the need to drink boiled water and follow safer hygienic practices, the outbreak was brought under control. The earthquake in Kashmir in 2005 led to widespread contamination of drinking water sources such as stream and tap water (source: stream or spring). This appears to have led to a common source outbreak of rotavirus between October and December 2005, leading to ADD, amongst infants and small children, transmitted by the faecal-oral route and perpetuated by person-to-person transmission.

Risk factors for typhoid outbreak in Sungai Congkak Recreational Park, Selangor 2009.

PubMed

Anita, S; Amir, K M; Fadzilah, K; Ahamad, J; Noorhaida, U; Marina, K; Paid, M Y; Hanif, Z

2012-02-01

Typhoid fever continues to pose public health problems in Selangor where cases are found sporadically with occasional outbreaks reported. In February 2009, Hospital Tengku Ampuan Rahimah (HTAR) reported a cluster of typhoid fever among four children in the pediatric ward. We investigated the source of the outbreak, risk factors for the infection to propose control measures. We conducted a case-control study to identify the risk factors for the outbreak. A case was defined as a person with S. typhi isolated from blood, urine or stool and had visited Sungai Congkak recreational park on 27th January 2010. Controls were healthy household members of cases who have similar exposure but no isolation of S. typhi in blood, urine or stool. Cases were identified from routine surveillance system, medical record searching from the nearest clinic and contact tracing other than family members including food handlers and construction workers in the recreational park. Immediate control measures were initiated and followed up. Twelve (12) cases were identified from routine surveillance with 75 household controls. The Case-control study showed cases were 17 times more likely to be 12 years or younger (95% CI: 2.10, 137.86) and 13 times more likely to have ingested river water accidentally during swimming (95% CI: 3.07, 58.71). River water was found contaminated with sewage disposal from two public toilets which effluent grew salmonella spp. The typhoid outbreak in Sungai Congkak recreational park resulted from contaminated river water due to poor sanitation. Children who accidentally ingested river water were highly susceptible. Immediate closure and upgrading of public toilet has stopped the outbreak.

Successful use of oseltamivir prophylaxis in managing a nosocomial outbreak of influenza A in a hematology and allogeneic stem cell transplant unit.

PubMed

Yue, Mimi C; Collins, Joel T; Subramoniapillai, Elango; Kennedy, Glen A

2017-02-01

To describe a nosocomial outbreak of H1N1 influenza A in an inpatient hematology and allogeneic stem cell transplant unit and outcomes of universal oseltamivir prophylaxis. Medical records of all patients admitted to the unit were reviewed to define the nosocomial outbreak, commencing 1 week prior to the index case until 4 weeks following institution of oseltamivir prophylaxis. Timelines for clinical symptoms, viral spread, management, patient outcomes and follow up testing were constructed. All cases of influenza were confirmed on nasopharyngeal swabs and/or bronchoalveolar lavages collected for polymerase chain reaction testing. In addition to the index case, further 11 patients were diagnosed with influenza A during the outbreak. Six patients (50%) had influenza-like-illness, five (42%) had respiratory symptoms only and one (8%) was asymptomatic. In total, five patients died, including four (33%) patients who were admitted to intensive care. A clustering of seven cases led to recognition of the outbreak and subsequent commencement of universal prophylaxis with oseltamivir 75 mg/day in all inpatients within the unit. Strict infection control processes were reinforced concurrently. There were no further cases of influenza A linked to the outbreak after the implementation of universal oseltamivir prophylaxis. Three later cases were linked to H1N1 exposure during the original outbreak. H1N1 influenza infection is associated with significant mortality in hematology patients. Universal prophylaxis with oseltamivir during a nosocomial outbreak appeared to be effective in controlling spread of the virus. We recommend early institution of infection control and universal prophylaxis in any nosocomial outbreak of influenza. © 2016 John Wiley & Sons Australia, Ltd.

Risk factors associated with anthrax outbreak in animals in North Dakota, 2005: a retrospective case-control study.

PubMed

Mongoh, Mafany Ndiva; Dyer, Neil W; Stoltenow, Charles L; Khaitsa, Margaret L

2008-01-01

We identified the risk factors associated with the anthrax outbreak Of 2005 in animals in North Dakota. Medical records of the 2005 anthrax outbreak were obtained from the Veterinary Diagnostic Laboratory at North Dakota State University. Additional data were obtained from the North Dakota state veterinarian's office, and supplemental questionnaires were administered to producers. The data obtained included ecological and environmental factors, animal health factors, and management factors. Anthrax occurred from July 1 to October 12, 2005. The cases were located in eastern North Dakota around the Red River Basin. Ransom, LaMoure, and Barnes counties reported most cases (71%). Species affected included cattle, bison, horses, sheep, elk, deer, pigs, and llamas. The predominant symptom was sudden death (38%) followed by bleeding from orifices (17%). Chi-square analysis indicated significant differences between case and control premises on the following variables: death reported on neighboring pasture, vaccination period, dry conditions, wet conditions, antibiotic use, multiple vaccination, and type of predator (coyote). Factors that significantly (p<0.05) predicted anthrax occurrences on the final logistic regression model were vaccination, use of antibiotics during an outbreak, and period of vaccine administration (before or during the outbreak). The characteristics of the anthrax outbreak regarding time and place of occurrence, animals affected, clinical signs reported, and mortality rate were consistent with previous reports of natural anthrax outbreaks in animals. A number of factors that significantly predicted anthrax occurrence in animals in the 2005 outbreak in North Dakota were identified. This information is important in planning appropriate control and prevention measures for anthrax, including recommending the right vaccination and treatment regimens in managing future anthrax outbreaks.

A cholera outbreak in Alborz Province, Iran: a matched case-control study.

PubMed

Moradi, Ghobad; Rasouli, Mohammad Aziz; Mohammadi, Parvin; Elahi, Elham; Barati, Hojatollah

2016-01-01

A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks. An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method. In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72). Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.

Detection of infectious disease outbreaks in twenty-two fragile states, 2000-2010: a systematic review

PubMed Central

2011-01-01

Fragile states are home to a sixth of the world's population, and their populations are particularly vulnerable to infectious disease outbreaks. Timely surveillance and control are essential to minimise the impact of these outbreaks, but little evidence is published about the effectiveness of existing surveillance systems. We did a systematic review of the circumstances (mode) of detection of outbreaks occurring in 22 fragile states in the decade 2000-2010 (i.e. all states consistently meeting fragility criteria during the timeframe of the review), as well as time lags from onset to detection of these outbreaks, and from detection to further events in their timeline. The aim of this review was to enhance the evidence base for implementing infectious disease surveillance in these complex, resource-constrained settings, and to assess the relative importance of different routes whereby outbreak detection occurs. We identified 61 reports concerning 38 outbreaks. Twenty of these were detected by existing surveillance systems, but 10 detections occurred following formal notifications by participating health facilities rather than data analysis. A further 15 outbreaks were detected by informal notifications, including rumours. There were long delays from onset to detection (median 29 days) and from detection to further events (investigation, confirmation, declaration, control). Existing surveillance systems yielded the shortest detection delays when linked to reduced barriers to health care and frequent analysis and reporting of incidence data. Epidemic surveillance and control appear to be insufficiently timely in fragile states, and need to be strengthened. Greater reliance on formal and informal notifications is warranted. Outbreak reports should be more standardised and enable monitoring of surveillance systems' effectiveness. PMID:21861869

A Participatory System for Preventing Pandemics of Animal Origins: Pilot Study of the Participatory One Health Disease Detection (PODD) System.

PubMed

Yano, Terdsak; Phornwisetsirikun, Somphorn; Susumpow, Patipat; Visrutaratna, Surasing; Chanachai, Karoon; Phetra, Polawat; Chaisowwong, Warangkhana; Trakarnsirinont, Pairat; Hemwan, Phonpat; Kaewpinta, Boontuan; Singhapreecha, Charuk; Kreausukon, Khwanchai; Charoenpanyanet, Arisara; Robert, Chongchit Sripun; Robert, Lamar; Rodtian, Pranee; Mahasing, Suteerat; Laiya, Ekkachai; Pattamakaew, Sakulrat; Tankitiyanon, Taweesart; Sansamur, Chalutwan; Srikitjakarn, Lertrak

2018-03-21

Aiming for early disease detection and prompt outbreak control, digital technology with a participatory One Health approach was used to create a novel disease surveillance system called Participatory One Health Disease Detection (PODD). PODD is a community-owned surveillance system that collects data from volunteer reporters; identifies disease outbreak automatically; and notifies the local governments (LGs), surrounding villages, and relevant authorities. This system provides a direct and immediate benefit to the communities by empowering them to protect themselves. The objective of this study was to determine the effectiveness of the PODD system for the rapid detection and control of disease outbreaks. The system was piloted in 74 LGs in Chiang Mai, Thailand, with the participation of 296 volunteer reporters. The volunteers and LGs were key participants in the piloting of the PODD system. Volunteers monitored animal and human diseases, as well as environmental problems, in their communities and reported these events via the PODD mobile phone app. LGs were responsible for outbreak control and provided support to the volunteers. Outcome mapping was used to evaluate the performance of the LGs and volunteers. LGs were categorized into one of the 3 groups based on performance: A (good), B (fair), and C (poor), with the majority (46%,34/74) categorized into group B. Volunteers were similarly categorized into 4 performance groups (A-D), again with group A showing the best performance, with the majority categorized into groups B and C. After 16 months of implementation, 1029 abnormal events had been reported and confirmed to be true reports. The majority of abnormal reports were sick or dead animals (404/1029, 39.26%), followed by zoonoses and other human diseases (129/1029, 12.54%). Many potentially devastating animal disease outbreaks were detected and successfully controlled, including 26 chicken high mortality outbreaks, 4 cattle disease outbreaks, 3 pig disease outbreaks, and 3 fish disease outbreaks. In all cases, the communities and animal authorities cooperated to apply community contingency plans to control these outbreaks, and community volunteers continued to monitor the abnormal events for 3 weeks after each outbreak was controlled. By design, PODD initially targeted only animal diseases that potentially could emerge into human pandemics (eg, avian influenza) and then, in response to community needs, expanded to cover human health and environmental health issues. ©Terdsak Yano, Somphorn Phornwisetsirikun, Patipat Susumpow, Surasing Visrutaratna, Karoon Chanachai, Polawat Phetra, Warangkhana Chaisowwong, Pairat Trakarnsirinont, Phonpat Hemwan, Boontuan Kaewpinta, Charuk Singhapreecha, Khwanchai Kreausukon, Arisara  Charoenpanyanet, Chongchit Sripun Robert, Lamar Robert, Pranee Rodtian, Suteerat Mahasing, Ekkachai Laiya, Sakulrat Pattamakaew, Taweesart Tankitiyanon, Chalutwan Sansamur, Lertrak Srikitjakarn. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 21.03.2018.

Outbreaks following wild poliovirus importations --- Europe, Africa, and Asia, January 2009-September 2010.

PubMed

2010-11-05

The Global Polio Eradication Initiative (GPEI) began in 1988. By 2006, indigenous transmission of wild poliovirus (WPV) had been interrupted in all but four countries (Afghanistan, India, Nigeria, and Pakistan). However, outbreaks following WPV importations into previously polio-free countries remain an ongoing risk until polio is eradicated. The GPEI Strategic Plan for 2010-2012 set the following two goals for outbreak control: 1) end outbreaks occurring in 2009 by mid-2010 and 2) end outbreaks occurring during 2010 to mid-2012 within 6 months of confirmation. This report describes new outbreaks that have occurred in the World Health Organization (WHO) European Region and updates previous reports on the status of outbreaks in Africa and Asia. In 2010, the first WPV importation into the European Region since the region was declared polio-free in 2002 resulted in 476 confirmed cases: 458 in Tajikistan, 14 in Russia, three in Turkmenistan, and one in Kazakhstan. In Africa and Asia, 11 new importations into six countries were observed in 2010; 30 WPV importations that occurred during 2008-2009 resulted in 215 cases in 15 African countries during 2009-2010. An outbreak is considered interrupted if 6 months have elapsed since the latest confirmed case and surveillance performance indicators meet WHO standards. All 2009 outbreaks in Africa appear to have been interrupted, and 2010 outbreaks in three countries appear to have been interrupted. Maintaining high routine vaccination coverage and sensitive surveillance at all times and rapidly instituting additional immunization programs to control outbreaks are key to limiting and stopping the spread of WPV.

Simulation study of the mechanisms underlying outbreaks of clinical disease caused by Actinobacillus pleuropneumoniae in finishing pigs.

PubMed

Klinkenberg, D; Tobias, T J; Bouma, A; van Leengoed, L A M G; Stegeman, J A

2014-10-01

Actinobacillus pleuropneumoniae is a major cause of respiratory disease in pigs. Many farms are endemically infected without apparent disease, but occasionally severe outbreaks of pleuropneumonia occur. To prevent and control these outbreaks without antibiotics, the underlying mechanisms of these outbreaks need to be understood. Outbreaks are probably initiated by a trigger (common risk factor) changing the host-pathogen interaction, but it is unclear whether this trigger causes all cases directly (trigger mechanism), or whether the first case starts a transmission chain inducing disease in the infected contacts (transmission mechanism). The aim of this study was to identify conditions under which these mechanisms could cause A. pleuropneumoniae outbreaks, and to assess means for prevention and control. Outbreaks were first characterised by data from a literature review, defining an average outbreak at 12 weeks of age, affecting 50% of animals within 4 days. Simple mathematical models describing the two mechanisms can reproduce average outbreaks, with two observations supporting the trigger mechanism: (1) disease should be transmitted 50 times faster than supported by literature if there is a transmission chain; and (2) the trigger mechanism is consistent with the absence of reported outbreaks in young pigs as they have not yet been colonised by the bacterium. In conclusion, outbreaks of A. pleuropneumoniae on endemic farms are most likely caused by a trigger inducing pneumonia in already infected pigs, but more evidence is needed to identify optimum preventive interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Outbreak of imipenem-resistant Acinetobacter baumannii in different wards at a regional hospital related to untrained bedside caregivers.

PubMed

Wang, Ching-Hsun; Li, Jin-Feng; Huang, Li-Yueh; Lin, Fu-Mei; Yang, Ya-Sung; Siu, L Kristopher; Chang, Feng-Yee; Lin, Jung-Chung

2017-10-01

This study describes an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) involving 2 general wards at the Penghu branch of Tri-Service General Hospital. Clinical data obtained from the patients with IRAB during an outbreak from May 2014-October 2014 were reviewed. Microbiologic sampling from the environment and the hands of health care workers (HCWs) was performed. Clinical isolates from case patients were genotyped using pulsed-field gel electrophoresis (PFGE). During the outbreak period, 12 patients were colonized or infected with IRAB. The hospital room environments of the case patients were contaminated with IRAB. Hands of nurses and physicians were not colonized with IRAB, but the hands of 2 bedside caregivers of case patients were colonized with IRAB. The PFGE analysis revealed that at least 2 major genetically distinct strains disseminated between 2 different wards. After implementation of infection control measures with a cohort of nursing patients, hand hygiene education for caregivers who had not received instructions before the outbreak, and a critical value alert system to notify case patients, the outbreak was controlled successfully. This outbreak study highlights the importance of adherence to hand hygiene by all HCWs to prevent the dissemination of multidrug-resistant organisms. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Early rigorous control interventions can largely reduce dengue outbreak magnitude: experience from Chaozhou, China.

PubMed

Liu, Tao; Zhu, Guanghu; He, Jianfeng; Song, Tie; Zhang, Meng; Lin, Hualiang; Xiao, Jianpeng; Zeng, Weilin; Li, Xing; Li, Zhihao; Xie, Runsheng; Zhong, Haojie; Wu, Xiaocheng; Hu, Wenbiao; Zhang, Yonghui; Ma, Wenjun

2017-08-02

Dengue fever is a severe public heath challenge in south China. A dengue outbreak was reported in Chaozhou city, China in 2015. Intensified interventions were implemented by the government to control the epidemic. However, it is still unknown the degree to which intensified control measures reduced the size of the epidemics, and when should such measures be initiated to reduce the risk of large dengue outbreaks developing? We selected Xiangqiao district as study setting because the majority of the indigenous cases (90.6%) in Chaozhou city were from this district. The numbers of daily indigenous dengue cases in 2015 were collected through the national infectious diseases and vectors surveillance system, and daily Breteau Index (BI) data were reported by local public health department. We used a compartmental dynamic SEIR (Susceptible, Exposed, Infected and Removed) model to assess the effectiveness of control interventions, and evaluate the control effect of intervention timing on dengue epidemic. A total of 1250 indigenous dengue cases was reported from Xiangqiao district. The results of SEIR modeling using BI as an indicator of actual control interventions showed a total of 1255 dengue cases, which is close to the reported number (n = 1250). The size and duration of the outbreak were highly sensitive to the intensity and timing of interventions. The more rigorous and earlier the control interventions implemented, the more effective it yielded. Even if the interventions were initiated several weeks after the onset of the dengue outbreak, the interventions were shown to greatly impact the prevalence and duration of dengue outbreak. This study suggests that early implementation of rigorous dengue interventions can effectively reduce the epidemic size and shorten the epidemic duration.

Lujo viral hemorrhagic fever: considering diagnostic capacity and preparedness in the wake of recent Ebola and Zika virus outbreaks.

PubMed

Simulundu, Edgar; Mweene, Aaron S; Changula, Katendi; Monze, Mwaka; Chizema, Elizabeth; Mwaba, Peter; Takada, Ayato; Ippolito, Guiseppe; Kasolo, Francis; Zumla, Alimuddin; Bates, Matthew

2016-11-01

Lujo virus is a novel Old World arenavirus identified in Southern Africa in 2008 as the cause of a viral hemorrhagic fever (VHF) characterized by nosocomial transmission with a high case fatality rate of 80% (4/5 cases). Whereas this outbreak was limited, the unprecedented Ebola virus disease outbreak in West Africa, and recent Zika virus disease epidemic in the Americas, has brought into acute focus the need for preparedness to respond to rare but potentially highly pathogenic outbreaks of zoonotic or arthropod-borne viral infections. A key determinant for effective control of a VHF outbreak is the time between primary infection and diagnosis of the index case. Here, we review the Lujo VHF outbreak of 2008 and discuss how preparatory measures with respect to developing diagnostic capacity might be effectively embedded into existing national disease control networks, such as those for human immunodeficiency virus, tuberculosis, and malaria. Copyright © 2016 John Wiley & Sons, Ltd.

An unwanted visitor. Aggressive infection control strategies are needed to shorten the hospital visit of the easily spread norovirus.

PubMed

Albers, Marilyn K

2004-11-01

Norovirus is the name for a group of Norwalk-like viruses that cause acute gastroenteritis of rapid onset. A recent outbreak at a tertiary care facility in Alberta provided an opportunityfor staff and management to review their outbreak protocol and improve their infection prevention and control procedures. The outbreak caused illness in 32 of 73 exposed patients as well as 42 staff members. None of the infected patients or staff developed complications. The source of norovirus contamination was probably associated with a symptomatic food services staff member serving food cafeteria style in a satellite patient dining room. Food service procedures and serving techniques were reviewed; although no breaks in technique were identified, correct food handling procedures were reviewed with staff. Subsequent patient and staff cases were probably related to the cross contamination of environmental surfaces and patient care equipment. The director of nursing and the infection control practitioner led the investigation and management of the outbreak. An Outbreak Management Committee was also formed to reinforce routine infection prevention practices and implement infection control strategies. Communication strategies for staff, patients and visitors were quickly devised and implemented. Gaps in the outbreak protocol were identified and resolved promptly Four permanent changes were made: the use of alcohol hand rinse in designated locations; the development of a comprehensive e-mail to facilitate site-wide communication; the development of teamwork checklists and accountabilities; and the establishment of criteria for use in outbreak situations to proactively determine essential and non-essential therapies and treatments.

EpideMiology and control measures of outBreaks due to Antibiotic-Resistant orGanisms in EurOpe (EMBARGO): a systematic review protocol.

PubMed

Babu Rajendran, Nithya; Gladstone, Beryl Primrose; Rodríguez-Baño, Jesús; Sifakis, Frangiscos; Voss, Andreas; Carmeli, Yehuda; Burkert, Francesco Robert; Gkolia, Panagiota; Tacconelli, Evelina

2017-01-05

Improving our understanding of outbreaks due to antibiotic-resistant bacteria (ARB) and their control is critical in the current public health scenario. The threat of outbreaks due to ARB requires multifaceted efforts. However, a global overview of epidemiological characteristics of outbreaks due to ARB and effective infection control measures is missing. In this paper, we describe the protocol of a systematic review aimed at mapping and characterising the epidemiological aspects of outbreaks due to ARB and infection control measures in European countries. The databases MEDLINE, Web of Knowledge and Cochrane library will be searched using a 3-step search strategy. Selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. All study designs will be included if they report an outbreak and define the microbiological methods used for microorganism identification. The target bacteria will be methicillin-resistant and vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, ceftazidime-resistant and carbapenem-resistant Acinetobacter baumannii, ceftazidime-resistant and carbapenem-resistant Pseudomonas aeruginosa, ciprofloxacin-resistant Escherichia coli, extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae, carbapenem-resistant and carbapenamase-producing Enterobacteriaceae. Data will be extracted using a tailored pilot tested form and the quality of reporting will be assessed using the ORION (Outbreak Reports and Intervention Studies Of Nosocomial infections) tool. Data will be synthesised and reported by the type of ARB, setting and country. Infection control measures and bundles of measures will be described. The effectiveness will be reported as defined by the authors. Regression analysis will be used to define independent factors associated with outbreaks' control. Heterogeneity between studies will be assessed by forest plots and I² statistics. Ethical approval is not applicable for this study. Findings will be disseminated through journal publication and conference presentations and talks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Medical Surveillance Monthly Report (MSMR). Volume 5, Number 4, May 1999

DTIC Science & Technology

1999-05-01

Reporting Chlamydia Urethritis non-spec. Gonorrhea Syphilis Prim/Sec Syphilis Latent Syphilis Tertiary Syphilis Congenital MTF/Post** Cur. Cum. Cur. Cum...is prepared by the Army Medical Surveillance Activity , Directorate of Epidemiology and Disease Surveillance, United States Army Center for Health...Outbreak investigation: During the period 4 March to 8 April 1999, an Epidemiologic Consulta- tion (EPICON) team from the US Army Center for Health

Epidemiological investigation and case-control study: a Legionnaires' disease outbreak associated with cooling towers in Warstein, Germany, August-September 2013.

PubMed

Maisa, Anna; Brockmann, Ansgar; Renken, Frank; Lück, Christian; Pleischl, Stefan; Exner, Martin; Daniels-Haardt, Inka; Jurke, Annette

2015-01-01

Between 1 August and 6 September 2013, an outbreak of Legionnaires' disease (LD) with 159 suspected cases occurred in Warstein, North Rhine-Westphalia, Germany. The outbreak consisted of 78 laboratory-confirmed cases of LD, including one fatality, with a case fatality rate of 1%. Legionella pneumophila, serogroup 1, subtype Knoxville, sequence type 345, was identified as the epidemic strain. A case-control study was conducted to identify possible sources of infection. In univariable analysis, cases were almost five times more likely to smoke than controls (odds ratio (OR): 4.81; 95% confidence interval (CI): 2.33-9.93; p < 0.0001). Furthermore, cases were twice as likely to live within a 3 km distance from one identified infection source as controls (OR: 2.14; 95% CI: 1.09-4.20; p < 0.027). This is the largest outbreak of LD in Germany to date. Due to a series of uncommon events, this outbreak was most likely caused by multiple sources involving industrial cooling towers. Quick epidemiological assessment, source tracing and shutting down of potential sources as well as rapid laboratory testing and early treatment are necessary to reduce morbidity and mortality. Maintenance of cooling towers must be carried out according to specification to prevent similar LD outbreaks in the future.

Outbreak of Serratia marcescens postsurgical bloodstream infection due to contaminated intravenous pain control fluids.

PubMed

Chiang, Ping-Cherng; Wu, Tsu-Lan; Kuo, An-Jing; Huang, Yhu-Chering; Chung, Ting-Ying; Lin, Chun-Sui; Leu, Hsieh-Shong; Su, Lin-Hui

2013-09-01

Serratia marcescens is an important nosocomial pathogen causing significant outbreaks. Here we report an outbreak of bloodstream infection caused by S. marcescens at a 3500-bed hospital in Taiwan. The effective cooperative efforts of both laboratory personnel and infection control practitioners (ICPs) jointly contributed to the total control of the outbreak. A sudden increase in the isolation of S. marcescens from blood cultures was noted in the Clinical Microbiology Laboratory. The information was passed to the ICPs and an investigation was initiated. Pulsed-field gel electrophoresis was used to study the relationships among the isolates. Pulsotype A was identified in 43 (82.7%) of the 52 blood isolates studied. They were isolated from 52 patients distributed across 22 wards that were surveyed by seven ICPs. All patients had undergone surgery before the infection, and fentanyl-containing intravenous fluids were used for pain control in 43 of them. Isolates from 42 belonged to pulsotype A. Three S. marcescens isolates, all from fentanyl-containing fluids and demonstrating pulsotype A, were identified from 251 environmental cultures. All fentanyl-containing fluids that were in use were withdrawn and the outbreak was stopped. The outbreak of S. marcescens bloodstream infection apparently occurred through the use of fentanyl-containing fluids contaminated by a pulsotype A S. marcescens. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Preventing Community-wide Transmission of Cryptosporidium: A Proactive Public Health Response to a Swimming Pool–Associated Outbreak — Auglaize County, Ohio, USA

PubMed Central

Cope, J.R.; Prosser, A.; Nowicki, S.; Roberts, M.W.; Scheer, D.; Anderson, C.; Longsworth, A.; Parsons, C.; Goldschmidt, D.; Johnston, S.; Bishop, H.; Xiao, L.; Hill, V.; Beach, M.; Hlavsa, M.C.

2015-01-01

Summary The incidence of recreational water–associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues. Because of the parasite's extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues, (e.g., pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g., child care facilities). In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to Pool A. Within 5 days of the first case being reported, Pool A was hyperchlorinated to achieve 99.9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in Pool A (matched odds ratio 121.7, 95% confidence interval 27.4–∞) but not with another venue or setting. The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak. PMID:25907106

Tularaemia outbreaks in Sakarya, Turkey: case-control and environmental studies.

PubMed

Meric, M; Sayan, M; Dundar, D; Willke, A

2010-08-01

Tularaemia is an important zoonotic disease that leads to outbreaks. This study aimed to compare the epidemiological characteristics of two tularaemia outbreaks that occurred in the Sakarya region of Turkey, analyse the risk factors for the development of outbreaks and identify Francisella (F.) tularensis in the water samples. Two tularaemia outbreaks occurred in the Kocadongel village in 2005 and 2006. A field investigation and a case-control study with 47 cases and 47 healthy households were performed during the second outbreak. Clinical samples from the patients and filtrated water samples were analysed for F. tularensis via real-time polymerase chain reaction. From the two outbreaks, a total of 58 patients were diagnosed with oropharyngeal tularaemia based on their clinical and serological results. Both outbreaks occurred between the months of January and April, and the number of patients peaked in February. Logistic regression analysis revealed that the consumption of natural spring water was the only significant risk factor for tularaemia infection (odds ratio 3.5, confidence interval 1.23-10.07). F. tularensis was detected in eight clinical samples and in the filtrated natural spring water. This study is the first report of tularaemia from this region. The results show that both tularaemia outbreaks were related to the consumption of untreated natural spring water. To prevent waterborne tularaemia, community water supplies should be treated and checked periodically.

Coccidioidomycosis Outbreaks, United States and Worldwide, 1940-2015.

PubMed

Freedman, Michael; Jackson, Brendan R; McCotter, Orion; Benedict, Kaitlin

2018-03-01

Coccidioidomycosis causes substantial illness and death in the United States each year. Although most cases are sporadic, outbreaks provide insight into the clinical and environmental features of coccidioidomycosis, high-risk activities, and the geographic range of Coccidioides fungi. We identified reports published in English of 47 coccidioidomycosis outbreaks worldwide that resulted in 1,464 cases during 1940-2015. Most (85%) outbreaks were associated with environmental exposures; the 2 largest outbreaks resulted from an earthquake and a large dust storm. More than one third of outbreaks occurred in areas where the fungus was not previously known to be endemic, and more than half of outbreaks involved occupational exposures. Coccidioidomycosis outbreaks can be difficult to detect and challenging to prevent given the unknown effectiveness of environmental control methods and personal protective equipment; therefore, increased awareness of coccidioidomycosis outbreaks is needed among public health professionals, healthcare providers, and the public.

Coccidioidomycosis Outbreaks, United States and Worldwide, 1940–2015

PubMed Central

Freedman, Michael; Jackson, Brendan R.; McCotter, Orion

2018-01-01

Coccidioidomycosis causes substantial illness and death in the United States each year. Although most cases are sporadic, outbreaks provide insight into the clinical and environmental features of coccidioidomycosis, high-risk activities, and the geographic range of Coccidioides fungi. We identified reports published in English of 47 coccidioidomycosis outbreaks worldwide that resulted in 1,464 cases during 1940–2015. Most (85%) outbreaks were associated with environmental exposures; the 2 largest outbreaks resulted from an earthquake and a large dust storm. More than one third of outbreaks occurred in areas where the fungus was not previously known to be endemic, and more than half of outbreaks involved occupational exposures. Coccidioidomycosis outbreaks can be difficult to detect and challenging to prevent given the unknown effectiveness of environmental control methods and personal protective equipment; therefore, increased awareness of coccidioidomycosis outbreaks is needed among public health professionals, healthcare providers, and the public. PMID:29460741

Outbreak of Salmonella Enteritidis phage type 13a: case-control investigation in Hertsmere, United Kingdom.

PubMed

Morgan, O; Milne, L; Kumar, S; Murray, D; Man, W; Georgiou, M; Verlander, N Q; de Pinna, E; McEvoy, M

2007-07-01

Cases of illness were reported to Hertsmere Borough Council among attendees of a children's charity event in June 2006. Initial laboratory investigation identified Salmonella Enteritidis PT13a as a possible cause of the outbreak. We carried out an unmatched case-control investigation. The population at risk included all individuals who attended the event. Self-completion questionnaires were sent to 53 presumptive cases and 212 randomly selected potential controls. Information was available for 49 cases and 128 controls (overall response rate=75%). We calculated odds ratios from single and multivariable analysis and tested for all two-way interactions. Risk factors for diarrhoea were eating egg mayonnaise bagels (OR=34.1, 95%CI 10.5 - 111.3) and drinking apple juice (OR=16.1, 95% CI 3.5 - 74.2). There was weak statistical evidence to suggest that the risk of diarrhoea after eating egg mayonnaise bagels was greater in the afternoon. No food samples were available to confirm which food item might have caused this outbreak. Eggs from Spain were used by the caterer. The ecology of salmonella, experience from previous outbreaks and epidemiological findings from this case-control investigation suggest that the most likely cause of the outbreak was contaminated eggs.

Meningococcal disease in South African goldmines--epidemiology and strategies for control.

PubMed

Sonnenberg, P; Silber, E; Ho, K C; Koornhof, H J

2000-05-01

To describe the epidemiology of meningococcal disease in South African goldmines and to suggest strategies for the prevention and control of further outbreaks. We prospectively investigated a meningococcal outbreak that occurred in 1996 and describe the control measures that were implemented. In addition, we conducted a retrospective analysis of routinely collected data on meningococcal disease in these mines from 1972 to 1996. Four goldmines in Gauteng, employing 30,000 workers who live in hostels. All cases of meningococcal disease at the mine hospital. Between 1972 and 1976, 588 cases were diagnosed, with peaks in 1972 (203 cases, 727/100,000) and 1975 (147 cases, 564/100,000). Since 1978 less than 5 cases have been reported in most years, but smaller outbreaks occurred in 1990 (30 cases, 89/100,000) and 1996 (14 cases, 50/100,000). The 1996 outbreak (group A, clone I-1) was part of a larger outbreak in Gauteng that originated in Mozambique and began in one mine in July 1996, after which a mass vaccination campaign was implemented. This was followed by a smaller outbreak among non-vaccinated workers at an adjacent mine. Five patients were new recruits. Despite a dramatic reduction in meningococcal disease over the last 25 years due mainly to changes in the work force, there are still outbreaks in this community. Those most at risk are young men who are new to the industry. Suggestions for prevention include effective surveillance, routine vaccination of new recruits and a rapid response to outbreaks, with mass vaccination and provision of chemoprophylaxis to close contacts.

[Investigation of a measles outbreak caused by genotype D8 virus in Pinghu city of Zhejiang province, 2017].

PubMed

Yan, R; He, B; Yao, F Y; Xiang, Z L; He, H Q; Xie, S Y; Feng, Y

2018-03-10

Objective: To investigate the epidemiological characteristics of measles outbreak caused by genotype D8 virus in Pinghu city of Zhejiang province, and provide evidence for the control of the outbreak. Methods: The measles outbreak data were collected through National Measles Surveillance System. The outpatient records and admission records were checked, field investigation and outbreak response were conducted. Blood samples in acute phase and swab specimens were collected from the patients for laboratory testing, including serology test, RNA extraction and amplification, measles virus isolation and genotype identification. Software SPSS 17.0 and Excel 2016 were used for data analysis. Results: A total of 10 confirmed measles cases were reported in Pinghu city, and 8 cases were aged >40 years. Six blood samples were collected, in which 5 were measles D8 virus positive and 1 was negative in measles virus detection. There were epidemiological links among 10 cases which occurred in a factory, a hospital and a family at the same time. There was no statistical difference in symptoms among cases caused by D8 virus and H1a virus. After the emergent measles vaccination, the measles outbreak was effectively controlled. Conclusion: Untimely response due to the uneasy detection of measles cases in the early stage, nosocomial infection and weak barrier of measles immunity in adults might be the main reasons for this outbreak. Measles vaccination is effective in the prevention of measles D8 virus infection. It is necessary to strengthen measles genotype monitoring for the tracing of infection source and control of outbreaks.

Management of nosocomial scabies, an outbreak of occupational disease.

PubMed

Jungbauer, Frank H W; Veenstra-Kyuchukova, Yanka K; Koeze, Jacqueline; KruijtSpanjer, Martijn R; Kardaun, Sylvia H

2015-05-01

The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient. Containment of an outbreak relies on a quick and strict implementation of appropriate infection control measures and should include simultaneous treatment of all infested persons and exposed contacts to prevent secondary spread and prolonged post-intervention surveillance. © 2015 Wiley Periodicals, Inc.

School Meal Programs: Few Outbreaks of Foodborne Illness Reported. Report to the Ranking Minority Member, Committee on Agriculture, Nutrition, and Forestry, U.S. Senate.

ERIC Educational Resources Information Center

Robertson, Robert E.

Twenty outbreaks of foodborne illness in schools were reported to the Centers for Disease Control and Prevention (CDC) during 1997; however, only 8 cases were associated with food served in the school meal programs. Preliminary findings identified nine outbreaks in 1998, affecting an estimated 1,609 individuals. CDC notes that such outbreaks are…

Unmasking leading to a health care worker Mycobacterium tuberculosis transmission.

PubMed

Holden, Kerry L; Bradley, Craig W; Curran, Evonne T; Pollard, Christopher; Smith, Grace; Holden, Elisabeth; Glynn, Patricia; Garvey, Mark

2018-05-09

Mycobacterium tuberculosis is a major health burden worldwide. The disease can present as an individual case, community outbreak or more rarely a nosocomial outbreak. Even in countries with a low prevalence such as the UK, tuberculosis (TB) presents a risk to healthcare workers (HCWs). To report an outbreak which manifested 12 months after a patient with pulmonary tuberculosis was admitted to Queen Elizabeth Hospital Birmingham (QEHB). We present the epidemiological and outbreak investigations; the role of whole genome sequencing (WGS) in identifying the outbreak and control measures to prevent further outbreaks. Subsequent to a case of open tuberculosis in a patient transmission was confirmed in one healthcare worker (HCW) who had active TB; HCW cases of latent TB infection (LTBI) were also identified amongst 7 HCW contacts of the index case. Of note, all the LBTI cases had other risk factors for TB. Routine use of Whole Genome Sequencing (WGS) identified the outbreak link between the index case to the HCW with active TB disease, and also informed our investigations. Exposure most likely occurred during an aerosol generating procedure (AGP) which was done in accordance with national guidance at that time without using respiratory protection. Enhanced control measures were implemented following the outbreak. Copyright © 2018. Published by Elsevier Ltd.

Networks and tuberculosis: an undetected community outbreak involving public places.

PubMed

Klovdahl, A S; Graviss, E A; Yaganehdoost, A; Ross, M W; Wanger, A; Adams, G J; Musser, J M

2001-03-01

After decades of decline in developed countries, there was a resurgence of tuberculosis in the mid-1980s accompanied by increased recognition that this infectious disease has long remained a major public health problem at the global level. New methods from molecular biology, in particular DNA 'fingerprinting' (of Mycobacterium tuberculosis), made it clear that current transmission and recent infection (in contrast to reactivation of earlier, latent infection) were much more significant than previously believed. Studies of tuberculosis outbreaks using these new tools pointed to complex networks through which infection was spreading and highlighted the need for new approaches to outbreak investigation and disease control. In the study reported here a new approach--combining methods from molecular biology, epidemiology and network analysis--was used to examine an outbreak of tuberculosis in Houston, Texas. Initial investigation using conventional strategies revealed few contacts among 37 patients with identical (six-band) DNA (IS6110-based) fingerprints but subsequent research uncovered over 40 places (including many gay bars) to which patients in this outbreak could be linked. Network methods were used to reconstruct an outbreak network and to quantify the relative importance (here, 'betweenness' centrality) of different actors (persons and places) playing a role in the outbreak. The multidisciplinary work provides the basis for a new approach to outbreak investigation and disease control.

An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland.

PubMed

Laine, J; Huovinen, E; Virtanen, M J; Snellman, M; Lumio, J; Ruutu, P; Kujansuu, E; Vuento, R; Pitkänen, T; Miettinen, I; Herrala, J; Lepistö, O; Antonen, J; Helenius, J; Hänninen, M-L; Maunula, L; Mustonen, J; Kuusi, M

2011-07-01

An inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment. To establish the true disease burden from this exposure, we undertook a population-based questionnaire investigation with a control population, infrequently used to study waterborne outbreaks. The study covered three areas, contaminated and uncontaminated parts of the town and a control town. An estimated 8453 residents fell ill during the outbreak, the excess number of illnesses being 6501. Attack rates were 53% [95% confidence interval (CI) 49.5-56.4] in the contaminated area, 15.6% (95% CI 13.1-18.5) in the uncontaminated area and 6.5% (95% CI 4.8-8.8) in the control population. Using a control population allowed us to differentiate baseline morbidity from the observed morbidity caused by the water contamination, thus enabling a more accurate estimate of the disease burden of this outbreak.

Outbreak of Escherichia coli O157:H7 Infections After Petting Zoo Visits, North Carolina State Fair, October-November 2004

USDA-ARS?s Scientific Manuscript database

Objectives: To identify cases, describe the outbreak, implement control measures, and identify factors associated with infection or protection from infection, including contact with animals and hand hygiene practices. Design: Case finding, a case-control study of 45 cases and 188 controls, enviro...

Epidemiological investigation of an outbreak of typhoid fever in Jorhat town of Assam, India.

PubMed

Roy, Jashbeer Singh; Saikia, Lahari; Medhi, Mithu; Tassa, Dipak

2016-10-01

Typhoid fever is a global health problem and is also endemic in India. An outbreak of fever occurred in January 2014 in Jorhat Town in Assam, India. Here we report the results of an investigation done to find out the aetiology and source of the outbreak. The affected areas were visited on January 23, 2014 by a team of Jorhat district Integrated Disease Surveillance Project personnel. A total of 13 blood samples from patients with fever as first symptom and six water samples were collected from the affected areas. The blood samples were cultured and isolates were identified using standard biochemical tests. Isolates were also tested for antimicrobial sensitivity. Widal test was performed on 10 of the 13 blood samples collected. Sanitary survey was carried out to find any leakage in the water supply and also the sewage system of the Jorhat town. Blood culture yielded Salmonella enterica serovar Typhi in six (46.15%) patients whereas Widal test was positive in 10 (76.9%) of 13 patients. Water culture showed presumptive coliform count of >180/100 ml in two out of the six samples tested. Salmonella Typhi was also isolated from water culture of these two samples. Sanitary survey carried out in the affected places showed that the water supply pipes of urban water supply were in close proximity to the sewage drainage system and there were few leakages. The outbreak occurred due to S. Typhi contaminating the water supply. Sanitation and immunization are the two most important components to be stressed to prevent such outbreaks.

Epidemiological investigation of an outbreak of typhoid fever in Jorhat town of Assam, India

PubMed Central

Roy, Jashbeer Singh; Saikia, Lahari; Medhi, Mithu; Tassa, Dipak

2016-01-01

Background & objectives: Typhoid fever is a global health problem and is also endemic in India. An outbreak of fever occurred in January 2014 in Jorhat Town in Assam, India. Here we report the results of an investigation done to find out the aetiology and source of the outbreak. Methods: The affected areas were visited on January 23, 2014 by a team of Jorhat district Integrated Disease Surveillance Project personnel. A total of 13 blood samples from patients with fever as first symptom and six water samples were collected from the affected areas. The blood samples were cultured and isolates were identified using standard biochemical tests. Isolates were also tested for antimicrobial sensitivity. Widal test was performed on 10 of the 13 blood samples collected. Sanitary survey was carried out to find any leakage in the water supply and also the sewage system of the Jorhat town. Results: Blood culture yielded Salmonella enterica serovar Typhi in six (46.15%) patients whereas Widal test was positive in 10 (76.9%) of 13 patients. Water culture showed presumptive coliform count of >180/100 ml in two out of the six samples tested. Salmonella Typhi was also isolated from water culture of these two samples. Sanitary survey carried out in the affected places showed that the water supply pipes of urban water supply were in close proximity to the sewage drainage system and there were few leakages. Interpretation & conclusions: The outbreak occurred due to S. Typhi contaminating the water supply. Sanitation and immunization are the two most important components to be stressed to prevent such outbreaks. PMID:28256469

Evaluation of Strategies to Control a Potential Outbreak of Foot-and-Mouth Disease in Sweden.

PubMed

Dórea, Fernanda C; Nöremark, Maria; Widgren, Stefan; Frössling, Jenny; Boklund, Anette; Halasa, Tariq; Ståhl, Karl

2017-01-01

To minimize the potential consequences of an introduction of foot-and-mouth disease (FMD) in Europe, European Union (EU) member states are required to present a contingency plan. This study used a simulation model to study potential outbreak scenarios in Sweden and evaluate the best control strategies. The model was informed by the Swedish livestock structure using herd information from cattle, pig, and small ruminant holdings in the country. The contact structure was based on animal movement data and studies investigating the movements between farms of veterinarians, service trucks, and other farm visitors. All scenarios of outbreak control included depopulation of detected herds, 3 km protection and 10 km surveillance zones, movement tracing, and 3 days national standstill. The effect of availability of surveillance resources, i.e., number of field veterinarians per day, and timeliness of enforcement of interventions, was assessed. With the estimated currently available resources, an FMD outbreak in Sweden is expected to be controlled (i.e., last infected herd detected) within 3 weeks of detection in any evaluated scenario. The density of farms in the area where the epidemic started would have little impact on the time to control the outbreak, but spread in high density areas would require more surveillance resources, compared to areas of lower farm density. The use of vaccination did not result in a reduction in the expected number of infected herds. Preemptive depopulation was able to reduce the number of infected herds in extreme scenarios designed to test a combination of worst-case conditions of virus introduction and spread, but at the cost of doubling the number of herds culled. This likely resulted from a combination of the small outbreaks predicted by the spread model, and the high efficacy of the basic control measures evaluated, under the conditions of the Swedish livestock industry, and considering the assumed control resources available. The results indicate that the duration and extent of FMD outbreaks could be kept limited in Sweden using the EU standard control strategy and a 3 days national standstill.

Evaluation of Strategies to Control a Potential Outbreak of Foot-and-Mouth Disease in Sweden

PubMed Central

Dórea, Fernanda C.; Nöremark, Maria; Widgren, Stefan; Frössling, Jenny; Boklund, Anette; Halasa, Tariq; Ståhl, Karl

2017-01-01

To minimize the potential consequences of an introduction of foot-and-mouth disease (FMD) in Europe, European Union (EU) member states are required to present a contingency plan. This study used a simulation model to study potential outbreak scenarios in Sweden and evaluate the best control strategies. The model was informed by the Swedish livestock structure using herd information from cattle, pig, and small ruminant holdings in the country. The contact structure was based on animal movement data and studies investigating the movements between farms of veterinarians, service trucks, and other farm visitors. All scenarios of outbreak control included depopulation of detected herds, 3 km protection and 10 km surveillance zones, movement tracing, and 3 days national standstill. The effect of availability of surveillance resources, i.e., number of field veterinarians per day, and timeliness of enforcement of interventions, was assessed. With the estimated currently available resources, an FMD outbreak in Sweden is expected to be controlled (i.e., last infected herd detected) within 3 weeks of detection in any evaluated scenario. The density of farms in the area where the epidemic started would have little impact on the time to control the outbreak, but spread in high density areas would require more surveillance resources, compared to areas of lower farm density. The use of vaccination did not result in a reduction in the expected number of infected herds. Preemptive depopulation was able to reduce the number of infected herds in extreme scenarios designed to test a combination of worst-case conditions of virus introduction and spread, but at the cost of doubling the number of herds culled. This likely resulted from a combination of the small outbreaks predicted by the spread model, and the high efficacy of the basic control measures evaluated, under the conditions of the Swedish livestock industry, and considering the assumed control resources available. The results indicate that the duration and extent of FMD outbreaks could be kept limited in Sweden using the EU standard control strategy and a 3 days national standstill. PMID:28791298

Rapid control of a chancroid outbreak: implications for Canada.

PubMed Central

Jessamine, P G; Brunham, R C

1990-01-01

From June to November 1987 an outbreak of chancroid occurred in Winnipeg, the first in more than 10 years; 14 people (9 men, 5 women) were involved. Nine of the cases were confirmed through culture. A control strategy was implemented in November 1987 that included presumptive treatment of genital ulcer disease with single-dose antimicrobial therapy, intensive tracing of contacts and treatment of asymptomatic sexual contacts. The origin of the outbreak was not determined, and an epidemiologic link between all the patients could not be demonstrated. The isolates were found to contain the same plasmid; this suggested that a single clone of Haemophilus ducreyi was responsible for the outbreak. Images Fig. 2 PMID:2337844

Simulation of Cross-border Impacts Resulting from Classical Swine Fever Epidemics within the Netherlands and Germany.

PubMed

Hop, G E; Mourits, M C M; Oude Lansink, A G J M; Saatkamp, H W

2016-02-01

The cross-border region of the Netherlands (NL) and the two German states of North Rhine Westphalia (NRW) and Lower Saxony (LS) is a large and highly integrated livestock production area. This region increasingly develops towards a single epidemiological area in which disease introduction is a shared veterinary and, consequently, economic risk. The objectives of this study were to examine classical swine fever (CSF) control strategies' veterinary and direct economic impacts for NL, NRW and LS given the current production structure and to analyse CSF's cross-border causes and impacts within the NL-NRW-LS region. The course of the epidemic was simulated by the use of InterSpread Plus, whereas economic analysis was restricted to calculating disease control costs and costs directly resulting from the control measures applied. Three veterinary control strategies were considered: a strategy based on the minimum EU requirements, a vaccination and a depopulation strategy based on NL and GER's contingency plans. Regardless of the veterinary control strategy, simulated outbreak sizes and durations for 2010 were much smaller than those simulated previously, using data from over 10 years ago. For example, worst-case outbreaks (50th percentile) in NL resulted in 30-40 infected farms and lasted for two to four and a half months; associated direct costs and direct consequential costs ranged from €24.7 to 28.6 million and €11.7 to 26.7 million, respectively. Both vaccination and depopulation strategies were efficient in controlling outbreaks, especially large outbreaks, whereas the EU minimum strategy was especially deficient in controlling worst-case outbreaks. Both vaccination and depopulation strategies resulted in low direct costs and direct consequential costs. The probability of cross-border disease spread was relatively low, and cross-border spread resulted in small, short outbreaks in neighbouring countries. Few opportunities for further cross-border harmonization and collaboration were identified, including the implementation of cross-border regions (free and diseased regions regardless of the border) in case of outbreaks within close proximity of the border, and more and quicker sharing of information across the border. It was expected, however, that collaboration to mitigate the market effects of an epidemic will create more opportunities to lower the impact of CSF outbreaks in a cross-border context. © 2014 Blackwell Verlag GmbH.

Clinical Validation Trial of a Diagnostic for Ebola Zaire Antigen Detection: Design Rationale and Challenges to Implementation

PubMed Central

Schieffelin, John; Moses, Lina M; Shaffer, Jeffrey; Goba, Augustine; Grant, Donald S

2015-01-01

The current Ebola outbreak in West Africa has affected more people than all previous outbreaks combined. The current diagnostic method of choice, quantitative polymerase chain reaction, requires specialized conditions as well as specially trained technicians. Insufficient testing capacity has extended the time from sample collection to results. These delays have led to further delays in the transfer and treatment to Ebola Treatment Units. A sensitive and specific point-of-care device that could be used reliably in low resource settings by healthcare workers with minimal training would increase the efficiency of triage and appropriate transfer of care. This article describes a study designed to validate the sensitivity and specificity of the ReEBOVTM RDT using venous whole blood and capillary blood obtained via fingerprick. We present the scientific and clinical rationale for the decisions made in the design of a diagnostic validation study to be conducted in an outbreak setting. The multi-site strategy greatly complicated implementation. In addition, a decrease in cases in one geographic area along with a concomitant increase in other areas made site selection challenging. Initiation of clinical trials during rapidly evolving outbreaks requires significant cooperation on a national level between research teams implementing studies and clinical care providers. Coordination and streamlining of approval process is essential if trials are to be implemented in a timely fashion. PMID:26768566

Chelonitoxism outbreak caused from consuming turtle, Eastern Samar, Philippines, August 2013.

PubMed

Ventura, Ray Justin; Ching, Paola Katrina; de los Reyes, Vikki Carr; Sucaldito, Ma Nemia; Tayag, Enrique

2015-01-01

On 21 August 2013, the Event-based Surveillance and Response system of the Department of Health, Philippines captured a foodborne illness event among residents of a coastal village in Eastern Samar, Philippines. The suspected cause was the consumption of a sea turtle found near the village. A team from the Department of Health was sent to conduct an outbreak investigation. A case was defined as any person in Arteche, Eastern Samar, who developed dry mouth and burning sensation in the throat from 15 August to 27 August, 2013. Severity of the disease was classified as mild, moderate or severe. We conducted records review, environmental investigation, interviews of key informants and a retrospective cohort study. Sixty-eight cases were identified; four died (case fatality rate = 6%). All cases had a history of turtle meat consumption. Dose-dependent relationship was noted between amount of turtle meat consumed and the risk of illness. In the cohort study, consumption of turtle meat and turtle meat soup were associated with illness. This study identified turtle meat as the source of this foodborne outbreak and emphasized the dangers of consuming turtle meat. Other reported cases of turtle meat poisoning in the Philippines suggest that turtle consumption is an ongoing practice in the country. By publishing information about sea turtle poisoning outbreaks in the Philippines, we hope to raise awareness of the potential severe health effects from ingesting these endangered sea creatures.

Dengue Contingency Planning: From Research to Policy and Practice

PubMed Central

Runge-Ranzinger, Silvia; Kroeger, Axel; Olliaro, Piero; McCall, Philip J.; Sánchez Tejeda, Gustavo; Lloyd, Linda S.; Hakim, Lokman; Bowman, Leigh R.; Horstick, Olaf; Coelho, Giovanini

2016-01-01

Background Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. Methodology/Principal findings Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. Conclusions/Significance Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan. PMID:27653786

[Infection control and safety culture in German hospitals].

PubMed

Hansen, Sonja; Schwab, Frank; Gropmann, Alexander; Behnke, Michael; Gastmeier, Petra

2016-07-01

Healthcare-associated infections (HAI) are the most frequent adverse events in the healthcare setting and their prevention is an important contribution to patient safety in hospitals. To analyse to what extent safety cultural aspects with relevance to infection control are implemented in German hospitals. Safety cultural aspects of infection control were surveyed with an online questionnaire; data were analysed descriptively. Data from 543 hospitals with a median of [IQR] 275 [157; 453] beds were analysed. Almost all hospitals (96.6 %) had internal guidelines for infection control (IC) in place; 82 % defined IC objectives, most often regarding hand hygiene (HH) (93 %) and multidrug resistant organisms (72 %) and less frequently for antibiotic stewardship (48 %) or prevention of specific HAI. In 94 % of hospitals, a reporting system for adverse events was in place, which was also used to report low compliance with HH, outbreaks and Clostridium difficile-associated infections. Members of the IC team were most often seen to hold daily responsibility for IC in the hospital, but rarely other hospital staff (94 versus 19 %). Safety cultural aspects are not fully implemented in German hospitals. IC should be more strongly implemented in healthcare workers' daily routine and more visibly supported by hospital management.

Estimated Cost to a Restaurant of a Foodborne Illness Outbreak.

PubMed

Bartsch, Sarah M; Asti, Lindsey; Nyathi, Sindiso; Spiker, Marie L; Lee, Bruce Y

Although outbreaks of restaurant-associated foodborne illness occur periodically and make the news, a restaurant may not be aware of the cost of an outbreak. We estimated this cost under varying circumstances. We developed a computational simulation model; scenarios varied outbreak size (5 to 250 people affected), pathogen (n = 15), type of dining establishment (fast food, fast casual, casual dining, and fine dining), lost revenue (ie, meals lost per illness), cost of lawsuits and legal fees, fines, and insurance premium increases. We estimated that the cost of a single foodborne illness outbreak ranged from $3968 to $1.9 million for a fast-food restaurant, $6330 to $2.1 million for a fast-casual restaurant, $8030 to $2.2 million for a casual-dining restaurant, and $8273 to $2.6 million for a fine-dining restaurant, varying from a 5-person outbreak, with no lost revenue, lawsuits, legal fees, or fines, to a 250-person outbreak, with high lost revenue (100 meals lost per illness), and a high amount of lawsuits and legal fees ($1 656 569) and fines ($100 000). This cost amounts to 10% to 5790% of a restaurant's annual marketing costs and 0.3% to 101% of annual profits and revenue. The biggest cost drivers were lawsuits and legal fees, outbreak size, and lost revenue. Pathogen type affected the cost by a maximum of $337 000, the difference between a Bacillus cereus outbreak (least costly) and a listeria outbreak (most costly). The cost of a single foodborne illness outbreak to a restaurant can be substantial and outweigh the typical costs of prevention and control measures. Our study can help decision makers determine investment and motivate research for infection-control measures in restaurant settings.

Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak.

PubMed

Pike, Jamison; Tippins, Ashley; Nyaku, Mawuli; Eckert, Maribeth; Helgenberger, Louisa; Underwood, J Michael

2017-10-13

After 20years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children's Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country's costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM's economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education. Published by Elsevier Ltd.

Establishing a milkborne disease outbreak profile: potential food defense implications.

PubMed

Newkirk, Ryan; Hedberg, Craig; Bender, Jeff

2011-03-01

The main objectives of this study were to establish baseline characteristics for milkborne outbreaks, establish an expected milkborne outbreak profile, and identify potential indicators of food terrorism. This study used 1990-2006 data from the Centers for Disease Control and Prevention Annual Listings of Disease Outbreaks and the Foodborne Outbreak Database (FOOD) to establish epidemiologic baseline characteristics for disease outbreaks associated with fluid milk. FOOD data from 2007 were used to qualitatively validate the potential of the baseline characteristics and the expected outbreak profile. Eighty-three fluid milkborne outbreaks were reported between 1990 and 2006, resulting in 3621 illnesses. The mean number of illnesses per outbreak was 43.6 (illness range: 2-1644). Consumption of unpasteurized milk was associated with 55.4% of reported outbreaks. Campylobacter spp., Escherichia coli, and Salmonella spp. caused 51.2%, 10.8%, and 9.6% of reported outbreaks, respectively. Private homes accounted for 41.0% of outbreak locations. Number ill, outbreak location, and etiology were the primary characteristics which could signal a potential intentional contamination event. In 2007, one pasteurized milk outbreak caused by Listeria was flagged as aberrative compared with the expected outbreak profile. The creation and dissemination of expected outbreak profiles and epidemiologic baseline characteristics allow public health and Homeland Security officials to quickly assess the potential of intentional food contamination. A faster public health and medical system response can result in decreased morbidity and mortality.

Influenza outbreak control practices and the effectiveness of interventions in long-term care facilities: a systematic review.

PubMed

Rainwater-Lovett, Kaitlin; Chun, Kevin; Lessler, Justin

2014-01-01

Evaluation of influenza control measures frequently focuses on the efficacy of chemoprophylaxis and vaccination, while the effectiveness of non-pharmaceutical interventions (NPI) receives less emphasis. While influenza control measures are frequently reported for individual outbreaks, there have been few efforts to characterize the real-world effectiveness of these interventions across outbreaks. To characterize influenza case and outbreak definitions and control measures reported by long-term care facilities (LTCFs) of elderly adults and estimate the reduction in influenza-like illness (ILI) attack rates due to chemoprophylaxis and NPI. We conducted a literature search in PubMed including English-language studies reporting influenza outbreaks among elderly individuals in LTCFs. A Bayesian hierarchical logistic regression model estimated the effects of control measures on ILI attack rates. Of 654 articles identified in the literature review, 37 articles describing 60 influenza outbreaks met the inclusion criteria. Individuals in facilities where chemoprophylaxis was used were significantly less likely to develop influenza A or B than those in facilities with no interventions [odds ratio (OR) 0·48, 95% CI: 0·28, 0·84]. Considered by drug class, adamantanes significantly reduced infection risk (OR 0·22, 95% CI: 0·12, 0·42), while neuraminidase inhibitors did not show a significant effect. Although NPI showed no significant effect, the results suggest that personal protective equipment may produce modest protective effects. Our results indicate pharmaceutical control measures have the clearest reported protective effect in LTCFs. Non-pharmaceutical approaches may be useful; however, most data were from observational studies and standardized reporting or well-conducted clinical trials of NPI are needed to more precisely measure these effects. © 2013 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Costs of dengue prevention and incremental cost of dengue outbreak control in Guantanamo, Cuba.

PubMed

Baly, Alberto; Toledo, Maria E; Rodriguez, Karina; Benitez, Juan R; Rodriguez, Maritza; Boelaert, Marleen; Vanlerberghe, Veerle; Van der Stuyft, Patrick

2012-01-01

To assess the economic cost of routine Aedes aegypti control in an at-risk environment without dengue endemicity and the incremental costs incurred during a sporadic outbreak. The study was conducted in 2006 in the city of Guantanamo, Cuba. We took a societal perspective to calculate costs in months without dengue transmission (January-July) and during an outbreak (August-December). Data sources were bookkeeping records, direct observations and interviews. The total economic cost per inhabitant (p.i.) per month. (p.m.) increased from 2.76 USD in months without dengue transmission to 6.05 USD during an outbreak. In months without transmission, the routine Aedes control programme cost 1.67 USD p.i. p.m. Incremental costs during the outbreak were mainly incurred by the population and the primary/secondary level of the healthcare system, hardly by the vector control programme (1.64, 1.44 and 0.21 UDS increment p.i. p.m., respectively). The total cost for managing a hospitalized suspected dengue case was 296.60 USD (62.0% direct medical, 9.0% direct non-medical and 29.0% indirect costs). In both periods, the main cost drivers for the Aedes control programme, the healthcare system and the community were the value of personnel and volunteer time or productivity losses. Intensive efforts to keep A. aegypti infestation low entail important economic costs for society. When a dengue outbreak does occur eventually, costs increase sharply. In-depth studies should assess which mix of activities and actors could maximize the effectiveness and cost-effectiveness of routine Aedes control and dengue prevention. © 2011 Blackwell Publishing Ltd.

Hand-hygiene compliance does not predict rates of resistant infections in critically ill surgical patients.

PubMed

Jayaraman, Sudha P; Klompas, Michael; Bascom, Molli; Liu, Xiaoxia; Piszcz, Regina; Rogers, Selwyn O; Askari, Reza

2014-10-01

Our institution had a major outbreak of multi-drug-resistant Acinetobacter (MDRA) in its general surgical and trauma intensive care units (ICUs) in 2011, requiring implementation of an aggressive infection-control response. We hypothesized that poor hand-hygiene compliance (HHC) may have contributed to the outbreak of MDRA. A response to the outbreak including aggressive environmental cleaning, cohorting, and increased hand hygiene compliance monitoring may have led to an increase in HHC after the outbreak and to a consequent decrease in the rates of infection by the nosocomial pathogens methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile. Hand-hygiene compliance, tracked in monthly audits by trained and anonymous observers, was abstracted from an infection control database. The incidences of nosocomial MRSA, VRE, and C. difficile were calculated from a separate prospectively collected data base for 6 mo before and 12 mo after the 2011 outbreak of MDRA in the institution's general surgical and trauma ICUs, and data collected prospectively from two unaffected ICUs (the thoracic surgical ICU and medical intensive care unit [MICU]). We created a composite endpoint of "any resistant pathogen," defined as MRSA, VRE, or C. difficile, and compared incidence rates over time, using the Wilcoxon signed rank test and Pearson product-moment correlation coefficient to measure the correlations among these rates. Rates of HHC before and after the outbreak of MDRA were consistently high in both the general surgical (median rates: 100% before and 97.6% after the outbreak, p=0.93) and trauma ICUs (median rates: 90% before and 96.75% after the outbreak, p=0.14). In none of the ICUs included in the study did the rates of HHC increase in response to the outbreak of MDRA. The incidence of "any resistant pathogen" decreased in the general surgical ICU after the outbreak (from 6.7/1,000 patient-days before the outbreak to 2.7/1,000 patient-days after the outbreak, p=0.04), but this decrease did not correlate with HHC (trauma ICU: Pearson correlation [ρ]=-0.34, p=0.28; general surgical ICU: ρ=0.52, p=0.08). The 2011 outbreak of MDRA at our institution occurred despite high rates of HHC. Notwithstanding stable rates of HHC, the rates of infection with MRSA, VRE and C. difficile decreased in the general surgical ICU after the outbreak. This suggests that infection control tactics other than HHC play a crucial role in preventing the transmission of nosocomial pathogens, especially when rates of HHC have been maximized.

Responding to the Potential of Ebola Virus Disease (EVD) Importation into Malaysia

PubMed Central

WAN MOHAMED NOOR, Wan Noraini; SANDHU, Sukhvinder Singh; AHMAD MAHIR, Husna Maizura; KURUP, Devan; RUSLI, Norhayati; SAAT, Zainah; CHONG, Chee Kheong; SULAIMAN, Lokman Hakim; ABDULLAH, Noor Hisham

2014-01-01

The current Ebola outbreak, which is the first to affect West African countries, has been declared to have met the conditions for a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO). Thus, the Ministry of Health (MOH) of Malaysia has taken steps to strengthen and enhanced the five core components of preparedness and response to mitigate the outbreak. The National Crisis Preparedness and Response Centre (CPRC) commands, controls and coordinates the preparedness and response plans for disasters, outbreaks, crises and emergencies (DOCE) related to health in a centralised way. Through standardised case definition and mandatory notification of Ebola by public and private practitioners, surveillance of Ebola is made possible. Government hospitals and laboratories have been identified to manage and diagnose Ebola virus infections, and medical staff members have been trained to handle an Ebola outbreak, with emphasis on strict infection prevention and control practices. Monitoring of the points of entry, focusing on travellers and students visiting or coming from West African countries is made possible by interagency collaborations. To alleviate the public’s anxiety, effective risk communications are being delivered through various channels. With experience in past outbreak control, the MOH’s preparedness and response plans are in place to abate an Ebola outbreak. PMID:25897276

Are ready-to-eat salads ready to eat? An outbreak of Salmonella Coeln linked to imported, mixed, pre-washed and bagged salad, Norway, November 2013.

PubMed

Vestrheim, D F; Lange, H; Nygård, K; Borgen, K; Wester, A L; Kvarme, M L; Vold, L

2016-06-01

We investigated a nationwide outbreak of Salmonella Coeln in Norway, including 26 cases identified between 20 October 2013 and 4 January 2014. We performed a matched case-control study, environmental investigation and detailed traceback of food purchases to identify the source of the outbreak. In the case-control study, cases were found to be more likely than controls to have consumed a ready-to-eat salad mix (matched odds ratio 20, 95% confidence interval 2·7-∞). By traceback of purchases one brand of ready-to-eat salad was indicated, but all environmental samples were negative for Salmonella. This outbreak underlines that pre-washed and bagged salads carry a risk of infection despite thorough cleaning procedures by the importer. To further reduce the risk of infection by consumption of ready-to-eat salads product quality should be ensured by importers. Outbreaks linked to salads reinforce the importance of implementation of appropriate food safety management systems, including good practices in lettuce production.

An outbreak of adult measles by nosocomial transmission in a high vaccination coverage community.

PubMed

Wang, Fen-juan; Sun, Xiang-jue; Wang, Fu-liang; Jiang, Long-fang; Xu, Er-ping; Guo, Jian-feng

2014-09-01

The aims of this study were to determine the mechanism of an outbreak of measles in adults and to provide scientific measures for putting forward a measles elimination program. We performed a cross-sectional investigation during the measles outbreak to identify a possible communication link. From November 1, 2011 to January 26, 2012, the town reported 11 cases of measles in total. The case study identified an obvious propagation chain, which showed ordered and intimate exposure between cases. Hospital exposure 1-2 weeks before infection with measles was the main cause of the measles outbreak. We must be fully aware of the possibility of nosocomial infection in an outbreak of measles; controlling nosocomial infections is a vital step in the prevention and control of the propagation of measles. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital.

PubMed

Dik, Jan-Willem H; Dinkelacker, Ariane G; Vemer, Pepijn; Lo-Ten-Foe, Jerome R; Lokate, Mariëtte; Sinha, Bhanu; Friedrich, Alex W; Postma, Maarten J

2016-01-01

Nosocomial outbreaks, especially with (multi-)resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands. Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day. Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042), with a mean of €546 and a median of €519. Majority of the costs (50%) were made because of closed beds. This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward). All outbreaks however cost considerable amounts of efforts and money (up to €356,754), including missed revenue and control measures.

Ebola Holding Units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning

PubMed Central

Johnson, Oliver; Youkee, Daniel; Brown, Colin S; Lado, Marta; Wurie, Alie; Bash-Taqi, Donald; Hall, Andy; Hanciles, Eva; Kamara, Isata; Kamara, Cecilia; Kamboz, Amardeep; Seedat, Ahmed; Thomas, Suzanne; Kamara, T B; Leather, Andrew J M; Kargbo, Brima

2016-01-01

The 2014-2015 West African outbreak of Ebola Virus Disease (EVD) claimed the lives of more than 11,000 people and infected over 27,000 across seven countries. Traditional approaches to containing EVD proved inadequate and new approaches for controlling the outbreak were required. The Ministry of Health & Sanitation and King’s Sierra Leone Partnership developed a model for Ebola Holding Units (EHUs) at Government Hospitals in the capital city Freetown. The EHUs isolated screened or referred suspect patients, provided initial clinical care, undertook laboratory testing to confirm EVD status, referred onward positive cases to an Ebola Treatment Centre or negative cases to the general wards, and safely stored corpses pending collection by burial teams. Between 29th May 2014 and 19th January 2015, our five units had isolated approximately 37% (1159) of the 3097 confirmed cases within Western Urban and Rural district. Nosocomial transmission of EVD within the units appears lower than previously documented at other facilities and staff infection rates were also low. We found that EHUs are a flexible and effective model of rapid diagnosis, safe isolation and early initial treatment. We also demonstrated that it is possible for international partners and government facilities to collaborate closely during a humanitarian crisis. PMID:28588922

Community-Centered Responses to Ebola in Urban Liberia: The View from Below

PubMed Central

Abramowitz, Sharon Alane; McLean, Kristen E.; McKune, Sarah Lindley; Bardosh, Kevin Louis; Fallah, Mosoka; Monger, Josephine; Tehoungue, Kodjo; Omidian, Patricia A.

2015-01-01

Background The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia. Methodology/Principal Findings This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support. Conclusions/Significance Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection. PMID:25856072

Community-centered responses to Ebola in urban Liberia: the view from below.

PubMed

Abramowitz, Sharon Alane; McLean, Kristen E; McKune, Sarah Lindley; Bardosh, Kevin Louis; Fallah, Mosoka; Monger, Josephine; Tehoungue, Kodjo; Omidian, Patricia A

2015-04-01

The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia. This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia--one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support. Local communities' strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.

National outbreak of Salmonella serotype saintpaul infections: importance of Texas restaurant investigations in implicating jalapeño peppers.

PubMed

Mody, Rajal K; Greene, Sharon A; Gaul, Linda; Sever, Adrianne; Pichette, Sarah; Zambrana, Ingrid; Dang, Thi; Gass, Angie; Wood, René; Herman, Karen; Cantwell, Laura B; Falkenhorst, Gerhard; Wannemuehler, Kathleen; Hoekstra, Robert M; McCullum, Isaac; Cone, Amy; Franklin, Lou; Austin, Jana; Delea, Kristin; Behravesh, Casey Barton; Sodha, Samir V; Yee, J Christopher; Emanuel, Brian; Al-Khaldi, Sufian F; Jefferson, Val; Williams, Ian T; Griffin, Patricia M; Swerdlow, David L

2011-02-23

In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak's source. We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain. Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination.

National Outbreak of Salmonella Serotype Saintpaul Infections: Importance of Texas Restaurant Investigations in Implicating Jalapeño Peppers

PubMed Central

Mody, Rajal K.; Greene, Sharon A.; Gaul, Linda; Sever, Adrianne; Pichette, Sarah; Zambrana, Ingrid; Dang, Thi; Gass, Angie; Wood, René; Herman, Karen; Cantwell, Laura B.; Falkenhorst, Gerhard; Wannemuehler, Kathleen; Hoekstra, Robert M.; McCullum, Isaac; Cone, Amy; Franklin, Lou; Austin, Jana; Delea, Kristin; Behravesh, Casey Barton; Sodha, Samir V.; Yee, J. Christopher; Emanuel, Brian; Al-Khaldi, Sufian F.; Jefferson, Val; Williams, Ian T.; Griffin, Patricia M.; Swerdlow, David L.

2011-01-01

Background In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak's source. Methodology/Principal Findings We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2–386; Restaurant B: mOR, 13; 95% CI 1.3–infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain. Conclusions/Significance Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination. PMID:21373185

Hospital-acquired listeriosis associated with sandwiches in the UK: a cause for concern.

PubMed

Little, C L; Amar, C F L; Awofisayo, A; Grant, K A

2012-09-01

Hospital-acquired outbreaks of listeriosis are not commonly reported but remain a significant public health problem. To raise awareness of listeriosis outbreaks that have occurred in hospitals and describe actions that can be taken to minimize the risk of foodborne listeriosis to vulnerable patients. Foodborne outbreaks and incidents of Listeria monocytogenes reported to the Health Protection Agency national surveillance systems were investigated and those linked to hospitals were extracted. The data were analysed to identify the outbreak/incident setting, the food vehicle, outbreak contributory factors and origin of problem. Most (8/11, 73%) foodborne outbreaks of listeriosis that occurred in the UK between 1999 and 2011 were associated with sandwiches purchased from or provided in hospitals. Recurrently in the outbreaks the infecting subtype of L. monocytogenes was detected in supplied prepacked sandwiches and sandwich manufacturing environments. In five of the outbreaks breaches in cold chain controls of food also occurred at hospital level. The outbreaks highlight the potential for sandwiches contaminated with L. monocytogenes to cause severe infection in vulnerable people. Control of L. monocytogenes in sandwich manufacturing and within hospitals is essential to minimize the potential for consumption of this bacterium at levels hazardous to health. Manufacturers supplying sandwiches to hospitals should aim to ensure absence of L. monocytogenes in sandwiches at the point of production and hospital-documented food safety management systems should ensure the integrity of the food cold chain. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Bacteria and poisonous plants were the primary causative hazards of foodborne disease outbreak: a seven-year survey from Guangxi, South China.

PubMed

Li, Yongqiang; Huang, Yaling; Yang, Jijun; Liu, Zhanhua; Li, Yanning; Yao, Xueting; Wei, Bo; Tang, Zhenzhu; Chen, Shidong; Liu, Decheng; Hu, Zhen; Liu, Junjun; Meng, Zenghui; Nie, Shaofa; Yang, Xiaobo

2018-04-18

Foodborne diseases are a worldwide public health problem. However, data regarding epidemiological characteristics are still lacking in China. We aimed to analyze the characteristics of foodborne diseases outbreak from 2010 to 2016 in Guangxi, South China. A foodborne disease outbreak is the occurrence of two or more cases of a similar foodborne disease resulting from the ingestion of a common food. All data are obtained from reports in the Public Health Emergency Report and Management Information System of the China Information System for Disease Control and Prevention, and also from special investigation reports from Guangxi province. A total of 138 foodborne diseases outbreak occurred in Guangxi in the past 7 years, leading to 3348 cases and 46 deaths. Foodborne disease outbreaks mainly occurred in the second and fourth quarters, and schools and private homes were the most common sites. Ingesting toxic food by mistake, improper cooking and cross contamination were the main routes of poisoning which caused 2169 (64.78%) cases and 37 (80.43%) deaths. Bacteria (62 outbreaks, 44.93%) and poisonous plants (46 outbreaks, 33.33%) were the main etiologies of foodborne diseases in our study. In particular, poisonous plants were the main cause of deaths involved in the foodborne disease outbreaks (26 outbreaks, 56.52%). Bacteria and poisonous plants were the primary causative hazard of foodborne diseases. Some specific measures are needed for ongoing prevention and control against the occurrence of foodborne diseases.

Outbreaks of infectious intestinal disease associated with person to person spread in hotels and restaurants.

PubMed

McDonnell, R J; Wall, P G; Adak, G K; Evans, H S; Cowden, J M; Caul, E O

1995-09-15

Twenty-eight outbreaks of infectious intestinal disease, reported as being transmitted mainly by the person to person route, were identified in association with retail catering premises, such as hotels, restaurants, and public houses, in England and Wales between 1992 and 1994. Five thousand and forty-eight people were at risk in these outbreaks and 1234 were affected. Most of the outbreaks (over 90%) occurred in hotels. Small round structured viruses were the most commonly detected pathogens. Diarrhoea and vomiting were common symptoms and most of the outbreaks occurred in the summer months. Control measures to contain infectious individuals and improved hygiene measures are necessary to contain such outbreaks.

Evaluation of outbreak response immunization in the control of pertussis using agent-based modeling.

PubMed

Doroshenko, Alexander; Qian, Weicheng; Osgood, Nathaniel D

2016-01-01

Pertussis control remains a challenge due to recently observed effects of waning immunity to acellular vaccine and suboptimal vaccine coverage. Multiple outbreaks have been reported in different ages worldwide. For certain outbreaks, public health authorities can launch an outbreak response immunization (ORI) campaign to control pertussis spread. We investigated effects of an outbreak response immunization targeting young adolescents in averting pertussis cases. We developed an agent-based model for pertussis transmission representing disease mechanism, waning immunity, vaccination schedule and pathogen transmission in a spatially-explicit 500,000-person contact network representing a typical Canadian Public Health district. Parameters were derived from literature and calibration. We used published cumulative incidence and dose-specific vaccine coverage to calibrate the model's epidemiological curves. We endogenized outbreak response by defining thresholds to trigger simulated immunization campaigns in the 10-14 age group offering 80% coverage. We ran paired simulations with and without outbreak response immunization and included those resulting in a single ORI within a 10-year span. We calculated the number of cases averted attributable to outbreak immunization campaign in all ages, in the 10-14 age group and in infants. The count of cases averted were tested using Mann-Whitney U test to determine statistical significance. Numbers needed to vaccinate during immunization campaign to prevent a single case in respective age groups were derived from the model. We varied adult vaccine coverage, waning immunity parameters, immunization campaign eligibility and tested stronger vaccination boosting effect in sensitivity analyses. 189 qualified paired-runs were analyzed. On average, ORI was triggered every 26 years. On a per-run basis, there were an average of 124, 243 and 429 pertussis cases averted across all age groups within 1, 3 and 10 years of a campaign, respectively. During the same time periods, 53, 96, and 163 cases were averted in the 10-14 age group, and 6, 11, 20 in infants under 1 (p < 0.001, all groups). Numbers needed to vaccinate ranged from 49 to 221, from 130 to 519 and from 1,031 to 4,903 for all ages, the 10-14 age group and for infants, respectively. Most sensitivity analyses resulted in minimal impact on a number of cases averted. Our model generated 30 years of longitudinal data to evaluate effects of outbreak response immunization in a controlled study. Immunization campaign implemented as an outbreak response measure among adolescents may confer benefits across all ages accruing over a 10-year period. Our inference is dependent on having an outbreak of significant magnitude affecting predominantly the selected age and achieving a comprehensive vaccine coverage during the campaign. Economic evaluations and comparisons with other control measures can add to conclusions generated by our work.

Dengue outbreak in a large military station: Have we learnt any lesson?

PubMed

Kunwar, R; Prakash, R

2015-01-01

An outbreak was reported from a large military station located in South India in 2013. In spite of instituting the preventive measures early, it took more than 2 months to bring the outbreak under control. This paper brings out lessons learnt and suggests strategy for controlling similar outbreak in future. The Military station comprises of 6 large Regimental Centres and many smaller units. The approximate strength of the serving personnel and their families is 25,000. Besides the unit Regimental Medical Officers, a large tertiary care hospital and a Station Health Organization is available to provide health care. A total of 266 patients including 192 serving personnel and 74 of their dependents were hospitalized for dengue between 15 May 2013 and 28 Jul 2013. Many dependents not having severe symptoms, were not hospitalized and treated on outpatient basis. Health advisories and instructions for constituting Dengue Task Force (DTF) were issued well in advance. Preventive measures were instituted early. But the outbreak was controlled only after intervention from higher administrative authorities. Lessons learnt included correct and timely perception of threat is essential; behavioural change of individuals is desired; availability of adequate health functionaries is mandatory; and complete dataset helps correct perception. Future strategy for control of dengue outbreak should include repeated and timely survey of entire area for correct risk perception, assessment of behavioural change among individuals; operational research to assess the impact of ongoing public health campaign.

Increase in Multistate Foodborne Disease Outbreaks-United States, 1973-2010.

PubMed

Nguyen, Von D; Bennett, Sarah D; Mungai, Elisabeth; Gieraltowski, Laura; Hise, Kelley; Gould, L Hannah

2015-11-01

Changes in food production and distribution have increased opportunities for foods contaminated early in the supply chain to be distributed widely, increasing the possibility of multistate outbreaks. In recent decades, surveillance systems for foodborne disease have been improved, allowing officials to more effectively identify related cases and to trace and identify an outbreak's source. We reviewed multistate foodborne disease outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1973-2010. We calculated the percentage of multistate foodborne disease outbreaks relative to all foodborne disease outbreaks and described characteristics of multistate outbreaks, including the etiologic agents and implicated foods. Multistate outbreaks accounted for 234 (0.8%) of 27,755 foodborne disease outbreaks, 24,003 (3%) of 700,600 outbreak-associated illnesses, 2839 (10%) of 29,756 outbreak-associated hospitalizations, and 99 (16%) of 628 outbreak-associated deaths. The median annual number of multistate outbreaks increased from 2.5 during 1973-1980 to 13.5 during 2001-2010; the number of multistate outbreak-associated illnesses, hospitalizations, and deaths also increased. Most multistate outbreaks were caused by Salmonella (47%) and Shiga toxin-producing Escherichia coli (26%). Foods most commonly implicated were beef (22%), fruits (13%), and leafy vegetables (13%). The number of identified and reported multistate foodborne disease outbreaks has increased. Improvements in detection, investigation, and reporting of foodborne disease outbreaks help explain the increasing number of reported multistate outbreaks and the increasing percentage of outbreaks that were multistate. Knowing the etiologic agents and foods responsible for multistate outbreaks can help to identify sources of food contamination so that the safety of the food supply can be improved.

Associations between biosecurity and outbreaks of canine distemper on Danish mink farms in 2012-2013.

PubMed

Gregers-Jensen, Louise; Agger, Jens Frederik; Hammer, Anne Sofie Vedsted; Andresen, Lars; Chrièl, Mariann; Hagberg, Emma; Jensen, Mette Kragh; Hansen, Mette Sif; Hjulsager, Charlotte Kristiane; Struve, Tina

2015-09-30

During 8 months from July 2012 to February 2013, a major outbreak of canine distemper involving 64 mink farms occurred on the Danish peninsula of Jutland. The canine distemper outbreak was associated with exposure of farmed mink to infected wild carnivores and could represent a deficit in biosecurity on the mink farms. The aim of this study was to investigate the extent and association of specific biosecurity measures with the outbreak. The study was carried out in an epidemiological case-control design. The case group consisted of the 61 farms, which had a confirmed outbreak of canine distemper from July 2012 to February 2013. The control group included 54 farms without an outbreak of canine distemper in 2012 or 2013, selected as the closest geographical neighbour to a case farm. The results showed that significantly more control than case farms had vaccinated their mink against canine distemper virus. Mortality was only assessed on the case farms, and there was a non-significantly lower mortality on vaccinated farms than on the non-vaccinated farms. Furthermore, the proportion of farms with observations of wild red foxes (Vulpes vulpes) inside the farm enclosures were larger for case farms, indicating that the control farms had a better biosecurity or were not equally exposed to canine distemper virus. Generally, all farms had very few specific precautions at the gate entrance in respect to human visitors as well as animals. The use of biosecurity measures was very variable in both case and control farms. Not using plastic boot covers, presence of dogs and cats, presence of demarcated area for changing clothes when entering and leaving the farm area and presence of hand washing facilities significantly lowered the odds of the farm having a canine distemper virus outbreak. The results of the study indicate that consistent use of correct vaccination strategies, implementation of biosecurity measures and limiting human and animal access to the mink farm can be important factors in reducing the risk for canine distemper outbreaks.

Research and Development of a Convertible Use Rapidly Expandable Model for Response to Disasters and Mass Casualties

DTIC Science & Technology

2009-10-01

Local health departments and communities must be prepared to address gaps where the capacity of healthcare systems is exceeded. 6 The...team to identify and understand gaps in available assets. Resources evaluated included regional hospitals, plans for patient care surge capacity...Tracking certain prescription purchases can yield clues to a new disease outbreak in the community. Software to evaluate for trends can monitor

Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control.

PubMed

Cardemil, Cristina V; Dahl, Rebecca M; James, Lisa; Wannemuehler, Kathleen; Gary, Howard E; Shah, Minesh; Marin, Mona; Riley, Jacob; Feikin, Daniel R; Patel, Manisha; Quinlisk, Patricia

2017-09-07

The effect of a third dose of the measles-mumps-rubella (MMR) vaccine in stemming a mumps outbreak is unknown. During an outbreak among vaccinated students at the University of Iowa, health officials implemented a widespread MMR vaccine campaign. We evaluated the effectiveness of a third dose for outbreak control and assessed for waning immunity. Of 20,496 university students who were enrolled during the 2015-2016 academic year, mumps was diagnosed in 259 students. We used Fisher's exact test to compare unadjusted attack rates according to dose status and years since receipt of the second MMR vaccine dose. We used multivariable time-dependent Cox regression models to evaluate vaccine effectiveness, according to dose status (three vs. two doses and two vs. no doses) after adjustment for the number of years since the second dose. Before the outbreak, 98.1% of the students had received at least two doses of MMR vaccine. During the outbreak, 4783 received a third dose. The attack rate was lower among the students who had received three doses than among those who had received two doses (6.7 vs. 14.5 cases per 1000 population, P<0.001). Students had more than nine times the risk of mumps if they had received the second MMR dose 13 years or more before the outbreak. At 28 days after vaccination, receipt of the third vaccine dose was associated with a 78.1% lower risk of mumps than receipt of a second dose (adjusted hazard ratio, 0.22; 95% confidence interval, 0.12 to 0.39). The vaccine effectiveness of two doses versus no doses was lower among students with more distant receipt of the second vaccine dose. Students who had received a third dose of MMR vaccine had a lower risk of mumps than did those who had received two doses, after adjustment for the number of years since the second dose. Students who had received a second dose of MMR vaccine 13 years or more before the outbreak had an increased risk of mumps. These findings suggest that the campaign to administer a third dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak. (Funded by the Centers for Disease Control and Prevention.).

An expensive adult measles outbreak and response in office buildings during the era of accelerated measles elimination, Beijing, China.

PubMed

Ma, Rui; Lu, Li; Suo, Luodan; Li, Xiaomei; Yang, Fan; Zhou, Tao; Zhai, Lijun; Bai, Hongwei; Pang, Xinghuo

2017-02-22

Few measles outbreaks among adults are reported in China, and outbreak response costs are seldom documented. We report an adult measles outbreak and response in 4 linked office buildings in Beijing and its associated costs. The World Health Organization measles case definitions were used to determine suspected and confirmed measles cases. Surveillance data were used to describe the outbreak, and records and interviews of response staff were used to describe the response. Costs were determined by use of retrospective surveys of cases, review of records, and interviews of staff. The outbreak lasted 19days, and involved 22 cases aged 23-49years. Nineteen cases had a local household registration. All cases were employed by 8 companies in 4 linked office buildings. Among the 22 cases, 8 had temperature less than 38.5 degree, 18 had no Koplik spots and none had complications or hospitalizations. A total of 7930 contacts were identified, and of these, 6869 were employees in the office buildings. All the child contacts aged 8months-14years had been up-to-date for measles-containing vaccine (MCV); no adult could document their vaccination or measles history. Of contacts, about 96% were offered post-exposure vaccination. The total household costs were $13,298, or $605 per case. Control costs were $384,594, or $17,481 per case. Involved companies paid for 90.7% of control costs. Office buildings provide a mechanism for measles transmission. Timely control activities were challenged by the highly infectious nature of measles and mild presentations of cases. The outbreak response was very costly. Financial support by involved companies can provide needed resources for outbreak management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Two aircraft carriers’ perspectives: a comparative of control measures in shipboard H1N1 outbreaks.

PubMed

Harwood, Jared L; LaVan, Joseph T; Brand, George J

2013-02-01

The USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned. Data were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis. Differences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction. GW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.

Outbreak Control and Clinical, Pathological, and Epidemiological Aspects and Molecular Characterization of a Bovine Herpesvirus Type 5 on a Feedlot Farm in São Paulo State

PubMed Central

Ferreira Vicente, Acácia; Appolinario, Camila Michele; Allendorf, Susan Dora; Gasparini Baraldi, Thaís; Cortez, Adriana; Bryan Heinemann, Marcos; Reinaldo Silva Fonseca, Clovis; Cristina Pelícia, Vanessa; Devidé Ribeiro, Bruna Leticia; Hiromi Okuda, Liria; Pituco, Edviges Maristela

2015-01-01

This paper describes the control, epidemiological, pathological, and molecular aspects of an outbreak of meningoencephalitis in calves due to bovine herpesvirus 5 at a feedlot with 540 animals in São Paulo State, Brazil. The introduction of new animals and contact between the resident animals and the introduced ones were most likely responsible for virus transmission. Bovine herpesvirus 1 vaccine was used, resulting in the efficacy of the outbreak control, although two bovine herpesvirus 1 positive animals, vaccinated and revaccinated, presented meningoencephalitis, thereby characterizing vaccinal failure. PMID:26090469

Outbreak of Tsukamurella species bloodstream infection among patients at an oncology clinic, West Virginia, 2011-2012.

PubMed

See, Isaac; Nguyen, Duc B; Chatterjee, Somu; Shwe, Thein; Scott, Melissa; Ibrahim, Sherif; Moulton-Meissner, Heather; McNulty, Steven; Noble-Wang, Judith; Price, Cindy; Schramm, Kim; Bixler, Danae; Guh, Alice Y

2014-03-01

To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility. Epidemiologic investigation of the outbreak with a case-control study. A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed. Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September-October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy. Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.

Being Ready to Treat Ebola Virus Disease Patients

PubMed Central

Brett-Major, David M.; Jacob, Shevin T.; Jacquerioz, Frederique A.; Risi, George F.; Fischer, William A.; Kato, Yasuyuki; Houlihan, Catherine F.; Crozier, Ian; Bosa, Henry Kyobe; Lawler, James V.; Adachi, Takuya; Hurley, Sara K.; Berry, Louise E.; Carlson, John C.; Button, Thomas. C.; McLellan, Susan L.; Shea, Barbara J.; Kuniyoshi, Gary G.; Ferri, Mauricio; Murthy, Srinivas G.; Petrosillo, Nicola; Lamontagne, Francois; Porembka, David T.; Schieffelin, John S.; Rubinson, Lewis; O'Dempsey, Tim; Donovan, Suzanne M.; Bausch, Daniel G.; Fowler, Robert A.; Fletcher, Thomas E.

2015-01-01

As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD. PMID:25510724

Monitoring and Evaluating the Ebola Response Effort in Two Liberian Communities.

PubMed

Munodawafa, Davison; Moeti, Matshidiso Rebecca; Phori, Peter Malekele; Fawcett, Stephen B; Hassaballa, Ithar; Sepers, Charles; Reed, Florence DiGennaro; Schultz, Jerry A; Chiriseri, Ephraim Tafadzwa

2018-04-01

Although credited with ultimately reducing incidence of Ebola Virus Disease (EVD) in West Africa, little is known about the amount and kind of Ebola response activities associated with reducing the incidence of EVD. Our team monitored Ebola response activities and associated effects in two rural counties in Liberia highly affected by Ebola. We used a participatory monitoring and evaluation system, and drew upon key informant interviews and document review, to systematically capture, code, characterize, and communicate patterns in Ebola response activities. We reviewed situation reports to obtain data on incidence of EVD over time. Results showed enhanced implementation of Ebola response activities corresponded with decreased incidence of EVD. The pattern of staggered implementation of activities and associated effects-replicated in both counties-is suggestive of the role of Ebola response activities in reducing EVD. Systematic monitoring of response activities to control disease outbreaks holds lessons for implementing and evaluating multi-sector, comprehensive community health efforts.

Measles (Rubeola): The Control of an Outbreak at a Large University.

ERIC Educational Resources Information Center

Bridgewater, Sharon C.; Lotz, Doris I.

1984-01-01

This article discusses the immunization program that followed an outbreak of measles (rubeloa) at Indiana University. Factors that may have contributed to the outbreak were less natural immunity in this age group, absence of school legislation requiring immunization, and use of killed vaccine which did not provide immunity. (Author/DF)

Multi-scale nest-site selection by black-backed woodpeckers in outbreaks of mountain pine beetles

Treesearch

Thomas W. Bonnot; Joshua J. Millspaugh; Mark A. Rumble

2009-01-01

Areas of mountain pine beetle (Dendroctonus ponderosae Hopkins) outbreaks in the Black Hills can provide habitat for black-backed woodpeckers (Picoides arcticus), a U.S. Forest Service, Region 2 Sensitive Species. These outbreaks are managed through removal of trees infested with mountain pine beetles to control mountain pine...

Lessons Learned from an Elementary School Norovirus Outbreak

ERIC Educational Resources Information Center

Gomez, Eileen Button

2008-01-01

Outbreaks of norovirus have been on the increase. The virus often spreads quickly through schools and similar institutions. The school nurse may be able to minimize the impact of a school norovirus outbreak by providing accurate information about the disease, the scope of the local situation, and instruction on infection control measures. This…

Investigation of serology for diagnosis of outbreaks of botulism in cattle.

PubMed

Mawhinney, I; Palmer, D; Gessler, F; Cranwell, M; Foyle, L; Otter, A; Payne, J; Strugnell, B

2012-06-01

Serology has been used to diagnose retrospectively types C and D outbreaks of botulism in cattle in Australia and this study has investigated whether the approach would be applicable in England and Wales. Three hundred sera from routine surveillance submissions in England and Wales were used as a negative control population. Some stored sera were available from a small number of clinical cases of botulism and 125 samples were collected from cohort groups of clinical cases in four new outbreaks of botulism. Three of these outbreaks were identified as being caused by type D Clostridium botulinum toxin. Sera were tested by antibody ELISA in laboratories in Australia and Germany. There was no increase in the proportion of animals seropositive to type C or D antibody in the botulism-associated cattle. The proportion of samples which were seropositive to type D antibodies was <2% in both the negative control and outbreak populations. It was concluded that single time serology is unlikely to be helpful for retrospective diagnosis of outbreaks of type D botulism in England and Wales. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Two consecutive large outbreaks of Salmonella Muenchen linked to pig farming in Germany, 2013 to 2014: Is something missing in our regulatory framework?

PubMed

Schielke, Anika; Rabsch, Wolfgang; Prager, Rita; Simon, Sandra; Fruth, Angelika; Helling, Rüdiger; Schnabel, Martin; Siffczyk, Claudia; Wieczorek, Sina; Schroeder, Sabine; Ahrens, Beate; Oppermann, Hanna; Pfeiffer, Stefan; Merbecks, Sophie Susann; Rosner, Bettina; Frank, Christina; Weiser, Armin A; Luber, Petra; Gilsdorf, Andreas; Stark, Klaus; Werber, Dirk

2017-05-04

In 2013, raw pork was the suspected vehicle of a large outbreak (n = 203 cases) of Salmonella Muenchen in the German federal state of Saxony. In 2014, we investigated an outbreak (n = 247 cases) caused by the same serovar affecting Saxony and three further federal states in the eastern part of Germany. Evidence from epidemiological, microbiological and trace-back investigations strongly implicated different raw pork products as outbreak vehicles. Trace-back analysis of S. Muenchen-contaminated raw pork sausages narrowed the possible source down to 54 pig farms, and S. Muenchen was detected in three of them, which traded animals with each other. One of these farms had already been the suspected source of the 2013 outbreak. S. Muenchen isolates from stool of patients in 2013 and 2014 as well as from food and environmental surface swabs of the three pig farms shared indistinguishable pulsed-field gel electrophoresis patterns. Our results indicate a common source of both outbreaks in the primary production of pigs. Current European regulations do not make provisions for Salmonella control measures on pig farms that have been involved in human disease outbreaks. In order to prevent future outbreaks, legislators should consider tightening regulations for Salmonella control in causative primary production settings. This article is copyright of The Authors, 2017.

Two consecutive large outbreaks of Salmonella Muenchen linked to pig farming in Germany, 2013 to 2014: Is something missing in our regulatory framework?

PubMed Central

Schielke, Anika; Rabsch, Wolfgang; Prager, Rita; Simon, Sandra; Fruth, Angelika; Helling, Rüdiger; Schnabel, Martin; Siffczyk, Claudia; Wieczorek, Sina; Schroeder, Sabine; Ahrens, Beate; Oppermann, Hanna; Pfeiffer, Stefan; Merbecks, Sophie Susann; Rosner, Bettina; Frank, Christina; Weiser, Armin A.; Luber, Petra; Gilsdorf, Andreas; Stark, Klaus; Werber, Dirk

2017-01-01

In 2013, raw pork was the suspected vehicle of a large outbreak (n = 203 cases) of Salmonella Muenchen in the German federal state of Saxony. In 2014, we investigated an outbreak (n = 247 cases) caused by the same serovar affecting Saxony and three further federal states in the eastern part of Germany. Evidence from epidemiological, microbiological and trace-back investigations strongly implicated different raw pork products as outbreak vehicles. Trace-back analysis of S. Muenchen-contaminated raw pork sausages narrowed the possible source down to 54 pig farms, and S. Muenchen was detected in three of them, which traded animals with each other. One of these farms had already been the suspected source of the 2013 outbreak. S. Muenchen isolates from stool of patients in 2013 and 2014 as well as from food and environmental surface swabs of the three pig farms shared indistinguishable pulsed-field gel electrophoresis patterns. Our results indicate a common source of both outbreaks in the primary production of pigs. Current European regulations do not make provisions for Salmonella control measures on pig farms that have been involved in human disease outbreaks. In order to prevent future outbreaks, legislators should consider tightening regulations for Salmonella control in causative primary production settings. PMID:28494842

Improved tools and strategies for the prevention and control of arboviral diseases: A research-to-policy forum.

PubMed

Olliaro, Piero; Fouque, Florence; Kroeger, Axel; Bowman, Leigh; Velayudhan, Raman; Santelli, Ana Carolina; Garcia, Diego; Skewes Ramm, Ronald; Sulaiman, Lokman H; Tejeda, Gustavo Sanchez; Morales, Fabiàn Correa; Gozzer, Ernesto; Garrido, César Basso; Quang, Luong Chan; Gutierrez, Gamaliel; Yadon, Zaida E; Runge-Ranzinger, Silvia

2018-02-01

Research has been conducted on interventions to control dengue transmission and respond to outbreaks. A summary of the available evidence will help inform disease control policy decisions and research directions, both for dengue and, more broadly, for all Aedes-borne arboviral diseases. A research-to-policy forum was convened by TDR, the Special Programme for Research and Training in Tropical Diseases, with researchers and representatives from ministries of health, in order to review research findings and discuss their implications for policy and research. The participants reviewed findings of research supported by TDR and others. Surveillance and early outbreak warning. Systematic reviews and country studies identify the critical characteristics that an alert system should have to document trends reliably and trigger timely responses (i.e., early enough to prevent the epidemic spread of the virus) to dengue outbreaks. A range of variables that, according to the literature, either indicate risk of forthcoming dengue transmission or predict dengue outbreaks were tested and some of them could be successfully applied in an Early Warning and Response System (EWARS). Entomological surveillance and vector management. A summary of the published literature shows that controlling Aedes vectors requires complex interventions and points to the need for more rigorous, standardised study designs, with disease reduction as the primary outcome to be measured. House screening and targeted vector interventions are promising vector management approaches. Sampling vector populations, both for surveillance purposes and evaluation of control activities, is usually conducted in an unsystematic way, limiting the potentials of entomological surveillance for outbreak prediction. Combining outbreak alert and improved approaches of vector management will help to overcome the present uncertainties about major risk groups or areas where outbreak response should be initiated and where resources for vector management should be allocated during the interepidemic period. The Forum concluded that the evidence collected can inform policy decisions, but also that important research gaps have yet to be filled.

Improved tools and strategies for the prevention and control of arboviral diseases: A research-to-policy forum

PubMed Central

Olliaro, Piero; Fouque, Florence; Kroeger, Axel; Bowman, Leigh; Velayudhan, Raman; Santelli, Ana Carolina; Garcia, Diego; Skewes Ramm, Ronald; Sulaiman, Lokman H.; Tejeda, Gustavo Sanchez; Morales, Fabiàn Correa; Gozzer, Ernesto; Garrido, César Basso; Quang, Luong Chan; Gutierrez, Gamaliel; Yadon, Zaida E.

2018-01-01

Background Research has been conducted on interventions to control dengue transmission and respond to outbreaks. A summary of the available evidence will help inform disease control policy decisions and research directions, both for dengue and, more broadly, for all Aedes-borne arboviral diseases. Method A research-to-policy forum was convened by TDR, the Special Programme for Research and Training in Tropical Diseases, with researchers and representatives from ministries of health, in order to review research findings and discuss their implications for policy and research. Results The participants reviewed findings of research supported by TDR and others. Surveillance and early outbreak warning. Systematic reviews and country studies identify the critical characteristics that an alert system should have to document trends reliably and trigger timely responses (i.e., early enough to prevent the epidemic spread of the virus) to dengue outbreaks. A range of variables that, according to the literature, either indicate risk of forthcoming dengue transmission or predict dengue outbreaks were tested and some of them could be successfully applied in an Early Warning and Response System (EWARS). Entomological surveillance and vector management. A summary of the published literature shows that controlling Aedes vectors requires complex interventions and points to the need for more rigorous, standardised study designs, with disease reduction as the primary outcome to be measured. House screening and targeted vector interventions are promising vector management approaches. Sampling vector populations, both for surveillance purposes and evaluation of control activities, is usually conducted in an unsystematic way, limiting the potentials of entomological surveillance for outbreak prediction. Combining outbreak alert and improved approaches of vector management will help to overcome the present uncertainties about major risk groups or areas where outbreak response should be initiated and where resources for vector management should be allocated during the interepidemic period. Conclusions The Forum concluded that the evidence collected can inform policy decisions, but also that important research gaps have yet to be filled. PMID:29389959

Return of epidemic dengue in the United States: implications for the public health practitioner.

PubMed

Bouri, Nidhi; Sell, Tara Kirk; Franco, Crystal; Adalja, Amesh A; Henderson, D A; Hynes, Noreen A

2012-01-01

Conditions that facilitate sustained dengue transmission exist in the United States, and outbreaks have occurred during the past decade in Texas, Hawaii, and Florida. More outbreaks can also be expected in years to come. To combat dengue, medical and public health practitioners in areas with mosquito vectors that are competent to transmit the virus must be aware of the threat of reemergent dengue, and the need for early reporting and control to reduce the impact of dengue outbreaks. Comprehensive dengue control includes human and vector surveillance, vector management programs, and community engagement efforts. Public health, medical, and vector-control communities must collaborate to prevent and control disease spread. Policy makers should understand the role of mosquito abatement and community engagement in the prevention and control of the disease.

Food Source Prediction of Shiga Toxin-Producing Escherichia coli Outbreaks Using Demographic and Outbreak Characteristics, United States, 1998-2014.

PubMed

White, Alice; Cronquist, Alicia; Bedrick, Edward J; Scallan, Elaine

2016-10-01

Foodborne illness is a continuing public health problem in the United States. Although outbreak-associated illnesses represent a fraction of all foodborne illnesses, foodborne outbreak investigations provide critical information on the pathogens, foods, and food-pathogen pairs causing illness. Therefore, identification of a food source in an outbreak investigation is key to impacting food safety. The objective of this study was to systematically identify outbreak-associated case demographic and outbreak characteristics that are predictive of food sources using Shiga toxin-producing Escherichia coli (STEC) outbreaks reported to Centers for Disease Control and Prevention (CDC) from 1998 to 2014 with a single ingredient identified. Differences between STEC food sources by all candidate predictors were assessed univariately. Multinomial logistic regression was used to build a prediction model, which was internally validated using a split-sample approach. There were 206 single-ingredient STEC outbreaks reported to CDC, including 125 (61%) beef outbreaks, 30 (14%) dairy outbreaks, and 51 (25%) vegetable outbreaks. The model differentiated food sources, with an overall sensitivity of 80% in the derivation set and 61% in the validation set. This study demonstrates the feasibility for a tool for public health professionals to rule out food sources during hypothesis generation in foodborne outbreak investigation and to improve efficiency while complementing existing methods.

Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control.

PubMed

Matua, Gerald Amandu; Van der Wal, Dirk Mostert; Locsin, Rozzano C

2015-01-01

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Outbreaks of Illness Associated with Recreational Water--United States, 2011-2012.

PubMed

Hlavsa, Michele C; Roberts, Virginia A; Kahler, Amy M; Hilborn, Elizabeth D; Mecher, Taryn R; Beach, Michael J; Wade, Timothy J; Yoder, Jonathan S

2015-06-26

Outbreaks of illness associated with recreational water use result from exposure to chemicals or infectious pathogens in recreational water venues that are treated (e.g., pools and hot tubs or spas) or untreated (e.g., lakes and oceans). For 2011-2012, the most recent years for which finalized data were available, public health officials from 32 states and Puerto Rico reported 90 recreational water-associated outbreaks to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS). The 90 outbreaks resulted in at least 1,788 cases, 95 hospitalizations, and one death. Among 69 (77%) outbreaks associated with treated recreational water, 36 (52%) were caused by Cryptosporidium. Among 21 (23%) outbreaks associated with untreated recreational water, seven (33%) were caused by Escherichia coli (E. coli O157:H7 or E. coli O111). Guidance, such as the Model Aquatic Health Code (MAHC), for preventing and controlling recreational water-associated outbreaks can be optimized when informed by national outbreak and laboratory (e.g., molecular typing of Cryptosporidium) data.

Recreational water-associated disease outbreaks--United States, 2009-2010.

PubMed

Hlavsa, Michele C; Roberts, Virginia A; Kahler, Amy M; Hilborn, Elizabeth D; Wade, Timothy J; Backer, Lorraine C; Yoder, Jonathan S

2014-01-10

Recreational water-associated disease outbreaks result from exposure to infectious pathogens or chemical agents in treated recreational water venues (e.g., pools and hot tubs or spas) or untreated recreational water venues (e.g., lakes and oceans). For 2009-2010, the most recent years for which finalized data are available, public health officials from 28 states and Puerto Rico electronically reported 81 recreational water-associated disease outbreaks to CDC's Waterborne Disease and Outbreak Surveillance System (WBDOSS) via the National Outbreak Reporting System (NORS). This report summarizes the characteristics of those outbreaks. Among the 57 outbreaks associated with treated recreational water, 24 (42%) were caused by Cryptosporidium. Among the 24 outbreaks associated with untreated recreational water, 11 (46%) were confirmed or suspected to have been caused by cyanobacterial toxins. In total, the 81 outbreaks resulted in at least 1,326 cases of illness and 62 hospitalizations; no deaths were reported. Laboratory and environmental data, in addition to epidemiologic data, can be used to direct and optimize the prevention and control of recreational water-associated disease outbreaks.

An outbreak of vancomycin-resistant Enterococcus faecium in an acute care pediatric hospital: Lessons from environmental screening and a case-control study

PubMed Central

Drews, Steven J; Richardson, Susan E; Wray, Rick; Freeman, Renee; Goldman, Carol; Streitenberger, Laurie; Stevens, Derek; Goia, Cristina; Kovach, Danuta; Brophy, Jason; Matlow, Anne G

2008-01-01

BACKGROUND The present study describes a vancomycin-resistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. OBJECTIVE To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). RESULTS Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions. PMID:19412380

Ensuring safety of home-produced eggs to control salmonellosis in Poland: lessons from an outbreak in September 2011.

PubMed

Zielicka-Hardy, A; Zarowna, D; Szych, J; Madajczak, G; Sadkowska-Todys, M

2012-11-22

Implementation of control measures in line with European Commission regulations has led to a decrease in salmonellosis in the European Union since 2004. However, control programmes do not address laying hens whose eggs are produced for personal consumption or local sale. This article reports an investigatxion of a salmonellosis outbreak linked to home-produced eggs following a family event held in a farm in September 2011 near Warsaw, Poland. In the outbreak, 34 people developed gastroenteritis symptoms. Results from a cohort study indicated a cake, prepared from raw home-produced eggs, as the vehicle of the outbreak. Laboratory analysis identified Salmonella enterica serotype Enteritidis (S. Enteritidis) in stool samples or rectal swabs from 18 of 24 people and in two egg samples. As no food items remained, we used phage typing to link the source of the outbreak with the isolated strains. Seven S. Enteritidis strains analysed (five from attendees and two from eggs) were phage type 21c. Our findings resulted in culling of the infected laying hens and symptomatic pigeons housed next to the hens. Salmonella poses as a public health problem in Poland: control measures should not forget home-produced eggs, as there is a risk of infection from their consumption.

Effect of intervention on the control of Highly Pathogenic Avian Influenza in Nigeria.

PubMed

Oladokun, Agnes Tinuke; Meseko, Clement Adebajo; Ighodalo, Edelokun; John, Benshak; Ekong, Pius Stephen

2012-01-01

The advent of HPAI in Nigeria was a traumatic experience for the poultry industry. Wealth and resources were lost to the ravages of the virus. The Government of Nigeria with the support of International donor agencies came up with a policy for the prevention of spread of the disease leading to the eventual control and eradication of the virus in Nigeria. The various measures implemented in the control of the outbreaks, and their effects on eradication of the virus in the country are highlighted. Using combined data from passive and active surveillance for HPAI in poultry farms, wetlands and live bird markets in Nigeria during 2006 - 2009, with laboratory diagnostic findings, we describe the characteristics of the control strategies implemented. The control measures include immediate reports of suspected outbreaks, prompt laboratory confirmation and rapid modified stamping out with compensations paid to affected farmers. Decontamination of infected farm premises, re-organization of live bird market were carried out, and bio security measures put in place before re-stocking. Three years following initial outbreak, the number of laboratory confirmed cases drastically reduced from 140 in 2006 and 160 in 2007 to only 2 cases of field outbreak in 2008. Only one case of human infection was documented during the period and no field outbreak or detection by surveillance was reported throughout 2009 and 2010. The measures employed by the Government through its agencies in the control of HPAI in Nigeria brought the incidence of the disease to naught.

Quantifying Reporting Timeliness to Improve Outbreak Control

PubMed Central

Swaan, Corien; van Steenbergen, Jim; Kretzschmar, Mirjam

2015-01-01

The extent to which reporting delays should be reduced to gain substantial improvement in outbreak control is unclear. We developed a model to quantitatively assess reporting timeliness. Using reporting speed data for 6 infectious diseases in the notification system in the Netherlands, we calculated the proportion of infections produced by index and secondary cases until the index case is reported. We assumed interventions that immediately stop transmission. Reporting delays render useful only those interventions that stop transmission from index and secondary cases. We found that current reporting delays are adequate for hepatitis A and B control. However, reporting delays should be reduced by a few days to improve measles and mumps control, by at least 10 days to improve shigellosis control, and by at least 5 weeks to substantially improve pertussis control. Our method provides quantitative insight into the required reporting delay reductions needed to achieve outbreak control and other transmission prevention goals. PMID:25625374

Using pheromones in the management of bark beetle outbreaks

Treesearch

Alf Bakke

1991-01-01

Identification of aggregation pheromones and field experiments using synthetic components have given scientists a better understanding of the behavior of many bark beetles. They have also yielded more effective weapons with which to control outbreaks of aggressive pest species. Synthetic pheromone components are commercially available for control of many species (...

U.S. Compounding Pharmacy-related Outbreaks, 2001–2013—Public Health and Patient Safety Lessons Learned

PubMed Central

Shehab, Nadine; Brown, Megan N.; Kallen, Alexander J.; Perz, Joseph F.

2015-01-01

Objectives Pharmacy-compounded sterile preparations (P-CSPs) are frequently relied upon in U.S. healthcare, but are increasingly being linked to outbreaks of infections. We provide an updated overview of outbreak burden and characteristics, identify drivers of P-CSP demand, and discuss public health and patient safety lessons learned to help inform prevention. Methods Outbreaks of infections linked to contaminated P-CSPs that occurred between January 1, 2001 and December 31, 2013 were identified from internal Centers for Disease Control and Prevention reports, Food and Drug Administration drug safety communications, and published literature. Results We identified 19 outbreaks linked to P-CSPs, resulting in at least 1000 cases, including deaths. Outbreaks were reported across two-thirds of states, with almost one-half (8/19) involving cases in more than one state. Almost one-half of outbreaks were linked to injectable steroids (5/19) and intraocular bevacizumab (3/19). Non-patient-specific compounding originating from non-sterile ingredients and re-packaging of already sterile products were the most common practices associated with P-CSP contamination. Breaches in aseptic processing and deficiencies in sterilization procedures or in sterility/endotoxin testing were consistent findings. Hospital outsourcing, preference for variations of commercially available products, commercial drug shortages, and lower prices were drivers of P-CSP demand. Conclusions Recognized outbreaks linked to P-CSPs have been most commonly associated with non-patient-specific re-packaging and non-sterile to sterile compounding, and linked to lack of adherence to sterile compounding standards. Recently-enhanced regulatory oversight of compounding may improve adherence to such standards. Additional measures to limit and control these outbreaks include vigilance when outsourcing P-CSPs, scrutiny of drivers for P-CSP demand, and early recognition and notification of possible outbreaks. PMID:26001553

Outbreaks-of Ebola virus disease in the West African sub-region.

PubMed

Osungbade, K O; Oni, A A

2014-06-01

Five West African countries, including Nigeria are currently experiencing the largest, most severe, most complex outbreak of Ebola virus disease in history. This paper provided a chronology of outbreaks of Ebola virus disease in the West African sub-region and provided an update on efforts at containing the present outbreak. Literature from Pubmed (MEDLINE), AJOL, Google Scholar and Cochrane database were reviewed. Outbreaks of Ebola, virus disease had frequently occurred mainly in Central and East African countries. Occasional outbreaks reported from outside of Africa were due to laboratory contamination and imported monkeys in quarantine facilities. The ongoing outbreak in West Africa is the largest and first in the sub-region; the number of suspected cases and deaths from this single current outbreak is already about three times the total of all cases and deaths from previous known outbreaks in 40 years. Prevention and control efforts are hindered not only by lack of a known vaccine and virus-specific treatment, but also by weak health systems, poor sanitation, poor personal hygiene and cultural beliefs and practices, including myths and misconceptions about Ebola virus disease--all of which are prevalent in affected countries. Constrained by this situation, the World Health Organisation departed from the global standard and recommended the use of not yet proven treatments to treat or prevent the disease in humans on ethical and evidential grounds. The large number of people affected by the present outbreak in West Africa and the high case-fatality rate calls for accelerated evaluation and development of the investigational medical interventions for life saving and curbing the epidemic. Meanwhile, existing interventions such as early detection and isolation, contact tracing and monitoring, and adherence to rigorous procedures of infection prevention and control should be intensified.

Bellary, India achieves negligible case fatality due to Japanese encephalitis despite no vaccination: an outbreak investigation in 2004.

PubMed

Gupta, Neeru; Chatterjee, Kunal; Karmakar, Somenath; Jain, S K; Venkatesh, S; Lal, Shiv

2008-01-01

To confirm the existence of the outbreak of suspected Japanese encephalitis, identify the source, to understand the circumstances due to which the outbreak was taking place and to suggest measures for its control. The team visited Bellary from 4th to 10th Sept, 2004. The team interviewed the key persons and analyzed the records at District Surveillance Unit and Entomological Surveillance Unit and case records of suspected JE cases admitted in Encephalitis ward in Vijay Nagar Institute of Medical Sciences (VIMS). Eco-entomological survey was done in houses and surroundings of 3 randomly selected cases of Encephalitis in rural and urban areas of District Bellary. Their family members and neighbors were also asked for the awareness and presence of disease. Data was analyzed for epidemiological and clinical profiles. The suspected JE cases were being reported from end of June 2004. The cases were sporadic and out of 34 cases reported to VIMS (till 10th of September), 32 were from Bellary district and 2 were from adjoining Andhra Pradesh. Among these 32, 22 were from Bellary Taluk, which in turn were mainly concentrated (10 were reported) in urban Bellary. The case fatality rate was zero as no death was reported. Entomological surveillance (done by District Surveillance Unit) revealed a high outdoor presence of Culex tritaeniorhynchus as well as an indoor rising density of this mosquito from 2 per man hour catch in January to 22 in the month of August in the affected villages. On the contrary, the investigations on 7th and 8th September revealed high densities of An.subpictus and An. peditaenatus and nil of Culex species in the urban areas. Amplifier host of pigs and water birds were occasionally sighted in the area. A good community awareness of encephalitis, a prompt referral system and a good supportive treatment for the patients and a good surveillance system and response were observed. Very close proximity with amplifying hosts of pigs was avoided by the community, though piggeries were still not very far away (1-3 Km). These may explain the reduction in cases, deaths and disabilities due to this disease in this district over the years. Possibilities of mutant strain which is less virulent and/or a better immune status of at risk population may also need to be explored. The impact of the mass vaccination with SA 14-14-2, imported from China in Bellary during July, 2006 remains to be evaluated. This will further decrease the case load.

Whole-genome Sequencing for Tracing the Transmission Link between Two ARD Outbreaks Caused by a Novel HAdV Serotype 7 Variant, China

PubMed Central

Qiu, Shaofu; Li, Peng; Liu, Hongbo; Wang, Yong; Liu, Nan; Li, Chengyi; Li, Shenlong; Li, Ming; Jiang, Zhengjie; Sun, Huandong; Li, Ying; Xie, Jing; Yang, Chaojie; Wang, Jian; Li, Hao; Yi, Shengjie; Wu, Zhihao; Jia, Leili; Wang, Ligui; Hao, Rongzhang; Sun, Yansong; Huang, Liuyu; Ma, Hui; Yuan, Zhengquan; Song, Hongbin

2015-01-01

From December 2012 to February 2013, two outbreaks of acute respiratory disease caused by HAdV-7 were reported in China. We investigated possible transmission links between these two seemingly unrelated outbreaks by integration of epidemiological and whole-genome sequencing (WGS) data. WGS analyses showed that the HAdV-7 isolates from the two outbreaks were genetically indistinguishable; however, a 12 bp deletion in the virus-associated RNA gene distinguished the outbreak isolates from other HAdV-7 isolates. Outbreak HAdV-7 isolates demonstrated increased viral replication compared to non-outbreak associated HAdV-7 isolate. Epidemiological data supported that the first outbreak was caused by introduction of the novel HAdV-7 virus by an infected recruit upon arrival at the training base. Nosocomial transmission by close contacts was the most likely source leading to onset of the second HAdV-7 outbreak, establishing the apparent transmission link between the outbreaks. Our findings imply that in-hospital contact investigations should be encouraged to reduce or interrupt further spread of infectious agents when treating outbreak cases, and WGS can provide useful information guiding infection-control interventions. PMID:26338697

An Outbreak of Ebola Virus Disease in the Lassa Fever Zone

PubMed Central

Goba, Augustine; Khan, S. Humarr; Fonnie, Mbalu; Fullah, Mohamed; Moigboi, Alex; Kovoma, Alice; Sinnah, Vandi; Yoko, Nancy; Rogers, Hawa; Safai, Siddiki; Momoh, Mambu; Koroma, Veronica; Kamara, Fatima K.; Konowu, Edwin; Yillah, Mohamed; French, Issa; Mustapha, Ibraham; Kanneh, Franklyn; Foday, Momoh; McCarthy, Helena; Kallon, Tiangay; Kallon, Mustupha; Naiebu, Jenneh; Sellu, Josephine; Jalloh, Abdul A.; Gbakie, Michael; Kanneh, Lansana; Massaly, James L. B.; Kargbo, David; Kargbo, Brima; Vandi, Mohamed; Gbetuwa, Momoh; Gevao, Sahr M.; Sandi, John D.; Jalloh, Simbirie C.; Grant, Donald S.; Blyden, Sylvia O.; Crozier, Ian; Schieffelin, John S.; McLellan, Susan L.; Jacob, Shevin T.; Boisen, Matt L.; Hartnett, Jessica N.; Cross, Robert W.; Branco, Luis M.; Andersen, Kristian G.; Yozwiak, Nathan L.; Gire, Stephen K.; Tariyal, Ridhi; Park, Daniel J.; Haislip, Allyson M.; Bishop, Christopher M.; Melnik, Lilia I.; Gallaher, William R.; Wimley, William C.; He, Jing; Shaffer, Jeffrey G.; Sullivan, Brian M.; Grillo, Sonia; Oman, Scott; Garry, Courtney E.; Edwards, Donna R.; McCormick, Stephanie J.; Elliott, Deborah H.; Rouelle, Julie A.; Kannadka, Chandrika B.; Reyna, Ashley A.; Bradley, Benjamin T.; Yu, Haini; Yenni, Rachael E.; Hastie, Kathryn M.; Geisbert, Joan B.; Kulakosky, Peter C.; Wilson, Russell B.; Oldstone, Michael B. A.; Pitts, Kelly R.; Henderson, Lee A.; Robinson, James E.; Geisbert, Thomas W.; Saphire, Erica Ollmann; Happi, Christian T.; Asogun, Danny A.; Sabeti, Pardis C.; Garry, Robert F.

2016-01-01

Background. Kenema Government Hospital (KGH) has developed an advanced clinical and laboratory research capacity to manage the threat of Lassa fever, a viral hemorrhagic fever (VHF). The 2013–2016 Ebola virus (EBOV) disease (EVD) outbreak is the first to have occurred in an area close to a facility with established clinical and laboratory capacity for study of VHFs. Methods. Because of its proximity to the epicenter of the EVD outbreak, which began in Guinea in March 2014, the KGH Lassa fever Team mobilized to establish EBOV surveillance and diagnostic capabilities. Results. Augustine Goba, director of the KGH Lassa laboratory, diagnosed the first documented case of EVD in Sierra Leone, on 25 May 2014. Thereafter, KGH received and cared for numbers of patients with EVD that quickly overwhelmed the capacity for safe management. Numerous healthcare workers contracted and lost their lives to EVD. The vast majority of subsequent EVD cases in West Africa can be traced back to a single transmission chain that includes this first diagnosed case. Conclusions. Responding to the challenges of confronting 2 hemorrhagic fever viruses will require continued investments in the development of countermeasures (vaccines, therapeutic agents, and diagnostic assays), infrastructure, and human resources. PMID:27402779

Flexibility of mobile laboratory unit in support of patient management during the 2007 Ebola-Zaire outbreak in the Democratic Republic of Congo.

PubMed

Grolla, A; Jones, S; Kobinger, G; Sprecher, A; Girard, G; Yao, M; Roth, C; Artsob, H; Feldmann, H; Strong, J E

2012-09-01

The mobile laboratory provides a safe, rapid and flexible platform to provide effective diagnosis of Ebola virus as well as additional differential diagnostic agents in remote settings of equatorial Africa. During the 2007 Democratic Republic of Congo outbreak of Ebola-Zaire, the mobile laboratory was set up in two different locations by two separate teams within a day of equipment arriving in each location. The first location was in Mweka where our laboratory took over the diagnostic laboratory space of the local hospital, whereas the second location, approximately 50 km south near Kampungu at the epicentre of the outbreak, required local labour to fabricate a tent structure as a suitable pre-existing structure was not available. In both settings, the laboratory was able to quickly set up, providing accurate and efficient molecular diagnostics (within 3 h of receiving samples) for 67 individuals, including four cases of Ebola, seven cases of Shigella and 13 cases of malaria. This rapid turn-around time provides an important role in the support of patient management and epidemiological surveillance. © 2012 Blackwell Verlag GmbH.

What caused the 2012 dengue outbreak in Pucallpa, Peru? A socio-ecological autopsy.

PubMed

Charette, Margot; Berrang-Ford, Lea; Llanos-Cuentas, Elmer Alejandro; Cárcamo, César; Kulkarni, Manisha

2017-02-01

Dengue is highly endemic in Peru, with increases in transmission particularly since vector re-infestation of the country in the 1980s. Pucallpa, the second largest city in the Peruvian Amazon, experienced a large outbreak in 2012 that caused more than 10,000 cases and 13 deaths. To date, there has been limited research on dengue in the Peruvian Amazon outside of Iquitos, and no published review or critical analysis of the 2012 Pucallpa dengue outbreak. This study describes the incidence, surveillance, and control of dengue in Ucayali to understand the factors that contributed to the 2012 Pucallpa outbreak. We employed a socio-ecological autopsy approach to consider distal and proximal contributing factors, drawing on existing literature and interviews with key personnel involved in dengue control, surveillance and treatment in Ucayali. Spatio-temporal analysis showed that relative risk of dengue was higher in the northern districts of Calleria (RR = 2.18), Manantay (RR = 1.49) and Yarinacocha (RR = 1.25) compared to all other districts between 2004 and 2014. The seasonal occurrence of the 2012 outbreak is consistent with typical seasonal patterns for dengue incidence in the region. Our assessment suggests that the outbreak was proximally triggered by the introduction of a new virus serotype (DENV-2 Asian/America) to the region. Increased travel, rapid urbanization, and inadequate water management facilitated the potential for virus spread and transmission, both within Pucallpa and regionally. These triggers occurred within the context of failures in surveillance and control programming, including underfunded and ad hoc vector control. These findings have implications for future prevention and control of dengue in Ucayali as new diseases such as chikungunya and Zika threaten the region. Copyright © 2016 Elsevier Ltd. All rights reserved.

Challenges in managing a school-based measles outbreak in Melbourne, Australia, 2014.

PubMed

Gibney, Katherine B; Brahmi, Aicha; O'Hara, Miriam; Morey, Rosemary; Franklin, Lucinda

2017-02-01

To identify barriers to control of a Victorian primary school-based measles outbreak. Confirmed measles cases notified in Victoria in 2014 were reviewed. Surveillance data, correspondence, and investigation notes for the school-based outbreak were assessed regarding timeliness of diagnosis and notification, and adequacy of school-based immunisation records. Twenty-three (31%) of the 75 measles cases notified in 2014 were school-aged (5-18 years); three had documentation of measles vaccination, 17 were unvaccinated, and three had unknown vaccination history. Eight measles outbreaks were identified, including a primary school-based outbreak with ten cases. Of the six unvaccinated pupils in the affected school, five (83%) contracted measles. The proportion of the school's prep students with documented vaccination records, as required by law, ranged from 39% in 2013 to 97% in 2014. Inadequately vaccinated students constitute a vulnerable population and schools are a potential site for measles outbreaks. Inadequate enforcement of school-based immunisation records impact the management and control of school-based measles outbreaks. Implications for Public Health: There is a need to educate clinicians on measles diagnosis and notification, and schools on the requirement to maintain up-to-date vaccination records. School entry is an opportunity to review student vaccination history and offer immunisations. © 2016 The Authors.

Acute hepatitis B outbreaks in 2 skilled nursing facilities and possible sources of transmission: North Carolina, 2009-2010.

PubMed

Seña, Arlene C; Moorman, Anne; Njord, Levi; Williams, Roxanne E; Colborn, James; Khudyakov, Yury; Drobenuic, Jan; Xia, Guo-Liang; Wood, Hattie; Moore, Zack

2013-07-01

Acute hepatitis B virus (HBV) infections have been reported in long-term care facilities (LTCFs), primarily associated with infection control breaks during assisted blood glucose monitoring. We investigated HBV outbreaks that occurred in separate skilled nursing facilities (SNFs) to determine factors associated with transmission. Outbreak investigation with case-control studies. Two SNFs (facilities A and B) in Durham, North Carolina, during 2009-2010. Residents with acute HBV infection and controls randomly selected from HBV-susceptible residents during the outbreak period. After initial cases were identified, screening was offered to all residents, with repeat testing 3 months later for HBV-susceptible residents. Molecular testing was performed to assess viral relatedness. Infection control practices were observed. Case-control studies were conducted to evaluate associations between exposures and acute HBV infection in each facility. Six acute HBV cases were identified in each SNF. Viral phylogenetic analysis revealed a high degree of HBV relatedness within, but not between, facilities. No evaluated exposures were significantly associated with acute HBV infection in facility A; those associated with infection in facility B (all odds ratios >20) included injections, hospital or emergency room visits, and daily blood glucose monitoring. Observations revealed absence of trained infection control staff at facility A and suboptimal hand hygiene practices during blood glucose monitoring and insulin injections at facility B. These outbreaks underscore the vulnerability of LTCF residents to acute HBV infection, the importance of surveillance and prompt investigation of incident cases, and the need for improved infection control education to prevent transmission.

Impact of delay on disease outbreak in a spatial epidemic model

NASA Astrophysics Data System (ADS)

Zhao, Xia-Xia; Wang, Jian-Zhong

2015-04-01

One of the central issues in studying epidemic spreading is the mechanism on disease outbreak. In this paper, we investigate the effects of time delay on disease outbreak in spatial epidemics based on a reaction-diffusion model. By mathematical analysis and numerical simulations, we show that when time delay is more than a critical value, the disease outbreaks. The obtained results show that the time delay is an important factor in the spread of the disease, which may provide new insights on disease control.

Cholera Outbreaks in Urban Bangladesh In 2011

PubMed Central

Haque, Farhana; Hossain, M. Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd.; Rahman, Mahmudur; Luby, Stephen P.

2015-01-01

Background In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. Methods We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. Results We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. Conclusion The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae. The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate approaches for ensuring safe drinking water in resource-poor cities. PMID:26702366

Cholera Outbreaks in Urban Bangladesh In 2011.

PubMed

Haque, Farhana; Hossain, M Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd; Rahman, Mahmudur; Luby, Stephen P

In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae . The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate approaches for ensuring safe drinking water in resource-poor cities.

Teachers' Risk Perception and Needs in Addressing Infectious Disease Outbreak

ERIC Educational Resources Information Center

Wong, Emmy M. Y.; Cheng, May M. H.; Lo, S.K.

2010-01-01

The outbreak of the Influenza A (H1N1) virus has led to numerous precautionary school closures in several countries. No research is available on the school teachers' perceptions as a health protective resource in controlling communicable disease outbreaks. The purposes of this study were to examine the risk perception, the perceived understanding…

Managing Sirex noctilio populations in Patagonia (Argentina): silviculture and biological control

Treesearch

José Villacide; Deborah Fischbein; Nélida Jofré; Juan Corley

2010-01-01

Sirex noctilio is a primitive wood boring solitary wasp with a univoltine life cycle. Characteristic of this species is the occurrence of severely damaging, pulse-like eruptive population outbreaks. During outbreaks, the damage to pine plantations can be severe; tree mortality may reach levels close to 80 percent. Outbreak behavior is thus important...

Evaluating a New Online Course in the Epidemiology of Infectious Diseases by Studying Student Learning Styles

ERIC Educational Resources Information Center

Rogers, James W.; Cox, James R.

2008-01-01

At RMIT University, students may now elect to study infectious diseases through a course called Outbreak--The Detection and Control of Infectious Disease. Outbreak was designed to simulate in an online class the effective teamwork required to bring resolution to outbreak crises and enable frameworks for future prevention. The appropriateness of…

A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda.

PubMed

Kwesiga, Benon; Pande, Gerald; Ario, Alex Riolexus; Tumwesigye, Nazarius Mbona; Matovu, Joseph K B; Zhu, Bao-Ping

2017-07-18

In May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. We conducted an investigation to identify the mode of transmission to guide control measures. We defined a suspected case as onset of acute watery diarrhoea from 1 February 2015 onwards in a Kasese resident. A confirmed case was a suspected case with Vibrio cholerae O1 El Tor, serotype Inaba cultured from a stool sample. We reviewed medical records to find cases. We conducted a case-control study to compare exposures among confirmed case-persons and asymptomatic controls, matched by village and age-group. We conducted environmental assessments. We tested water samples from the most affected area for total coliforms using the Most Probable Number (MPN) method. We identified 183 suspected cases including 61 confirmed cases of Vibrio cholerae 01; serotype Inaba, with onset between February and July 2015. 2 case-persons died of cholera. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in the 5-14 year age group (4.1/10,000). The outbreak started in Bwera Sub-County bordering the Democratic Republic of Congo and spread eastward through sustained community transmission. The first case-persons were involved in cross-border trading. The case-control study, which involved 49 confirmed cases and 201 controls, showed that 94% (46/49) of case-persons compared with 79% (160/201) of control-persons drank water without boiling or treatment (OR M-H =4.8, 95% CI: 1.3-18). Water collected from the two main sources, i.e., public pipes (consumed by 39% of case-persons and 38% of control-persons) or streams (consumed by 29% of case-persons and 24% control-persons) had high coliform counts, a marker of faecal contamination. Environmental assessment revealed evidence of open defecation along the streams. No food items were significantly associated with illness. This prolonged, community-wide cholera outbreak was associated with drinking water contaminated by faecal matter and cross-border trading. We recommended rigorous disposal of patients' faeces, chlorination of piped water, and boiling or treatment of drinking water. The outbreak stopped 6 weeks after these recommendations were implemented.

Legionnaires' disease from a cooling tower in a community outbreak in Lidköping, Sweden- epidemiological, environmental and microbiological investigation supported by meteorological modelling.

PubMed

Ulleryd, Peter; Hugosson, Anna; Allestam, Görel; Bernander, Sverker; Claesson, Berndt E B; Eilertz, Ingrid; Hagaeus, Anne-Christine; Hjorth, Martin; Johansson, Agneta; de Jong, Birgitta; Lindqvist, Anna; Nolskog, Peter; Svensson, Nils

2012-11-21

An outbreak of Legionnaires' Disease took place in the Swedish town Lidköping on Lake Vänern in August 2004 and the number of pneumonia cases at the local hospital increased markedly. As soon as the first patients were diagnosed, health care providers were informed and an outbreak investigation was launched. Classical epidemiological investigation, diagnostic tests, environmental analyses, epidemiological typing and meteorological methods. Thirty-two cases were found. The median age was 62 years (range 36 - 88) and 22 (69%) were males. No common indoor exposure was found. Legionella pneumophila serogroup 1 was found at two industries, each with two cooling towers. In one cooling tower exceptionally high concentrations, 1.2 × 109 cfu/L, were found. Smaller amounts were also found in the other tower of the first industry and in one tower of the second plant. Sero- and genotyping of isolated L. pneumophila serogroup 1 from three patients and epidemiologically suspected environmental strains supported the cooling tower with the high concentration as the source. In all, two L. pneumophila strains were isolated from three culture confirmed cases and both these strains were detected in the cooling tower, but one strain in another cooling tower as well. Meteorological modelling demonstrated probable spread from the most suspected cooling tower towards the town centre and the precise location of four cases that were stray visitors to Lidköping. Classical epidemiological, environmental and microbiological investigation of an LD outbreak can be supported by meteorological modelling methods.The broad competence and cooperation capabilities in the investigation team from different authorities were of paramount importance in stopping this outbreak.

Legionnaires’ disease from a cooling tower in a community outbreak in Lidköping, Sweden- epidemiological, environmental and microbiological investigation supported by meteorological modelling

PubMed Central

2012-01-01

Background An outbreak of Legionnaires’ Disease took place in the Swedish town Lidköping on Lake Vänern in August 2004 and the number of pneumonia cases at the local hospital increased markedly. As soon as the first patients were diagnosed, health care providers were informed and an outbreak investigation was launched. Methods Classical epidemiological investigation, diagnostic tests, environmental analyses, epidemiological typing and meteorological methods. Results Thirty-two cases were found. The median age was 62 years (range 36 – 88) and 22 (69%) were males. No common indoor exposure was found. Legionella pneumophila serogroup 1 was found at two industries, each with two cooling towers. In one cooling tower exceptionally high concentrations, 1.2 × 109 cfu/L, were found. Smaller amounts were also found in the other tower of the first industry and in one tower of the second plant. Sero- and genotyping of isolated L. pneumophila serogroup 1 from three patients and epidemiologically suspected environmental strains supported the cooling tower with the high concentration as the source. In all, two L. pneumophila strains were isolated from three culture confirmed cases and both these strains were detected in the cooling tower, but one strain in another cooling tower as well. Meteorological modelling demonstrated probable spread from the most suspected cooling tower towards the town centre and the precise location of four cases that were stray visitors to Lidköping. Conclusions Classical epidemiological, environmental and microbiological investigation of an LD outbreak can be supported by meteorological modelling methods. The broad competence and cooperation capabilities in the investigation team from different authorities were of paramount importance in stopping this outbreak. PMID:23171054

Big Data and the Global Public Health Intelligence Network (GPHIN)

PubMed Central

Dion, M; AbdelMalik, P; Mawudeku, A

2015-01-01

Background Globalization and the potential for rapid spread of emerging infectious diseases have heightened the need for ongoing surveillance and early detection. The Global Public Health Intelligence Network (GPHIN) was established to increase situational awareness and capacity for the early detection of emerging public health events. Objective To describe how the GPHIN has used Big Data as an effective early detection technique for infectious disease outbreaks worldwide and to identify potential future directions for the GPHIN. Findings Every day the GPHIN analyzes over more than 20,000 online news reports (over 30,000 sources) in nine languages worldwide. A web-based program aggregates data based on an algorithm that provides potential signals of emerging public health events which are then reviewed by a multilingual, multidisciplinary team. An alert is sent out if a potential risk is identified. This process proved useful during the Severe Acute Respiratory Syndrome (SARS) outbreak and was adopted shortly after by a number of countries to meet new International Health Regulations that require each country to have the capacity for early detection and reporting. The GPHIN identified the early SARS outbreak in China, was credited with the first alert on MERS-CoV and has played a significant role in the monitoring of the Ebola outbreak in West Africa. Future developments are being considered to advance the GPHIN’s capacity in light of other Big Data sources such as social media and its analytical capacity in terms of algorithm development. Conclusion The GPHIN’s early adoption of Big Data has increased global capacity to detect international infectious disease outbreaks and other public health events. Integration of additional Big Data sources and advances in analytical capacity could further strengthen the GPHIN’s capability for timely detection and early warning. PMID:29769954

Typhoid fever outbreak associated with frozen mamey pulp imported from Guatemala to the western United States, 2010.

PubMed

Loharikar, Anagha; Newton, Anna; Rowley, Patricia; Wheeler, Charlotte; Bruno, Tami; Barillas, Haroldo; Pruckler, James; Theobald, Lisa; Lance, Susan; Brown, Jeffrey M; Barzilay, Ezra J; Arvelo, Wences; Mintz, Eric; Fagan, Ryan

2012-07-01

Fifty-four outbreaks of domestically acquired typhoid fever were reported between 1960 and 1999. In 2010, the Southern Nevada Health District detected an outbreak of typhoid fever among persons who had not recently travelled abroad. We conducted a case-control study to examine the relationship between illness and exposures. A case was defined as illness with the outbreak strain of Salmonella serotype Typhi, as determined by pulsed-field gel electrophoresis (PFGE), with onset during 2010. Controls were matched by neighborhood, age, and sex. Bivariate and multivariate statistical analyses were completed using logistic regression. Traceback investigation was completed. We identified 12 cases in 3 states with onset from 15 April 2010 to 4 September 2010. The median age of case patients was 18 years (range, 4-48 years), 8 (67%) were female, and 11 (92%) were Hispanic. Nine (82%) were hospitalized; none died. Consumption of frozen mamey pulp in a fruit shake was reported by 6 of 8 case patients (75%) and none of the 33 controls (matched odds ratio, 33.9; 95% confidence interval, 4.9). Traceback investigations implicated 2 brands of frozen mamey pulp from a single manufacturer in Guatemala, which was also implicated in a 1998-1999 outbreak of typhoid fever in Florida. Reporting of individual cases of typhoid fever and subtyping of isolates by PFGE resulted in rapid detection of an outbreak associated with a ready-to-eat frozen food imported from a typhoid-endemic region. Improvements in food manufacturing practices and monitoring will prevent additional outbreaks.

Assessment of the risk posed to Singapore by the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea

PubMed Central

Zhang, Emma Xuxiao; Oh, Olivia Seen Huey; See, Wanhan; Raj, Pream; James, Lyn; Khan, Kamran

2016-01-01

Objective To assess the public health risk to Singapore posed by the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea in 2015. Methods The likelihood of importation of MERS cases and the magnitude of the public health impact in Singapore were assessed to determine overall risk. Literature on the epidemiology and contextual factors associated with MERS coronavirus infection was collected and reviewed. Connectivity between the Republic of Korea and Singapore was analysed. Public health measures implemented by the two countries were reviewed. Results The epidemiology of the 2015 MERS outbreak in the Republic of Korea remained similar to the MERS outbreaks in Saudi Arabia. In addition, strong infection control and response measures were effective in controlling the outbreak. In view of the air traffic between Singapore and MERS-affected areas, importation of MERS cases into Singapore is possible. Nonetheless, the risk of a serious public health impact to Singapore in the event of an imported case of MERS would be mitigated by its strong health-care system and established infection control practices. Discussion The MERS outbreak was sparked by an exported case from the Middle East, which remains a concern as the reservoir of infection (thought to be camels) continues to exist in the Middle East, and sporadic cases in the community and outbreaks in health-care settings continue to occur there. This risk assessment highlights the need for Singapore to stay vigilant and to continue enhancing core public health capacities to detect and respond to MERS coronavirus. PMID:27508087

Assessment of the risk posed to Singapore by the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea.

PubMed

Zhang, Emma Xuxiao; Oh, Olivia Seen Huey; See, Wanhan; Raj, Pream; James, Lyn; Khan, Kamran; Tey, Jeannie Su Hui

2016-01-01

To assess the public health risk to Singapore posed by the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea in 2015. The likelihood of importation of MERS cases and the magnitude of the public health impact in Singapore were assessed to determine overall risk. Literature on the epidemiology and contextual factors associated with MERS coronavirus infection was collected and reviewed. Connectivity between the Republic of Korea and Singapore was analysed. Public health measures implemented by the two countries were reviewed. The epidemiology of the 2015 MERS outbreak in the Republic of Korea remained similar to the MERS outbreaks in Saudi Arabia. In addition, strong infection control and response measures were effective in controlling the outbreak. In view of the air traffic between Singapore and MERS-affected areas, importation of MERS cases into Singapore is possible. Nonetheless, the risk of a serious public health impact to Singapore in the event of an imported case of MERS would be mitigated by its strong health-care system and established infection control practices. The MERS outbreak was sparked by an exported case from the Middle East, which remains a concern as the reservoir of infection (thought to be camels) continues to exist in the Middle East, and sporadic cases in the community and outbreaks in health-care settings continue to occur there. This risk assessment highlights the need for Singapore to stay vigilant and to continue enhancing core public health capacities to detect and respond to MERS coronavirus.

Reaching out to Ebola victims: Coercion, persuasion or an appeal for self-sacrifice?

PubMed

Calain, Philippe; Poncin, Marc

2015-12-01

The 2014-2015 Ebola crisis in West Africa has highlighted the practical limits of upholding human rights and common ethical principles when applying emergency public-health measures. The role of medical teams in the implementation of quarantine and isolation has been equivocal, particularly when such measures are opposed by communities who are coerced by the temporary suspension of civil liberties. In their encounters with Ebola victims, outreach teams face moral dilemmas, where the boundaries are unclear between coercion, persuasion and appeals for self-sacrifice. For those teams, we propose a set of practical recommendations aimed at respecting the autonomy of epidemic victims and easing tensions within communities. We recognize that some of these recommendations are progressively achievable, depending on the specific stage or setting of an outbreak. Yet with the increasing availability of experimental treatments and research interventions, weighing patients' autonomy against the common good will become an even more pressing ethical obligation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Lessons learned in the control of Aedes aegypti to address dengue and the emergency of chikungunya in Iquitos, Peru].

PubMed

Vilcarromero, Stalin; Casanova, Wilma; Ampuero, Julia S; Ramal-Asayag, Cesar; Siles, Crystyan; Díaz, Gloria; Durand, Salomón; Celis-Salinas, Juan C; Astete, Helvio; Rojas, Percy; Vásquez-La Torre, Gabriela; Marín, Johan; Bazán, Isabel; Alegre, Yuri; Morrison, Amy C; Rodriguez-Ferrucci, Hugo

2015-01-01

Dengue has affected Iquitos since 1990 causing outbreaks of major impact on public health and for this reason great efforts have been made for its temporal control. Currently, with the expansion of the chikungunya virus in the Americas and the threat of the emergence of the virus in Iquitos, we reflect on lessons learned by way of the activities undertaken in the area of vector control; epidemiological surveillance, diagnosis and clinical management during periods of outbreaks of dengue, in a way that will allow us to better face the threat of an outbreak of chikungunya virus in the largest city in the Peruvian Amazon.

An outbreak investigation of scrub typhus in Western Province, Solomon Islands, 2014.

PubMed

Marks, Michael; Joshua, Cynthia; Longbottom, Jenny; Longbottom, Katherine; Sio, Alison; Puiahi, Elliot; Jilini, Greg; Stenos, John; Dalipanda, Tenneth; Musto, Jennie

2016-01-01

To identify the etiology and risk factors of undifferentiated fever in a cluster of patients in Western Province, Solomon Islands, May 2014. An outbreak investigation with a case control study was conducted. A case was defined as an inpatient in one hospital in Western Province, Solomon Islands with high fever (> 38.5 °C) and a negative malaria microscopy test admitted between 1 and 31 May 2014. Asymptomatic controls matched with the cases residentially were recruited in a ratio of 1:2. Serum samples from the subjects were tested for rickettsial infections using indirect micro-immunofluorescence assay. Nine cases met the outbreak case definition. All cases were male. An eschar was noted in five cases (55%), and one developed pneumonitis. We did not identify any environmental factors associated with illness. Serum samples of all five follow-up cases (100%) had strong-positive IgG responses to scrub typhus. All but one control (10%) had a moderate response against scrub typhus. Four controls had low levels of antibodies against spotted fever group rickettsia, and only one had a low-level response to typhus group rickettsia. This outbreak represents the first laboratory-confirmed outbreak of scrub typhus in the Western Province of Solomon Islands. The results suggest that rickettsial infections are more common than currently recognized as a cause of an acute febrile illness. A revised clinical case definition for rickettsial infections and treatment guidelines were developed and shared with provincial health staff for better surveillance and response to future outbreaks of a similar kind.

Control of a community outbreak of measles which started in a poorly immunised high school population.

PubMed

Merianos, A; Miller, N C; Patel, M S

1993-09-01

An outbreak of measles occurred in Darwin from February to March 1991. The first case was in a 13-year-old high school student who had returned from a holiday overseas. She was symptomatic on the second day of the new school term. She infected an infant while both waited in a doctor's surgery. Outbreak control measures were instituted 18 days later when the Communicable Diseases Centre was first alerted of cases through the laboratory notification scheme. Through active surveillance, we identified 76 cases of measles, of whom 92 per cent (70 cases) were under 20 years of age. Of these, 46 were students at the index high school in which the attack rate was 39.2 per 1,000. They transmitted the disease to six unvaccinated siblings aged 11 to 18 years, resulting in a secondary attack rate of 113 per 1,000 in this age group (relative risk of disease in siblings 2.8, 95 per cent confidence interval 1.2 to 6.2). The outbreak affected one other high school, a number of primary schools, one tertiary institution, and nine children under five years. Only four of the cases had a verified history of previous immunisation against measles. The outbreak was arrested within two weeks of instituting community-wide control measures. Inadequate immunisation coverage among school-aged children and delays in notification contributed to the severity of the outbreak. Improved measles surveillance systems, including telephone notification of clinical cases are needed so that control measures can be instituted immediately within the household and in the community.

Acquisition Challenges of a Lethal Virus

DTIC Science & Technology

2014-10-01

March 23, 2014. Since then it has spread to Sierra Leone and Liberia . As of July 3, 2014, WHO reported 779 clini- cal cases of Ebola virus disease...Health Organization team responding to an Ebola virus outbreak. It’s 1995. “The Hot Zone” tops best-seller lists, and millions of people the world...over are fixated on the threat of incurable “hot” hemorrhagic fever viruses like Ebola . Gruesome depictions of melting skin and oozing blood fill

Establishment of a Research Pharmacy to Support Ebola Clinical Research in Liberia

PubMed Central

Pierson, Jerome F.; Kirchoff, Matthew Carl; Tyee, Rev Tegli; Rhie, Julie K.; Montello, Michael J

2017-01-01

Objective This paper describes the establishment of a research pharmacy to support the PREVAIL vaccine study for Ebola Virus Disease. Setting This paper describes the establishment of the pharmacy element to support the overall research program during an Ebola outbreak in Monrovia, Liberia in 2014 and 2015. Practice Innovation The need to rapidly establish infrastructure to support the Liberian-US joint clinical research partnership in response to the emerging Ebola Virus Disease provided the opportunity for collaboration among Liberian and US pharmacists. Evaluation and Results Experiences of the Liberian and US pharmacists involved in the program are described. Conclusion The partnership was successful in the conduct of the study, but more importantly, capacity for Liberian pharmacists to support clinical research was established. Additionally, the US team learned several important lessons that will help prepare them for responding to research needs in future infectious disease outbreaks. PMID:28610940

Design and evaluation of a web-based decision support tool for district-level disease surveillance in a low-resource setting

PubMed Central

Pore, Meenal; Sengeh, David M.; Mugambi, Purity; Purswani, Nuri V.; Sesay, Tom; Arnold, Anna Lena; Tran, Anh-Minh A.; Myers, Ralph

2017-01-01

During the 2014 West African Ebola Virus outbreak it became apparent that the initial response to the outbreak was hampered by limitations in the collection, aggregation, analysis and use of data for intervention planning. As part of the post-Ebola recovery phase, IBM Research Africa partnered with the Port Loko District Health Management Team (DHMT) in Sierra Leone and GOAL Global, to design, implement and deploy a web-based decision support tool for district-level disease surveillance. This paper discusses the design process and the functionality of the first version of the system. The paper presents evaluation results prior to a pilot deployment and identifies features for future iterations. A qualitative assessment of the tool prior to pilot deployment indicates that it improves the timeliness and ease of using data for making decisions at the DHMT level. PMID:29854209

In-depth assessment of an outbreak of Nipah encephalitis with person-to-person transmission in Bangladesh: implications for prevention and control strategies.

PubMed

Blum, Lauren S; Khan, Rasheda; Nahar, Nazmun; Breiman, Robert F

2009-01-01

Continued Nipah encephalitis outbreaks in Bangladesh highlight the need for preventative and control measures to reduce transmission from bats to humans and human-to-human spread. Qualitative research was conducted at the end of an encephalitis outbreak in Faridpur, Bangladesh in May 2004 and continued through December 2004. Methods included in-depth interviews with caretakers of cases, case survivors, neighbors of cases, and health providers. Results show contrasts between local and biomedical views on causal explanations and appropriate care. Social norms demanded that family members maintain physical contact with sick patients, potentially increasing the risk of human-to-human transmission. Initial treatment strategies by community members involved home remedies, and public health officials encouraged patient hospitalization. Over time, communities linked the outbreak to supernatural powers and sought care with spiritual healers. Differing popular and medical views of illness caused conflict and rejection of biomedical recommendations. Future investigators should consider local perceptions of disease and treatment when developing outbreak strategies.

Global concern regarding the fifth epidemic of human infection with avian influenza A (H7N9) virus in China.

PubMed

Shen, Yinzhong; Lu, Hongzhou

2017-03-22

Since the first outbreak of human infection with avian influenza A (H7N9) virus was identified in 2013, five seasonal outbreaks have occurred in China. The fifth outbreak started earlier than usual. A sudden increase in cases of human infection with avian influenza A (H7N9) virus has been reported in China since September 2016, and the number of cases reported in this season is exceeding that reported in previous seasons. This increase in the number of new cases of H7N9 infection has caused domestic and international concern. This paper summarizes the current prevalence of H7N9 in China and it also discusses measures that China has taken to control this outbreak. This paper also describes steps China must take in the future. This paper can serve as a reference for prevention and control of H7N9 outbreaks around the world.

Association between heavy precipitation events and waterborne outbreaks in four Nordic countries, 1992-2012.

PubMed

Guzman Herrador, Bernardo; de Blasio, Birgitte Freiesleben; Carlander, Anneli; Ethelberg, Steen; Hygen, Hans Olav; Kuusi, Markku; Lund, Vidar; Löfdahl, Margareta; MacDonald, Emily; Martinez-Urtaza, Jaime; Nichols, Gordon; Schönning, Caroline; Sudre, Bertrand; Trönnberg, Linda; Vold, Line; Semenza, Jan C; Nygård, Karin

2016-12-01

We conducted a matched case-control study to examine the association between heavy precipitation events and waterborne outbreaks (WBOs) by linking epidemiological registries and meteorological data between 1992 and 2012 in four Nordic countries. Heavy precipitation events were defined by above average (exceedance) daily rainfall during the preceding weeks using local references. We performed conditional logistic regression using the four previous years as the controls. Among WBOs with known onset date (n = 89), exceedance rainfall on two or more days was associated with occurrence of outbreak, OR = 3.06 (95% CI 1.38-6.78), compared to zero exceedance days. Stratified analyses revealed a significant association with single household water supplies, ground water as source and for outbreaks occurring during spring and summer. These findings were reproduced in analyses including all WBOs with known outbreak month (n = 186). The vulnerability of single households to WBOs associated with heavy precipitation events should be communicated to homeowners and implemented into future policy planning to reduce the risk of waterborne illness.

Molecular subtyping of Clostridium perfringens by pulsed-field gel electrophoresis to facilitate food-borne-disease outbreak investigations.

PubMed

Maslanka, S E; Kerr, J G; Williams, G; Barbaree, J M; Carson, L A; Miller, J M; Swaminathan, B

1999-07-01

Clostridium perfringens is a common cause of food-borne illness. The illness is characterized by profuse diarrhea and acute abdominal pain. Since the illness is usually self-limiting, many cases are undiagnosed and/or not reported. Investigations are often pursued after an outbreak involving large numbers of people in institutions, at restaurants, or at catered meals. Serotyping has been used in the past to assist epidemiologic investigations of C. perfringens outbreaks. However, serotyping reagents are not widely available, and many isolates are often untypeable with existing reagents. We developed a pulsed-field gel electrophoresis (PFGE) method for molecular subtyping of C. perfringens isolates to aid in epidemiologic investigations of food-borne outbreaks. Six restriction endonucleases (SmaI, ApaI, FspI, MluI, KspI, and XbaI) were evaluated with a select panel of C. perfringens strains. SmaI was chosen for further studies because it produced 11 to 13 well-distributed bands of 40 to approximately 1,100 kb which provided good discrimination between isolates. Seventeen distinct patterns were obtained with 62 isolates from seven outbreak investigations or control strains. In general, multiple isolates from a single individual had indistinguishable PFGE patterns. Epidemiologically unrelated isolates (outbreak or control strains) had unique patterns; isolates from different individuals within an outbreak had similar, if not identical, patterns. PFGE identifies clonal relationships of isolates which will assist epidemiologic investigations of food-borne-disease outbreaks caused by C. perfringens.

Automatic early warning of tail biting in pigs: 3D cameras can detect lowered tail posture before an outbreak

PubMed Central

Jack, Mhairi; Futro, Agnieszka; Talbot, Darren; Zhu, Qiming; Barclay, David; Baxter, Emma M.

2018-01-01

Tail biting is a major welfare and economic problem for indoor pig producers worldwide. Low tail posture is an early warning sign which could reduce tail biting unpredictability. Taking a precision livestock farming approach, we used Time-of-flight 3D cameras, processing data with machine vision algorithms, to automate the measurement of pig tail posture. Validation of the 3D algorithm found an accuracy of 73.9% at detecting low vs. not low tails (Sensitivity 88.4%, Specificity 66.8%). Twenty-three groups of 29 pigs per group were reared with intact (not docked) tails under typical commercial conditions over 8 batches. 15 groups had tail biting outbreaks, following which enrichment was added to pens and biters and/or victims were removed and treated. 3D data from outbreak groups showed the proportion of low tail detections increased pre-outbreak and declined post-outbreak. Pre-outbreak, the increase in low tails occurred at an increasing rate over time, and the proportion of low tails was higher one week pre-outbreak (-1) than 2 weeks pre-outbreak (-2). Within each batch, an outbreak and a non-outbreak control group were identified. Outbreak groups had more 3D low tail detections in weeks -1, +1 and +2 than their matched controls. Comparing 3D tail posture and tail injury scoring data, a greater proportion of low tails was associated with more injured pigs. Low tails might indicate more than just tail biting as tail posture varied between groups and over time and the proportion of low tails increased when pigs were moved to a new pen. Our findings demonstrate the potential for a 3D machine vision system to automate tail posture detection and provide early warning of tail biting on farm. PMID:29617403

33 CFR 274.7 - Authorization of pesticide use.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF DEFENSE PEST CONTROL PROGRAM FOR CIVIL WORKS PROJECTS Project Operation § 274.7 Authorization... unexpected outbreak of a pest requires control measures which are not according to the registered use, such... Engineer. An emergency will be deemed to exist when: (1) A pest outbreak has or is about to occur and no...

A Review of Gastrointestinal Outbreaks in Schools: Effective Infection Control Interventions

ERIC Educational Resources Information Center

Lee, Marilyn B.; Greig, Judy D.

2010-01-01

Background: The purpose of this study was to review documented outbreaks of gastrointestinal illness in schools, published in the last 10 years, to identify etiology, mode of transmission, the number of children affected, morbidity and mortality patterns, and interventions for control and prevention. Methods: Searches of electronic databases,…

Modeling the transmission dynamics of Ebola virus disease in Liberia.

PubMed

Xia, Zhi-Qiang; Wang, Shi-Fu; Li, Shen-Long; Huang, Liu-Yu; Zhang, Wen-Yi; Sun, Gui-Quan; Gai, Zhong-Tao; Jin, Zhen

2015-09-08

Ebola virus disease (EVD) has erupted many times in some zones since it was first found in 1976. The 2014 EVD outbreak in West Africa is the largest ever, which has caused a large number of deaths and the most serious country is Liberia during the outbreak period. Based on the data released by World Health Organization and the actual transmission situations, we investigate the impact of different transmission routes on the EVD outbreak in Liberia and estimate the basic reproduction number R0 = 2.012 in the absence of effective control measures. Through sensitivity and uncertainty analysis, we reveal that the transmission coefficients of suspected and probable cases have stronger correlations on the basic reproduction number. Furthermore, we study the influence of control measures (isolation and safe burial measures) on EVD outbreak. It is found that if combined control measures are taken, the basic reproduction number will be less than one and thus EVD in Liberia may be well contained. The obtained results may provide new guidance to prevent and control the spread of disease.

Restaurant-associated outbreak of Salmonella typhi in Nauru: an epidemiological and cost analysis.

PubMed Central

Olsen, S. J.; Kafoa, B.; Win, N. S.; Jose, M.; Bibb, W.; Luby, S.; Waidubu, G.; O'Leary, M.; Mintz, E.

2001-01-01

Typhoid fever is endemic in the South Pacific. We investigated an outbreak in Nauru. Through interviews and medical records, we identified 50 persons with onset between 1 October 1998 and 10 May 1999, of fever lasting > or = 3 days and one other symptom. Salmonella Typhi was isolated from 19 (38%) cases. Thirty-two (64%) patients were school-aged children, and 17 (34%) were in four households. Case-control studies of (a) culture-confirmed cases and age- and neighbourhood-matched controls; and (b) household index cases and randomly selected age-matched controls implicated two restaurants: Restaurant M (matched OR [MOR] = 11, 95% confidence interval [CI] = 1.3-96) and Restaurant I (MOR = 5.8, 95% CI = 1.2-29). Food-handlers at both restaurants had elevated anti-Vi antibody titres indicative of carrier state. The annual incidence was 5.0/1000 persons. Outbreak-associated costs were $46,000. Routine or emergency immunization campaigns targeting school-aged children may help prevent or control outbreaks of typhoid fever in endemic disease areas. PMID:11811872

A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions.

PubMed

Cummings, M J; Wamala, J F; Eyura, M; Malimbo, M; Omeke, M E; Mayer, D; Lukwago, L

2012-08-01

In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83-15·70], eating roadside food (aOR 2·91, 95% CI 1·24-6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54-161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63-9·14), female gender (aOR 2·43, 95% CI 1·09-5·43), and childhood age (10-17 years) (aOR 7·14, 95% CI 1·97-25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.

Detection limit of Mycobacterium chimaera in water samples for monitoring medical device safety: insights from a pilot experimental series.

PubMed

Schreiber, P W; Köhler, N; Cervera, R; Hasse, B; Sax, H; Keller, P M

2018-07-01

A growing number of Mycobacterium chimaera infections after cardiosurgery have been reported by several countries. These potentially fatal infections were traced back to contaminated heater-cooler devices (HCDs), which use water as a heat transfer medium. Aerosolization of water contaminated with M. chimaera from HCDs enables airborne transmission to patients undergoing open chest surgery. Infection control teams test HCD water samples for mycobacterial growth to guide preventive measures. The detection limit of M. chimaera in water samples, however, has not previously been investigated. To determine the detection limit of M. chimaera in water samples using laboratory-based serial dilution tests. An M. chimaera strain representative of the international cardiosurgery-associated M. chimaera outbreak was used to generate a logarithmic dilution series. Two different water volumes, 50 and 1000mL, were inoculated, and, after identical processing (centrifugation, decantation, and decontamination), seeded on mycobacteria growth indicator tube (MGIT) and Middlebrook 7H11 solid media. MGIT consistently showed a lower detection limit than 7H11 solid media, corresponding to a detection limit of ≥1.44 × 10 4 cfu/mL for 50mL and ≥2.4cfu/mL for 1000mL water samples. Solid media failed to detect M. chimaera in 50mL water samples. Depending on water volume and culture method, major differences exist in the detection limit of M. chimaera. In terms of sensitivity, 1000mL water samples in MGIT media performed best. Our results have important implications for infection prevention and control strategies in mitigation of the M. chimaera outbreak and healthcare water safety in general. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Recent loss of closed forests is associated with Ebola virus disease outbreaks.

PubMed

Olivero, Jesús; Fa, John E; Real, Raimundo; Márquez, Ana L; Farfán, Miguel A; Vargas, J Mario; Gaveau, David; Salim, Mohammad A; Park, Douglas; Suter, Jamison; King, Shona; Leendertz, Siv Aina; Sheil, Douglas; Nasi, Robert

2017-10-30

Ebola virus disease (EVD) is a contagious, severe and often lethal form of hemorrhagic fever in humans. The association of EVD outbreaks with forest clearance has been suggested previously but many aspects remained uncharacterized. We used remote sensing techniques to investigate the association between deforestation in time and space, with EVD outbreaks in Central and West Africa. Favorability modeling, centered on 27 EVD outbreak sites and 280 comparable control sites, revealed that outbreaks located along the limits of the rainforest biome were significantly associated with forest losses within the previous 2 years. This association was strongest for closed forests (>83%), both intact and disturbed, of a range of tree heights (5->19 m). Our results suggest that the increased probability of an EVD outbreak occurring in a site is linked to recent deforestation events, and that preventing the loss of forests could reduce the likelihood of future outbreaks.

Tick-Borne Relapsing Fever Outbreak Among a High School Football Team at an Outdoor Education Camping Trip, Arizona, 2014.

PubMed

Jones, Jefferson M; Hranac, Carter R; Schumacher, Mare; Horn, Kim; Lee, Darlene M; Terriquez, Joel; Engelthaler, David M; Peoples, Marie; Corrigan, Jennifer; Replogle, Adam; Souders, Nina; Komatsu, Kenneth K; Nieto, Nathan C

2016-09-07

During August 2014, five high school students who had attended an outdoor education camp were hospitalized with a febrile illness, prompting further investigation. Ten total cases of tick-borne relapsing fever (TBRF) were identified-six cases confirmed by culture or visualization of spirochetes on blood smear and four probable cases with compatible symptoms (attack rate: 23%). All patients had slept in the campsite's only cabin. Before the camp, a professional pest control company had rodent proofed the cabin, but no acaricides had been applied. Cabin inspection after the camp found rodents and Ornithodoros ticks, the vector of TBRF. Blood samples from a chipmunk trapped near the cabin and from patients contained Borrelia hermsii with identical gene sequences (100% over 630 base pairs). Health departments in TBRF endemic areas should consider educating cabin owners and pest control companies to apply acaricides during or following rodent proofing, because ticks that lack rodents for a blood meal might feed on humans. © The American Society of Tropical Medicine and Hygiene.

Epidemic keratoconjunctivitis outbreak at a tertiary referral eye care clinic.

PubMed

Montessori, V; Scharf, S; Holland, S; Werker, D H; Roberts, F J; Bryce, E

1998-08-01

An outbreak of epidemic keratoconjunctivitis (EKC) occurred at a tertiary referral eye care clinic between late September and mid-November 1995. Before the outbreak, instruments were cleaned with 70% isopropyl alcohol and handwashing between patients was not routine. Infection control measures were implemented when the outbreak was recognized in mid-October. Control measures included triaging suspected cases to a separate waiting area, cohorting cases to a specific examining room, endorsing the use of gloves and handwashing during examinations of patients, and cleaning instruments with a buffered bleach solution. Thirty-six cases were diagnosed before the infection control measures were taken, and 3 cases were seen after the control measures were taken. Also, numerous secondary cases occurred in the community. No additional cases were diagnosed from DEcember to February 25, 1996. Acquisition of the infection was linked to visits to 4 of 20 physicians in the eye clinic with 61% of cases associated with visits to 1 of those 4 physicians. The use of diagnostic lenses applied directly to the eye was associated with infection (odds ratio = 2.83, 95% confidence interval = 0.79 to 10.4), although this did not reach statistical significance. The use of tonometers, ophthalmic solutions, or laser therapy was not associated with infection, and all environmental cultures were negative. This outbreak emphasizes the need for implementation of routine infection control guidelines to prevent nosocomial transmission of epidemic keratoconjunctivitis and stresses the need for appropriate disinfection of instruments.

High Hand Contamination Rates During Norovirus Outbreaks in Long-Term Care Facilities.

PubMed

Park, Geun Woo; Williamson, Keenan J; DeBess, Emilio; Cieslak, Paul R; Gregoricus, Nicole; De Nardo, Elizabeth; Fricker, Christopher; Costantini, Verónica; Vinjé, Jan

2018-02-01

We examined norovirus contamination on hands of ill patients during 12 norovirus outbreaks in 12 long-term care facilities (LTCFs). The higher frequency and norovirus titers on hands of residents compared to hands of heathcare workers highlights the importance of adhering to appropriate hand hygiene practices during norovirus outbreaks in LTCFs. Infect Control Hosp Epidemiol 2018;39:219-221.

Outbreak of Ciprofloxacin-Resistant Shigella sonnei Associated with Travel to Vietnam, Republic of Korea.

PubMed

Kim, Jin Seok; Kim, Jae Joon; Kim, Soo Jin; Jeon, Se-Eun; Seo, Ki Yeon; Choi, Jun-Kil; Kim, Nan-Ok; Hong, Sahyun; Chung, Gyung Tae; Yoo, Cheon-Kwon; Kim, Young-Taek; Cheun, Hyeng Il; Bae, Geun-Ryang; Yeo, Yeong-Hee; Ha, Gang-Ja; Choi, Mi-Suk; Kang, Shin-Jung; Kim, Junyoung

2015-07-01

We investigated an October 2014 outbreak of illness caused by Shigella sonnei in a daycare center in the Republic of Korea (South Korea). The outbreak strain was resistant to extended-spectrum cephalosporins and fluoroquinolones and was traced to a child who had traveled to Vietnam. Improved hygiene and infection control practices are needed for prevention of shigellosis.

Study of a measles outbreak in Granada with preventive measures applied by the courts, Spain, 2010 to 2011.

PubMed

Navarro, E; Mochón, M M; Galicia, M D; Marín, I; Laguna, J

2013-10-24

Measles had practically been eliminated in Granada since the systematic vaccination of children with two doses introduced in 1984. However, in 2009 the disease returned in the form of small outbreaks. This study describes the measles outbreak that occurred in Granada from October 2010 to August 2011 and the measures imposed to control it. Information was sourced from the records of the Andalusian epidemiological surveillance system. A total of 308 cases were recorded, representing an incidence rate of 33.6 cases per 100,000 inhabitants. The first wave of the epidemic took place in Granada city, with the majority of cases occurring among families who lived in the Albaycín neighbourhood and were opposed to vaccination for ideological and/or religious reasons. The initial cases were in unvaccinated children aged 1 to 13 years. The outbreak later spread throughout the province. To control the outbreak, the vaccination schedule for the exposed children was brought up to date. The Regional Ministry of Health decided to take legal action in order to ensure vaccination of those in the initial nucleus of the outbreak.

Evidence for Emergency Vaccination Having Played a Crucial Role to Control the 1965/66 Foot-and-Mouth Disease Outbreak in Switzerland

PubMed Central

Zingg, Dana; Häsler, Stephan; Schuepbach-Regula, Gertraud; Schwermer, Heinzpeter; Dürr, Salome

2015-01-01

Foot-and-mouth disease (FMD) is a highly contagious disease that caused several large outbreaks in Europe in the last century. The last important outbreak in Switzerland took place in 1965/66 and affected more than 900 premises and more than 50,000 animals were slaughtered. Large-scale emergency vaccination of the cattle and pig population has been applied to control the epidemic. In recent years, many studies have used infectious disease models to assess the impact of different disease control measures, including models developed for diseases exotic for the specific region of interest. Often, the absence of real outbreak data makes a validation of such models impossible. This study aimed to evaluate whether a spatial, stochastic simulation model (the Davis Animal Disease Simulation model) can predict the course of a Swiss FMD epidemic based on the available historic input data on population structure, contact rates, epidemiology of the virus, and quality of the vaccine. In addition, the potential outcome of the 1965/66 FMD epidemic without application of vaccination was investigated. Comparing the model outcomes to reality, only the largest 10% of the simulated outbreaks approximated the number of animals being culled. However, the simulation model highly overestimated the number of culled premises. While the outbreak duration could not be well reproduced by the model compared to the 1965/66 epidemic, it was able to accurately estimate the size of the area infected. Without application of vaccination, the model predicted a much higher mean number of culled animals than with vaccination, demonstrating that vaccination was likely crucial in disease control for the Swiss FMD outbreak in 1965/66. The study demonstrated the feasibility to analyze historical outbreak data with modern analytical tools. However, it also confirmed that predicted epidemics from a most carefully parameterized model cannot integrate all eventualities of a real epidemic. Therefore, decision makers need to be aware that infectious disease models are useful tools to support the decision-making process but their results are not equal valuable as real observations and should always be interpreted with caution. PMID:26697436

[Scarlet fever outbreak in a public school in Granada in 2012].

PubMed

Fernández-Prada, M; Martínez-Diz, S; Colina López, A; Almagro Nievas, D; Martínez Romero, B; Huertas Martínez, J

2014-04-01

Scarlet fever is a streptococcal disease characterized by a skin rash in children. It can be endemic, epidemic or sporadic. In April 2012, the headmaster of a primary school in Granada reported an outbreak of scarlet fever in the school. To describe an outbreak of scarlet fever, analyse its epidemiological and clinical characteristics, and present the preventive measures taken to control it. A case-control study was conducted using an ad hoc questionnaire, developed for this purpose. The R program, Epidat 3.1 and Microsoft Excel were used for the statistics analysis. There were 13 cases and 30 controls. The attack rate was 3.9%. There was a statistically significant difference for the variable "relative affected". There has been a confirmed outbreak of person-to-person transmitted scarlet fever, and the main risk factor was having a relative with tonsillitis. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Contaminated drinking water in one town manifesting as an outbreak of cryptosporidiosis in another.

PubMed

McAnulty, J M; Keene, W E; Leland, D; Hoesly, F; Hinds, B; Stevens, G; Fleming, D W

2000-08-01

In early 1992 we identified an outbreak of cryptosporidiosis in Oregon and sought to identify and control its source. We used a series of studies to identify risk factors for illness: (i) a case-control study among employees of a long-term-care facility (LTCF); (ii) a matched case-control study of the general community; (iii) a cohort study of wedding attendees; and (iv) a cross-sectional survey of the general community. Drinking Talent water was associated with illness in the LTCF (OR = 22.7, 95 % CI = 2.7-1009.0), and in the community (matched OR = 9.5, 95% CI 2.3-84.1). Drinking Talent water was associated with illness only among non-Talent residents who attended the wedding (P < 0.001) and in the community (RR = 6.5, 95 % CI 3.3-12.9). The outbreak was caused by contaminated municipal water from Talent in the absence of a discernible outbreak among Talent residents, suggesting persons exposed to contaminated water may develop immunity to cryptosporidiosis.

Fresh Produce-Associated Listeriosis Outbreaks, Sources of Concern, Teachable Moments, and Insights.

PubMed

Garner, Danisha; Kathariou, Sophia

2016-02-01

Foodborne transmission of Listeria monocytogenes was first demonstrated through the investigation of the 1981 Maritime Provinces outbreak involving coleslaw. In the following two decades, most listeriosis outbreaks involved foods of animal origin, e.g., deli meats, hot dogs, and soft cheeses. L. monocytogenes serotype 4b, especially epidemic clones I, II, and Ia, were frequently implicated in these outbreaks. However, since 2008 several outbreaks have been linked to diverse types of fresh produce: sprouts, celery, cantaloupe, stone fruit, and apples. The 2011 cantaloupe-associated outbreak was one of the deadliest foodborne outbreaks in recent U.S. history. This review discusses produce-related outbreaks of listeriosis with a focus on special trends, unusual findings, and potential paradigm shifts. With the exception of sprouts, implicated produce types were novel, and outbreaks were one-time events. Several involved serotype 1/2a, and in the 2011 cantaloupe-associated outbreak, serotype 1/2b was for the first time conclusively linked to a common-source outbreak of invasive listeriosis. Also in this outbreak, for the first time multiple strains were implicated in a common-source outbreak. In 2014, deployment of whole genome sequencing as part of outbreak investigation validated this technique as a pivotal tool for outbreak detection and speedy resolution. In spite of the unusual attributes of produce-related outbreaks, in all but one of the investigated cases (the possible exception being the coleslaw outbreak) contamination was traced to the same sources as those for outbreaks associated with other vehicles (e.g., deli meats), i.e., the processing environment and equipment. The public health impact of farm-level contamination remains uncharacterized. This review highlights knowledge gaps regarding virulence and other potentially unique attributes of produce outbreak strains, the potential for novel fresh produce items to become unexpectedly implicated in outbreaks, and the key role of good control strategies in the processing environment.

Depression after Exposure to Stressful Events: Lessons Learned from the SARS Epidemic

PubMed Central

Liu, Xinhua; Kakade, Meghana; Fuller, Cordelia J.; Fan, Bin; Fang, Yunyun; Kong, Junhui; Guan, Zhiqiang; Wu, Ping

2011-01-01

Aim To examine, among hospital employees exposed to an outbreak of severe acute respiratory syndrome (SARS), post-outbreak levels of depressive symptoms, and the relationship between those depressive symptom levels and the types of outbreak event exposures experienced. Methods In 2006, randomly selected employees (n = 549) of a hospital in Beijing were surveyed concerning their exposures to the city’s 2003 SARS outbreak, and the ways in which the outbreak had affected their mental health. Subjects were assessed on sociodemographic factors, on types of exposure to the outbreak, and on symptoms of post-traumatic stress disorder (PTSD) and depression. Results The results of multinomial regression analyses showed that, with other relevant factors controlled for, being single, having been quarantined during the outbreak, having been exposed to other traumatic events prior to SARS, and perceived SARS-related risk level during the outbreak were found to increase the odds of having a high level of depressive symptoms three years later. Altruistic acceptance of risk during the outbreak was found to decrease the odds of high post-outbreak depressive symptom levels. Conclusions Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware that the experience of being quarantined can, in some cases, lead to long-term adverse mental health consequences. PMID:21489421

Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward.

PubMed

Mounsey, K E; Murray, H C; King, M; Oprescu, F

2016-08-01

Scabies outbreaks can be disruptive in institutional settings, and are associated with considerable but under-researched morbidity, especially in vulnerable populations. In this paper, we describe key findings from a retrospective review of scabies outbreaks reported in the literature over the past 30 years. We undertook this review to gain insights into the impact of institutional outbreaks, the burden in terms of attack rates, economic costs, treatment trends, the types of index cases and outbreak progression. We found 84 reports over 30 years, with outbreaks most frequently reported in aged care facilities (n = 40) and hospitals (n = 33). On average, scabies outbreaks persisted for 3 months, and the median attack rate was 38%. While 1% lindane was once the most commonly employed acaricide, 5% permethrin and oral ivermectin are increasingly used. Crusted scabies represented the index case for 83% of outbreaks, and scabies was misdiagnosed in 43% outbreaks. The frequency of reported scabies outbreaks has not declined consistently over time suggesting the disease is still highly problematic. We contend that more research and practice emphasis must be paid to improve diagnostic methods, surveillance and control, health staff education and management of crusted scabies to prevent the development of scabies outbreaks in institutional settings.

Risk of Human Infections With Highly Pathogenic H5N2 and Low Pathogenic H7N1 Avian Influenza Strains During Outbreaks in Ostriches in South Africa

PubMed Central

Venter, Marietjie; Treurnicht, Florette K.; Buys, Amelia; Tempia, Stefano; Samudzi, Rudo; McAnerney, Johanna; Jacobs, Charlene A.; Thomas, Juno; Blumberg, Lucille

2017-01-01

Background Risk factors for human infection with highly pathogenic (HP) and low-pathogenic (LP) avian influenza (AI) H5N2 and H7N1 were investigated during outbreaks in ostriches in the Western Cape province, South Africa. Methods Serum surveys were conducted for veterinarians, farmworkers, and laboratory and abattoir workers involved in 2 AI outbreaks in the Western Cape province: (1) controlling and culling of 42 000 ostriches during (HPAI)H5N2 outbreaks in ostriches (2011) (n = 207); (2) movement control during (LPAI)H7N1 outbreaks in 2012 (n = 66). A third serosurvey was conducted on state veterinarians from across the country in 2012 tasked with disease control in general (n = 37). Antibodies to H5 and H7 were measured by means of hemagglutination inhibition and microneutralization assays, with microneutralization assay titers >40 considered positive. Results Two of 207 (1%) participants were seropositive for H5 and 4 of 207 (2%) for H7 in 2011, compared with 1 of 66 (1.5%) and 8 of 66 (13%) in 2012. Although individuals in all professions tested seropositive, abattoir workers (10 of 97; 10.3%) were significantly more at risk of influenza A(H7N1) infection (P = .001) than those in other professions (2 of 171;1.2%). Among state veterinarians, 4 of 37(11%) were seropositive for H7 and 1 of 37 (2.7%) for H5. Investigations of (LP)H7N1-associated fatalities in wild birds and quarantined exotic birds in Gauteng, AI outbreaks in poultry in KwaZulu-Natal, and ostriches in Western Cape province provide possible exposure events. Conclusion (LPAI)H7N1 strains pose a greater infection-risk than (HPAI)H5N2 strains to persons involved in control of outbreaks in infected birds, with ostrich abattoir workers at highest risk. PMID:28934458

Control of an H1N1 outbreak in a correctional facility in central Taiwan.

PubMed

Chao, Wen-Cheng; Liu, Po-Yu; Wu, Chieh-Liang

2017-04-01

Controlling the outbreak of H1N1 in correctional facilities is difficult due to the inevitable close and prolonged contact between inmates. The current study reports an H1N1 outbreak in a correction facility and investigates the effectiveness of oseltamivir to control the spread of H1N1. All 2690 inmates at the prison received medical service from a single hospital. A list of patients with a diagnosis of influenza was compiled based on medical diagnoses with respiratory symptoms during the outbreak period. The outbreak was then investigated using both chart review and questionnaires. In the 4-week outbreak period, 24.6% (663/2690) of inmates experienced influenza-associated symptoms, 50.5% (335/663) fulfilled the criteria for influenza-like illness (ILI) with fever, and the overall attack rate of ILI was 12.8%. Twelve inmates were admitted for complicated influenza, and three of them experienced respiratory failure. Oseltamivir was provided at the end of the 2nd week, and the effectiveness of oseltamivir in the 1004 inmates from seven major sections in the prison was analyzed. The ILI incidence rate reduced from 12.6 ± 4.1% between the 1st and 2nd weeks to 4.8 ± 2.4% between the 3rd and 4th weeks (p = 0.018) after the oseltamivir intervention. In the 878 uninfected inmates 47.0% (413/878) of inmates received prophylactic oseltamivir at the end of the 2nd week, the incidence of ILI was lower than those without prophylaxis (6.2% versus 2.4%; p = 0.013). H1N1 influenza spread rapidly in the correctional facility. The use of oseltamivir may be a practical intervention to control an H1N1 outbreak an enclosed environment such as this. Copyright © 2015. Published by Elsevier B.V.

Benefit-cost analysis of spruce budworm (Choristoneura fumiferana Clem.) control: incorporating market and non-market values.

PubMed

Chang, Wei-Yew; Lantz, Van A; Hennigar, Chris R; MacLean, David A

2012-01-01

This study employs a benefit-cost analysis framework to estimate market and non-market benefits and costs of controlling future spruce budworm (Choristoneura fumiferana) outbreaks on Crown forest lands in New Brunswick, Canada. We used: (i) an advanced timber supply model to project potential timber volume saved, timber value benefits, and costs of pest control efforts; and (ii) a recent contingent valuation method analysis that evaluated non-market benefits (i.e., changes in recreation opportunities and existence values) of controlling future spruce budworm outbreaks in the Province. A total of six alternative scenarios were evaluated, including two uncontrolled future budworm outbreak severities (moderate vs. severe) and, for each severity, three control program levels (protecting 10%, 20%, or 40% of the susceptible Crown land forest area). The economic criteria used to evaluate each scenario included benefit-cost ratios and net present values. Under severe outbreak conditions, results indicated that the highest benefit-cost ratio (4.04) occurred when protecting 10% (284,000 ha) of the susceptible area, and the highest net present value ($111 M) occurred when protecting 20% (568,000 ha) of the susceptible area. Under moderate outbreak conditions, the highest benefit-cost ratio (3.24) and net present value ($58.7 M) occurred when protecting 10% (284,000 ha) of the susceptible area. Inclusion of non-market values generally increased the benefit-cost ratios and net present values of the control programs, and in some cases, led to higher levels of control being supported. Results of this study highlight the importance of including non-market values into the decision making process of forest pest management. Copyright © 2011 Elsevier Ltd. All rights reserved.

Multinational outbreak of Salmonella Enteritidis infection during an international youth ice hockey competition in Riga, Latvia, preliminary report, March and April 2015.

PubMed

Pesola, A K; Parn, T; Huusko, S; Perevosčikovs, J; Ollgren, J; Salmenlinna, S; Lienemann, T; Gossner, C; Danielsson, N; Rimhanen-Finne, R

2015-05-21

A multinational outbreak of salmonellosis linked to the Riga Cup 2015 junior ice-hockey competition was detected by the Finnish health authorities in mid-April and immediately notified at the European Union level. This prompted an international outbreak investigation supported by the European Centre for Disease Prevention and Control. As of 8 May 2015, seven countries have reported 214 confirmed and suspected cases, among which 122 from Finland. The search for the source of the outbreak is ongoing.

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility.

PubMed

Murray, Meghan T; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie

2016-07-01

We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. Infect Control Hosp Epidemiol 2016;37:859-862.

Assessing the impact of public health interventions on the transmission of pandemic H1N1 influenza a virus aboard a Peruvian navy ship

PubMed Central

Vera, Delphis M; Hora, Ricardo A; Murillo, Anarina; Wong, Juan F; Torre, Armando J; Wang, David; Boulay, Darbi; Hancock, Kathy; Katz, Jacqueline M; Ramos, Mariana; Loayza, Luis; Quispe, Jose; Reaves, Erik J; Bausch, Daniel G; Chowell, Gerardo; Montgomery, Joel M

2014-01-01

Background Limited data exist on transmission dynamics and effectiveness of control measures for influenza in confined settings. Objectives To investigate the transmission dynamics of a 2009 pandemic H1N1 influenza A outbreak aboard a Peruvian Navy ship and quantify the effectiveness of the implemented control measures. Methods We used surveillance data and a simple stochastic epidemic model to characterize and evaluate the effectiveness of control interventions implemented during an outbreak of 2009 pandemic H1N1 influenza A aboard a Peruvian Navy ship. Results The serological attack rate for the outbreak was 49·1%, with younger cadets and low-ranking officers at greater risk of infection than older, higher-ranking officers. Our transmission model yielded a good fit to the daily time series of new influenza cases by date of symptom onset. We estimated a reduction of 54·4% in the reproduction number during the period of intense control interventions. Conclusion Our results indicate that the patient isolation strategy and other control measures put in place during the outbreak reduced the infectiousness of isolated individuals by 86·7%. Our findings support that early implementation of control interventions can limit the spread of influenza epidemics in confined settings. PMID:24506160

Exploring governance for a One Health collaboration for leptospirosis prevention and control in Fiji: Stakeholder perceptions, evidence, and processes.

PubMed

McPherson, Anna; Hill, Peter S; Kama, Mike; Reid, Simon

2018-03-30

Fiji has a high burden of leptospirosis, with endemic infection and epidemic outbreaks with high mortality, often associated with flooding and cyclones. As a zoonosis, leptospirosis control requires interventions in sectors beyond the usual control of health-in Fiji, the dairy and sugar industries, and water and sanitation and rodent control in communities. This paper presents the findings of qualitative research to inform policy around governance for a One Health multisectoral approach to leptospirosis control. Key informants from relevant government agencies and industry organizations were interviewed in late 2014, and the interviews analyzed and triangulated with documentary analysis. The analysis identified 5 themes: perceptions of the impact of leptospirosis, governance processes, models for collaboration, leptospirosis control, and preferred leadership for leptospirosis management. Data were limited, with poor communication between ministries, and limited awareness of leptospirosis outside outbreaks. Collaboration during outbreaks was positive but not sustained in endemic periods. Mechanism for enhanced collaboration was developed for endemic and outbreak situations. The findings informed a One Health governance approach to leptospirosis, framed within a National Strategic Plan, with a specific National Action Plan for Leptospirosis. The process provides a research based One Health template for application to other zoonotic diseases. Copyright © 2018 John Wiley & Sons, Ltd.

Oseltamivir prophylaxis in controlling influenza outbreak in nursing homes: a comparison between three different approaches.

PubMed

Gorišek Miksić, N; Uršič, T; Simonović, Z; Lusa, L; Lobnik Rojko, P; Petrovec, M; Strle, F

2015-02-01

To assess influenza outbreaks in nursing homes (NHs) using different pharmacological preventive measures. We compared characteristics of influenza A outbreaks that occurred during 2011/2012 influenza season in three NHs of similar size (208, 167, and 164 residents in NH1, NH2, and NH3, respectively) implementing comparable treatment approaches and non-pharmacological outbreak control measures but different prophylactic pharmacological interventions including oseltamivir 75 mg o.d. for 10 days for all residents (NH1), for directly exposed residents (NH2), and no prophylaxis (NH3). The proportions of residents who developed acute respiratory infection (ARI) in the course of influenza outbreak were 55/208 (26.4 %) in NH1, 64/167 (38.3 %) in NH2, and 31/164 (18.9 %) in NH3; hospital admission was required in 2/55 (3.6 %), 5/64 (7.8 %), and 5/31 (16.1 %) residents of NH1, NH2, and NH3, respectively, while 1/55 (1.8 %), 1/64 (1.6 %), and 3/31 (9.7 %) residents of the corresponding NHs died during influenza outbreak. The duration of the outbreak was shorter in the NH1 where oseltamivir prophylaxis was instituted for all residents (8 days), than in NHs where selective prophylaxis with oseltamivir and no prophylaxis were used (14 and 12 days, respectively). The calculated vaccine effectiveness in residents was 48, 71, and 44 % in NH1, NH2, and NH3, respectively. Staff members had similar ARI attack rate but in comparison to residents were less often vaccinated against influenza and demonstrated higher influenza vaccine effectiveness. Comparison of influenza outbreaks in three NHs revealed that the duration of the outbreak was the shortest in the NH where prophylaxis with oseltamivir was given to all residents.

Epidemiology of Foodborne Disease Outbreaks Caused by Clostridium perfringens, United States, 1998–2010

PubMed Central

Grass, Julian E.; Gould, L. Hannah; Mahon, Barbara E.

2015-01-01

Clostridium perfringens is estimated to be the second most common bacterial cause of foodborne illness in the United States, causing one million illnesses each year. Local, state, and territorial health departments voluntarily report C. perfringens outbreaks to the U.S. Centers for Disease Control and Prevention through the Foodborne Disease Outbreak Surveillance System. Our analysis included outbreaks confirmed by laboratory evidence during 1998–2010. A food item was implicated if C. perfringens was isolated from food or based on epidemiologic evidence. Implicated foods were classified into one of 17 standard food commodities when possible. From 1998 to 2010, 289 confirmed outbreaks of C. perfringens illness were reported with 15,208 illnesses, 83 hospitalizations, and eight deaths. The number of outbreaks reported each year ranged from 16 to 31 with no apparent trend over time. The annual number of outbreak-associated illnesses ranged from 359 to 2,173, and the median outbreak size was 24 illnesses. Outbreaks occurred year round, with the largest number in November and December. Restaurants (43%) were the most common setting of food preparation. Other settings included catering facility (19%), private home (16%), prison or jail (11%), and other (10%). Among the 144 (50%) outbreaks attributed to a single food commodity, beef was the most common commodity (66 outbreaks, 46%), followed by poultry (43 outbreaks, 30%), and pork (23 outbreaks, 16%). Meat and poultry outbreaks accounted for 92% of outbreaks with an identified single food commodity. Outbreaks caused by C. perfringens occur regularly, are often large, and can cause substantial morbidity yet are preventable if contamination of raw meat and poultry products is prevented at the farm or slaughterhouse or, after contamination, if these products are properly handled and prepared, particularly in restaurants and catering facilities. PMID:23379281

A Web-Based Multidrug-Resistant Organisms Surveillance and Outbreak Detection System with Rule-Based Classification and Clustering

PubMed Central

Tseng, Yi-Ju; Wu, Jung-Hsuan; Ping, Xiao-Ou; Lin, Hui-Chi; Chen, Ying-Yu; Shang, Rung-Ji; Chen, Ming-Yuan; Lai, Feipei

2012-01-01

Background The emergence and spread of multidrug-resistant organisms (MDROs) are causing a global crisis. Combating antimicrobial resistance requires prevention of transmission of resistant organisms and improved use of antimicrobials. Objectives To develop a Web-based information system for automatic integration, analysis, and interpretation of the antimicrobial susceptibility of all clinical isolates that incorporates rule-based classification and cluster analysis of MDROs and implements control chart analysis to facilitate outbreak detection. Methods Electronic microbiological data from a 2200-bed teaching hospital in Taiwan were classified according to predefined criteria of MDROs. The numbers of organisms, patients, and incident patients in each MDRO pattern were presented graphically to describe spatial and time information in a Web-based user interface. Hierarchical clustering with 7 upper control limits (UCL) was used to detect suspicious outbreaks. The system’s performance in outbreak detection was evaluated based on vancomycin-resistant enterococcal outbreaks determined by a hospital-wide prospective active surveillance database compiled by infection control personnel. Results The optimal UCL for MDRO outbreak detection was the upper 90% confidence interval (CI) using germ criterion with clustering (area under ROC curve (AUC) 0.93, 95% CI 0.91 to 0.95), upper 85% CI using patient criterion (AUC 0.87, 95% CI 0.80 to 0.93), and one standard deviation using incident patient criterion (AUC 0.84, 95% CI 0.75 to 0.92). The performance indicators of each UCL were statistically significantly higher with clustering than those without clustering in germ criterion (P < .001), patient criterion (P = .04), and incident patient criterion (P < .001). Conclusion This system automatically identifies MDROs and accurately detects suspicious outbreaks of MDROs based on the antimicrobial susceptibility of all clinical isolates. PMID:23195868

Outbreak-associated Salmonella enterica Serotypes and Food Commodities, United States, 1998–2008

PubMed Central

Griffin, Patricia M.; Cole, Dana; Walsh, Kelly A.; Chai, Shua J.

2013-01-01

Salmonella enterica infections are transmitted not only by animal-derived foods but also by vegetables, fruits, and other plant products. To clarify links between Salmonella serotypes and specific foods, we examined the diversity and predominance of food commodities implicated in outbreaks of salmonellosis during 1998–2008. More than 80% of outbreaks caused by serotypes Enteritidis, Heidelberg, and Hadar were attributed to eggs or poultry, whereas >50% of outbreaks caused by serotypes Javiana, Litchfield, Mbandaka, Muenchen, Poona, and Senftenberg were attributed to plant commodities. Serotypes Typhimurium and Newport were associated with a wide variety of food commodities. Knowledge about these associations can help guide outbreak investigations and control measures. PMID:23876503

Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015.

PubMed

Bwire, Godfrey; Munier, Aline; Ouedraogo, Issaka; Heyerdahl, Leonard; Komakech, Henry; Kagirita, Atek; Wood, Richard; Mhlanga, Raymond; Njanpop-Lafourcade, Berthe; Malimbo, Mugagga; Makumbi, Issa; Wandawa, Jennifer; Gessner, Bradford D; Orach, Christopher Garimoi; Mengel, Martin A

2017-03-01

The communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities. We conducted a prospective study between 2011-15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5-10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5-9 years had increased risk. Cholera was endemic in some villages with well-defined "hotspots". Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty. Cholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities.

Epidemiology of cholera outbreaks and socio-economic characteristics of the communities in the fishing villages of Uganda: 2011-2015

PubMed Central

Ouedraogo, Issaka; Heyerdahl, Leonard; Komakech, Henry; Kagirita, Atek; Wood, Richard; Mhlanga, Raymond; Njanpop-Lafourcade, Berthe; Malimbo, Mugagga; Makumbi, Issa; Wandawa, Jennifer; Gessner, Bradford D.; Orach, Christopher Garimoi; Mengel, Martin A.

2017-01-01

Background The communities in fishing villages in the Great Lakes Region of Africa and particularly in Uganda experience recurrent cholera outbreaks that lead to considerable mortality and morbidity. We evaluated cholera epidemiology and population characteristics in the fishing villages of Uganda to better target prevention and control interventions of cholera and contribute to its elimination from those communities. Methodology/Principal findings We conducted a prospective study between 2011–15 in fishing villages in Uganda. We collected, reviewed and documented epidemiological and socioeconomic data for 10 cholera outbreaks that occurred in fishing communities located along the African Great Lakes and River Nile in Uganda. These outbreaks caused 1,827 suspected cholera cases and 43 deaths, with a Case-Fatality Ratio (CFR) of 2.4%. Though the communities in the fishing villages make up only 5–10% of the Ugandan population, they bear the biggest burden of cholera contributing 58% and 55% of all reported cases and deaths in Uganda during the study period. The CFR was significantly higher among males than females (3.2% vs. 1.3%, p = 0.02). The outbreaks were seasonal with most cases occurring during the months of April-May. Male children under age of 5 years, and 5–9 years had increased risk. Cholera was endemic in some villages with well-defined “hotspots”. Practices predisposing communities to cholera outbreaks included: the use of contaminated lake water, poor sanitation and hygiene. Additional factors were: ignorance, illiteracy, and poverty. Conclusions/Significance Cholera outbreaks were a major cause of morbidity and mortality among the fishing communities in Uganda. In addition to improvements in water, sanitation, and hygiene, oral cholera vaccines could play an important role in the prevention and control of these outbreaks, particularly when targeted to high-risk areas and populations. Promotion and facilitation of access to social services including education and reduction in poverty should contribute to cholera prevention, control and elimination in these communities. PMID:28288154

Outbreaks of infections associated with drug diversion by US health care personnel.

PubMed

Schaefer, Melissa K; Perz, Joseph F

2014-07-01

To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions. We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation. We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing. These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies. Published by Elsevier Inc.

Investigation and control of a Plasmodium falciparum malaria outbreak in Shan Special Region II of Myanmar along the China-Myanmar Border from June to December 2014.

PubMed

Liu, Hui; Xu, Jian-Wei; Yang, Heng-Lin; Li, Mei; Sun, Cheng-De; Yin, Yi-Jie; Zheng, Zhi-Liang; Zhang, Guang-Yun; Yu, Ai-Shui; Yang, Yong-Hui; Li, Chun-Hui; Ai, Shui

2016-04-25

From 2007 to 2013, intensive control measures reduced malaria burden by 90 % along the China-Myanmar border. However, despite these measures a P. falciparum malaria outbreak was reported in the Shan Special Region II of Myanmar in June of 2014. Epidemiological, parasitological and entomological investigations were performed. Dihydroartemisinin piperaquine (DAPQ) was immediately administered to treat parasite positive individuals. Long lasting insecticidal nets (LLIN), indoor residual spraying (IRS) with insecticides and behavior change communication (BCC) were also provided for outbreak control. An embedded efficacy study was conducted evaluating DP. Molecular genotyping via polymerase chain reaction (PCR) was performed on the Kelch gene on chromosome 13. All infections were identified as Plasmodium falciparum by RDT and microscopy. Two fatalities resulted from the outbreak. The attack rate was 72.8 % (67/92) and the incidence density rate was 14.2 per 100 person-weeks. The positive rate of rapid diagnostic test (RDT) was 72.2 % (65/90) and microscopically-determine parasite rate 42.2 % (38/90). Adjusted odds ratio (OR) of multivariate logistic regression analysis for aged <15 years, 15-45 years, inappropriate treatment from a private healer and lack of bed nets were 13.51 (95 % confidence interval, 2.21-105.89), 7.75 (1.48-44.97), 3.78 (1.30-46.18) and 3.21(1.21-15.19) respectively. In the six surrounding communities of the outbreak site, positive RDT rate was 1.2 % (4/328) and microscopically-determine parasite rate 0.6 % (2/328). Two light traps collected a total of 110 anopheline mosquitoes including local vectors, An. minimus, An. sinensis and An. maculates. After intensive control, the detection of malaria attacks, parasites and antigen were reduced to zero between July 1 and December 1, 2014. The cure rate of P. falciparum patients at day 42 was 94.3 % (95 % CI, 80.8-99.3 %). The PCR did not detect K13-propeller mutations. Imported P. falciparum caused the outbreak. Age, seeking inappropriate treatment and lack of bed nets were risk factors for infection during the outbreak. P. falciparum was sensitive to treatment with DAPQ. The integrated measures controlled the outbreak and prevented the spread of P. falciparum effectively. The results of this study indicate that malaria control on the China-Myanmar border, especially among special populations, needs further collaboration between China, Myanmar and international societies.

Evaluation of movement restriction zone sizes in controlling classical swine fever outbreaks

USDA-ARS?s Scientific Manuscript database

The objective of this study was to compare the movement restriction zone sizes of 3-km, 5-km, 9-km, and 11-km with that of 7-km in controlling a classical swine fever (CSF) outbreak. Three assumptions of compliance level were considered: baseline, baseline ±10%, and baseline ±15%. The compliance lev...

Results from the First 12 Months of the National Surveillance of Healthcare Associated Outbreaks in Germany, 2011/2012

PubMed Central

Haller, Sebastian; Eckmanns, Tim; Benzler, Justus; Tolksdorf, Kristin; Claus, Hermann; Gilsdorf, Andreas; Sin, Muna Abu

2014-01-01

Background In August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI). Objective To describe the reported HAI-outbreaks and the surveillance system’s structure and capabilities. Methods Information on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed. Results Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%). Conclusion The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation. PMID:24875674

Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage.

PubMed

Parker, Lucy A; Rumunu, John; Jamet, Christine; Kenyi, Yona; Lino, Richard Laku; Wamala, Joseph F; Mpairwe, Allan M; Muller, Vincent; Llosa, Augusto E; Uzzeni, Florent; Luquero, Francisco J; Ciglenecki, Iza; Azman, Andrew S

2017-06-01

In June 2015, a cholera outbreak was declared in Juba, South Sudan. In addition to standard outbreak control measures, oral cholera vaccine (OCV) was proposed. As sufficient doses to cover the at-risk population were unavailable, a campaign using half the standard dosing regimen (one-dose) targeted high-risk neighborhoods and groups including neighbors of suspected cases. Here we report the operational details of this first public health use of a single-dose regimen of OCV and illustrate the feasibility of conducting highly targeted vaccination campaigns in an urban area. Neighborhoods of the city were prioritized for vaccination based on cumulative attack rates, active transmission and local knowledge of known cholera risk factors. OCV was offered to all persons older than 12 months at 20 fixed sites and to select groups, including neighbors of cholera cases after the main campaign ('case-triggered' interventions), through mobile teams. Vaccination coverage was estimated by multi-stage surveys using spatial sampling techniques. 162,377 individuals received a single-dose of OCV in the targeted neighborhoods. In these neighborhoods vaccine coverage was 68.8% (95% Confidence Interval (CI), 64.0-73.7) and was highest among children ages 5-14 years (90.0%, 95% CI 85.7-94.3), with adult men being less likely to be vaccinated than adult women (Relative Risk 0.81, 95% CI: 0.68-0.96). In the case-triggered interventions, each lasting 1-2 days, coverage varied (range: 30-87%) with an average of 51.0% (95% CI 41.7-60.3). Vaccine supply constraints and the complex realities where cholera outbreaks occur may warrant the use of flexible alternative vaccination strategies, including highly-targeted vaccination campaigns and single-dose regimens. We showed that such campaigns are feasible. Additional work is needed to understand how and when to use different strategies to best protect populations against epidemic cholera.

Combined interventions for mitigation of an influenza A (H1N1) 2009 outbreak in a physical training camp in Beijing, China.

PubMed

Chu, Chen-Yi; de Silva, U Chandimal; Guo, Jin-Peng; Wang, Yong; Wen, Liang; Lee, Vernon J; Li, Shen-Long; Huang, Liu-Yu

2017-07-01

Many studies have suggested the effectiveness of single control measures in the containment and mitigation of pandemic influenza A (H1N1) 2009. The effects of combined interventions by multiple control measures in reducing the impact of an influenza A (H1N1) 2009 outbreak in a closed physical training camp in Beijing, China were evaluated. Oseltamivir was prescribed for the treatment of confirmed cases and possible cases and as prophylaxis for all other participants in this training camp. Public health control measures were applied simultaneously, including the isolation of patients and possible cases, personal protection and hygiene, and social distancing measures. Symptom surveillance of all participants was initiated, and the actual attack rate was calculated. For comparison, the theoretical attack rate for this outbreak was projected using the Newton-Raphson numerical method. A total of 3256 persons were present at the physical training camp. During the outbreak, 405 (68.3%) possible cases and 26 (4.4%) confirmed cases were reported before the intervention and completed oseltamivir treatment; 162 (27.3%) possible cases were reported after the intervention and received part treatment and part prophylaxis. The other 2663 participants completed oseltamivir prophylaxis. Of the possible cases, 181 with fever ≥38.5°C were isolated. The actual attack rate for this outbreak of pandemic influenza A (H1N1) 2009 was 18.2%, which is much lower than the theoretical attack rate of 80% projected. Combined interventions of large-scale antiviral ring prophylaxis and treatment and public health control measures could be applied to reduce the magnitude of influenza A (H1N1) 2009 outbreaks in closed settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents.

PubMed

Melendez, Carlos Pantoja; Florentino, Margarita Matias; Martinez, Irma Lopez; Lopez, Herlinda Mejia

2009-01-01

The present work documents an outbreak of epidemic keratoconjunctivitis among ophthalmology residents, its influence in the presentation of the community cases, the use of molecular techniques for its diagnosis, and the implementation of successful control measures for its containment. Isolation of the etiologic agent was achieved using cultured African green monkey kidney epithelial cells (VERO). Through molecular tests, such as polymerase chain reaction (PCR) and DNA sequencing, the genotype of the isolated virus was identified. The sequences obtained were aligned with data reported in the NCBI GenBank. A scheme of outbreak control measures was designed to enforce correct sanitary measures in the clinic. The statistical program, Epi info 2002, and openepi were used to determine the attack rate. The Excel Microsoft program was used to elaborate the endemic channel. Nine of the ten samples studied were isolated from the culture and identified by Adenovirus-specifc PCR. Sequencing allowed identification of Ad8 as the agent responsible for the outbreak. The attack rate was 24.39 cases per 100. The epidemic curve allowed identification of a disseminated source in the Institute of Ophthalmology "Conde de Valenciana." It was not possible to calculate the incubation periods among the cases. The endemic channel showed the presence of an epidemic keratoconjunctivitis among the patients that had been cared for at the out-patient services of the institute. One outbreak of a disseminated source caused by Ad8 was detected in the institute among its medical residents, probably associated with relaxation of the habitual sanitary measures during an epidemic of hemorrhagic conjunctivitis among the patients cared for at the institute. The proposed scheme to control the outbreak allowed for its containment and controlled the epidemic of associated cases.

Outbreak of Influenza and Rhinovirus Co-circulation Among Unvaccinated Recruits, U.S. Coast Guard Training Center Cape May, NJ, 24 July-21 August 2016

DTIC Science & Technology

2018-01-01

mission success. The on-site health clinic includes a 21-bed patient care unit for recruits requiring overnight treatment. TCCM participates as a...patients and sends them for laboratory testing and characterization at the Naval Health Research Center (NHRC) in San Diego, CA. TCCM typically...and facilities, as well as laundry regimen. Eliminated close physical contact during training and team-building activities. Pharmaceutical Treatment

Backs against the Wall: Novel and Existing Strategies Used during the 2014-2015 Ebola Virus Outbreak

PubMed Central

Wong, Gary

2015-01-01

SUMMARY The 2014-2015 outbreak of Ebola virus (EBOV), originating from Guinea, is now responsible for the infection of >20,000 people in 9 countries. Whereas past filovirus outbreaks in sub-Saharan Africa have been rapidly brought under control with comparably few cases, this outbreak has been particularly resistant to containment efforts. Both the general population and primary health care workers have been affected by this outbreak, with hundreds of doctors and nurses being infected in the line of duty. In the absence of approved therapeutics, several caregivers have turned to investigational new drugs as well as experimental therapies in an effort to save lives. This review aims to summarize the candidates currently under consideration for postexposure use in infected patients during the largest EBOV outbreak in history. PMID:25972518

Global alert to avian influenza virus infection: From H5N1 to H7N9

PubMed Central

Poovorawan, Yong; Pyungporn, Sunchai; Prachayangprecha, Slinporn; Makkoch, Jarika

2013-01-01

Outbreak of a novel influenza virus is usually triggered by mutational change due to the process known as ‘antigenic shift’ or re-assortment process that allows animal-to-human or avian-to-human transmission. Birds are a natural reservoir for the influenza virus, and subtypes H5, H7, and H9 have all caused outbreaks of avian influenza in human populations. An especially notorious strain is the HPAI influenza virus H5N1, which has a mortality rate of approximately 60% and which has resulted in numerous hospitalizations, deaths, and significant economic loss. In March 2013, in Eastern China, there was an outbreak of the novel H7N9 influenza virus, which although less pathogenic in avian species, resulted in 131 confirmed cases and 36 deaths in humans over a two-month span. The rapid outbreak of this virus caused global concern but resulted in international cooperation to control the outbreak. Furthermore, cooperation led to valuable research-sharing including genome sequencing of the virus, the development of rapid and specific diagnosis, specimen sharing for future studies, and vaccine development. Although a H7N9 pandemic in the human population is possible due to its rapid transmissibility and extensive surveillance, the closure of the live-bird market will help mitigate the possibility of another H7N9 outbreak. In addition, further research into the source of the outbreak, pathogenicity of the virus, and the development of specific and sensitive detection assays will be essential for controlling and preparing for future H7N9 outbreaks. PMID:23916331

Deciphering Dynamics of Recent Epidemic Spread and Outbreak in West Africa: The Case of Ebola Virus

NASA Astrophysics Data System (ADS)

Upadhyay, Ranjit Kumar; Roy, Parimita

Recently, the 2014 Ebola virus (EBOV) outbreak in West Africa was the largest outbreak to date. In this paper, an attempt has been made for modeling the virus dynamics using an SEIR model to better understand and characterize the transmission trajectories of the Ebola outbreak. We compare the simulated results with the most recent reported data of Ebola infected cases in the three most affected countries Guinea, Liberia and Sierra Leone. The epidemic model exhibits two equilibria, namely, the disease-free and unique endemic equilibria. Existence and local stability of these equilibria are explored. Using central manifold theory, it is established that the transcritical bifurcation occurs when basic reproduction number passes through unity. The proposed Ebola epidemic model provides an estimate to the potential number of future cases. The model indicates that the disease will decline after peaking if multisectorial and multinational efforts to control the spread of infection are maintained. Possible implication of the results for disease eradication and its control are discussed which suggests that proper control strategies like: (i) transmission precautions, (ii) isolation and care of infectious Ebola patients, (iii) safe burial, (iv) contact tracing with follow-up and quarantine, and (v) early diagnosis are needed to stop the recurrent outbreak.

Description of an outbreak of highly pathogenic avian influenza in domestic ostriches (Struthio camelus) in South Africa in 2011.

PubMed

van Helden, L S; Sinclair, M; Koen, P; Grewar, J D

2016-06-01

In 2011, the commercial ostrich production industry of South Africa experienced an outbreak of highly pathogenic avian influenza (HPAI), subtype H5N2. Surveillance using antibody and antigen detection revealed 42 infected farms with a between-farm prevalence in the affected area of 16%. The outbreak was controlled using depopulation of infected farms, resulting in the direct loss of 10% of the country's domestic ostrich population. Various factors in the ostrich production system were observed that could have contributed to the spread of the virus between farms, including the large number of legal movements of ostriches between farms, access of wild birds to ostrich camps and delays in depopulation of infected farms. Negative effects on the ostrich industry and the local economy of the ostrich-producing area were observed as a result of the outbreak and the disease control measures applied. Prevention and control measures applied as a result of avian influenza in South Africa were informed by this large outbreak and the insights into epidemiology of avian influenza in ostriches that it provided, resulting in stricter biosecurity measures required on every registered ostrich farm in the country. Copyright © 2016 Elsevier B.V. All rights reserved.

Risk and Outbreak Communication: Lessons from Taiwan's Experiences in the Post-SARS Era.

PubMed

Hsu, Yu-Chen; Chen, Yu-Ling; Wei, Han-Ning; Yang, Yu-Wen; Chen, Ying-Hwei

In addition to the impact of a disease itself, public reaction could be considered another outbreak to be controlled during an epidemic. Taiwan's experience with SARS in 2003 highlighted the critical role played by the media during crisis communication. After the SARS outbreak, Taiwan's Centers for Disease Control (Taiwan CDC) followed the WHO outbreak communication guidelines on trust, early announcements, transparency, informing the public, and planning, in order to reform its risk communication systems. This article describes the risk communication framework in Taiwan, which has been used to respond to the 2009-2016 influenza epidemics, Ebola in West Africa (2014-16), and MERS-CoV in South Korea (2015) during the post-SARS era. Many communication strategies, ranging from traditional media to social and new media, have been implemented to improve transparency in public communication and promote civic engagement. Taiwan CDC will continue to maintain the strengths of its risk communication systems and resolve challenges as they emerge through active evaluation and monitoring of public opinion to advance Taiwan's capacity in outbreak communication and control. Moreover, Taiwan CDC will continue to implement the IHR (2005) and to promote a global community working together to fight shared risks and to reach the goal of "One World, One Health."

Risk and Outbreak Communication: Lessons from Taiwan's Experiences in the Post-SARS Era

PubMed Central

Chen, Yu-Ling; Wei, Han-Ning; Yang, Yu-Wen; Chen, Ying-Hwei

2017-01-01

In addition to the impact of a disease itself, public reaction could be considered another outbreak to be controlled during an epidemic. Taiwan's experience with SARS in 2003 highlighted the critical role played by the media during crisis communication. After the SARS outbreak, Taiwan's Centers for Disease Control (Taiwan CDC) followed the WHO outbreak communication guidelines on trust, early announcements, transparency, informing the public, and planning, in order to reform its risk communication systems. This article describes the risk communication framework in Taiwan, which has been used to respond to the 2009-2016 influenza epidemics, Ebola in West Africa (2014-16), and MERS-CoV in South Korea (2015) during the post-SARS era. Many communication strategies, ranging from traditional media to social and new media, have been implemented to improve transparency in public communication and promote civic engagement. Taiwan CDC will continue to maintain the strengths of its risk communication systems and resolve challenges as they emerge through active evaluation and monitoring of public opinion to advance Taiwan's capacity in outbreak communication and control. Moreover, Taiwan CDC will continue to implement the IHR (2005) and to promote a global community working together to fight shared risks and to reach the goal of “One World, One Health.” PMID:28418746

Modifiable risk factors for typhoid intestinal perforations during a large outbreak of typhoid fever, Kampala Uganda, 2015.

PubMed

Bulage, Lilian; Masiira, Ben; Ario, Alex R; Matovu, Joseph K B; Nsubuga, Peter; Kaharuza, Frank; Nankabirwa, Victoria; Routh, Janell; Zhu, Bao-Ping

2017-09-25

Between January and June, 2015, a large typhoid fever outbreak occurred in Kampala, Uganda, with 10,230 suspected cases. During the outbreak, area surgeons reported a surge in cases of typhoid intestinal perforation (TIP), a complication of typhoid fever. We conducted an investigation to characterize TIP cases and identify modifiable risk factors for TIP. We defined a TIP case as a physician-diagnosed typhoid patient with non-traumatic terminal ileum perforation. We identified cases by reviewing medical records at all five major hospitals in Kampala from 2013 to 2015. In a matched case-control study, we compared potential risk factors among TIP cases and controls; controls were typhoid patients diagnosed by TUBEX TF, culture, or physician but without TIP, identified from the outbreak line-list and matched to cases by age, sex and residence. Cases and controls were interviewed using a standard questionnaire from 1st -23rd December 2015. We used conditional logistic regression to assess risk factors for TIP and control for confounding. Of the 88 TIP cases identified during 2013-2015, 77% (68/88) occurred between January and June, 2015; TIPs sharply increased in January and peaked in March, coincident with the typhoid outbreak. The estimated risk of TIP was 6.6 per 1000 suspected typhoid infections (68/10,230). The case-fatality rate was 10% (7/68). Cases sought care later than controls; Compared with 29% (13/45) of TIP cases and 63% (86/137) of controls who sought treatment within 3 days of onset, 42% (19/45) of cases and 32% (44/137) of controls sought treatment 4-9 days after illness onset (OR adj  = 2.2, 95%CI = 0.83-5.8), while 29% (13/45) of cases and 5.1% (7/137) of controls sought treatment ≥10 days after onset (OR adj  = 11, 95%CI = 1.9-61). 68% (96/141) of cases and 23% (23/100) of controls had got treatment before being treated at the treatment centre (OR adj  = 9.0, 95%CI = 1.1-78). Delay in seeking treatment increased the risk of TIPs. For future outbreaks, we recommended aggressive community case-finding, and informational campaigns in affected communities and among local healthcare providers to increase awareness of the need for early and appropriate treatment.

A Guide to the Investigation of Waterborne Outbreaks

ERIC Educational Resources Information Center

Rosenberg, Mark L.

1977-01-01

Explained is the process of investigating an alleged waterborne disease outbreak. The information is designed to help water personnel work more effectively with health authorities in tracing, controlling, and preventing waterborne disease. (Author/MA)

Community-based outbreaks of tuberculosis.

PubMed

Raffalli, J; Sepkowitz, K A; Armstrong, D

1996-05-27

Numerous recent reports have detailed outbreaks of tuberculosis in hospitals and other congregate settings. The characteristics of such settings, including high concentrations of infectious patients and immunocompromised hosts, the potential for sustained daily contact for weeks and often months, and improper precautions taken for protection, make them well suited for tuberculosis transmission. However, community-based outbreaks, which are the source of much public concern, have not been reviewed since 1964, when 109 community outbreaks were examined. Since few of the characteristics of institutional settings are present in the community, the lessons learned may not be applicable to community-based outbreaks. Furthermore, recent studies with analysis by restriction fragment length polymorphisms have documented unexpectedly high rates of primary disease in certain urban communities, suggesting that our understanding of community-based transmission may be incomplete. We reviewed all reported community-based outbreaks of tuberculosis occurring in the last 30 years to assess the basis of our current understanding of community-based transmission. More than 70 outbreaks were identified, with schools being the most common site. In most, a delay in diagnosis, sustained contact with the index case, inadequate ventilation, or overcrowding was contributory. We conclude that community-based outbreaks of tuberculosis continue to occur and that well-established risks contribute to most outbreaks. Many outbreaks can be prevented or limited by attention to basic infection control principles.

Evaluation of Movement Restriction Zone Sizes in Controlling Classical Swine Fever Outbreaks

PubMed Central

Yadav, Shankar; Olynk Widmar, Nicole; Lay, Donald C.; Croney, Candace; Weng, Hsin-Yi

2017-01-01

The objective of this study was to compare the impacts of movement restriction zone sizes of 3, 5, 9, and 11 km with that of 7 km (the recommended zone size in the United States) in controlling a classical swine fever (CSF) outbreak. In addition to zone size, different compliance assumptions and outbreak types (single site and multiple site) were incorporated in the study. Three assumptions of compliance level were simulated: baseline, baseline ± 10%, and baseline ± 15%. The compliance level was held constant across all zone sizes in the baseline simulation. In the baseline ± 10% and baseline ± 15% simulations, the compliance level was increased for 3 and 5 km and decreased for 9 and 11 km from the baseline by the indicated percentages. The compliance level remained constant in all simulations for the 7-km zone size. Four single-site (i.e., with one index premises at the onset of outbreak) and four multiple-site (i.e., with more than one index premises at the onset of outbreak) CSF outbreak scenarios in Indiana were simulated incorporating various zone sizes and compliance assumptions using a stochastic between-premises disease spread model to estimate epidemic duration, percentage of infected, and preemptively culled swine premises. Furthermore, a risk assessment model that incorporated the results from the disease spread model was developed to estimate the number of swine premises under movement restrictions that would experience animal welfare outcomes of overcrowding or feed interruption during a CSF outbreak in Indiana. Compared with the 7-km zone size, the 3-km zone size resulted in a longer median epidemic duration, larger percentages of infected premises, and preemptively culled premises (P’s < 0.001) across all compliance assumptions and outbreak types. With the assumption of a higher compliance level, the 5-km zone size significantly (P < 0.001) reduced the epidemic duration and percentage of swine premises that would experience animal welfare outcomes in both outbreak types, whereas assumption of a lower compliance level for 9- and 11-km zone sizes significantly (P < 0.001) increased the epidemic duration and percentage of swine premises with animal welfare outcomes compared with the 7-km zone size. The magnitude of impact due to a zone size varied across the outbreak types (single site and multiple site). Overall, the 7-km zone size was found to be most effective in controlling CSF outbreaks, whereas the 5-km zone size was comparable to the 7-km zone size in some circumstances. PMID:28119920

[Epidemic outbreak of 81 cases of brucellosis following the consumption of fresh cheese without pasteurization].

PubMed

Castell Monsalve, J; Rullán, J V; Peiró Callizo, E F; Nieto-Sandoval Alcolea, A

1996-01-01

In spite of the great effort that has been made in recent years in Castilla-La Mancha to control brucelosis, a lack of awareness on the part of producers and consumers leads to major epidemic outbreak, such as the one described below. A description of the outbreak is described and a study is conducted of cases and controls to determine the factors which are responsible for the epidemic. Unadjusted and adjusted Odds Ratios (O.R.) are obtained together with their confidence intervals, for the main epidemiological factors studied. A total of 81 cases of brucelosis were recorded in a period of 25 weeks. All the cases occurred in the same borough or were in some way linked to it. In the case and controls study no differences were found with regard to age, sex, contact with livestock or the consumption of pasteurised milk or cheese. A strong link was established between the illness and the consumption of home-made cottage cheese prepared by a small-scale producer in the borough, (O.R. = 311.9; C.I. = 95% = 41.48-12735)., whose livestock turned out to be infected with Brucella Mellitensis. This outbreak showed that in Spain, there is a risk of contracting brucelosis by consuming non-pasteurised dairy products, particularly cheese, when these are not subjected to the normal sanitary and health controls. The benefits of epidemiological research in the search for cases and determining the factors responsible for the outbreak are also demonstrated. An intensification of controls, the cleansing of the herds and flocks and health education in general, are suitable instruments for controlling this zoonosis in Spain.

Distribution of outbreak reporting in health care institutions by day of the week.

PubMed

Amirov, Chingiz; Walton, Ryan N; Ahmed, Sarah; Binns, Malcolm A; Van Toen, Jane E; Candon, Heather L

2012-12-01

The notion that outbreaks are more likely to occur on Friday is prevalent among staff in health care institutions. However, there is little evidence to support or discredit this notion. We postulated that outbreaks were no more likely to be reported on any particular day of the week. A total of 901 institutional outbreaks in Toronto health care facilities were tabulated according to type, outbreak setting, and day of the week reported. A χ(2) goodness-of-fit test compared daily values for 7-day per week and 5-day per week periods. Post hoc partitioning was used to pinpoint specific day(s) of the week that differed significantly. Fewer outbreaks were reported on Saturdays and Sundays. Further analysis examined the distribution of outbreak reporting specifically focusing on the Monday to Friday weekday period. Among the weekdays, higher proportions of outbreaks were reported on Mondays and Fridays. Our null hypothesis was rejected. Overall, Mondays and Fridays had the highest occurrence of outbreak reporting. We suggest that this might be due to "deadline" and "catch-up" reporting related to the "weekend effect," whereby structural differences in weekend staffing affect detection of outbreaks. Such delays warrant reexamination of surveillance processes for timely outbreak detection independent of calendar cycle. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Outbreak of drug-resistant Acinetobacter baumannii ST219 caused by oral care using tap water from contaminated hand hygiene sinks as a reservoir.

PubMed

Umezawa, Kazuo; Asai, Satomi; Ohshima, Toshio; Iwashita, Hideo; Ohashi, Maya; Sasaki, Mika; Kaneko, Akihiro; Inokuchi, Sadaki; Miyachi, Hayato

2015-11-01

An outbreak of amikacin- and ciprofloxacin-resistant Acinetobacter baumannii ST219 in Tokai University hospital's emergency intensive care unit was caused by its colonization in water systems and subsequent spread through oral care using tap water. The outbreak was successfully controlled after replacement of the water system and implementation as of daily cleaning of water taps and oral care with a dry method. It is important to strictly manage the water system in critical care areas. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Health care-associated infection outbreaks in pediatric long-term care facilities.

PubMed

Murray, Meghan T; Pavia, Marianne; Jackson, Olivia; Keenan, Mary; Neu, Natalie M; Cohen, B; Saiman, Lisa; Larson, Elaine L

2015-07-01

Children in pediatric long-term care facilities (pLTCFs) have complex medical conditions and increased risk for health care-associated infections (HAIs). We performed a retrospective study from January 2010-December 2013 at 3 pLTCFs to describe HAI outbreaks and associated infection control interventions. There were 62 outbreaks involving 700 cases in residents and 250 cases in staff. The most common interventions were isolation precautions and education and in-services. Further research should examine interventions to limit transmission of infections in pLTCFs. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of live attenuated S79 mumps vaccine effectiveness in mumps outbreaks: a matched case-control study.

PubMed

Fu, Chuan-xi; Nie, Jun; Liang, Jian-hua; Wang, Ming

2009-02-05

Mumps virus infection is a potentially serious viral infection of childhood and early adulthood. In China, live attenuated S(79) mumps vaccine has been licensed for pediatric use since 1990. The objective of this study was to determine the effectiveness of live attenuated S(79) mumps vaccine against clinical mumps in outbreaks. Cases were selected from mumps outbreaks in schools in Guangzhou between 2004 and 2005. Each case was matched by gender, age and classroom. Vaccination information was obtained from Children's EPI Administrative Computerized System. Vaccine effectiveness (VE) was calculated for 1 or 2 doses of S(79) vaccine with 95% confidence intervals (CI). One hundred and ninety-four cases and 194 controls were enrolled into the study. VE of the S(79) mumps vaccine for 1 dose versus 0 confer protection 80.4% (95% CI, 60.0%-90.4%) and VEs against mumps in outbreaks for 1 dose of mumps vaccine are similar among those children aged 4-9 years and aged over 10 years old. The live attenuated S(79) mumps vaccine can be effective in preventing clinical mumps outbreaks.

Clostridium perfringens in London, July 2009: two weddings and an outbreak.

PubMed

Eriksen, J; Zenner, D; Anderson, S R; Grant, K; Kumar, D

2010-06-24

Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer. The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyse possible associations between the food consumed and becoming ill. Food, environmental and stool samples were tested for common causative agents, including enterotoxigenic C. perfringens. The clinical presentation and the epidemiological findings were compatible with C. perfringens food poisoning and C. perfringens enterotoxin was detected in stool samples from two cases. The case-control study found statistically significant associations between becoming ill and eating either a specific chicken or lamb dish prepared by the same food handler of the implicated catering company. A rapid outbreak investigation with preliminary real-time results and the successful collaboration between the agencies and the caterer led to timely identification and rectification of the failures in the food handling practices.

Disrupting seasonality to control disease outbreaks: the case of koi herpes virus.

PubMed

Omori, Ryosuke; Adams, Ben

2011-02-21

Common carp accounts for a substantial proportion of global freshwater aquaculture production. Koi herpes virus (KHV), a highly virulent disease affecting carp that emerged in the late 1990s, is a serious threat to this industry. After a fish is infected with KHV, there is a temperature dependent delay before it becomes infectious, and a further delay before mortality. Consequently, KHV epidemiology is driven by seasonal changes in water temperature. Also, it has been proposed that outbreaks could be controlled by responsive management of water temperature in aquaculture setups. We use a mathematical model to analyse the effect of seasonal temperature cycles on KHV epidemiology, and the impact of attempting to control outbreaks by disrupting this cycle. We show that, although disease progression is fast in summer and slow in winter, total mortality over a 2-year period is similar for outbreaks that start in either season. However, for outbreaks that start in late autumn, mortality may be low and immunity high. A single bout of water temperature management can be an effective outbreak control strategy if it is started as soon as dead fish are detected and maintained for a long time. It can also be effective if the frequency of infectious fish is used as an indicator for the beginning of treatment. In this case, however, there is a risk that starting the treatment too soon will increase mortality relative to the case when no treatment is used. This counterproductive effect can be avoided if multiple bouts of temperature management are used. We conclude that disrupting normal seasonal patterns in water temperature can be an effective strategy for controlling koi herpes virus. Exploiting the seasonal patterns, possibly in combination with temperature management, can also induce widespread immunity to KHV in a cohort of fish. However, employing these methods successfully requires careful assessment to ensure that the treatment is started, and finished, at the correct time. Copyright © 2010 Elsevier Ltd. All rights reserved.

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility

PubMed Central

Murray, Meghan T.; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie

2016-01-01

We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. PMID:27053088

Outbreaks of diarrhoeal illness on passenger cruise ships, 1975-85.

PubMed Central

Addiss, D. G.; Yashuk, J. C.; Clapp, D. E.; Blake, P. A.

1989-01-01

We reviewed data from the Vessel Sanitation Program (VSP), established by the US Public Health Service in 1975, to describe the epidemiology of shipboard diarrhoeal outbreaks, determine the risk of outbreak-related illness among cruise ship passengers, and evaluate changes in rates and patterns of shipboard diarrhoeal illness since the VSP was implemented. When the programme began, none of the cruise ships passed periodic VSP sanitation inspections; since 1978, more than 50% of ships have met the standard each year. On cruises lasting 3-15 days and having at least 100 passengers, diarrhoeal disease outbreaks investigated by the Centers for Disease Control decreased from 8.1 to 3.0 per 10 million passenger days between 1975-79 and 1980-85. The proportion of outbreaks due to bacterial pathogens (36%) did not change. Seafood cocktail was implicated in 8 of 13 documented food-borne outbreaks. The risk of diarrhoeal disease outbreaks on cruise ships appears to have decreased since implementation of the VSP but has not been eliminated. PMID:2776853

A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy.

PubMed

Sood, Geeta; Vaidya, Dhananjay; Dam, Lisa; Grubb, Lisa M; Zenilman, Jonathan; Krout, Kelly; Khouri-Stevens, Zeina; Bennett, Richard; Blanding, Renee; Riedel, Stefan; Milner, Stephen; Price, Leigh Ann; Perl, Trish M

2018-03-30

To describe a polymicrobial fungal outbreak after Hurricane Sandy. An observational concurrent outbreak investigation and retrospective descriptive review. A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually. Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit. An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed. A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design. Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A comprehensive database of the geographic spread of past human Ebola outbreaks

PubMed Central

Mylne, Adrian; Brady, Oliver J.; Huang, Zhi; Pigott, David M.; Golding, Nick; Kraemer, Moritz U.G.; Hay, Simon I.

2014-01-01

Ebola is a zoonotic filovirus that has the potential to cause outbreaks of variable magnitude in human populations. This database collates our existing knowledge of all known human outbreaks of Ebola for the first time by extracting details of their suspected zoonotic origin and subsequent human-to-human spread from a range of published and non-published sources. In total, 22 unique Ebola outbreaks were identified, composed of 117 unique geographic transmission clusters. Details of the index case and geographic spread of secondary and imported cases were recorded as well as summaries of patient numbers and case fatality rates. A brief text summary describing suspected routes and means of spread for each outbreak was also included. While we cannot yet include the ongoing Guinea and DRC outbreaks until they are over, these data and compiled maps can be used to gain an improved understanding of the initial spread of past Ebola outbreaks and help evaluate surveillance and control guidelines for limiting the spread of future epidemics. PMID:25984346

Epidemiologic and molecular trends of "Norwalk-like viruses" associated with outbreaks of gastroenteritis in the United States.

PubMed

Fankhauser, Rebecca L; Monroe, Stephan S; Noel, Jacqueline S; Humphrey, Charles D; Bresee, Joseph S; Parashar, Umesh D; Ando, Tamie; Glass, Roger I

2002-07-01

Between July 1997 and June 2000, fecal specimens from 284 outbreaks of nonbacterial gastroenteritis were submitted to the Centers for Disease Control and Prevention for testing for "Norwalk-like viruses" (NLVs). Specimens were examined by reverse-transcription polymerase chain reaction and direct electron microscopy for the presence of NLVs. Adequate descriptive data were available from 233 of the outbreaks, and, of these, 217 (93%) were positive for NLVs. Restaurants and events with catered food were the most common settings, and contaminated food was the most common mode of transmission. Genogroup II (GII) strains were the predominant type (73%), with genogroup I strains causing 26% of all NLV-positive outbreaks. Certain GII clusters (GII/1,4,j) were more commonly associated with outbreaks in nursing home settings than with outbreaks in other settings. Strain diversity was great: one potential new sequence cluster was implicated in multiple outbreaks, and strains belonging to a tentative new genogroup were identified.

A comprehensive database of the geographic spread of past human Ebola outbreaks.

PubMed

Mylne, Adrian; Brady, Oliver J; Huang, Zhi; Pigott, David M; Golding, Nick; Kraemer, Moritz U G; Hay, Simon I

2014-01-01

Ebola is a zoonotic filovirus that has the potential to cause outbreaks of variable magnitude in human populations. This database collates our existing knowledge of all known human outbreaks of Ebola for the first time by extracting details of their suspected zoonotic origin and subsequent human-to-human spread from a range of published and non-published sources. In total, 22 unique Ebola outbreaks were identified, composed of 117 unique geographic transmission clusters. Details of the index case and geographic spread of secondary and imported cases were recorded as well as summaries of patient numbers and case fatality rates. A brief text summary describing suspected routes and means of spread for each outbreak was also included. While we cannot yet include the ongoing Guinea and DRC outbreaks until they are over, these data and compiled maps can be used to gain an improved understanding of the initial spread of past Ebola outbreaks and help evaluate surveillance and control guidelines for limiting the spread of future epidemics.

Outbreaks of paralytic poliomyelitis during 1996-2012: the changing epidemiology of a disease in the final stages of eradication.

PubMed

Mach, Ondrej; Tangermann, Rudolf H; Wassilak, Steve G; Singh, Simarjit; Sutter, Roland W

2014-11-01

Despite substantial progress toward eradication of poliomyelitis, the risk of poliomyelitis outbreaks resulting from virus importations into polio-free areas persists. We reviewed the changing epidemiology of outbreaks in the final stages of the eradication initiative. Available literature on outbreaks of poliomyelitis caused by wild polioviruses between 1996 and 2012 was reviewed. During this period, there were 22 outbreaks involving 39 countries. Outbreaks ranged in size from 1 to 1335 cases. These outbreaks caused 4571 cases, representing 21% of all cases reported during this period. Five outbreaks involved multiple countries. In 76% of outbreaks (16/21) with a known age distribution, cases concentrated among children aged <5 years; in 19% (4/21), most cases were among adolescents and adults. The outbreaks among adolescents and adults were associated with higher case-fatality ratios, ranging from 12% in Albania in 1994 to 41% in the Republic of Congo in 2010. The majority of outbreaks were controlled within 6 months with oral poliovirus vaccine. Importations resulting in epidemic transmission of wild poliovirus caused thousands of cases of paralysis often in countries where poliomyelitis had not occurred for many years. The changing epidemiology, with cases and higher case-fatality ratios among adults, increased the severity of these outbreaks. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Quantifying the Value of Perfect Information in Emergency Vaccination Campaigns.

PubMed

Bradbury, Naomi V; Probert, William J M; Shea, Katriona; Runge, Michael C; Fonnesbeck, Christopher J; Keeling, Matt J; Ferrari, Matthew J; Tildesley, Michael J

2017-02-01

Foot-and-mouth disease outbreaks in non-endemic countries can lead to large economic costs and livestock losses but the use of vaccination has been contentious, partly due to uncertainty about emergency FMD vaccination. Value of information methods can be applied to disease outbreak problems such as FMD in order to investigate the performance improvement from resolving uncertainties. Here we calculate the expected value of resolving uncertainty about vaccine efficacy, time delay to immunity after vaccination and daily vaccination capacity for a hypothetical FMD outbreak in the UK. If it were possible to resolve all uncertainty prior to the introduction of control, we could expect savings of £55 million in outbreak cost, 221,900 livestock culled and 4.3 days of outbreak duration. All vaccination strategies were found to be preferable to a culling only strategy. However, the optimal vaccination radius was found to be highly dependent upon vaccination capacity for all management objectives. We calculate that by resolving the uncertainty surrounding vaccination capacity we would expect to return over 85% of the above savings, regardless of management objective. It may be possible to resolve uncertainty about daily vaccination capacity before an outbreak, and this would enable decision makers to select the optimal control action via careful contingency planning.

Quantifying the relative effects of environmental and direct transmission of norovirus

PubMed Central

Chen, J.; Cruz, C.; Melendez, J.; Rodriguez, J.; Salinas, A.; Yu, F.; Kang, Y.

2018-01-01

Norovirus is a common cause of outbreaks of acute gastroenteritis in health- and child-care settings, with serial outbreaks also frequently observed aboard cruise ships. The relative contributions of environmental and direct person-to-person transmission of norovirus have hitherto not been quantified. We employ a novel mathematical model of norovirus transmission, and fit the model to daily incidence data from a major norovirus outbreak on a cruise ship, and examine the relative efficacy of potential control strategies aimed at reducing environmental and/or direct transmission. The reproduction number for environmental and direct transmission combined is R0tot=7.2 [6.1,9.5], and of environmental transmission alone is R0environ=1.6 [0.9,2.6]. Direct transmission is overwhelmingly due to passenger-to-passenger contacts, but crew can act as a reservoir of infection from cruise to cruise. This is the first quantification of the relative roles of environmental and direct transmission of norovirus. While environmental transmission has the potential to maintain a sustained series of outbreaks aboard a cruise ship in the absence of strict sanitation practices, direct transmission dominates. We find that intensive promotion of good hand washing practices may prevent outbreaks. Isolation of ill passengers and cleaning are beneficial, but appear to be less efficacious at outbreak control. PMID:29657742

Bluetongue in small ruminants: An opinionated review, with a brief appraisal of the 2014 outbreak of the disease in Greece and the south-east Europe.

PubMed

Kyriakis, C S; Billinis, C; Papadopoulos, E; Vasileiou, N G C; Athanasiou, L V; Fthenakis, G C

2015-12-14

Bluetongue is an arthropod-borne viral disease of ruminants, especially of sheep, caused by Bluetongue virus, which belongs to the genus Orbivirus of the family Reoviridae and is classified into 26 antigenically distinct serotypes. Once thought to be restricted in Africa and parts of the Middle East, bluetongue has now become a concern in sheep-rearing countries around the world. In the past 10 years, severe outbreaks have occurred in Europe with important economic consequences; of these, the 2006-20008 outbreak in Europe was caused by a serotype 8 strain and the 2014 outbreak in Greece and the other countries of south-east Europe was caused by a serotype 4 strain, suggested to be a reassortant strain with genome segments from lineages of serotype 1, 2 and 4. Immunisation campaigns can be implemented for successful control and limiting of the disease. Nevertheless, in both of the above outbreaks, late application of vaccinations led to a wide spread of the disease, which subsequently resulted in significant losses in livestock in the affected regions. In view of that, standardisation of control measures in the future will be beneficial for efficiently limiting outbreaks of the disease. Copyright © 2015 Elsevier B.V. All rights reserved.

Quantifying the Value of Perfect Information in Emergency Vaccination Campaigns

PubMed Central

Probert, William J. M.; Shea, Katriona; Fonnesbeck, Christopher J.; Ferrari, Matthew J.; Tildesley, Michael J.

2017-01-01

Foot-and-mouth disease outbreaks in non-endemic countries can lead to large economic costs and livestock losses but the use of vaccination has been contentious, partly due to uncertainty about emergency FMD vaccination. Value of information methods can be applied to disease outbreak problems such as FMD in order to investigate the performance improvement from resolving uncertainties. Here we calculate the expected value of resolving uncertainty about vaccine efficacy, time delay to immunity after vaccination and daily vaccination capacity for a hypothetical FMD outbreak in the UK. If it were possible to resolve all uncertainty prior to the introduction of control, we could expect savings of £55 million in outbreak cost, 221,900 livestock culled and 4.3 days of outbreak duration. All vaccination strategies were found to be preferable to a culling only strategy. However, the optimal vaccination radius was found to be highly dependent upon vaccination capacity for all management objectives. We calculate that by resolving the uncertainty surrounding vaccination capacity we would expect to return over 85% of the above savings, regardless of management objective. It may be possible to resolve uncertainty about daily vaccination capacity before an outbreak, and this would enable decision makers to select the optimal control action via careful contingency planning. PMID:28207777

Beliefs underlying blood donors' intentions to donate during two phases of an avian influenza outbreak.

PubMed

Masser, Barbara M; White, Katherine M; Hamilton, Kyra; McKimmie, Blake M

2012-02-01

Using a Theory of Planned Behavior (TPB) framework the current study explored the beliefs of current blood donors (N=172) about donating during a low and high-risk phase of a potential avian influenza outbreak. While the majority of behavioral, normative, and control beliefs identified in preliminary research differed as a function of donors' intentions to donate during both phases of an avian influenza outbreak, regression analyses suggested that the targeting of different specific beliefs during each phase of an outbreak would yield most benefit in bolstering donors' intentions to remain donating. The findings provide insight in how to best motivate donors in different phases of an avian influenza outbreak. Copyright © 2011 Elsevier Ltd. All rights reserved.

An Outbreak of Sheep Pox in Zabajkalskij kray of Russia.

PubMed

Maksyutov, R A; Gavrilova, E V; Agafonov, A P; Taranov, O S; Glotov, A G; Miheev, V N; Shchelkunov, S N; Sergeev, A N

2015-08-01

In this study, we investigated recent sheep pox outbreaks that occurred in Ononsky and Borzunsky regions of Zabajkalskij kray of Russia. The outbreaks involved in 2756 animals of which 112 were infected and 3 were slaughtered. Samples of injured skin of infected sheep were analysed by electron microscopy and CaPV-specific P32 gene amplification. Following sequence analysis of entire P32 gene showed that both specimens were identical to the sequence of several sheep poxvirus isolates from China and India. The close location of China to the last decade's Russian outbreaks suggest that possible future outbreaks in Russia could occur along the border regions with countries where sheep and goat pox are not controlled. © 2013 Blackwell Verlag GmbH.

A review of outbreaks of infectious disease in schools in England and Wales 1979-88.

PubMed Central

Joseph, C.; Noah, N.; White, J.; Hoskins, T.

1990-01-01

In this review of 66 outbreaks of infectious disease in schools in England and Wales between 1979-88, 27 were reported from independent and 39 from maintained schools. Altogether, over 8000 children and nearly 500 adults were affected. Most of the outbreaks investigated were due to gastrointestinal infections which affected about 5000 children: respiratory infections affected a further 2000 children. Fifty-two children and seven adults were admitted to hospital and one child with measles died. Vaccination policies and use of immunoglobulin for control and prevention of outbreaks in schools have been discussed. PMID:2209745

[Community outbreak of hepatitis A in a marginal population. Vaccination for its control and acceptance of the measure].

PubMed

Arce Arnáez, Araceli; Cabello Ballesteros, Luisa; Iñigo Martínez, Jesús

2007-03-01

To study a community outbreak of hepatitis A in a marginal population and the public health response in order to bring it under control. Descriptive study of the outbreak that occurred in February-June, 2004. An epidemiological survey was conducted to detect prior cases and active vigilance was set up. Case and susceptibility definitions were established. A gypsy population in Madrid, Spain. They had basic provision of sewerage, water supply and waste disposal. A population of 550 in census; estimated population, 800. 70% were under 40 and 55% were illiterate. Control measures were: a) health education activities to strengthen habits of hygiene, and b) immunisation of susceptible individuals. A total of 646 people were vaccinated, with the active help of staff from the Institute of Rehousing and Integration into Society. The outbreak affected 26 people, with an average age of 8 (95% CI, 6.2-9.8), similar distribution by sex and 3.3% attack rate. Fourteen cases were students at state schools, not all in the same classes. There were 7 pairs of siblings among the cases. The diagnosis was conformed by serology in 17 cases. Five needed hospital admission. The epidemic curve suggested person-person transmission. All those affected were under 20 years old. Vaccination was seen to be effective in controlling the outbreak. Interventions were assisted by intermediaries in order to respect the gypsies' cultural context and were well accepted.

Post Outbreak Review: Dengue Preparedness and Response in Key West, Florida

PubMed Central

Hayden, Mary H.; Cavanaugh, Jamie L.; Tittel, Christopher; Butterworth, Melinda; Haenchen, Steven; Dickinson, Katherine; Monaghan, Andrew J.; Ernst, Kacey C.

2015-01-01

Dengue is the most prevalent mosquito-borne viral infection. Recent outbreaks in the southern United States illustrate the risk of reemergence. The first autochthonous cases since 1934 in Key West, FL, occurred in 2009–2010. We conducted a survey in 2012 with decision makers instrumental to the control of the outbreak to 1) determine their awareness of the multiple strategies used to control the outbreak and 2) assess their perceptions of the relative effectiveness of these strategies. An online survey was delivered to a predefined list of decision makers from multiple sectors to better understand dengue preparedness and response. Thirty-six out of 45 surveys were returned for an 80% response rate. Results indicate the need to focus prevention strategies on educational campaigns designed to increase population awareness of transmission risk. Respondents remain concerned about future dengue transmission risk in Key West and lack of resources to respond. PMID:26078319

Investigation of an outbreak of Salmonella enterica serovar Newport infection.

PubMed

Irvine, W N; Gillespie, I A; Smyth, F B; Rooney, P J; McClenaghan, A; Devine, M J; Tohani, V K

2009-10-01

A large outbreak of Salmonella enterica serotype Newport infection occurred in Northern Ireland during September and October 2004. Typing of isolates from patients confirmed that this strain was indistinguishable from that in concurrent outbreaks in regions of England, in Scotland and in the Isle of Man. A total of 130 cases were distributed unequally across local government district areas in Northern Ireland. The epidemic curve suggested a continued exposure over about 4 weeks. A matched case-control study of 23 cases and 39 controls found a statistically significant association with a history of having eaten lettuce in a meal outside the home and being a case (odds ratio 23.7, 95% confidence interval 1.4-404.3). This exposure was reported by 57% of cases. Although over 300 food samples were tested, none yielded any Salmonella spp. Complexity and limited traceability in salad vegetable distribution hindered further investigation of the ultimate source of the outbreak.

Wound and soft tissue infections of Serratia marcescens in patients receiving wound care: A health care-associated outbreak.

PubMed

Us, Ebru; Kutlu, Huseyin H; Tekeli, Alper; Ocal, Duygu; Cirpan, Sevilay; Memikoglu, Kemal O

2017-04-01

We described a health care-associated Serratia marcescens outbreak of wound and soft tissue infection lasting approximately 11 months at Ankara University Ibni Sina Hospital. After identification of S marcescens strains from the clinical and environmental samples, and their susceptibility testing to antimicrobial agents, pulsed-field gel electrophoresis (PFGE) was performed to detect molecular epidemiologic relationships among these isolates. The strains which were isolated from the saline bottles used for wound cleansing in the wound care unit were found to be 100% interrelated by PFGE to the strains from the samples of the outbreak patients. Reuse of the emptied bottles has no longer been allowed since the outbreak occurred. Besides, more efficient and frequent infection control training for hospital staff has been conducted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Consecutive Outbreaks of Enterotoxigenic Escherichia coli O6 in Schools in South Korea Caused by Contamination of Fermented Vegetable Kimchi.

PubMed

Shin, Jaeseung; Yoon, Ki-Bok; Jeon, Doo-Young; Oh, Sung-Suk; Oh, Kyung-Hwan; Chung, Gyung Tae; Kim, Seung Woo; Cho, Seung-Hak

2016-10-01

Two outbreaks of gastroenteritis occurred in South Korea, affecting a middle school in the Jeollanam-do province in 2013 (Outbreak 1) and 10 schools in the Incheon province in 2014 (Outbreak 2). We investigated the outbreaks to identify the pathogen and mode of transmission. A retrospective cohort study was conducted in the Outbreak 1; and case-control studies were performed for the Outbreak 2. Samples from students, environments, and preserved food items were collected and pulsed-field gel electrophoresis (PFGE) was conducted to identify strains of pathogen. We identified 167 and 1022 students who met the case definition (≥3 loose stools in any 24-h period) in the Outbreaks 1 and 2, respectively. The consumption of cabbage kimchi and young radish kimchi were significantly associated with the illness. Adjusted odds ratios of kimchi were 2.62-11.74. In the Outbreak 1, cabbage kimchi was made and consumed in the school restaurant and in the Outbreak 2, young radish kimchi was supplied by food company X and distributed to all the 10 schools in the Incheon province. Enterotoxigenic Escherichia coli (ETEC) O6 was isolated from fecal samples in 375 cases (33.9%) and from kimchi samples. PFGE patterns of the outbreak strains isolated from cases and food were indistinguishable in each outbreak. The suspected food vehicle in these two consecutive outbreaks was kimchi contaminated with ETEC O6. We recommend continued monitoring and stricter sanitation requirements for the food supply process in Korea, especially in relation to kimchi.

Managing Ebola from rural to urban slum settings: experiences from Uganda.

PubMed

Okware, Sam I; Omaswa, Francis; Talisuna, Ambrose; Amandua, Jacinto; Amone, Jackson; Onek, Paul; Opio, Alex; Wamala, Joseph; Lubwama, Julius; Luswa, Lukwago; Kagwa, Paul; Tylleskar, Thorkild

2015-03-01

Five outbreaks of ebola occurred in Uganda between 2000-2012. The outbreaks were quickly contained in rural areas. However, the Gulu outbreak in 2000 was the largest and complex due to insurgency. It invaded Gulu municipality and the slum- like camps of the internally displaced persons (IDPs). The Bundigugyo district outbreak followed but was detected late as a new virus. The subsequent outbreaks in the districts of Luwero district (2011, 2012) and Kibaale (2012) were limited to rural areas. Detailed records of the outbreak presentation, cases, and outcomes were reviewed and analyzed. Each outbreak was described and the outcomes examined for the different scenarios. Early detection and action provided the best outcomes and results. The ideal scenario occurred in the Luwero outbreak during which only a single case was observed. Rural outbreaks were easier to contain. The community imposed quarantine prevented the spread of ebola following introduction into Masindi district. The outbreak was confined to the extended family of the index case and only one case developed in the general population. However, the outbreak invasion of the town slum areas escalated the spread of infection in Gulu municipality. Community mobilization and leadership was vital in supporting early case detection and isolations well as contact tracing and public education. Palliative care improved survival. Focusing on treatment and not just quarantine should be emphasized as it also enhanced public trust and health seeking behavior. Early detection and action provided the best scenario for outbreak containment. Community mobilization and leadership was vital in supporting outbreak control. International collaboration was essential in supporting and augmenting the national efforts.

Disaster response under One Health in the aftermath of Nepal earthquake, 2015.

PubMed

Asokan, G V; Vanitha, A

2017-03-01

Until now, an estimate quotes that 1100 healthcare facilities were damaged and over 100,000 livestock lost in the two earthquakes that occurred in April and May of 2015 in Nepal. Threats of infectious diseases, mostly zoonoses, could affect Nepal's economy, trade, and tourism, and reaching the targets of the United Nations Millennium Development Goals. Historically, outbreaks of infectious diseases, including zoonoses, were largely associated with the aftereffects of the earthquakes. It has been documented that zoonoses constitute 61% of all known infectious diseases. Therefore, the purpose of this communication was to examine the infectious disease outbreaks after earthquakes around the world and explore the risk assessment of the zoonoses threats reported in Nepal and highlight adopting One Health. Our summaries on reported zoonoses in Nepal have shown that parasitic zoonoses were predominant, but other infectious disease outbreaks can occur. The fragile public health infrastructure and inadequately trained public health personnel can accelerate the transmission of infections, mostly zoonoses, in the post impact phase of the earthquake in Nepal. Therefore, we believe that with the support of aid agencies, veterinarians and health professionals can team up to resolve the crisis under One Health. Copyright © 2016 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Nosocomial transmission of respiratory syncytial virus in an outpatient cancer center.

PubMed

Chu, Helen Y; Englund, Janet A; Podczervinski, Sara; Kuypers, Jane; Campbell, Angela P; Boeckh, Michael; Pergam, Steven A; Casper, Corey

2014-06-01

Respiratory syncytial virus (RSV) outbreaks in inpatient settings are associated with poor outcomes in cancer patients. The use of molecular epidemiology to document RSV transmission in the outpatient setting has not been well described. We performed a retrospective cohort study of 2 nosocomial outbreaks of RSV at the Seattle Cancer Care Alliance. Subjects included patients seen at the Seattle Cancer Care Alliance with RSV detected in 2 outbreaks in 2007-2008 and 2012 and all employees with respiratory viruses detected in the 2007-2008 outbreak. A subset of samples was sequenced using semi-nested PCR targeting the RSV attachment glycoprotein coding region. Fifty-one cases of RSV were identified in 2007-2008. Clustering of identical viral strains was detected in 10 of 15 patients (67%) with RSV sequenced from 2007 to 2008. As part of a multimodal infection control strategy implemented as a response to the outbreak, symptomatic employees had nasal washes collected. Of 254 employee samples, 91 (34%) tested positive for a respiratory virus, including 14 with RSV. In another RSV outbreak in 2012, 24 cases of RSV were identified; 9 of 10 patients (90%) had the same viral strain, and 1 (10%) had another viral strain. We document spread of clonal strains within an outpatient cancer care setting. Infection control interventions should be implemented in outpatient, as well as inpatient, settings to reduce person-to-person transmission and limit progression of RSV outbreaks. Copyright © 2014 American Society for Blood and Marrow Transplantation. All rights reserved.

Nosocomial Transmission of Respiratory Syncytial Virus in an Outpatient Cancer Center

PubMed Central

Chu, Helen Y.; Englund, Janet A.; Podczervinski, Sara; Kuypers, Jane; Campbell, Angela P.; Boeckh, Michael; Pergam, Steven A.; Casper, Crey

2014-01-01

Background Respiratory syncytial virus (RSV) outbreaks in inpatient settings are associated with poor outcomes in cancer patients. The use of molecular epidemiology to document RSV transmission in the outpatient setting has not been well described. Methods We performed a retrospective cohort study of two nosocomial outbreaks of RSV at the Seattle Cancer Care Alliance (SCCA). Subjects included patients seen at the SCCA with RSV detected in two outbreaks in 2007-2008 and 2012, and all employees with respiratory viruses detected in the 2007-2008 outbreak. A subset of samples was sequenced using semi-nested polymerase chain reaction targeting the RSV attachment glycoprotein coding region. Results Fifty-one cases of RSV were identified in 2007-2008. Clustering of identical viral strains was detected in 10 (67%) of 15 patients with RSV sequenced from 2007-2008. As part of a multimodal infection control strategy implemented as a response to the outbreak, symptomatic employees had nasal washes collected. Of 254 employee samples, 91 (34%) tested positive for a respiratory virus, including 14 with RSV. In another RSV outbreak in 2012, 24 cases of RSV were identified; nine (90%) of 10 patients had the same viral strain, and 1 (10%) had another viral strain. Conclusions We document spread of clonal strains within an outpatient cancer care setting. Infection control interventions should be implemented in outpatient, as well as inpatient, settings to reduce person-to-person transmission and limit progression of RSV outbreaks. PMID:24607551

An outbreak of gastroenteritis on board an oil drilling rig in Ghana.

PubMed

Babayara, Michael N K; Addo, Bright

2018-01-01

The article describes an outbreak of gastroenteritis which occurred on an oil drilling rig which operated in the Jubilee fields of Ghana (offshore Takoradi) between May 2011 and December 2013. An outbreak occurred on board approximately 10 h following a Christmas day buffet. Various Ghanaian and continental dishes were served during the occasion. Over a 3 day period, a total of 33 cases were recorded at the rig's sick bay. In order to describe the outbreak and determine its possible association with the meals served at the buffet, this case control study was conducted. A short questionnaire was used for data collection and a line list prepared for summarising data of cases. Samples of food could not be taken but water samples from multiple points of the rig's pipe water system were collected and cultured for coliforms. Data was analysed using Epi info version 7. Six foods appeared to be associated with the outbreak with odds ratios ranging from 1.2 to 2.7. The epidemic curve showed a propagated fashion of transmission and the outbreak was brought under control with public education on hand washing and disinfection of surfaces and door handles. The conclusion was that food items served at the buffet were not associated with the outbreak. Instead, a possible contamination of surfaces and door handles probably caused it. To prevent future occurrences, routine and regular hand washing and disinfection of surfaces and door handles is recommended.

Enhanced HIV-1 surveillance using molecular epidemiology to study and monitor HIV-1 outbreaks among intravenous drug users (IDUs) in Athens and Bucharest.

PubMed

Paraskevis, Dimitrios; Paraschiv, Simona; Sypsa, Vana; Nikolopoulos, Georgios; Tsiara, Chryssa; Magiorkinis, Gkikas; Psichogiou, Mina; Flampouris, Andreas; Mardarescu, Mariana; Niculescu, Iulia; Batan, Ionelia; Malliori, Meni; Otelea, Dan; Hatzakis, Angelos

2015-10-01

A significant increase in HIV-1 diagnoses was reported among Injecting Drug Users (IDUs) in the Athens (17-fold) and Bucharest (9-fold) metropolitan areas starting 2011. Molecular analyses were conducted on HIV-1 sequences from IDUs comprising 51% and 20% of the diagnosed cases among IDUs during 2011-2013 for Greece and Romania, respectively. Phylodynamic analyses were performed using the newly developed birth-death serial skyline model which allows estimating of important epidemiological parameters, as implemented in BEAST programme. Most infections (>90%) occurred within four and three IDU local transmission networks in Athens and Bucharest, respectively. For all Romanian clusters, the viral strains originated from local circulating strains, whereas in Athens, the local strains seeded only two of the four sub-outbreaks. Birth-death skyline plots suggest a more explosive nature for sub-outbreaks in Bucharest than in Athens. In Athens, two sub-outbreaks had been controlled (Re<1.0) by 2013 and two appeared to be endemic (Re∼1). In Bucharest one outbreak continued to expand (Re>1.0) and two had been controlled (Re<1.0). The lead times were shorter for the outbreak in Athens than in Bucharest. Enhanced molecular surveillance proved useful to gain information about the origin, causal pathways, dispersal patterns and transmission dynamics of the outbreaks that can be useful in a public health setting. Copyright © 2015 Elsevier B.V. All rights reserved.

Importance of Internet Surveillance in Public Health Emergency Control and Prevention: Evidence From a Digital Epidemiologic Study During Avian Influenza A H7N9 Outbreaks

PubMed Central

Zhu, Honghong; Jiang, Tao; Wang, Xinyi; Chen, Lei; Jiang, Zhenggang; Zheng, Dawei

2014-01-01

Background Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media. Objective This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks. Methods Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword “H7N9” from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine. Results Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (P<.001). So were the median daily posted and forwarded number and daily BAI in each province/city except Anhui province. We retrieved a total of 32 confirmed rumors spread across 19 provinces/cities in China. In all, 84% (27/32) of rumors were disseminated and transmitted by social media. Conclusions The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to prevent and control the epidemic, including preparation of personnel, technology, and other resources; information release; collection of public opinion and reaction; and clarification, prevention, and control of rumors. Internet surveillance can be used as an efficient and economical tool to prevent and control public health emergencies, such as H7N9 outbreaks. PMID:24440770

Importance of Internet surveillance in public health emergency control and prevention: evidence from a digital epidemiologic study during avian influenza A H7N9 outbreaks.

PubMed

Gu, Hua; Chen, Bin; Zhu, Honghong; Jiang, Tao; Wang, Xinyi; Chen, Lei; Jiang, Zhenggang; Zheng, Dawei; Jiang, Jianmin

2014-01-17

Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media. This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks. Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword "H7N9" from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine. Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (P<.001). So were the median daily posted and forwarded number and daily BAI in each province/city except Anhui province. We retrieved a total of 32 confirmed rumors spread across 19 provinces/cities in China. In all, 84% (27/32) of rumors were disseminated and transmitted by social media. The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to prevent and control the epidemic, including preparation of personnel, technology, and other resources; information release; collection of public opinion and reaction; and clarification, prevention, and control of rumors. Internet surveillance can be used as an efficient and economical tool to prevent and control public health emergencies, such as H7N9 outbreaks.

Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

PubMed Central

Martinez, Ana; Dominguez, Angela; Torner, Nuria; Ruiz, Laura; Camps, Neus; Barrabeig, Irene; Arias, Cesar; Alvarez, Josep; Godoy, Pere; Balaña, Pilar Jorgina; Pumares, Analia; Bartolome, Rosa; Ferrer, Dolors; Perez, Unai; Pinto, Rosa; Buesa, Javier

2008-01-01

Background Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions. PMID:18410687

There's No Place Like Home: Crown-of-Thorns Outbreaks in the Central Pacific Are Regionally Derived and Independent Events

PubMed Central

Timmers, Molly A.; Bird, Christopher E.; Skillings, Derek J.; Smouse, Peter E.; Toonen, Robert J.

2012-01-01

One of the most significant biological disturbances on a tropical coral reef is a population outbreak of the fecund, corallivorous crown-of-thorns sea star, Acanthaster planci. Although the factors that trigger an initial outbreak may vary, successive outbreaks within and across regions are assumed to spread via the planktonic larvae released from a primary outbreak. This secondary outbreak hypothesis is predominantly based on the high dispersal potential of A. planci and the assertion that outbreak populations (a rogue subset of the larger population) are genetically more similar to each other than they are to low-density non-outbreak populations. Here we use molecular techniques to evaluate the spatial scale at which A. planci outbreaks can propagate via larval dispersal in the central Pacific Ocean by inferring the location and severity of gene flow restrictions from the analysis of mtDNA control region sequence (656 specimens, 17 non-outbreak and six outbreak locations, six archipelagos, and three regions). Substantial regional, archipelagic, and subarchipelagic-scale genetic structuring of A. planci populations indicate that larvae rarely realize their dispersal potential and outbreaks in the central Pacific do not spread across the expanses of open ocean. On a finer scale, genetic partitioning was detected within two of three islands with multiple sampling sites. The finest spatial structure was detected at Pearl & Hermes Atoll, between the lagoon and forereef habitats (<10 km). Despite using a genetic marker capable of revealing subtle partitioning, we found no evidence that outbreaks were a rogue genetic subset of a greater population. Overall, outbreaks that occur at similar times across population partitions are genetically independent and likely due to nutrient inputs and similar climatic and ecological conditions that conspire to fuel plankton blooms. PMID:22363570

Epidemiology of Escherichia coli O157:H7 Outbreaks, United States, 1982–2002

PubMed Central

Sparling, Phyllis H.; Crowe, Collen; Griffin, Patricia M.; Swerdlow, David L.

2005-01-01

Escherichia coli O157:H7 causes 73,000 illnesses in the United States annually. We reviewed E. coli O157 outbreaks reported to Centers for Disease Control and Prevention (CDC) to better understand the epidemiology of E. coli O157. E. coli O157 outbreaks (≥2 cases of E. coli O157 infection with a common epidemiologic exposure) reported to CDC from 1982 to 2002 were reviewed. In that period, 49 states reported 350 outbreaks, representing 8,598 cases, 1,493 (17%) hospitalizations, 354 (4%) hemolytic uremic syndrome cases, and 40 (0.5%) deaths. Transmission route for 183 (52%) was foodborne, 74 (21%) unknown, 50 (14%) person-to-person, 31 (9%) waterborne, 11 (3%) animal contact, and 1 (0.3%) laboratory-related. The food vehicle for 75 (41%) foodborne outbreaks was ground beef, and for 38 (21%) outbreaks, produce. PMID:15829201

Emergence of new norovirus variants on spring cruise ships and prediction of winter epidemics.

PubMed

Verhoef, Linda; Depoortere, Evelyn; Boxman, Ingeborg; Duizer, Erwin; van Duynhoven, Yvonne; Harris, John; Johnsen, Christina; Kroneman, Annelies; Le Guyader, Soizick; Lim, Wilina; Maunula, Leena; Meldal, Hege; Ratcliff, Rod; Reuter, Gábor; Schreier, Eckart; Siebenga, Joukje; Vainio, Kirsti; Varela, Carmen; Vennema, Harry; Koopmans, Marion

2008-02-01

In June 2006, reported outbreaks of norovirus on cruise ships suddenly increased; 43 outbreaks occurred on 13 vessels. All outbreaks investigated manifested person-to-person transmission. Detection of a point source was impossible because of limited investigation of initial outbreaks and data sharing. The most probable explanation for these outbreaks is increased norovirus activity in the community, which coincided with the emergence of 2 new GGII.4 variant strains in Europe and the Pacific. As in 2002, a new GGII.4 variant detected in the spring and summer corresponded with high norovirus activity in the subsequent winter. Because outbreaks on cruise ships are likely to occur when new variants circulate, an active reporting system could function as an early warning system. Internationally accepted guidelines are needed for reporting, investigating, and controlling norovirus illness on cruise ships in Europe.

Cholera outbreak in Homa Bay County, Kenya, 2015.

PubMed

Githuku, Jane Njoki; Boru, Waqo Gufu; Hall, Casey Daniel; Gura, Zeinab; Oyugi, Elvis; Kishimba, Rogath Saika; Semali, Innocent; Farhat, Ghada Nadim; Mattie Park, Meeyoung

2017-01-01

Cholera is among the re-emerging diseases in Kenya. Beginning in December 2014, a persistent outbreak occurred involving 29 out of the 47 countries. Homa Bay County in Western Kenya was among the first counties to report cholera cases from January to April 2015. This case study is based on an outbreak investigation conducted by FELTP residents in Homa Bay County in February 2015. It simulates an outbreak investigation including laboratory confirmation, active case finding, descriptive epidemiology and implementation of control measures. This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.

Emergence of New Norovirus Variants on Spring Cruise Ships and Prediction of Winter Epidemics

PubMed Central

Depoortere, Evelyn; Boxman, Ingeborg; Duizer, Erwin; van Duynhoven, Yvonne; Harris, John; Johnsen, Christina; Kroneman, Annelies; Le Guyader, Soizick; Lim, Wilina; Maunula, Leena; Meldal, Hege; Ratcliff, Rod; Reuter, Gábor; Schreier, Eckart; Siebenga, Joukje; Vainio, Kirsti; Varela, Carmen; Vennema, Harry; Koopmans, Marion

2008-01-01

In June 2006, reported outbreaks of norovirus on cruise ships suddenly increased; 43 outbreaks occurred on 13 vessels. All outbreaks investigated manifested person-to-person transmission. Detection of a point source was impossible because of limited investigation of initial outbreaks and data sharing. The most probable explanation for these outbreaks is increased norovirus activity in the community, which coincided with the emergence of 2 new GGII.4 variant strains in Europe and the Pacific. As in 2002, a new GGII.4 variant detected in the spring and summer corresponded with high norovirus activity in the subsequent winter. Because outbreaks on cruise ships are likely to occur when new variants circulate, an active reporting system could function as an early warning system. Internationally accepted guidelines are needed for reporting, investigating, and controlling norovirus illness on cruise ships in Europe. PMID:18258116

Waterborne norovirus outbreak in a municipal drinking-water supply in Sweden.

PubMed

Riera-Montes, M; Brus Sjölander, K; Allestam, G; Hallin, E; Hedlund, K-O; Löfdahl, M

2011-12-01

During Easter 2009, almost 200 people resident in a small Swedish village fell ill with gastrointestinal symptoms. We conducted a retrospective cohort study and a molecular investigation in order to identify the source of the outbreak. Residents living in households connected to the public water network were at an increased risk of developing disease (relative risk 4·80, 95% confidence interval 1·68-13·73) compared to those with no connection to the public network. Norovirus genotype GI.3 was identified in stool samples from six patients and in a sample from the public water network. Contamination of one of the wells supplying the public water network was thought to be the source of the outbreak. This is a description of a norovirus outbreak linked to a municipal drinking-water supply in Sweden. Information from epidemiological and molecular investigations is of utmost importance to guide outbreak control measures and to prevent future outbreaks.

Large outbreak of Legionnaires' disease and Pontiac fever at a military base.

PubMed

Ambrose, J; Hampton, L M; Fleming-Dutra, K E; Marten, C; McClusky, C; Perry, C; Clemmons, N A; McCormic, Z; Peik, S; Mancuso, J; Brown, E; Kozak, N; Travis, T; Lucas, C; Fields, B; Hicks, L; Cersovsky, S B

2014-11-01

We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2-22·0] and 5·5 (95% CI 2·1-14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.

Nigerian response to the 2014 Ebola viral disease outbreak: lessons and cautions

PubMed Central

Oleribe, Obinna Ositadimma; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2015-01-01

The Ebola virus disease outbreak that initially hit Guinea, Liberia and Senegal in 2014 was projected to affect Nigeria very badly when the first case was reported in July 2014. However, the outbreak was effectively and swiftly contained with only eight deaths out of 20 cases, confounding even the most optimistic predictions of the disease modelers. A combination of health worker and public education, a coordinated field epidemiology and laboratory training program (with prior experience in disease outbreak control in other diseases) and effective set-up of emergency operations centers were some of the measures that helped to confound the critics and contain what would have been an otherwise deadly outbreak in a densely populated country with a highly mobile population. This article highlights the measures taken in Nigeria and looks to the translatable lessons learnt for future disease outbreaks, whether that be from the Ebola virus or other infectious agents. PMID:26740841

Proactive approach to containment of enterovirus infection in the nursery.

PubMed

Fuchs, Inbal; Golan, Agneta; Borer, Abraham; Shemer-Avni, Yonat; Dagan, Ron; Greenberg, David

2013-07-01

Administration of prophylactic intravenous immunoglobulins to contacts of infants actively shedding enterovirus during a hospital nursery outbreak may attenuate severity of disease in those contacts and aid in containment of the outbreak. Four cases of neonatal enteroviral disease were treated in our hospital nursery in July and August 2011; 3 were presumed or proven vertical transmission cases and 1 was a presumed horizontal transmission. We aimed to prevent development of severe illness in contacts of affected neonates following a ministry of health advisory during the summer of 2011 warning of increased neonatal enteroviral morbidity and mortality in Israel. Strict infection control measures were implemented, including meticulous decontamination of the nursery environment and administration of intravenous immunoglobulin prophylaxis to contacts. No further horizontal transmission occurred after infection control interventions. Immunoglobulin prophylaxis to control enteroviral infection in the nursery should be considered as an auxiliary infection control intervention during a nursery outbreak.

Evaluating the control of HPAIV H5N1 in Vietnam: virus transmission within infected flocks reported before and after vaccination.

PubMed

Soares Magalhães, Ricardo J; Pfeiffer, Dirk U; Otte, Joachim

2010-06-05

Currently, the highly pathogenic avian influenza virus (HPAIV) of the subtype H5N1 is believed to have reached an endemic cycle in Vietnam. We used routine surveillance data on HPAIV H5N1 poultry outbreaks in Vietnam to estimate and compare the within-flock reproductive number of infection (R0) for periods before (second epidemic wave, 2004-5; depopulation-based disease control) and during (fourth epidemic wave, beginning 2007; vaccination-based disease control) vaccination. Our results show that infected premises (IPs) in the initial (exponential) phases of outbreak periods have the highest R0 estimates. The IPs reported during the outbreak period when depopulation-based disease control was implemented had higher R0 estimates than IPs reported during the outbreak period when vaccination-based disease control was used. In the latter period, in some flocks of a defined size and species composition, within-flock transmission estimates were not significantly below the threshold for transmission (R0 < 1). Our results indicate that the current control policy based on depopulation plus vaccination has protected the majority of poultry flocks against infection. However, in some flocks the determinants associated with suboptimal protection need to be further investigated as these may explain the current pattern of infection in animal and human populations.

Incomplete sanitation of a meat grinder and ingestion of raw ground beef: contributing factors to a large outbreak of Salmonella typhimurium infection.

PubMed

Roels, T H; Frazak, P A; Kazmierczak, J J; Mackenzie, W R; Proctor, M E; Kurzynski, T A; Davis, J P

1997-10-01

Consumers in the United States continue to eat raw or undercooked foods of animal origin despite public health warnings following several well-publicized outbreaks. We investigated an outbreak of Salmonella serotype Typhimurium infection in 158 patients in Wisconsin during the 1994 Christmas holiday period. To determine the vehicle and source of the outbreak, we conducted cohort and case-control studies, and environmental investigations in butcher shop A. Eating raw ground beef purchased from butcher shop A was the only item significantly associated with illness [cohort study: relative risk = 5.8, 95% confidence interval (CI) = 1.5-21.8; case control study: odds ratio = 46.2, 95% CI = 3.8-2751]. Inadequate cleaning and sanitization of the meat grinder in butcher shop A likely resulted in sustained contamination of ground beef during an 8-day interval. Consumer education, coupled with hazard reduction efforts at multiple stages in the food processing chain, will continue to play an important role in the control of foodborne illness.

Incomplete sanitation of a meat grinder and ingestion of raw ground beef: contributing factors to a large outbreak of Salmonella typhimurium infection.

PubMed Central

Roels, T. H.; Frazak, P. A.; Kazmierczak, J. J.; Mackenzie, W. R.; Proctor, M. E.; Kurzynski, T. A.; Davis, J. P.

1997-01-01

Consumers in the United States continue to eat raw or undercooked foods of animal origin despite public health warnings following several well-publicized outbreaks. We investigated an outbreak of Salmonella serotype Typhimurium infection in 158 patients in Wisconsin during the 1994 Christmas holiday period. To determine the vehicle and source of the outbreak, we conducted cohort and case-control studies, and environmental investigations in butcher shop A. Eating raw ground beef purchased from butcher shop A was the only item significantly associated with illness [cohort study: relative risk = 5.8, 95% confidence interval (CI) = 1.5-21.8; case control study: odds ratio = 46.2, 95% CI = 3.8-2751]. Inadequate cleaning and sanitization of the meat grinder in butcher shop A likely resulted in sustained contamination of ground beef during an 8-day interval. Consumer education, coupled with hazard reduction efforts at multiple stages in the food processing chain, will continue to play an important role in the control of foodborne illness. PMID:9363010

Shigellosis Outbreak in Al Batinah South Governorate, Oman

PubMed Central

Abaidani, Idris; Raju, Prasanna A.; Al-Shualli, Issa; Al-Sa’di, Khalid; Al-Shaqsi, Nasser; Al-Khatri, Amer

2015-01-01

Objectives: An outbreak of acute gastroenteritis due to Shigella flexneri occurred in August 2012 in the catchment area of the Wadi Sahtan Health Center in Rustaq, Al Batinah South Governorate, Oman. The aim of this study was to discover possible causes of this outbreak in the villages of Fassa, Rogh and Amk and to measure the risk of exposure among cases and controls. Methods: A case-control study was conducted in September 2012 in Fassa, Rogh and Amk. All households in the three villages were interviewed. Case and control households were compared to determine possible exposure avenues, including place of residence, source of drinking water, hand hygiene levels and practices related to drinking water, food preparation and environmental sanitation. Results: Residing in Fassa (P <0.0001; odds ratio [OR] = 4.86, 95% confidence interval [CI] = 2.22–10.63) and average hand hygiene practices (P = 0.008; OR = 13.97, 95% CI = 1.58–123.36) were associated with an increased risk of contracting shigellosis. No significant differences were found with regards to the other exposure avenues. Conclusion: This was the first study conducted in Oman regarding an outbreak of shigellosis in a community setting. The only variables that significantly impacted the risk of acute gastroenteritis were residing in Fassa and average hand hygiene practices. The source of the outbreak could not be identified. However, septic tank sanitation and water and food consumption practices were not satisfactory in the studied villages. These need to be addressed to prevent similar outbreaks of acute gastroenteritis in this region in the future. PMID:26357558

Pertussis, pertussis vaccine, and care of exposed persons.

PubMed

Zimmerman, R K; Wald, E R; Ahwesh, E R

1996-01-01

Pertussis is a highly contagious bacterial infection caused by Bordetella pertussis. Before routine vaccination against pertussis was available, most persons were infected during childhood. After widespread vaccination, however, the incidence of pertussis in the United States dropped by more than 95 percent, though localized outbreaks continue to occur. A multidisciplinary team developed a set of review articles as part of continuing medical education modules in the Teaching Immunization in Medical Education (TIME) Project. The team developed the materials using expert judgment and selected materials from the literature and the Centers for Disease Control and Prevention (CDC). The first step was the creation of specific learning objectives that used the spectrum of Bloom's taxonomy, when possible. After the materials were developed, they were pilot-tested and revised. Subsequently they underwent summative evaluation by field-testing the materials with 24 other primary care physicians. Then the materials were reviewed by the CDC and national vaccine experts and revised based on their comments. The efficacy of whole-cell pertussis vaccine is about 70 to 90 percent, though local adverse events are common. Since 1990 several purified, acellular pertussis vaccines have been developed that have one quarter to one half of the common adverse events associated with whole-cell vaccine and have similar efficacy rates. The incidence of pertussis can be further reduced by increasing age-appropriate vaccination rates.

Team Cognition in Experienced Command-and-Control Teams

ERIC Educational Resources Information Center

Cooke, Nancy J.; Gorman, Jamie C.; Duran, Jasmine L.; Taylor, Amanda R.

2007-01-01

Team cognition in experienced command-and-control teams is examined in an UAV (Uninhabited Aerial Vehicle) simulation. Five 3-person teams with experience working together in a command-and-control setting were compared to 10 inexperienced teams. Each team participated in five 40-min missions of a simulation in which interdependent team members…

Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico

PubMed Central

Hampton, Lee M.; Garrison, Laurel; Kattan, Jessica; Brown, Ellen; Kozak-Muiznieks, Natalia A.; Lucas, Claressa; Fields, Barry; Fitzpatrick, Nicole; Sapian, Luis; Martin-Escobar, Teresa; Waterman, Stephen; Hicks, Lauri A.; Alpuche-Aranda, Celia; Lopez-Gatell, Hugo

2016-01-01

Background. A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods. Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella. Results. Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions. Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so. PMID:27704023

Legionnaires' Disease Outbreak at a Resort in Cozumel, Mexico.

PubMed

Hampton, Lee M; Garrison, Laurel; Kattan, Jessica; Brown, Ellen; Kozak-Muiznieks, Natalia A; Lucas, Claressa; Fields, Barry; Fitzpatrick, Nicole; Sapian, Luis; Martin-Escobar, Teresa; Waterman, Stephen; Hicks, Lauri A; Alpuche-Aranda, Celia; Lopez-Gatell, Hugo

2016-09-01

Background.  A Legionnaires' disease (LD) outbreak at a resort on Cozumel Island in Mexico was investigated by a joint Mexico-United States team in 2010. This is the first reported LD outbreak in Mexico, where LD is not a reportable disease. Methods.  Reports of LD among travelers were solicited from US health departments and the European Working Group for Legionella Infections. Records from the resort and Cozumel Island health facilities were searched for possible LD cases. In April 2010, the resort was searched for possible Legionella exposure sources. The temperature and total chlorine of the water at 38 sites in the resort were measured, and samples from those sites were tested for Legionella . Results.  Nine travelers became ill with laboratory-confirmed LD within 2 weeks of staying at the resort between May 2008 and April 2010. The resort and its potable water system were the only common exposures. No possible LD cases were identified among resort workers. Legionellae were found to have extensively colonized the resort's potable water system. Legionellae matching a case isolate were found in the resort's potable water system. Conclusions.  Medical providers should test for LD when treating community-acquired pneumonia that is severe or affecting patients who traveled in the 2 weeks before the onset of symptoms. When an LD outbreak is detected, the source should be identified and then aggressively remediated. Because LD can occur in tropical and temperate areas, all countries should consider making LD a reportable disease if they have not already done so.

Investigation of a measles outbreak in Cordillera, Northern Philippines, 2013

PubMed Central

Zapanta, Ma Justina; de los Reyes, Vikki Carr; Tayag, Enrique; Magpantay, Rio

2016-01-01

Introduction Measles is a highly infectious viral illness that remains one of the leading causes of death among children worldwide. In the Philippines, decreasing routine vaccination coverage from 2007 to 2011 led to local measles outbreaks. A team investigated a measles outbreak reported in Cordillera of the Philippines in May 2013. Methods Measles case data with symptom onset from 2 February to 27 May 2013 were obtained from official sources and verified on site. Data included age, sex, residential address, signs and symptoms and vaccination status. Active case-findings were also conducted for contacts of these cases. The living environments of the cases were investigated. A survey was conducted with the cases and caregivers to understand their knowledge and attitudes about measles. Results There were 50 measles cases identified with an age range from six months to 32 years (median: 16 years). Thirty-two were male (64%). Twenty (40%) were hospitalized with one death. Thirty-two (64%) cases were laboratory confirmed, and 36 (72%) received a single dose of measles vaccine. Overcrowded living environments were observed among many cases. The majority of respondents (46/48, 96%) knew about measles, but there were misconceptions about the cause of measles and how it can be prevented and managed. Conclusion This measles outbreak occurred in an area with low immunization coverage. Achieving 95% measles immunization coverage and strengthening routine immunization strategies to address high-risk populations are recommended. Also, we recommend health education campaigns to include components that address misconceptions about measles. PMID:27766180

Investigation of a measles outbreak in Cordillera, Northern Philippines, 2013.

PubMed

Ching, Paola Katrina; Zapanta, Ma Justina; de Los Reyes, Vikki Carr; Tayag, Enrique; Magpantay, Rio

2016-01-01

Measles is a highly infectious viral illness that remains one of the leading causes of death among children worldwide. In the Philippines, decreasing routine vaccination coverage from 2007 to 2011 led to local measles outbreaks. A team investigated a measles outbreak reported in Cordillera of the Philippines in May 2013. Measles case data with symptom onset from 2 February to 27 May 2013 were obtained from official sources and verified on site. Data included age, sex, residential address, signs and symptoms and vaccination status. Active case-findings were also conducted for contacts of these cases. The living environments of the cases were investigated. A survey was conducted with the cases and caregivers to understand their knowledge and attitudes about measles. There were 50 measles cases identified with an age range from six months to 32 years (median: 16 years). Thirty-two were male (64%). Twenty (40%) were hospitalized with one death. Thirty-two (64%) cases were laboratory confirmed, and 36 (72%) received a single dose of measles vaccine. Overcrowded living environments were observed among many cases. The majority of respondents (46/48, 96%) knew about measles, but there were misconceptions about the cause of measles and how it can be prevented and managed. This measles outbreak occurred in an area with low immunization coverage. Achieving 95% measles immunization coverage and strengthening routine immunization strategies to address high-risk populations are recommended. Also, we recommend health education campaigns to include components that address misconceptions about measles.

Multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals: association with contaminated hospital waste-water systems.

PubMed

Breathnach, A S; Cubbon, M D; Karunaharan, R N; Pope, C F; Planche, T D

2012-09-01

Multidrug-resistant Pseudomonas aeruginosa (MDR-P) expressing VIM-metallo-beta-lactamase is an emerging infection control problem. The source of many such infections is unclear, though there are reports of hospital outbreaks of P. aeruginosa related to environmental contamination, including tap water. We describe two outbreaks of MDR-P, sensitive only to colistin, in order to highlight the potential for hospital waste-water systems to harbour this organism. The outbreaks were investigated by a combination of descriptive epidemiology, inspection and microbiological sampling of the environment, and molecular strain typing. The outbreaks occurred in two English hospitals; each involved a distinct genotype of MDR-P. One outbreak was hospital-wide, involving 85 patients, and the other was limited to four cases in one specialized medical unit. Extensive environmental sampling in each outbreak yielded MDR-P only from the waste-water systems. Inspection of the environment and estates records revealed many factors that may have contributed to contamination of clinical areas, including faulty sink, shower and toilet design, clean items stored near sluices, and frequent blockages and leaks from waste pipes. Blockages were due to paper towels, patient wipes, or improper use of bedpan macerators. Control measures included replacing sinks and toilets with easier-to-clean models less prone to splashback, educating staff to reduce blockages and inappropriate storage, reviewing cleaning protocols, and reducing shower flow rates to reduce flooding. These measures were followed by significant reductions in cases. The outbreaks highlight the potential of hospital waste systems to act as a reservoir of MDR-P and other nosocomial pathogens. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Collaborative Public Health Investigation of Clenbuterol-Adulterated Heroin Outbreak-Richmond, Virginia, March-April 2015.

PubMed

Gleason, Brigette; West, Angela; Avula, Danny; Utah, Okey; Vogt, Marshall; Cumpston, Kirk; Kelly, Michael; Brasler, Paul; Wyatt, Shane; Forlano, Laurie

In March 2015, the Virginia Department of Health (VDH) was alerted by the Virginia Poison Center of a 6-patient cluster treated for severe clinical presentations after using heroin. Patients' symptoms were atypical for heroin use, and concern existed that patients were exposed to heroin that had been adulterated with or replaced by another substance. To understand the extent and characterization of the outbreak and implement response measures to prevent further cases. The purpose of this report is to highlight the collaborative nature of a public health investigation among a diverse group of stakeholders. Active surveillance and retrospective case finding. Richmond metro area community and hospitals. Regional poison centers, the Division of Consolidated Laboratory Services, the Department of Behavioral Health and Developmental Services, community partners, local law enforcement, and multiple VDH divisions. Outbreak investigation, communication to public health professionals, clinicians, and the community, and liaising with the local law enforcement. Outbreak control. Laboratory confirmation of clenbuterol in clinical specimens implicated it as the heroin adulterant. Thirteen patients met clinical and epidemiologic criteria for exposure to clenbuterol-adulterated heroin. All patients were associated with a localized area within Richmond, and patient interviews elucidated heroin supplier information. VDH collaborated with local law enforcement agents who investigated and arrested the supplier, leading to cessation of the outbreak. This outbreak highlights the value of policies and practices that support an integrated outbreak response among public health practitioners, poison center staff, laboratorians, clinicians, law enforcement agents, community groups, and other agencies. Collaboration enabled implementation of effective control measures-including those outside the purview of the health department-and should be standard practice in future outbreaks involving illicit substances.

Influenza Outbreaks Among Passengers and Crew on Two Cruise Ships: A Recent Account of Preparedness and Response to an Ever-Present Challenge

PubMed Central

Millman, Alexander J.; Duong, Krista Kornylo; Lafond, Kathryn; Green, Nicole M.; Lippold, Susan A.; Jhung, Michael A.

2016-01-01

Background During spring 2014, two large influenza outbreaks occurred among cruise ship passengers and crew on trans-hemispheric itineraries. Methods Passenger and crew information for both ships was obtained from components of the ship medical records. Data included demographics, diagnosis of influenza-like illness (ILI) or acute respiratory illness (ARI), illness onset date, passenger cabin number, crew occupation, influenza vaccination history, and rapid influenza diagnostic test (RIDT) result, if performed. Results In total, 3.7% of passengers and 3.1% of crew on Ship A had medically attended acute respiratory illness (MAARI). On Ship B, 6.2% of passengers and 4.7% of crew had MAARI. In both outbreaks, passengers reported illness prior to the ship’s departure. Influenza activity was low in the places of origin of the majority of passengers and both ships’ ports of call. The median age of affected passengers on both ships was 70 years. Diagnostic testing revealed three different co-circulating influenza viruses [influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B] on Ship A and one circulating influenza virus (influenza B) on Ship B. Both ships voluntarily reported the outbreaks to the Centers for Disease Control and Prevention (CDC) and implemented outbreak response plans including isolation of sick individuals and antiviral treatment and prophylaxis. Conclusions Influenza activity can become widespread during cruise ship outbreaks and can occur outside of traditional influenza seasons. Comprehensive outbreak prevention and control plans, including prompt antiviral treatment and prophylaxis, may mitigate the impact of influenza outbreaks on cruise ships. PMID:26031322

Influenza Outbreaks Among Passengers and Crew on Two Cruise Ships: A Recent Account of Preparedness and Response to an Ever-Present Challenge.

PubMed

Millman, Alexander J; Kornylo Duong, Krista; Lafond, Kathryn; Green, Nicole M; Lippold, Susan A; Jhung, Michael A

2015-01-01

During spring 2014, two large influenza outbreaks occurred among cruise ship passengers and crew on trans-hemispheric itineraries. Passenger and crew information for both ships was obtained from components of the ship medical records. Data included demographics, diagnosis of influenza-like illness (ILI) or acute respiratory illness (ARI), illness onset date, passenger cabin number, crew occupation, influenza vaccination history, and rapid influenza diagnostic test (RIDT) result, if performed. In total, 3.7% of passengers and 3.1% of crew on Ship A had medically attended acute respiratory illness (MAARI). On Ship B, 6.2% of passengers and 4.7% of crew had MAARI. In both outbreaks, passengers reported illness prior to the ship's departure. Influenza activity was low in the places of origin of the majority of passengers and both ships' ports of call. The median age of affected passengers on both ships was 70 years. Diagnostic testing revealed three different co-circulating influenza viruses [influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B] on Ship A and one circulating influenza virus (influenza B) on Ship B. Both ships voluntarily reported the outbreaks to the Centers for Disease Control and Prevention (CDC) and implemented outbreak response plans including isolation of sick individuals and antiviral treatment and prophylaxis. Influenza activity can become widespread during cruise ship outbreaks and can occur outside of traditional influenza seasons. Comprehensive outbreak prevention and control plans, including prompt antiviral treatment and prophylaxis, may mitigate the impact of influenza outbreaks on cruise ships. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Contribution of market value chain to the control of African swine fever in Zambia.

PubMed

Siamupa, C; Saasa, N; Phiri, A M

2018-01-01

African swine fever (ASF) is a worldwide disease of pigs endemic in most sub-Saharan African countries. Zambia has been experiencing outbreaks of ASF for many years because the disease is endemic in the eastern part of the country, with incursion into the central part of Lusaka Province. The latest outbreaks of ASF in Lusaka occurred in 2013 with substantial pig mortalities, loss in trade, and cost of control measures and compensation of affected farmers. The aims of the study were to identify market value chain-related factors that were associated with ASF outbreaks and assess why these outbreaks are becoming frequent despite control measures being put in place. Using a mixed-method design, participants involved in the value chain were purposively sampled. Some pig farmers were included using a respondent-driven technique. Farmers came from Lusaka, Chilanga, Kafue, and Chongwe districts. Other participants included district veterinary officers, veterinary assistants, police officers, and veterinary staff manning veterinary checkpoints, abattoir and processing plant managers, meat inspectors, market chairpersons, and traders. Semi-structured questionnaires, in-depth interviews, and direct observations were used to collect data to come up with narrations, tables, and flow charts. In assessing the contribution of the value chain in ASF, aspects of ASF screening, market availability and procedures, knowledge on ASF transmission, occurrence of ASF outbreak, and regulation of pig movement were investigated. Despite government ASF control measures being applied, the following were noted: (1) low awareness levels of ASF transmission among pig farmers and traders; (2) only 50% of farmers had their animals screened for ASF before sale; (3) all the markets did not have the pork inspected; (4) laxity in enforcing livestock movement control because of inadequate police and veterinary staff manning checkpoints; (5) lack of enforcement of meat inspection and food safety regulations at pig markets; and (6) inadequate and bureaucratic ASF screening. Improving biosecurity; sensitizing farmers, traders, and all stakeholders in the pig value chain on ASF prevention and control; reinforcement of staff at checkpoints; and regulation of pig markets are some of the ways in which future outbreaks can be prevented.

Outbreak of human metapneumovirus infection in psychiatric inpatients: implications for directly observed use of alcohol hand rub in prevention of nosocomial outbreaks.

PubMed

Cheng, V C C; Wu, A K L; Cheung, C H Y; Lau, S K P; Woo, P C Y; Chan, K H; Li, K S M; Ip, I K S; Dunn, E L W; Lee, R A; Yam, L Y C; Yuen, K Y

2007-12-01

Nosocomial outbreaks of infectious diseases in psychiatric facilities are not uncommon but the implementation of infection control measures is often difficult. Here, we report an outbreak of an acute respiratory illness in a psychiatric ward between 29 July and 20 August 2005 involving 31 patients. Human metapneumovirus was detected in seven (23%) patients by reverse transcription-polymerase chain reaction and nucleotide sequencing. A review of outbreak surveillance records showed that six nosocomial outbreaks occurred in the year 2005, of which four (67%) were confirmed or presumably related to a respiratory viral infection. Directly observed deliveries of alcohol hand rub 4-hourly during daytime to all psychiatric patients was instituted in December 2005. Only one nosocomial respiratory viral outbreak occurred in the following year. The total number of patients and staff involved in nosocomial outbreaks due to presumed or proven respiratory virus infections decreased significantly from 60 to six (P<0.001), whereas those due to all types of nosocomial outbreaks also decreased from 70 to 24 (P=0.004). Alcohol hand rub has been shown to have potent bactericidal and virucidal activity against a wide range of nosocomial pathogens. Regular use of directly observed alcohol hand rub may decrease the incidence and scale of nosocomial outbreaks due to enveloped respiratory viruses especially in mentally incapacitated patients.

Dynamics of a Tularemia Outbreak in a Closely Monitored Free-Roaming Population of Wild House Mice.

PubMed

Dobay, Akos; Pilo, Paola; Lindholm, Anna K; Origgi, Francesco; Bagheri, Homayoun C; König, Barbara

2015-01-01

Infectious disease outbreaks can be devastating because of their sudden occurrence, as well as the complexity of monitoring and controlling them. Outbreaks in wildlife are even more challenging to observe and describe, especially when small animals or secretive species are involved. Modeling such infectious disease events is relevant to investigating their dynamics and is critical for decision makers to accomplish outbreak management. Tularemia, caused by the bacterium Francisella tularensis, is a potentially lethal zoonosis. Of the few animal outbreaks that have been reported in the literature, only those affecting zoo animals have been closely monitored. Here, we report the first estimation of the basic reproduction number R0 of an outbreak in wildlife caused by F. tularensis using quantitative modeling based on a susceptible-infected-recovered framework. We applied that model to data collected during an extensive investigation of an outbreak of tularemia caused by F. tularensis subsp. holarctica (also designated as type B) in a closely monitored, free-roaming house mouse (Mus musculus domesticus) population in Switzerland. Based on our model and assumptions, the best estimated basic reproduction number R0 of the current outbreak is 1.33. Our results suggest that tularemia can cause severe outbreaks in small rodents. We also concluded that the outbreak self-exhausted in approximately three months without administrating antibiotics.

Dynamics of a Tularemia Outbreak in a Closely Monitored Free-Roaming Population of Wild House Mice

PubMed Central

Dobay, Akos; Pilo, Paola; Lindholm, Anna K.; Origgi, Francesco; Bagheri, Homayoun C.; König, Barbara

2015-01-01

Infectious disease outbreaks can be devastating because of their sudden occurrence, as well as the complexity of monitoring and controlling them. Outbreaks in wildlife are even more challenging to observe and describe, especially when small animals or secretive species are involved. Modeling such infectious disease events is relevant to investigating their dynamics and is critical for decision makers to accomplish outbreak management. Tularemia, caused by the bacterium Francisella tularensis, is a potentially lethal zoonosis. Of the few animal outbreaks that have been reported in the literature, only those affecting zoo animals have been closely monitored. Here, we report the first estimation of the basic reproduction number R 0 of an outbreak in wildlife caused by F. tularensis using quantitative modeling based on a susceptible-infected-recovered framework. We applied that model to data collected during an extensive investigation of an outbreak of tularemia caused by F. tularensis subsp. holarctica (also designated as type B) in a closely monitored, free-roaming house mouse (Mus musculus domesticus) population in Switzerland. Based on our model and assumptions, the best estimated basic reproduction number R 0 of the current outbreak is 1.33. Our results suggest that tularemia can cause severe outbreaks in small rodents. We also concluded that the outbreak self-exhausted in approximately three months without administrating antibiotics. PMID:26536232

[Foodborne disease outbreaks surveillance in Chile].

PubMed

Olea, Andrea; Díaz, Janepsy; Fuentes, Rodrigo; Vaquero, Alejandra; García, Maritza

2012-10-01

Foodborne disease outbreaks are one of the main health problems globally, having an extensive impact on human welfare. The World Health Organization considers them as the main cause of morbidity and mortality in developing countries, and responsible for high levels of loss of productivity in developed countries. To describe the epidemiology of foodborne disease outbreaks according to data contained in an automated surveillance system. Descriptive observational study of notified outbreaks from the surveillance system, between 2005 and 2010 in Chile. The information was based on etiology, temporal and spatial distribution, and epidemiologic description of outbreaks during this period. There were 5,689 notified outbreaks. Most of them occurred during 2006 (1,106 outbreaks, rate 6.7 per 100,000 inhabitants) and 2008 (1,316 outbreaks, rate 7.9 per 100, 000 inhabitants) with an increase during summer. Fifty four percent occurred in the Metropolitan region. The group aged 15 to 44 years old, was the most affected one. Sixty four percent of the outbreaks had the food involved registered, of which fish and fishery products reached 42%. An 81% of the outbreaks did not have a precise etiologic diagnosis. Of all patients involved, 97% were outpatients, 3,2% were hospitalized patients, and 0,1% died. Only 49% of the outbreaks had information about the lack of food safety, with a 34,1% related to food handling procedures. Through the information on the epidemiology of foodborne diseases obtained by the Chilean surveillance system, appropriate control measures could be taken.

Epidemiology of Foot and Mouth Disease in Ethiopia: a Retrospective Analysis of District Level Outbreaks, 2007-2012.

PubMed

Jemberu, W T; Mourits, M C M; Sahle, M; Siraw, B; Vernooij, J C M; Hogeveen, H

2016-12-01

This study aimed at determining the incidence, distribution, risk factors, and causal serotypes of foot and mouth disease (FMD) outbreaks in Ethiopia based on 5 years of retrospective outbreak data (September 2007 until August 2012). District level outbreak data were collected from 115 randomly selected districts using a questionnaire administered to district animal health officers. The national incidence of FMD outbreaks during the study period was 1.45 outbreaks per five district years. Outbreaks were geographically widespread affecting all major regional states in the country and were more frequent in the central, southern, and southeastern parts of the country. Neither long-term nor seasonal trends were observed in the incidence of outbreaks. A mixed effects logistic regression analysis revealed that the type of production system (market oriented system versus subsistence systems), presence of a major livestock market and/or route, and adjacency to a national parks or wildlife sanctuary were found to be associated with increased risk of outbreaks in the districts. FMD virus serotypes O, A, SAT 2, and SAT 1 were identified as the causal serotypes of the outbreaks during the study period. Whereas O was the dominant serotype, SAT 2 was the serotype that showed increase in relative frequency of occurrence. The estimated incidence of outbreaks is useful in assessing the economic impacts of the disease, and the identified risk factors provide important knowledge to target a progressive FMD control policy for Ethiopia. © 2015 Blackwell Verlag GmbH.

A review of the vector management methods to prevent and control outbreaks of West Nile virus infection and the challenge for Europe

PubMed Central

2014-01-01

West Nile virus infection is a growing concern in Europe. Vector management is often the primary option to prevent and control outbreaks of the disease. Its implementation is, however, complex and needs to be supported by integrated multidisciplinary surveillance systems and to be organized within the framework of predefined response plans. The impact of the vector control measures depends on multiple factors and the identification of the best combination of vector control methods is therefore not always straightforward. Therefore, this contribution aims at critically reviewing the existing vector control methods to prevent and control outbreaks of West Nile virus infection and to present the challenges for Europe. Most West Nile virus vector control experiences have been recently developed in the US, where ecological conditions are different from the EU and vector control is organized under a different regulatory frame. The extrapolation of information produced in North America to Europe might be limited because of the seemingly different epidemiology in the European region. Therefore, there is an urgent need to analyse the European experiences of the prevention and control of outbreaks of West Nile virus infection and to perform robust cost-benefit analysis that can guide the implementation of the appropriate control measures. Furthermore, to be effective, vector control programs require a strong organisational backbone relying on a previously defined plan, skilled technicians and operators, appropriate equipment, and sufficient financial resources. A decision making guide scheme is proposed which may assist in the process of implementation of vector control measures tailored on specific areas and considering the available information and possible scenarios. PMID:25015004

Socio-epidemiological determinants of 2002 plague outbreak in Himachal Pradesh, India: a qualitative study

PubMed Central

2014-01-01

Background This qualitative investigation was conducted to determine the socio-epidemiological factors related to the plague outbreak (2002) in Himachal Pradesh (HP), India. Methods The data for socio-epidemiological factors related to the plague outbreak (2002) in HP was obtained from residents through 150 in-depth Interviews (IDI) and 30 Focus Group Discussions (FGD) during six visits (from May 2011 to April 2012) by the research team. Natives, health officials and the nomadic population were interviewed. According to their opinion and viewpoints data was collected and their lifestyle and hunting practices were studied in detail. Tape recorders were used during various FGDs and IDIs. The interviews and FGDs were later transcribed and coded. In-depth analysis of the recorded data was done using an inductive thematic analysis approach. Results The study reports that the outbreak in 2002 in a few villages of Himachal Pradesh was that of plague and it occurred by the contact of an index case with wild animals after hunting and de-skinning. The first wave of plague transmission which took 16 lives of residents was followed by a second wave of transmission in a ward of a tertiary care hospital where one visitor acquired it from relatives of the index case and succumbed. The life-style practices of residents (hunting behavior, long stay in caves and jungles, overcrowding in houses, poor hygiene and sanitation, belief in ‘God’ and faith healers for cure of diseases) was optimal for the occurrence and rapid spread of such a communicable disease. The man-rodent contact is intensified due to the practice of hunting in such a rodent-ridden environment. The residents harbor a strong belief that plague occurs due to the wrath of gods. Various un-reported outbreaks of plague were also observed by officials, residents and old folk. The persistence of plague in HP is favoured by its hilly terrain, inaccessible areas, inclement weather (snow) in winters, unhygienic lifestyle, hunting practices of residents, and treatment practices through faith healers. Conclusions This study suggests that the lifestyle of the natives of HP and other socio-epidemiological factors played a role in the outbreak of plague in that area. PMID:24708892

Foodborne outbreaks of campylobacteriosis: the United States experience, 1980-1982.

PubMed

Finch, M J; Blake, P A

1985-08-01

During 1980-1982, 23 foodborne outbreaks of diseases caused by Campylobacter were reported to the Centers for Diseases Control through the National Foodborne Surveillance Program, which collects reports from state and territorial epidemiologists throughout the United States. These outbreaks involved 748 ill persons, of whom 4% were hospitalized. For outbreaks with six or more ill persons, the median attack rate was 41%, the mean or median incubation periods ranged from 66 to 120 hours, and the mean duration of symptoms ranged from three to seven days. Raw milk was implicated or suspected in 14 outbreaks. In four of the other outbreaks, food handling errors were identified, and in five outbreaks, poultry, eggs, or beef were implicated or suspected. In three of four outbreaks in which Campylobacter was recovered from cows at the implicated dairies, some isolates from cows were serotypically identical to isolates from ill persons. In one egg-associated outbreak, one of the isolates of Campylobacter recovered from hens at the implicated egg farm was serotypically identical to an isolate recovered from an ill person. These findings underscore the hazard of eating undercooked or raw foods of animal origin such as raw milk. Raw milk contaminated by infected cows is a major cause of foodborne campylobacteriosis in the United States.

Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

PubMed Central

Kroeger, Axel; Runge-Ranzinger, Silvia; O'Dempsey, Tim

2013-01-01

Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans. PMID:24222774

Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks.

PubMed

Benedict, Kaitlin; Richardson, Malcolm; Vallabhaneni, Snigdha; Jackson, Brendan R; Chiller, Tom

2017-12-01

Several high-profile outbreaks have drawn attention to invasive fungal infections (IFIs) as an increasingly important public health problem. IFI outbreaks are caused by many different fungal pathogens and are associated with numerous settings and sources. In the community, IFI outbreaks often occur among people without predisposing medical conditions and are frequently precipitated by environmental disruption. Health-care-associated IFI outbreaks have been linked to suboptimal hospital environmental conditions, transmission via health-care workers' hands, contaminated medical products, and transplantation of infected organs. Outbreak investigations provide important insights into the epidemiology of IFIs, uncover risk factors for infection, and identify opportunities for preventing similar events in the future. Well recognised challenges with IFI outbreak recognition, response, and prevention include the need for improved rapid diagnostic methods, the absence of routine surveillance for most IFIs, adherence to infection control practices, and health-care provider awareness. Additionally, IFI outbreak investigations have revealed several emerging issues, including new populations at risk because of travel or relocation, occupation, or immunosuppression; fungal pathogens appearing in geographical areas in which they have not been previously recognised; and contaminated compounded medications. This report highlights notable IFI outbreaks in the past decade, with an emphasis on these emerging challenges in the USA. Copyright © 2017 Elsevier Ltd. All rights reserved.

Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg.

PubMed

Gastmeier, P; Vonberg, R-P

2014-02-01

Two endoscopy-associated nosocomial outbreaks caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) were recently observed in two German hospitals. In this study, we performed a systematic search of the medical literature in order to elucidate the epidemiology of Klebsiella spp. in endoscopy-associated outbreaks. Medline, the Outbreak Database ( http://www.outbreak-database.com ) and reference lists of articles extracted from these databases were screened for descriptions of endoscopy-associated nosocomial outbreaks. The data extracted and analysed were: (1) the type of medical department affected; (2) characterisation of pathogen to species and conspicuous resistance patterns (if applicable); (3) type of endoscope and the grade of its contamination; (4) number and the types of infections; (5) actual cause of the outbreak. A total of seven nosocomial outbreaks were identified, of which six were outbreaks of endoscopic retrograde cholangiopancreatography-related infections and caused by contaminated duodenoscopes. Including our own outbreaks in the analysis, we identified one extended-spectrum beta-lactamase-producing K. pneumoniae strain and six CPKP strains. Insufficient reprocessing after the use of the endoscope was the main reason for subsequent pathogen transmission. There were only two reports of nosocomial outbreaks due to Klebsiella spp. in the first three decades of endoscopic procedures, but seven additional outbreaks of this kind have been reported within the last 4 years. It is very likely that many of such outbreaks have been missed in the past because this pathogen belongs to the physiological gut flora. However, with the emergence of highly resistant (carbapenemase-producing) strains, strict adherence to infection control guidelines is more important than ever.

Wetland environmental conditions associated with the risk of avian cholera outbreaks and the abundance of Pasteurella multocida

USGS Publications Warehouse

Blanchong, Julie A.; Samuel, Michael D.; Goldberg, Diana R.; Shadduck, Daniel J.; Creekmore, L.H.

2006-01-01

Avian cholera is a significant infectious disease affecting waterfowl across North America and occurs worldwide among various avian species. Despite the importance of this disease, little is known about the factors that cause avian cholera outbreaks and what management strategies might be used to reduce disease mortality. Previous studies indicated that wetland water conditions may affect survival and transmission of Pasteurella multocida, the agent that causes avian cholera. These studies hypothesized that water conditions affect the likelihood that avian cholera outbreaks will occur in specific wetlands. To test these predictions, we collected data from avian cholera outbreak and non-outbreak (control) wetlands throughout North America (wintera??spring 1995a??1996 to 1998a??1999) to evaluate whether water conditions were associated with outbreaks. Conditional logistic regression analysis on paired outbreak and non-outbreak wetlands indicated no significant association between water conditions and the risk of avian cholera outbreaks. For wetlands where avian cholera outbreaks occurred, linear regression showed that increased eutrophic nutrient concentrations (Potassium [K], nitrate [NO3], phosphorus [P], and phosphate [PO3]) were positively related to the abundance of P. multocida recovered from water and sediment samples. Wetland protein concentration and an El Ni??o event were also associated with P. multocida abundance. Our results indicate that wetland water conditions are not strongly associated with the risk of avian cholera outbreaks; however, some variables may play a role in the abundance of P. multocida bacteria and might be important in reducing the severity of avian cholera outbreaks.

Risk of Human Infections With Highly Pathogenic H5N2 and Low Pathogenic H7N1 Avian Influenza Strains During Outbreaks in Ostriches in South Africa.

PubMed

Venter, Marietjie; Treurnicht, Florette K; Buys, Amelia; Tempia, Stefano; Samudzi, Rudo; McAnerney, Johanna; Jacobs, Charlene A; Thomas, Juno; Blumberg, Lucille

2017-09-15

Risk factors for human infection with highly pathogenic (HP) and low-pathogenic (LP) avian influenza (AI) H5N2 and H7N1 were investigated during outbreaks in ostriches in the Western Cape province, South Africa. Serum surveys were conducted for veterinarians, farmworkers, and laboratory and abattoir workers involved in 2 AI outbreaks in the Western Cape province: (1) controlling and culling of 42000 ostriches during (HPAI)H5N2 outbreaks in ostriches (2011) (n = 207); (2) movement control during (LPAI)H7N1 outbreaks in 2012 (n = 66). A third serosurvey was conducted on state veterinarians from across the country in 2012 tasked with disease control in general (n = 37). Antibodies to H5 and H7 were measured by means of hemagglutination inhibition and microneutralization assays, with microneutralization assay titers >40 considered positive. Two of 207 (1%) participants were seropositive for H5 and 4 of 207 (2%) for H7 in 2011, compared with 1 of 66 (1.5%) and 8 of 66 (13%) in 2012. Although individuals in all professions tested seropositive, abattoir workers (10 of 97; 10.3%) were significantly more at risk of influenza A(H7N1) infection (P = .001) than those in other professions (2 of 171;1.2%). Among state veterinarians, 4 of 37(11%) were seropositive for H7 and 1 of 37 (2.7%) for H5. Investigations of (LP)H7N1-associated fatalities in wild birds and quarantined exotic birds in Gauteng, AI outbreaks in poultry in KwaZulu-Natal, and ostriches in Western Cape province provide possible exposure events. (LPAI)H7N1 strains pose a greater infection-risk than (HPAI)H5N2 strains to persons involved in control of outbreaks in infected birds, with ostrich abattoir workers at highest risk. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.