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Sample records for successful outbreak control

  1. 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.

  2. Forest dynamics after successive spruce budworm outbreaks in mixedwood forests.

    PubMed

    Bouchard, Mathieu; Kneeshaw, Daniel; Bergeron, Yves

    2006-09-01

    In order to assess the long-term spatiotemporal influence of the spruce budworm in sub-boreal mixedwood forests, we studied the effect of three successive outbreaks in a region of western Quebec, Canada. We used dendrochronology to detect past outbreaks in three areas (111-185 ha), based on the recruitment age of balsam fir (Abies balsamea) and on growth patterns of white spruce (Picea glauca), the two main host species of this defoliating insect. We also used a series of aerial photographs taken between 1935 and 2003 to evaluate overstory mortality and post-outbreak succession patterns in these same areas. Individual outbreaks had a spatially homogenous impact on host species throughout the region, but successive outbreaks differed in intensity: the two outbreaks around 1910 and 1980 caused widespread mortality in the overstory, but an outbreak around 1945 had little impact, probably because the forest mosaic had not yet recuperated from the 1910 outbreak. No clear outbreak was detected in the later part of the 19th century. In portions of the study areas where the 1910 outbreak had a major impact, between 36% and 50% of the stands were reoccupied by balsam fir stands in the period up to the 1980 outbreak (cyclic succession), the rest being at least partly replaced by nonhost species such as Betula spp. Changes in forest composition after the 1910 outbreak were mostly associated with upper-slope positions in all study areas. The 1980 outbreak also had a higher impact than earlier outbreaks in lower-slope positions dominated by black spruce (Picea mariana)-balsam fir mixtures. These results suggest that, at the regional scale, the abundance of mature or over-mature balsam fir stands does not determine the outbreak cycle. When an outbreak occurs, however, its impact will be strongly constrained by forest characteristics such as stand composition and structure, which are themselves influenced by previous disturbances and slope position.

  3. Controlling viral outbreaks: Quantitative strategies

    PubMed Central

    2017-01-01

    Preparing for and responding to outbreaks of serious livestock infectious diseases are critical measures to safeguard animal health, public health, and food supply. Almost all of the current control strategies are empirical, and mass culling or “stamping out” is frequently the principal strategy for controlling epidemics. However, there are ethical, ecological, and economic reasons to consider less drastic control strategies. Here we use modeling to quantitatively study the efficacy of different control measures for viral outbreaks, where the infectiousness, transmissibility and death rate of animals commonly depends on their viral load. We develop a broad theoretical framework for exploring and understanding this heterogeneity. The model includes both direct transmission from infectious animals and indirect transmission from an environmental reservoir. We then incorporate a large variety of control measures, including vaccination, antivirals, isolation, environmental disinfection, and several forms of culling, which may result in fewer culled animals. We provide explicit formulae for the basic reproduction number, R0, for each intervention and for combinations. We evaluate the control methods for a realistic simulated outbreak of low pathogenic avian influenza on a mid-sized turkey farm. In this simulated outbreak, culling results in more total dead birds and dramatically more when culling all of the infected birds. PMID:28187137

  4. Infection Control During Filoviral Hemorrhagic Fever Outbreaks

    PubMed Central

    Vanessa, N Raabe; Matthias, Borchert

    2012-01-01

    Breaking the human-to-human transmission cycle remains the cornerstone of infection control during filoviral (Ebola and Marburg) hemorrhagic fever outbreaks. This requires effective identification and isolation of cases, timely contact tracing and monitoring, proper usage of barrier personal protection gear by health workers, and safely conducted burials. Solely implementing these measures is insufficient for infection control; control efforts must be culturally sensitive and conducted in a transparent manner to promote the necessary trust between the community and infection control team in order to succeed. This article provides a review of the literature on infection control during filoviral hemorrhagic fever outbreaks focusing on outbreaks in a developing setting and lessons learned from previous outbreaks. The primary search database used to review the literature was PUBMED, the National Library of Medicine website. PMID:22529631

  5. Infection control during filoviral hemorrhagic Fever outbreaks.

    PubMed

    Raabea, Vanessa N; Borcherta, Matthias

    2012-01-01

    Breaking the human-to-human transmission cycle remains the cornerstone of infection control during filoviral (Ebola and Marburg) hemorrhagic fever outbreaks. This requires effective identification and isolation of cases, timely contact tracing and monitoring, proper usage of barrier personal protection gear by health workers, and safely conducted burials. Solely implementing these measures is insufficient for infection control; control efforts must be culturally sensitive and conducted in a transparent manner to promote the necessary trust between the community and infection control team in order to succeed. This article provides a review of the literature on infection control during filoviral hemorrhagic fever outbreaks focusing on outbreaks in a developing setting and lessons learned from previous outbreaks. The primary search database used to review the literature was PUBMED, the National Library of Medicine website.

  6. A successful response to an outbreak of cholera in Afghanistan.

    PubMed

    Kakar, Faizullah; Ahmadzai, Abdul Hamid; Habib, Najibullah; Taqdeer, Asadullah; Hartman, A Frederick

    2008-01-01

    Although postconflict Afghanistan has some of the worst health indicators in the world, the government is working hard to rebuild the health infrastructure, extend services to underserved areas and improve the quality of health services. An outbreak of cholera ElTor O1 that struck Kabul and spread nationwide in 2005, prompted a collaborative response from the Afghan Ministry of Public Health, partner agencies, and the system established to provide the Basic Package of Health Services, of which diarrhoeal disease control is an essential component. This response illustrates that, with good preparation, it is possible to respond to an outbreak of cholera effectively. The very low mortality rate during the outbreak (0.1%) shows how a resource-poor country can succeed in providing high-quality health services with government commitment, coordinated action by partners, proper case management and treatment and expanded access to services.

  7. Population control methods in stochastic extinction and outbreak scenarios

    PubMed Central

    Segura, Juan; 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. PMID:28151983

  8. 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.

  9. A Hospital-wide Outbreak of Serratia marcescens, and Ishikawa's "Fishbone" Analysis to Support Outbreak Control.

    PubMed

    Vetter, Luzia; Schuepfer, Guido; Kuster, Stefan P; Rossi, Marco

    2016-01-01

    A nosocomial outbreak of Serratia marcescens in respiratory samples predominantly from patients in a surgical intensive care unit is reported. Most of these patients were cardiac surgical patients. Initially, a vigorous but inconclusive investigation was implemented on the basis of standardized (according the US Centers for Disease Control and Prevention) steps of outbreak investigation. Then, a systemic quality management approach with "fishbone" analysis was added. As a consequence, plausible causes for the outbreak were identified: (i) S marcescens was found on the transesophageal echocardiography probe used during cardiac surgery; and (ii) the quality of the surface disinfection was insufficient due to multiple reasons and was completely reengineered. In conclusion, in addition to the standardized steps of outbreak investigation, the complementary use of quality management tools such as the Ishikawa "fishbone" analysis is helpful for outbreak control. The complete reengineering of the disinfectant procurement and logistics is assumed to have been the most effective measure to control the described outbreak.

  10. The outbreak of cooperation among success-driven individuals under noisy conditions

    PubMed Central

    Helbing, Dirk; Yu, Wenjian

    2009-01-01

    According to Thomas Hobbes' Leviathan [1651; 2008 (Touchstone, New York), English Ed], “the life of man [is] solitary, poor, nasty, brutish, and short,” and it would need powerful social institutions to establish social order. In reality, however, social cooperation can also arise spontaneously, based on local interactions rather than centralized control. The self-organization of cooperative behavior is particularly puzzling for social dilemmas related to sharing natural resources or creating common goods. Such situations are often described by the prisoner's dilemma. Here, we report the sudden outbreak of predominant cooperation in a noisy world dominated by selfishness and defection, when individuals imitate superior strategies and show success-driven migration. In our model, individuals are unrelated, and do not inherit behavioral traits. They defect or cooperate selfishly when the opportunity arises, and they do not know how often they will interact or have interacted with someone else. Moreover, our individuals have no reputation mechanism to form friendship networks, nor do they have the option of voluntary interaction or costly punishment. Therefore, the outbreak of prevailing cooperation, when directed motion is integrated in a game-theoretical model, is remarkable, particularly when random strategy mutations and random relocations challenge the formation and survival of cooperative clusters. Our results suggest that mobility is significant for the evolution of social order, and essential for its stabilization and maintenance. PMID:19237576

  11. The outbreak of cooperation among success-driven individuals under noisy conditions.

    PubMed

    Helbing, Dirk; Yu, Wenjian

    2009-03-10

    According to Thomas Hobbes' Leviathan [1651; 2008 (Touchstone, New York), English Ed], "the life of man [is] solitary, poor, nasty, brutish, and short," and it would need powerful social institutions to establish social order. In reality, however, social cooperation can also arise spontaneously, based on local interactions rather than centralized control. The self-organization of cooperative behavior is particularly puzzling for social dilemmas related to sharing natural resources or creating common goods. Such situations are often described by the prisoner's dilemma. Here, we report the sudden outbreak of predominant cooperation in a noisy world dominated by selfishness and defection, when individuals imitate superior strategies and show success-driven migration. In our model, individuals are unrelated, and do not inherit behavioral traits. They defect or cooperate selfishly when the opportunity arises, and they do not know how often they will interact or have interacted with someone else. Moreover, our individuals have no reputation mechanism to form friendship networks, nor do they have the option of voluntary interaction or costly punishment. Therefore, the outbreak of prevailing cooperation, when directed motion is integrated in a game-theoretical model, is remarkable, particularly when random strategy mutations and random relocations challenge the formation and survival of cooperative clusters. Our results suggest that mobility is significant for the evolution of social order, and essential for its stabilization and maintenance.

  12. Climate affects predator control of an herbivore outbreak.

    PubMed

    Preisser, Evan L; Strong, Donald R

    2004-05-01

    Herbivore outbreaks and the accompanying devastation of plant biomass can have enormous ecological effects. Climate directly affects such outbreaks through plant stress or alterations in herbivore life-history traits. Large-scale variation in climate can indirectly affect outbreaks through trophic interactions, but the magnitude of such effects is unknown. On the California coast, rainfall in years during and immediately previous to mass lupine mortality was two-thirds that of years without such mortality. However, neither mature lupines nor their root-feeding herbivores are directly affected by annual variation in rainfall. By increasing soil moisture to levels characteristic of summers following El Niño/Southern Oscillation (ENSO) events, we increased persistence of a predator (the entomopathogenic nematode Heterorhabditis marelatus). This led to suppression of an outbreak of the herbivorous moth Hepialus californicus, indirectly protecting bush lupine (Lupinus arboreus). Our results are consistent with the marine-oriented Menge-Sutherland hypothesis (Menge and Sutherland 1987) that abiotic stress has greater effects on higher than on lower trophic levels. The mechanisms producing these results differ from those proposed by Menge-Sutherland, however, highlighting differences between trophic processes in underground and terrestrial/marine food webs. Our evidence suggests that herbivore outbreaks and mass lupine mortality are indirectly affected by ENSO's facilitation of top-down control in this food web.

  13. Control of a measles outbreak by prohibiting non-vaccinated susceptible students from attending school in Akita Prefecture, Japan.

    PubMed

    Takimoto, Noriaki; Takahashi, Yoshihiro; Ishiyama, Akira; Kishimoto, Kaoru; Iwama, Renji; Nakano, Megumi

    2011-01-01

    In 2007-2008, a measles outbreak occurred among children above the age of 10 years in Akita Prefecture, northeastern Japan (population, approximately 1,120,000 at the time). Our group controlled the outbreak by (i) implementing a publically financed urgent vaccination program and (ii) prohibiting non-vaccinated and non-infected students from attending school as per regulations of the school public health law. We encouraged high-risk students to undergo a vaccination program, which resulted in the successful containment of the outbreak without the development of any severe cases. After the outbreak, the Akita Prefectural Government began an annual"Akita measles elimination month" every April, and no measles case found in Akita Prefecture during 2009-2010 subsequently. Our outbreak response initiative can be applied nationally for the complete elimination of measles throughout Japan.

  14. 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

    ... of Norovirus Gastroenteritis Outbreaks in Healthcare Settings AGENCY: Centers for Disease Control and... for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings... infection prevention staff, healthcare epidemiologists, healthcare administrators, nurses, other...

  15. Economic value of norovirus outbreak control measures in healthcare settings.

    PubMed

    Lee, B Y; Wettstein, Z S; McGlone, S M; Bailey, R R; Umscheid, C A; Smith, K J; Muder, R R

    2011-04-01

    Although norovirus is a significant cause of nosocomial viral gastroenteritis, the economic value of hospital outbreak containment measures following identification of a norovirus case is currently unknown. We developed computer simulation models to determine the potential cost-savings from the hospital perspective of implementing the following norovirus outbreak control interventions: (i) increased hand hygiene measures, (ii) enhanced disinfection practices, (iii) patient isolation, (iv) use of protective apparel, (v) staff exclusion policies, and (vi) ward closure. Sensitivity analyses explored the impact of varying intervention efficacy, number of initial norovirus cases, the norovirus reproductive rate (R(0)), and room, ward size, and occupancy. Implementing increased hand hygiene, using protective apparel, staff exclusion policies or increased disinfection separately or in bundles provided net cost-savings, even when the intervention was only 10% effective in preventing further norovirus transmission. Patient isolation or ward closure was cost-saving only when transmission prevention efficacy was very high (≥ 90%), and their economic value decreased as the number of beds per room and the number of empty beds per ward increased. Increased hand hygiene, using protective apparel or increased disinfection practices separately or in bundles are the most cost-saving interventions for the control and containment of a norovirus outbreak.

  16. Control selection methods in recent case-control studies conducted as part of infectious disease outbreaks.

    PubMed

    Waldram, Alison; McKerr, Caoimhe; Gobin, Maya; Adak, Goutam; Stuart, James M; Cleary, Paul

    2015-06-01

    Successful investigation of national outbreaks of communicable disease relies on rapid identification of the source. Case-control methodologies are commonly used to achieve this. We assessed control selection methods used in recently published case-control studies for methodological and resource issues to determine if a standard approach could be identified. Neighbourhood controls were the most frequently used method in 53 studies of a range of different sizes, infections and settings. The most commonly used method of data collection was face to face interview. Control selection issues were identified in four areas: method of identification of controls, appropriateness of controls, ease of recruitment of controls, and resource requirements. Potential biases arising from the method of control selection were identified in half of the studies assessed. There is a need to develop new ways of selecting controls in a rapid, random and representative manner to improve the accuracy and timeliness of epidemiological investigations and maximise the effectiveness of public health interventions. Innovative methods such as prior recruitment of controls could improve timeliness and representativeness of control selection.

  17. A Hospital-wide Outbreak of Serratia marcescens, and Ishikawa's “Fishbone” Analysis to Support Outbreak Control

    PubMed Central

    Vetter, Luzia; Schuepfer, Guido; Kuster, Stefan P.

    2016-01-01

    A nosocomial outbreak of Serratia marcescens in respiratory samples predominantly from patients in a surgical intensive care unit is reported. Most of these patients were cardiac surgical patients. Initially, a vigorous but inconclusive investigation was implemented on the basis of standardized (according the US Centers for Disease Control and Prevention) steps of outbreak investigation. Then, a systemic quality management approach with “fishbone” analysis was added. As a consequence, plausible causes for the outbreak were identified: (i) S marcescens was found on the transesophageal echocardiography probe used during cardiac surgery; and (ii) the quality of the surface disinfection was insufficient due to multiple reasons and was completely reengineered. In conclusion, in addition to the standardized steps of outbreak investigation, the complementary use of quality management tools such as the Ishikawa “fishbone” analysis is helpful for outbreak control. The complete reengineering of the disinfectant procurement and logistics is assumed to have been the most effective measure to control the described outbreak. PMID:26783861

  18. Animal disease outbreak control: the use of crisis management tools.

    PubMed

    Kroschewski, K; Kramer, M; Micklich, A; Staubach, C; Carmanns, R; Conraths, F J

    2006-04-01

    In this era of globalisation the effective control of animal disease outbreaks requires powerful crisis management tools. In the 1990s software packages for different sectors of the government and agricultural industry began to be developed. In 2004, as a special application for tracking the movement of animals and animal products, the European Union developed the Trade Control and Expert System (TRACES) on the basis of its predecessor, the ANImal MOvement (ANIMO) project. The nationwide use of the ANIMO system by the veterinary authorities in Germany marked the beginning of the development in 1993 of a computerised national animal disease reporting system--the TierSeuchenNachrichten (TSN)--using the ANIMO hardware and software components. In addition to TRACES and TSN the third pillar for the management of animal disease outbreaks and crises in Germany is the national cattle and swine database--called Herkunftssicherungs- und Informationssystem für Tiere. A high degree of standardisation is necessary when integrating the different solutions at all levels of government and with the private sector. In this paper, the authors describe the use of these tools on the basis of their experience and in relation to what we can do now and what we should opt for in the future.

  19. Control of meningococcal meningitis outbreaks in sub-Saharan Africa.

    PubMed

    Chippaux, Jean-Philippe

    2008-10-01

    Outbreaks of Neisseria meningitidis recur frequently in the African Sahel where they are responsible for high mortality and morbidity, especially in children. An effective vaccine has been in existence for more than 30 years, but despite this, the control of epidemics has failed. Moreover, the geographical distribution of N. meningitidis seems to be increasing, perhaps because of climate change but also because of the economic crisis which prevails throughout much of Africa leading to population movements and the breakdown of essential services. Although alarming, the emergence of new serogroups in recent epidemics (such as serogroups X and W135) should not mask the fact that serogroup A remains the most common meningococcal isolate from meningitis cases and is therefore the most significant target for control. The development of a low-cost conjugate meningococcal vaccine should support a strategy of preventive immunization, as this strategy is one that appears most effective to control this plague.

  20. Tularemia Outbreak Investigation in Kosovo: Case Control and Environmental Studies

    PubMed Central

    Dedushaj, Isuf; Gjini, Ardiana; Jorgensen, Tine Rikke; Cotter, Benvon; Lieftucht, Alfons; D’Ancona, Fortunato; Dennis, David T.; Kosoy, Michael A.; Mulliqi-Osmani, Gjyle; Grunow, Roland; Kalaveshi, Ariana; Gashi, Luljeta; Humolli, Isme

    2002-01-01

    A large outbreak of tularemia occurred in Kosovo in the early postwar period, 1999-2000. Epidemiologic and environmental investigations were conducted to identify sources of infection, modes of transmission, and household risk factors. Case and control status was verified by enzyme-linked immunosorbent assay, Western blot, and microagglutination assay. A total of 327 serologically confirmed cases of tularemia pharyngitis and cervical lymphadenitis were identified in 21 of 29 Kosovo municipalities. Matched analysis of 46 case households and 76 control households suggested that infection was transmitted through contaminated food or water and that the source of infection was rodents. Environmental circumstances in war-torn Kosovo led to epizootic rodent tularemia and its spread to resettled rural populations living under circumstances of substandard housing, hygiene, and sanitation. PMID:11749751

  1. 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

  2. [Control measures for a VRE outbreak in a haemodialysis unit].

    PubMed

    Diguio, N; Chanet, P; Hautemanière, A; Cao-Huu, T; Hartemann, P; Kessler, M

    2009-06-01

    We report an outbreak of colonization with Vancomycin Resistant Enterococci (VRE) in the Haemodialysis unit of our hospital. From October 2004 to September 2008, 19 patients were found positive. The risk of acquiring this multi-resistant bacterium is extremely important in patients undergoing haemodialysis, heightened measures have gradually been set to control cross transmissions: first isolation, then geographic clustering of carriers and finally creating cohorting sectors with different staff for carriers, contacts and VRE free patients. This re-organization was supplemented by strengthening procedures for hand hygiene, active screening of patients and enhanced cleaning. Monitoring of the epidemic curve has allowed us to demonstrate the effectiveness of measures introduced. However, deleterious effects were observed in patients whose habits were changed; we could also highlight significant impact on the activity of the unit.

  3. Pathogen filtration to control plant disease outbreak in greenhouse production

    NASA Astrophysics Data System (ADS)

    Jeon, Sangho; Krasnow, Charles; Bhalsod, Gemini; Granke, Leah; Harlan, Blair; Hausbeck, Mary; Zhang, Wei

    2016-04-01

    Previous research has been extensively focused on understanding the fate and transport of human microbial pathogens in soil and water environments. However, little is known about the transport of plant pathogens, although these pathogens are often found in irrigation waters and could cause severe crop damage and economical loss. Water mold pathogens including Phytophthora spp. and Pythium spp. are infective to a wide range of vegetable and floriculture crops, and they are primarily harbored in soils and disseminated through water flow. It is challenging to control these pathogens because they often quickly develop resistance to many fungicides. Therefore, this multi-scale study aimed to investigate physical removal of plant pathogens from water by filtration, thus reducing the pathogen exposure risks to crops. In column-scale experiments, we studied controlling factors on the transport and retention of Phytophthora capsici zoospores in saturated columns packed with iron oxide coated-sand and uncoated-sand under varying solution chemistry. Biflagellate zoospores were less retained than encysted zoospores, and lower solution pH and greater iron oxide content increased the retention of encysted zoospores. These results provided insights on environmental dispersal of Phytophthora zoospores in natural soils as well as on developing cost-effective engineered filtration systems for pathogen removal. Using small-scale greenhouse filtration systems, we further investigated the performance of varying filter media (i.e., granular sand, iron oxide coated ceramic porous media, and activated carbon) in mitigating disease outbreaks of Phytophthora and Pythium for greenhouse-grown squash and poinsettia, respectively, in comparison with fungicide treatment. For squash, filtration by iron oxide coated media was more effective in reducing the Phytophthora infection, comparing to sand filtration and fungicide application. For poinsettia, sand filtration performed better in controlling

  4. Program control for mission success

    NASA Technical Reports Server (NTRS)

    Longanecker, G. W.

    1994-01-01

    This article suggests that in order to be able to exercise control over a particular program, the program itself must be controllable. A controllable program therefore, according to the author, is one that has been properly scoped technically, realistically scheduled, and adequately budgeted. The article delves indepth into each of the above aspects of a controllable program and discusses both the pros and cons of each.

  5. Factors affecting prevention and control of viral gastroenteritis outbreaks in care homes.

    PubMed

    Vivancos, R; Trainor, E; Oyinloye, A; Keenan, A

    2012-10-01

    We assess the effect of key care quality indicators on viral gastroenteritis outbreaks and control in care homes using mandatory inspection data collected by a non-departmental public body. Outbreak occurrence was associated with care home size but not with overall quality or individual environmental standards. Care home size, hygiene and infection control standard scores were inversely associated with attack rate in residents, whereas delayed reporting to the local public health agency was associated with higher attack rates.

  6. Measles: Current Status and Outbreak Control on Campus.

    ERIC Educational Resources Information Center

    Amler, Robert W.; Orenstein, Walter A.

    1984-01-01

    The current effort to eliminate measles in the United States has caused record low levels of the disease. This strategy must continue to be applied in order to break the transmission of measles on college campuses through high immunization levels, promotion of rapid reporting of cases, and quick responses to outbreaks. (Author/DF)

  7. Salmon as a food-poisoning vehicle--two successive Salmonella outbreaks.

    PubMed Central

    Cartwright, K. A.; Evans, B. G.

    1988-01-01

    Gastroenteritis due to Salmonella montevideo occurred amongst guests attending two social functions held within 24 h, food for both having been provided by the same catering firm. Salmon was the most likely vehicle of infection in each case, although cross-contamination of other foods occurred. There were no deaths; four patients were admitted to hospital, one of whom underwent appendicectomy. A review of salmon-associated food-poisoning outbreaks suggests that fresh salmon is an infrequent cause of food poisoning in the United Kingdom. The two outbreaks described here resulted from a failure of simple kitchen hygiene measures at a time of high ambient temperatures. Some current cooking instructions for salmon are inadequate. PMID:3181309

  8. Modelling Aedes aegypti mosquito control via transgenic and sterile insect techniques: endemics and emerging outbreaks.

    PubMed

    Seirin Lee, S; Baker, R E; Gaffney, E A; White, S M

    2013-08-21

    The invasion of pest insects often changes or destroys a native ecosystem, and can result in food shortages and disease endemics. Issues such as the environmental effects of chemical control methods, the economic burden of maintaining control strategies and the risk of pest resistance still remain, and mosquito-borne diseases such as malaria and dengue fever prevail in many countries, infecting over 100 million worldwide in 2010. One environmentally friendly method for mosquito control is the Sterile Insect Technique (SIT). This species-specific method of insect control relies on the mass rearing, sterilization and release of large numbers of sterile insects. An alternative transgenic method is the Release of Insects carrying a Dominant Lethal (RIDL). Our objective is to consider contrasting control strategies for two invasive scenarios via SIT and RIDL: an endemic case and an emerging outbreak. We investigate how the release rate and size of release region influence both the potential for control success and the resources needed to achieve it, under a range of conditions and control strategies, and we discuss advantageous strategies with respect to reducing the release resources and strategy costs (in terms of control mosquito numbers) required to achieve complete eradication of wild-type mosquitoes.

  9. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers.

    PubMed Central

    Mohle-Boetani, J C; Stapleton, M; Finger, R; Bean, N H; Poundstone, J; Blake, P A; Griffin, P M

    1995-01-01

    OBJECTIVES. The study's objectives were to assess (1) control of a community outbreak of shigellosis through the promotion of handwashing, (2) risk factors in day-care centers, and (3) shigellosis attributable to attendance at a day-care center. METHODS. In 1991, an outbreak of Shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared day-care centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable to attendance at day-care centers. RESULTS. The outbreak abated 3 weeks after the interventions' initiation. Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance. CONCLUSIONS. Community involvement in increasing hand washing most likely resulted in control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease. PMID:7762715

  10. 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.

  11. Control of a Non-foodborne Outbreak of Salmonellosis: Day Care in Isolation.

    ERIC Educational Resources Information Center

    Chorba, Terence, L.; And Others

    1987-01-01

    In this study of a salmonellosis outbreak at a day care center an analysis of five variables revealed that the disease was transferred person to person or by a continuing common source. Successful preventive measures included instruction in proper handwashing and diaper changing procedures and isolation of the infected children. (VM)

  12. 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.

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

    PubMed Central

    2016-01-01

    OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. PMID:27188308

  14. Control of a non-foodborne outbreak of salmonellosis: day care in isolation.

    PubMed Central

    Chorba, T L; Meriwether, R A; Jenkins, B R; Gunn, R A; MacCormack, J N

    1987-01-01

    We report an outbreak of Salmonella typhimurium in the infant room of a day care center. Time between onset dates, clustering of cases in the room, lack of a common food exposure, lack of illness among other children and staff, and lack of community-wide infection suggested person-to-person or continuing-common-source transmission. Successful preventive measures included instruction of personnel in proper handwashing and diaper-changing procedures and cohorting of infected and non-infected children. This is the second description of a non-foodborne outbreak of salmonellosis in a day care center, and the first involving S. typhimurium. PMID:3300382

  15. Importance of Multifaceted Approaches in Infection Control: A Practical Experience from an Outbreak Investigation

    PubMed Central

    Petráš, Petr; Melter, Oto; Kapounová, Gabriela; Vopalková, Petra; Kubele, Jan; Vaniš, Václav; Tkadlec, Jan; Bukáčková, Eva; Machová, Ivana; Jindrák, Vlastimil

    2016-01-01

    Background This study presents the results of a multidisciplinary, nosocomial MRSA outbreak investigation in an 8-bed medical intensive care unit (ICU). The identification of seven MRSA positive patients in the beginning of 2014 led to the closure of the ward for several weeks. A multidisciplinary, retrospective investigation was initiated in order to identify the reason and the source for the outbreak, describe MRSA transmission in the department and identify limitations in infection control. Methods The investigation comprised an epidemiological description of MRSA cases from 2012 to 2014 and a characterization of MRSA isolates, including phage-, spa- and PFGE-typing. Additionally, MRSA screening was performed from the hospital staff and the environment. To identify the reason for the outbreak, work-related, psychological and behavioral factors were investigated by impartial audits and staff interviews. Results Thirty-one MRSA cases were registered during the study period, and 36 isolates were investigated. Molecular typing determined the outbreak strain (phage type 54/812, PFGE type A4, spa type t003) and identified the probable index case. Nasal carriage in one employee and a high environmental contamination with the outbreak strain was documented. Important gaps in nursing procedures and general management were identified. Elevated stress levels and communication problems preceded the outbreak. Compliance with hand hygiene and isolation procedures was evaluated as appropriate. Conclusion This study demonstrates the complexity of controlling hospital-associated infections. The combined use of different typing methods is beneficial for outbreak investigations. Psychological, behavioral and other work-related factors have an important impact on the spread of nosocomial pathogens. These factors should be addressed and integrated in routine infection control practice. PMID:27322433

  16. Is closure of entire wards necessary to control norovirus outbreaks in hospital? Comparing the effectiveness of two infection control strategies.

    PubMed

    Illingworth, E; Taborn, E; Fielding, D; Cheesbrough, J; Diggle, P J; Orr, D

    2011-09-01

    The standard approach for norovirus control in hospitals in the UK, as outlined by the Health Protection Agency guidance and implemented previously by Lancashire Teaching Hospitals, involves the early closure of affected wards. However, this has a major impact on bed-days lost and cancelled admissions. In 2008, a new strategy was introduced in the study hospital, key elements of which included closure of affected ward bays (rather than wards), installation of bay doors, enhanced cleaning, a rapid in-house molecular test and an enlarged infection control team. The impact of these changes was assessed by comparing two norovirus seasons (2007-08 and 2009-10) before and after implementation of the new strategy, expressing the contrast between seasons as a ratio (r) of expected counts in the two seasons. There was a significant decrease in the ratio of confirmed hospital outbreaks to community outbreaks (r = 0.317, P = 0.025), the number of days of restricted admissions on hospital wards per outbreak (r = 0.742, P = 0.041), and the number of hospital bed-days lost per outbreak (r = 0.344, P <0.001). However, there was no significant change in the number of patients affected per hospital outbreak (r = 1.080, P = 0.517), or the number of hospital staff affected per outbreak (r = 0.651, P = 0.105). Closure of entire wards during norovirus outbreaks is not always necessary. The changes implemented at the study hospital resulted in a significant reduction in the number of bed-days lost per outbreak, and this, together with a reduction in outbreak frequency, resulted in considerable cost savings.

  17. Evidence of a Louse-Borne Outbreak Involving Typhus in Douai, 1710-1712 during the War of Spanish Succession

    PubMed Central

    Nguyen-Hieu, Tung; Aboudharam, Gérard; Signoli, Michel; Rigeade, Catherine; Drancourt, Michel; Raoult, Didier

    2010-01-01

    Background The new field of paleomicrobiology allows past outbreaks to be identified by testing dental pulp of human remains with PCR. Methods We identified a mass grave in Douai, France dating from the early XVIIIth century. This city was besieged during the European war of Spanish succession. We tested dental pulp from 1192 teeth (including 40 from Douai) by quantitative PCR (qPCR) for R. prowazekii and B. quintana. We also used ultra-sensitive suicide PCR to detect R. prowazekii and genotyped positive samples. Results and Discussion In the Douai remains, we identified one case of B. quintana infection (by qPCR) and R. prowazekii (by suicide PCR) in 6/21 individuals (29%). The R. prowazekii was genotype B, a genotype previously found in a Spanish isolate obtained in the first part of the XXth century. Conclusion Louse-borne outbreaks were raging during the XVIIIth century; our results support the hypothesis that typhus was imported into Europe by Spanish soldiers from America. PMID:21060879

  18. 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

  19. Genetic Similarity of Island Populations of Tent Caterpillars during Successive Outbreaks

    PubMed Central

    Franklin, Michelle T.; Myers, Judith H.; Cory, Jenny S.

    2014-01-01

    Cyclic or fluctuating populations experience regular periods of low population density. Genetic bottlenecks during these periods could give rise to temporal or spatial genetic differentiation of populations. High levels of movement among increasing populations, however, could ameliorate any differences and could also synchronize the dynamics of geographically separated populations. We use microsatellite markers to investigate the genetic differentiation of four island and one mainland population of western tent caterpillars, Malacosoma californicum pluviale, in two periods of peak or pre-peak density separated by 8 years. Populations showed high levels of genetic variation and little genetic differentiation either temporally between peaks or spatially among sites. Mitochondrial haplotypes were also shared between one island population and one mainland population in the two years studied. An isolation-by-distance analysis showed the FST values of the two geographically closest populations to have the highest level of differentiation in both years. We conclude that high levels of dispersal among populations maintain both synchrony of population dynamics and override potential genetic differentiation that might occur during population troughs. As far we are aware, this is the first time that genetic similarity between temporally separated population outbreaks in insects has been investigated. A review of genetic data for both vertebrate and invertebrate species of cyclic animals shows that a lack of spatial genetic differentiation is typical, and may result from high levels of dispersal associated with fluctuating dynamics. PMID:24858905

  20. Genetic similarity of island populations of tent caterpillars during successive outbreaks.

    PubMed

    Franklin, Michelle T; Myers, Judith H; Cory, Jenny S

    2014-01-01

    Cyclic or fluctuating populations experience regular periods of low population density. Genetic bottlenecks during these periods could give rise to temporal or spatial genetic differentiation of populations. High levels of movement among increasing populations, however, could ameliorate any differences and could also synchronize the dynamics of geographically separated populations. We use microsatellite markers to investigate the genetic differentiation of four island and one mainland population of western tent caterpillars, Malacosoma californicum pluviale, in two periods of peak or pre-peak density separated by 8 years. Populations showed high levels of genetic variation and little genetic differentiation either temporally between peaks or spatially among sites. Mitochondrial haplotypes were also shared between one island population and one mainland population in the two years studied. An isolation-by-distance analysis showed the FST values of the two geographically closest populations to have the highest level of differentiation in both years. We conclude that high levels of dispersal among populations maintain both synchrony of population dynamics and override potential genetic differentiation that might occur during population troughs. As far we are aware, this is the first time that genetic similarity between temporally separated population outbreaks in insects has been investigated. A review of genetic data for both vertebrate and invertebrate species of cyclic animals shows that a lack of spatial genetic differentiation is typical, and may result from high levels of dispersal associated with fluctuating dynamics.

  1. Control of an outbreak of postoperative bone mucormycosis: An intervention study of contiguous cohorts.

    PubMed

    Chaves, Marcelo S; Franco, Diego; Nanni, Juan C; Basaldúa, María L; Boleas, Mariana; Aphalo, Germán; Feltes Silva, Patricia; Elgadban, María C; Emery, Felipa; Gamarra, Soledad; Garcia-Effron, Guillermo; Bantar, Carlos

    2016-12-01

    An outbreak of postoperative bone mucormycosis following arthroscopic anterior cruciate ligament reconstruction in a tertiary referral center in Paraná, Argentina, could have been transmitted through an arthroscopic anterior cruciate ligament reconstruction-exclusive contaminated item. The outbreak was controlled after changing from a system of direct delivery of implants and instruments to the operating room without proper verification, to a controlled and centralized process; specifically, the institution's pharmacy verified the quality and traceability of implants, and instruments were processed only by the institution's central sterile services department.

  2. Community Involvement in Dengue Outbreak Control: An Integrated Rigorous Intervention Strategy

    PubMed Central

    Lin, Hualiang; Liu, Tao; Song, Tie; Lin, Lifeng; Xiao, Jianpeng; Lin, Jinyan; He, Jianfeng; Zhong, Haojie; Hu, Wenbiao; Deng, Aiping; Peng, Zhiqiang; Ma, Wenjun; Zhang, Yonghui

    2016-01-01

    Background An explosive outbreak of dengue fever occurred in Guangdong Province, China in 2014. A community-based integrated intervention was applied to control this outbreak in the capital city Guangzhou, where dengue epidemic was mainly caused by imported cases. Methodology/Principal Findings We used a time series generalized additive model based on meteorological factors to assess the effectiveness of this intervention. The results showed that there was significant reduction in mosquito density following the intervention, and there was a 70.47% (95% confidence interval: 66.07%, 74.88%) reduction in the reported dengue cases compared with the predicted cases after 12 days since the beginning of the intervention, we estimated that a total of 23,302 dengue cases were prevented. Conclusions This study suggests that an integrated dengue intervention program has significant effects to control a dengue outbreak in areas where dengue epidemic was mainly caused by imported dengue cases. PMID:27548481

  3. Identification and control of a gentamicin resistant, meticillin susceptible Staphylococcus aureus outbreak on a neonatal unit

    PubMed Central

    Davies, Bethany; Menson, Esse; Klein, John L; Watts, Timothy L; Kearns, Angela M; Pichon, Bruno; Edgeworth, Jonathan D; French, Gary L

    2014-01-01

    We describe the identification and control of an outbreak of gentamicin resistant, meticillin susceptible Staphylococcus aureus (GR-MSSA) on a 36-bed neonatal unit (NNU) in London. Control measures included admission and weekly screening for GR-MSSA, cohorting affected babies, environmental and staff screening, hydrogen peroxide vapour (HPV) for terminal disinfection of cohort rooms, and reinforcement of hand hygiene. Seventeen babies were affected by the outbreak strain over ten months; seven were infected and ten were asymptomatic carriers. The outbreak strain was gentamicin resistant and all isolates were indistinguishable by pulsed-field gel electrophoresis. The outbreak strains spread rapidly and were associated with a high rate of bacteraemia (35% of 17 affected patients had bacteraemia vs. 10% of 284 patients with MSSA prior to the outbreak, p=0.007). None of 113 staff members tested were colonised with GR-MSSA. GR-MSSA was recovered from 11.5% of 87 environmental surfaces in cohort rooms, 7.1% of 28 communal surfaces and 4.1% of 74 surfaces after conventional terminal disinfection. None of 64 surfaces sampled after HPV decontamination yielded GR-MSSA. Recovery of GR-MSSA from two high level sites suggested that the organism could have been transmitted via air. Occasional breakdown in hand hygiene compliance and contaminated environmental surfaces probably contributed to transmission.

  4. Outbreaks of H5N1 in poultry in Thailand: the relative role of poultry production types in sustaining transmission and the impact of active surveillance in control.

    PubMed

    Walker, Patrick; Cauchemez, Simon; Hartemink, Nienke; Tiensin, Thanawat; Ghani, Azra C

    2012-08-07

    H5N1, highly pathogenic avian influenza, continues to pose a public health risk in the countries of southeast Asia where it has become endemic. However, in Thailand, which experienced two of the largest recorded epidemics in 2004-2005, the disease has been successfully reduced to very low levels. We fitted a spatio-temporal model of the spread of infection to outbreak data collected during the second wave of outbreaks to assess the extent to which different poultry types were responsible for propagating infection. Our estimates suggest that the wave of outbreaks would not have been possible without the contribution of backyard flocks to the susceptibility of a sub-district. However, we also estimated that outbreaks involving commercial poultry, a much larger sector in Thailand than in neighbouring countries, were disproportionately infectious, a factor which was also crucial in sustaining the wave. As a result, implemented measures that aim to reduce the role of commercial farms in the spread of infection, such as the drive to bring aspects of the supply chain 'in house', may help to explain the subsequent success in controlling H5N1 in Thailand. We also found that periods of active surveillance substantially improved the rate of outbreak detection.

  5. Estimates of Outbreak Risk from New Introductions of Ebola with Immediate and Delayed Transmission Control

    PubMed Central

    Gundlapalli, Adi V.; Khader, Karim; Pettey, Warren B.P.; Rubin, Michael A.; Adler, Frederick R.; Samore, Matthew H.

    2015-01-01

    While the ongoing Ebola outbreak continues in the West Africa countries of Guinea, Sierra Leone, and Liberia, health officials elsewhere prepare for new introductions of Ebola from infected evacuees or travelers. We analyzed transmission data from patients (i.e., evacuees, international travelers, and those with locally acquired illness) in countries other than the 3 with continuing Ebola epidemics and quantitatively assessed the outbreak risk from new introductions by using different assumptions for transmission control (i.e., immediate and delayed). Results showed that, even in countries that can quickly limit expected number of transmissions per case to <1, the probability that a single introduction will lead to a substantial number of transmissions is not negligible, particularly if transmission variability is high. Identifying incoming infected travelers before symptom onset can decrease worst-case outbreak sizes more than reducing transmissions from patients with locally acquired cases, but performing both actions can have a synergistic effect. PMID:26196264

  6. Success with an automated computer control system

    NASA Astrophysics Data System (ADS)

    Roberts, M. L.; Moore, T. L.

    1991-05-01

    LLNL has successfully implemented a distributed computer control system for automated operation of an FN tandem accelerator. The control system software utilized is the Thaumaturgic Automated Control Logic (TACL) written by the Continuous Electron Beam Accelerator Facility and co-developed with LLNL. Using TACL, accelerator components are controlled through CAMAC using a two-tiered structure. Analog control and measurement are at 12 or 16 bit precision as appropriate. Automated operation has been implemented for several nuclear analytical techniques including hydrogen depth profiling and accelerator mass Spectrometry. An additional advantage of TACL lies in its expansion capabilities. Without disturbing existing control definitions and algorithms, additional control algorithms and display functions can be implemented quickly.

  7. Factors associated with larval control practices in a dengue outbreak prone area.

    PubMed

    Mohamad, Mariam; Selamat, Mohamad Ikhsan; Ismail, Zaliha

    2014-01-01

    In order to reduce the risk of dengue outbreak recurrence in a dengue outbreak prone area, the members of the community need to sustain certain behavior to prevent mosquito from breeding. Our study aims to identify the factors associated with larval control practices in this particular community. A cross-sectional study involves 322 respondents living in a dengue outbreak prone area who were interviewed using a pretested questionnaire. The level of knowledge about Aedes mosquitoes, dengue transmission, its symptoms, and personal preventive measures ranges from fair to good. The level of attitude towards preventive measures was high. However, reported level of personal larval control practices was low (33.2%). Our multiple logistic regression analysis showed that only those with a good level of attitude towards personal preventive measure and frequent attendance to health campaigns were significantly associated with the good larval control practices. We conclude that, in a dengue outbreak prone area, having a good attitude towards preventive measures and frequent participation in health campaigns are important factors to sustain practices on larval control.

  8. 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,…

  9. Evaluation of movement restriction zone sizes in controlling classical swine fever outbreaks

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  10. Successes and Challenges for Flow Control Simulations

    NASA Technical Reports Server (NTRS)

    Rumsey, Christopher L.

    2008-01-01

    A survey is made of recent computations published for synthetic jet flow control cases from a CFD workshop held in 2004. The three workshop cases were originally chosen to represent different aspects of flow control physics: nominally 2-D synthetic jet into quiescent air, 3-D circular synthetic jet into turbulent boundary-layer crossflow, and nominally 2-D flow-control (both steady suction and oscillatory zero-net-mass-flow) for separation control on a simple wall-mounted aerodynamic hump shape. The purpose of this survey is to summarize the progress as related to these workshop cases, particularly noting successes and remaining challenges for computational methods. It is hoped that this summary will also by extension serve as an overview of the state-of-the-art of CFD for these types of flow-controlled flow fields in general.

  11. Successes and Challenges for Flow Control Simulations

    NASA Technical Reports Server (NTRS)

    Rumsey, Christopher L.

    2008-01-01

    A survey is made of recent computations published for synthetic jet flow control cases from a CFD workshop held in 2004. The three workshop cases were originally chosen to represent different aspects of flow control physics: nominally 2-D synthetic jet into quiescent air, 3-D circular synthetic jet into turbulent boundarylayer crossflow, and nominally 2-D flow-control (both steady suction and oscillatory zero-net-mass-flow) for separation control on a simple wall-mounted aerodynamic hump shape. The purpose of this survey is to summarize the progress as related to these workshop cases, particularly noting successes and remaining challenges for computational methods. It is hoped that this summary will also by extension serve as an overview of the state-of-the-art of CFD for these types of flow-controlled flow fields in general.

  12. Measles outbreak in Greater Manchester, England, October 2012 to September 2013: epidemiology and control.

    PubMed

    Pegorie, M; Shankar, K; Welfare, W S; Wilson, R W; Khiroya, C; Munslow, G; Fiefield, D; Bothra, V; McCann, R

    2014-12-11

    This paper describes the epidemiology and management of a prolonged outbreak of measles across the 2.7 million conurbation of Greater Manchester in the United Kingdom. Over a period of one year (from October 2012 to September 2013), over a thousand suspected measles cases (n = 1,073) were notified across Greater Manchester; of these, 395 (37%) were laboratory-confirmed, 91 (8%) were classed as probable, 312 (29%) were classed as possible and 275 (26%) excluded. Most confirmed and probable cases occurred in children within two age groups—infants (too young to be eligible for measles-mumps-rubella (MMR) vaccination according to the national immunisation programme) and children aged 10-19 years (low vaccine uptake in this cohort because of unfounded alleged links between the MMR vaccine and autism). During this one year period, there were a series of local outbreaks and many of these occurred within the secondary school setting. A series of public health measures were taken to control this prolonged outbreak: setting up incident management teams to control local outbreaks, a concerted immunisation catch-up campaign (initially local then national) to reduce the pool of children partially or totally unprotected against measles, and the exclusion of close contacts from nurseries and school settings for a period of 10 days following the last exposure to a case of measles.

  13. Fire Severity Controlled Susceptibility to a 1940s Spruce Beetle Outbreak in Colorado, USA

    PubMed Central

    Kulakowski, Dominik; Veblen, Thomas T.; Bebi, Peter

    2016-01-01

    killed in the 1940s outbreak. No young post-fire trees (< ca. 128 years) were susceptible to the 1940s outbreak, implying that under the relatively cool and wet conditions of the mid-20th century, susceptibility to and spatial patterns of spruce beetle outbreak were most likely controlled by variations in severity of prior disturbance by fire. This study provides a baseline for comparing linked disturbances under the relatively warmer and drier conditions of recent (e.g. post-1990) outbreaks in order to assess how climate mitigates the degree to which pre-disturbance history and structure affect susceptibility to disturbances. PMID:27438289

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

    PubMed Central

    Qian, Weicheng; Osgood, Nathaniel D.

    2016-01-01

    Background 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. Methods 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. Results 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

  15. Cryptosporidiosis in Wisconsin: a case-control study of post-outbreak transmission.

    PubMed

    Osewe, P; Addiss, D G; Blair, K A; Hightower, A; Kamb, M L; Davis, J P

    1996-10-01

    During March-April 1993, an estimated 403000 residents of the 5-county greater Milwaukee, Wisconsin area developed cryptosporidiosis after drinking contaminated municipal water. Although the number of cases dropped precipitously after the implicated water plant closed on 9 April, cases continued to occur. To investigate risk factors for post-outbreak cryptosporidiosis, 33 Milwaukee-area residents who had laboratory-confirmed Cryptosporidium infection with onset of diarrhoea between 1 May and 27 June 1993 were interviewed by telephone. Of these, 28 (85%) had onset of diarrhoea during May, 12 (36%) had watery diarrhoea during the outbreak, and 5(15%) were HIV-infected. In a neighbourhood-matched case-control study, immunosuppression (matched odds ratio (MOR) not calculable, 95% confidence interval (CI) 3.0, infinity) and having a child less than 5 years old in the household (MOR = 17.0, CI 2.0, 395.0) were independently associated with infection. When persons who had diarrhoea during the outbreak were excluded, immunosuppression remained significantly associated with illness (MOR not calculable, CI 1.6, infinity). Cryptosporidium transmission continued after this massive waterborne outbreak but decreased rapidly within 2 months.

  16. One Health approach to controlling a Q fever outbreak on an Australian goat farm.

    PubMed

    Bond, K A; Vincent, G; Wilks, C R; Franklin, L; Sutton, B; Stenos, J; Cowan, R; Lim, K; Athan, E; Harris, O; Macfarlane-Berry, L; Segal, Y; Firestone, S M

    2016-04-01

    A recent outbreak of Q fever was linked to an intensive goat and sheep dairy farm in Victoria, Australia, 2012-2014. Seventeen employees and one family member were confirmed with Q fever over a 28-month period, including two culture-positive cases. The outbreak investigation and management involved a One Health approach with representation from human, animal, environmental and public health. Seroprevalence in non-pregnant milking goats was 15% [95% confidence interval (CI) 7-27]; active infection was confirmed by positive quantitative PCR on several animal specimens. Genotyping of Coxiella burnetii DNA obtained from goat and human specimens was identical by two typing methods. A number of farming practices probably contributed to the outbreak, with similar precipitating factors to the Netherlands outbreak, 2007-2012. Compared to workers in a high-efficiency particulate arrestance (HEPA) filtered factory, administrative staff in an unfiltered adjoining office and those regularly handling goats and kids had 5·49 (95% CI 1·29-23·4) and 5·65 (95% CI 1·09-29·3) times the risk of infection, respectively; suggesting factory workers were protected from windborne spread of organisms. Reduction in the incidence of human cases was achieved through an intensive human vaccination programme plus environmental and biosecurity interventions. Subsequent non-occupational acquisition of Q fever in the spouse of an employee, indicates that infection remains endemic in the goat herd, and remains a challenge to manage without source control.

  17. Diagnosis and Control of a LPAI H5N8 Outbreak in a Japanese Quail (Coturnix coturnix japonica) Commercial Flock in the Central Valley of California.

    PubMed

    Carnaccini, Silvia; Crossley, Beate; Breitmeyer, Richard; Charlton, Bruce R; Bland, Mark; Fowler, Kent; De La Torre, Felicia; Torchetti, Mia Kim; Wong, Sook-San; Wilson, Dennis; Jones, Annette; Sentíes-Cué, C Gabriel

    2015-06-01

    In April 2014 an outbreak of low pathogenic avian influenza H5N8 North American genetic lineage was diagnosed in a commercial quail operation in Stanislaus County, California. Sudden increase in mortality prompted the submission of 20 Japanese quail hens (Coturnix c. japonica) to the California Animal Health and Food Safety Laboratory, Turlock Branch. Oropharyngeal and cloacal swabs tested positive for influenza A virus H5N8 by real-time reverse transcription-polymerase chain reaction. The virus was subsequently isolated. In vivo assay and sequencing of the hemagglutinin protein cleavage site classified the virus as a North American genetic lineage of low pathogenicity for chickens. Following the diagnosis, a rapid and coordinated response took place to contain the outbreak. The affected premise was depopulated, cleaned, and disinfected. Three areas from the affected premises-a 3 kilometer (km) radius (High Risk Zone), a 3-10 km area (Buffer Zone), and a 10-20 km (Surveillance Zone)-were established for avian influenza testing of commercial and noncommercial poultry operations. Surveillance testing and rapid control measures were successful in the control and eradication of the outbreak and revealed no area of spread of the virus from the index flock. This report describes the history, diagnosis, surveillance, and control measures applied to manage this outbreak.

  18. Factors precipitating outbreaks of measles in district Kangra of North India: A case-control study

    PubMed Central

    Gupta, Surender Nikhil; Vidya, Ramachandran; Gupta, Naveen; Gupte, Mohan D

    2011-01-01

    Background: Globally, measles is the fifth killer disease among children under five years of age. Despite high immunization coverage in Himachal, outbreaks are occurring. Upon two outbreaks in a hilly district in North India, a case control study was conducted to identify factors contributing to outbreaks and to recommend remedial measures to prevent further outbreaks. Materials and Methods: Factors were reviewed under three heads: program related, health care providers, and beneficiaries related. Cold chain maintenance was determined and responses were compared between workers from study Shahpur and control Nagrota Bagwan blocks. All 69 mothers of age and sex matched children with measles were enrolled. A pre-designed pre-tested data collection instrument was used. For statistical analysis, the odds ratio (OR) and adjusted odds ratio with 95% confidence interval (C.I.) among women of children exposed and unexposed to selected characteristics were calculated. Results: Poor cold chain maintenance and gaps in knowledge of health workers supplemented with beneficiary-related issues precipitated outbreaks in case area. Univariate analysis yielded strong statistical significance to 17 variables. Important statistically significant variables are educational status; OR 27.63 (C.I. 9.46-85.16); occupation; OR 0.35 (C.I. 0.16-0.75); income; OR 5.49 (C.I. 2.36-13.00); mode of transport to health care facility; OR 8.74 (C.I. 2.90-28.23); spread of illness from one person to another; OR 5.60 (95% C.I. 1.40-25.97); first help for sick child OR 2.12 (C.I. 1.00-4.50), and place of visit after recovery; OR 3.92 (C.I. 1.80-8.63). Multiple logistic regression yielded significant association with educational status, drinking water sources, and time taken to reach the nearest health facility. Conclusion: Measles outbreaks were confirmed in high immunization coverage areas. We recommend 2nd dose opportunity for measles (MR) between 5 and 17 years; refresher trainings to workers; mobile

  19. Outbreak of Legionnaires' disease at University Hospital, Nottingham. Epidemiology, microbiology and control.

    PubMed Central

    Colville, A.; Crowley, J.; Dearden, D.; Slack, R. C.; Lee, J. V.

    1993-01-01

    Twelve patients in a large teaching hospital contracted Legionnaires' disease over a period of 11 months. The source was a domestic hot water system in one of the hospital blocks, which was run at a temperature of 43 degrees C. Five different subtypes of Legionella pneumophila serogroup 1 have been isolated from water in different parts of the hospital, over a period of time. Only one subtype, Benidorm RFLP 14, was implicated in disease. Circumstantial evidence suggested that the outbreak may have been due to recent colonization of the hot water system with a virulent strain of Legionella pneumophila. The outbreak was controlled by raising the hot water temperature to 60 degrees C, but careful surveillance uncovered two further cases in the following 30 months. Persistent low numbers of Legionella pneumophila were isolated from the domestic hot water of wards where Legionnaires' disease had been contracted, until an electrolytic unit was installed releasing silver and copper ions into this supply. PMID:8432314

  20. Strategies for controlling non-transmissible infection outbreaks using a large human movement data set.

    PubMed

    Hancock, Penelope A; Rehman, Yasmin; Hall, Ian M; Edeghere, Obaghe; Danon, Leon; House, Thomas A; Keeling, Matthew J

    2014-09-01

    Prediction and control of the spread of infectious disease in human populations benefits greatly from our growing capacity to quantify human movement behavior. Here we develop a mathematical model for non-transmissible infections contracted from a localized environmental source, informed by a detailed description of movement patterns of the population of Great Britain. The model is applied to outbreaks of Legionnaires' disease, a potentially life-threatening form of pneumonia caused by the bacteria Legionella pneumophilia. We use case-report data from three recent outbreaks that have occurred in Great Britain where the source has already been identified by public health agencies. We first demonstrate that the amount of individual-level heterogeneity incorporated in the movement data greatly influences our ability to predict the source location. The most accurate predictions were obtained using reported travel histories to describe movements of infected individuals, but using detailed simulation models to estimate movement patterns offers an effective fast alternative. Secondly, once the source is identified, we show that our model can be used to accurately determine the population likely to have been exposed to the pathogen, and hence predict the residential locations of infected individuals. The results give rise to an effective control strategy that can be implemented rapidly in response to an outbreak.

  1. Strategies for Controlling Non-Transmissible Infection Outbreaks Using a Large Human Movement Data Set

    PubMed Central

    Hancock, Penelope A.; Rehman, Yasmin; Hall, Ian M.; Edeghere, Obaghe; Danon, Leon; House, Thomas A.; Keeling, Matthew J.

    2014-01-01

    Prediction and control of the spread of infectious disease in human populations benefits greatly from our growing capacity to quantify human movement behavior. Here we develop a mathematical model for non-transmissible infections contracted from a localized environmental source, informed by a detailed description of movement patterns of the population of Great Britain. The model is applied to outbreaks of Legionnaires' disease, a potentially life-threatening form of pneumonia caused by the bacteria Legionella pneumophilia. We use case-report data from three recent outbreaks that have occurred in Great Britain where the source has already been identified by public health agencies. We first demonstrate that the amount of individual-level heterogeneity incorporated in the movement data greatly influences our ability to predict the source location. The most accurate predictions were obtained using reported travel histories to describe movements of infected individuals, but using detailed simulation models to estimate movement patterns offers an effective fast alternative. Secondly, once the source is identified, we show that our model can be used to accurately determine the population likely to have been exposed to the pathogen, and hence predict the residential locations of infected individuals. The results give rise to an effective control strategy that can be implemented rapidly in response to an outbreak. PMID:25211122

  2. First Outbreak with MRSA in a Danish Neonatal Intensive Care Unit: Risk Factors and Control Procedures

    PubMed Central

    Ramsing, Benedicte Grenness Utke; Arpi, Magnus; Andersen, Erik Arthur; Knabe, Niels; Mogensen, Dorthe; Buhl, Dorte; Westh, Henrik; Østergaard, Christian

    2013-01-01

    Introduction The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission. Methods Data were collected retrospectively from medical records and the Danish Neobase database. All MRSA isolates obtained from neonates, relatives and NICU health care workers (HCW) as well as environmental cultures were typed. Results During the 46 day outbreak period, 102 neonates were admitted to the two neonatal wards. Ninety-nine neonates were subsequently sampled, and 32 neonates (32%) from 25 families were colonized with MRSA (spa-type t127, SCCmec V, PVL negative). Thirteen family members from 11 of those families (44%) and two of 161 HCWs (1%) were colonized with the same MRSA. No one was infected. Five environmental cultures were MRSA positive. In a multiple logistic regression analysis, nasal Continuous Positive Airway Pressure (nCPAP) treatment (p = 0.006) and Caesarean section (p = 0.016) were independent risk factors for MRSA acquisition, whereas days of exposure to MRSA was a risk factors in the unadjusted analysis (p = 0.04). Conclusions MRSA transmission occurs with high frequency in the NICU during hospitalization with unidentified MRSA neonates. Caesarean section and nCPAP treatment were identified as risk factors for MRSA colonization. The MRSA outbreak was controlled through infection control procedures. PMID:23825581

  3. Investigation and control of a Norovirus outbreak of probable waterborne transmission through a municipal groundwater system.

    PubMed

    Giammanco, Giovanni M; Di Bartolo, Ilaria; Purpari, Giuseppa; Costantino, Claudio; Rotolo, Valentina; Spoto, Vittorio; Geraci, Gaetano; Bosco, Girolama; Petralia, Agata; Guercio, Annalisa; Macaluso, Giusi; Calamusa, Giuseppe; De Grazia, Simona; Ruggeri, Franco M; Vitale, Francesco; Maida, Carmelo M; Mammina, Caterina

    2014-09-01

    During March 2011 an outbreak of gastroenteritis occurred in Santo Stefano di Quisquina, Agrigento, Sicily, Italy. Within two weeks 156 cases were identified among the 4,965 people living in the municipality. An epidemiological investigation was conducted to characterize the outbreak and target the control measures. A case was defined as a person developing diarrhea or vomiting during February 27-March 13, 2011. Stool specimens were collected from 12 cases. Norovirus (NoV) genotype GII.4 variant New Orleans 2009 was identified in stool samples from 11 of 12 cases tested (91.7%). Epidemiological investigations suggested a possible association with municipal drinking water consumption. Water samples from the public water system were tested for NoV and a variety of genotypes were detected during the first 3 months of surveillance, including GII.4 strains belonging to different variants from that involved in the gastroenteritis outbreak. Contamination of the well and springs supplying the public water network was eventually thought to be the source of the NoV contamination.

  4. A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality

    PubMed Central

    CASTILLA, J.; BARRICARTE, A.; ALDAZ, J.; GARCÍA CENOZ, M.; FERRER, T.; PELAZ, C.; PINEDA, S.; BALADRÓN, B.; MARTÍN, I.; GOÑI, B.; ARATAJO, P.; CHAMORRO, J.; LAMEIRO, F.; TORROBA, L.; DORRONSORO, I.; MARTÍNEZ-ARTOLA, V.; ESPARZA, M. J.; GASTAMINZA, M. A.; FRAILE, P.; ALDAZ, P.

    2008-01-01

    SUMMARY An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality. PMID:17662166

  5. 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

  6. Environmental Control of Phase Transition and Polyp Survival of a Massive-Outbreaker Jellyfish

    PubMed Central

    Prieto, Laura; Astorga, Diana; Navarro, Gabriel; Ruiz, Javier

    2010-01-01

    A number of causes have been proposed to account for the occurrence of gelatinous zooplankton (both jellyfish and ctenophore) blooms. Jellyfish species have a complex life history involving a benthic asexual phase (polyp) and a pelagic sexual phase (medusa). Strong environmental control of jellyfish life cycles is suspected, but not fully understood. This study presents a comprehensive analysis on the physicochemical conditions that control the survival and phase transition of Cotylorhiza tuberculata; a scyphozoan that generates large outbreaks in the Mediterranean Sea. Laboratory experiments indicated that the influence of temperature on strobilation and polyp survival was the critical factor controlling the capacity of this species to proliferate. Early life stages were less sensitive to other factors such as salinity variations or the competitive advantage provided by zooxanthellae in a context of coastal eutrophication. Coherently with laboratory results, the presence/absence of outbreaks of this jellyfish in a particular year seems to be driven by temperature. This is the first time the environmental forcing of the mechanism driving the life cycle of a jellyfish has been disentangled via laboratory experimentation. Projecting this understanding to a field population under climatological variability results in a pattern coherent with in situ records. PMID:21072185

  7. Environmental control of phase transition and polyp survival of a massive-outbreaker jellyfish.

    PubMed

    Prieto, Laura; Astorga, Diana; Navarro, Gabriel; Ruiz, Javier

    2010-11-03

    A number of causes have been proposed to account for the occurrence of gelatinous zooplankton (both jellyfish and ctenophore) blooms. Jellyfish species have a complex life history involving a benthic asexual phase (polyp) and a pelagic sexual phase (medusa). Strong environmental control of jellyfish life cycles is suspected, but not fully understood. This study presents a comprehensive analysis on the physicochemical conditions that control the survival and phase transition of Cotylorhiza tuberculata; a scyphozoan that generates large outbreaks in the Mediterranean Sea. Laboratory experiments indicated that the influence of temperature on strobilation and polyp survival was the critical factor controlling the capacity of this species to proliferate. Early life stages were less sensitive to other factors such as salinity variations or the competitive advantage provided by zooxanthellae in a context of coastal eutrophication. Coherently with laboratory results, the presence/absence of outbreaks of this jellyfish in a particular year seems to be driven by temperature. This is the first time the environmental forcing of the mechanism driving the life cycle of a jellyfish has been disentangled via laboratory experimentation. Projecting this understanding to a field population under climatological variability results in a pattern coherent with in situ records.

  8. Factors associated to duration of hepatitis a outbreaks: implications for control.

    PubMed

    Torner, Nuria; Broner, Sonia; Martinez, Ana; Tortajada, Cecilia; Garcia de Olalla, Patricia; Barrabeig, Irene; Sala, MariaRosa; Camps, Neus; Minguell, Sofia; Alvarez, Josep; Ferrús, Gloria; Torra, Roser; Godoy, Pere; Dominguez, Angela

    2012-01-01

    Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.

  9. Undesirable Consequences of Insecticide Resistance following Aedes aegypti Control Activities Due to a Dengue Outbreak

    PubMed Central

    Maciel-de-Freitas, Rafael; Avendanho, Fernando Campos; Santos, Rosangela; Sylvestre, Gabriel; Araújo, Simone Costa; Lima, José Bento Pereira; Martins, Ademir Jesus; Coelho, Giovanini Evelim; Valle, Denise

    2014-01-01

    Background During a dengue outbreak with co-circulation of DENV-1 and -2 in the city of Boa Vista, one patient was diagnosed with DENV-4, a serotype supposed absent from Brazil for almost 30 years. The re-emergence of DENV-4 triggered the intensification of mechanical and chemical Aedes aegypti control activities in order to reduce vector density and avoid DENV-4 dissemination throughout the country. Methods/Principal Findings Vector control activities consisted of (a) source reduction, (b) application of diflubenzuron against larvae and (c) vehicle-mounted space spraying of 2% deltamethrin to eliminate adults. Control activity efficacy was monitored by comparing the infestation levels and the number of eggs collected in ovitraps before and after interventions, performed in 22 Boa Vista districts, covering an area of ∼80% of the city and encompassing 56,837 dwellings. A total of 94,325 containers were eliminated or treated with diflubenzuron. The most frequently positive containers were small miscellaneous receptacles, which corresponded to 59% of all positive breeding sites. Insecticide resistance to deltamethrin was assessed before, during and after interventions by dose-response bioassays adopting WHO-based protocols. The intense use of the pyrethroid increased fourfold the resistance ratio of the local Ae. aegypti population only six months after the beginning of vector control. Curiously, this trend was also observed in the districts in which no deltamethrin was applied by the public health services. On the other hand, changes in the resistance ratio to the organophosphate temephos seemed less influenced by insecticide in Boa Vista. Conclusions Despite the intense effort, mosquito infestation levels were only slightly reduced. Besides, the median number of eggs in ovitraps remained unaltered after control activity intensification. The great and rapid increase in pyrethroid resistance levels of natural Ae. aegypti populations is discussed in the context of

  10. Nosocomial outbreak of Legionnaires' disease: molecular epidemiology and disease control measures.

    PubMed

    Johnston, J M; Latham, R H; Meier, F A; Green, J A; Boshard, R; Mooney, B R; Edelstein, P H

    1987-02-01

    Molecular laboratory techniques were used to study the epidemiology of an outbreak of nosocomial Legionnaires' disease. All patient isolates were Legionella pneumophila serogroup 1 and showed identical plasmid profiles and reactions with serogroup-specific monoclonal antibodies. L pneumophila was also cultured from four of five cooling tower water samples; however, the isolate from only one tower was serogroup 1 of the same subtype as patient isolates. Since the cases were temporally clustered and epidemiologically associated with exposure to cooling tower aerosols, the single cooling tower implicated by molecular analysis was the most likely source of the outbreak. Chlorination of cooling tower ponds has eradicated the epidemic strain. Since potable water also harbored the infecting organism and was the probable source for cooling tower contamination, decontamination of the hospital water system was also undertaken. Superchlorination of hot water holding tanks to 17 ppm on a weekly basis has effectively eradicated L pneumophila from the potable water system and appears to be a reasonable, simple, and relatively inexpensive alternative to previously described methods of control.

  11. Brucellosis outbreak in Chouf district of Lebanon in 2009: a case-control study.

    PubMed

    Al-Shaar, L; Chaaya, M; Ghosn, N; Mahfoud, Z

    2014-05-01

    A study was conducted to determine risk factors associated with brucellosis infection in an outbreak in Chouf district of Lebanon during summer 2009. Cases of brucellosis reported to the Ministry of Public Health were identified, and for each case 2 controls were matched by sex, age and residence. Sociodemographic data, exposure to animals and animal products, knowledge about brucellosis, symptoms and history of past brucellosis infections were collected. Consumption of raw cheese was a significant risk factor for contracting brucellosis (matched OR = 29.5), whereas wearing gloves when in contact with animals and animal products and self-preparing dairy products were protective factors (OR = 0.08 and 0.13 respectively). Low and inaccurate knowledge about brucellosis was prevalent among subjects, with a common misconception about human-human transmission. Ensuring animal vaccination, educating people on correct ways of milk pasteurization and handling meat products, and elevating food safety monitoring threshold are key elements in controlling brucellosis.

  12. Investigation and control of an outbreak of Enterobacter aerogenes bloodstream infection in a neonatal intensive care unit in Fiji.

    PubMed

    Narayan, Swastika A; Kool, Jacob L; Vakololoma, Miriama; Steer, Andrew C; Mejia, Amelita; Drake, Anne; Jenney, Adam; Turton, Jane F; Kado, Joseph; Tikoduadua, Lisi

    2009-08-01

    Ten neonates developed blood stream infection with extended-spectrum beta-lactamase-producing Enterobacter aerogenes in a neonatal intensive care unit in Fiji. The source of the outbreak was traced to a bag of contaminated normal saline in the ward, which was used for multiple patients. All isolates recovered from patients were indistinguishable from the bacteria recovered from the normal saline by pulsed-field gel electrophoresis. The outbreak was controlled using simple infection control practices such as reinforcement of strict hand hygiene policy, provision of single use vials of normal saline, and strict aseptic technique for injections.

  13. 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.

  14. Pacemaker pocket infection due to environmental mycobacteria: Successful management of an outbreak and steps for prevention in future

    PubMed Central

    Bharat, Vijaya; Hittinahalli, Vivek; Mishra, Meenakshi; Pradhan, Sridhar

    2016-01-01

    Background An outbreak of surgical site infection (SSI) due to environmental mycobacteria (EMB) occurred in a hospital in Eastern India. Method A quality improvement project (QIP) was undertaken to analyze the causes and prevent further outbreak. Step (1) Proof of the need: Four patients who had undergone pacemaker implantation consecutively during a 10-day period developed SSI. Step (2) Diagnostic journey: Since all patients developed SSI within 2 months of implantation, a common source of infection was likely. Atypical mycobacteria (AMB) were grown from surgical sites as well as from the surface of operation table, image intensifier, and lead aprons. It was a rapid growing variety that lacked pigment, a characteristic of EMB with pathogenic potential. The EMB was finally traced to its source, the overhead water tank. Step (3) Remedial journey: By thorough cleaning of the water tank and enriching its chlorine content, the EMB was eliminated from its source. Step (4) Holding the gains: Protocol for cleaning the water tank once in 3 months was made. A checklist was prepared to ensure compliance to asepsis protocol in the operation theater. In the ensuing 5 years, the infection did not recur. Result The bacteria that caused SSI were identified as EMB that grew in the water tank and contaminated the operation room. It could be eliminated by appropriate measures. Interpretation Water is a potential reservoir for EMB. Use of the term ‘environmental mycobacteria’ instead of ‘atypical mycobacteria’ will generate awareness about contamination as the cause of SSI. PMID:26896269

  15. Biocontained carcass composting for control of infectious disease outbreak in livestock.

    PubMed

    Reuter, Tim; Xu, Weiping; Alexander, Trevor W; Gilroyed, Brandon H; Inglis, G Douglas; Larney, Francis J; Stanford, Kim; McAllister, Tim A

    2010-05-06

    Intensive livestock production systems are particularly vulnerable to natural or intentional (bioterrorist) infectious disease outbreaks. Large numbers of animals housed within a confined area enables rapid dissemination of most infectious agents throughout a herd. Rapid containment is key to controlling any infectious disease outbreak, thus depopulation is often undertaken to prevent spread of a pathogen to the larger livestock population. In that circumstance, a large number of livestock carcasses and contaminated manure are generated that require rapid disposal. Composting lends itself as a rapid-response disposal method for infected carcasses as well as manure and soil that may harbor infectious agents. We designed a bio-contained mortality composting procedure and tested its efficacy for bovine tissue degradation and microbial deactivation. We used materials available on-farm or purchasable from local farm supply stores in order that the system can be implemented at the site of a disease outbreak. In this study, temperatures exceeded 55 degrees C for more than one month and infectious agents implanted in beef cattle carcasses and manure were inactivated within 14 days of composting. After 147 days, carcasses were almost completely degraded. The few long bones remaining were further degraded with an additional composting cycle in open windrows and the final mature compost was suitable for land application. Duplicate compost structures (final dimensions 25 m x 5 m x 2.4 m; L x W x H) were constructed using barley straw bales and lined with heavy black silage plastic sheeting. Each was loaded with loose straw, carcasses and manure totaling approximately 95,000 kg. A 40-cm base layer of loose barley straw was placed in each bunker, onto which were placed 16 feedlot cattle mortalities (average weight 343 kg) aligned transversely at a spacing of approximately 0.5 m. For passive aeration, lengths of flexible, perforated plastic drainage tubing (15 cm diameter) were

  16. Margaret Sanger: birth control's successful revolutionary.

    PubMed Central

    Wardell, D

    1980-01-01

    The year 1979 marked the centennial of Margaret Sanger, birth control pioneer. Sanger worked to secure two new human rights: the right to decide whether to have a child and the right of a child to be wanted. Beginning in 1873, antipornography crusader Anthony Comstock lobbied through Congress and the state legislatures laws forbidding the distribution of contraceptive devices and even information. He equated these with erotic postcards as "obscene, lewd, lascivious, filthy, indecent and disgusting." Sanger's strategy was to challenge the Comstock laws in the courts. She studied birth control methods abroad and published a pamphlet, Family Limitation, in 1914. It was the first modern marriage manual; it was also illegal. The publicity her trial generated was immense and highly sympathetic. The government dropped its case when it saw it could only make her a martyr. An obstetrical nurse, Sanger had seen the plight of factory women in the poorest sections of New York City. In order to provide the medical advice and supplies women clamored for, Sanger opened the first U.S. birth control clinic, in Brooklyn in 1916. The New York City Vice Squad raided and closed it, and jailed Sanger. Margaret Sanger underwent other trials, raids, and harassments, but each time won additional public support for her organization--Planned Parenthood--and her cause. Images p737-a p740-a p741-a PMID:6992603

  17. 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)

  18. 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.

  19. Investigation and control of a suspected nosocomial outbreak of pan-drug resistant Acinetobacter baumannii in an intensive care unit

    PubMed Central

    Ying, Qian; Qun, Li; Qinzhong, Liu; Mingliang, Chen; Hong, Chen; Ni, Zou

    2016-01-01

    Abstract Acinetobacter baumannii, a non-fermenting Gram-negative bacterium, is a common pathogen in intensive care units (ICU) that is easily spread through contact and can cause nosocomial outbreaks. This study investigated the risk factors associated with outbreaks of pan-drug resistant Acinetobacter baumannii (PDR-Ab) infection by studying a suspected nosocomial outbreak in a comprehensive ICU in a teaching hospital in China, and discusses the effectiveness of current prevention and control measures. Pathogen detection methods involving pulsed field gel electrophoresis (PFGE) were employed to survey patients infected or colonized with PDR-Ab. An epidemiological investigation was conducted to determine the risk factors for infection or colonization with PDR-Ab between 1 October 2014 and 16 January 2015. The rate of PDR-Ab infection in the ICU was higher during the period from 1 October 2014 to 16 January 2015 than it was between 1 October 2013 and 16 January 2014. Only two cases were confirmed to have the same genotype. Risk factors were explored and the rate of infection was found to be controlled by interventions targeting these risk factors. A decrease in the number of infections was observed after multiple prevention and control measures were implemented, preventing the outbreak of a nosocomial infection. PMID:28352851

  20. How can health systems be strengthened to control and prevent an Ebola outbreak? A narrative review

    PubMed Central

    Regmi, Krishna; Gilbert, Ruth; Thunhurst, Colin

    2015-01-01

    The emergence and re-emergence of infectious diseases are now more than ever considered threats to public health systems. There have been over 20 outbreaks of Ebola in the past 40 years. Only recently, the World Health Organization has declared a public health emergency of international concern (PHEIC) in West Africa, with a projected estimate of 1.2 million deaths expected in the next 6 months. Ebola virus is a highly virulent pathogen, often fatal in humans and non-human primates. Ebola is now a great priority for global health security and often becomes fatal if left untreated. This study employed a narrative review. Three major databases – MEDLINE, EMBASE, and Global Health – were searched using both ‘text-words’ and ‘thesaurus terms’. Evidence shows that low- and middle-income countries (LMICs) are not coping well with the current challenges of Ebola, not only because they have poor and fragile systems but also because there are poor infectious disease surveillance and response systems in place. The identification of potential cases is problematic, particularly in the aspects of contact tracing, infection control, and prevention, prior to the diagnosis of the case. This review therefore aims to examine whether LMICs’ health systems would be able to control and manage Ebola in future and identifies two key elements of health systems strengthening that are needed to ensure the robustness of the health system to respond effectively. PMID:26609690

  1. Cost-Effective Control of Infectious Disease Outbreaks Accounting for Societal Reaction

    PubMed Central

    Fast, Shannon M.; González, Marta C.; Markuzon, Natasha

    2015-01-01

    Background Studies of cost-effective disease prevention have typically focused on the tradeoff between the cost of disease transmission and the cost of applying control measures. We present a novel approach that also accounts for the cost of social disruptions resulting from the spread of disease. These disruptions, which we call social response, can include heightened anxiety, strain on healthcare infrastructure, economic losses, or violence. Methodology The spread of disease and social response are simulated under several different intervention strategies. The modeled social response depends upon the perceived risk of the disease, the extent of disease spread, and the media involvement. Using Monte Carlo simulation, we estimate the total number of infections and total social response for each strategy. We then identify the strategy that minimizes the expected total cost of the disease, which includes the cost of the disease itself, the cost of control measures, and the cost of social response. Conclusions The model-based simulations suggest that the least-cost disease control strategy depends upon the perceived risk of the disease, as well as media intervention. The most cost-effective solution for diseases with low perceived risk was to implement moderate control measures. For diseases with higher perceived severity, such as SARS or Ebola, the most cost-effective strategy shifted toward intervening earlier in the outbreak, with greater resources. When intervention elicited increased media involvement, it remained important to control high severity diseases quickly. For moderate severity diseases, however, it became most cost-effective to implement no intervention and allow the disease to run its course. Our simulation results imply that, when diseases are perceived as severe, the costs of social response have a significant influence on selecting the most cost-effective strategy. PMID:26288274

  2. Outbreak of resistant Acinetobacter baumannii- measures and proposal for prevention and control.

    PubMed

    Romanelli, Roberta Maia de Castro; Jesus, Lenize Adriana de; Clemente, Wanessa Trindade; Lima, Stella Sala Soares; Rezende, Edna Maria; Coutinho, Rosane Luiza; Moreira, Ricardo Luiz Fontes; Neves, Francelli Aparecida Cordeiro; Brás, Nelma de Jesus

    2009-10-01

    Acinetobacter baumannii colonization and infection, frequent in Intensive Care Unit (ICU) patients, is commonly associated with high morbimortality. Several outbreaks due to multidrug-resistant (MDR) A. baumanii have been reported but few of them in Brazil. This study aimed to identify risk factors associated with colonization and infection by MDR and carbapenem-resistant A. baumannii strains isolated from patients admitted to the adult ICU at HC/UFMG. A case-control study was performed from January 2007 to June 2008. Cases were defined as patients colonized or infected by MDR/carbapenem-resistant A. baumannii, and controls were patients without MDR/carbapenem-resistant A. baumannii isolation, in a 1:2 proportion. For statistical analysis, due to changes in infection control guidelines, infection criteria and the notification process, this study was divided into two periods. During the first period analyzed, from January to December 2007, colonization or infection by MDR/carbapenem-resistant A. baumannii was associated with prior infection, invasive device utilization, prior carbapenem use and clinical severity. In the multivariate analysis, prior infection and mechanical ventilation proved to be statistically significant risk factors. Carbapenem use showed a tendency towards a statistical association. During the second study period, from January to June 2008, variables with a significant association with MDR/carbapenem-resistant A. baumannii colonization/infection were catheter utilization, carbapenem and third-generation cephalosporin use, hepatic transplantation, and clinical severity. In the multivariate analysis, only CVC use showed a statistical difference. Carbapenem and third-generation cephalosporin use displayed a tendency to be risk factors. Risk factors must be focused on infection control and prevention measures considering A. baumanni dissemination.

  3. Preparedness for the prevention and control of influenza outbreaks on passenger ships in the EU: the SHIPSAN TRAINET project communication.

    PubMed

    Mouchtouri, Va; Black, N; Nichols, G; Paux, T; Riemer, T; Rjabinina, J; Schlaich, C; Menel Lemos, C; Kremastinou, J; Hadjichristodoulou, C

    2009-05-28

    Passenger ships carry a large number of people in confined spaces. A case of the new influenza A (H1N1) virus aboard a passenger ship is an expected event and would lead to rapid spread of the virus, if preventive measures are not in place. However, many cruise lines have detailed policies and procedures to deal with cases of influenza like illness (ILI). The EU SHIPSAN and SHIPSAN TRAINET projects include in their objectives guidelines for the prevention and control of communicable diseases aboard passenger ships. A literature review showed that from 1997 to 2005, nine confirmed outbreaks of influenza were linked to passenger ships, with attack rates up to 37%. It is important to establish and maintain a surveillance system for ILI aboard passenger ships, in order to systematically collect data that can help to determine the baseline illness levels. Monitoring these will enable early identification of outbreaks and allow timely implementation of control measures.

  4. Controlling outbreaks of the coral-eating crown-of-thorns starfish using a single injection of common household vinegar

    NASA Astrophysics Data System (ADS)

    Boström-Einarsson, Lisa; Rivera-Posada, Jairo

    2016-03-01

    Outbreaks of the destructive coral-eating crown-of-thorns starfish, Acanthaster planci, present a considerable threat to coral reefs worldwide, and mitigating their impact has proven challenging. The most effective methods to control A. planci require injecting individual starfish with lethal chemicals. While some of these are highly effective, their administration often requires permits, training and access to specialised equipment. We aimed to identify a widely available and highly efficient alternative. We discovered that common household vinegar is lethal to A. planci individuals when injected at the base of one their arms. A single injection of 25 ml vinegar induced functional mortality in <24 h and 100 % mortality in <48 h. These results demonstrate that vinegar is an effective alternative to currently used chemicals. Vinegar is a viable alternative in the toolkit of methods that can control and eradicate local outbreaks of COTS on coral reefs.

  5. Lime Juice and Vinegar Injections as a Cheap and Natural Alternative to Control COTS Outbreaks

    PubMed Central

    Moutardier, Grégoire; Gereva, Sompert; Mills, Suzanne C.; Adjeroud, Mehdi; Beldade, Ricardo; Ham, Jayven; Kaku, Rocky; Dumas, Pascal

    2015-01-01

    Outbreaks of the corallivorous crown-of-thorns seastar Acanthaster planci (COTS) represent one of the greatest disturbances to coral reef ecosystems in the Indo-Pacific, affecting not only coral reefs but also the coastal communities which rely on their resources. While injection approaches are increasingly used in an attempt to control COTS densities, most of them display severe drawbacks including logistical challenges, high residual environmental impacts or low cost-effectiveness. We tested a new alternative control method based upon acidic injections of cheap, 100% natural products. We investigated the lethal doses, intra- and inter-specific disease transmission and immune responses of COTS when injected with fresh lime juice (extracted from local Citrus arantifolia) and white spirit vinegar. High COTS mortality was achieved with small volumes: 10–20 ml per seastar induced death in 89%/97% of injected specimens after an average 34.3 h/29.8 h for lime juice and vinegar respectively. Highest efficiency was reached for both solutions with double shots of (2 × 10 ml) in two different areas on the body: 100% mortality occurred within 12–24 h, which is similar or faster compared with other current injection methods. Multiple immune measures suggested that death was very likely caused by pH stress from the acidic solutions rather than a bacterial infection. Contagion to either conspecifics or a variety of other reef species was not observed, even at COTS densities 15 times higher than the highest naturally reported. 10 to 20 l lime juice/vinegar could kill up to a thousand COTS at a cost of less than 0.05 USD per specimen; no permits or special handling procedures are required. We conclude that injections of lime juice and vinegar offer great advantages when compared to current best practises and constitute a cheap and natural option for all reefs affected by COTS. PMID:26356840

  6. Lime Juice and Vinegar Injections as a Cheap and Natural Alternative to Control COTS Outbreaks.

    PubMed

    Moutardier, Grégoire; Gereva, Sompert; Mills, Suzanne C; Adjeroud, Mehdi; Beldade, Ricardo; Ham, Jayven; Kaku, Rocky; Dumas, Pascal

    2015-01-01

    Outbreaks of the corallivorous crown-of-thorns seastar Acanthaster planci (COTS) represent one of the greatest disturbances to coral reef ecosystems in the Indo-Pacific, affecting not only coral reefs but also the coastal communities which rely on their resources. While injection approaches are increasingly used in an attempt to control COTS densities, most of them display severe drawbacks including logistical challenges, high residual environmental impacts or low cost-effectiveness. We tested a new alternative control method based upon acidic injections of cheap, 100% natural products. We investigated the lethal doses, intra- and inter-specific disease transmission and immune responses of COTS when injected with fresh lime juice (extracted from local Citrus arantifolia) and white spirit vinegar. High COTS mortality was achieved with small volumes: 10-20 ml per seastar induced death in 89%/97% of injected specimens after an average 34.3 h/29.8 h for lime juice and vinegar respectively. Highest efficiency was reached for both solutions with double shots of (2 × 10 ml) in two different areas on the body: 100% mortality occurred within 12-24 h, which is similar or faster compared with other current injection methods. Multiple immune measures suggested that death was very likely caused by pH stress from the acidic solutions rather than a bacterial infection. Contagion to either conspecifics or a variety of other reef species was not observed, even at COTS densities 15 times higher than the highest naturally reported. 10 to 20 l lime juice/vinegar could kill up to a thousand COTS at a cost of less than 0.05 USD per specimen; no permits or special handling procedures are required. We conclude that injections of lime juice and vinegar offer great advantages when compared to current best practises and constitute a cheap and natural option for all reefs affected by COTS.

  7. Beating the Odds: Successful Establishment of a Phase II/III Clinical Research Trial in Resource-Poor Liberia during the Largest-Ever Ebola Outbreak

    PubMed Central

    Doe-Anderson, J; Baseler, B; Driscoll, P; Johnson, M; Lysander, J; McNay, L; Njoh, WS; Smolskis, M; Wehrlen, L; Zuckerman, J

    2016-01-01

    It has been argued that a country such as Liberia, not fully recovered from the devastation of decades of civil unrest, lacked the appropriate ethical and regulatory framework, basic human and health care services, and infrastructure to carry out clinical trials according to international standards of quality during a public health emergency. However, as Liberia, Sierra Leone, and Guinea were being ravaged by the largest and most devastating Ebola Virus Disease (EVD) outbreak ever recorded, the topic of conducting clinical trials of experimental vaccine and treatment candidates in these resource-poor countries generated the keen interest and concern of scientists, researchers, physicians, bioethicists, philanthropists, and even politicians. Decisive action on behalf of the Liberian government, and a timely positive and supportive response from the United States (U.S.) government, led to the formation of PREVAIL (Partnership for Research on Ebola Vaccines in Liberia) – a clinical research partnership between the two governments. Within a span of 12 weeks, this partnership accomplished the unimaginable: the successful initiation of a Phase II/III vaccine clinical trial for EVD in Liberia. This paper will discuss the dynamics of the research collaboration, barriers encountered, breakthroughs realized, key elements of success, and lessons learned in the process. PMID:28042619

  8. Success Stories in Control: Nonlinear Dynamic Inversion Control

    NASA Technical Reports Server (NTRS)

    Bosworth, John T.

    2010-01-01

    NASA plays an important role in advancing the state of the art in flight control systems. In the case of Nonlinear Dynamic Inversion (NDI) NASA supported initial implementation of the theory in an aircraft and demonstration in a space vehicle. Dr. Dale Enns of Honeywell Aerospace Advanced Technology performed this work in cooperation with NASA and under NASA contract. Honeywell and Lockheed Martin were subsequently contracted by AFRL to create "Design Guidelines for Multivariable Control Theory". This foundational work directly contributed to the advancement of the technology and the credibility of the control law as a design option. As a result Honeywell collaborated with Lockheed Martin to produce a Nonlinear Dynamic Inversion controller for the X-35 and subsequently Lockheed Martin did the same for the production Lockheed Martin F-35 vehicle. The theory behind NDI is to use a systematic generalized approach to controlling a vehicle. Using general aircraft nonlinear equations of motion and onboard aerodynamic, mass properties, and engine models specific to the vehicle, a relationship between control effectors and desired aircraft motion can be formulated. Using this formulation a control combination is used that provides a predictable response to commanded motion. Control loops around this formulation shape the response as desired and provide robustness to modeling errors. Once the control law is designed it can be used on a similar class of vehicle with only an update to the vehicle specific onboard models.

  9. Chikungunya outbreak in Al-Hudaydah, Yemen, 2011: epidemiological characterization and key lessons learned for early detection and control.

    PubMed

    Malik, Mamunur Rahman; Mnzava, Abraham; Mohareb, Emad; Zayed, Alia; Al Kohlani, Abdulhakeem; Thabet, Ahmed A K; El Bushra, Hassan

    2014-09-01

    Little is known about the occurrence of chikungunya fever in the Eastern Mediterranean Region of the World Health Organization (WHO). In January 2011, the Ministry of Public Health and Population (MoPH&P) of Yemen reported to WHO an increasing number of "dengue-like" acute febrile illnesses of unknown origin from one of its coastal governorates. An epidemiological investigation was conducted in Al-Hudaydah governorate between 23 and 26 January 2011 by a joint team of WHO, the MoPH&P of Yemen and the U.S. Naval Medical Research Unit (NAMRU-3) in Cairo, Egypt. The investigation led to the detection of an outbreak of chikungunya in Yemen which was the first time ever from any of the 22 countries in the Eastern Mediterranean Region of WHO. Appropriate public health control measures were strengthened following the investigation, and the outbreak was contained. This paper provides a short description of the outbreak and its epidemiological characteristics and highlights the important lessons that were learned for early detection and control of chikungunya in countries where competent vectors for transmission of the virus exist.

  10. Seasonal Succession of Fungi Associated with Ips typographus Beetles and Their Phoretic Mites in an Outbreak Region of Finland

    PubMed Central

    Mahilainen, Saila; Harrington, Alison; Vanhanen, Henri; Eriksson, Miikka; Mehtätalo, Lauri; Pappinen, Ari; Wingfield, Michael J.

    2016-01-01

    The ophiostomatoid fungi (Microascales and Ophiostomatales, Ascomycota) are common associates of Ips typographus, and include tree pathogens and species responsible for blue-stain of timber. Fungal assemblages associated with I. typographus have varied considerably between studies but few investigations have attempted to explain this variation. For this reason, we assessed the overall cultivable fungal diversity associated with I. typographus in a storm-felled spruce forest in south-eastern Finland. Fungi were isolated from the individually collected beetles as well as their phoretic mites in spring, summer and autumn, including different life stages of the beetle (hibernation, dispersal flight and first generation). The internal transcribed spacer (ITS) gene region was used to identify the fungi. A total of 32 operational taxonomic units (OTUs) were found and these resided in four fungal phyla/subphyla (24 Ascomycota, 2 Basidiomycota, 5 Mucoromycotina, 1 Mortierellomycotina) in association with adult bark beetles. Ophiostomatoid species were the most commonly detected fungal associates. A generalized linear model analysis showed a clear association between fungal communities and season, indicating seasonal succession among I. typographus-associated fungi. The season of sampling appears to be an important factor that has resulted in inconsistencies between results in previous studies. Many of these fungi were also found on phoretic mites and their presence or absence could have influenced variation in patterns of association. PMID:27187192

  11. Investigation and control of anthrax outbreak at the human-animal interface, Bhutan, 2010.

    PubMed

    Thapa, Nirmal K; Tenzin; Wangdi, Karma; Dorji, Tshering; Migma; Dorjee, Jambay; Marston, Chung K; Hoffmaster, Alex R

    2014-09-01

    In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan.

  12. Rubella: Current Status, Diagnosis, Outbreak Control, and Use of Rubella Vaccine in Females of Childbearing Age.

    ERIC Educational Resources Information Center

    Preblud, Stephen R.

    1984-01-01

    Widespread rubella vaccination of young children with a secondary emphasis on vaccinating susceptible adolescents and young adults has prevented epidemics of rubella and congenital rubella syndrome. Benefits of ensuring high immunity levels in college students, quick response to disease outbreak, and safety and efficacy of rubella vaccine in this…

  13. Biosurveillance in outbreak investigations.

    PubMed

    Kaydos-Daniels, S Cornelia; Rojas Smith, Lucia; Farris, Tonya R

    2013-03-01

    Following the terrorist attacks of September 11 and the anthrax attacks in 2001, public health entities implemented automated surveillance systems based on disease syndromes for early detection of bioterror events and to increase timeliness of responses. Despite widespread adoption, syndromic surveillance systems' ability to provide early notification of outbreaks is unproven, and there is little documentation on their role in outbreak response. We hypothesized that biosurveillance is used in practice to augment classical outbreak investigations, and we used case studies conducted in 2007-08 to determine (1) which steps in outbreak investigations were best served by biosurveillance, and (2) which steps presented the greatest opportunities for improvement. The systems used in the case studies varied in how they functioned, and there were examples in which syndromic systems had identified outbreaks before other methods. Biosurveillance was used successfully for all steps of outbreak investigations. Key advantages of syndromic systems were sensitivity, timeliness, and flexibility and as a source of data for situational awareness. Limitations of biosurveillance were a lack of specificity, reliance on chief complaint data, and a lack of formal training for users. Linking syndromic data to triage notes and medical chart data would substantially increase the value of biosurveillance in the conduct of outbreak investigations and reduce the burden on health department staff.

  14. Epidemiology, control and management of an EBHS outbreak in captive hares.

    PubMed

    Drews, Barbara; Szentiks, Claudia A; Roellig, Kathleen; Fickel, Joerns; Schroeder, Katharina; Duff, J Paul; Lavazza, Antonio; Hildebrandt, Thomas B; Goeritz, Frank

    2011-12-29

    Here we describe an outbreak of European brown hare syndrome (EBHS) in a captive hare population. The EBHS outbreak occurred in March 2009, at the beginning of the breeding season. Overall mortality was 53% out of an original population of 61 animals. Animals between five and eleven months showed a significantly higher mortality rate than other age classes. Pregnant females either aborted their foetuses and survived or died pregnant. All foetuses (n=10) of the pregnant hares were PCR positive for EBHSV. Only one offspring born during the outbreak survived. Shortly after the outbreak, the surviving hares developed a specific anti-EBHSV titre between 1:80 and 1:2560, which dropped to 1:10-1:160 nine months later. Hares between one and three years of age developed a significantly higher titre than hares younger than one year or older than four years. Offspring born after the outbreak showed a lower titre of 1:10, indicating passive antibody transfer via placenta and milk. After two months, the titre was not detectable any longer. In December 2009, the captive population was vaccinated against EBHS virus with inactivated virus prepared from the organs of infected hares. The titres after the first vaccination ranged from 1:10 to 1:640, and after the second vaccination from 1:10 to 1:320. To estimate the effect of EBHS on reproduction, we compared the breeding seasons 2008 and 2009. Several possible sources of infection of the colony are discussed, but the definite cause could not be determined.

  15. An outbreak of tuberculosis in a shelter for homeless men. A description of its evolution and control.

    PubMed

    Nolan, C M; Elarth, A M; Barr, H; Saeed, A M; Risser, D R

    1991-02-01

    An outbreak of tuberculosis at a shelter for homeless men was studied in detail to further the understanding of the epidemiology of tuberculosis in this setting. The shelter provides evening accommodations for men aged 50 yr and older. The capacity is approximately 200 clients, and the client pool is approximately 1,000 men/yr. During a 6-wk period in December 1986 and January 1987, seven cases of tuberculosis were diagnosed in shelter clients. Nine cases were reported in clients during the preceding 12 months, and four cases in the year previous to that. The majority of outbreak cases were pulmonary tuberculosis, sputum smear positive. Drug resistance was rare. Phage typing of 15 Mycobacterium tuberculosis isolates revealed one predominant type and four other types. The goals of the control plan (and the steps taken to achieve them) were to render known infectious cases noninfectious (directly observed therapy); to find undiagnosed infectious cases (repetitive mass screenings); to protect exposed clients (repetitive tuberculin skin testing and isoniazid preventive therapy); and to make the shelter environment safe (exclude infectious, noncompliant clients and improve the shelter's ventilation system). Implementation of this plan rapidly terminated the outbreak; following the first mass screening in January 1987, at which six asymptomatic cases were detected, only five additional cases occurred in shelter clients during a 2-yr period of follow-up. The investigation suggested that the outbreak evolved during 1986 as a result of the presence at the shelter of an increasing number of men with undiagnosed infectious pulmonary tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study

    PubMed Central

    O'Loughlin, Rosalyn E; Kightlinger, Lon; Werpy, Matthew C; Brown, Ellen; Stevens, Valerie; Hepper, Clark; Keane, Tim; Benson, Robert F; Fields, Barry S; Moore, Matthew R

    2007-01-01

    Background From June to November 2005, 18 cases of community-acquired Legionnaires' disease (LD) were reported in Rapid City South Dakota. We conducted epidemiologic and environmental investigations to identify the source of the outbreak. Methods We conducted a case-control study that included the first 13 cases and 52 controls randomly selected from emergency department records and matched on underlying illness. We collected information about activities of case-patients and controls during the 14 days before symptom onset. Environmental samples (n = 291) were cultured for Legionella. Clinical and environmental isolates were compared using monoclonal antibody subtyping and sequence based typing (SBT). Results Case-patients were significantly more likely than controls to have passed through several city areas that contained or were adjacent to areas with cooling towers positive for Legionella. Six of 11 case-patients (matched odds ratio (mOR) 32.7, 95% CI 4.7-∞) reported eating in Restaurant A versus 0 controls. Legionella pneumophila serogroup 1 was isolated from four clinical specimens: 3 were Benidorm type strains and 1 was a Denver type strain. Legionella were identified from several environmental sites including 24 (56%) of 43 cooling towers tested, but only one site, a small decorative fountain in Restaurant A, contained Benidorm, the outbreak strain. Clinical and environmental Benidorm isolates had identical SBT patterns. Conclusion This is the first time that small fountain without obvious aerosol-generating capability has been implicated as the source of a LD outbreak. Removal of the fountain halted transmission. PMID:17688692

  17. An integrated approach to control a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit.

    PubMed

    Knoester, M; de Boer, M G J; Maarleveld, J J; Claas, E C J; Bernards, A T; de Jonge, E; van Dissel, J T; Veldkamp, K E

    2014-04-01

    In this paper we aim to provide insight into the complexity of outbreak management in an intensive care unit (ICU) setting. In October 2010 four patients on the ICU of our tertiary care centre were colonized or infected with a multidrug-resistant strain of Pseudomonas aeruginosa (MDR-PA). An outbreak investigation was carried out and infection control measures were taken in an attempt to identify a potential source and stop transmission. The outbreak investigation included descriptive epidemiology, comprising retrospective case finding by reviewing the laboratory information system back to 2004 and prospective case finding by patient screening for MDR-PA. Furthermore, microbiological analysis, environmental screening and a case-control study were carried out. Infection control measures consisted of re-education of healthcare personnel on basic hygiene measures, auditing of hygiene procedures used in daily practice by infection control practitioners, and stepwise up-regulation of isolation measures. From February 2009 to January 2012, 44 patients on our ICU were found to be MDR-PA positive. MDR-PA isolates of the 44 patients showed two distinct AFLP patterns, with homology within each of the AFLP clusters of more than 93%. The VIM metallo-β-lactamase gene was detected in 20 of 21 tested isolates. A descriptive epidemiology investigation identified the rooms with the highest numbers of MDR-PA positive patients. The case-control study showed three factors to be independently associated with MDR-PA positivity: admission to ICU subunit 1 (OR, 6.1; 95% CI, 1.7, 22), surgery prior to or during admission (OR, 5.7; 95% CI, 1.6, 20) and being warmed-up with the warm-air blanket (OR, 3.6; 95% CI, 1.2, 11). After three environmental screening rounds, with sampling of sinks, furniture and devices in the ICU, without revealing a clear common source, a fourth environmental investigation included culturing of faucet aerators. Two faucets were found to be positive for MDR-PA and

  18. Who Controls Succession in the Superintendency? A Minority Perspective.

    ERIC Educational Resources Information Center

    Ortiz, Flora Ida

    2000-01-01

    Studied a sample of 12 Hispanic American women seeking and being appointed to the superintendency. Demonstrated that the succession to the superintendency was controlled by school board members and former superintendents who held search committee membership. Hispanic women are hired when it is perceived that Hispanics were the source of school…

  19. Motive to Avoid Success, Locus of Control, and Reinforcement Avoidance.

    ERIC Educational Resources Information Center

    Katovsky, Walter

    Subjects were four groups of 12 college women, high or low in motive to avoid success (MAS) and locus of control (LC), were reinforced for response A on a fixed partial reinforcement schedule on three concept learning tasks, one task consisting of combined reward and punishment, another of reward only, and one of punishment only. Response B was…

  20. Chronic cryptosporidiosis in Australian elapid snakes: control of an outbreak in a captive colony.

    PubMed

    Carmel, B P; Groves, V

    1993-08-01

    An outbreak of chronic cryptosporidiosis resulting in hypertrophic gastritis occurred in a captive colony of Australian elapid snakes. Two species of the genus Notechis were involved: Notechis ater (Black Tiger Snake) and Notechis scutatus (Eastern or Mainland Tiger Snake). The infection was eventually fatal in all 9 affected snakes. Typical histopathological findings of the stomach included mucosal thickening with cystic dilatation of gastric glands, moderate oedema and fibrosis of the lamina propria, and a mild to moderate patchy infiltration of inflammatory cells. Procedures implemented to contain the outbreak included the use of a formaldehyde-based disinfectant, prompt removal of faecal matter, uneaten and regurgitated food from enclosures, and examination of faecal specimens for Cryptosporidium oocytes and other pathogens.

  1. Controlling equine influenza: policy networks and decision-making during the 2007 Australian equine influenza outbreak.

    PubMed

    Schemann, K; Gillespie, J A; Toribio, J-A L M L; Ward, M P; Dhand, N K

    2014-10-01

    Rapid, evidence-based decision-making is critical during a disease outbreak response; however, compliance by stakeholders is necessary to ensure that such decisions are effective - especially if the response depends on voluntary action. This mixed method study evaluated technical policy decision-making processes during the 2007 outbreak of equine influenza in Australia by identifying and analysing the stakeholder network involved and the factors driving policy decision-making. The study started with a review of the outbreak literature and published policy documents. This identified six policy issues regarding policy modifications or differing interpretations by different state agencies. Data on factors influencing the decision-making process for these six issues and on stakeholder interaction were collected using a pre-tested, semi-structured questionnaire. Face-to-face interviews were conducted with 24 individuals representing 12 industry and government organizations. Quantitative data were analysed using social network analysis. Qualitative data were coded and patterns matched to test a pre-determined general theory using a method called theory-oriented process-tracing. Results revealed that technical policy decisions were framed by social, political, financial, strategic and operational considerations. Industry stakeholders had influence through formal pre-existing channels, yet specific gaps in stakeholder interaction were overcome by reactive alliances formed during the outbreak response but outside the established system. Overall, the crisis management system and response were seen as positive, and 75-100% of individuals interviewed were supportive of, had interest in and considered the outcome as good for the majority of policy decisions, yet only 46-75% of those interviewed considered that they had influence on these decisions. Training to increase awareness and knowledge of emergency animal diseases (EADs) and response systems will improve stakeholder

  2. Climatic controls on West Nile virus and Sindbis virus transmission and outbreaks in South Africa.

    PubMed

    Uejio, Christopher K; Kemp, Alan; Comrie, Andrew C

    2012-02-01

    The processes influencing the magnitude of West Nile virus (WNV) transmission from 1 year to the next require thorough investigation. The intensity of WNV transmission is related to the dynamics and interactions between the pathogen, vector, vertebrate hosts, and environment. Climatic variability is one process that can influence interannual disease transmission. South Africa has a long WNV and Sindbis virus (SINV) record where consistent climate and disease relationships can be identified. We relate climate conditions to historic mosquito infection rates. Next, we detect similar associations with reported human outbreaks dating back to 1941. Both concurrent summer precipitation and the change in summer precipitation from the previous to the current summer were strongly associated with WNV and SINV transmission and recorded human outbreaks. Each 100 mm interannual summer precipitation change increased WNV infection rates by 0.39 WNV-positive Culex univittatus/1000 tested Cx. univittatus. An improved understanding of biotic and abiotic disease transmission dynamics may help anticipate and mitigate future outbreaks.

  3. Groundwater controls on biogeomorphic succession and river channel morphodynamics

    NASA Astrophysics Data System (ADS)

    Bätz, N.; Colombini, P.; Cherubini, P.; Lane, S. N.

    2016-10-01

    Biogeomorphic succession describes feedbacks between vegetation succession and fluvial processes that, at the decadal timescale, lead to a transition from bare river-deposited sediment to fully developed riparian forest. Where the rate of stabilization by biogeomorphic succession is greater than the rate of ecological disturbance by fluvial processes, a river is likely to evolve into less dynamic states. While river research has frequently considered the physical dimensions of morphodynamics, less is known about physical controls on succession rates, and how these impact stream morphodynamics. Here we test the hypothesis that groundwater dynamics influence morphodynamics via the rate of biogeomorphic succession. We applied historic imagery analysis in combination with dendroecological methods for willows growing on young gravelly fluvial landforms along a steep groundwater-depth gradient. We determined the following: floodplain morphodynamics and plant encroachment at the decadal scale, pioneer willow growth rates, and their relationships to hydrological variables. Willow growth rates were correlated with moisture availability (groundwater, discharge, and precipitation variability) in the downwelling reach, while little correlation was found in the upwelling reach. After a reduction in ecological disturbance frequency, data suggest that where groundwater is upwelling, biogeomorphic succession is fast, the engineering effect of vegetation is quickly established, and hence channel stability increased and active channel width reduces. Where groundwater is downwelling, deeper and more variable, biogeomorphic succession is slower, the engineering effect is reduced, and a wider active width is maintained. Thus, groundwater is an important control on biogeomorphic feedbacks intensity and, through the stabilizing effect of vegetation, may drive long-term river channel morphodynamics.

  4. 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

  5. Hazard analysis of critical control points assessment as a tool to respond to emerging infectious disease outbreaks.

    PubMed

    Edmunds, Kelly L; Hunter, Paul R; Few, Roger; Bell, Diana J

    2013-01-01

    Highly pathogenic avian influenza virus (HPAI) strain H5N1 has had direct and indirect economic impacts arising from direct mortality and control programmes in over 50 countries reporting poultry outbreaks. HPAI H5N1 is now reported as the most widespread and expensive zoonotic disease recorded and continues to pose a global health threat. The aim of this research was to assess the potential of utilising Hazard Analysis of Critical Control Points (HACCP) assessments in providing a framework for a rapid response to emerging infectious disease outbreaks. This novel approach applies a scientific process, widely used in food production systems, to assess risks related to a specific emerging health threat within a known zoonotic disease hotspot. We conducted a HACCP assessment for HPAI viruses within Vietnam's domestic poultry trade and relate our findings to the existing literature. Our HACCP assessment identified poultry flock isolation, transportation, slaughter, preparation and consumption as critical control points for Vietnam's domestic poultry trade. Introduction of the preventative measures highlighted through this HACCP evaluation would reduce the risks posed by HPAI viruses and pressure on the national economy. We conclude that this HACCP assessment provides compelling evidence for the future potential that HACCP analyses could play in initiating a rapid response to emerging infectious diseases.

  6. 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 I

  7. Using Positive Deviance for Determining Successful Weight-Control Practices

    PubMed Central

    Stuckey, Heather L.; Boan, Jarol; Kraschnewski, Jennifer L.; Miller-Day, Michelle; Lehman, Erik B.; Sciamanna, Christopher N.

    2013-01-01

    Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3×/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight. PMID:20956609

  8. Prediction of the spatial evolution and effects of control measures for the unfolding Haiti cholera outbreak

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Mari, L.; Righetto, L.; Gatto, M.; Casagrandi, R.; Blokesch, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2011-03-01

    Here we propose spatially explicit predictions of the residual progression of the current Haiti cholera outbreak accounting for the dynamics of susceptible and infected individuals within different local human communities, and for the redistribution among them of Vibrio cholerae, the causative agent of the disease. Spreading mechanisms include the diffusion of pathogens in the aquatic environment and their dissemination due to the movement of human carriers. The model reproduces the spatiotemporal features of the outbreak to date, thus suggesting the robustness of predicted future developments of the epidemic. We estimate that, under unchanged conditions, the number of new cases in the whole country should start to decrease in January. During this month the epidemic should mainly involve the Ouest department (Port-au-Prince) while fading out in northern regions. Our spatially explicit model allows also the analysis of the effectiveness of alternative intervention strategies. To that end our results show that mass vaccinations would have a negligible impact at this stage of the epidemic. We also show that targeted sanitation strategies, providing clean drinking water supply and/or staging educational campaigns aimed at reducing exposure, may weaken the strength of the residual evolution of the infection.

  9. Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone

    PubMed Central

    Lokuge, Kamalini; Caleo, Grazia; Greig, Jane; Duncombe, Jennifer; McWilliam, Nicholas; Squire, James; Lamin, Manjo; Veltus, Emily; Wolz, Anja; Kobinger, Gary; de la Vega, Marc-Antoine; Gbabai, Osman; Nabieu, Sao; Lamin, Mohammed; Kremer, Ronald; Danis, Kostas; Banks, Emily; Glass, Kathryn

    2016-01-01

    Introduction The scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas. Methods Internal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected. Results There were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased

  10. Developing new approaches for detecting and preventing Aedes aegypti population outbreaks: basis for surveillance, alert and control system.

    PubMed

    Regis, Lêda; Monteiro, Antonio Miguel; Melo-Santos, Maria Alice Varjal de; SilveiraJr, José Constantino; Furtado, André Freire; Acioli, Ridelane Veiga; Santos, Gleice Maria; Nakazawa, Mitsue; Carvalho, Marilia Sá; Ribeiro Jr, Paulo Justiniano; Souza, Wayner Vieira de

    2008-02-01

    A new approach to dengue vector surveillance based on permanent egg-collection using a modified ovitrap and Bacillus thuringiensis israelensis(Bti) was evaluated in different urban landscapes in Recife, Northeast Brazil. From April 2004 to April 2005, 13 egg-collection cycles of four weeks were carried out. Geo-referenced ovitraps containing grass infusion, Bti and three paddles were placed at fixed sampling stations distributed over five selected sites. Continuous egg-collections yielded more than four million eggs laid into 464 sentinel-ovitraps over one year. The overall positive ovitrap index was 98.5% (over 5,616 trap observations). The egg density index ranged from 100 to 2,500 eggs per trap-cycle, indicating a wide spread and high density of Aedes aegypti (Diptera: Culicidae) breeding populations in all sites. Fluctuations in population density over time were observed, particularly a marked increase from January on, or later, according to site. Massive egg-collection carried out at one of the sites prevented such a population outbreak. At intra-site level, egg counts made it possible to identify spots where the vector population is consistently concentrated over the time, pinpointing areas that should be considered high priority for control activities. The results indicate that these could be promising strategies for detecting and preventing Ae. aegypti population outbreaks.

  11. Using epidemiologic tools to control an outbreak of diarrhoea in a textile factory, Bulawayo, Zimbabwe.

    PubMed

    Tshimanga, M; Peterson, D E; Dlodlo, R A

    1997-11-01

    Dysentery is endemic in Zimbabwe. More than 260,000 cases and a case fatality of four per thousand were reported in 1993. In late July 1994, the Health Services Department in Bulawayo was informed of two cases of Shigella dysenteriae type I at a textile factory that employs 138 workers. Workers were interviewed at the factory regarding the date of the onset of illness, symptoms, food consumed, and treatment received. Factory water supply, cooking, and sanitary facilities were inspected. Stool and water samples were obtained for analysis. A case was defined as an employee presenting with diarrhoea with onset from July 24 to August 25, 1994. Of the 99 workers on day and evening shifts, 75 (75%) were interviewed. Thirty eight workers met the case definition (Attack Rate 51%). Common symptoms were abdominal cramps (71%), and blood in stools (37%); median duration of diarrhoea was 11 days (range 5 to 32 days). Thirty seven (64%) of 58 workers who drank borehole water were ill compared to one (6%) of the 17 who did not (RR = 10.8, 95% CI = 1.6-73). No food items consumed were significantly associated with the illness. Two different shigella species (2 sonnei and 2 boydii) were isolated from five (13%) of 38 stool specimens. Water samples from the two boreholes yielded numerous faecal coliforms. Neither borehole was registered as required by the municipal bylaws, which also forbid use of borehole water for drinking. The epidemiologic and laboratory evidence implicate contaminated borehole water as the most likely cause of this outbreak. Enforcement of municipal bylaws on drilling, registration and use of boreholes is essential to avoid further outbreaks of waterborne diseases.

  12. 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.

  13. EPICS: A control system software co-development success story

    SciTech Connect

    Knott, M.; Gurd, D.; Lewis, S.; Thuot, M.

    1993-11-01

    The Experimental Physics and Industrial Control Systems (EPICS) is the result of a software sharing and co-development effort of major importance now underway. The initial two participants, LANL and ANL, have now been joined by three other labs, and an earlier version of the software has been transferred to three commercial firms and is currently undergoing separate development. The reasons for EPICS`s success may be useful to enumerate and explain and the desire and prospects for its continued development are certainly worth examining.

  14. 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

    Megid, Jane; Ferreira Vicente, Acácia; Appolinario, Camila Michele; Allendorf, Susan Dora; de Souza Ribeiro Mioni, Mateus; 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.

  15. 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

  16. Successful Control of Lymphatic Filariasis in the Republic of Korea

    PubMed Central

    Cheun, Hyeng-Il; Kong, Yoon; Cho, Shin-Hyeong; Lee, Jong-Soo; Chai, Jong-Yil; Lee, Joo-Shil; Lee, Jong-Koo

    2009-01-01

    A successful experience of lymphatic filariasis control in the Republic of Korea is briefly reviewed. Filariasis in the Republic of Korea was exclusively caused by infection with Brugia malayi. Over the past several decades from the 1950s to 2006, many investigators exerted their efforts to detection, treatment, and follow-up of filariasis patients in endemic areas, and to control filariasis. Mass, combined with selective, treatments with diethylcarbamazine to microfilaria positive persons had been made them free from microfilaremia and contributed to significant decrease of the microfilarial density in previously endemic areas. Significant decrease of microfilaria positive cases in an area influenced eventually to the endemicity of filariasis in the relevant locality. Together with remarkable economic growth followed by improvement of environmental and personal hygiene and living standards, the factors stated above have contributed to blocking the transmission cycle of B. malayi and led to disappearance of this mosquito-borne ancient disease in the Republic of Korea. PMID:19967079

  17. Analysing Spatio-Temporal Clustering of Meningococcal Meningitis Outbreaks in Niger Reveals Opportunities for Improved Disease Control

    PubMed Central

    Paireau, Juliette; Girond, Florian; Collard, Jean-Marc; Maïnassara, Halima B.; Jusot, Jean-François

    2012-01-01

    Background Meningococcal meningitis is a major health problem in the “African Meningitis Belt” where recurrent epidemics occur during the hot, dry season. In Niger, a central country belonging to the Meningitis Belt, reported meningitis cases varied between 1,000 and 13,000 from 2003 to 2009, with a case-fatality rate of 5–15%. Methodology/Principal Findings In order to gain insight in the epidemiology of meningococcal meningitis in Niger and to improve control strategies, the emergence of the epidemics and their diffusion patterns at a fine spatial scale have been investigated. A statistical analysis of the spatio-temporal distribution of confirmed meningococcal meningitis cases was performed between 2002 and 2009, based on health centre catchment areas (HCCAs) as spatial units. Anselin's local Moran's I test for spatial autocorrelation and Kulldorff's spatial scan statistic were used to identify spatial and spatio-temporal clusters of cases. Spatial clusters were detected every year and most frequently occurred within nine southern districts. Clusters most often encompassed few HCCAs within a district, without expanding to the entire district. Besides, strong intra-district heterogeneity and inter-annual variability in the spatio-temporal epidemic patterns were observed. To further investigate the benefit of using a finer spatial scale for surveillance and disease control, we compared timeliness of epidemic detection at the HCCA level versus district level and showed that a decision based on threshold estimated at the HCCA level may lead to earlier detection of outbreaks. Conclusions/Significance Our findings provide an evidence-based approach to improve control of meningitis in sub-Saharan Africa. First, they can assist public health authorities in Niger to better adjust allocation of resources (antibiotics, rapid diagnostic tests and medical staff). Then, this spatio-temporal analysis showed that surveillance at a finer spatial scale (HCCA) would be more

  18. Social and cultural factors in the successful control of tuberculosis.

    PubMed

    Rubel, A J; Garro, L C

    1992-01-01

    The burden of tuberculosis on the public health is staggering. Worldwide, annual incidence of new cases is estimated to be about 8 million. Almost 3 million deaths occur yearly. Early case identification and adherence to treatment regimens are the remaining barriers to successful control. In many nations, however, fewer than half those with active disease receive a diagnosis, and fewer than half those beginning treatment complete it. The twin problems of delay in seeking treatment and abandonment of a prescribed regimen derive from complex factors. People's confusion as to the implications of the tuberculosis symptoms, costs of transportation to clinic services, the social stigma that attaches to tuberculosis, the high cost of medication, organizational problems in providing adequate followup services, and patients' perception of clinic facilities as inhospitable all contribute to the complexity. Sociocultural factors are emphasized in this report because hitherto they have not been adequately explored. Salient among those sociocultural factors is the health culture of the patients. That is, the understanding and information people have from family, friends, and neighbors as to the nature of a health problem, its cause, and its implications. A knowledge of the health culture of their patients has become a critical tool if tuberculosis control programs are to be successful. Several anthropological procedures are recommended to help uncover the health culture of people served by tuberculosis clinics.

  19. Social and cultural factors in the successful control of tuberculosis.

    PubMed Central

    Rubel, A J; Garro, L C

    1992-01-01

    The burden of tuberculosis on the public health is staggering. Worldwide, annual incidence of new cases is estimated to be about 8 million. Almost 3 million deaths occur yearly. Early case identification and adherence to treatment regimens are the remaining barriers to successful control. In many nations, however, fewer than half those with active disease receive a diagnosis, and fewer than half those beginning treatment complete it. The twin problems of delay in seeking treatment and abandonment of a prescribed regimen derive from complex factors. People's confusion as to the implications of the tuberculosis symptoms, costs of transportation to clinic services, the social stigma that attaches to tuberculosis, the high cost of medication, organizational problems in providing adequate followup services, and patients' perception of clinic facilities as inhospitable all contribute to the complexity. Sociocultural factors are emphasized in this report because hitherto they have not been adequately explored. Salient among those sociocultural factors is the health culture of the patients. That is, the understanding and information people have from family, friends, and neighbors as to the nature of a health problem, its cause, and its implications. A knowledge of the health culture of their patients has become a critical tool if tuberculosis control programs are to be successful. Several anthropological procedures are recommended to help uncover the health culture of people served by tuberculosis clinics. PMID:1454974

  20. Variability among states in investigating foodborne disease outbreaks.

    PubMed

    Jones, Timothy F; Rosenberg, Lauren; Kubota, Kristy; Ingram, L Amanda

    2013-01-01

    Over 1,100 foodborne disease outbreaks cause over 23,000 illnesses in the United States annually, but the rates of outbreaks reported and successful investigation vary dramatically among states. We used data from the Centers for Disease Control and Prevention's outbreak reporting database, Association of Public Health Laboratories' PulseNet laboratory subtyping network survey and Salmonella laboratory survey, national public health surveillance data, and national surveys to examine potential causes of this variability. The mean rate of reporting of Salmonella outbreaks was higher in states requiring submission of all isolates to the state public health laboratory, compared to those that do not (5.9 vs. 4.1 per 10 million population, p=0.0062). Rates of overall outbreak reporting or successful identification of an etiology or food vehicle did not correlate at the state level with population, rates of sporadic disease reporting, health department organizational structure, or self-reported laboratory or epidemiologic capacity. Foodborne disease outbreak surveillance systems are complex, and improving them will require a multi-faceted approach to identifying and overcoming barriers.

  1. Scabies outbreaks in nursing homes for the elderly: recognition, treatment options and control of reinfestation.

    PubMed

    Tjioe, Milan; Vissers, Wynand H P M

    2008-01-01

    The scabies mite is an ectoparasite able to infest humans. Its clinical presentation is typical, although in immunocompromised, mentally retarded and elderly patients the clinical presentation may be altered. Diagnosis may therefore be difficult in such patient groups, who often reside in nursing homes. Because delay in diagnosis may induce rapid spread of the scabies mite, immediate diagnosis and treatment are necessary. Normal scabies (scabies vulgaris) and crusted scabies (scabies crustosa, scabies norvegica), although sometimes difficult to diagnose, especially in the elderly, are fortunately quite easy to treat. However, the elderly patient may experience toxicity from local or systemic scabicidal treatment. Single cases of scabies vulgaris should be treated with permethrin cream because of its outstanding efficacy and favourable adverse events profile. Scabies outbreaks and cases of scabies crustosa can easily be managed using combination therapy consisting of topical application of permethrin and two oral doses of ivermectin 200 microg/kg (administered 1 week apart). In addition to treatment of the scabies infestation, preventative measures are necessary, particularly in nursing homes.

  2. Seroprevalence of 2009 H1N1 virus infection and self-reported infection control practices among healthcare professionals following the first outbreak in Bangkok, Thailand.

    PubMed

    Chokephaibulkit, Kulkanya; Assanasen, Susan; Apisarnthanarak, Anucha; Rongrungruang, Yong; Kachintorn, Kanchana; Tuntiwattanapibul, Yuwadee; Judaeng, Tepnimitr; Puthavathana, Pilaipan

    2013-05-01

    A serologic study with simultaneous self-administered questionnaire regarding infection control (IC) practices and other risks of influenza A (H1N1) pdm09 (2009 H1N1) infection was performed approximately 1 month after the first outbreak among frontline healthcare professionals (HCPs). Of 256 HCPs, 33 (13%) were infected. Self-reported adherence to IC practices in >90% of exposure events was 82·1%, 73·8%, and 53·5% for use of hand hygiene, masks, and gloves, respectively. Visiting crowded public places during the outbreak was associated with acquiring infection (OR 3·1, P = 0·019). Amongst nurses, exposure to HCPs with influenza-like illness during the outbreak without wearing a mask was the only identified risk factor for infection (OR = 2·3, P = 0·039).

  3. Holding back the tiger: Successful control program protects Australia from Aedes albopictus expansion

    PubMed Central

    Devine, Gregor; Davis, Joseph; Crunkhorn, Bruce; van den Hurk, Andrew; Whelan, Peter; Russell, Richard; Walker, James; Horne, Peter; Ehlers, Gerhard; Ritchie, Scott

    2017-01-01

    islands were undetectable in 70–90% of surveys conducted. Importantly, a comprehensive surveillance network in selected strategic areas has not identified established populations of this species on the Australian mainland. Conclusions / Significance The program has successfully reduced Ae. albopictus populations on Thursday Island and Horn Island to levels where it is undetectable in up to 90% of surveys, and has largely removed the risk of mainland establishment via that route. The vector management strategies adopted in the later years of the program have been demonstrably successful and provide a practical management framework for dengue, chikungunya or Zika virus outbreaks vectored by Ae. albopictus. As of June 2016, Ae. albopictus had not established on the Australian mainland and this program has likely contributed significantly to this outcome. PMID:28192520

  4. An Infection Control Program for a 2009 Influenza A H1N1 Outbreak in a University-Based Summer Camp

    ERIC Educational Resources Information Center

    Tsalik, Ephraim L.; Cunningham, Coleen K.; Cunningham, Hannah M.; Lopez-Marti, Maria G.; Sangvai, Devdutta G.; Purdy, William K.; Anderson, Deverick J.; Thompson, Jessica R.; Brown, Monte; Woods, Christopher W.; Jaggers, L. Brett; Hendershot, Edward F.

    2011-01-01

    Objectives: Describe two 2009-H1N1 influenza outbreaks in university-based summer camps and the implementation of an infection control program. Participants: 7,906 campers across 73 residential camps from May 21-August 2, 2009. Methods: Influenza-like-illness (ILI) was defined as fever with cough and/or sore throat. Influenza A was identified…

  5. Planning for smallpox outbreaks

    NASA Astrophysics Data System (ADS)

    Ferguson, Neil M.; Keeling, Matt J.; John Edmunds, W.; Gani, Raymond; Grenfell, Bryan T.; Anderson, Roy M.; Leach, Steve

    2003-10-01

    Mathematical models of viral transmission and control are important tools for assessing the threat posed by deliberate release of the smallpox virus and the best means of containing an outbreak. Models must balance biological realism against limitations of knowledge, and uncertainties need to be accurately communicated to policy-makers. Smallpox poses the particular challenge that key biological, social and spatial factors affecting disease spread in contemporary populations must be elucidated largely from historical studies undertaken before disease eradication in 1979. We review the use of models in smallpox planning within the broader epidemiological context set by recent outbreaks of both novel and re-emerging pathogens.

  6. 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...

  7. Emergence and outbreak of carbapenemase-producing KPC-3 Klebsiella pneumoniae in Spain, September 2009 to February 2010: control measures.

    PubMed

    Robustillo Rodela, A; Díaz-Agero Pérez, C; Sanchez Sagrado, T; Ruiz-Garbajosa, P; Pita López, M J; Monge, V

    2012-02-16

    This report describes the epidemiological features of the first outbreak caused by KPC3 carbapenemase-producing Klebsiella pneumoniae (KPC-3-KP) in Spain and how it was effectively controlled. From 16 September 2009 to the end of February 2010, seven patients infected or colonised with KPC-3-KP were detected. Stool surveillance cultures were recovered from patients, doctors, nurses, nursing assistants, cleaners and hospital porters working in the affected units. Hand swabs were taken from workers and patients’ relatives for culturing. Environmental samples were also taken. Patients infected or colonised with KPC-3-KP were placed in single rooms under contact precautions and 4% chlorhexidine soap was used for their daily hygiene. Staff attended educational seminars and workshops on hand hygiene and isolation of patients. An alcohol-based disinfectant was used for surface cleaning and disinfecting. The floor was cleaned with a disinfectant containing benzalkonium chloride and didecyldimethylammonium. All samples collected were negative for KPC-3-KP. After implementing the control measures, no further cases were reported in the affected units. All cases had comorbidities, long hospital stay and aggressive/intensive antimicrobial treatment. This study emphasises the importance of early intensification of infection control to interrupt the transmission of KPC-producing organisms.

  8. Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital.

    PubMed

    Lucet, J C; Decré, D; Fichelle, A; Joly-Guillou, M L; Pernet, M; Deblangy, C; Kosmann, M J; Régnier, B

    1999-12-01

    Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) were isolated from clinical specimens from 130 to 140 patients/year in 1989-1991 in our hospital. In February 1992, a control program was initiated: screening tests in 3 intensive care units (ICUs) and contact-isolation precautions in all units. The septic surgical unit served as an isolation ward for surgical patients from whom ESBLPE was isolated. In 1992, the incidence of ESBLPE acquisition failed to decrease, and most acquisitions occurred in 3 ICUs. Critical evaluation of implementation of isolation procedures in these ICUs prompted corrective measures for barrier precautions. The incidence of acquired cases subsequently decreased, and a second evaluation determined that these measures had been correctly applied. The incidence of acquired cases in the septic surgical unit was lower than those in the other units. Decreases were also found in the incidence of acquisition of other hand-transmitted multidrug-resistant organisms. Barrier precautions, screening tests for ICU patients, and grouping of cohorts after ICU discharge are effective in controlling the spread of multidrug-resistant microorganisms by cross-contamination. The outbreak was effectively controlled without restricting antimicrobial use.

  9. Effects of a Five-Year Citywide Intervention Program To Control Aedes aegypti and Prevent Dengue Outbreaks in Northern Argentina

    PubMed Central

    Gürtler, Ricardo E.; Garelli, Fernando M.; Coto, Héctor D.

    2009-01-01

    Background Dengue has propagated widely through the Americas. Most countries have not been able to maintain permanent larval mosquito control programs, and the long-term effects of control actions have rarely been documented. Methodology The study design was based on a before-and-after citywide assessment of Aedes aegypti larval indices and the reported incidence of dengue in Clorinda, northeastern Argentina, over 2003–2007. Interventions were mainly based on focal treatment with larvicides of every mosquito developmental site every four months (14 cycles), combined with limited source reduction efforts and ultra-low-volume insecticide spraying during emergency operations. The program conducted 120,000 house searches for mosquito developmental sites and 37,000 larvicide applications. Principal Findings Random-effects regression models showed that Breteau indices declined significantly in nearly all focal cycles compared to pre-intervention indices clustered by neighborhood, after allowing for lagged effects of temperature and rainfall, baseline Breteau index, and surveillance coverage. Significant heterogeneity between neighborhoods was revealed. Larval indices seldom fell to 0 shortly after interventions at the same blocks. Large water-storage containers were the most abundant and likely to be infested. The reported incidence of dengue cases declined from 10.4 per 10,000 in 2000 (by DEN-1) to 0 from 2001 to 2006, and then rose to 4.5 cases per 10,000 in 2007 (by DEN-3). In neighboring Paraguay, the reported incidence of dengue in 2007 was 30.6 times higher than that in Clorinda. Conclusions Control interventions exerted significant impacts on larval indices but failed to keep them below target levels during every summer, achieved sustained community acceptance, most likely prevented new dengue outbreaks over 2003–2006, and limited to a large degree the 2007 outbreak. For further improvement, a shift is needed towards a multifaceted program with intensified

  10. Control of malaria: a successful experience from Viet Nam.

    PubMed Central

    Hung, Le Q.; Vries, Peter J. de; Giao, Phan T.; Nam, Nguyen V.; Binh, Tran Q.; Chong, M. T.; Quoc, N. T. T. A.; Thanh, T. N.; Hung, L. N.; Kager, P. A.

    2002-01-01

    OBJECTIVE: To follow malaria prospectively in an ethnic minority commune in the south of Viet Nam with high malaria transmission and seasonal fluctuation, during malaria control interventions using insecticide-treated bednets (ITBNs) and early diagnosis and treatment (EDT) of symptomatic patients. METHODS: From 1994 onwards the following interventions were used: distribution of ITBNs to all households with biannual reimpregnation; construction of a health post and appointment of staff trained in microscopic diagnosis and treatment of malaria; regular supply of materials and drugs; annual cross-sectional malaria surveys with treatment of all parasitaemic subjects, and a programme of community involvement and health education. Surveys were held yearly at the end of the rainy season. During the surveys, demographic data were updated. Diagnosis and treatment of malaria were free of charge. Plasmodium falciparum infection was treated with artesunate and P. vivax infection with chloroquine plus primaquine. FINDINGS: The baseline survey in 1994 recorded 716 inhabitants. Of the children under 2 years of age, 37% were parasitaemic; 56% of children aged 2-10 years, and 35% of the remaining population were parasitaemic. P. falciparum accounted for 73-79% of these infections. The respective splenomegaly rates for the above-mentioned age groups were 20%, 56%, and 32%. In 1999, the proportion of parasitaemic subjects was 4%, 7% and 1%, respectively, of which P.falciparum contributed 56%. The splenomegaly rate was 0%, 5% and 2%, respectively. CONCLUSIONS: A combination of ITBNs and EDT, provided free of charge, complemented by annual diagnosis and treatment during malaria surveys and community involvement with health education successfully brought malaria under control. This approach could be applied to other regions in the south of Viet Nam and provides a sound basis for further studies in other areas with different epidemiological patterns of malaria. PMID:12219158

  11. Lactococcus garvieae outbreaks in Brazilian farms Lactococcosis in Pseudoplatystoma sp. - development of an autogenous vaccine as a control strategy.

    PubMed

    Fukushima, H C S; Leal, C A G; Cavalcante, R B; Figueiredo, H C P; Arijo, S; Moriñigo, M A; Ishikawa, M; Borra, R C; Ranzani-Paiva, M J T

    2017-02-01

    This study evaluated the control of streptococcosis outbreaks in Brazil, isolated from diseased sorubim and identified as Lactococcus garvieae by genetic sequencing. This report determined the potential for lactococcosis control in sorubim Pseudoplatystoma sp. with two vaccines: an aqueous-based, whole-cell inactivated vaccine (bacterin) and an oil-adjuvanted bacterin. Their efficacy was evaluated at 30 days post-vaccination (d.p.v.) by challenge with L. garvieae, and the antibody production response at 15, 30 and 60 d.p.v. and the non-specific immune response were compared amongst treatments. High protection levels (P < 0.05) were achieved with the oil-adjuvanted vaccine with a relative percentage survival value of 81.7% at 30 d.p.v. Additionally, the oil-adjuvanted vaccine increased the immunogenicity of the bacterin as indicated by greater agglutination antibody titres from 15 until 60 d.p.v. This is the first report of a positive effect of vaccine administration on the specific immunity of sorubim, and the study showed that a specific antibody plays an important role in sorubim defence against lactococcosis because the innate immune responses were similar in all of the studied animals. These results demonstrated that oil-adjuvanted vaccine can be an effective alternative for the protection of sorubim from L. garvieae disease.

  12. Conditioned food aversion to control outbreaks of intoxication by Ipomoea carnea and Turbina cordata in goats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Conditioned food aversion is used to train livestock to avoid the ingestion of toxic plants. This technique was used to control Turbina cordata poisoning in goats in one farm, and to control Ipomoea carnea subsp. istulosa poisoning in another farm. The goats were penned at night and the next mornin...

  13. Correlates of Successful Response to a Behavioral Weight Control Clinic.

    ERIC Educational Resources Information Center

    And Others; Gormally, Jim

    1980-01-01

    Initial weight-loss success was correlated with two severity variables. Persons reporting frequent binge eating and histories of previous dieting weight loss lost the most weight. Persons who were successful at maintenance used frequent exercise. Those who relapsed reported high levels of stress during follow-up. (Author)

  14. Use of the CDC Autocidal Gravid Ovitrap to Control and Prevent Outbreaks of Aedes aegypti (Diptera: Culicidae)

    PubMed Central

    Barrera, Roberto; Amador, Manuel; Acevedo, Veronica; Caban, Belkis; Felix, Gilberto; Mackay, Andrew J.

    2015-01-01

    Populations of Aedes aegypti (L.) can be managed through reductions in adult mosquito survival, number of offspring produced, or both. Direct adult mortality can be caused by the use of space sprays or residual insecticides to mosquito resting sites, and with a variety of residual insecticide-impregnated surfaces that are being tested, such as curtains, covers for water-storage vessels, bednets, and ovitraps. The fertility of Ae. aegypti populations can be reduced by the use of autocidal oviposition cups that prevent the development of mosquitoes inside the trap by mechanical means or larvicides, as well as by releasing sterile, transgenic, and para-transgenic mosquitoes. Survival and fertility can be simultaneously reduced by capturing gravid female Ae. aegypti with sticky gravid traps. We tested the effectiveness of the novel Centers for Disease Control and Prevention autocidal gravid ovitrap (CDC-AGO trap) to control natural populations of Ae. aegypti under field conditions in two isolated urban areas (reference vs. intervention areas) in southern Puerto Rico for 1 yr. There were significant reductions in the captures of female Ae. aegypti (53–70%) in the intervention area. The presence of three to four AGO control traps per home in 81% of the houses prevented outbreaks of Ae. aegypti, which would be expected after rains. Mosquito captures in BG-Sentinel and AGO traps were significantly and positively correlated, showing that AGO traps are useful and inexpensive mosquito surveillance devices. The use of AGO traps to manage Ae. aegypti populations is compatible with other control means such as source reduction, larviciding, adulticiding, sterile insect techniques, induced cytoplasmic incompatibility, and dominant lethal gene systems. PMID:24605464

  15. Use of the CDC autocidal gravid ovitrap to control and prevent outbreaks of Aedes aegypti (Diptera: Culicidae).

    PubMed

    Barrera, Roberto; Amador, Manuel; Acevedo, Veronica; Caban, Belkis; Felix, Gilberto; Mackay, Andrew J

    2014-01-01

    Populations ofAedes aegypti (L.) can be managed through reductions in adult mosquito survival, number of offspring produced, or both. Direct adult mortality can be caused by the use of space sprays or residual insecticides to mosquito resting sites, and with a variety of residual insecticide-impregnated surfaces that are being tested, such as curtains, covers for water-storage vessels, bednets, and ovitraps. The fertility ofAe. aegypti populations can be reduced by the use of autocidal oviposition cups that prevent the development of mosquitoes inside the trap by mechanical means or larvicides, as well as by releasing sterile, transgenic, and para-transgenic mosquitoes. Survival and fertility can be simultaneously reduced by capturing gravid female Ae. aegypti with sticky gravid traps. We tested the effectiveness of the novel Centers for Disease Control and Prevention autocidal gravid ovitrap (CDC-AGO trap) to control natural populations ofAe. aegypti under field conditions in two isolated urban areas (reference vs. intervention areas) in southern Puerto Rico for 1 yr. There were significant reductions in the captures of female Ae. aegypti (53-70%) in the intervention area The presence of three to four AGO control traps per home in 81% of the houses prevented outbreaks of Ae. aegypti, which would be expected after rains. Mosquito captures in BG-Sentinel and AGO traps were significantly and positively correlated, showing that AGO traps are useful and inexpensive mosquito surveillance devices. The use of AGO traps to manage Ae. aegypti populations is compatible with other control means such as source reduction, larviciding, adulticiding, sterile insect techniques, induced cytoplasmic incompatibility, and dominant lethal gene systems.

  16. Outbreak investigation and case-control study: penta-resistant Salmonella Typhimurium DT104 associated with biltong in London in 2008.

    PubMed

    Mindlin, M J; Lang, N; Maguire, H; Walsh, B; Verlander, N Q; Lane, C; Taylor, C; Bishop, L A; Crook, P D

    2013-09-01

    In August 2008 an outbreak of Salmonella Typhimurium DT104 occurred in South West London. Sixteen cases were identified with a particular multilocus variable number tandem repeat analysis (MLVA) pattern. In a matched case-control study 14 primary cases were included. These were defined as individuals with gastrointestinal symptoms and Salmonella Typhimurium DT104 isolated from a stool specimen, with a characteristic antibiotic resistance profile and MLVA pattern, and diagnosed in a local laboratory. Four controls per case were matched on age, gender and area of residence. Cases were 26 times more likely than controls to have eaten beef biltong, a South African speciality meat product (odds ratio 25·83, 95% confidence interval 4·92–135·59, P < 0·01). Although environmental investigation failed to identify Salmonella in the food product we conclude that beef biltong consumption led to this outbreak. This conclusion has importance in informing the ongoing risk assessment relating to uncontrolled foodstuffs.

  17. 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.

  18. Improved husbandry to control an outbreak of rainbow trout fry syndrome caused by infection with Flavobacterium psychrophilum

    USGS Publications Warehouse

    Bebak, J.A.; Welch, T.J.; Starliper, C.E.; Baya, A.M.; Garner, M.M.

    2007-01-01

    Case Description - A cohort of 35,200, 13-week-old, female rainbow trout at a fish farm was evaluated because of a 2-week history of anorexia and lethargy and a mortality rate of approximately 100 fish/d. Clinical Findings - Affected fish were lethargic and thin and had disequilibrium, bilateral exophthalmia, pale red gills and kidneys, red-tinged coelomic fluid, and pale brown livers. Some fish were differentially pigmented bilaterally. The presumptive diagnosis was bacterial or viral septicemia. The definitive diagnosis was rainbow trout fry syndrome caused by infection with Flavobacterium psychrophilum. Treatment and Outcome - A strategy for controlling the outbreak based on reducing pathogen numbers in affected tanks and reducing pathogen spread among tanks was developed. The option of treating with antimicrobial-medicated feed was discussed with the farmer, but was declined. After changes were made, mortality rate declined quickly, with no more deaths within 10 days after the initial farm visit. Clinical Relevance - Bacterial coldwater disease is the most common manifestation of infection with F psychrophilum in fingerling and adult rainbow trout. However, the organism can also cause rainbow trout fry syndrome. This condition should be included on a list of differential diagnoses for septicemia in hatchery-reared rainbow trout fry.

  19. 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

  20. There's no place like home: crown-of-thorns outbreaks in the central pacific are regionally derived and independent events.

    PubMed

    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.

  1. 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

  2. Middle East respiratory syndrome coronavirus: transmission, virology and therapeutic targeting to aid in outbreak control

    PubMed Central

    Durai, Prasannavenkatesh; Batool, Maria; Shah, Masaud; Choi, Sangdun

    2015-01-01

    Middle East respiratory syndrome coronavirus (MERS-CoV) causes high fever, cough, acute respiratory tract infection and multiorgan dysfunction that may eventually lead to the death of the infected individuals. MERS-CoV is thought to be transmitted to humans through dromedary camels. The occurrence of the virus was first reported in the Middle East and it subsequently spread to several parts of the world. Since 2012, about 1368 infections, including ~487 deaths, have been reported worldwide. Notably, the recent human-to-human ‘superspreading' of MERS-CoV in hospitals in South Korea has raised a major global health concern. The fatality rate in MERS-CoV infection is four times higher compared with that of the closely related severe acute respiratory syndrome coronavirus infection. Currently, no drug has been clinically approved to control MERS-CoV infection. In this study, we highlight the potential drug targets that can be used to develop anti-MERS-CoV therapeutics. PMID:26315600

  3. EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD).

    PubMed

    Mao, Qun-ying; Wang, Yiping; Bian, Lianlian; Xu, Miao; Liang, Zhenglun

    2016-05-01

    On December 3rd 2015, the China Food and Drug Administration (CFDA) approved the first inactivated Enterovirus 71 (EV71) whole virus vaccine for preventing severe hand, foot and mouth disease (HFMD). As one of the few preventive vaccines for children's infectious diseases generated by the developing countries in recent years, EV71 vaccine is a blessing to children's health in China and worldwide. However, there are still a few challenges facing the worldwide use of EV71 vaccine, including the applicability against various EV71 pandemic strains in other countries, international requirements on vaccine production and quality control, standardization and harmonization on different pathogen monitoring and detecting methods, etc. In addition, the affordability of EV71 vaccine in other countries is a factor to be considered in HFMD prevention. Therefore, with EV71 vaccine commercially available, there is still a long way to go before reaching effective protection against severe HFMD after EV71 vaccines enter the market. In this paper, the bottlenecks and prospects for the wide use of EV71 vaccine after its approval are evaluated.

  4. Can Contextual Cues Control Consummatory Successive Negative Contrast?

    ERIC Educational Resources Information Center

    Daniel, Alan M.; Wood, Michael; Pellegrini, Santiago; Norris, Jacob N.; Papini, Mauricio R.

    2008-01-01

    Rats exposed to incentive downshift show behavioral deterioration. This phenomenon, called successive negative contrast (SNC), occurs in instrumental and consummatory responses (iSNC, cSNC). Whereas iSNC is related to the violation of reward expectancies retrieved in anticipation of the goal (cued-recall), cSNC involves reward rejection and may…

  5. Results of a Randomized Controlled Trial of Student Success Skills

    ERIC Educational Resources Information Center

    Webb, Linda; Carey, John; Villares, Elizabeth; Wells, Craig; Sayer, Aline

    2014-01-01

    Numerous authors have reviewed research to determine which skills are considered fundamental to successful academic and social outcomes for students (Hattie, Briggs, & Purdie, 1996; Masten & Coatworth, 1998; Wang, Haertel, & Walberg, 1994; Zins, Weissberg, Wang, & Walberg, 2004). These skills include: (1) cognitive and…

  6. Controlling Your Environment and Yourself: Implications for Career Success

    ERIC Educational Resources Information Center

    Converse, Patrick D.; Pathak, Jaya; DePaul-Haddock, Anne Marie; Gotlib, Tomer; Merbedone, Matthew

    2012-01-01

    Given the complex and rapidly changing nature of the current work environment, individuals' capabilities to effectively influence their environment and regulate their behavior may be critical to career success. Drawing from the model of emergent interactive agency (Bandura, 1989), the current research examines this perspective, focusing on…

  7. Lessons for control of heroin-associated anthrax in Europe from 2009-2010 outbreak case studies, London, UK.

    PubMed

    Abbara, Aula; Brooks, Tim; Taylor, Graham P; Nolan, Marianne; Donaldson, Hugo; Manikon, Maribel; Holmes, Alison

    2014-07-01

    Outbreaks of serious infections associated with heroin use in persons who inject drugs (PWIDs) occur intermittently and require vigilance and rapid reporting of individual cases. Here, we give a firsthand account of the cases in London during an outbreak of heroin-associated anthrax during 2009-2010 in the United Kingdom. This new manifestation of anthrax has resulted in a clinical manifestation distinct from already recognized forms. During 2012-13, additional cases of heroin-associated anthrax among PWIDs in England and other European countries were reported, suggesting that anthrax-contaminated heroin remains in circulation. Antibacterial drugs used for serious soft tissue infection are effective against anthrax, which may lead to substantial underrecognition of this novel illness. The outbreak in London provides a strong case for ongoing vigilance and the use of serologic testing in diagnosis and serologic surveillance schemes to determine and monitor the prevalence of anthrax exposure in the PWID community.

  8. Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK

    PubMed Central

    Abbara, Aula; Brooks, Tim; Taylor, Graham P.; Nolan, Marianne; Donaldson, Hugo; Manikon, Maribel

    2014-01-01

    Outbreaks of serious infections associated with heroin use in persons who inject drugs (PWIDs) occur intermittently and require vigilance and rapid reporting of individual cases. Here, we give a firsthand account of the cases in London during an outbreak of heroin-associated anthrax during 2009–2010 in the United Kingdom. This new manifestation of anthrax has resulted in a clinical manifestation distinct from already recognized forms. During 2012–13, additional cases of heroin-associated anthrax among PWIDs in England and other European countries were reported, suggesting that anthrax-contaminated heroin remains in circulation. Antibacterial drugs used for serious soft tissue infection are effective against anthrax, which may lead to substantial underrecognition of this novel illness. The outbreak in London provides a strong case for ongoing vigilance and the use of serologic testing in diagnosis and serologic surveillance schemes to determine and monitor the prevalence of anthrax exposure in the PWID community. PMID:24959910

  9. The One Health approach to identify knowledge, attitudes and practices that affect community involvement in the control of Rift Valley fever outbreaks

    PubMed Central

    Hassan, Osama Ahmed; Affognon, Hippolyte; Rocklöv, Joacim; Mburu, Peter; Sang, Rosemary; Ahlm, Clas; Evander, Magnus

    2017-01-01

    Rift Valley fever (RVF) is a viral mosquito-borne disease with the potential for global expansion, causes hemorrhagic fever, and has a high case fatality rate in young animals and in humans. Using a cross-sectional community-based study design, we investigated the knowledge, attitudes and practices of people living in small village in Sudan with respect to RVF outbreaks. A special One Health questionnaire was developed to compile data from 235 heads of household concerning their knowledge, attitudes, and practices with regard to controlling RVF. Although the 2007 RVF outbreak in Sudan had negatively affected the participants’ food availability and livestock income, the participants did not fully understand how to identify RVF symptoms and risk factors for both humans and livestock. For example, the participants mistakenly believed that avoiding livestock that had suffered spontaneous abortions was the least important risk factor for RVF. Although the majority noticed an increase in mosquito population during the 2007 RVF outbreak, few used impregnated bed nets as preventive measures. The community was reluctant to notify the authorities about RVF suspicion in livestock, a sentinel for human RVF infection. Almost all the respondents stressed that they would not receive any compensation for their dead livestock if they notified the authorities. In addition, the participants believed that controlling RVF outbreaks was mainly the responsibility of human health authorities rather than veterinary authorities. The majority of the participants were aware that RVF could spread from one region to another within the country. Participants received most their information about RVF from social networks and the mass media, rather than the health system or veterinarians. Because the perceived role of the community in controlling RVF was fragmented, the probability of RVF spread increased. PMID:28207905

  10. 7 CFR 4288.137 - Succession and loss of control of advanced biofuel facilities and production.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Succession and loss of control of advanced biofuel... PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.137 Succession and loss of control of advanced biofuel facilities and production. (a) Contract succession. An entity who becomes the...

  11. 7 CFR 4288.137 - Succession and loss of control of advanced biofuel facilities and production.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Succession and loss of control of advanced biofuel... PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.137 Succession and loss of control of advanced biofuel facilities and production. (a) Contract succession. An entity...

  12. 7 CFR 4288.137 - Succession and loss of control of advanced biofuel facilities and production.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Succession and loss of control of advanced biofuel... PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.137 Succession and loss of control of advanced biofuel facilities and production. (a) Contract succession. An entity who becomes the...

  13. A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012.

    PubMed

    Umulisa, Irenee; Omolo, Jared; Muldoon, Katherine A; Condo, Jeanine; Habiyaremye, Francois; Uwimana, Jean Marie; Muhimpundu, Marie Aimee; Galgalo, Tura; Rwunganira, Samuel; Dahourou, Anicet G; Tongren, Eric; Koama, Jean Baptiste; McQuiston, Jennifer; Raghunathan, Pratima L; Massung, Robert; Gatei, Wangeci; Boer, Kimberly; Nyatanyi, Thierry; Mills, Edward J; Binagwaho, Agnes

    2016-08-03

    In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1-5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6-9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0-11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10-0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.

  14. Investigation of a staphylococcal food poisoning outbreak combining case-control, traditional typing and whole genome sequencing methods, Luxembourg, June 2014.

    PubMed

    Mossong, Joël; Decruyenaere, Frédéric; Moris, Gilbert; Ragimbeau, Catherine; Olinger, Christophe M; Johler, Sophia; Perrin, Monique; Hau, Patrick; Weicherding, Pierre

    2015-01-01

    In June 2014, a staphylococcal food poisoning outbreak occurred at an international equine sports event in Luxembourg requiring the hospitalisation of 31 persons. We conducted a microbiological investigation of patients and buffet items, a case-control study and a carriage study of catering staff. Isolates of Staphylococcus aureus from patients, food and catering staff were characterised and compared using traditional typing methods and whole genome sequencing. Genotypically identical strains (sequence type ST8, spa-type t024, MLVA-type 4698, enterotoxin A FRI100) were isolated in 10 patients, shiitake mushrooms, cured ham, and in three members of staff. The case-control study strongly suggested pasta salad with pesto as the vehicle of infection (p<0.001), but this food item could not be tested, because there were no leftovers. Additional enterotoxigenic strains genetically unrelated to the outbreak strain were found in four members of staff. Non-enterotoxigenic strains with livestock-associated sequence type ST398 were isolated from three food items and two members of staff. The main cause of the outbreak is likely to have been not maintaining the cold chain after food preparation. Whole genome sequencing resulted in phylogenetic clustering which concurred with traditional typing while simultaneously characterising virulence and resistance traits.

  15. Control of a Reassortant Pandemic 2009 H1N1 Influenza Virus Outbreak in an Intensive Swine Breeding Farm: Effect of Vaccination and Enhanced Farm Management Practices.

    PubMed

    Mughini-Gras, Lapo; Beato, Maria Serena; Angeloni, Giorgia; Monne, Isabella; Buniolo, Filippo; Zuliani, Federica; Morini, Matteo; Castellan, Alberto; Bonfanti, Lebana; Marangon, Stefano

    2015-04-13

    Influenza A viruses in swine cause considerable economic losses and raise concerns about their zoonotic potential. The current paucity of thorough empirical assessments of influenza A virus infection levels in swine herds under different control interventions hinders our understanding of their effectiveness. Between 2012 and 2013, recurrent outbreaks of respiratory disease caused by a reassortant pandemic 2009 H1N1 (H1N1pdm) virus were registered in a swine breeding farm in North-East Italy, providing the opportunity to assess an outbreak response plan based on vaccination and enhanced farm management. All sows/gilts were vaccinated with a H1N1pdm-specific vaccine, biosecurity was enhanced, weaning cycles were lengthened, and cross-fostering of piglets was banned. All tested piglets had maternally-derived antibodies at 30 days of age and were detectable in 5.3% of ~90 day-old piglets. There was a significant reduction in H1N1pdm RT-PCR detections after the intervention. Although our study could not fully determine the extent to which the observed trends in seropositivity or RT-PCR positivity among piglets were due to the intervention or to the natural course of the disease in the herd, we provided suggestive evidence that the applied measures were useful in controlling the outbreak, even without an all-in/all-out system, while keeping farm productivity at full.

  16. Control of a Reassortant Pandemic 2009 H1N1 Influenza Virus Outbreak in an Intensive Swine Breeding Farm: Effect of Vaccination and Enhanced Farm Management Practices

    PubMed Central

    Mughini-Gras, Lapo; Beato, Maria Serena; Angeloni, Giorgia; Monne, Isabella; Buniolo, Filippo; Zuliani, Federica; Morini, Matteo; Castellan, Alberto; Bonfanti, Lebana; Marangon, Stefano

    2015-01-01

    Influenza A viruses in swine cause considerable economic losses and raise concerns about their zoonotic potential. The current paucity of thorough empirical assessments of influenza A virus infection levels in swine herds under different control interventions hinders our understanding of their effectiveness. Between 2012 and 2013, recurrent outbreaks of respiratory disease caused by a reassortant pandemic 2009 H1N1 (H1N1pdm) virus were registered in a swine breeding farm in North-East Italy, providing the opportunity to assess an outbreak response plan based on vaccination and enhanced farm management. All sows/gilts were vaccinated with a H1N1pdm-specific vaccine, biosecurity was enhanced, weaning cycles were lengthened, and cross-fostering of piglets was banned. All tested piglets had maternally-derived antibodies at 30 days of age and were detectable in 5.3% of ~90 day-old piglets. There was a significant reduction in H1N1pdm RT-PCR detections after the intervention. Although our study could not fully determine the extent to which the observed trends in seropositivity or RT-PCR positivity among piglets were due to the intervention or to the natural course of the disease in the herd, we provided suggestive evidence that the applied measures were useful in controlling the outbreak, even without an all-in/all-out system, while keeping farm productivity at full. PMID:25932349

  17. Developmental Transitions as Successive Reorganizations of a Control Hierarchy.

    ERIC Educational Resources Information Center

    Plooij, Frans X.; And Others

    1990-01-01

    Describes two studies involving chimpanzee mother-infant pairs in Tanzania between 1980 and 1987 that implemented control theory concepts. The first identified behavioral development in infant chimps; the second observed the growth of independence and parenting patterns. Concludes that the hierarchy of controlled variables develops consecutively…

  18. Applying Bayesian network modelling to understand the links between on-farm biosecurity practice during the 2007 equine influenza outbreak and horse managers' perceptions of a subsequent outbreak.

    PubMed

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

    2014-10-01

    Australia experienced its first ever outbreak of equine influenza in August 2007. Horses on 9359 premises were infected over a period of 5 months before the disease was successfully eradicated through the combination of horse movement controls, on-farm biosecurity and vaccination. In a previous premises-level case-control study of the 2007 equine influenza outbreak in Australia, the protective effect of several variables representing on-farm biosecurity practices were identified. Separately, factors associated with horse managers' perceptions of the effectiveness of biosecurity measures have been identified. In this analysis we applied additive Bayesian network modelling to describe the complex web of associations linking variables representing on-farm human behaviours during the 2007 equine influenza outbreak (compliance or lack thereof with advised personal biosecurity measures) and horse managers' perceptions of the effectiveness of such measures in the event of a subsequent outbreak. Heuristic structure discovery enabled identification of a robust statistical model for 31 variables representing biosecurity practices and perceptions of the owners and managers of 148 premises. The Bayesian graphical network model we present statistically describes the associations linking horse managers' on-farm biosecurity practices during an at-risk period in the 2007 outbreak and their perceptions of whether such measures will be effective in a future outbreak. Practice of barrier infection control measures were associated with a heightened perception of preparedness, whereas horse managers that considered their on-farm biosecurity to be more stringent during the outbreak period than normal practices had a heightened perception of the effectiveness of other measures such as controlling access to the premises. Past performance in an outbreak setting may indeed be a reliable predictor of future perceptions, and should be considered when targeting infection control guidance to

  19. Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden

    PubMed Central

    2012-01-01

    Background The first outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in horses in Sweden occurred in 2008 at the University Animal Hospital and highlighted the need for improved infection prevention and control. The present study describes interventions and infection prevention control in an equine hospital setting July 2008 - April 2010. Method This descriptive study of interventions is based on examination of policy documents, medical records, notes from meetings and cost estimates. MRSA cases were identified through clinical sampling and telephone enquiries about horses post-surgery. Prospective sampling in the hospital environment with culture for MRSA and genotyping of isolates by spa-typing and pulsed-field gel electrophoresis (PFGE) were performed. Results Interventions focused on interruption of indirect contact spread of MRSA between horses via staff and equipment and included: Temporary suspension of elective surgery; and identification and isolation of MRSA-infected horses; collaboration was initiated between authorities in animal and human public health, human medicine infection control and the veterinary hospital; extensive cleaning and disinfection was performed; basic hygiene and cleaning policies, staff training, equipment modification and interior renovation were implemented over seven months. Ten (11%) of 92 surfaces sampled between July 2008 and April 2010 tested positive for MRSA spa-type 011, seven of which were from the first of nine sampling occasions. PFGE typing showed the isolates to be the outbreak strain (9 of 10) or a closely related strain. Two new cases of MRSA infection occurred 14 and 19 months later, but had no proven connections to the outbreak cases. Conclusions Collaboration between relevant authorities and the veterinary hospital and formation of an infection control committee with an executive working group were required to move the intervention process forward. Support from hospital management and the

  20. Forecasting Infectious Disease Outbreaks

    NASA Astrophysics Data System (ADS)

    Shaman, J. L.

    2015-12-01

    Dynamic models of infectious disease systems abound and are used to study the epidemiological characteristics of disease outbreaks, the ecological mechanisms affecting transmission, and the suitability of various control and intervention strategies. The dynamics of disease transmission are non-linear and consequently difficult to forecast. Here, we describe combined model-inference frameworks developed for the prediction of infectious diseases. We show that accurate and reliable predictions of seasonal influenza outbreaks can be made using a mathematical model representing population-level influenza transmission dynamics that has been recursively optimized using ensemble data assimilation techniques and real-time estimates of influenza incidence. Operational real-time forecasts of influenza and other infectious diseases have been and are currently being generated.

  1. Control of fluoroquinolone resistance through successful regulation, Australia.

    PubMed

    Cheng, Allen C; Turnidge, John; Collignon, Peter; Looke, David; Barton, Mary; Gottlieb, Thomas

    2012-09-01

    Fluoroquinolone antimicrobial drugs are highly bioavailable, broad-spectrum agents with activity against gram-negative pathogens, especially those resistant to other classes of antimicrobial drugs. Australia has restricted the use of quinolones in humans through its national pharmaceutical subsidy scheme; and, through regulation, has not permitted the use of quinolones in food-producing animals. As a consequence, resistance to fluoroquinolones in the community has been slow to emerge and has remained at low levels in key pathogens, such as Escherichia coli. In contrast to policies in most other countries, this policy has successfully preserved the utility of this class of antimicrobial drugs for treatment of most infections.

  2. 76 FR 45600 - Order of Succession for the Office of Healthy Homes and Lead Hazard Control

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-29

    ... URBAN DEVELOPMENT Order of Succession for the Office of Healthy Homes and Lead Hazard Control AGENCY: Office of Healthy Homes and Lead Hazard Control, HUD. ACTION: Notice of Order of Succession. SUMMARY: In this notice, the Director of the Office of Healthy Homes and Lead Hazard Control for the Department...

  3. Nanopore Sequencing as a Rapidly Deployable Ebola Outbreak Tool.

    PubMed

    Hoenen, Thomas; Groseth, Allison; Rosenke, Kyle; Fischer, Robert J; Hoenen, Andreas; Judson, Seth D; Martellaro, Cynthia; Falzarano, Darryl; Marzi, Andrea; Squires, R Burke; Wollenberg, Kurt R; de Wit, Emmie; Prescott, Joseph; Safronetz, David; van Doremalen, Neeltje; Bushmaker, Trenton; Feldmann, Friederike; McNally, Kristin; Bolay, Fatorma K; Fields, Barry; Sealy, Tara; Rayfield, Mark; Nichol, Stuart T; Zoon, Kathryn C; Massaquoi, Moses; Munster, Vincent J; Feldmann, Heinz

    2016-02-01

    Rapid sequencing of RNA/DNA from pathogen samples obtained during disease outbreaks provides critical scientific and public health information. However, challenges exist for exporting samples to laboratories or establishing conventional sequencers in remote outbreak regions. We successfully used a novel, pocket-sized nanopore sequencer at a field diagnostic laboratory in Liberia during the current Ebola virus outbreak.

  4. Successful risk assessment may not always lead to successful risk control: A systematic literature review of risk control after root cause analysis.

    PubMed

    Card, Alan J; Ward, James; Clarkson, P John

    2012-01-01

    Root cause analysis is perhaps the most widely used tool in healthcare risk management, but does it actually lead to successful risk control? Are there categories of risk control that are more likely to be effective? And do healthcare risk managers have the tools they need to support the risk control process? This systematic review examines how the healthcare sector translates risk analysis to risk control action plans and examines how to do better. It suggests that the hierarchy of risk controls should inform risk control action planning and that new tools should be developed to improve the risk control process.

  5. Community Attitudes toward Mass Drug Administration for Control and Elimination of Neglected Tropical Diseases after the 2014 Outbreak of Ebola Virus Disease in Lofa County, Liberia

    PubMed Central

    Bogus, Joshua; Gankpala, Lincoln; Fischer, Kerstin; Krentel, Alison; Weil, Gary J.; Fischer, Peter U.; Kollie, Karsor; Bolay, Fatorma K.

    2016-01-01

    The recent outbreak of Ebola virus disease (EVD) interrupted mass drug administration (MDA) programs to control and eliminate neglected tropical diseases in Liberia. MDA programs treat entire communities with medication regardless of infection status to interrupt transmission and eliminate lymphatic filariasis and onchocerciasis. Following reports of hostilities toward health workers and fear that they might be spreading EVD, it was important to determine whether attitudes toward MDA might have changed after the outbreak. We surveyed 140 community leaders from 32 villages in Lofa County, Liberia, that had previously participated in MDA and are located in an area that was an early epicenter of the EVD outbreak. Survey respondents reported a high degree of community trust in the MDA program, and 97% thought their communities were ready to resume MDA. However, respondents predicted that fewer people would comply with MDA after the EVD epidemic than before. The survey also uncovered fears in the community that EVD and MDA might be linked. Respondents suggested that MDA programs emphasize to people that the medications are identical to those previously distributed and that MDA programs have nothing to do with EVD. PMID:26666700

  6. Predictors of successful self control during brain-computer communication

    PubMed Central

    Neumann, N; Birbaumer, N

    2003-01-01

    Objectives: Direct brain-computer communication uses self regulation of brain potentials to select letters, words, or symbols from a computer menu to re-establish communication in severely paralysed patients. However, not all healthy subjects, or all paralysed patients acquire the skill to self regulate their brain potentials, and predictors of successful learning have not been found yet. Predictors are particularly important, because only successful self regulation will in the end lead to efficient brain-computer communication. This study investigates the question whether initial performance in the self regulation of slow cortical potentials of the brain (SCPs) may be positively correlated to later performance and could thus be used as a predictor. Methods: Five severely paralysed patients diagnosed with amyotrophic lateral sclerosis were trained to produce SCP amplitudes of negative and positive polarity by means of visual feedback and operant conditioning strategies. Performance was measured as percentage of correct SCP amplitude shifts. To determine the relation between initial and later performance in SCP self regulation, Spearman's rank correlations were calculated between maximum and mean performance at the beginning of training (runs 1–30) and mean performance at two later time points (runs 64–93 and 162–191). Results: Spearman's rank correlations revealed a significant relation between maximum and mean performance in runs 1–30 and mean performance in runs 64–93 (r= 0.9 and 1.0) and maximum and mean performance in runs 1–30 and mean performance in runs 162–191 (r=1.0 and 1.0). Conclusions: Initial performance in the self regulation of SCP is positively correlated with later performance in severely paralysed patients, and thus represents a useful predictor for efficient brain-computer communication. PMID:12876247

  7. Successful emotion regulation requires both conviction and skill: beliefs about the controllability of emotions, reappraisal, and regulation success.

    PubMed

    Gutentag, Tony; Halperin, Eran; Porat, Roni; Bigman, Yochanan E; Tamir, Maya

    2016-08-05

    To succeed in self-regulation, people need to believe that it is possible to change behaviour and they also need to use effective means to enable such a change. We propose that this also applies to emotion regulation. In two studies, we found that people were most successful in emotion regulation, the more they believed emotions can be controlled and the more they used an effective emotion regulation strategy - namely, cognitive reappraisal. Cognitive reappraisal moderated the link between beliefs about the controllability of emotion and success in emotion regulation, when reappraisal was measured as a trait (Study 1) or manipulated (Study 2). Such moderation was found when examining the regulation of disgust elicited by emotion-inducing films (Study 1), and the regulation of anger elicited by real political events (Study 2). We discuss the implications of our findings for research and practice in emotion regulation.

  8. Tobacco industry successfully prevented tobacco control legislation in Argentina

    PubMed Central

    Sebrie, E; Barnoya, J; Perez-Stable, E; Glantz, S

    2005-01-01

    Objective: To evaluate how transnational tobacco companies, working through their local affiliates, influenced tobacco control policymaking in Argentina between 1966 and 2005. Methods: Analysis of internal tobacco industry documents, local newspapers and magazines, internet resources, bills from the Argentinean National Congress Library, and interviews with key individuals in Argentina. Results: Transnational tobacco companies (Philip Morris International, British American Tobacco, Lorillard, and RJ Reynolds International) have been actively influencing public health policymaking in Argentina since the early 1970s. As in other countries, in 1977 the tobacco industry created a weak voluntary self regulating code to avoid strong legislated restrictions on advertising. In addition to direct lobbying by the tobacco companies, these efforts involved use of third party allies, public relations campaigns, and scientific and medical consultants. During the 1980s and 1990s efforts to pass comprehensive tobacco control legislation intensified, but the organised tobacco industry prevented its enactment. There has been no national activity to decrease exposure to secondhand smoke. Conclusions: The tobacco industry, working through its local subsidiaries, has subverted meaningful tobacco control legislation in Argentina using the same strategies as in the USA and other countries. As a result, tobacco control in Argentina remains governed by a national law that is weak and restricted in its scope. PMID:16183967

  9. Successful biological control of tropical soda apple in Florida

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tropical soda apple, Solanum viarum, is a small shrub native to tropical regions of Brazil, Paraguay, and Argentina. This weed was first found in Florida in 1988. In May 2003, a leaf feeding beetle, Gratiana boliviana, from South America was released in Florida as a biological control agent of tro...

  10. Anillin Phosphorylation Controls Timely Membrane Association and Successful Cytokinesis

    PubMed Central

    Kim, Hyunjung; Johnson, James M.; Brahma, Sarang; Burkard, Mark E.

    2017-01-01

    During cytokinesis, a contractile ring generates the constricting force to divide a cell into two daughters. This ring is composed of filamentous actin and the motor protein myosin, along with additional structural and regulatory proteins, including anillin. Anillin is a required scaffold protein that links the actomyosin ring to membrane and its organizer, RhoA. However, the molecular basis for timely action of anillin at cytokinesis remains obscure. Here, we find that phosphorylation regulates efficient recruitment of human anillin to the equatorial membrane. Anillin is highly phosphorylated in mitosis, and is a substrate for mitotic kinases. We surveyed function of 46 residues on anillin previously found to be phosphorylated in human cells to identify those required for cytokinesis. Among these sites, we identified S635 as a key site mediating cytokinesis. Preventing S635 phosphorylation adjacent to the AH domain disrupts anillin concentration at the equatorial cortex at anaphase, whereas a phosphomimetic mutant, S635D, partially restores this localization. Time-lapse videomicroscopy reveals impaired recruitment of S635A anillin to equatorial membrane and a transient unstable furrow followed by ultimate failure in cytokinesis. A phosphospecific antibody confirms phosphorylation at S635 in late cytokinesis, although it does not detect phosphorylation in early cytokinesis, possibly due to adjacent Y634 phosphorylation. Together, these findings reveal that anillin recruitment to the equatorial cortex at anaphase onset is enhanced by phosphorylation and promotes successful cytokinesis. PMID:28081137

  11. Management of an outbreak of rat theilovirus.

    PubMed

    Dyson, Melissa C

    2010-05-01

    Rat theilovirus is a commonly reported infection in research rat colonies. The author's institution experienced an outbreak of rat theilovirus in a breeding colony of unique outbred rats. To manage this outbreak, the institution chose to use a 'test and cull' strategy because this approach is reported to be successful in mouse colonies infected with Theiler's murine encephalomyelitis virus, a related virus. Here the author describes the outbreak and subsequent management of rat theilovirus. The strategy successfully cleared the virus from the rat colony.

  12. Vigorous cleaning and adequate ventilation are necessary to control an outbreak in a neonatal intensive care unit.

    PubMed

    Shimono, Nobuyuki; Hayashi, Jun; Matsumoto, Hiroko; Miyake, Noriko; Uchida, Yujiro; Shimoda, Shinji; Furusyo, Norihiro; Akashi, Koichi

    2012-06-01

    An outbreak of Bacillus cereus (B. cereus) bacteremia occurred in our neonatal intensive care unit (NICU) in July 2005. Many strains of B. cereus were cultured from patient specimens, as well as from environmental samples such as the surfaces of instruments and air in the NICU. Some of these strains were analyzed by pulsed field gel electrophoresis, and several were confirmed to be identical. We speculated that the bacterial load in the environment had initially increased and then possibly spread throughout the NICU facility via the airflow of the ventilation system. For this reason, besides maintaining standard precautions, we performed a vigorous clean of the NICU, and covered the vents to prevent dust falling from them. These protective measures ended the outbreak. In the hospital environment, adequate ventilation is important, especially in single-occupancy isolation rooms and operating theaters. However, the criteria for the adequate ventilation of multioccupancy rooms for acute care environments such as the NICU have not yet been defined. We need to pay more attention to these environmental factors in order to avoid cross contamination and infectious outbreaks.

  13. First norovirus outbreaks associated with consumption of green seaweed (Enteromorpha spp.) in South Korea.

    PubMed

    Park, J H; Jeong, H S; Lee, J S; Lee, S W; Choi, Y H; Choi, S J; Joo, I S; Kim, Y R; Park, Y K; Youn, S K

    2015-02-01

    In February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1-56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1-24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.

  14. 7 CFR 1424.10 - Succession and control of facilities and production.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Succession and control of facilities and production... § 1424.10 Succession and control of facilities and production. A person who obtains a facility that is... may terminate a contract and demand full refund of payments made if a contracting party loses...

  15. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009.

    PubMed

    Carbonne, A; Thiolet, J M; Fournier, S; Fortineau, N; Kassis-Chikhani, N; Boytchev, I; Aggoune, M; Seguier, J C; Senechal, H; Tavolacci, M P; Coignard, B; Astagneau, P; Jarlier, V

    2010-12-02

    An outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae type 2 was detected in September 2009 in two hospitals in a suburb south of Paris, France. In total, 13 KPC-producing K. pneumoniae type 2 cases (four with infections and nine with digestive-tract colonisations) were identified, including a source case transferred from a Greek hospital. Of the 13 cases, seven were secondary cases associated with use of a contaminated duodenoscope used to examine the source case (attack rate: 41%) and five were secondary cases associated with patient-to-patient transmission in hospital. All isolated strains from the 13 patients: (i) exhibited resistance to all antibiotics except gentamicin and colistin, (ii) were more resistant to ertapenem (minimum inhibitory concentration (MIC) always greater than 4 mg/L) than to imipenem (MIC: 1–8 mg/L, depending on the isolate), (iii) carried the blaKPC-2 and blaSHV12 genes and (iv) had an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern. These cases occurred in three hospitals: some were transferred to four other hospitals. Extended infection control measures implemented in the seven hospitals included: (i) limiting transfer of cases and contact patients to other wards, (ii) cohorting separately cases and contact patients, (iii) reinforcing hand hygiene and contact precautions and (iv) systematic screening of contact patients. Overall, 341 contact patients were screened. A year after the outbreak, no additional case has been identified in these seven hospitals. This outbreak emphasises the importance of rapid identification and notification of emerging highly resistant K. pneumoniae strains in order to implement reinforced control measures.

  16. Modeling cholera outbreaks

    PubMed Central

    Longini, Ira M.; Morris, J. Glenn

    2014-01-01

    Mathematical modeling can be a valuable tool for studying infectious disease outbreak dynamics and simulating the effects of possible interventions. Here, we describe approaches to modeling cholera outbreaks and how models have been applied to explore intervention strategies, particularly in Haiti. Mathematical models can play an important role in formulating and evaluating complex cholera outbreak response options. Major challenges to cholera modeling are insufficient data for calibrating models and the need to tailor models for different outbreak scenarios. PMID:23412687

  17. Outbreak Column 16: Cognitive errors in outbreak decision making

    PubMed Central

    2015-01-01

    During outbreaks, decisions must be made without all the required information. People, including infection prevention and control teams (IPCTs), who have to make decisions during uncertainty use heuristics to fill the missing data gaps. Heuristics are mental model short cuts that by-and-large enable us to make good decisions quickly. However, these heuristics contain biases and effects that at times lead to cognitive (thinking) errors. These cognitive errors are not made to deliberately misrepresent any given situation; we are subject to heuristic biases when we are trying to perform optimally. The science of decision making is large; there are over 100 different biases recognised and described. Outbreak Column 16 discusses and relates these heuristics and biases to decision making during outbreak prevention, preparedness and management. Insights as to how we might recognise and avoid them are offered.

  18. Changes in and shortcomings of control strategies, drug stockpiles, and vaccine development during outbreaks of avian influenza A H5N1, H1N1, and H7N9 among humans.

    PubMed

    Mei, Lin; Song, Peipei; Tang, Qi; Shan, Ke; Tobe, Ruoyan Gai; Selotlegeng, Lesego; Ali, Asghar Hammad; Cheng, Yangyang; Xu, Lingzhong

    2013-04-01

    The purpose of this review is to provide a reference for the future prevention and control of emerging infectious diseases by summarizing the control strategies, the status of drugs and vaccines, and shortcomings during three major outbreaks of avian influenza among humans (H5N1 in 2003, H1N1 in 2009, and H7N9 in 2013). Data on and documents regarding the three influenza outbreaks have been reviewed. Results indicated that the response to pandemic influenza outbreaks has improved markedly in terms of control strategies, stockpiles of antivirals, and vaccine development. These improvements also suggest advances in disease surveillance, transparency in reporting, and regional collaboration and cooperation. These trends also foreshadow better prospects for prevention and control of emerging infectious diseases. However, there are shortcomings since strategies failed to focus on high-risk groups, quantitative and measurable results (both direct and indirect) were unclear, and quantitative assessment is still lacking.

  19. An outbreak of viral gastroenteritis associated with consumption of sandwiches: implications for the control of transmission by food handlers.

    PubMed Central

    Parashar, U. D.; Dow, L.; Fankhauser, R. L.; Humphrey, C. D.; Miller, J.; Ando, T.; Williams, K. S.; Eddy, C. R.; Noel, J. S.; Ingram, T.; Bresee, J. S.; Monroe, S. S.; Glass, R. I.

    1998-01-01

    Although food handlers are often implicated as the source of infection in outbreaks of food-borne viral gastroenteritis, little is known about the timing of infectivity in relation to illness. We investigated a gastroenteritis outbreak among employees of a manufacturing company and found an association (RR = 14.1, 95% CI = 2.0-97.3) between disease and eating sandwiches prepared by 6 food handlers, 1 of whom reported gastroenteritis which had subsided 4 days earlier. Norwalk-like viruses were detected by electron microscopy or reverse transcriptase-polymerase chain reaction (RT-PCR) in stool specimens from several company employees, the sick food handler whose specimen was obtained 10 days after resolution of illness, and an asymptomatic food handler. All RT-PCR product sequences were identical, suggesting a common source of infection. These data support observations from recent volunteer studies that current recommendations to exclude food handlers from work for 48-72 h after recovery from illness may not always prevent transmission of Norwalk-like viruses because virus can be shed up to 10 days after illness or while exhibiting no symptoms. PMID:10030711

  20. Risk factors for the transmission of foot-and-mouth disease during the 2010 outbreak in Japan: a case–control study

    PubMed Central

    2013-01-01

    Background In 2010, foot-and-mouth disease (FMD) occurred for the first time in a decade in Japan. Movement or shipment of people and animals around infected farms was restricted; however these contingency measures proved insufficient to prevent FMD spread. Consequently, a total of 292 farms were confirmed as infected during this outbreak. We conducted a case–control study to identify the risk factors associated with FMD transmission between farms during these restrictions. As there was discordance in the control measures taken, risk factors were examined separately for two areas. Analyses were also performed separately for cattle and pig farms given their different infectivity and susceptibility. Results For cattle farms in the movement restriction area, the odds of having the factor ‘farm equipment was shared with other farms’ was significantly higher for case farms than for control farms. For cattle farms in the shipment restriction area, the odds of having the factors ‘feed transport vehicles visited the farm’ and ‘staff of livestock-related companies visited the farm’ were significantly higher on case farms than control farms. In pig farms in the movement restriction area, the odds of having factor ‘farm staff commuted from outside’ was 20 times higher for case farms than control farms. In addition, case farms were less likely to have the factors ‘fattening farm’ and ‘barn has physical barriers’ compared with control farms. Conclusions In the movement restriction area, the disease was likely to spread regardless of the movement of people and vehicles, and physical barriers were found to be a protective factor. Therefore, physical barriers from the surrounding environments seemed to prevent farms from being infected. Conversely, in the shipment restriction area, movement of people and vehicles was strongly associated with disease spread. These results allow a better understanding of the risk factors associated with FMD transmission and

  1. Food cravings mediate the relationship between rigid, but not flexible control of eating behavior and dieting success.

    PubMed

    Meule, Adrian; Westenhöfer, Joachim; Kübler, Andrea

    2011-12-01

    Both food cravings and rigid dietary control strategies have been implicated in low dieting success while flexible control often is associated with successful weight loss. An online survey was conducted (N=616) to test the mediational role of food cravings between dietary control strategies and self-perceived dieting success. Food cravings fully mediated the inverse relationship between rigid control and dieting success. Contrarily, flexible control predicted dieting success independently of food cravings, which were negatively associated with dieting success. Differential mechanisms underlie the relationship between rigid and flexible control of eating behavior and dieting success.

  2. Biological Control of Melaleuca quinquenervia: Goal-based Assessment of Success.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Success means different things to different people. Unfortunately, the success or failure of weed biological control projects is often evaluated by non-participants lacking knowledge of the original goals set by project architects. The Australian tree Melaleuca quinquenervia, which is an aggressive ...

  3. An outbreak of Salmonella enteritidis phage type 34a infection in primary school children: the use of visual aids and food preferences to overcome recall bias in a case control study.

    PubMed Central

    Linnane, E.; Roberts, R. J.; Mannion, P. T.

    2002-01-01

    Outbreaks of infectious intestinal disease are common in schools. Case control studies are useful in the investigation of infectious disease outbreaks but the time interval between illness and investigation can lead to recall bias, particularly in young children. We describe an outbreak of Salmonella enteritidis phage type 34a infection involving 54 clinical cases in two adjacent schools, and a novel approach to overcome recall bias. The likely dates of infection were identified from the epidemic curve. We created a visual display of the menu from those days and asked 9 cases and 18 matched controls to identify their food preferences from this display. Preference for chocolate mouse was significantly associated with illness (P = 0.006). The results of the case control study agreed with the findings of the environmental investigation. We believe our approach could be used in other circumstances, where subjects are young children or recall bias is a concern. PMID:12211594

  4. The ring vaccination trial: a novel cluster randomised controlled trial design to evaluate vaccine efficacy and effectiveness during outbreaks, with special reference to Ebola.

    PubMed

    2015-07-27

    A World Health Organization expert meeting on Ebola vaccines proposed urgent safety and efficacy studies in response to the outbreak in West Africa. One approach to communicable disease control is ring vaccination of individuals at high risk of infection due to their social or geographical connection to a known case. This paper describes the protocol for a novel cluster randomised controlled trial design which uses ring vaccination.In the Ebola ça suffit ring vaccination trial, rings are randomised 1:1 to (a) immediate vaccination of eligible adults with single dose vaccination or (b) vaccination delayed by 21 days. Vaccine efficacy against disease is assessed in participants over equivalent periods from the day of randomisation. Secondary objectives include vaccine effectiveness at the level of the ring, and incidence of serious adverse events. Ring vaccination trials are adaptive, can be run until disease elimination, allow interim analysis, and can go dormant during inter-epidemic periods.

  5. Individual differences in self-reported self-control predict successful emotion regulation.

    PubMed

    Paschke, Lena M; Dörfel, Denise; Steimke, Rosa; Trempler, Ima; Magrabi, Amadeus; Ludwig, Vera U; Schubert, Torsten; Stelzel, Christine; Walter, Henrik

    2016-08-01

    Both self-control and emotion regulation enable individuals to adapt to external circumstances and social contexts, and both are assumed to rely on the overlapping neural resources. Here, we tested whether high self-reported self-control is related to successful emotion regulation on the behavioral and neural level. One hundred eight participants completed three self-control questionnaires and regulated their negative emotions during functional magnetic resonance imaging using reappraisal (distancing). Trait self-control correlated positively with successful emotion regulation both subjectively and neurally, as indicated by online ratings of negative emotions and functional connectivity strength between the amygdala and prefrontal areas, respectively. This stronger overall connectivity of the left amygdala was related to more successful subjective emotion regulation. Comparing amygdala activity over time showed that high self-controllers successfully maintained down-regulation of the left amygdala over time, while low self-controllers failed to down-regulate towards the end of the experiment. This indicates that high self-controllers are better at maintaining a motivated state supporting emotion regulation over time. Our results support assumptions concerning a close relation of self-control and emotion regulation as two domains of behavioral control. They further indicate that individual differences in functional connectivity between task-related brain areas directly relate to differences in trait self-control.

  6. Taking credit for success: the phenomenology of control in a goal-directed task.

    PubMed

    Dewey, John A; Seiffert, Adriane E; Carr, Thomas H

    2010-03-01

    We studied how people determine when they are in control of objects. In a computer task, participants moved a virtual boat towards a goal using a joystick to investigate how subjective control is shaped by (1) correspondence between motor actions and the visual consequences of those actions, and (2) attainment of higher-level goals. In Experiment 1, random discrepancies from joystick input (noise) decreased judgments of control (JoCs), but discrepancies that brought the boat closer to the goal and increased success (the autopilot) increased JoCs. In Experiment 2, participants raced to the goal against a computer-controlled rival boat while varying levels of noise interfered with each boat. Participants reached the goal more often and rated their own control higher when the computer rival had good control. Subjective control over moving objects depends partly on consistency between motor actions and their effects, but is also modulated by perceived success and competition.

  7. Concurrent outbreaks of Shigella sonnei and enterotoxigenic Escherichia coli infections associated with parsley: implications for surveillance and control of foodborne illness.

    PubMed

    Naimi, Timothy S; Wicklund, Julie H; Olsen, Sonja J; Krause, Gerard; Wells, Joy G; Bartkus, Joanne M; Boxrud, David J; Sullivan, Maureen; Kassenborg, Heidi; Besser, John M; Mintz, Eric D; Osterholm, Michael T; Hedberg, Craig W

    2003-04-01

    In recent years, the globalization of the food supply and the development of extensive food distribution networks have increased the risk of foodborne disease outbreaks involving multiple states or countries. In particular, outbreaks associated with fresh produce have emerged as an important public health concern. During July and August 1998, eight restaurant-associated outbreaks of shigellosis caused by a common strain of Shigella sonnei occurred in the United States and Canada. The outbreak strain was characterized by unique pulsed-field gel electrophoresis patterns. Epidemiologic investigation determined that the illness was associated with the ingestion of parsley at four restaurants; at the other four restaurants, the majority of the people who contracted the illness ate parsley. Isolates from patrons in two unrelated restaurant-associated enterotoxigenic Escherichia coli (ETEC) outbreaks in Minnesota shared a common serotype and pulsed-field gel electrophoresis (PFGE) pattern. Parsley was the implicated or suspected source of both ETEC outbreaks. In each of the outbreak-associated restaurants, parsley was chopped, held at room temperature, and used as an ingredient or garnish for multiple dishes. Infected food workers at several restaurants may also have contributed to the propagation of the outbreak. The sources of parsley served in outbreak-associated restaurants were traced, and a 1,600-acre farm in Baja California, Mexico, was identified as a likely source of the parsley implicated in six of the seven Shigella outbreaks and as a possible source of the parsley implicated in the two ETEC outbreaks. Global food supplies and large distribution networks demand strengthened laboratory and epidemiologic capacity to enable state and local public health agencies to conduct foodborne disease surveillance and to promote effective responses to multistate outbreaks.

  8. Interventions to control virus transmission during an outbreak of Ebola hemorrhagic fever: experience from Kikwit, Democratic Republic of the Congo, 1995.

    PubMed

    Kerstiëns, B; Matthys, F

    1999-02-01

    On 6 May 1995, the Médecins sans Frontières (MSF) coordinator in Kinshasa, Democratic Republic of the Congo (DRC), received a request for assistance for what was believed to be a concurrent outbreak of bacillary dysentery and viral hemorrhagic fever (suspected Ebola hemorrhagic fever [EHF]) in the town of Kikwit, DRC. On 11 May, the MSF intervention team assessed Kikwit General Hospital. This initial assessment revealed a nonfunctional isolation ward for suspected EHF cases; a lack of water and electricity; no waste disposal system; and no protective gear for medical staff. The priorities set by MSF were to establish a functional isolation ward to deal with EHF and to distribute protective supplies to individuals who were involved with patient care. Before the intervention, 67 health workers contracted EHF; after the initiation of control measures, just 3 cases were reported among health staff and none among Red Cross volunteers involved in body burial.

  9. 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.

  10. Assessing Measles Transmission in the United States Following a Large Outbreak in California.

    PubMed

    Blumberg, Seth; Worden, Lee; Enanoria, Wayne; Ackley, Sarah; Deiner, Michael; Liu, Fengchen; Gao, Daozhou; Lietman, Thomas; Porco, Travis

    2015-05-07

    The recent increase in measles cases in California may raise questions regarding the continuing success of measles control. To determine whether the dynamics of measles is qualitatively different in comparison to previous years, we assess whether the 2014-2015 measles outbreak associated with an Anaheim theme park is consistent with subcriticality by calculating maximum-likelihood estimates for the effective reproduction numbe given this year's outbreak, using the Galton-Watson branching process model. We find that the dynamics after the initial transmission event are consistent with prior transmission, but does not exclude the possibilty that the effective reproduction number has increased.

  11. Assessing Measles Transmission in the United States Following a Large Outbreak in California

    PubMed Central

    Blumberg, Seth; Worden, Lee; Enanoria, Wayne; Ackley, Sarah; Deiner, Michael; Liu, Fengchen; Gao, Daozhou; Lietman, Thomas; Porco, Travis

    2015-01-01

    The recent increase in measles cases in California may raise questions regarding the continuing success of measles control. To determine whether the dynamics of measles is qualitatively different in comparison to previous years, we assess whether the 2014-2015 measles outbreak associated with an Anaheim theme park is consistent with subcriticality by calculating maximum-likelihood estimates for the effective reproduction numbe given this year’s outbreak, using the Galton-Watson branching process model. We find that the dynamics after the initial transmission event are consistent with prior transmission, but does not exclude the possibilty that the effective reproduction number has increased. PMID:26052471

  12. Environmentally controlled succession in a late Pleistocene coral reef (Sinai, Egypt)

    NASA Astrophysics Data System (ADS)

    Mewis, H.; Kiessling, W.

    2013-03-01

    The concept of ecological succession has been frequently applied in the study of ancient reefs. Whereas Paleozoic and Mesozoic reefs are commonly thought to reveal an autogenic primary—climax zonation, patterns in Neogene and Quaternary reefs are much more diverse. Here, we describe a well-preserved late Pleistocene coral reef from Dahab on Sinai Peninsula (Egypt), which shows a distinct zonation that resembles an ecological succession. In contrast to classical examples of ecological successions, species composition, paleoenvironmental conditions, and coral biodiversity of the Dahab reef indicate an allogenic, sea-level controlled community change, from marginal marine to reef slope and back reef. A review of the literature confirms that autogenic, short-term successions are virtually absent in Quaternary reefs. We predict that long generation times of corals make it unlikely that classical autogenic successions develop in reefs at all, unless environmental conditions are unusually stable.

  13. Why achievement motivation predicts success in business but failure in politics: the importance of personal control.

    PubMed

    Winter, David G

    2010-12-01

    Several decades of research have established that implicit achievement motivation (n Achievement) is associated with success in business, particularly in entrepreneurial or sales roles. However, several political psychology studies have shown that achievement motivation is not associated with success in politics; rather, implicit power motivation often predicts political success. Having versus lacking control may be a key difference between business and politics. Case studies suggest that achievement-motivated U.S. presidents and other world leaders often become frustrated and thereby fail because of lack of control, whereas power-motivated presidents develop ways to work with this inherent feature of politics. A reevaluation of previous research suggests that, in fact, relationships between achievement motivation and business success only occur when control is high. The theme of control is also prominent in the development of achievement motivation. Cross-national data are also consistent with this analysis: In democratic industrialized countries, national levels of achievement motivation are associated with strong executive control. In countries with low opportunity for education (thus fewer opportunities to develop a sense of personal control), achievement motivation is associated with internal violence. Many of these manifestations of frustrated achievement motivation in politics resemble authoritarianism. This conclusion is tested by data from a longitudinal study of 113 male college students, showing that high initial achievement motivation combined with frustrated desires for control is related to increases in authoritarianism (F-scale scores) during the college years. Implications for the psychology of leadership and practical politics are discussed.

  14. Cholera outbreaks in India.

    PubMed

    Ramamurthy, Thandavarayan; Sharma, Naresh C

    2014-01-01

    Cholera is a global health problem as several thousands of cases and deaths occur each year. The unique epidemiologic attribute of the disease is its propensity to occur as outbreaks that may flare-up into epidemics, if not controlled. The causative bacterial pathogen Vibrio cholerae prevails in the environment and infects humans whenever there is a breakdown in the public health component. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding. Recently, it was shown that climatic conditions also play a major role in the persistence and spread of cholera. Constant change in the biotypes and serotypes of V. cholerae are also important aspects that changes virulence and survival of the pathogen. Such continuous changes increase the infection ability of the pathogen affecting the susceptible population including the children. The short-term carrier status of V. cholerae has been studied well at community level and this facet significantly contributes to the recurrence of cholera. Several molecular tools recognized altering clonality of V. cholerae in relation with the advent of a serogroup or serotype. Rapid identification systems were formulated for the timely detection of the pathogen so as to identify and control the outbreak and institute proper treatment of the patients. The antimicrobials used in the past are no longer useful in the treatment of cholera as V. cholerae has acquired several mechanisms for multiple antimicrobial resistance. This upsurge in antimicrobial resistance directly influences the management of the disease. This chapter provides an overview of cholera prevalence in India, possible sources of infection, and molecular epidemiology along with antimicrobial resistance of V. cholerae.

  15. Nitrogen availability as a control mechanism of secondary succession within a semiarid shrubland ecosystem

    SciTech Connect

    Redente, E.F.; McLendon, T.

    1992-09-25

    Three experiments were conducted within a semiarid shrubland to test the role of nitrogen availability as a control mechanism in secondary succession. Secondary succession patterns were documented for seven years and effects of increased and decreased N availability levels, fumigation, and competition by early-seral species were tested. Differential responses by seral species were determined and related to successional patterns. Nitrogen availability was found to be a primary mechanism controlling the rate of succession. Relative growth rate was an important factor determining which species initially dominated and N availability became the primary control factor by the third year. As N availability increased, the rate of succession decreased. Conversely, as N availability was decreased, the rate of succession increased. The abundance of annuals was increased and abundance of perennials decreased by increased N availability. Tissue N concentration was related to lifeform and seral position, and these relationships were important in the transition from early- to mid-seral stages. Decomposer subsystem dynamics were correlated with seral community dynamics. The effect of fumigation was minimized by initially planting with late-seral species. A conceptual model of secondary succession is presented based on N availability, relative growth rate, lifeform, and decomposition dynamics.

  16. Self-Control and Grit: Related but Separable Determinants of Success

    PubMed Central

    Duckworth, Angela; Gross, James J.

    2015-01-01

    Other than talent and opportunity, what makes some people more successful than others? One important determinant of success is self-control – the capacity to regulate attention, emotion, and behavior in the presence of temptation. A second important determinant of success is grit – the tenacious pursuit of a dominant superordinate goal despite setbacks. Self-control and grit are strongly correlated, but not perfectly so. This means that some people with high levels of self-control capably handle temptations but do not consistently pursue a dominant goal. Likewise, some exceptional achievers are prodigiously gritty but succumb to temptations in domains other than their chosen life passion. Understanding how goals are hierarchically organized clarifies how self-control and grit are related but distinct: Self-control entails aligning actions with any valued goal despite momentarily more-alluring alternatives; grit, in contrast, entails having and working assiduously toward a single challenging superordinate goal through thick and thin, on a timescale of years or even decades. Although both self-control and grit entail aligning actions with intentions, they operate in different ways and at different time scales. This hierarchical goal framework suggests novel directions for basic and applied research on success. PMID:26855479

  17. Economic Costs of Measles Outbreak in the Netherlands, 2013-2014.

    PubMed

    Suijkerbuijk, Anita W M; Woudenberg, Tom; Hahné, Susan J M; Nic Lochlainn, Laura; de Melker, Hester E; Ruijs, Wilhelmina L M; Lugnér, Anna K

    2015-11-01

    In 2013 and 2014, the Netherlands experienced a measles outbreak in orthodox Protestant communities with low measles-mumps-rubella vaccination coverage. Assessing total outbreak costs is needed for public health outbreak preparedness and control. Total costs of this outbreak were an estimated $4.7 million.

  18. 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

  19. Cholera outbreaks in Africa.

    PubMed

    Mengel, Martin A; Delrieu, Isabelle; Heyerdahl, Leonard; Gessner, Bradford D

    2014-01-01

    an infectious dose of Vibrio cholerae and on the virulence of the implicated strain. Cholera transmission can then be amplified by several factors including contamination of human water- or food sources; climate and extreme weather events; political and economic crises; high population density combined with poor quality informal housing and poor hygiene practices; spread beyond a local community through human travel and animals, e.g., water birds. At an individual level, cholera risk may increase with decreasing immunity and hypochlorhydria, such as that induced by Helicobacter pylori infection, which is endemic in much of Africa, and may increase individual susceptibility and cholera incidence. Since contaminated water is the main vehicle for the spread of cholera, the obvious long-term solution to eradicate the disease is the provision of safe water to all African populations. This requires considerable human and financial resources and time. In the short and medium term, vaccination may help to prevent and control the spread of cholera outbreaks. Regardless of the intervention, further understanding of cholera biology and epidemiology is essential to identify populations and areas at increased risk and thus ensure the most efficient use of scarce resources for the prevention and control of cholera.

  20. Cortisol reaction in success and failure condition in endogenous depressed patients and controls.

    PubMed

    Croes, S; Merz, P; Netter, P

    1993-01-01

    The authors studied differences in cortisol response to controllable and uncontrollable stress and its relationship to Seligman's theory of learned helplessness in hospitalized unipolar depressed patients (11 nontreated, acutely depressed; 11 treated patients) and 11 age and sex matched controls hospitalized for traumatic surgery. Control and lack of control were achieved by induction of success and failure in a simple number addition test and applied in balanced order on 2 consecutive days. Saliva cortisol samples were collected before and after the test. No group differences in baseline cortisol levels were observed. Cortisol increased after uncontrollable and decreased after controllable stress in control patients, whereas cortisol decreased after both conditions in the acutely depressed group and less so in the treated group, although they were as emotionally upset after failure as controls. Thus, the normally observed ability of the neuroendocrine system to discriminate between controllable and uncontrollable stress deteriorates with increasing severity of depression.

  1. Prevalence of Listeria monocytogenes in Retail Lightly Pickled Vegetables and Its Successful Control at Processing Plants.

    PubMed

    Taguchi, Masumi; Kanki, Masashi; Yamaguchi, Yuko; Inamura, Hideichi; Koganei, Yosuke; Sano, Tetsuya; Nakamura, Hiromi; Asakura, Hiroshi

    2017-03-01

    Incidences of food poisoning traced to nonanimal food products have been increasingly reported. One of these was a recent large outbreak of Shiga toxin-producing Escherichia coli (STEC) O157 infection from the consumption of lightly pickled vegetables, indicating the necessity of imposing hygienic controls during manufacturing. However, little is known about the bacterial contamination levels in these minimally processed vegetables. Here we examined the prevalence of STEC, Salmonella spp., and Listeria monocytogenes in 100 lightly pickled vegetable products manufactured at 55 processing factories. Simultaneously, we also performed quantitative measurements of representative indicator bacteria (total viable counts, coliform counts, and β-glucuronidase-producing E. coli counts). STEC and Salmonella spp. were not detected in any of the samples; L. monocytogenes was detected in 12 samples manufactured at five of the factories. Microbiological surveillance at two factories (two surveys at factory A and three surveys at factory B) between June 2014 and January 2015 determined that the areas predominantly contaminated with L. monocytogenes included the refrigerators and packaging rooms. Genotyping provided further evidence that the contaminants found in these areas were linked to those found in the final products. Taken together, we demonstrated the prevalence of L. monocytogenes in lightly pickled vegetables sold at the retail level. Microbiological surveillance at the manufacturing factories further clarified the sources of the contamination in the retail products. These data indicate the necessity of implementing adequate monitoring programs to minimize health risks attributable to the consumption of these minimally processed vegetables.

  2. 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.

  3. Measles (Rubeola) Cases and Outbreaks

    MedlinePlus

    ... outbreak linked to two Disney theme parks in Orange County, California... MMWR: 2014 Outbreaks Measles Outbreak in ... Family and a Possibly Associated International Traveler — Orange County, Florida, December 2012-January 2013 MMWR . Sep ...

  4. Outbreaks of acute gastroenteritis on cruise ships and on land: identification of a predominant circulating strain of norovirus--United States, 2002.

    PubMed

    Widdowson, Marc-Alain; Cramer, Elaine H; Hadley, Leslie; Bresee, Joseph S; Beard, R Suzanne; Bulens, Sandra N; Charles, Myrna; Chege, Wairimu; Isakbaeva, Elmira; Wright, Jennifer G; Mintz, Eric; Forney, David; Massey, Jeffrey; Glass, Roger I; Monroe, Stephan S

    2004-07-01

    In 2002, a sharp increase in outbreaks of norovirus-associated illness, both on cruise ships and on land, encouraged us to examine the molecular epidemiology of detected noroviruses, to identify a common strain or source. Of 14 laboratory-confirmed outbreaks on cruise ships, 12 (86%) were attributed to caliciviruses; among these 12, outbreak characteristics included continuation on successive cruises in 6 (50%), multiple modes of transmission in 7 (58%), and high (>10%) attack rates in 7 (58%). Eleven of the 12 calicivirus outbreaks were attributed to noroviruses, 7 (64%) of which were attributed to a previously unreported lineage, provisionally named "the Farmington Hills strain." From May 2002 to December 2002, 10 (45%) of 22 land-based outbreaks also were attributed to this strain. Nucleotide-sequence analysis provided insights into norovirus transmission, by documenting links among outbreaks, the introduction of strains onto ships, and viral persistence on board (despite cleaning). Control measures for outbreaks should address all routes of transmission. Better outbreak surveillance and collection of data on sequences will help to monitor norovirus strains and to identify common sources.

  5. The neural correlates of cognitive control: successful remembering and intentional forgetting.

    PubMed

    Rizio, Avery A; Dennis, Nancy A

    2013-02-01

    The ability to control how we process information by remembering that which is important and forgetting that which is irrelevant is essential to maintain accurate, up-to-date memories. As such, memory success is predicated on both successful intentional encoding and successful intentional forgetting. The current study used an item-method directed forgetting paradigm to elucidate the cognitive and neural processes that underlie both processes while also examining the relationship between them to understand how the two may work together. Results indicated that encoding-related processes in the left inferior PFC and medial-temporal lobe (MTL) contribute to subsequent memory success, whereas inhibitory processes in the right superior frontal gyrus and right inferior parietal lobe contribute to subsequent forgetting success. Furthermore, connectivity analyses found a negative correlation between activity in the right superior frontal cortex and activity in the left MTL during successful intentional forgetting but not during successful encoding, incidental forgetting, or incidental encoding. Results support the theory that intentional forgetting is mediated by inhibition-related activity in the right frontal cortex and the interaction of this activity with that of encoding-related activity in the MTL. Further support for this inhibitory-related account was found through a clear dissociation between intentional and incidental forgetting, such that intentional forgetting was associated with regions shown to support inhibition, whereas incidental forgetting was associated with regions supporting encoding.

  6. Internal control and success orientation in a token economy for emotionally disturbed adolescents.

    PubMed

    Deiker, T; Matson, J L

    1979-01-01

    Forty-one emotionally disturbed adolescents were tested at each of three token economy levels on Rotter's Internal-External Locus of Control Scale and Guevar's Success-Failure Inventory. Delay of reinforcement (immediate, daily, weekly) was the primary differentiation between levels. One-way analyses of variance indicated a change across levels in the direction of more perceived internal control of behavior (p less than .025) and a greater success orientation (p less than .005). Change scores were not correlated with length of time in the program. Results suggest that the token economy as an external source of control is not necessarily incompatible with increasing patient expectancies of present and future control of the environment.

  7. Community-wide outbreak of Neisseria gonorrhoeae conjunctivitis in Konso district, North Omo administrative region.

    PubMed

    Mikru, F S; Molla, T; Ersumo, M; Henriksen, T H; Klungseyr, P; Hudson, P J; Kindan, T T

    1991-01-01

    We describe a large outbreak of severe pustular conjunctivitis due to Neiserria gonorrhoeae. Over 9,000 cases occurred during 8 months in 1987-1988 in one district in North Omo, Ethiopia. Both sexes and all age groups were affected, particularly children under 5 years of age; only a small minority were neonates. Despite a highly successful cure rate for individual cases, the outbreak continued for a number of months. Several epidemiologic approaches were used to monitor the outbreak and identify the mechanism of transmission. The epidemic curve suggested person-to-person transmission. Routine surveillance data showed that there was no concurrent genital gonorrhea outbreak and genital transmission could not explain a community-wide outbreak. In the setting of intense crowding and relative lack of water, peak transmission of illness coincided with two periods following the rains, suggesting that flies were important in transmission. A case-control study identified lack of face-washing as a household risk factor. Eighty seven of one-hundred and forty six (59%) control houses with children were judged to contain children with clean faces, while only 102 of 216 (47%) case households contained children with clean faces (p less than .05). Our recommendations include measures to improve personal hygiene.

  8. Waterborne outbreaks of cryptosporidiosis.

    PubMed

    Chalmers, Rachel M

    2012-01-01

    Water is the most commonly reported vehicle of transmission in Cryptosporidium outbreaks. While mains drinking water quality is highly regulated in industrialised countries, treated recreational water venues remain highly variable and these have emerged as important settings in the transmission of cryptosporidiosis. Epidemiological investigations of outbreaks benefit from supplementary microbiological evidence and, more recently, the application of molecular typing data to link isolates from cases to each other and to suspected sources. This article documents how waterborne Cryptosporidium outbreaks are identified and reported, how such outbreaks have acted as drivers of regulatory change, and some of the recent developments in the detection and investigation of these outbreaks and their spread, especially the application of molecular typing assays.

  9. 7 CFR 4288.25 - Succession and control of facilities and production.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... biorefinery whose production of heat or power from renewable biomass is the basis of a program payment, or... 7 Agriculture 15 2014-01-01 2014-01-01 false Succession and control of facilities and production... production. Any party obtaining a biorefinery that is participating in this program must request...

  10. 7 CFR 4288.25 - Succession and control of facilities and production.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... biorefinery whose production of heat or power from renewable biomass is the basis of a program payment, or... 7 Agriculture 15 2013-01-01 2013-01-01 false Succession and control of facilities and production... production. Any party obtaining a biorefinery that is participating in this program must request...

  11. 7 CFR 4288.25 - Succession and control of facilities and production.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... biorefinery whose production of heat or power from renewable biomass is the basis of a program payment, or... 7 Agriculture 15 2012-01-01 2012-01-01 false Succession and control of facilities and production... production. Any party obtaining a biorefinery that is participating in this program must request...

  12. 7 CFR 1424.10 - Succession and control of facilities and production.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Succession and control of facilities and production. 1424.10 Section 1424.10 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOENERGY...

  13. 7 CFR 1424.10 - Succession and control of facilities and production.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Succession and control of facilities and production. 1424.10 Section 1424.10 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOENERGY...

  14. 7 CFR 1424.10 - Succession and control of facilities and production.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Succession and control of facilities and production. 1424.10 Section 1424.10 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOENERGY...

  15. 7 CFR 1424.10 - Succession and control of facilities and production.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 10 2014-01-01 2014-01-01 false Succession and control of facilities and production. 1424.10 Section 1424.10 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS BIOENERGY...

  16. Determinants of lemming outbreaks.

    PubMed

    Ims, Rolf A; Yoccoz, Nigel G; Killengreen, Siw T

    2011-02-01

    Population outbreaks in tundra rodents have intrigued scientists for a century as a result of their spectacular appearances and their general lessons in ecology. One outstanding question that has led to competing hypotheses is why sympatric lemmings and voles differ in regularity and shape of their outbreaks. Lemming outbreaks may be lost for decades while vole populations maintain regular population cycles. Moreover, when lemming populations eventually irrupt, they do so more steeply than the vole populations. Norwegian lemmings exhibited a large-scale outbreak synchronously with gray-sided voles in Finnmark, northern Fennoscandia, during 2006 to 2007 for the first time in two decades. Analyses of spatial variability of this outbreak across altitudinal gradients allowed us to identify determinants of the contrasting lemming and vole dynamics. The steeper lemming outbreak trajectories were caused by breeding and population growth during winter, when nonbreeding vole populations consistently declined. The differently shaped lemming and vole outbreaks appear to result from a particular demographic tactic of lemmings that evolved as an adaptation to the long and cold Arctic-Alpine winters. The lemming outbreak amplitude increased with altitude and vole density, indicating that lemming outbreaks are jointly facilitated by low temperatures and apparent mutualism with voles mediated by shared predators. High sensitivity to variation in climate and predation is likely to be the reasons why lemmings have more erratic population dynamics than sympatric voles. The combination of continued climatic warming and dampened vole cycles is expected to further decrease the frequency, amplitude, and geographic range of lemming outbreaks in tundra ecosystems.

  17. Flatness-based control in successive loops for stabilization of heart's electrical activity

    NASA Astrophysics Data System (ADS)

    Rigatos, Gerasimos; Melkikh, Alexey

    2016-12-01

    The article proposes a new flatness-based control method implemented in successive loops which allows for stabilization of the heart's electrical activity. Heart's pacemaking function is modeled as a set of coupled oscillators which potentially can exhibit chaotic behavior. It is shown that this model satisfies differential flatness properties. Next, the control and stabilization of this model is performed with the use of flatness-based control implemented in cascading loops. By applying a per-row decomposition of the state-space model of the coupled oscillators a set of nonlinear differential equations is obtained. Differential flatness properties are shown to hold for the subsystems associated with the each one of the aforementioned differential equations and next a local flatness-based controller is designed for each subsystem. For the i-th subsystem, state variable xi is chosen to be the flat output and state variable xi+1 is taken to be a virtual control input. Then the value of the virtual control input which eliminates the output tracking error for the i-th subsystem becomes reference setpoint for the i + 1-th subsystem. In this manner the control of the entire state-space model is performed by successive flatness-based control loops. By arriving at the n-th row of the state-space model one computes the control input that can be actually exerted on the aforementioned biosystem. This real control input of the coupled oscillators' system, contains recursively all virtual control inputs associated with the previous n - 1 rows of the state-space model. This control approach achieves asymptotically the elimination of the chaotic oscillation effects and the stabilization of the heart's pulsation rhythm. The stability of the proposed control scheme is proven with the use of Lyapunov analysis.

  18. Depositional controls on tidally influenced fluvial successions, Neslen Formation, Utah, USA

    NASA Astrophysics Data System (ADS)

    Shiers, M. N.; Mountney, N. P.; Hodgson, D. M.; Cobain, S. L.

    2014-08-01

    The stratigraphic architecture of marginal marine successions records the interplay of autogenic and allogenic processes, and discerning their relative role in governing the morphology of the palaeoenvironment and the architecture of the preserved sedimentary succession is not straightforward. The Campanian Neslen Formation, Mesaverde Group, Utah, is a tidally influenced fluvial succession sourced from the Sevier Orogen, which prograded eastwards into the Western Interior Seaway. Detailed mapping in three dimensions of architectural relationships between sandstone bodies has enabled documentation of lateral and vertical changes in the style of channel-body stacking and analysis of the distribution of sedimentary evidence for tidal influence. Upwards, through the succession, sandstone channel bodies become larger and more amalgamated. Laterally, the dominant style of channel bodies changes such that ribbon channel-fills are restricted to the east of the study area whereas lateral accretion deposits dominate to the west. Combined allogenic and autogenic controls gave rise to the observed stratigraphy. A temporal decrease in the rate of accommodation generation resulted in an upward increase in amalgamation of sand-bodies. Autogenic processes likely played a significant role in moderating the preserved succession: up-succession changes in the style of stacking of channelized bodies could have arisen either from progradation of a distributive fluvial system or from an upstream nodal avulsion of a major trunk channel; accumulation of tide influenced, wave dominated units likely record episodes of delta-lobe abandonment, subsidence and submergence to allow accumulation of near shore sand bars with associated washover complexes.

  19. Outbreak of Neisseria meningitidis C in workers at a large food-processing plant in Brazil: challenges of controlling disease spread to the larger community.

    PubMed

    Iser, B P M; Lima, H C A V; de Moraes, C; de Almeida, R P A; Watanabe, L T; Alves, S L A; Lemos, A P S; Gorla, M C O; Gonçalves, M G; Dos Santos, D A; Sobel, J

    2012-05-01

    SUMMARYAn outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3-207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11-43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.

  20. Q Fever Outbreak in Industrial Setting

    PubMed Central

    Mason, Brendan W.; Nehaul, Lika K.; Smith, Robert; Salmon, Roland L.; Healy, Brendan; Valappil, Manoj; Westmoreland, Diana; de Martin, Sarah; Evans, Meirion R.; Lloyd, Graham; Hamilton-Kirkwood, Marysia; Williams, Nina S.

    2004-01-01

    An outbreak of Q fever occurred in South Wales, United Kingdom, from July 15 through September 30, 2002. To investigate the outbreak a cohort and nested case-control study of persons who had worked at a cardboard manufacturing plant was conducted. The cohort included 282 employees and subcontractors, of whom 253 (90%) provided blood samples and 214 (76%) completed questionnaires. Ninety-five cases of acute Q fever were identified. The epidemic curve and other data suggested an outbreak source likely occurred August 5–9, 2002. Employees in the factory's offices were at greatest risk for infection (odds ratio 3.46; 95% confidence interval 1.38–9.06). The offices were undergoing renovation work around the time of likely exposure and contained straw board that had repeatedly been drilled. The outbreak may have been caused by aerosolization of Coxiella burnetii spore-like forms during drilling into contaminated straw board. PMID:15324550

  1. Whole-Genome Sequencing for the Investigation of a Hospital Outbreak of MRSA in China

    PubMed Central

    Kong, Zhenzhen; Zhao, Peipei; Liu, Haibing; Yu, Xiang; Qin, Yanyan; Su, Zhaoliang; Wang, Shengjun; Xu, Huaxi; Chen, Jianguo

    2016-01-01

    Staphylococcus aureus is a globally disseminated drug-resistant bacterial species. It remains a leading cause of hospital-acquired infection, primarily among immunocompromised patients. In 2012, the Affiliated People’s Hospital of Jiangsu University experienced a putative outbreak of methicillin-resistant S. aureus (MRSA) that affected 12 patients in the Neurosurgery Department. In this study, whole-genome sequencing (WGS) was used to gain insight into the epidemiology of the outbreak caused by MRSA, and traditional bacterial genotyping approaches were also applied to provide supportive evidence for WGS. We sequenced the DNA from 6 isolates associated with the outbreak. Phylogenetic analysis was constructed by comparing single-nucleotide polymorphisms (SNPs) in the core genome of 6 isolates in the present study and another 3 referenced isolates from GenBank. Of the 6 MRSA sequences in the current study, 5 belonged to the same group, clustering with T0131, while the other one clustered closely with TW20. All of the isolates were identified as ST239-SCCmecIII clones. Whole-genome analysis revealed that four of the outbreak isolates were more tightly clustered into a group and SA13002 together with SA13009 were distinct from the outbreak strains, which were considered non-outbreak strains. Based on the sequencing results, the antibiotic-resistance gene status (present or absent) was almost perfectly concordant with the results of phenotypic susceptibility testing. Various toxin genes were also analyzed successfully. Our analysis demonstrates that using traditional molecular methods and WGS can facilitate the identification of outbreaks and help to control nosocomial transmission. PMID:26950298

  2. Keyboard before Head Tracking Depresses User Success in Remote Camera Control

    NASA Astrophysics Data System (ADS)

    Zhu, Dingyun; Gedeon, Tom; Taylor, Ken

    In remote mining, operators of complex machinery have more tasks or devices to control than they have hands. For example, operating a rock breaker requires two handed joystick control to position and fire the jackhammer, leaving the camera control to either automatic control or require the operator to switch between controls. We modelled such a teleoperated setting by performing experiments using a simple physical game analogue, being a half size table soccer game with two handles. The complex camera angles of the mining application were modelled by obscuring the direct view of the play area and the use of a Pan-Tilt-Zoom (PTZ) camera. The camera control was via either a keyboard or via head tracking using two different sets of head gestures called “head motion” and “head flicking” for turning camera motion on/off. Our results show that the head motion control was able to provide a comparable performance to using a keyboard, while head flicking was significantly worse. In addition, the sequence of use of the three control methods is highly significant. It appears that use of the keyboard first depresses successful use of the head tracking methods, with significantly better results when one of the head tracking methods was used first. Analysis of the qualitative survey data collected supports that the worst (by performance) method was disliked by participants. Surprisingly, use of that worst method as the first control method significantly enhanced performance using the other two control methods.

  3. 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.

  4. Outbreaks and Investigations

    MedlinePlus

    ... 1 page] Blastomycosis in Wisconsin Outbreak of blastomycosis, Marathon County, Wisconsin, 2010-2011 Number of cases: 55 ... Blastomyces dermatitidis Type of infection: Mostly pulmonary Setting: Marathon County, Wisconsin Source: Likely multiple foci in the ...

  5. Mumps Cases and Outbreaks

    MedlinePlus

    ... Articles Related Links World Health Organization Medline Plus Mumps Cases and Outbreaks Language: English Español (Spanish) Recommend ... Professionals Español: Casos y brotes de paperas Mumps Cases From January 1 to March 25 2017, ...

  6. Comparative Analysis of the Effectiveness of Three Immunization Strategies in Controlling Disease Outbreaks in Realistic Social Networks

    PubMed Central

    Xu, Zhijing; Zu, Zhenghu; Zheng, Tao; Zhang, Wendou; Xu, Qing; Liu, Jinjie

    2014-01-01

    The high incidence of emerging infectious diseases has highlighted the importance of effective immunization strategies, especially the stochastic algorithms based on local available network information. Present stochastic strategies are mainly evaluated based on classical network models, such as scale-free networks and small-world networks, and thus are insufficient. Three frequently referred stochastic immunization strategies—acquaintance immunization, community-bridge immunization, and ring vaccination—were analyzed in this work. The optimal immunization ratios for acquaintance immunization and community-bridge immunization strategies were investigated, and the effectiveness of these three strategies in controlling the spreading of epidemics were analyzed based on realistic social contact networks. The results show all the strategies have decreased the coverage of the epidemics compared to baseline scenario (no control measures). However the effectiveness of acquaintance immunization and community-bridge immunization are very limited, with acquaintance immunization slightly outperforming community-bridge immunization. Ring vaccination significantly outperforms acquaintance immunization and community-bridge immunization, and the sensitivity analysis shows it could be applied to controlling the epidemics with a wide infectivity spectrum. The effectiveness of several classical stochastic immunization strategies was evaluated based on realistic contact networks for the first time in this study. These results could have important significance for epidemic control research and practice. PMID:24787718

  7. Successfully maintaining program funding during trying times: lessons from tobacco control programs in five states.

    PubMed

    Nelson, David E; Reynolds, Jennifer H; Luke, Douglas A; Mueller, Nancy B; Eischen, Monica H; Jordan, Jerelyn; Lancaster, R Brick; Marcus, Stephen E; Vallone, Donna

    2007-01-01

    Despite negative financial conditions in recent years, several states were able to successfully maintain funding for tobacco prevention and control, which provided an opportunity to understand the factors associated with success. One explanation may be the level of long-term program sustainability in some states. According to a model developed by Saint Louis University researchers, the five elements critical to tobacco control sustainability are state political and financial climate; community awareness and capacity; program structure and administration; funding stability and planning; and surveillance and evaluation. Five states (Nebraska, New York, Indiana, Virginia, and Colorado) maintained funding for their tobacco control programs. Four of these states gained additional legislative appropriations or prevented a massive reduction; Colorado used a statewide ballot initiative to increase funding. On the basis of the sustainability framework, case studies, and prior research, the major lessons learned for maintaining funding were the importance of (1) strong and experienced leadership, (2) broad and deep organizational and community ties, (3) coordinated efforts, (4) strategic use of surveillance and evaluation data, (5) active dissemination of information about program successes, and (6) policy maker champions. The sustainability framework and lessons learned may provide valuable insights for other public health programs facing funding threats.

  8. Data modeling for detection of epidemic outbreak

    NASA Astrophysics Data System (ADS)

    Jaenisch, Holger M.; Handley, James W.; Jaenisch, Kristina L.; Conn, Michael S.; Faucheux, Jeffrey P.

    2005-05-01

    Data Modeling is successfully applied to outbreak detection using epidemicological time series data. With proper selection of features, same day detection was demonstrated. Predictive Data Models are derived from the features in the form of integro-differential equations or their solution. These models are used as real-time change detectors. Data Modeling enables change detection using only nominal (no-outbreak) examples for training. Modeling naturally occurring dynamics due to assignable causes such as flu season enables distinction to be made of chemical and biological (chem-bio) causes.

  9. Controlling disease outbreaks in wildlife using limited culling: modelling classical swine fever incursions in wild pigs in Australia.

    PubMed

    Cowled, Brendan D; Garner, M Graeme; Negus, Katherine; Ward, Michael P

    2012-01-16

    Disease modelling is one approach for providing new insights into wildlife disease epidemiology. This paper describes a spatio-temporal, stochastic, susceptible- exposed-infected-recovered process model that simulates the potential spread of classical swine fever through a documented, large and free living wild pig population following a simulated incursion. The study area (300 000 km2) was in northern Australia. Published data on wild pig ecology from Australia, and international Classical Swine Fever data was used to parameterise the model. Sensitivity analyses revealed that herd density (best estimate 1-3 pigs km-2), daily herd movement distances (best estimate approximately 1 km), probability of infection transmission between herds (best estimate 0.75) and disease related herd mortality (best estimate 42%) were highly influential on epidemic size but that extraordinary movements of pigs and the yearly home range size of a pig herd were not. CSF generally established (98% of simulations) following a single point introduction. CSF spread at approximately 9 km2 per day with low incidence rates (< 2 herds per day) in an epidemic wave along contiguous habitat for several years, before dying out (when the epidemic arrived at the end of a contiguous sub-population or at a low density wild pig area). The low incidence rate indicates that surveillance for wildlife disease epidemics caused by short lived infections will be most efficient when surveillance is based on detection and investigation of clinical events, although this may not always be practical. Epidemics could be contained and eradicated with culling (aerial shooting) or vaccination when these were adequately implemented. It was apparent that the spatial structure, ecology and behaviour of wild populations must be accounted for during disease management in wildlife. An important finding was that it may only be necessary to cull or vaccinate relatively small proportions of a population to successfully contain

  10. Historical inability to control Aedes aegypti as a main contributor of fast dispersal of chikungunya outbreaks in Latin America.

    PubMed

    Fernández-Salas, Ildefonso; Danis-Lozano, Rogelio; Casas-Martínez, Mauricio; Ulloa, Armando; Bond, J Guillermo; Marina, Carlos F; Lopez-Ordóñez, Teresa; Elizondo-Quiroga, Armando; Torres-Monzón, Jorge A; Díaz-González, Esteban E

    2015-12-01

    The arrival of chikungunya fever (CHIKF) in Latin American countries has been expected to trigger epidemics and challenge health systems. Historically considered as dengue-endemic countries, abundant Aedes aegypti populations make this region highly vulnerable to chikungunya virus (CHIKV) circulation. This review describes the current dengue and CHIKF epidemiological situations, as well as the role of uncontrolled Ae. aegypti and Aedes albopictus vectors in spreading the emerging CHIKV. Comments are included relating to the vector competence of both species and failures of surveillance and vector control measures. Dengue endemicity is a reflection of these abundant and persistent Aedes populations that are now spreading CHIKV in the Americas. This article forms part of a symposium in Antiviral Research on "Chikungunya discovers the New World."

  11. Small-mammal herbivore control of secondary succession in New England tidal marshes.

    PubMed

    Gedan, Keryn Bromberg; Crain, Caitlin M; Bertness, Mark D

    2009-02-01

    Secondary succession is impacted by both biotic and abiotic forces, but their relative importance varies due to environmental drivers. Across estuarine salinity gradients, physical stress increases with salinity, and biotic stresses are greater at lower salinities. In southern New England tidal marshes spanning a landscape-scale salinity gradient, we experimentally examined the effects of physical stress and consumer pressure by mammalian herbivores on secondary succession in artificially created bare patches. Recovery was slower in marshes exposed to full-strength seawater, where physical stress is high. Compared to full-strength salt marshes, recovery in low-salinity marshes was much faster and was influenced by small-mammal consumers. At lower salinities, small mammals selectively ate and prevented the establishment of several native and two invasive, nuisance species (Typha angustifolia and Phragmites australis) but were unable to control the expansion of established P. australis stands. By controlling the establishment of competitively dominant species and the trajectory of secondary succession in low-salinity marshes, small mammals may play a cryptic keystone role in estuarine plant communities and are a critical, overlooked consideration in the conservation and management of estuarine marshes.

  12. History of malaria research and its contribution to the malaria control success in Suriname: a review.

    PubMed

    Breeveld, Florence J V; Vreden, Stephen G S; Grobusch, Martin P

    2012-03-29

    Suriname has cleared malaria from its capital city and coastal areas mainly through the successful use of chloroquine and DDT (dichloro-diphenyl-trichloroethane) during the Global Malaria Eradication programme that started in 1955. Nonetheless, malaria transmission rates remained high in the interior of the country for a long time. An impressive decline in malaria cases was achieved in the past few years, from 14,403 registered cases in 2003 to 1,371 in 2009. The introduction of artemisinin-based combination therapy (ACT) in 2004 has further fuelled the decrease in the number of infections with Plasmodium falciparum. The only population group still heavily burdened with malaria is gold mining industry workers. Interestingly, an important part of malaria cases diagnosed and treated in Suriname originate from border regions. Therefore, practical initiatives of combined efforts between neighbouring countries must be scaled up in order to effectively attack these specific areas. Furthermore, it is of vital importance to keep investing into the malaria control programme and public awareness campaigns. Especially the correct use of ACT must be promoted in order to prevent the emergence of resistance. However, effective preventive measures and adequate therapeutic options are on their own not enough to control, let alone eliminate malaria. Changing personal and social behaviour of people is particularly difficult, but crucial in making the current success sustainable. With this in mind, research on successfully implemented interventions, focusing on behavioural modifications and methods of measuring their effectiveness, must be expanded.

  13. Concurrent assessment of schedule and intensity control across successive discriminations1

    PubMed Central

    Raslear, Thomas G.; Pierrel-Sorrentino, Rosemary; Brissey, Catherine

    1975-01-01

    Two chinchillas were trained on a series of two-valued auditory intensity discriminations. Lever presses were reinforced when no tone was present and not reinforced in the presence of a four-kiloHertz tone. The intensity of the nonreinforced tone was successively decreased, increasing the difficulty of the discrimination, until differential responding resembled that on a mixed schedule (no-tone–no-tone). Response data were partitioned in such a way as to provide a continuing assessment of the relative amounts of control exerted by the reinforcement schedule and the sound intensity, respectively. Control by reinforcement density was a direct function of discrimination difficulty, whereas the control exerted by intensity was inversely related to difficulty. For these chinchillas, the absolute threshold value obtained at four kiloHertz was about two decibels referenced to 20 microNewtons per meter squared. PMID:16811846

  14. Deltamethrin flea-control preserves genetic variability of black-tailed prairie dogs during a plague outbreak

    USGS Publications Warehouse

    Jones, P.H.; Biggins, D.E.; Eads, D.A.; Eads, S.L.; Britten, H.B.

    2012-01-01

    Genetic variability and structure of nine black-tailed prairie dog (BTPD, Cynomys ludovicianus) colonies were estimated with 15 unlinked microsatellite markers. A plague epizootic occurred between the first and second years of sampling and our study colonies were nearly extirpated with the exception of three colonies in which prairie dog burrows were previously dusted with an insecticide, deltamethrin, used to control fleas (vectors of the causative agent of plague, Yersinia pestis). This situation provided context to compare genetic variability and structure among dusted and non-dusted colonies pre-epizootic, and among the three dusted colonies pre- and post-epizootic. We found no statistical difference in population genetic structures between dusted and non-dusted colonies pre-epizootic. On dusted colonies, gene flow and recent migration rates increased from the first (pre-epizootic) year to the second (post-epizootic) year which suggested dusted colonies were acting as refugia for prairie dogs from surrounding colonies impacted by plague. Indeed, in the dusted colonies, estimated densities of adult prairie dogs (including dispersers), but not juveniles (non-dispersers), increased from the first year to the second year. In addition to preserving BTPDs and many species that depend on them, protecting colonies with deltamethrin or a plague vaccine could be an effective method to preserve genetic variability of prairie dogs. ?? 2011 Springer Science+Business Media B.V.

  15. 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

  16. Bacterial Community Succession During in situ Uranium Bioremediation: Spatial Similarities Along Controlled Flow Paths

    SciTech Connect

    Hwang, Chiachi; Wu, Weimin; Gentry, Terry J.; Carley, Jack; Corbin, Gail A.; Carroll, Sue L.; Watson, David B.; Jardine, Phil M.; Zhou, Jizhong; Criddle, Craig S.; Fields, Matthew W.

    2009-05-22

    Bacterial community succession was investigated in a field-scale subsurface reactor formed by a series of wells that received weekly ethanol additions to re-circulating groundwater. Ethanol additions stimulated denitrification, metal reduction, sulfate reduction, and U(VI) reduction to sparingly soluble U(IV). Clone libraries of SSU rRNA gene sequences from groundwater samples enabled tracking of spatial and temporal changes over a 1.5 y period. Analyses showed that the communities changed in a manner consistent with geochemical variations that occurred along temporal and spatial scales. Canonical correspondence analysis revealed that the levels of nitrate, uranium, sulfide, sulfate, and ethanol strongly correlated with particular bacterial populations. As sulfate and U(VI) levels declined, sequences representative of sulfate-reducers and metal-reducers were detected at high levels. Ultimately, sequences associated with sulfate-reducing populations predominated, and sulfate levels declined as U(VI) remained at low levels. When engineering controls were compared to the population variation via canonical ordination, changes could be related to dissolved oxygen control and ethanol addition. The data also indicated that the indigenous populations responded differently to stimulation for bio-reduction; however, the two bio-stimulated communities became more similar after different transitions in an idiosyncratic manner. The strong associations between particular environmental variables and certain populations provide insight into the establishment of practical and successful remediation strategies in radionuclide-contaminated environments with respect to engineering controls and microbial ecology.

  17. Identification of successive flowering phases highlights a new genetic control of the flowering pattern in strawberry

    PubMed Central

    Perrotte, Justine; Guédon, Yann; Gaston, Amèlia; Denoyes, Béatrice

    2016-01-01

    The genetic control of the switch between seasonal and perpetual flowering has been deciphered in various perennial species. However, little is known about the genetic control of the dynamics of perpetual flowering, which changes abruptly at well-defined time instants during the growing season. Here, we characterize the perpetual flowering pattern and identify new genetic controls of this pattern in the cultivated strawberry. Twenty-one perpetual flowering strawberry genotypes were phenotyped at the macroscopic scale for their course of emergence of inflorescences and stolons during the growing season. A longitudinal analysis based on the segmentation of flowering rate profiles using multiple change-point models was conducted. The flowering pattern of perpetual flowering genotypes takes the form of three or four successive phases: an autumn-initiated flowering phase, a flowering pause, and a single stationary perpetual flowering phase or two perpetual flowering phases, the second one being more intense. The genetic control of flowering was analysed by quantitative trait locus mapping of flowering traits based on these flowering phases. We showed that the occurrence of a fourth phase of intense flowering is controlled by a newly identified locus, different from the locus FaPFRU, controlling the switch between seasonal and perpetual flowering behaviour. The role of this locus was validated by the analysis of data obtained previously during six consecutive years. PMID:27664957

  18. Identification of successive flowering phases highlights a new genetic control of the flowering pattern in strawberry.

    PubMed

    Perrotte, Justine; Guédon, Yann; Gaston, Amèlia; Denoyes, Béatrice

    2016-10-01

    The genetic control of the switch between seasonal and perpetual flowering has been deciphered in various perennial species. However, little is known about the genetic control of the dynamics of perpetual flowering, which changes abruptly at well-defined time instants during the growing season. Here, we characterize the perpetual flowering pattern and identify new genetic controls of this pattern in the cultivated strawberry. Twenty-one perpetual flowering strawberry genotypes were phenotyped at the macroscopic scale for their course of emergence of inflorescences and stolons during the growing season. A longitudinal analysis based on the segmentation of flowering rate profiles using multiple change-point models was conducted. The flowering pattern of perpetual flowering genotypes takes the form of three or four successive phases: an autumn-initiated flowering phase, a flowering pause, and a single stationary perpetual flowering phase or two perpetual flowering phases, the second one being more intense. The genetic control of flowering was analysed by quantitative trait locus mapping of flowering traits based on these flowering phases. We showed that the occurrence of a fourth phase of intense flowering is controlled by a newly identified locus, different from the locus FaPFRU, controlling the switch between seasonal and perpetual flowering behaviour. The role of this locus was validated by the analysis of data obtained previously during six consecutive years.

  19. Assessment of African Swine Fever Diagnostic Techniques as a Response to the Epidemic Outbreaks in Eastern European Union Countries: How To Improve Surveillance and Control Programs.

    PubMed

    Gallardo, C; Nieto, R; Soler, A; Pelayo, V; Fernández-Pinero, J; Markowska-Daniel, I; Pridotkas, G; Nurmoja, I; Granta, R; Simón, A; Pérez, C; Martín, E; Fernández-Pacheco, P; Arias, M

    2015-08-01

    This study represents a complete comparative analysis of the most widely used African swine fever (ASF) diagnostic techniques in the European Union (EU) using field and experimental samples from animals infected with genotype II ASF virus (ASFV) isolates circulating in Europe. To detect ASFV, three different PCRs were evaluated in parallel using 785 field and experimental samples. The results showed almost perfect agreement between the Universal ProbeLibrary (UPL-PCR) and the real-time (κ = 0.94 [95% confidence interval {CI}, 0.91 to 0.97]) and conventional (κ = 0.88 [95% CI, 0.83 to 0.92]) World Organisation for Animal Health (OIE)-prescribed PCRs. The UPL-PCR had greater diagnostic sensitivity for detecting survivors and allows earlier detection of the disease. Compared to the commercial antigen enzyme-linked immunosorbent assay (ELISA), good-to-moderate agreement (κ = 0.67 [95% CI, 0.58 to 0.76]) was obtained, with a sensitivity of 77.2% in the commercial test. For ASF antibody detection, five serological methods were tested, including three commercial ELISAs, the OIE-ELISA, and the confirmatory immunoperoxidase test (IPT). Greater sensitivity was obtained with the IPT than with the ELISAs, since the IPT was able to detect ASF antibodies at an earlier point in the serological response, when few antibodies are present. The analysis of the exudate tissues from dead wild boars showed that IPT might be a useful serological tool for determining whether or not animals had been exposed to virus infection, regardless of whether antibodies were present. In conclusion, the UPL-PCR in combination with the IPT was the most trustworthy method for detecting ASF during the epidemic outbreaks affecting EU countries in 2014. The use of the most appropriate diagnostic tools is critical when implementing effective control programs.

  20. 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

  1. Increased reports of measles in a low endemic region during a rubella outbreak in adult populations.

    PubMed

    Kurata, Takako; Kanbayashi, Daiki; Nishimura, Hiroshi; Komano, Jun; Kase, Tetsuo; Takahashi, Kazuo

    2015-06-01

    In 2013, a rubella outbreak was observed in Japan, Romania, and Poland. The outbreak in Japan was accompanied by an increase of measles reports, especially from a region where measles is highly controlled. This was attributed to the adult populations affected by this rubella outbreak, similarity of clinical signs between rubella and measles, sufficiently small impact of measles outbreaks from neighboring nations, and elimination levels of measles endemicity. Current and future concerns for measles control are discussed.

  2. Legionnaires’ Disease Outbreak in Murcia, Spain

    PubMed Central

    Navarro, Carmen; Fenoll, Daniel; García, José; González-Diego, Paulino; Jiménez-Buñuales, Teresa; Rodriguez, Miguel; Lopez, Rosa; Pacheco, Francisco; Ruiz, Joaquín; Segovia, Manuel; Baladrón, Beatriz; Pelaz, Carmen

    2003-01-01

    An explosive outbreak of Legionnaires’ disease occurred in Murcia, Spain, in July 2001. More than 800 suspected cases were reported; 449 of these cases were confirmed, which made this the world’s largest outbreak of the disease reported to date. Dates of onset for confirmed cases ranged from June 26 to July 19 , with a case-fatality rate of 1%. The epidemic curve and geographic pattern from the 600 completed epidemiologic questionnaires indicated an outdoor point-source exposure in the northern part of the city. A case-control study matching 85 patients living outside the city of Murcia with two controls each was undertaken to identify the outbreak source; the epidemiologic investigation implicated the cooling towers at a city hospital. An environmental isolate from these towers with an identical molecular pattern as the clinical isolates was subsequently identified and supported that epidemiologic conclusion. PMID:12967487

  3. Women dentists' office apparel: dressing for success in an age of infection control.

    PubMed

    Austin, G B; Tenzer, A; Lo Monaco, C

    1991-01-01

    A questionnaire on office apparel was answered by 928 of the 2000 women dentists surveyed. The most surprising aspect of this study is that only 51% of all the women surveyed feel the need to wear some type of lab coat or uniform for infection control. Women dentists who do wear a lab coat over street clothes do so primarily for the enhancement of their professional image. Women dentists reporting the highest gross incomes were more likely to wear only street clothes (P = .01) in the office. This study suggests that the dichotomy of dressing for success and dressing for infection control is an issue that needs to be addressed by the profession. Guidelines would be especially helpful for the majority of women dentists who are currently in their first years of practice.

  4. [The EHEC O104:H4 outbreak in Germany 2011 - lessons learned?!].

    PubMed

    Rissland, J; Kielstein, J T; Stark, K; Wichmann-Schauer, H; Stümpel, F; Pulz, M

    2013-04-01

    The EHEC O104:H4 outbreak 2011 in Germany provided numerous insights into the recognition and control of such epidemic situations. Food-borne outbreaks and their related dynamics may lead to a critical burden of disease and an eventual capacity overload of the medical care system. Possible difficulties in the microbiological diagnostics of new or significantly altered infectious agents may result in a delayed detection of the outbreak as well as the launching of interventional measures. Besides an early notification of the local public health office by the affected institutions, in which a complete electronic procedure and additional sentinel or surveillance instruments (e. g., in emergency departments of hospitals) may be of great help, an interdisciplinary cooperation of the local public health and food safety agencies is the key to an effective outbreak control. Corresponding organizations on the state and federal level should support the investigation process by microbiological diagnostics and advanced epidemiological analysis as well as examination of the food chains. Finally, successful crisis communication relies on "speaking with one voice" (not necessarily one person). Immediate, transparent, appropriate and honest information of the general public concerning the reasons, consequences and (counter-) measures of a crisis are the best means to keep the trust of the population and to counteract the otherwise inevitable speculations.

  5. Managing for Successful Control of Naturally Occurring Asbestos During Large Scale Grading

    NASA Astrophysics Data System (ADS)

    Saur, R.; Harnish, D.; Cavanaugh, J.; Kendall, K.; Virdee, A.; Ludlam, D.

    2012-12-01

    caused trigger level exceedences in perimeter monitors, including from off-site vehicles, nearby construction, and mechanical vegetation management (e.g. weed whacking). Regulatory and Owner Oversight. Monitoring results were reported daily to agencies, agencies made frequent inspections, and owner's independent compliance representatives observed the NOA mitigation and provided real-time feedback to the construction team. NOA Controls. NOA emissions were controlled site-wide and for each work activity. Site systems included misting, water trucks on roads, temporary covers and soil sealants. Work activity controls for excavation/grading included both source and perimeter controls. Water application technologies specially designed for NOA fiber mitigation, and not just dust mitigation, were effective without adding excessive water to work areas. These activities collectively created a management structure that facilitated successful implementation of NOA control technologies.

  6. 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

  7. 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

    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

  8. 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…

  9. 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…

  10. An outbreak of hepatitis A virus associated with a multi-national inner-city nursery in Glasgow, Scotland.

    PubMed

    Li, Kathy K; Penrice, Glillian M; Gunson, Rory N

    2015-08-01

    This report describes an outbreak of hepatitis A virus linked to a nursery which affected a total of 10 individuals. Active case finding, using oral fluid testing, helped identify asymptomatic cases. Nucleotide sequencing showed that all cases were caused by the same virus, which was most similar to HAV strains circulating Zimbabwe. Interestingly, an asymptomatic child had recently returned from visiting family in that country. Standard infection control procedures and vaccination of contacts successfully contained the outbreak. Only one patient developed hepatitis A despite having been vaccinated a week before symptoms began. This hepatitis A outbreak scenario may become more common as the numbers of international travellers and immigrants increase in the UK. It highlights the importance of recommending HAV vaccination to foreign nationals and their families who are travelling to countries endemic for hepatitis A.

  11. Rationalizing historical successes of malaria control in Africa in terms of mosquito resource availability management.

    PubMed

    Killeen, Gerry F; Seyoum, Aklilu; Knols, Bart G J

    2004-08-01

    Environmental management of mosquito resources is a promising approach with which to control malaria, but it has seen little application in Africa for more than half a century. Here we present a kinetic model of mosquito foraging for aquatic habitats and vertebrate hosts that allows estimation of malaria transmission intensity by defining the availability of these resources as the rate at which individual mosquitoes encounter and use them. The model captures historically observed responses of malaria transmission to environmental change, highlights important gaps in current understanding of vector ecology, and suggests convenient solutions. Resource availability is an intuitive concept that provides an adaptable framework for models of mosquito population dynamics, gene flow, and pathogen transmission that can be conveniently parameterized with direct field measurements. Furthermore, the model presented predicts that drastic reductions of malaria transmission are possible with environmental management and elucidates an ecologic basis for previous successes of integrated malaria control in Africa before the advent of DDT or chloroquine. Environmental management for malaria control requires specialist skills that are currently lacking in sub-Saharan Africa where they are needed most. Infrastructure and human capacity building in clinical, public health, and environmental disciplines should therefore be prioritized so that growing financial support for tackling malaria can be translated into truly integrated control programs.

  12. 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

  13. lin-28 controls the succession of cell fate choices via two distinct activities.

    PubMed

    Vadla, Bhaskar; Kemper, Kevin; Alaimo, Jennifer; Heine, Christian; Moss, Eric G

    2012-01-01

    lin-28 is a conserved regulator of cell fate succession in animals. In Caenorhabditis elegans, it is a component of the heterochronic gene pathway that governs larval developmental timing, while its vertebrate homologs promote pluripotency and control differentiation in diverse tissues. The RNA binding protein encoded by lin-28 can directly inhibit let-7 microRNA processing by a novel mechanism that is conserved from worms to humans. We found that C. elegans LIN-28 protein can interact with four distinct let-7 family pre-microRNAs, but in vivo inhibits the premature accumulation of only let-7. Surprisingly, however, lin-28 does not require let-7 or its relatives for its characteristic promotion of second larval stage cell fates. In other words, we find that the premature accumulation of mature let-7 does not account for lin-28's precocious phenotype. To explain let-7's role in lin-28 activity, we provide evidence that lin-28 acts in two steps: first, the let-7-independent positive regulation of hbl-1 through its 3'UTR to control L2 stage-specific cell fates; and second, a let-7-dependent step that controls subsequent fates via repression of lin-41. Our evidence also indicates that let-7 functions one stage earlier in C. elegans development than previously thought. Importantly, lin-28's two-step mechanism resembles that of the heterochronic gene lin-14, and the overlap of their activities suggests a clockwork mechanism for developmental timing. Furthermore, this model explains the previous observation that mammalian Lin28 has two genetically separable activities. Thus, lin-28's two-step mechanism may be an essential feature of its evolutionarily conserved role in cell fate succession.

  14. A Case-Controlled Study of Successful Aging in Older Adults with HIV

    PubMed Central

    Moore, Raeanne C.; Moore, David J.; Thompson, Wesley; Vahia, Ipsit V.; Grant, Igor; Jeste, Dilip V.

    2013-01-01

    OBJECTIVES There is a growing public health interest in the aging HIV-infected (HIV+) population, although there is a dearth of research on successful aging with HIV. This study aimed to understand the risk and protective factors associated with self-rated successful aging (SRSA) with HIV. DESIGN Cross-sectional, case-controlled. SETTING HIV Neurobehavioral Research Program and the Stein Institute for Research on Aging at University of California, San Diego. PARTICIPANTS Eighty-three community-dwelling HIV+ and 83 demographically matched HIV-uninfected (HIV−) individuals, enrolled between 12/1/11 and 5/10/12, mean age of 59 years, primarily Caucasian males, 69% with AIDS, who had been living with an HIV diagnosis for 16 years. Diagnostic criteria for HIV/AIDS was obtained through a blood draw. MEASUREMENTS Participants provided ratings of SRSA as part of a comprehensive survey which included measures of physical and emotional functioning and positive psychological traits. Relationships between how the different variables related to SRSA were explored. RESULTS While SRSA was lower in the HIV+ individuals than their HIV− counterparts, 66% of adults with HIV reported scores of 5 or higher on a 10-point scale of SRSA. Despite worse physical and mental functioning and greater psychosocial stress among the HIV+ participants, the two groups had comparable levels of optimism, personal mastery, and social support. SRSA in HIV+ individuals was associated with better physical and emotional functioning and positive psychological factors, but not HIV disease status or negative life events. CONCLUSION Successful psychosocial aging is possible in older HIV+ individuals. Positive psychological traits such as resilience, optimism, and sense of personal mastery have stronger relationship with SRSA than duration or severity of HIV disease. Research on interventions to enhance these positive traits in HIV+ adults is warranted. PMID:23759460

  15. Bed bug outbreak in a neonatal unit.

    PubMed

    Bandyopadhyay, T; Kumar, A; Saili, A

    2015-10-01

    There has been a worldwide increase in bed bug infestations over the last 10-15 years. A major stigma is placed upon the institutions found to be infested. We report our experience with an outbreak of the tropical bed bug, Cimex hemipterus, in a neonatal unit. The outbreak not only affected the admitted newborns and mothers by causing a wide variety of rashes and inducing sleeplessness, but also impinged upon the health professionals and their families by producing similar symptomology. It is important for healthcare providers to be aware of, and for each healthcare facility to have, bed bug prevention and control policies.

  16. Blood, sweat, tears and success of technology transfer long-term controlled-release of herbicides

    SciTech Connect

    Van Voris, P.; Cataldo, D.A.; Burton, F.G.; Skeins, W.E.

    1988-01-01

    The problems encountered, the technical difficulties that had to be overcome, and the successful transfer of technology related to controlled-release of pesticides is reviewed. Research on control-release of pesticides to date has resulted in products designed to extend bioactivity for periods of several days, months, or at most, several years. However, research supported by the U.S. Department of Energy directed toward solving problems associated with plant-root penetration through caps and liners engineered to minimize leaching or movement of buried nuclear and chemical wastes has resulted in development of a long-term controlled-release herbicide delivery system designed to stop root growth for periods of up to 100 years. Through the unique combination of polymers with a herbicidally active dinitroaniline, a cylindrical pellet was developed that continuously releases a herbicide for a period of up to 100 years. Equilibrium concentration of the herbicide in soil adjacent to the pellet and the bioactive lifetime of the device can be adjusted by changing the size of the pellet; the type of polymer; the type, quality, and quantity of carrier; and/or the concentration and type of dinitroaniline was used.

  17. A study on the vegetation succession of pioneer trees in landslide control areas

    NASA Astrophysics Data System (ADS)

    Lee, J. H.; Lin, S. H.

    2015-12-01

    Located in subtropics, the steep terrain, concentrated rainy season, natural disaster, and artificial development have damaged the surface vegetation and resulted in soil loss and landslide in Taiwan. The control of landslide should stabilize the side slope as the priority. Furthermore, a proper engineering is applied to grow plants for the rapid forestation on landslide. Taking the location which has been done hydroseeding in the Shihmen Reservoir watershed as the example, the vegetation succession within the 8 years after the hydroseeding is investigated in this study. The growth and decline of pioneer trees like Rhus javanica is particularly discussed the vegetation recovery role and function on landslide. The research result could provide reference for the planning and design of vegetation recovery.

  18. Canine distemper outbreak in rhesus monkeys, China.

    PubMed

    Qiu, Wei; Zheng, Ying; Zhang, Shoufeng; Fan, Quanshui; Liu, Hua; Zhang, Fuqiang; Wang, Wei; Liao, Guoyang; Hu, Rongliang

    2011-08-01

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

  19. Project SUCCESS' Effects on Substance Use-Related Attitudes and Behaviors: A Randomized Controlled Trial in Alternative High Schools

    ERIC Educational Resources Information Center

    Clark, Heddy Kovach; Ringwalt, Chris L.; Shamblen, Stephen R.; Hanley, Sean M.

    2011-01-01

    Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets…

  20. Successful control of dyslipidemia in patients with metabolic syndrome: focus on lifestyle changes.

    PubMed

    Stone, Neil J

    2006-01-01

    Approaches to controlling dyslipidemia in patients with metabolic syndrome must take into consideration a patient's individual characteristics and underlying lipid disorder. Some patients will require pharmacologic therapy, whereas others can be controlled with lifestyle changes alone. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines recommend that patients with at least 3 of the following clinical variables be designated as having metabolic syndrome: abdominal obesity as reflected in increased waist circumference; a low high-density lipoprotein cholesterol (HDL-C) level; an elevated triglyceride level; elevated blood pressure or treatment with antihypertensive medications; and/or elevated fasting plasma glucose or treatment with antidiabetic medications. Unless patients with metabolic syndrome change their lifestyle, existing cardiovascular and metabolic risk factors will worsen or new risk factors will develop. This helps explain why these patients are at increased risk for developing type 2 diabetes mellitus (DM) and coronary heart disease (CHD). The lifestyle changes recommended by NCEP ATP III for controlling dyslipidemia (i.e., elevated levels of triglycerides and decreased levels of HDL-C) in patients with metabolic syndrome or type 2 DM include (1) reduced intake of saturated fats and dietary cholesterol, (2) intake of dietary options to enhance lowering of low-density lipoprotein cholesterol, (3) weight control, and (4) increased physical activity. If lifestyle changes are not successful for individuals at high risk of developing CHD, or for those who currently have CHD, a CHD risk equivalent, or persistent atherogenic dyslipidemia, then pharmacotherapy may be necessary as defined by NCEP ATP III guidelines.

  1. 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

  2. [First ciguatera outbreak in Germany in 2012].

    PubMed

    Friedemann, Miriam

    2016-12-01

    In November 2012, 23 cases of ciguatera with typical combinations of gastrointestinal and neurological symptoms occurred in Germany after consumption of imported tropical fish (Lutjanus spp.). A questionnaire was used to gather information on the disease course and fish consumption. All patients suffered from pathognomonic cold allodynia. Aside from two severe courses of illness, all other cases showed symptoms of moderate intensity. During a three-year follow-up, seven patients reported prolonged paresthesia for more than one year. Two of them reported further neuropathies over almost three years. This is the first time that long-term persistence of symptoms has been documented in detail. Outbreak cases were allocated to eight clusters in seven German cities. A further cluster was prevented by the successful recall of ciguatoxic fish. Three clusters were confirmed by the detection of ciguatoxin in samples of suspicious and recalled fish. An extrapolation on the basis of ciguatoxic samples revealed twenty prevented cases of ciguatera. Further officially unknown cases should be assumed. During the outbreak investigations, inadvertently falsely labelled fish species and fishing capture areas on import and retail level documents were observed. The ascertainment of cases and the outbreak investigations proved to be difficult due to inconsistent case reports to poisons centers, local health and veterinary authorities. In Germany, many physicians are unaware of the disease pattern of ciguatera and the risks caused by tropical fish. The occurrence of further outbreaks during the following years emphasizes the increasing significance of ciguatera in Germany.

  3. Effect of a lactation nurse on the success of breast-feeding: a randomised controlled trial.

    PubMed Central

    Jones, D A; West, R R

    1986-01-01

    An evaluation of a lactation nurse by means of a randomised controlled trial is described. The lactation nurse was employed to assist, support, and encourage mothers during the early weeks after parturition in hospital and at home. All mothers who breast-fed at least once were entered into the trial. Altogether 649 mothers were interviewed 12 months later to establish the duration of breast-feeding and to enquire after practices of and attitudes towards infant feeding. The lactation nurse significantly extended the duration of breast-feeding, particularly during the first four weeks and among women of lower social class. Although she did not reduce problems or change practices significantly, all the trends were consistently in the right direction. Mothers in the experimental group were more satisfied with the help they received than were mothers in the control group. It seems likely that the lactation nurse by consistent advice, assistance, support, and encouragement enabled mothers to cope more successfully with difficulties and that this led to significantly fewer ending breast-feeding prematurely. PMID:3519825

  4. Effects of prenatal substance exposure on neurocognitive correlates of inhibitory control success and failure.

    PubMed

    Roos, Leslie E; Beauchamp, Kathryn G; Pears, Katherine C; Fisher, Philip A; Berkman, Elliot T; Capaldi, Deborah

    2016-06-03

    Adolescents with prenatal substance (drug and alcohol) exposure exhibit inhibitory control (IC) deficits and aberrations in associated neural function. Nearly all research to date examines exposure to individual substances, and a minimal amount is known about the effects of heterogeneous exposure-which is more representative of population exposure levels. Using functional magnetic resonance imaging (fMRI), we investigated IC (Go/NoGo) in heterogeneously exposed (n = 7) vs. control (n = 7) at-risk adolescents (ages 13-17). The fMRI results indicated multiple IC processing differences consistent with a more immature developmental profile for exposed adolescents (Exposed  >  Nonexposed: NoGo > Go: right ventrolateral prefrontal cortex, right cuneus, and left inferior parietal lobe; NoGo > false alarm: occipital lobe; Go > false alarm: right anterior prefrontal cortex). Simple effects suggest exposed adolescents exhibited exaggerated correct trial but decreased incorrect trial activation. Results provide initial evidence that prenatal exposure across substances creates similar patterns of atypical brain activation to IC success and failure.

  5. Controlling Neglected Tropical Diseases (NTDs) in Haiti: Implementation Strategies and Evidence of Their Success

    PubMed Central

    Lemoine, Jean Frantz; Desormeaux, Anne Marie; Monestime, Franck; Fayette, Carl Renad; Desir, Luccene; Direny, Abdel Nasser; Carciunoiu, Sarah; Miller, Lior; Knipes, Alaine; Lammie, Patrick; Smith, Penelope; Stockton, Melissa; Trofimovich, Lily; Bhandari, Kalpana; Reithinger, Richard; Crowley, Kathryn; Ottesen, Eric; Baker, Margaret

    2016-01-01

    Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti’s neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a “directly observed treatment” strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained– 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH—and the significant reduction in burden of infection– 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti’s very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of “best practices” for

  6. Controlling Neglected Tropical Diseases (NTDs) in Haiti: Implementation Strategies and Evidence of Their Success.

    PubMed

    Lemoine, Jean Frantz; Desormeaux, Anne Marie; Monestime, Franck; Fayette, Carl Renad; Desir, Luccene; Direny, Abdel Nasser; Carciunoiu, Sarah; Miller, Lior; Knipes, Alaine; Lammie, Patrick; Smith, Penelope; Stockton, Melissa; Trofimovich, Lily; Bhandari, Kalpana; Reithinger, Richard; Crowley, Kathryn; Ottesen, Eric; Baker, Margaret

    2016-10-01

    Lymphatic filariasis (LF) and soil-transmitted helminths (STH) have been targeted since 2000 in Haiti, with a strong mass drug administration (MDA) program led by the Ministry of Public Health and Population and its collaborating international partners. By 2012, Haiti's neglected tropical disease (NTD) program had reached full national scale, and with such consistently good epidemiological coverage that it is now able to stop treatment for LF throughout almost all of the country. Essential to this success have been in the detail of how MDAs were implemented. These key programmatic elements included ensuring strong community awareness through an evidence-based, multi-channel communication and education campaign facilitated by voluntary drug distributors; strengthening community trust of the drug distributors by ensuring that respected community members were recruited and received appropriate training, supervision, identification, and motivation; enforcing a "directly observed treatment" strategy; providing easy access to treatment though numerous distribution posts and a strong drug supply chain; and ensuring quality data collection that was used to guide and inform MDA strategies. The evidence that these strategies were effective lies in both the high treatment coverage obtained- 100% geographical coverage reached in 2012, with almost all districts consistently achieving well above the epidemiological coverage targets of 65% for LF and 75% for STH-and the significant reduction in burden of infection- 45 communes having reached the target threshold for stopping treatment for LF. By taking advantage of sustained international financial and technical support, especially during the past eight years, Haiti's very successful MDA campaign resulted in steady progress toward LF elimination and development of a strong foundation for ongoing STH control. These efforts, as described, have not only helped establish the global portfolio of "best practices" for NTD control but

  7. Mitigating Infectious Disease Outbreaks

    NASA Astrophysics Data System (ADS)

    Davey, Victoria

    The emergence of new, transmissible infections poses a significant threat to human populations. As the 2009 novel influenza A/H1N1 pandemic and the 2014-2015 Ebola epidemic demonstrate, we have observed the effects of rapid spread of illness in non-immune populations and experienced disturbing uncertainty about future potential for human suffering and societal disruption. Clinical and epidemiologic characteristics of a newly emerged infectious organism are usually gathered in retrospect as the outbreak evolves and affects populations. Knowledge of potential effects of outbreaks and epidemics and most importantly, mitigation at community, regional, national and global levels is needed to inform policy that will prepare and protect people. Study of possible outcomes of evolving epidemics and application of mitigation strategies is not possible in observational or experimental research designs, but computational modeling allows conduct of `virtual' experiments. Results of well-designed computer simulations can aid in the selection and implementation of strategies that limit illness and death, and maintain systems of healthcare and other critical resources that are vital to public protection. Mitigating Infectious Disease Outbreaks.

  8. Successes and Challenges in Implementation of Radon Control Activities in Iowa, 2010–2015

    PubMed Central

    Abbott, Anne L.; Miller, Laura L.

    2016-01-01

    Background Radon gas has recently become more prominent in discussions of lung cancer prevention nationally and in Iowa. A review in 2013 of cancer plans in the National Comprehensive Cancer Control Program found that 42% of cancer plans, including Iowa’s, had terminology on radon. Plans included awareness activities, home testing, remediation, policy, and policy evaluation. Community Context Iowa has the highest average radon concentrations in the United States; 70% of homes have radon concentrations above the Environmental Protection Agency’s action levels. Radon control activities in Iowa are led by the Iowa Cancer Consortium, the Iowa Department of Public Health, and the Iowa Radon Coalition. Methods A collaborative approach was used to increase levels of awareness, testing, and (if necessary) mitigation, and to introduce a comprehensive radon control policy in Iowa by engaging partners and stakeholders across the state. Outcome The multipronged approach and collaborative work in Iowa appears to have been successful in increasing awareness: the number of radon tests completed in Iowa increased by 20% from 19,600 in 2009 to 23,500 in 2014, and the number of mitigations completed by certified mitigators increased by 108% from 2,600 to more than 5,400. Interpretation Through collaboration, Iowa communities are engaged in activities that led to increases in awareness, testing, mitigation, and policy. States interested in establishing a similar program should consider a multipronged approach involving multiple entities and stakeholders with different interests and abilities. Improvements in data collection and analysis are necessary to assess impact. PMID:27079648

  9. Biotic and abiotic controls of argentine ant invasion success at local and landscape scales

    USGS Publications Warehouse

    Menke, S.B.; Fisher, R.N.; Jetz, W.; Holway, D.A.

    2007-01-01

    Although the ecological success of introduced species hinges on biotic interactions and physical conditions, few experimental studies - especially on animals - have simultaneously investigated the relative importance of both types of factors. The lack of such research may stem from the common assumption that native and introduced species exhibit similar environmental tolerances. Here we combine experimental and spatial modeling approaches (1) to determine the relative importance of biotic and abiotic controls of Argentine ant (Linepithema humile) invasion success, (2) to examine how the importance of these factors changes with spatial scale in southern California (USA), and (3) to assess how Argentine ants differ from native ants in their environmental tolerances. A factorial field experiment that combined native ant removal with irrigation revealed that Argentine ants failed to invade any dry plots (even those lacking native ants) but readily invaded all moist plots. Native ants slowed the spread of Argentine ants into irrigated plots but did not prevent invasion. In areas without Argentine ants, native ant species showed variable responses to irrigation. At the landscape scale, Argentine ant occurrence was positively correlated with minimum winter temperature (but not precipitation), whereas native ant diversity increased with precipitation and was negatively correlated with minimum winter temperature. These results are of interest for several reasons. First, they demonstrate that fine-scale differences in the physical environment can eclipse biotic resistance from native competitors in determining community susceptibility to invasion. Second, our results illustrate surprising complexities with respect to how the abiotic factors limiting invasion can change with spatial scale, and third, how native and invasive species can differ in their responses to the physical environment. Idiosyncratic and scale-dependent processes complicate attempts to forecast where

  10. Impact of Infection Control Measures to Control an Outbreak of Multidrug-Resistant Tuberculosis in a Human Immunodeficiency Virus Ward, Peru

    PubMed Central

    Ticona, Eduardo; Huaroto, Luz; Kirwan, Daniela E.; Chumpitaz, Milagros; Munayco, César V.; Maguiña, Mónica; Tovar, Marco A.; Evans, Carlton A.; Escombe, Roderick; Gilman, Robert H.

    2016-01-01

    Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000—56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug–susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB–coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective. PMID:27621303

  11. Impact of Infection Control Measures to Control an Outbreak of Multidrug-Resistant Tuberculosis in a Human Immunodeficiency Virus Ward, Peru.

    PubMed

    Ticona, Eduardo; Huaroto, Luz; Kirwan, Daniela E; Chumpitaz, Milagros; Munayco, César V; Maguiña, Mónica; Tovar, Marco A; Evans, Carlton A; Escombe, Roderick; Gilman, Robert H

    2016-12-07

    Multidrug-resistant tuberculosis (MDRTB) rates in a human immunodeficiency virus (HIV) care facility increased by the year 2000-56% of TB cases, eight times the national MDRTB rate. We reported the effect of tuberculosis infection control measures that were introduced in 2001 and that consisted of 1) building a respiratory isolation ward with mechanical ventilation, 2) triage segregation of patients, 3) relocation of waiting room to outdoors, 4) rapid sputum smear microscopy, and 5) culture/drug-susceptibility testing with the microscopic-observation drug-susceptibility assay. Records pertaining to patients attending the study site between 1997 and 2004 were reviewed. Six hundred and fifty five HIV/TB-coinfected patients (mean age 33 years, 79% male) who attended the service during the study period were included. After the intervention, MDRTB rates declined to 20% of TB cases by the year 2004 (P = 0.01). Extremely limited access to antiretroviral therapy and specific MDRTB therapy did not change during this period, and concurrently, national MDRTB prevalence increased, implying that the infection control measures caused the fall in MDRTB rates. The infection control measures were estimated to have cost US$91,031 while preventing 97 MDRTB cases, potentially saving US$1,430,026. Thus, this intervention significantly reduced MDRTB within an HIV care facility in this resource-constrained setting and should be cost-effective.

  12. Enhanced hygiene measures and norovirus transmission during an outbreak.

    PubMed

    Heijne, Janneke C M; Teunis, Peter; Morroy, Gabriella; Wijkmans, Clementine; Oostveen, Sandy; Duizer, Erwin; Kretzschmar, Mirjam; Wallinga, Jacco

    2009-01-01

    Control of norovirus outbreaks relies on enhanced hygiene measures, such as handwashing, surface cleaning, using disposable paper towels, and using separate toilets for sick and well persons. However, little is known about their effectiveness in limiting further spread of norovirus infections. We analyzed norovirus outbreaks in 7 camps at an international scouting jamboree in the Netherlands during 2004. Implementation of hygiene measures coincided with an 84.8% (95% predictive interval 81.2%-86.6%) reduction in reproduction number. This reduction was unexpectedly large but still below the reduction needed to contain a norovirus outbreak. Even more stringent control measures are required to break the chain of transmission of norovirus.

  13. Cholera outbreak--southern Sudan, 2007.

    PubMed

    2009-04-10

    Vibrio cholerae causes cholera, an acute infectious diarrheal disease that can result in death without appropriate therapy, depending on the severity of the disease. War, poverty, inadequate sanitation, and large numbers of refugees and internally displaced persons (IDPs) are major precursors to cholera outbreaks. In 2005, Southern Sudan ended its 22-year civil war with North Sudan; as a result, IDPs and refugees are returning to the south. During April--June 2007, investigators from the Southern Sudan Field Epidemiology and Laboratory Training Program (SS-FELTP) and CDC investigated a cholera outbreak in the town of Juba, Southern Sudan. This report summarizes the results of that investigation, which found that 3,157 persons were diagnosed with suspected cholera during January--June 2007, with 74 deaths resulting from the disease. An environmental investigation revealed suboptimal hygiene practices and a lack of water and sanitation infrastructure in Juba. A case-control study indicated that persons less likely to have cholera were more likely to have consumed hot meals containing meat during the outbreak. Contaminated food or water were not identified as possible sources of the cholera outbreak in Juba. However, this might be attributed to limitations of the study, including small sample size. Cholera can reach epidemic proportions if adequate control measures are not implemented early. Mass media campaigns are important for current and new residents in Juba to understand the importance of proper food handling, clean water, and optimal hygiene practices to prevent the spread of cholera.

  14. Outbreak of cyclosporiasis in British Columbia associated with imported Thai basil.

    PubMed Central

    Hoang, L. M. N.; Fyfe, M.; Ong, C.; Harb, J.; Champagne, S.; Dixon, B.; Isaac-Renton, J.

    2005-01-01

    Sporadic outbreaks of cyclosporiasis, a common cause of protracted diarrhoea in underdeveloped countries, are often undetected and undiagnosed in industrial countries. In May 2001, an outbreak of Cyclospora cayetanensis gastroenteritis was identified in British Columbia, Canada, with 17 reported cases. We conducted a case-control study involving 12 out of the 17 reported and confirmed case patients. Eleven (92%) of the patients had consumed Thai basil, an essential ingredient in Vietnamese cuisine, compared to 3 out of 16 (19%) of the control patients (P = 0.003). Trace-back investigations implicated Thai basil imported via the United States as the vehicle for this outbreak. This is the first documented sporadic outbreak of cyclosporiasis linked to Thai basil in Canada, and the first outbreak of cyclosporiasis identified in an ethnic immigrant population. This outbreak provides the opportunity to increase our understanding of this emerging pathogen and improve on our prevention and control for future outbreaks. PMID:15724706

  15. Outbreak of cyclosporiasis in British Columbia associated with imported Thai basil.

    PubMed

    Hoang, L M N; Fyfe, M; Ong, C; Harb, J; Champagne, S; Dixon, B; Isaac-Renton, J

    2005-02-01

    Sporadic outbreaks of cyclosporiasis, a common cause of protracted diarrhoea in underdeveloped countries, are often undetected and undiagnosed in industrial countries. In May 2001, an outbreak of Cyclospora cayetanensis gastroenteritis was identified in British Columbia, Canada, with 17 reported cases. We conducted a case-control study involving 12 out of the 17 reported and confirmed case patients. Eleven (92%) of the patients had consumed Thai basil, an essential ingredient in Vietnamese cuisine, compared to 3 out of 16 (19%) of the control patients (P = 0.003). Trace-back investigations implicated Thai basil imported via the United States as the vehicle for this outbreak. This is the first documented sporadic outbreak of cyclosporiasis linked to Thai basil in Canada, and the first outbreak of cyclosporiasis identified in an ethnic immigrant population. This outbreak provides the opportunity to increase our understanding of this emerging pathogen and improve on our prevention and control for future outbreaks.

  16. Slithering on sand: kinematics and controls for success on granular media

    NASA Astrophysics Data System (ADS)

    Schiebel, Perrin E.; Zhang, Tingnan; Dai, Jin; Gong, Chaohui; Yu, Miao; Astley, Henry C.; Travers, Matthew; Choset, Howie; Goldman, Daniel I.

    Previously, we studied the subsurfacelocomotion of undulatory sand-swimming snakes and lizards; using empirical drag response of GM to subsurface intrusion of simple objects allowed us to develop a granular resistive force theory (RFT) to model the locomotion and predict optimal movement patterns. However, our knowledge of the physics of GM at the surface is limited; this makes it impossible to determine how the desert-dwelling snake C. occipitalis moves effectively (0.45 +/-0.04 bodylengths/sec) on the surface of sand .We combine organism biomechanics studies, GM drag experiments, RFT calculations and tests of a physical model (a snake-like robot), to reveal how multiple factors acting together contribute to slithering on sandy surfaces. These include the kinematics--targeting an ideal waveform which maximizes speed while minimizing joint-level torque, the ability to modulate ground interactions by lifting body segments, and the properties of the GM. Based on the sensitive nature of the relationship between these factors, we hypothesize that having an element of force-based control, where the waveform is modulated in response to the forces acting between the body and the environment, is necessary for successful locomotion on yielding substrates.

  17. Arterial microanatomy determines the success of energy-based renal denervation in controlling hypertension

    PubMed Central

    Tzafriri, Abraham R.; Keating, John H.; Markham, Peter M.; Spognardi, Anna-Maria; Stanley, James R. L.; Wong, Gee; Zani, Brett G.; Grunewald, Debby; O’Fallon, Patrick; Fuimaono, Kristine; Mahfoud, Felix; Edelman, Elazer R.

    2015-01-01

    Renal Denervation (RDN) is a treatment option for patients with hypertension resistant to conventional therapy. Clinical trials have demonstrated variable benefit. To understand the determinants of successful clinical response to this treatment, we integrated porcine and computational models of intravascular radiofrequency RDN. Controlled single-electrode denervation resulted in ablation zone geometries that varied in arc, area and depth, depending on the composition of the adjacent tissue substructure. Computational simulations predicted that delivered power density was influenced by tissue substructure, and peaked at the conductivity discontinuities between soft fatty adventitia and water rich tissues (media, lymph nodes etc.), not at the electrode-tissue interface). Electrode irrigation protected arterial wall tissue adjacent to the electrode by clearing heat that diffuses from within the tissue, without altering peri-arterial ablation. Seven days after multi-electrode treatments, renal norepinephrine and blood pressure were reduced. Blood pressure reductions were correlated with the size-weighted number of degenerative nerves, implying that the effectiveness of the treatment in decreasing hypertension depends on the extent of nerve injury and ablation, which in turn are determined by the tissue microanatomy at the electrode site. These results may explain the variable patient response to RDN and suggest a path to more robust outcomes. PMID:25925684

  18. The role of quality improvement in disease management: a statewide tuberculosis control success story.

    PubMed

    Fos, Peter J; Lee, Jae Eun; Sung, Jung Hye; Zuniga, Miguel A; Amy, Brian W

    2005-01-01

    This study describes Mississippi's statewide latent tuberculosis infection (LTBI) control management efforts to improve treatment outcomes using scientific quality improvement tools. LTBI medication completion rates were observed by month and by nine administrative health districts for a 12-month period. Analysis of variance (ANOVA) was conducted to see if there was any significant change between preintervention and postintervention in medication completion rates. Regression analysis was performed to test the linearity of change across the monthly rates. A change from a rate of 79.7 percent to 90.5 percent completion of the LTBI medication regimen was observed after the quality improvement intervention was instituted. During the quality improvement intervention, the mean reached 96.5 percent completion, followed by a slight decline at the end of the intervention to 90.5 percent. The analysis revealed that the mean LTBI medication completion rate across the nine administrative health districts was significantly increased and variability was decreased across all administrative health districts, with minor exceptions. A quality improvement team approach was shown to be effective in disease management by increasing LTBI medication completion. New baseline expectations can be established when quality improvement initiatives are implemented. This success can be linked, in part, to the use of scientific methods, precise and valid data, persuasive and clear goal setting, appropriate feedback, and ongoing monitoring.

  19. Role of auditory feedback in the control of successive keystrokes during piano playing

    PubMed Central

    Soechting, John F.

    2011-01-01

    The purpose of this study was to elucidate the role of auditory feedback derived from one keystroke in the control of the rhythmicity and velocity of successive keystrokes during piano playing. We examined the effects of transient auditory perturbations with respect to the pitch, loudness, and timing of one tone on subsequent keystrokes while six pianists played short excerpts from three simple musical pieces having different tempi (“event rates”). Immediately after a delay in tone production, the inter-keystroke interval became shorter. This compensatory action depended on the tempo, being most prominent at the medium tempo. This indicates that temporal information provided by auditory feedback is utilized to regulate the timing of movement elements produced in a sequence. We also found that the keystroke velocity changed after the timing, pitch, or loudness of a tone was altered, although the response differed depending on the type of perturbation. While delaying the timing or altering the pitch led to an increase in the velocity, altering the loudness changed the velocity in an inconsistent manner. Furthermore, perturbing a tone elicited by the right hand also affected the rhythmicity and velocity of keystrokes with the left hand, indicating that bimanual coordination of tone production was maintained. Finally, altering the pitch sometimes resulted in striking an incorrect key, mostly in the slow piece, emphasizing the importance of pitch information for accurate planning and execution of sequential piano keystrokes. PMID:20521031

  20. Outbreak Caused by Enterobacteriaceae Harboring NDM-1 Metallo-β-Lactamase Carried in an IncFII Plasmid in a Tertiary Care Hospital in Mexico City

    PubMed Central

    Torres-González, Pedro; Bobadilla-del Valle, Miriam; Tovar-Calderón, Estrella; Leal-Vega, Francisco; Hernández-Cruz, Araceli; Martínez-Gamboa, Areli; Niembro-Ortega, María Dolores; Sifuentes-Osornio, José

    2015-01-01

    Carbapenem-resistant Enterobacteriaceae carrying New Delhi metallo-β-lactamase 1 (NDM-1) have rarely been reported in Latin America. We report of an outbreak caused by a blaNDM-1-harboring plasmid spread through different bacterial species, including Escherichia coli (ST617) and Enterobacter cloacae (ST182) isolates from the same patient and three Klebsiella pneumoniae isolates (ST22) derived from three epidemiologically related patients. IncFII plasmids were found in all strains. Measures to control the outbreak were applied successfully. PMID:26282410

  1. Outbreak caused by Enterobacteriaceae harboring NDM-1 metallo-β-lactamase carried in an IncFII plasmid in a tertiary care hospital in Mexico City.

    PubMed

    Torres-González, Pedro; Bobadilla-Del Valle, Miriam; Tovar-Calderón, Estrella; Leal-Vega, Francisco; Hernández-Cruz, Araceli; Martínez-Gamboa, Areli; Niembro-Ortega, María Dolores; Sifuentes-Osornio, José; Ponce-de-León, Alfredo

    2015-11-01

    Carbapenem-resistant Enterobacteriaceae carrying New Delhi metallo-β-lactamase 1 (NDM-1) have rarely been reported in Latin America. We report of an outbreak caused by a blaNDM-1-harboring plasmid spread through different bacterial species, including Escherichia coli (ST617) and Enterobacter cloacae (ST182) isolates from the same patient and three Klebsiella pneumoniae isolates (ST22) derived from three epidemiologically related patients. IncFII plasmids were found in all strains. Measures to control the outbreak were applied successfully.

  2. Non-biomedical factors in the Ebola virus disease outbreak in West Africa.

    PubMed

    Adachi, Takuya

    2015-01-01

    The outbreak of Ebola virus disease, reported in West Africa in 2014, has become the largest ever one in the history. Tremendous efforts by all the parties concerned are now bringing this epidemic closer to the end, while observing a large number of cases and deaths, including health care workers.This paper features five questions:1. Why did it emerge in West Africa?2. Why has it spread so wide and intensely?3. Why were so many health care workers infected?4. Why is it being brought under control?5. Would it emerge and spread in Japan in the same way?Ebola virus transmits through human acts such as caregiving of the sick and attending a funeral, therefore an epidemic is not likely to subside naturally, but intentional interventions are needed to terminate its transmission. Who the outbreak response is meant for, either patients, the general public in the affected countries, or international communities, also determines its success or failure.

  3. Epidemiological dynamics of Ebola outbreaks.

    PubMed

    House, Thomas

    2014-09-12

    Ebola is a deadly virus that causes frequent disease outbreaks in the human population. In this study, we analyse its rate of new introductions, case fatality ratio, and potential to spread from person to person. The analysis is performed for all completed outbreaks and for a scenario where these are augmented by a more severe outbreak of several thousand cases. The results show a fast rate of new outbreaks, a high case fatality ratio, and an effective reproductive ratio of just less than 1.

  4. Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs.

    PubMed

    Barreto, Mauricio L; Teixeira, M Gloria; Bastos, Francisco I; Ximenes, Ricardo A A; Barata, Rita B; Rodrigues, Laura C

    2011-05-28

    Despite pronounced reductions in the number of deaths due to infectious diseases over the past six decades, infectious diseases are still a public health problem in Brazil. In this report, we discuss the major successes and failures in the control of infectious diseases in Brazil, and identify research needs and policies to further improve control or interrupt transmission. Control of diseases such as cholera, Chagas disease, and those preventable by vaccination has been successful through efficient public policies and concerted efforts from different levels of government and civil society. For these diseases, policies dealt with key determinants (eg, the quality of water and basic sanitation, vector control), provided access to preventive resources (such as vaccines), and successfully integrated health policies with broader social policies. Diseases for which control has failed (such as dengue fever and visceral leishmaniasis) are vector-borne diseases with changing epidemiological profiles and major difficulties in treatment (in the case of dengue fever, no treatment is available). Diseases for which control has been partly successful have complex transmission patterns related to adverse environmental, social, economic, or unknown determinants; are sometimes transmitted by insect vectors that are difficult to control; and are mostly chronic diseases with long infectious periods that require lengthy periods of treatment.

  5. An outbreak of Cyclospora infection on a cruise ship.

    PubMed

    Gibbs, R A; Nanyonjo, R; Pingault, N M; Combs, B G; Mazzucchelli, T; Armstrong, P; Tarling, G; Dowse, G K

    2013-03-01

    In 2010, an outbreak of cyclosporiasis affected passengers and crew on two successive voyages of a cruise ship that departed from and returned to Fremantle, Australia. There were 73 laboratory-confirmed and 241 suspected cases of Cyclospora infection reported in passengers and crew from the combined cruises. A case-control study performed in crew members found that illness was associated with eating items of fresh produce served onboard the ship, but the study was unable conclusively to identify the responsible food(s). It is likely that one or more of the fresh produce items taken onboard at a south-east Asian port during the first cruise was contaminated. If fresh produce supplied to cruise ships is sourced from countries or regions where Cyclospora is endemic, robust standards of food production and hygiene should be applied to the supply chain.

  6. The History of Dengue Outbreaks in the Americas

    PubMed Central

    Brathwaite Dick, Olivia; San Martín, José L.; Montoya, Romeo H.; del Diego, Jorge; Zambrano, Betzana; Dayan, Gustavo H.

    2012-01-01

    Dengue is a viral disease usually transmitted by Aedes aegypti mosquitoes. Dengue outbreaks in the Americas reported in medical literature and to the Pan American Health Organization are described. The outbreak history from 1600 to 2010 was categorized into four phases: Introduction of dengue in the Americas (1600–1946); Continental plan for the eradication of the Ae. aegypti (1947–1970) marked by a successful eradication of the mosquito in 18 continental countries by 1962; Ae. aegypti reinfestation (1971–1999) caused by the failure of the mosquito eradication program; Increased dispersion of Ae. aegypti and dengue virus circulation (2000–2010) characterized by a marked increase in the number of outbreaks. During 2010 > 1.7 million dengue cases were reported, with 50,235 severe cases and 1,185 deaths. A dramatic increase in the number of outbreaks has been reported in recent years. Urgent global action is needed to avoid further disease spread. PMID:23042846

  7. The history of dengue outbreaks in the Americas.

    PubMed

    Brathwaite Dick, Olivia; San Martín, José L; Montoya, Romeo H; del Diego, Jorge; Zambrano, Betzana; Dayan, Gustavo H

    2012-10-01

    Dengue is a viral disease usually transmitted by Aedes aegypti mosquitoes. Dengue outbreaks in the Americas reported in medical literature and to the Pan American Health Organization are described. The outbreak history from 1600 to 2010 was categorized into four phases: Introduction of dengue in the Americas (1600-1946); Continental plan for the eradication of the Ae. aegypti (1947-1970) marked by a successful eradication of the mosquito in 18 continental countries by 1962; Ae. aegypti reinfestation (1971-1999) caused by the failure of the mosquito eradication program; Increased dispersion of Ae. aegypti and dengue virus circulation (2000-2010) characterized by a marked increase in the number of outbreaks. During 2010 > 1.7 million dengue cases were reported, with 50,235 severe cases and 1,185 deaths. A dramatic increase in the number of outbreaks has been reported in recent years. Urgent global action is needed to avoid further disease spread.

  8. Impact of climate change on larch budmoth cyclic outbreaks.

    PubMed

    Iyengar, Sudharsana V; Balakrishnan, Janaki; Kurths, Jürgen

    2016-06-13

    Periodic outbreaks of the larch budmoth Zeiraphera diniana population (and the massive forest defoliation they engender) have been recorded in the Alps over the centuries and are known for their remarkable regularity. But these have been conspicuously absent since 1981. On the other hand, budmoth outbreaks have been historically unknown in the larches of the Carpathian Tatra mountains. To resolve this puzzle, we propose here a model which includes the influence of climate and explains both the 8-9 year periodicity in the budmoth cycle and the variations from this, as well as the absence of cycles. We successfully capture the observed trend of relative frequencies of outbreaks, reproducing the dominant periodicities seen. We contend that the apparent collapse of the cycle in 1981 is due to changing climatic conditions following a tipping point and propose the recurrence of the cycle with a changed periodicity of 40 years - the next outbreak could occur in 2021. Our model also predicts longer cycles.

  9. Impact of climate change on larch budmoth cyclic outbreaks

    NASA Astrophysics Data System (ADS)

    Iyengar, Sudharsana V.; Balakrishnan, Janaki; Kurths, Jürgen

    2016-06-01

    Periodic outbreaks of the larch budmoth Zeiraphera diniana population (and the massive forest defoliation they engender) have been recorded in the Alps over the centuries and are known for their remarkable regularity. But these have been conspicuously absent since 1981. On the other hand, budmoth outbreaks have been historically unknown in the larches of the Carpathian Tatra mountains. To resolve this puzzle, we propose here a model which includes the influence of climate and explains both the 8–9 year periodicity in the budmoth cycle and the variations from this, as well as the absence of cycles. We successfully capture the observed trend of relative frequencies of outbreaks, reproducing the dominant periodicities seen. We contend that the apparent collapse of the cycle in 1981 is due to changing climatic conditions following a tipping point and propose the recurrence of the cycle with a changed periodicity of 40 years – the next outbreak could occur in 2021. Our model also predicts longer cycles.

  10. Outbreaks of salmonella infection in hospitals in England and Wales 1978-87.

    PubMed Central

    Joseph, C. A.; Palmer, S. R.

    1989-01-01

    A total of 248 outbreaks of salmonella infection in hospital affecting over 3000 patients and 110 associated deaths were ascertained in England and Wales in 1978-87, compared with 522 outbreaks of salmonella in 1968-77. The largest reduction was found in outbreaks from children's units and maternity units. Fifty seven (24%) outbreaks were considered to be due to foodborne salmonellosis, and 70 (30%) were reported as person to person spread of the infection. The psychiatric hospital was the type of hospital in which foodborne outbreaks most often occurred, but the risk of being affected in an outbreak not due to food seemed to be highest in maternity units. Better control of infection and better surveillance should lead to earlier investigation and control of outbreaks. Images p1164-a PMID:2500174

  11. 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.

  12. Rumors of disease in the global village: outbreak verification.

    PubMed Central

    Grein, T. W.; Kamara, K. B.; Rodier, G.; Plant, A. J.; Bovier, P.; Ryan, M. J.; Ohyama, T.; Heymann, D. L.

    2000-01-01

    Emerging infectious diseases and the growth of information technology have produced new demands and possibilities for disease surveillance and response. Increasing numbers of outbreak reports must be assessed rapidly so that control efforts can be initiated and unsubstantiated reports can be identified to protect countries from unnecessary economic damage. The World Health Organization has set up a process for timely outbreak verification to convert large amounts of data into accurate information for suitable action. We describe the context and processes of outbreak verification and information dissemination. PMID:10756142

  13. Zika virus outbreak in Brazil.

    PubMed

    Heukelbach, Jorg; Alencar, Carlos Henrique; Kelvin, Alyson Ann; de Oliveira, Wanderson Kleber; Pamplona de Góes Cavalcanti, Luciano

    2016-02-28

    Zika virus (ZIKV) infection is spreading rapidly within the Americas after originating from an outbreak in Brazil. We describe the current ZIKV infection epidemic in Brazil and the neurological symptoms arising. First cases of an acute exanthematic disease were reported in Brazil's Northeast region at the end of 2014. In March 2015, autochthonous ZIKV was determined to be the causative agent of the exanthematic disease. As cases of neurological syndromes in regions where ZIKV, dengue and/or Chikungunya viruses co-circulate were reported, ZIKV was also identified in the cerebrospinal fluid of patients with acute neurological syndromes and previous exanthematic disease. By the end of September 2015, an increasing number of infants with small head circumference or microcephaly were noted in Brazil's Northeast which was estimated to be 29 cases between August and October. ZIKV was identified in blood and tissue samples of a newborn and in mothers who had given birth to infants with microcephaly and ophthalmological anomalies. In 2015, there were an estimated 440,000 - 1,300,000 Zika cases in Brazil. There have been 4,783 suspected cases of microcephaly, most of them in the Northeast of Brazil associated with 76 deaths. The Ministry of Health is intensifying control measures against the mosquito Aedes aegypti and implemented intensive surveillance actions. Further studies are needed to confirm the suspected association between ZIKV infection and microcephaly; to identify antiviral, immunotherapy, or prophylactic vaccine; to introduce diagnostic ELISA testing. Clinical and epidemiological studies must be performed to describe viral dynamics and expansion of the outbreak.

  14. Disease Outbreaks Caused by Water.

    ERIC Educational Resources Information Center

    Craun, Gunther F.

    1978-01-01

    Presents a literature review of the disease outbreaks caused by drinking polluted water, covering publications of 1976-77. Some of the waterborn outbreaks included are: (1) cholera; (2) gastroenteritis; (3) giardiasis; and (4) typhoid fever and salmonellosis. A list of 66 references is also presented. (HM)

  15. 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.

  16. 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

  17. Ebola virus disease outbreak; the role of field epidemiology training programme in the fight against the epidemic, Liberia, 2014

    PubMed Central

    Lubogo, Mutaawe; Donewell, Bangure; Godbless, Lucas; Shabani, Sasita; Maeda, Justin; Temba, Herilinda; Malibiche, Theophil C; Berhanu, Naod

    2015-01-01

    The African Field Epidemiology Network (AFENET) is a public health network established in 2005 as a non-profit networking alliance of Field Epidemiology and Laboratory Training Programs (FELTPs) and Field Epidemiology Training Programs (FETPs) in Africa. AFENET is dedicated to supporting Ministries of Health in Africa build strong, effective and sustainable programs and capacity to improve public health systems by partnering with global public health experts. The Network's goal is to strengthen field epidemiology and public health laboratory capacity to contribute effectively to addressing epidemics and other major public health problems in Africa. The goal for the establishment of FETP and FELTP was and still is to produce highly competent multi-disciplinary public health professionals who would assume influential posts in the public health structures and tackle emerging and re-emerging communicable and non-communicable diseases. AFENET currently networks 12 FELTPs and FETPs in sub-Saharan Africa with operations in 20 countries. During the Ebola Virus Disease (EVD) outbreak in West Africa, African Union Support for the Ebola Outbreak in West Africa (ASEOWA) supported FETP graduates from Uganda, Zimbabwe, Ethiopia and Tanzania for the investigation and control of the EVD outbreak in Liberia. The graduates were posted in different counties in Liberia where they lead teams of other experts conduct EVD outbreak investigations, Infection Control and Prevention trainings among health workers and communities, Strengthening integrated disease surveillance, developing Standard Operating Procedures for infection control and case notification in the Liberian setting as well as building capacity of local surveillance officers’ conduct outbreak investigation and contact tracing. The team was also responsible for EVD data management at the different Counties in Liberia. The FETP graduates have been instrumental in the earlier successes registered in various counties in

  18. Ebola virus disease outbreak; the role of field epidemiology training programme in the fight against the epidemic, Liberia, 2014.

    PubMed

    Lubogo, Mutaawe; Donewell, Bangure; Godbless, Lucas; Shabani, Sasita; Maeda, Justin; Temba, Herilinda; Malibiche, Theophil C; Berhanu, Naod

    2015-01-01

    The African Field Epidemiology Network (AFENET) is a public health network established in 2005 as a non-profit networking alliance of Field Epidemiology and Laboratory Training Programs (FELTPs) and Field Epidemiology Training Programs (FETPs) in Africa. AFENET is dedicated to supporting Ministries of Health in Africa build strong, effective and sustainable programs and capacity to improve public health systems by partnering with global public health experts. The Network's goal is to strengthen field epidemiology and public health laboratory capacity to contribute effectively to addressing epidemics and other major public health problems in Africa. The goal for the establishment of FETP and FELTP was and still is to produce highly competent multi-disciplinary public health professionals who would assume influential posts in the public health structures and tackle emerging and re-emerging communicable and non-communicable diseases. AFENET currently networks 12 FELTPs and FETPs in sub-Saharan Africa with operations in 20 countries. During the Ebola Virus Disease (EVD) outbreak in West Africa, African Union Support for the Ebola Outbreak in West Africa (ASEOWA) supported FETP graduates from Uganda, Zimbabwe, Ethiopia and Tanzania for the investigation and control of the EVD outbreak in Liberia. The graduates were posted in different counties in Liberia where they lead teams of other experts conduct EVD outbreak investigations, Infection Control and Prevention trainings among health workers and communities, Strengthening integrated disease surveillance, developing Standard Operating Procedures for infection control and case notification in the Liberian setting as well as building capacity of local surveillance officers' conduct outbreak investigation and contact tracing. The team was also responsible for EVD data management at the different Counties in Liberia. The FETP graduates have been instrumental in the earlier successes registered in various counties in Liberia

  19. Epidemiology of foodborne norovirus outbreaks, United States, 2001-2008.

    PubMed

    Hall, Aron J; Eisenbart, Valerie G; Etingüe, Amy Lehman; Gould, L Hannah; Lopman, Ben A; Parashar, Umesh D

    2012-10-01

    Noroviruses are the leading cause of foodborne illness in the United States. To better guide interventions, we analyzed 2,922 foodborne disease outbreaks for which norovirus was the suspected or confirmed cause, which had been reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 2001-2008. On average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death. In 364 outbreaks attributed to a single commodity, leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%) were implicated most commonly. Infected food handlers were the source of 53% of outbreaks and may have contributed to 82% of outbreaks. Most foods were likely contaminated during preparation and service, except for mollusks, and occasionally, produce was contaminated during production and processing. Interventions to reduce the frequency of foodborne norovirus outbreaks should focus on food workers and production of produce and shellfish.

  20. Giardiasis outbreaks in the United States, 1971-2011.

    PubMed

    Adam, E A; Yoder, J S; Gould, L H; Hlavsa, M C; Gargano, J W

    2016-10-01

    Giardia intestinalis is the leading parasitic aetiology of human enteric infections in the United States, with an estimated 1·2 million cases occurring annually. To better understand transmission, we analysed data on all giardiasis outbreaks reported to the Centers for Disease Control and Prevention for 1971-2011. The 242 outbreaks, affecting ~41 000 persons, resulted from waterborne (74·8%), foodborne (15·7%), person-to-person (2·5%), and animal contact (1·2%) transmission. Most (74·6%) waterborne outbreaks were associated with drinking water, followed by recreational water (18·2%). Problems with water treatment, untreated groundwater, and distribution systems were identified most often during drinking water-associated outbreak investigations; problems with water treatment declined after the 1980s. Most recreational water-associated outbreaks were linked to treated swimming venues, with pools and wading pools implicated most often. Produce was implicated most often in foodborne outbreaks. Additionally, foods were most commonly prepared in a restaurant and contaminated by a food handler. Lessons learned from examining patterns in outbreaks over time can help prevent future disease. Groundwater and distribution system vulnerabilities, inadequate pool disinfection, fruit and vegetable contamination, and poor food handler hygiene are promising targets for giardiasis prevention measures.

  1. Giardiasis outbreaks in the United States, 1971–2011

    PubMed Central

    Adam, E. A.; Yoder, J. S.; Gould, L. H.; Hlavsa, M. C.; Gargano, J. W.

    2016-01-01

    Summary Giardia intestinalis is the leading parasitic aetiology of human enteric infections in the United States, with an estimated 1.2 million cases occurring annually. To better understand transmission, we analysed data on all giardiasis outbreaks reported to the Centers for Disease Control and Prevention for 1971–2011. The 242 outbreaks, affecting ∼41 000 persons, resulted from waterborne (74.8%), foodborne (15.7%), person-to-person (2.5%), and animal contact (1.2%) transmission. Most (74.6%) waterborne outbreaks were associated with drinking water, followed by recreational water (18.2%). Problems with water treatment, untreated groundwater, and distribution systems were identified most often during drinking water-associated outbreak investigations; problems with water treatment declined after the 1980s. Most recreational water-associated outbreaks were linked to treated swimming venues, with pools and wading pools implicated most often. Produce was implicated most often in foodborne outbreaks. Additionally, foods were most commonly prepared in a restaurant and contaminated by a food handler. Lessons learned from examining patterns in outbreaks over time can help prevent future disease. Groundwater and distribution system vulnerabilities, inadequate pool disinfection, fruit and vegetable contamination, and poor food handler hygiene are promising targets for giardiasis prevention measures. PMID:26750152

  2. PREDICTIVE MODELING OF CHOLERA OUTBREAKS IN BANGLADESH

    PubMed Central

    Koepke, Amanda A.; Longini, Ira M.; Halloran, M. Elizabeth; Wakefield, Jon; Minin, Vladimir N.

    2016-01-01

    Despite seasonal cholera outbreaks in Bangladesh, little is known about the relationship between environmental conditions and cholera cases. We seek to develop a predictive model for cholera outbreaks in Bangladesh based on environmental predictors. To do this, we estimate the contribution of environmental variables, such as water depth and water temperature, to cholera outbreaks in the context of a disease transmission model. We implement a method which simultaneously accounts for disease dynamics and environmental variables in a Susceptible-Infected-Recovered-Susceptible (SIRS) model. The entire system is treated as a continuous-time hidden Markov model, where the hidden Markov states are the numbers of people who are susceptible, infected, or recovered at each time point, and the observed states are the numbers of cholera cases reported. We use a Bayesian framework to fit this hidden SIRS model, implementing particle Markov chain Monte Carlo methods to sample from the posterior distribution of the environmental and transmission parameters given the observed data. We test this method using both simulation and data from Mathbaria, Bangladesh. Parameter estimates are used to make short-term predictions that capture the formation and decline of epidemic peaks. We demonstrate that our model can successfully predict an increase in the number of infected individuals in the population weeks before the observed number of cholera cases increases, which could allow for early notification of an epidemic and timely allocation of resources. PMID:27746850

  3. Epidemiology of foodborne disease outbreaks caused by Clostridium perfringens, United States, 1998-2010.

    PubMed

    Grass, Julian E; Gould, L Hannah; Mahon, Barbara E

    2013-02-01

    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.

  4. Epidemiology of bacterial toxin-mediated foodborne gastroenteritis outbreaks in Australia, 2001 to 2013.

    PubMed

    May, Fiona J; Polkinghorne, Benjamin G; Fearnley, Emily J

    2016-12-24

    Bacterial toxin-mediated foodborne outbreaks, such as those caused by Clostridium perfringens, Staphylococcus aureus and Bacillus cereus, are an important and preventable cause of morbidity and mortality. Due to the short incubation period and duration of illness, these outbreaks are often under-reported. This is the first study to describe the epidemiology of bacterial toxin-mediated outbreaks in Australia. Using data collected between 2001 and 2013, we identify high risk groups and risk factors to inform prevention measures. Descriptive analyses of confirmed bacterial toxin-mediated outbreaks between 2001 and 2013 were undertaken using data extracted from the OzFoodNet Outbreak Register, a database of all outbreaks of gastrointestinal disease investigated by public health authorities in Australia. A total of 107 laboratory confirmed bacterial toxin-mediated outbreaks were reported between 2001 and 2013, affecting 2,219 people, including 47 hospitalisations and 13 deaths. Twelve deaths occurred in residents of aged care facilities. Clostridium perfringens was the most commonly reported aetiological agent (81 outbreaks, 76%). The most commonly reported food preparation settings were commercial food preparation services (51 outbreaks, 48%) and aged care facilities (42 outbreaks, 39%). Bacterial toxin outbreaks were rarely associated with food preparation in the home (2 outbreaks, 2%). In all outbreaks, the primary factor contributing to the outbreak was inadequate temperature control of the food. Public health efforts aimed at improving storage and handling practices for pre-cooked and re-heated foods, especially in commercial food preparation services and aged care facilities, could help to reduce the magnitude of bacterial toxin outbreaks.

  5. Use of Norovirus Genotype Profiles to Differentiate Origins of Foodborne Outbreaks

    PubMed Central

    Vennema, Harry; van Pelt, Wilfrid; Lees, David; Boshuizen, Hendriek; Henshilwood, Kathleen; Koopmans, Marion

    2010-01-01

    Because secondary transmission masks the connection between sources and outbreaks, estimating the proportion of foodborne norovirus infections is difficult. We studied whether norovirus genotype frequency distributions (genotype profiles) can enhance detection of the sources of foodborne outbreaks. Control measures differ substantially; therefore, differentiating this transmission mode from person-borne or food handler–borne outbreaks is of public health interest. Comparison of bivalve mollusks collected during monitoring (n = 295) and outbreak surveillance strains (n = 2,858) showed 2 distinguishable genotype profiles in 1) human feces and 2) source-contaminated food and bivalve mollusks; genotypes I.2 and I.4 were more frequently detected in foodborne outbreaks. Overall, ≈21% of all outbreaks were foodborne; further analysis showed that 25% of the outbreaks reported as food handler–associated were probably caused by source contamination of the food. PMID:20350375

  6. Locus of Control and Other Psycho-Social Parameters in Successful American Age-Group Swimmers.

    ERIC Educational Resources Information Center

    Burke, Edmund J., Jr.; Straub, William F.

    Psycho-social factors in successful age-group swimmers were explored in this study. The subjects were 50 female and 39 male participants in the 1975 Amateur Athletic Union National Junior Olympics who were asked to answer a set of questions from an open-ended questionnaire. The results support a picture of young persons who invest a great deal of…

  7. Outbreaks of infection with methicillin-resistant Staphylococcus aureus on neonatal and burns units of a new hospital.

    PubMed Central

    Farrington, M.; Ling, J.; Ling, T.; French, G. L.

    1990-01-01

    Multiple introductions of methicillin-resistant Staphylococcus aureus (MRSA) strains occurred to a new hospital in Hong Kong. Two years of clinical microbiological surveillance of the resulting outbreaks was combined with laboratory investigation by phage and antibiogram typing, and plasmid profiling. The outbreaks on the special care baby (SCBU) and burns (BU) units were studied in detail, and colonization of staff and contamination of the environment were investigated. MRSA were spread by the hands of staff on the SCBU, where long-term colonization of dermatitis was important, but were probably transmitted on the BU by a combination of the airborne, transient hand-borne and environmental routes. Simple control measures to restrict hand-borne spread on the SCBU were highly effective, but control was not successful on the BU. PMID:2209730

  8. Outbreaks associated with cantaloupe, watermelon, and honeydew in the United States, 1973-2011.

    PubMed

    Walsh, Kelly A; Bennett, Sarah D; Mahovic, Michael; Gould, L Hannah

    2014-12-01

    Fresh fruits and vegetables are an important part of a healthy diet. Melons have been associated with enteric infections. We reviewed outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System during 1973-2011 in which the implicated food was a single melon type. We also reviewed published literature and records obtained from investigating agencies. During 1973-2011, 34 outbreaks caused by a single melon type were reported, resulting in 3602 illnesses, 322 hospitalizations, 46 deaths, and 3 fetal losses. Cantaloupes accounted for 19 outbreaks (56%), followed by watermelons (13, 38%) and honeydew (2, 6%). Melon-associated outbreaks increased from 0.5 outbreaks per year during 1973-1991 to 1.3 during 1992-2011. Salmonella was the most common etiology reported (19, 56%), followed by norovirus (5, 15%). Among 13 outbreaks with information available, melons imported from Mexico and Central America were implicated in 9 outbreaks (69%) and domestically grown melons were implicated in 4 outbreaks (31%). The point of contamination was known for 20 outbreaks; contamination occurred most commonly during growth, harvesting, processing, or packaging (13, 65%). Preventive measures focused on reducing bacterial contamination of melons both domestically and internationally could decrease the number and severity of melon-associated outbreaks.

  9. Whole-Genome Sequencing to Determine Origin of Multinational Outbreak of Sarocladium kiliense Bloodstream Infections

    PubMed Central

    Roe, Chandler C.; Smith, Rachel M.; Vallabhaneni, Snigdha; Duarte, Carolina; Escandón, Patricia; Castañeda, Elizabeth; Gómez, Beatriz L.; de Bedout, Catalina; López, Luisa F.; Salas, Valentina; Hederra, Luz Maria; Fernández, Jorge; Pidal, Paola; Hormazabel, Juan Carlos; Otaíza-O’Ryan, Fernando; Vannberg, Fredrik O.; Gillece, John; Lemmer, Darrin; Driebe, Elizabeth M.; Engelthaler, David M.; Litvintseva, Anastasia P.

    2016-01-01

    We used whole-genome sequence typing (WGST) to investigate an outbreak of Sarocladium kiliense bloodstream infections (BSI) associated with receipt of contaminated antinausea medication among oncology patients in Colombia and Chile during 2013–2014. Twenty-five outbreak isolates (18 from patients and 7 from medication vials) and 11 control isolates unrelated to this outbreak were subjected to WGST to elucidate a source of infection. All outbreak isolates were nearly indistinguishable (<5 single-nucleotide polymorphisms), and >21,000 single-nucleotide polymorphisms were identified from unrelated control isolates, suggesting a point source for this outbreak. S. kiliense has been previously implicated in healthcare-related infections; however, the lack of available typing methods has precluded the ability to substantiate point sources. WGST for outbreak investigation caused by eukaryotic pathogens without reference genomes or existing genotyping methods enables accurate source identification to guide implementation of appropriate control and prevention measures. PMID:26891230

  10. Complete Genome Sequence of Mycobacterium tuberculosis Strain MtURU-001, Isolated from a Rapidly Progressing Outbreak in Uruguay

    PubMed Central

    Greif, Gonzalo; Iraola, Gregorio; Berná, Luisa; Coitinho, Cecilia; Rivas, Carlos M.; Naya, Hugo

    2014-01-01

    Despite efficient control programs, large clonal outbreaks of tuberculosis (TB) may arise in low-risk populations. Recently, an unusual TB outbreak was reported in Uruguay, reaching an elevated disease attack rate (53 to 69%). Here, we report the genome sequence of the Mycobacterium tuberculosis strain associated with this rapidly progressing outbreak, named MtURU-001. PMID:24459279

  11. Environmental Variation Generates Environmental Opportunist Pathogen Outbreaks.

    PubMed

    Anttila, Jani; Kaitala, Veijo; Laakso, Jouni; Ruokolainen, Lasse

    2015-01-01

    Many socio-economically important pathogens persist and grow in the outside host environment and opportunistically invade host individuals. The environmental growth and opportunistic nature of these pathogens has received only little attention in epidemiology. Environmental reservoirs are, however, an important source of novel diseases. Thus, attempts to control these diseases require different approaches than in traditional epidemiology focusing on obligatory parasites. Conditions in the outside-host environment are prone to fluctuate over time. This variation is a potentially important driver of epidemiological dynamics and affect the evolution of novel diseases. Using a modelling approach combining the traditional SIRS models to environmental opportunist pathogens and environmental variability, we show that epidemiological dynamics of opportunist diseases are profoundly driven by the quality of environmental variability, such as the long-term predictability and magnitude of fluctuations. When comparing periodic and stochastic environmental factors, for a given variance, stochastic variation is more likely to cause outbreaks than periodic variation. This is due to the extreme values being further away from the mean. Moreover, the effects of variability depend on the underlying biology of the epidemiological system, and which part of the system is being affected. Variation in host susceptibility leads to more severe pathogen outbreaks than variation in pathogen growth rate in the environment. Positive correlation in variation on both targets can cancel the effect of variation altogether. Moreover, the severity of outbreaks is significantly reduced by increase in the duration of immunity. Uncovering these issues helps in understanding and controlling diseases caused by environmental pathogens.

  12. National guidelines for outbreak investigation: an evaluation study.

    PubMed

    Fararouei, M; Rezaee, S; Shirazi, A Raigan; Naghmachi, M; Shirazi, K Karimzadeh; Jamshidi, A; Jafari, J

    2013-09-01

    This paper reports an independent epidemiological study to evaluate the validity of the results of an official investigation into an outbreak of gastroenteritis at a university campus in Yasuj, central-south Islamic Republic of Iran. The official report of the outbreak by the Department for Disease Control at the provincial health centre found only 65 cases over a 5-day period, all females, living in the student halls of residence. This contrasts with a questionnaire survey of 963 students at the same university, which found 395 students (192 males and 203 females), living in residences and at home, who reported at least 1 gastrointestinal symptom over a 12-week period. Within this period at least 2 outbreaks occurred. Such a large discrepancy between the official report and the current study suggests that the health services and the public may have been misled about the proper response to the outbreak.

  13. 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.

  14. Outbreak of hepatitis A in Korean military personnel.

    PubMed

    Lee, Chang-Seop; Lee, Ju-Hyung; Kwon, Keun-Sang

    2008-05-01

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

  15. Controls of biological soil crust cover and composition shift with succession in sagebrush shrub-steppe

    USGS Publications Warehouse

    Dettweiler-Robinson, E.; Bakker, J.D.; Grace, J.B.

    2013-01-01

    Successional stage may determine strength and causal direction of interactions among abiotic and biotic factors; e.g., species that facilitate the establishment of other species may later compete with them. We evaluated multivariate hypotheses about abiotic and biotic factors shaping biological soil crusts (BSCs) in early and late successional stages. We surveyed vegetation and BSC in the shrub-steppe ecosystem of the Columbia Basin. We analyzed the relationships with bryophyte and lichen covers using structural equation models, and analyzed the relationships with BSC composition using Indicator Species Analysis and distance-based linear models. Cover, indicator species, and composition varied with successional stage. Increasing elevation and bryophyte cover had higher lichen cover early in succession; these relationships were negative in the later successional stage. Lichen cover did not appear to impede B. tectorum cover, but B. tectorum appeared to strongly negatively affect lichen cover in both stages. Biological soil crust composition varied with bunchgrass cover in the early successional stage, but with elevation and B. tectorum cover later in succession. Our findings support the hypotheses that as succession progresses, the strength and direction of certain community interactions shift, and B. tectorum leads to reductions in biological soil crust cover regardless of successional stage.

  16. Decentralized control of continuous time interconnected stochastic systems based on successive pole assignment

    NASA Astrophysics Data System (ADS)

    Ray, G.; Yadaiah, N.

    1992-12-01

    A simple decentralized Kalman filter based regulator problem is proposed to achieve sub-system closed-loop eigenvalues at desired locations and subsequently to minimize the local quadratic performance index of each decoupled sub-system. The proposed scheme reduces the information exchange, telemetry and instrumentation costs and computational burden compared to a centralized control scheme. A consideration of the stability of the global decentralized control system is included. The effectiveness of the proposed control scheme is tested by considering a load-frequency control problem of a two-area power system.

  17. Surveillance for foodborne disease outbreaks --- United States, 2007.

    PubMed

    2010-08-13

    Foodborne agents cause an estimated 76 million illnesses annually in the United States. Outbreak surveillance provides insights into the causes of foodborne illness, types of implicated foods, and settings of foodborne infections that can be used in food safety strategies to prevent and control foodborne disease. CDC collects data on foodborne disease outbreaks submitted from all states and territories. This report summarizes epidemiologic data for the 1,097 reported outbreaks occurring during 2007 (the most recent finalized data), which resulted in 21,244 cases of foodborne illness and 18 deaths. Among the 497 foodborne outbreaks with a laboratory-confirmed single etiologic agent reported, norovirus was the most common cause, followed by Salmonella. Among the 18 reported deaths, 11 were attributed to bacterial etiologies (five Salmonella, three Listeria monocytogenes, two Escherichia coli O157:H7, and one Clostridium botulinum), two to viral etiologies (norovirus), and one to a chemical (mushroom toxin). Four deaths occurred in outbreaks with unknown etiologies. Among the 235 outbreaks attributed to a single food commodity, poultry (17%), beef (16%), and leafy vegetables (14%) were most often the cause of illness. Public health, regulatory, and agricultural professionals can use this information when creating targeted control strategies and to support efforts to promote safe food preparation practices among food employees and the public.

  18. 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

  19. Modeling and Prediction of Oyster Norovirus Outbreaks along Gulf of Mexico Coast

    PubMed Central

    Wang, Jiao; Deng, Zhiqiang

    2015-01-01

    Background: Oyster norovirus outbreaks often pose high risks to human health. However, little is known about environmental factors controlling the outbreaks, and little can be done to prevent the outbreaks because they are generally considered to be unpredictable. Objective: We sought to develop a mathematical model for predicting risks of oyster norovirus outbreaks using environmental predictors. Methods: We developed a novel probability-based Artificial Neural Network model, called NORF model, using 21 years of environmental and norovirus outbreak data collected from Louisiana oyster harvesting areas along the Gulf of Mexico coast, USA. The NORF model involves six input variables that were selected through stepwise regression analysis and sensitivity analysis. Results: We found that the model-based probability of norovirus outbreaks was most sensitive to gage height (the depth of water in an oyster bed) and water temperature, followed by wind, rainfall, and salinity, respectively. The NORF model predicted all historical oyster norovirus outbreaks from 1994 through 2014. Specifically, norovirus outbreaks occurred when the NORF model probability estimate was > 0.6, whereas no outbreaks occurred when the estimated probability was < 0.5. Outbreaks may also occur when the estimated probability is 0.5–0.6. Conclusions: Our findings require further confirmation, but they suggest that oyster norovirus outbreaks may be predictable using the NORF model. The ability to predict oyster norovirus outbreaks at their onset may make it possible to prevent or at least reduce the risk of norovirus outbreaks by closing potentially affected oyster beds. Citation: Wang J, Deng Z. 2016. Modeling and prediction of oyster norovirus outbreaks along Gulf of Mexico coast. Environ Health Perspect 124:627–633; http://dx.doi.org/10.1289/ehp.1509764 PMID:26528621

  20. Asthma outbreak during a thunderstorm.

    PubMed

    Packe, G E; Ayres, J G

    1985-07-27

    An outbreak of acute asthma occurred in Birmingham and the surrounding area on July 6 and 7, 1983. In most patients symptoms began at the time of sudden climatic changes associated with a thunderstorm. Air pollution was not a factor. The large and sudden increase in numbers of airborne fungal spores, especially Didymella exitialis and Sporobolomyces, around the time of the outbreak suggests that they may have been partly contributory, although a direct causal effect has not yet been established.

  1. Full-Scaled Advanced Systems Testbed: Ensuring Success of Adaptive Control Research Through Project Lifecycle Risk Mitigation

    NASA Technical Reports Server (NTRS)

    Pavlock, Kate M.

    2011-01-01

    The National Aeronautics and Space Administration's Dryden Flight Research Center completed flight testing of adaptive controls research on the Full-Scale Advance Systems Testbed (FAST) in January of 2011. The research addressed technical challenges involved with reducing risk in an increasingly complex and dynamic national airspace. Specific challenges lie with the development of validated, multidisciplinary, integrated aircraft control design tools and techniques to enable safe flight in the presence of adverse conditions such as structural damage, control surface failures, or aerodynamic upsets. The testbed is an F-18 aircraft serving as a full-scale vehicle to test and validate adaptive flight control research and lends a significant confidence to the development, maturation, and acceptance process of incorporating adaptive control laws into follow-on research and the operational environment. The experimental systems integrated into FAST were designed to allow for flexible yet safe flight test evaluation and validation of modern adaptive control technologies and revolve around two major hardware upgrades: the modification of Production Support Flight Control Computers (PSFCC) and integration of two, fourth-generation Airborne Research Test Systems (ARTS). Post-hardware integration verification and validation provided the foundation for safe flight test of Nonlinear Dynamic Inversion and Model Reference Aircraft Control adaptive control law experiments. To ensure success of flight in terms of cost, schedule, and test results, emphasis on risk management was incorporated into early stages of design and flight test planning and continued through the execution of each flight test mission. Specific consideration was made to incorporate safety features within the hardware and software to alleviate user demands as well as into test processes and training to reduce human factor impacts to safe and successful flight test. This paper describes the research configuration

  2. Perceived Academic Control and Academic Emotions Predict Undergraduate University Student Success: Examining Effects on Dropout Intention and Achievement.

    PubMed

    Respondek, Lisa; Seufert, Tina; Stupnisky, Robert; Nett, Ulrike E

    2017-01-01

    The present study addressed concerns over the high risk of university students' academic failure. It examined how perceived academic control and academic emotions predict undergraduate students' academic success, conceptualized as both low dropout intention and high achievement (indicated by GPA). A cross-sectional survey was administered to 883 undergraduate students across all disciplines of a German STEM orientated university. The study additionally compared freshman students (N = 597) vs. second-year students (N = 286). Using structural equation modeling, for the overall sample of undergraduate students we found that perceived academic control positively predicted enjoyment and achievement, as well as negatively predicted boredom and anxiety. The prediction of dropout intention by perceived academic control was fully mediated via anxiety. When taking perceived academic control into account, we found no specific impact of enjoyment or boredom on the intention to dropout and no specific impact of all three academic emotions on achievement. The multi-group analysis showed, however, that perceived academic control, enjoyment, and boredom among second-year students had a direct relationship with dropout intention. A major contribution of the present study was demonstrating the important roles of perceived academic control and anxiety in undergraduate students' academic success. Concerning corresponding institutional support and future research, the results suggested distinguishing incoming from advanced undergraduate students.

  3. Perceived Academic Control and Academic Emotions Predict Undergraduate University Student Success: Examining Effects on Dropout Intention and Achievement

    PubMed Central

    Respondek, Lisa; Seufert, Tina; Stupnisky, Robert; Nett, Ulrike E.

    2017-01-01

    The present study addressed concerns over the high risk of university students' academic failure. It examined how perceived academic control and academic emotions predict undergraduate students' academic success, conceptualized as both low dropout intention and high achievement (indicated by GPA). A cross-sectional survey was administered to 883 undergraduate students across all disciplines of a German STEM orientated university. The study additionally compared freshman students (N = 597) vs. second-year students (N = 286). Using structural equation modeling, for the overall sample of undergraduate students we found that perceived academic control positively predicted enjoyment and achievement, as well as negatively predicted boredom and anxiety. The prediction of dropout intention by perceived academic control was fully mediated via anxiety. When taking perceived academic control into account, we found no specific impact of enjoyment or boredom on the intention to dropout and no specific impact of all three academic emotions on achievement. The multi-group analysis showed, however, that perceived academic control, enjoyment, and boredom among second-year students had a direct relationship with dropout intention. A major contribution of the present study was demonstrating the important roles of perceived academic control and anxiety in undergraduate students' academic success. Concerning corresponding institutional support and future research, the results suggested distinguishing incoming from advanced undergraduate students. PMID:28326043

  4. Factors controlling accumulation of soil organic carbon along vegetation succession in a typical karst region in Southwest China.

    PubMed

    Liu, Shujuan; Zhang, Wei; Wang, Kelin; Pan, Fujing; Yang, Shan; Shu, Shiyan

    2015-07-15

    Vegetation succession enhances the accumulation of carbon in the soil. However, little is known about the mechanisms underlying soil organic carbon (SOC) accumulation in different vegetation types in the karst region of Southwest China. The goal of this study was to identify and prioritize the effects of environmental parameters, including soil physico-chemical properties, microbial biomass, enzyme activities, and litter characteristics, on SOC accumulation along a vegetation succession sere (grassland, shrubland, secondary forest, and primary forest) in the karst landscape of Southwest China. Relationships between these parameters and SOC were evaluated by redundancy analysis. The results showed that SOC accumulation was significantly different among vegetation types (P<0.01) and increased with vegetation succession (from 29.10g·kg(-1) in grassland to 73.92g·kg(-1) in primary forest). Soil biochemistry and physical characteristics significantly affected the accumulation of SOC. Soil microbial biomass showed a predominant effect on SOC in each of the four vegetation types. In addition, the soil physical property (especially the silt content) was another controlling factor in the early stages (grassland), and urease activity and saccharase activity were important controlling factors in the early-middle and middle-late stages, respectively. Litter characteristics only showed mild effects on SOC accumulation. Variation partitioning analysis showed that the contribution of sole main factors to SOC variation decreased, while the interaction effect among parameters increased along the succession gradient.

  5. 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

  6. A successful waste stream analysis on a large construction project in a radiologically controlled facility

    SciTech Connect

    Kennicott, M. |; Durrer, R. |; Richardson, D.; Starke, T.P.

    1997-12-01

    The Los Alamos National Laboratory (the Laboratory) Chemistry and Metallurgy Research (CMR) Facility, constructed in 1952, is currently under going a major, multi-year demolition and construction project. Many of the operations required under this project (i.e., design, demolition, decontamination, construction, and waste management) mimic the processes required of a large scale decontamination and decommissioning (D and D) job and are identical to the requirements of any of several upgrades projects anticipated for the laboratory and other Department of Energy (DOE) sites. For these reasons the CMR upgrades Project is seen as an ideal model facility--to test the application and measure the success of waste minimization techniques which could be implemented for any similar projects. The purpose of this paper will be to discuss the successful completion of a waste stream analysis. The analyses performed was to measure the potential impact of waste generation, in terms of volume and costs, for a reconfiguration option being considered to change the approach and execution of the original project.

  7. A successful national control programme for enzootic respiratory diseases in pigs in Switzerland.

    PubMed

    Stärk, K D C; Miserez, R; Siegmann, S; Ochs, H; Infanger, P; Schmidt, J

    2007-12-01

    Before the start of systematic disease control, respiratory diseases in swine in Switzerland caused estimated losses of several million euros per year. In 1993, a national programme to control enzootic respiratory diseases in pigs was proposed, with the aim of reducing the incidence of clinical cases to less than 1%. Enzootic pneumonia (EP) caused by Mycoplasma hyopneumoniae and clinical cases of pleuropneumonia caused by any serotype of Actinobacillus pleuropneumoniae (APP) would be targeted, in addition to any cases with serological evidence of APP serotype 2. This control programme was initiated in 1996, region by region, and fully implemented by 2004. Clinical, epidemiological and laboratory test results were used to identify the appropriate disease control measures. Partial depopulation was used to control EP on breeding and breeding-finishing farms. Total depopulation was implemented on all farms affected with APP and finishing farms affected with EP Animal trade was strictly regulated during the programme and all suspected cases of respiratory disease in pigs were made notifiable. Continued monitoring is based on clinical suspicion of infection and/or the detection of gross pathological lesions at slaughter, followed by laboratory confirmation. In 2005, the incidence of clinical cases was less than 1%. Regulations have been introduced to control the international trade in live pigs and prevent the re-introduction of respiratory diseases into Switzerland.

  8. Foodborne outbreak of group G streptococcal pharyngitis.

    PubMed

    Stryker, W S; Fraser, D W; Facklam, R R

    1982-09-01

    An outbreak of pharyngitis associated with beta-hemolytic streptococci of Lancefield group G occurred among persons who had attended a convention that was held June 21-24, 1979, in a Florida hotel. Seventy-two (31 per cent) of 231 interviewed conventioneers were ill. Group G streptococci were isolated from the throats of 10 (63 per cent) of 16 persons with pharyngitis and 1 (2 per cent) of 41 persons without pharyngitis (p less than 10(-5)). Antistreptolysin O titers in convalescent-phase serum samples from persons with pharyngitis were significantly higher than those from age-matched controls. Fifty-seven (51 per cent) of 111 conventioneers who had attended a convention luncheon developed pharyngitis compared with 12 (10 per cent) of 117 persons who did not (p less than 10(-9)). All persons who had attended the luncheon and had become ill had eaten a chicken salad served at the luncheon. Their median incubation period was two days. The cook who had prepared this chicken salad developed pharyngitis after the luncheon and had a throat culture positive for group G streptococci. No instances of rheumatic fever were identified and secondary illness in household contracts was rare. This outbreak indicates that group G streptococci can cause outbreaks of pharyngitis similar to those caused by group A streptococci and suggests that penicillin therapy and prophylaxis may not be needed.

  9. Environmental role in influenza virus outbreaks.

    PubMed

    Sooryanarain, Harini; Elankumaran, Subbiah

    2015-01-01

    The environmental drivers of influenza outbreaks are largely unknown. Despite more than 50 years of research, there are conflicting lines of evidence on the role of the environment in influenza A virus (IAV) survival, stability, and transmissibility. With the increasing and looming threat of pandemic influenza, it is important to understand these factors for early intervention and long-term control strategies. The factors that dictate the severity and spread of influenza would include the virus, natural and acquired hosts, virus-host interactions, environmental persistence, virus stability and transmissibility, and anthropogenic interventions. Virus persistence in different environments is subject to minor variations in temperature, humidity, pH, salinity, air pollution, and solar radiations. Seasonality of influenza is largely dictated by temperature and humidity, with cool-dry conditions enhancing IAV survival and transmissibility in temperate climates in high latitudes, whereas humid-rainy conditions favor outbreaks in low latitudes, as seen in tropical and subtropical zones. In mid-latitudes, semiannual outbreaks result from alternating cool-dry and humid-rainy conditions. The mechanism of virus survival in the cool-dry or humid-rainy conditions is largely determined by the presence of salts and proteins in the respiratory droplets. Social determinants of heath, including health equity, vaccine acceptance, and age-related illness, may play a role in influenza occurrence and spread.

  10. Leaking Containers: Success and Failure in Controlling the Mosquito Aedes aegypti in Brazil.

    PubMed

    Löwy, Ilana

    2017-04-01

    In 1958, the Pan American Health Organization declared that Brazil had successfully eradicated the mosquito Aedes aegypti, responsible for the transmission of yellow fever, dengue fever, chikungunya, and Zika virus. Yet in 2016 the Brazilian minister of health described the situation of dengue fever as "catastrophic." Discussing the recent epidemic of Zika virus, which amplified the crisis produced by the persistence of dengue fever, Brazil's president declared in January 2016 that "we are in the process of losing the war against the mosquito Aedes aegypti." I discuss the reasons for the failure to contain Aedes in Brazil and the consequences of this failure. A longue durée perspective favors a view of the Zika epidemic that does not present it as a health crisis to be contained with a technical solution alone but as a pathology that has the persistence of deeply entrenched structural problems and vulnerabilities.

  11. Vandetanib Successfully Controls Medullary Thyroid Cancer-Related Cushing Syndrome in an Adolescent Patient

    PubMed Central

    Nella, A. A.; Fox, E.; Balis, F. M.; Quezado, M. M.; Whitcomb, P. O.; Derdak, J.; Kebebew, E.; Widemann, B. C.; Stratakis, C. A.

    2014-01-01

    Context: Ectopic Cushing syndrome due to ACTH secretion from metastatic medullary thyroid cancer (MTC) is associated with significant morbidity and mortality. Objective: The aim of the study was to describe the first case of Cushing syndrome associated with MTC in a pediatric patient and the successful reversal of Cushing syndrome with tyrosine kinase inhibitor (vandetanib) therapy. Patient and Methods: A 17-year-old Brazilian adolescent presented with metastatic MTC and associated ACTH-dependent ectopic Cushing syndrome in the context of multiple endocrine neoplasia type 2B. When the patient was treated with the tyrosine kinase inhibitor vandetanib, rapid decrease in serum cortisol and improvement of clinical symptoms were observed. Conclusion: We describe the first pediatric case of clinical and biochemical improvement of paraneoplastic MTC-related Cushing syndrome after treatment with vandetanib. Vandetanib and possibly other tyrosine kinase inhibitors may be a novel beneficial option in patients with neuroendocrine tumor-related ectopic Cushing syndrome. PMID:24617713

  12. From global agenda-setting to domestic implementation: successes and challenges of the global health network on tobacco control.

    PubMed

    Gneiting, Uwe

    2016-04-01

    Global policy attention to tobacco control has increased significantly since the 1990 s and culminated in the first international treaty negotiated under the auspices of the World Health Organization--the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC's progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member countries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990 s, in translating countries' commitment to the FCTC into domestic policy change. By comparing the network's influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network's effectiveness around the FCTC's implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buy-in, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network's success than the evidence base for the effectiveness of tobacco control interventions. The network's variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment.

  13. Activating Killer Immunoglobulin Receptors and HLA-C: a successful combination providing HIV-1 control

    PubMed Central

    Malnati, Mauro S.; Ugolotti, Elisabetta; Monti, Maria Cristina; Battista, Davide De; Vanni, Irene; Bordo, Domenico; Sironi, Francesca; Larghero, Patrizia; Marco, Eddi Di; Biswas, Priscilla; Poli, Guido; Vicenzi, Elisa; Riva, Agostino; Tarkowski, Maciej; Tambussi, Giuseppe; Nozza, Silvia; Tripodi, Gino; Marras, Francesco; Maria, Andrea De; Pistorio, Angela; Biassoni, Roberto

    2017-01-01

    Several studies demonstrated a relevant role of polymorphisms located within the HLA-B and -C loci and the Killer Immunoglobulin Receptors (KIRs) 3DL1 and 3DS1 in controlling HIV-1 replication. KIRs are regulatory receptors expressed at the surface of NK and CD8+ T-cells that specifically bind HLA-A and -B alleles belonging to the Bw4 supratype and all the -C alleles expressing the C1 or C2 supratype. We here disclose a novel signature associated with the Elite Controller but not with the long-term nonprogressor status concerning 2DS activating KIRs and HLA-C2 alleles insensitive to miRNA148a regulation. Overall, our findings support a crucial role of NK cells in the control of HIV-1 viremia. PMID:28211903

  14. Mycoplasma pneumoniae outbreak at a university - Georgia, 2012.

    PubMed

    2013-08-02

    On October 17, 2012, the Georgia Department of Public Health (DPH) was notified by the Fulton County Department of Health and Wellness that a local university, the Georgia Institute of Technology, was experiencing a pneumonia outbreak among students. DPH epidemiologists investigated to identify the etiology, find additional cases, and recommend control measures. Respiratory swabs collected from students with pneumonia and tested at CDC using a quantitative real-time polymerase chain reaction (qPCR) assay were positive for Mycoplasma pneumoniae. The university alerted students, faculty, and staff members to the outbreak and recommended prevention measures by e-mail, social media, and posters. A survey administered to students assessed illness prevention behaviors, outbreak awareness, and communication preferences. Eighty-three cases were diagnosed among students during September 1-December 4, 2012, making this outbreak the largest reported at a U.S. university in 35 years. No cases were reported among faculty or staff members. Of the 83 patients, 19 had specimens tested by qPCR, of which 12 (63%) were positive for M. pneumoniae. Despite university communication efforts, approximately half of students surveyed were unaware of the outbreak when surveyed in December. DPH recommendations included implementing university policies that facilitate students staying home and seeking medical care when ill and refining health messages and communication methods to improve awareness of disease outbreaks among students.

  15. 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

  16. Micrometeorological and Edaphic Controls on Soil CO2 Efflux During Secondary Succession in Virginia Old-Fields

    NASA Astrophysics Data System (ADS)

    Dunker, S.; Epstein, H. E.

    2011-12-01

    The area of land in the eastern United States undergoing secondary succession following agriculture abandonment is large and growing. As plant communities change from short statured herbaceous vegetation to taller statured closed canopy forests in many of these fields, the micrometorological and edaphic variables that control soil respiration (RS) can be expected to change. Constraining the dynamics of RS and its controls during secondary succession is important because RS, as a component of ecosystem respiration, can influence the dynamics of net ecosystem production. We are currently studying changes in soil CO2 efflux and its controls during secondary succession using a chronosequence approach at Blandy Experimental Farm near Boyce, VA. The six study fields (two each in early, mid, and late stages of secondary succession) range in age from 8 years to >100 years old. In each field are six 1 m2 plots, half of which are amended with 20 g ammonium-nitrate-N m-2 yr-1. We have measured soil CO2 efflux, soil volumetric water content (VWC) and soil temperature at 5 cm, both during the day and at night, year round since June 2009. Total soil organic matter content was determined by the loss-on-ignition method. Multiple regression of soil CO2 efflux against Julian day, year, nitrogen fertilization level, soil organic matter content, time of day of measurement, soil temperature, VWC, and field age resulted in only soil temperature, VWC and time of day of measurement exerting significant control on soil CO2 efflux (p < 0.0001, p < 0.0001, p = 0.0041 for soil temperature, VWC, and time of day, respectively). Soil temperature exerted the greatest control over soil CO2 efflux (R2partial = 0.2590, 0.0555, and 0.0046 for soil temperature, VWC, and time of day, respectively). Soil temperature decreases significantly with field age (p = 0.0288), but the effect is very slight (Tsoil = -0.00985(age) + 18.311). VWC does not change significantly with field age. The result that age

  17. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization

    SciTech Connect

    Violari, Elena G. Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T.; Reidy, Diane L.; Jarnagin, William R.; Brown, Karen T.

    2015-04-15

    No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

  18. Successful establishment of epiphytotics of Puccinia punctiformis for biological control of Cirsium arvense

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Canada thistle (Cirsium arvense, CT) is one of the worst weeds in temperate areas of the world. The rust fungus Puccinia punctiformis was first proposed as a biological control agent for CT in 1893. The rust causes systemic disease, is specific to CT, and is in all countries where CT is found. Despi...

  19. Evaluating rehabilitation efforts following the Milford Flat Fire: successes, failures, and controlling factors

    USGS Publications Warehouse

    Duniway, Michael C.; Palmquist, Emily C.; Miller, Mark E.

    2015-01-01

    response to moister conditions, seeded forage species. These results suggest the post-fire rehabilitation efforts conducted in the lower elevation regions affected by the Milford Flat Fire were not generally successful. Though dry conditions are likely to blame for the lack of success, the low and variable precipitation characteristic of these regions suggest future post-fire rehabilitation decisions must assume that precipitation is going to be insufficient and plan rehabilitation efforts that are resilient to dry conditions.

  20. Surface Water Nutrient Budget Controlled by Vegetation Succession in the Deglaciating Copper River Basin, Southcentral Alaska

    NASA Astrophysics Data System (ADS)

    Tomco, P. L.; Zulueta, R. C.; Welker, J. M.

    2011-12-01

    In southcentral Alaska, rapid climate change is manifested by extensive recession of glaciers. This is accompanied by an acceleration of plant succession, as recently deglaciated landscapes evolve to form mature forests and wetlands over time. As ice melt exposes ancient labile nutrients, and as vegetation succession generates high ecosystem productivity, changes in the patterns of dissolved C and N transport from terrestrial to aquatic systems are hypothesized, with cascading impacts on in-river, estuarine and possibly ocean nutrient processing. The Copper River watershed, at 63,000 km2, is the largest drainage basin in the Gulf of Alaska, and derives the major portion of discharge from glacier melt. The commercial fishery based on returning salmon is valued at 25 million dollars, and with salmon return directly linked to phytoplankton blooms in the Gulf of Alaska, understanding nutrient delivery to the marine environment is vital in determining population dynamics of marine and freshwater organisms at all trophic levels. To make predictions about the evolution of terrestrial nutrient contributions to the Copper River, we employ a space-for-time substitution at two endmembers representative of glacial successional stages in the watershed: 1) Lakina River, a recently deglaciated ecosystem dominated by rocky glacial debris containing early successional vegetation species (Dryas, spp., Shepherdia spp., and Salix spp.), and 2) May Creek, a mature spruce-dominated forested ecosystem with surface water contributions from permafrost, snow melt, and precipitation. In addition, we attempted to determine the relative contribution of source water to May Creek via sampling of two nearby springs throughout the season. To determine the seasonality of each site's nutrient budget, we measured dissolved organic carbon (DOC), dissolved organic nitrogen (DON), soluble reactive phosphorus (SRP), δ18O, δD, conductivity, NH4-N, NO3-N, Fe (soluble and colloidal), and Si flux from grab

  1. Response to a Large Polio Outbreak in a Setting of Conflict - Middle East, 2013-2015.

    PubMed

    Mbaeyi, Chukwuma; Ryan, Michael J; Smith, Philip; Mahamud, Abdirahman; Farag, Noha; Haithami, Salah; Sharaf, Magdi; Jorba, Jaume C; Ehrhardt, Derek

    2017-03-03

    As the world advances toward the eradication of polio, outbreaks of wild poliovirus (WPV) in polio-free regions pose a substantial risk to the timeline for global eradication. Countries and regions experiencing active conflict, chronic insecurity, and large-scale displacement of persons are particularly vulnerable to outbreaks because of the disruption of health care and immunization services (1). A polio outbreak occurred in the Middle East, beginning in Syria in 2013 with subsequent spread to Iraq (2). The outbreak occurred 2 years after the onset of the Syrian civil war, resulted in 38 cases, and was the first time WPV was detected in Syria in approximately a decade (3,4). The national governments of eight countries designated the outbreak a public health emergency and collaborated with partners in the Global Polio Eradication Initiative (GPEI) to develop a multiphase outbreak response plan focused on improving the quality of acute flaccid paralysis (AFP) surveillance* and administering polio vaccines to >27 million children during multiple rounds of supplementary immunization activities (SIAs).(†) Successful implementation of the response plan led to containment and interruption of the outbreak within 6 months of its identification. The concerted approach adopted in response to this outbreak could serve as a model for responding to polio outbreaks in settings of conflict and political instability.

  2. Origin Detection During Food-borne Disease Outbreaks - A Case Study of the 2011 EHEC/HUS Outbreak in Germany.

    PubMed

    Manitz, Juliane; Kneib, Thomas; Schlather, Martin; Helbing, Dirk; Brockmann, Dirk

    2014-04-01

    The key challenge during food-borne disease outbreaks, e.g. the 2011 EHEC/HUS outbreak in Germany, is the design of efficient mitigation strategies based on a timely identification of the outbreak's spatial origin. Standard public health procedures typically use case-control studies and tracings along food shipping chains. These methods are time-consuming and suffer from biased data collected slowly in patient interviews. Here we apply a recently developed, network-theoretical method to identify the spatial origin of food-borne disease outbreaks. Thereby, the network captures the transportation routes of contaminated foods. The technique only requires spatial information on case reports regularly collected by public health institutions and a model for the underlying food distribution network. The approach is based on the idea of replacing the conventional geographic distance with an effective distance that is derived from the topological structure of the underlying food distribution network. We show that this approach can efficiently identify most probable epicenters of food-borne disease outbreaks. We assess and discuss the method in the context of the 2011 EHEC epidemic. Based on plausible assumptions on the structure of the national food distribution network, the approach can correctly localize the origin of the 2011 German EHEC/HUS outbreak.

  3. Continuing professional competence: peer feedback success from determination of nurse locus of control.

    PubMed

    Mantesso, Jaime; Petrucka, Pammla; Bassendowski, Sandra

    2008-05-01

    Continuing competence programs (CCPs) are becoming required in many nursing jurisdictions across Canada. CCPs have the common goal of ensuring nurses remain up-to-date and competent in their professional practice. They often incorporate reflective practice as a tool for nurses to critically explore their practice and professionalism on an ongoing basis. Feedback is one of the strategies within reflective practice which enables nurses to increase reflective capabilities and enhance professional performance through collegial exchange. Locus of control, a personality variable, is considered as a potential indicator of how receptive nurses may be toward CCPs. For CCPs to be optimally embraced by nurses, it is imperative that professional nursing bodies address nurses' loci of control in developing, supporting, and strategizing for reflective practice, generally, and feedback, specifically.

  4. Ensuring Success of Adaptive Control Research Through Project Lifecycle Risk Mitigation

    NASA Technical Reports Server (NTRS)

    Pavlock, Kate M.

    2011-01-01

    Lessons Learne: 1. Design-out unnecessary risk to prevent excessive mitigation management during flight. 2. Consider iterative checkouts to confirm or improve human factor characteristics. 3. Consider the total flight test profile to uncover unanticipated human-algorithm interactions. 4. Consider test card cadence as a metric to assess test readiness. 5. Full-scale flight test is critical to development, maturation, and acceptance of adaptive control laws for operational use.

  5. Contribution of Personality to the Prediction of Success in Initial Air Traffic Control Specialist Training

    DTIC Science & Technology

    1993-04-01

    age of 26 (range from 18 to 32): the were not reported. majority reported some college education . As shown in Critique of past research. At the time...CS Nonradar Screen cost approximately S 10,000 per student to administer (AerospaLe Siences , Inc., I1))I1). Utility of Personality Measures With about...controller occupatinn. 24 Such research could provide the foundation for ATCS RETE-LENCLS career guidance tools for use by aviation educators and agency

  6. Successful GP intervention with frequent attenders in primary care: randomised controlled trial

    PubMed Central

    Bellón, Juan Ángel; Rodríguez-Bayón, Antonina; de Dios Luna, Juan; Torres-González, Francisco

    2008-01-01

    Background Frequent attenders to GP clinics can place an unnecessary burden on primary care. Interventions to reduce frequent attendance have had mixed results. Aim To assess the effectiveness of a GP intervention to reduce frequent-attender consultations. Design of study Randomised controlled trial with frequent attenders divided into an intervention group and two control groups (one control group was seen by GPs also providing care to patients undergoing the intervention). Setting A health centre in southern Spain. Method Six GPs and 209 randomly-selected frequent attenders participated. Three GPs were randomly allocated to perform the new intervention: of the 137 frequent attenders registered with these three GPs, 66 were randomly allocated to receive the intervention (IG) and 71 to a usual care control group (CG2). The other three GPs offered usual care to the other 72 frequent attenders (CG1). The main outcome measure was the total number of consultations 1 year post-intervention. Baseline measurements were recorded of sociodemographic characteristics, provider–user interface, chronic illnesses, and psychosocial variables. GPs allocated to the new intervention received 15 hours' training which incorporated biopsychosocial, organisational, and relational approaches. After 1 year of follow-up frequent attenders were contacted. An intention-to-treat analysis was used. Results A multilevel model was built with three factors: time, patient, and doctor. After adjusting for covariates, the mean number of visits at 1 year in IG was 13.10 (95% confidence interval [CI] = 11.39 to 14.94); in the CG1 group was 19.37 (95% CI = 17.31 to 21.55); and in the CG2 group this was 16.72 (95% CI =14.84 to 18.72). Conclusion The new intervention with GPs resulted in a significant and relevant reduction in frequent-attender consultations. Although further trials are needed, this intervention is recommended to GPs interested in reducing consultations by their frequent attenders

  7. 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

  8. Scabies: Prevention and Control

    MedlinePlus

    ... Diagnostic Assistance [DPDx] Error processing SSI file 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. ...

  9. Vaccine breaks: Outbreaks of myxomatosis on Spanish commercial rabbit farms.

    PubMed

    Dalton, K P; Nicieza, I; de Llano, D; Gullón, J; Inza, M; Petralanda, M; Arroita, Z; Parra, F

    2015-08-05

    Despite the success of vaccination against myxoma virus, myxomatosis remains a problem on rabbit farms throughout Spain and Europe. In this study we set out to evaluate possible causes of myxoma virus (MYXV) vaccine failures addressing key issues with regard to pathogen, vaccine and vaccination strategies. This was done by genetically characterising MYXV field isolates from farm outbreaks, selecting a representative strain for which to assay its virulence and measuring the protective capability of a commercial vaccine against this strain. Finally, we compare methods (route) of vaccine administration under farm conditions and evaluate immune response in vaccinated rabbits. The data presented here show that the vaccine tested is capable of eliciting protection in rabbits that show high levels of seroconversion. However, the number of animals failing to seroconvert following subcutaneous vaccination may leave a large number of rabbits unprotected following vaccine administration. Successful vaccination requires the strict implication of workable, planned, on farm programs. Following this, analysis to confirm seroconversion rates may be advisable. Factors such as the wild rabbit reservoir, control of biting insects and good hygienic practices must be taken into consideration to prevent vaccine failures from occurring.

  10. Genetic Diversity among Food-Borne and Waterborne Norovirus Strains Causing Outbreaks in Sweden▿

    PubMed Central

    Lysén, Maria; Thorhagen, Margareta; Brytting, Maria; Hjertqvist, Marika; Andersson, Yvonne; Hedlund, Kjell-Olof

    2009-01-01

    A total of 101 food-borne and waterborne outbreaks that were caused by norovirus and that resulted in more than 4,100 cases of illness were reported to the Swedish Institute for Infectious Disease Control from January 2002 to December 2006. Sequence and epidemiological data for isolates from 73 outbreaks were analyzed. In contrast to health care-related outbreaks, no clear seasonality could be observed. Sequence analysis showed a high degree of genetic variation among the noroviruses detected. Genogroup II (GII) viruses were detected in 70% of the outbreaks, and of those strains, strains of GII.4 were the most prevalent and were detected in 25% of all outbreaks. The GII.4 variants detected in global outbreaks in health care settings during 2002, 2004, and 2006 were also found in the food-borne outbreaks. GI strains totally dominated as the cause of water-related (drinking and recreational water) outbreaks and were found in 12 of 13 outbreaks. In 14 outbreaks, there were discrepancies among the polymerase and capsid genotype results. In four outbreaks, the polymerase of the recombinant GII.b virus occurred together with the GII.1 or GII.3 capsids, while the GII.7 polymerase occurred together with the GII.6 and GII.7 capsids. Mixed infections were observed in six outbreaks; four of these were due to contaminated water, and two were due to imported frozen berries. Contaminated food and water serve as important reservoirs for noroviruses. The high degree of genetic diversity found among norovirus strains causing food-borne and waterborne infections stresses the importance of the use of broad reaction detection methods when such outbreaks are investigated. PMID:19494060

  11. Foodborne Disease Outbreaks Associated with Organic Foods in the United States.

    PubMed

    Harvey, R Reid; Zakhour, Christine M; Gould, L Hannah

    2016-11-01

    Consumer demand for organically produced foods is increasing in the United States as well as globally. Consumer perception often credits organic foods as being safer than conventionally produced foods, although organic standards do not directly address safety issues such as microbial or chemical hazards. We reviewed outbreaks reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System where the implicated food was reported to be organic. Information collected for each outbreak included the year, state, number of illnesses, pathogen, and implicated food. We identified 18 outbreaks caused by organic foods from 1992 to 2014, resulting in 779 illnesses, 258 hospitalizations, and 3 deaths; 56% of outbreaks occurred from 2010 to 2014. Nine outbreaks occurred in a single state, and nine outbreaks were multistate. Salmonella sp. (44% of outbreaks) and Escherichia coli O157:H7 (33%) were the most commonly occurring pathogens. Eight of the outbreaks were attributed to produce items, four to unpasteurized dairy products, two to eggs, two to nut and seed products, and two to multi-ingredient foods. Fifteen (83%) outbreaks were associated with foods that were definitely or likely U.S. Department of Agriculture certified. More foodborne outbreaks associated with organic foods in the United States have been reported in recent years, in parallel with increases in organic food production and consumption. We are unable to assess risk of outbreaks due to organic foods compared with conventional foods because foodborne outbreak surveillance does not systematically collect food production method. Food safety requires focused attention by consumers, regardless of whether foods are produced organically or conventionally. Consumers should be aware of the risk of milk and produce consumed raw, including organic.

  12. Investigation and management of multidrug-resistant Acinetobacter baumannii spread in a French medical intensive care unit: one outbreak may hide another.

    PubMed

    Bourigault, Céline; Corvec, Stéphane; Bretonnière, Cédric; Guillouzouic, Aurélie; Crémet, Lise; Marraillac, Julie; Juvin, Marie-Emmanuelle; Bemer, Pascale; Le Gallou, Florence; Reynaud, Alain; Boutoille, David; Villers, Daniel; Lepelletier, Didier

    2013-07-01

    An outbreak in a medical intensive care unit was due to an OXA-23-producing Acinetobacter baumannii strain imported from a repatriate hospitalized in Singapore. This outbreak revealed another multidrug resistant epidemic strain that had been present in the hospital for 2 years. Both outbreaks were controlled after 9 months of an extensive infection control program.

  13. Conflict processing in juvenile patients with neurofibromatosis type 1 (NF1) and healthy controls - Two pathways to success.

    PubMed

    Bluschke, Annet; von der Hagen, Maja; Papenhagen, Katharina; Roessner, Veit; Beste, Christian

    2017-01-01

    Neurofibromatosis Type 1 (NF1) is a monogenetic autosomal-dominant disorder with a broad spectrum of clinical symptoms and is commonly associated with cognitive deficits. Patients with NF1 frequently exhibit cognitive impairments like attention problems, working memory deficits and dysfunctional inhibitory control. The latter is also relevant for the resolution of cognitive conflicts. However, it is unclear how conflict monitoring processes are modulated in NF1. To examine this question in more detail, we used a system neurophysiological approach combining high-density ERP recordings with source localisation analyses in juvenile patients with NF1 and controls during a flanker task. Behaviourally, patients with NF1 perform significantly slower than controls. Specifically on trials with incompatible flanker-target pairings, however, the patients with NF1 made significantly fewer errors than healthy controls. Yet, importantly, this overall successful conflict resolution was reached via two different routes in the two groups. The healthy controls seem to arrive at a successful conflict monitoring performance through a developing conflict recognition via the N2 accompanied by a selectively enhanced N450 activation in the case of perceived flanker-target conflicts. The presumed dopamine deficiency in the patients with NF1 seems to result in a reduced ability to process conflicts via the N2. However, NF1 patients show an increased N450 irrespective of cognitive conflict. Activation differences in the orbitofrontal cortex (BA11) and anterior cingulate cortex (BA24) underlie these modulations. Taken together, juvenile patients with NF1 and juvenile healthy controls seem to accomplish conflict monitoring via two different cognitive neurophysiological pathways.

  14. Outbreak-associated Salmonella enterica serotypes and food Commodities, United States, 1998-2008.

    PubMed

    Jackson, Brendan R; Griffin, Patricia M; Cole, Dana; Walsh, Kelly A; Chai, Shua J

    2013-08-01

    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.

  15. Community matters - why outbreak responses need to integrate health promotion.

    PubMed

    Kickbusch, Ilona; Reddy, K Srikanth

    2016-03-01

    Communities are characterized by common interests, common ecology, and common social system or structure. These characteristics, qualities, and processes involved in the community affect both health behaviors and health outcomes during disease outbreaks. Hence, health promotion theorists and practitioners emphasize working 'with' rather than 'on' communities. They believe health promotion, with all its experiences in community mobilization, empowerment, and health literacy programs, should be part of disease prevention and control efforts from the very beginning. Health promotion knowledge needs to be fully integrated into infectious disease control, especially in the context of outbreaks.

  16. Air quality control in the ART laboratory is a major determinant of IVF success

    PubMed Central

    Esteves, Sandro C; Bento, Fabiola C

    2016-01-01

    A recently published article described how a fertility center in the United States implemented air quality control to newly designed in vitro fertilization (IVF) laboratory.1 A highly-efficient air filtration was achieved by installing a centered system supplying filtered air to the IVF laboratory and related critical areas, combining air particulate and volatile organic compound (VOC) filtration. As a consequence, live birth rates were increased by improvements in air quality. This article highlights the key aspects of air contamination in the IVF context. The topic is important not only to IVF specialists but also to Andrologists due to the great number of male infertility patients referred to assisted reproductive technology (ART) treatments. The evidence is growing that laboratory air quality is paramount importance for improved IVF outcome. PMID:26585700

  17. Malaria Control and Elimination in Sri Lanka: Documenting Progress and Success Factors in a Conflict Setting

    PubMed Central

    Abeyasinghe, Rabindra R.; Galappaththy, Gawrie N. L.; Smith Gueye, Cara; Kahn, James G.; Feachem, Richard G. A.

    2012-01-01

    Background Sri Lanka has a long history of malaria control, and over the past decade has had dramatic declines in cases amid a national conflict. A case study of Sri Lanka's malaria programme was conducted to characterize the programme and explain recent progress. Methods The case study employed qualitative and quantitative methods. Data were collected from published and grey literature, district-level and national records, and thirty-three key informant interviews. Expenditures in two districts for two years – 2004 and 2009 – were compiled. Findings Malaria incidence in Sri Lanka has declined by 99.9% since 1999. During this time, there were increases in the proportion of malaria infections due to Plasmodium vivax, and the proportion of infections occurring in adult males. Indoor residual spraying and distribution of long-lasting insecticide-treated nets have likely contributed to the low transmission. Entomological surveillance was maintained. A strong passive case detection system captures infections and active case detection was introduced. When comparing conflict and non-conflict districts, vector control and surveillance measures were maintained in conflict areas, often with higher coverage reported in conflict districts. One of two districts in the study reported a 48% decline in malaria programme expenditure per person at risk from 2004 to 2009. The other district had stable malaria spending. Conclusions/Significance Malaria is now at low levels in Sri Lanka – 124 indigenous cases were found in 2011. The majority of infections occur in adult males and are due to P. vivax. Evidence-driven policy and an ability to adapt to new circumstances contributed to this decline. Malaria interventions were maintained in the conflict districts despite an ongoing war. Sri Lanka has set a goal of eliminating malaria by the end of 2014. Early identification and treatment of infections, especially imported ones, together with effective surveillance and response, will

  18. The biopharmaceutics of successful controlled release drug product: Segmental-dependent permeability of glipizide vs. metoprolol throughout the intestinal tract.

    PubMed

    Zur, Moran; Cohen, Noa; Agbaria, Riad; Dahan, Arik

    2015-07-15

    The purpose of this work was to study the challenges and prospects of regional-dependent absorption in a controlled-release scenario, through the oral biopharmaceutics of the sulfonylurea antidiabetic drug glipizide. The BCS solubility class of glipizide was determined, and its physicochemical properties and intestinal permeability were thoroughly investigated, both in-vitro (PAMPA and Caco-2) and in-vivo in rats. Metoprolol was used as the low/high permeability class boundary marker. Glipizide was found to be a low-solubility compound. All intestinal permeability experimental methods revealed similar trend; a mirror image small intestinal permeability with opposite regional/pH-dependency was obtained, a downward trend for glipizide, and an upward trend for metoprolol. Yet the lowest permeability of glipizide (terminal Ileum) was comparable to the lowest permeability of metoprolol (proximal jejunum). At the colon, similar permeability was evident for glipizide and metoprolol, that was higher than metoprolol's jejunal permeability. We present an analysis that identifies metoprolol's jejunal permeability as the low/high permeability class benchmark anywhere throughout the intestinal tract; we show that the permeability of both glipizide and metoprolol matches/exceeds this threshold throughout the entire intestinal tract, accounting for their success as controlled-release dosage form. This represents a key biopharmaceutical characteristic for a successful controlled-release dosage form.

  19. 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

  20. Scabies and bedbugs in hospital outbreaks.

    PubMed

    Sfeir, Maroun; Munoz-Price, L Silvia

    2014-08-01

    Scabies and bedbugs are two emerging ectoparasitic infections reported in crowded areas, including hospitals. Skin involvement is the main presenting initial manifestation for both infections, and the diagnosis is yet challenging for both. Topical permethrin is considered the first-line therapy for scabies except for crusted scabies which is mainly treated with oral ivermectin. To the contrary, treatment of bedbugs is mainly symptomatic. Avoiding close contact, early diagnosis and treatment of infected persons as well as decontamination of the involved environment play an essential role in controlling outbreaks in healthcare settings.

  1. Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control

    PubMed Central

    Zaheer, Amir; Redmond, H. Paul; Corrigan, Mark A.

    2016-01-01

    The successful prevention and treatment of cancer is dependent upon efficient and reliable communication between healthcare workers and patients. Advances in social media and mHealth platforms have provided new ways in which to enhance the sharing of cancer related information. Other benefits of embracing this technology include utilising its analytic capabilities which can process the vast quantity of information generated from genome exploration in a highly efficient manner. The aim of this review is to provide an overview of the rapidly evolving areas through which digital engagement is proving useful in the prevention and control of cancer. PMID:28293611

  2. From global agenda-setting to domestic implementation: successes and challenges of the global health network on tobacco control

    PubMed Central

    Gneiting, Uwe

    2016-01-01

    Global policy attention to tobacco control has increased significantly since the 1990s and culminated in the first international treaty negotiated under the auspices of the World Health Organization—the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC’s progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member countries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990s, in translating countries’ commitment to the FCTC into domestic policy change. By comparing the network’s influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network’s effectiveness around the FCTC’s implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buy-in, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network’s success than the evidence base for the effectiveness of tobacco control interventions. The network’s variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment. PMID:26253698

  3. Successful control with carbamazepine of family with paroxysmal kinesigenic dyskinesia of PRRT2 mutation.

    PubMed

    Chou, I-Ching; Lin, Sheng-Shing; Lin, Wei-De; Wang, Chung-Hsing; Chang, Yu-Tzu; Tsai, Fuu-Jen; Tsai, Chang-Hai

    2014-01-01

    Paroxysmal kinesigenic dyskinesia (PKD), a rare paroxysmal movement disorder often misdiagnosed as epilepsy, is characterized by recurrent, brief dyskinesia attacks triggered by sudden voluntary movement. Pathophysiological mechanism of PKD remains not well understood. Ion channelopathy has been suggested, since the disease responds well to ion channel blockers. Mutations in proline-rich transmembrane protein 2 (PRRT2) were recently identified in patients with familial PKD. To extend these genetic reports, we studied a family with clinical manifestations of familial PKD responding well to low dose carbamazepine. Therapeutic dose ranged from 1.5 to 2.0 mg/ kg/day, below that in seizure control. One insertion mutation c.649_650insC (p.P217fsX7) was identified in three patients of the family. This study avers PRRT2's high sensitivity for PKD phenotype. Identification of genes underlying pathogenesis will enhance diagnosis and treatment. Function of PRRT2 and its role in PKD warrant further investigation.

  4. Outbreak of mortality in Russian (Acipenser gueldenstaedtii) and Siberian (Acipenser baerii) sturgeons associated with sturgeon nucleo-cytoplasmatic large DNA virus.

    PubMed

    Ciulli, S; Volpe, E; Sirri, R; Passalacqua, P L; Cesa Bianchi, F; Serratore, P; Mandrioli, L

    2016-08-15

    Diseased outbreaks with high mortality in farmed sturgeon are a limiting factor to the success of this emerging aquaculture sector in Europe. Thorough investigations of outbreaks can determine the aetiological agents, identify important pathological and epidemiological pathways of infections and pave the way for effective control strategies. A thorough investigation of a mortality outbreak in Russian (Acipenser gueldenstaedtii) and Siberian (Acipenser baerii) sturgeons in Italy, demonstrated the primary involvement of a sturgeon nucleo-cytoplasmic large DNA virus (NCLDV). While, the taxonomy classification of this new virus is still uncertain, its involvement in sturgeon mortality outbreaks in Europe is, for the first time, fully investigated and described. Furthermore, the coinfection of bacteria such as motile Aeromonas spp. and Acinetobacter spp. was reported. Genetic characterisation showed the close relationship between the European sturgeon NCLDV with North American sturgeon NCLDVs. Similarly to the latter, the European sturgeon NCLDV persists in survivors. Furthermore, a systemic distribution of the European sturgeon NCLDV was evident in diseased A. baerii and A. gueldenstaedtii and in recovered A. gueldenstaedtii. These epidemiological and pathological findings will help in the identification of effective control strategies for sturgeon NCLDV infection, which afflicts an important and emerging European aquaculture sector.

  5. Influence of visual feedback on successive control mechanisms in upright quiet stance in humans assessed by fractional Brownian motion modelling.

    PubMed

    Rougier, P

    1999-05-14

    An up-to-date way to model the centre of pressure (CP) trajectories may consist in using fractional Brownian motion (fBm). By doing so, one may note that standing still is in fact controlled by two separate and successive mechanisms. The point raised in this study concerns the nature of these control mechanisms and their level of interaction. Following this idea, visual feedback (VFB), which is known to affect postural control by significantly decreasing sway magnitudes, was used. Twelve healthy adults, instructed to stand as still as possible, were tested under this VFB protocol (via a PC screen). In order to model the CP trajectories as fBm, variograms (mean square distances, MSD, expressed as a function of increasing time intervals deltat) were bi-logarithmically plotted. The main visual effect of VFB on these variograms concerns longest latency scaling regimes which reveal less stochastic and consequently more accurate control (P < 0.05 and P < 0.01 for X and Y components, respectively). An increase in the MSD of the transition point, which corresponds to the switch between the two control mechanisms, is also noted (P < 0.05). Overall, evidence is provided from this data that long latency scaling regimes do operate through a feedback process. Interestingly, this improved determinism in feedback control in turn induces a similar effect on the control operating over the shortest deltat. Thus, by privileging a control strategy based on feedback mechanisms, VFB in turn would make the subjects quicker in their initial displacement in order to reach a position capable of initiating a feedback mechanism.

  6. Outbreak of carbapenem-resistant Providencia stuartii in an intensive care unit.

    PubMed

    Zavascki, Alexandre P; Carvalhaes, Cecília G; da Silva, Geórgia L; Tavares Soares, Sílvia Pedroso; de Alcântara, Luciana R; Elias, Laura S; Sandri, Ana M; Gales, Ana C

    2012-06-01

    Outbreaks by carbapenem-resistant Providencia stuartii (CRPS) are rarely described. Clinical characteristics of patients with CRPS in an intensive care unit and resistance mechanisms were investigated. Carbapenemase production and/or outer membrane alterations were not detected; only CTX-M-2 and AmpC hyperproduction were noted. The outbreak was ultimately controlled in a 3-month period.

  7. Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant

    PubMed Central

    Poulou, Aggeliki; Voulgari, Evangelia; Vrioni, Georgia; Koumaki, Vasiliki; Xidopoulos, Grigorios; Chatzipantazi, Vasiliki; Markou, Fani

    2013-01-01

    Although numerous studies have documented outbreaks of carbapenem-resistant Klebsiella pneumoniae (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum β-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal K. pneumoniae strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant K. pneumoniae isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining β-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the blaCTX-M-15 gene on a conjugative 100-kb plasmid, disruption in the expression of the ompK35 gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental K. pneumoniae isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak. PMID:23850951

  8. Assessing maintenance of evaporative cooling systems in legionellosis outbreaks.

    PubMed

    Rangel, Kelly M; Delclos, George; Emery, Robert; Symanski, Elaine

    2011-04-01

    This study was designed to conduct systematic reviews of existing evaporative cooling system maintenance guidelines and of published Legionnaires' disease outbreaks to determine what, if any, maintenance practices were in place at the time of the disease outbreaks and then to contrast the reported practices with the published guidelines for evaporative cooling systems. For the first review, similarities in the reported recommendations were assessed; in the second review, any reported information about the state of the evaporative cooling system during the outbreak investigation was summarized. The systematic reviews yielded 38 current guidelines for evaporative cooling systems and 38 published outbreak investigations. The guidelines varied regarding the recommended type and dose of biocides, frequency of general inspections and total system maintenance, the preferred disinfection and cleaning procedures when testing a system for microbiological contamination, the type and frequency of testing procedures, and interpretation of test results. Overall, the maintenance guidelines did not contain sufficiently detailed procedures to prevent the problems that were observed in the outbreak investigations. These maintenance procedures included lack or improper use of a biocide; infrequent testing for microbiological contamination; improper use or maintenance of drift eliminators; and lack of a total system cleaning within 6 months of the outbreak for cooling systems that were either under continuous use, recently started up, or frequently switched on and off. This study suggests that more specific and standardized maintenance guidelines for the control of Legionella bacteria are needed and that these guidelines must be properly implemented to help reduce further Legionnaires' disease outbreaks associated with evaporative cooling systems.

  9. Chikungunya fever outbreak, Bhutan, 2012.

    PubMed

    Wangchuk, Sonam; Chinnawirotpisan, Piyawan; Dorji, Tshering; Tobgay, Tashi; Dorji, Tandin; Yoon, In-Kyu; Fernandez, Stefan

    2013-10-01

    In 2012, chikungunya virus (CHIKV) was reported for the first time in Bhutan. IgM ELISA results were positive for 36/210 patient samples; PCR was positive for 32/81. Phylogenetic analyses confirmed that Bhutan CHIKV belongs to the East/Central/South African genotype. Appropriate responses to future outbreaks require a system of surveillance and improved laboratory capacity.

  10. IMPROVING WATERBORNE DISEASE OUTBREAK INVESTIGATIONS

    EPA Science Inventory

    This article summarizes the discussions and conclusions of a workshop held December 7-8, 1998, to consider the inherent limitations and weaknesses of waterborne outbreak investigations and make recommendations for their improvement. In recent years, an increased number of suspec...

  11. Contributing factors in restaurant-associated foodborne disease outbreaks, FoodNet sites, 2006 and 2007.

    PubMed

    Gould, L Hannah; Rosenblum, Ida; Nicholas, David; Phan, Quyen; Jones, Timothy F

    2013-11-01

    An estimated 48 million cases of foodborne illness occur each year in the United States, resulting in approximately 128,000 hospitalizations and 3,000 deaths. Over half of all foodborne disease outbreaks reported to the Centers for Disease Control and Prevention are associated with eating in restaurants or delicatessens. We reviewed data from restaurant-associated foodborne disease outbreaks to better understand the factors that contribute to these outbreaks. Data on restaurant-associated foodborne disease outbreaks reported by sites participating in the Foodborne Diseases Active Surveillance Network (FoodNet) were analyzed to characterize contributing factors reported in foodborne disease outbreaks and the levels of evidence used to identify these factors. Of 457 foodborne disease outbreaks reported in 2006 and 2007 by FoodNet sites, 300 (66%) were restaurant associated, and of these 295 (98%) had at least one reported contributing factor. One to nine (with a median of two) contributing factors were reported per outbreak. Of the 257 outbreaks with a single etiology reported, contributing factors associated with food worker health and hygiene were reported for 165 outbreaks (64%), factors associated with food preparation practices within the establishment were reported for 88 outbreaks (34%), and factors associated with contamination introduced before reaching the restaurant were reported for 56 outbreaks (22%). The pronounced role of food workers in propagating outbreaks makes it clear that more work is needed to address prevention at the local level. Food workers should be instructed not to prepare food while ill to prevent the risk of transmitting pathogens.

  12. 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.

  13. Surveillance for foodborne disease outbreaks--United States, 2009-2010.

    PubMed

    2013-01-25

    Known pathogens cause an estimated 9.4 million foodborne illnesses annually in the United States. CDC collects data on foodborne disease outbreaks submitted by all states, the District of Columbia, and Puerto Rico through CDC's Foodborne Disease Outbreak Surveillance System. Data reported for each outbreak include the number of illnesses, hospitalizations, and deaths; the etiologic agent; the implicated food vehicle; and other factors involved in food preparation and consumption. During 2009-2010, a total of 1,527 foodborne disease outbreaks (675 in 2009 and 852 in 2010) were reported, resulting in 29,444 cases of illness, 1,184 hospitalizations, and 23 deaths. Among the 790 outbreaks with a single laboratory-confirmed etiologic agent, norovirus was the most commonly reported, accounting for 42% of outbreaks. Salmonella was second, accounting for 30% of outbreaks. Among the 299 outbreaks attributed to a food composed of ingredients from one of 17 predefined, mutually exclusive food commodities, those most often implicated were beef (13%), dairy (12%), fish (12%), and poultry (11%). The commodities in the 299 outbreaks associated with the most illnesses were eggs (27% of illnesses), beef (11%), and poultry (10%). Public health, regulatory, and food industry professionals can use this information when creating targeted control strategies along the farm-to-table continuum for specific agents, specific foods, and specific pairs of agents and foods. This information also supports efforts to promote safe food-handling practices among food workers and the public.

  14. A trichinosis outbreak among Southeast Asian refugees.

    PubMed

    McAuley, J B; Michelson, M K; Hightower, A W; Engeran, S; Wintermeyer, L A; Schantz, P M

    1992-06-15

    The number of cases of trichinosis reported to Centers for Disease Control has declined steadily, with an average of only 44 cases per year from 1984 through 1988. This decline was almost entirely due to a reduction in cases acquired from ingestion of fresh commercial pork. However, from July 21 through September 3, 1990, 90 (72%) of 125 Southeast Asian refugees from six states and Canada developed trichinosis after attending or eating pork sausage taken from a wedding held in Des Moines, Iowa, on July 14, 1990. Eating uncooked sausage prepared at home from commercially obtained pork was associated with the development of this illness (odds ratio = 34.0, p less than 0.001). Analysis by amount of pork consumed was significant (Mann-Whitney U rank sum test, p less than 0.001). This outbreak of trichinosis in Iowa is the fourth reported within the last 15 years among the 900,000 Southeast Asian refugees resident in the United States and one of the largest reported outbreaks in US history. The continued presence of Trichinella spiralis in commercial pork emphasizes the need for further education and control measures for persons whose dietary habits place them at risk for developing trichinosis.

  15. Controlled continuous systemic heparinization increases success rate of artery-only anastomosis replantation in single distal digit amputation

    PubMed Central

    Lee, Jun Yong; Kim, Hak Soo; Heo, Sang Taek; Kwon, Ho; Jung, Sung-No

    2016-01-01

    Abstract Replantation is a prime indication for distal digital amputation, as it helps restore hand aesthetics and functions; however, venous anastomosis is often not feasible. Previous studies used systemic anticoagulation in distal digital artery only anastomosis replantation surgery to improve replantation success rate, however, which yielded limited level of clinical evidence. This study aimed to compare controlled continuous heparinization (CCH) and intermittent bolus heparinization (IBH) for surgical outcome and clinical variables after single distal digital artery only anastomosis replantation surgery. A single-institution, retrospective cohort study was performed. Out of 324 patients who underwent digital replantation surgery, we focused the study for the Zone I and II single distal digital amputation patients excluding confounding factors. Sixty-one patients were included in this study and underwent artery-only anastomosis replantation surgery with postoperative CCH (34 patients) or IBH (27 patients) protocols. The CCH group targeted activated partial thromboplastin time (aPTT) at 51 to 70 seconds, monitoring aPTT levels every eight hours and administering 100 mg of aspirin per day. The IBH group received 300 mg of aspirin per day and underwent IBH (12,500 U). Both groups received intravenous prostaglandin E1 drips (10 μg). To verify the factors affecting the success rate of the heparin protocol, patient factors, clinical factors, and operative factors were extracted from the medical records. Statistical analysis with inverse probability of treatment weights propensity score methods compared treatment outcomes and clinical variables. The CCH group's replantation success rate was higher (91.17% vs 59.25%), and the transfusion rate was increased (P = 0.032). However, the significant decrease in hemoglobin levels (>15%) did not differ between the groups (P = 0.108). Multivariable logistic regression analysis with potent univariate variables (P

  16. A Geographic Perspective on Factors Controlling Post-Fire Succession in Boreal Black Spruce Forests in Western North America

    NASA Astrophysics Data System (ADS)

    Kasischke, E. S.; Kane, E. S.; Genet, H.; Turetsky, M. R.; ODonnell, J. A.; Hoy, E.; Barrett, K.; Baltzer, J. L.

    2014-12-01

    Recent changes to climate and the fire regime have resulted in a number of distinct changes to patterns of post-fire succession in the boreal forest region of western North America. In interior Alaska and Yukon, these responses include a shift from spruce to deciduous dominated forests in black spruce forests that experienced exposure of mineral soils from deep burning of surface organic soils, as well as low seedling recruitment in white spruce forests as a result of moisture stress. In this presentation, we will use a physical geography framework to analyze factors controlling low seedling recruitment in recently burned black spruce forests in Alaska. This approach allows for understanding how changes in the biologic components of black spruce forest ecosystems (e.g., biogeography) are controlled by factors related to geomorphology and climate over multiple spatial and temporal scales. In particular, this framework will be used to examine how the interactions between fire, climate, topography and soil texture influence pre-fire and post-fire permafrost conditions, which interact to have a strong influence on variations in soil moisture. In turn, recent changes to climate combined with variations in soil moisture controlled by differences in permafrost conditions (ground ice content, active layer thickness) can be used to explain variations in post-fire seedling recruitment in black spruce forests, where low recruitment is occurring on the sites with the driest soils. In addition, we will examine the need for further research in other boreal forest regions of western North America where the presence of pine species (jack and lodgepole) that are absent in Alaska, as well as differences in soils and permafrost conditions, are likely resulting in additional patterns of post-fire succession as a result of recent changes to climate and the fire regime.

  17. A Humidity-Driven Prediction System for Influenza Outbreaks

    NASA Astrophysics Data System (ADS)

    Thrastarson, H. T.; Teixeira, J.

    2015-12-01

    Recent studies have highlighted the role of absolute (or specific) humidity conditions as a leading explanation for the seasonal behavior of influenza outbreaks in temperate regions. If the timing and intensity of seasonal influenza outbreaks can be forecast, this would be of great value for public health response efforts. We have developed and implemented a SIRS (Susceptible-Infectious-Recovered-Susceptible) type numerical prediction system that is driven by specific humidity to predict influenza outbreaks. For the humidity, we have explored using both satellite data from the AIRS (Atmospheric Infrared Sounder) instrument as well as ERA-Interim re-analysis data. We discuss the development, testing, sensitivities and limitations of the prediction system and show results for influenza outbreaks in the United States during the years 2010-2014 (modeled in retrospect). Comparisons are made with other existing prediction systems and available data for influenza outbreaks from Google Flu Trends and the CDC (Center for Disease Control), and the incorporation of these datasets into the forecasting system is discussed.

  18. Outbreaks of food-borne and waterborne viral gastroenteritis.

    PubMed Central

    Hedberg, C W; Osterholm, M T

    1993-01-01

    Norwalk virus infection is the epidemiologic prototype for outbreaks of food-borne and waterborne gastroenteritis. Around the world, Norwalk virus and Norwalk-like viruses appear to be major causes of food-borne and waterborne illness. Assessment of the overall significance of viral agents to the epidemiology of food-borne and waterborne illness is hampered by the lack of surveillance throughout much of the world. In areas where food-borne and waterborne illness surveillance is conducted, outbreaks of viral gastroenteritis are underreported because of the lack of availability of routine laboratory services to confirm the viral etiology. Routine use of epidemiologic criteria as an alternative to laboratory confirmation will allow better assessments of the importance of viral gastroenteritis until effective laboratory methods can be widely implemented. Outbreaks of viral gastroenteritis have been propagated by contamination of water supplies, raw foods, and ill food handlers. Controlling an outbreak depends on identifying and removing the source of contamination. The demonstrated occurrence of person-to-person transmission and the likely occurrence of transmission of Norwalk-like viruses by aerosol make it necessary to evaluate the potential for transmission by food handlers and servers in every outbreak, regardless of primary source. PMID:8395330

  19. Innovation in observation: a vision for early outbreak detection

    PubMed Central

    Fefferman, NH; Naumova, EN

    2010-01-01

    The emergence of new infections and resurgence of old ones—health threats stemming from environmental contamination or purposeful acts of bioterrorism—call for a worldwide effort in improving early outbreak detection, with the goal of ameliorating current and future risks. In some cases, the problem of outbreak detection is logistically straightforward and mathematically easy: a single case of a disease of great concern can constitute an outbreak. However, for the vast majority of maladies, a simple analytical solution does not exist. Furthermore, each step in developing reliable, sensitive, effective surveillance systems demonstrates enormous complexities in the transmission, manifestation, detection, and control of emerging health threats. In this communication, we explore potential future innovations in early outbreak detection systems that can overcome the pitfalls of current surveillance. We believe that modern advances in assembling data, techniques for collating and processing information, and technology that enables integrated analysis will facilitate a new paradigm in outbreak definition and detection. We anticipate that moving forward in this direction will provide the highly desired sensitivity and specificity in early detection required to meet the emerging challenges of global disease surveillance. PMID:22460396

  20. Outbreak of Hepatitis A on an Offshore Petroleum Platform, Alaska

    PubMed Central

    Kosatsky, Tom; Middaugh, John P.; Hall, David

    1988-01-01

    An outbreak of 8 cases of hepatitis A among the 36-member crew of an offshore Alaska petroleum production platform was linked to a previous outbreak in an urban day-care center. Transmission of hepatitis A on the platform related most plausibly to refrigerated food items contaminated by a cook with mild disease. Control efforts included identifying and treating contacts of case patients who had traveled far from the platform before becoming ill. Early serologic confirmation of diagnosed cases and rapid reporting to public health authorities are essential to prevent disease transmission. Timely investigation can limit the administration of immune globulin to persons at high risk of contracting the disease. PMID:3348024

  1. [Shigella sonnei outbreak in a school in Northern Spain].

    PubMed

    Artieda, Juncal; Manterola, Jose Maria; Tolosa, Elena; Moreno, Belen; Alustiza, Jesus; Astigarraga, Uxue; Botello, Rene; Arostegui, Nerea; Basterrechea, Mikel

    2015-03-01

    In October 2012, an outbreak of acute gastroenteritis caused by Shigella sonnei was detected in a nursery and primary school in the north of Spain affecting 112 people: 63.7% were pupils and teachers and 35.7% their co-habitants. The source was a sick child who had travelled to an endemic country, and the key trigger factor was inadequate hygiene in one of the toilets of the school. The enforcement of strict hygiene measures was essential for controlling the outbreak.

  2. Distinguishing epidemiological features of the 2013–2016 West Africa Ebola virus disease outbreak

    PubMed Central

    Shultz, James M.; Espinel, Zelde; Espinola, Maria; Rechkemmer, Andreas

    2016-01-01

    ABSTRACT The 2013–2016 West Africa Ebola virus disease epidemic was notable for its scope, scale, and complexity. This briefing presents a series of distinguishing epidemiological features that set this outbreak apart. Compared to one concurrent and 23 previous outbreaks of the disease over 40 years, this was the only occurrence of Ebola virus disease involving multiple nations and qualifying as a pandemic. Across multiple measures of magnitude, the 2013–2016 outbreak was accurately described using superlatives: largest and deadliest in terms of numbers of cases and fatalities; longest in duration; and most widely dispersed geographically, with outbreak-associated cases occurring in 10 nations. In contrast, the case-fatality rate was much lower for the 2013–2016 outbreak compared to the other 24 outbreaks. A population of particular interest for ongoing monitoring and public health surveillance is comprised of more than 17,000 “survivors,” Ebola patients who successfully recovered from their illness. The daunting challenges posed by this outbreak were met by an intensive international public health response. The near-exponential rate of increase of incident Ebola cases during mid-2014 was successfully slowed, reversed, and finally halted through the application of multiple disease containment and intervention strategies. PMID:28229017

  3. [Serratia marcescens outbreak in Neonatal Intensive Care Unit: Guayaquil, Ecuador].

    PubMed

    Soria, Claudia; Nieto, Nelson; Villacís, José E; Lainez, Sara; Cartelle, Mónica

    2016-12-01

    We report a Serratia marcescens outbreak occurred in the NICU of a pediatric hospital in Guayaquil, Ecuador. Nine cases of infection were detected, from which septicemia was developed in 55.5%. The index case was a newborn derived from another institution with septic arthritis caused by the outbreak strain. The infection rate was 17.6% and mortality rate was 33.3%. All isolates were resistant to aminoglycosides and susceptible to third generation cephalosporins and carbapenems. Clonality analysis by pulsed-field gel electrophoresis (PFGE) revealed the presence of two closely related clones confirming the horizontal spread. Measures were taken by the committee such as: strengthening the hand hygiene, patient hygiene and cohort studies of gastrointestinal colonization, which allowed the control of the outbreak.

  4. Guidance for Schools on the Recent Flu Outbreak

    ERIC Educational Resources Information Center

    US Department of Education, 2009

    2009-01-01

    The document provides a transcript of a conference call moderated by Bill Modzeleski, Director of the Office of Safe and Drug-Free Schools. The focus of the call was the recent outbreak of swine flu in Mexico and the United States. Centers for Disease Control (CDC) actions and recommendations to the education community were discussed. A comparison…

  5. Multinational Cholera Outbreak after Wedding in the Dominican Republic

    PubMed Central

    Apostolou, Andria; Suarez, Alba Jazmin Palmera; Meyer, Luis; Hiciano, Salvador; Newton, Anna; Morgan, Oliver; Then, Cecilia; Pimentel, Raquel

    2011-01-01

    We conducted a case–control study of a cholera outbreak after a wedding in the Dominican Republic, January 22, 2011. Ill persons were more likely to report having consumed shrimp on ice (odds ratio 8.50) and ice cubes in beverages (odds ratio 3.62). Travelers to cholera-affected areas should avoid consuming uncooked seafood and untreated water. PMID:22204039

  6. 79 FR 53430 - Georgia Tuberculosis Outbreak Among Homeless

    Federal Register 2010, 2011, 2012, 2013, 2014

    2014-09-09

    ... HUMAN SERVICES Centers for Disease Control and Prevention Georgia Tuberculosis Outbreak Among Homeless... Department of Public Health, Tuberculosis (TB) Program. This award will be in the amount of $419,095.00. The purpose of this award is to halt the further spread of a drug- resistant strain of tuberculosis...

  7. Sharing Data for Global Infectious Disease Surveillance and Outbreak Detection.

    PubMed

    Aarestrup, Frank M; Koopmans, Marion G

    2016-04-01

    Rapid global sharing and comparison of epidemiological and genomic data on infectious diseases would enable more rapid and efficient global outbreak control and tracking of diseases. Several barriers for global sharing exist but, in our opinion, the presumed magnitude of the problems appears larger than they are, and solutions can be found.

  8. 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.

  9. Strategies to Mitigate a Mycobacterium marinum Outbreak in a Zebrafish Research Facility.

    PubMed

    Mason, Timothy; Snell, Kathy; Mittge, Erika; Melancon, Ellie; Montgomery, Rebecca; McFadden, Marcie; Camoriano, Javier; Kent, Michael L; Whipps, Christopher M; Peirce, Judy

    2016-07-01

    In 2011, the zebrafish research facility at the University of Oregon experienced an outbreak of Mycobacterium marinum that affected both research fish and facility staff. A thorough review of risks to personnel, the zebrafish veterinary care program, and zebrafish husbandry procedures at the research facility followed. In the years since 2011, changes have been implemented throughout the research facility to protect the personnel, the fish colony, and ultimately the continued success of the zebrafish model research program. In this study, we present the history of the outbreak, the changes we implemented, and recommendations to mitigate pathogen outbreaks in zebrafish research facilities.

  10. Strategies to Mitigate a Mycobacterium marinum Outbreak in a Zebrafish Research Facility

    PubMed Central

    Snell, Kathy; Mittge, Erika; Melancon, Ellie; Montgomery, Rebecca; McFadden, Marcie; Camoriano, Javier; Kent, Michael L.; Whipps, Christopher M.; Peirce, Judy

    2016-01-01

    Abstract In 2011, the zebrafish research facility at the University of Oregon experienced an outbreak of Mycobacterium marinum that affected both research fish and facility staff. A thorough review of risks to personnel, the zebrafish veterinary care program, and zebrafish husbandry procedures at the research facility followed. In the years since 2011, changes have been implemented throughout the research facility to protect the personnel, the fish colony, and ultimately the continued success of the zebrafish model research program. In this study, we present the history of the outbreak, the changes we implemented, and recommendations to mitigate pathogen outbreaks in zebrafish research facilities. PMID:27351618

  11. Diagnosis and management of bovine babesiosis outbreaks in cattle in Punjab state

    PubMed Central

    Bal, Mandeep Singh; Mahajan, Vishal; Filia, Gursimran; Kaur, Paramjit; Singh, Amarjit

    2016-01-01

    Aim: The aim of the present study was to diagnose severe outbreaks of bovine babesiosis in Punjab state, in the year 2015 and to suggest control and preventive measures to animal owners. Materials and Methods: Mortality of animals was recorded in two cattle herd comprising a total of 465 cattle in Sangrur (n=125) and Faridkot (n=340) districts. There was a history of purchase of animals at one farm. 23 blood samples were collected from diseased (n=15) and healthy animals (n=8) for hematological analysis, parasitological, and polymerase chain reaction (PCR)-based diagnosis. Ticks were also collected from animals for identification. Results: Out of 465 cattle at risk, 28 were critically ill and 14 died of disease with morbidity, mortality, and case fatality rate of 6.02%, 3.01%, and 50.00%, respectively. Clinical signs and necropsy findings were suggestive of babesiosis. Ticks collected from both the outbreaks were identified as Rhipicephalus (Boophilus) microplus. Thin blood smears from infected animals (especially with clinical sign of hemoglobinuria) were found positive for Babesia bigemina organisms; however, molecular diagnosis (PCR) further confirmed the disease. Animals were successfully treated with diminazene aceturate, hematinics, and antipyretics. Conclusions: Two fatal outbreaks of babesiosis in cattle were diagnosed with application of conventional parasitological, hematological, and molecular diagnostic techniques. PCR was found to be far more sensitive in detecting the disease, especially in latent infections. Animal owners were advised to follow quarantine measures before mixing new animals in the herd and strategic acaricidal treatments for effective tick control. PMID:28096607

  12. 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…

  13. Host-Parasitoid Dynamics and the Success of Biological Control When Parasitoids Are Prone to Allee Effects

    PubMed Central

    Bompard, Anaïs; Amat, Isabelle; Fauvergue, Xavier; Spataro, Thierry

    2013-01-01

    In sexual organisms, low population density can result in mating failures and subsequently yields a low population growth rate and high chance of extinction. For species that are in tight interaction, as in host-parasitoid systems, population dynamics are primarily constrained by demographic interdependences, so that mating failures may have much more intricate consequences. Our main objective is to study the demographic consequences of parasitoid mating failures at low density and its consequences on the success of biological control. For this, we developed a deterministic host-parasitoid model with a mate-finding Allee effect, allowing to tackle interactions between the Allee effect and key determinants of host-parasitoid demography such as the distribution of parasitoid attacks and host competition. Our study shows that parasitoid mating failures at low density result in an extinction threshold and increase the domain of parasitoid deterministic extinction. When proned to mate finding difficulties, parasitoids with cyclic dynamics or low searching efficiency go extinct; parasitoids with high searching efficiency may either persist or go extinct, depending on host intraspecific competition. We show that parasitoids suitable as biocontrol agents for their ability to reduce host populations are particularly likely to suffer from mate-finding Allee effects. This study highlights novel perspectives for understanding of the dynamics observed in natural host-parasitoid systems and improving the success of parasitoid introductions. PMID:24116153

  14. Coherence-controlled holographic microscopy principle embodiment into Q-PHASE microscope: story of a successful technology transfer

    NASA Astrophysics Data System (ADS)

    Lostak, M.; Chmelik, R.

    2016-03-01

    Curiously, the coherence-controlled holographic microscopy (CCHM) was brought into the world owing to the endeavor of Chmelik's team at Brno University of Technology (BUT) to avoid scanning in confocal microscopy. As coherence gating seemed to be the way, the Leith & Upatnieks proposal of incoherent holography had been considered attractive. Their method made interference system free from strict dependence on both spatial and temporal coherence. Off axis holographic system proposed on such basis has been proved capable of coherence based depth discrimination in single wide-field shot in reflected-light arrangement. Consequently, extremely low-coherence holographic imaging had been found highly contributive also to the image quality depriving it from coherence artefacts and improving its transversal resolution. This is why CCHM promised high precision of quantitative phase imaging (QPI) in transmitted light set up that was realized for cell biology. However the cost of necessarily complicated optical design and need of very precise mechanics forced the team of prof Chmelik at BUT to search for a company capable of mastering the instrument. It was TESCAN ORSAY the highly successful scanning electron microscopes producer that finally took charge of the commercial design. Long-term collaboration of the company with BUT made possible both the CCHM technology successful transfer up to Q-PHASE microscope production as well as the company Light microscopy division reinforcement. This contribution merges views of CCHM technology author and the TESCAN development team.

  15. A pragmatic randomised controlled trial on routine iron prophylaxis during pregnancy in Maputo, Mozambique (PROFEG): rationale, design, and success.

    PubMed

    Nwaru, Bright I; Parkkali, Saara; Abacassamo, Fatima; Salomé, Graca; Chilundo, Baltazar; Augusto, Orvalho; Cliff, Julie; Dgedge, Martinho; Regushevskaya, Elena; Nikula, Minna; Hemminki, Elina

    2015-04-01

    The effects of prophylactic iron during pregnancy on maternal and child health in developing settings with endemic malaria and high prevalence of HIV remain unclear. This paper describes the rationale, implementation and success of a pragmatic randomised controlled trial comparing routine iron supplementation vs. screening and treatment for anaemia during pregnancy. The setting was two health centres in Maputo, Mozambique. Pregnant women (≥ 12-week gestation; ≥ 18 years old; and not with a high-risk pregnancy, n=4326) were recruited. The main outcomes are preterm delivery and low birthweight. The women were randomly assigned to one of two iron administration policies: a routine iron group (n=2184) received 60 mg of ferrous sulphate plus 400 μg of folic acid daily while a selective iron group (n=2142) had screening and treatment for anaemia and a daily intake of 1 mg of folic acid. The recruitment, follow-up, and collection of follow-up data were successful; both groups were similar to each other in all the trial stages. Collection of delivery data was challenging and data on about 40% of births is missing. These are currently being traced through different hospitals and health centres. The compliance of the study personnel and the women with regard to regular measurement of haemoglobin and intake of the iron and folic acid tablets was high and similar in both trial arms. Taking into account the various constraints encountered, the stages of the present trial prior to delivery were carried out well.

  16. The cognitive control of memory: age differences in the neural correlates of successful remembering and intentional forgetting.

    PubMed

    Rizio, Avery A; Dennis, Nancy A

    2014-01-01

    Successful memory encoding depends on the ability to intentionally encode relevant information (via differential encoding) and intentionally forget that which is irrelevant (via inhibition). Both cognitive processes have been shown to decline in aging and are theorized to underlie age-related deficits in the cognitive control of memory. The current study uses the Directed Forgetting paradigm in conjunction with fMRI to investigate age-related differences in both cognitive processes, with the specific aim of elucidating neural evidence supporting these theorized deficits. Results indicate relatively preserved differential encoding, with age differences consistent with previous models of age-related compensation (i.e., increased frontal and bilateral recruitment). Older adults did display noticeable differences in the recruitment of brain regions related to intentional forgetting, specifically exhibiting reduced activity in the right superior prefrontal cortex, a region shown to be critical to inhibitory processing. However, older adults exhibited increased reliance on processing in right inferior parietal lobe associated with successful forgetting. Activity in this region was negatively correlated with activity in the medial temporal lobe, suggesting a shift in the locus of inhibition compared to the frontally mediated inhibition observed in younger adults. Finally, while previous studies found intentional and incidental forgetting to be dissociable in younger adults, this differentiation appears to be reduced in older adults. The current results are the first to provide neural evidence for an age-related reduction in processes that support intentional forgetting.

  17. Dietary habits and weight maintenance success in high versus low exercisers in the National Weight Control Registry

    PubMed Central

    Ogden, Lorraine G.; Phelan, Suzanne; Thomas, J. Graham; Hill, James O; Wing, Rena R.; Wyatt, Holly R.

    2015-01-01

    Background The National Weight Control Registry (NWCR) was established to examine characteristics of successful weight loss maintainers. This study compares the diet and behavioral characteristics and weight regain trajectories of NWCR members with differing physical activity (PA) levels at baseline. Methods Participants (n=3591) were divided into 4 levels of self-reported PA at registry entry (<1000, 1000 to <2250, 2250 to <3500, and ≥3500 kcals/week). We compared self-reported energy intake (EI), macronutrient composition, eating behaviors (dietary restraint, hunger, and disinhibition), weight loss maintenance strategies, and 3 year weight regain between these 4 activity groups. Results Those with the highest PA at registry entry had lost the most weight, and reported lower fat intake, more dietary restraint, and greater reliance on several specific dietary strategies to maintain weight loss. Those in the lowest PA category maintained weight loss despite low levels of PA and without greater reliance on dietary strategies. There were no differences in odds of weight regain at year 3 between PA groups. Conclusions These findings suggest that there is not a “one size fits all strategy” for successful weight loss maintenance and that weight loss maintenance may require the use of more strategies by some individuals than others. PMID:24385447

  18. Ebola virus outbreak, updates on current therapeutic strategies.

    PubMed

    Elshabrawy, Hatem A; Erickson, Timothy B; Prabhakar, Bellur S

    2015-07-01

    Filoviruses are enveloped negative-sense single-stranded RNA viruses, which include Ebola and Marburg viruses, known to cause hemorrhagic fever in humans with a case fatality of up to 90%. There have been several Ebola virus outbreaks since the first outbreak in the Democratic Republic of Congo in 1976 of which, the recent 2013-2015 epidemic in Guinea, Liberia, and Sierra Leone is the largest in recorded history. Within a few months of the start of the outbreak in December 2013, thousands of infected cases were reported with a significant number of deaths. As of March 2015, according to the Centers for Disease Control and Prevention, there have been nearly 25,000 suspected cases, with 15,000 confirmed by laboratory testing, and over 10,000 deaths. The large number of cases and the high mortality rate, combined with the lack of effective Food and Drug Administration-approved treatments, necessitate the development of potent and safe therapeutic measures to combat the current and future outbreaks. Since the beginning of the outbreak, there have been considerable efforts to develop and characterize protective measures including vaccines and antiviral small molecules, and some have proven effective in vitro and in animal models. Most recently, a cocktail of monoclonal antibodies has been shown to be highly effective in protecting non-human primates from Ebola virus infection. In this review, we will discuss what is known about the nature of the virus, phylogenetic classification, genomic organization and replication, disease transmission, and viral entry and highlight the current approaches and efforts, in the development of therapeutics, to control the outbreak.

  19. Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.

    PubMed

    Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  20. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    PubMed Central

    Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

  1. [Structural requirements and conditions for effective microbiological diagnostics in disease outbreak].

    PubMed

    Allerberger, F

    2013-01-01

    After the International Health Regulations of 2005, 194 states agreed to minimal standards to assure health; accordingly, the obligation for safeguarding appropriate laboratory diagnostic capacities has existed under international law since 15 June 2007. Basically, developing and optimizing faster and more innovative testing methods should be the main aim of public health reference laboratories in order to guarantee optimal outbreak detection, control measures, and patient management. All these measures can only be successfully implemented if microbiological primary diagnostics remain comprehensive and do not fall victim to apparent budgetary restrictions. Effective microbiological diagnostics not only help the patient who is directly affected, but also have an effect on the efforts of public health services in controlling infectious disease. In this respect, microbiological routine diagnostics differ substantially from medical-chemical laboratory diagnostics.

  2. Insecticides promote viral outbreaks by altering herbivore competition.

    PubMed

    Pan, Huipeng; Preisser, Evan L; Chu, Dong; Wang, Shaoli; Wu, Qingjun; Carriére, Yves; Zhou, Xuguo; Zhang, Youjun

    2015-09-01

    While the management of biological invasions is often characterized by a series of single-specieg decisions, invasive species exist within larger food webs. These biotic interactions can alter the impact of control/eradication programs and may cause suppression efforts to inadvertently facilitate invasion spread and impact. We document the rapid replacement of the invasive Bemisia Middle East-Asia Minor I (MEAM1) cryptic biotype by the cryptic Mediterranean (MED) biotype throughout China and demonstrate that MED is more tolerant of insecticides and a better vector of tomato yellow leaf curl virus (TYLCV) than MEAMJ. While MEAM1 usually excludes MED under natural conditions, insecticide application reverses the MEAM1-MED competitive hierarchy and allows MED to exclude MEAMI. The insecticide-mediated success of MED has led to TYLCV outbreaks throughout China. Our work strongly supports the hypothesis that insecticide use in China reverses the MEAMl-MED competitive hierarchy and allows MED to displace MEAM1 in managed landscapes. By promoting the dominance of a Bemisia species that is a competent viral vector, insecticides thus increase the spread and impact of TYLCV in heterogeneous agroecosystems.

  3. Impact of climate change on larch budmoth cyclic outbreaks

    PubMed Central

    Iyengar, Sudharsana V.; Balakrishnan, Janaki; Kurths, Jürgen

    2016-01-01

    Periodic outbreaks of the larch budmoth Zeiraphera diniana population (and the massive forest defoliation they engender) have been recorded in the Alps over the centuries and are known for their remarkable regularity. But these have been conspicuously absent since 1981. On the other hand, budmoth outbreaks have been historically unknown in the larches of the Carpathian Tatra mountains. To resolve this puzzle, we propose here a model which includes the influence of climate and explains both the 8–9 year periodicity in the budmoth cycle and the variations from this, as well as the absence of cycles. We successfully capture the observed trend of relative frequencies of outbreaks, reproducing the dominant periodicities seen. We contend that the apparent collapse of the cycle in 1981 is due to changing climatic conditions following a tipping point and propose the recurrence of the cycle with a changed periodicity of 40 years – the next outbreak could occur in 2021. Our model also predicts longer cycles. PMID:27293118

  4. A large outbreak of salmonellosis associated with sandwiches contaminated with multiple bacterial pathogens purchased via an online shopping service.

    PubMed

    Wei, Sung-Hsi; Huang, Angela S; Liao, Ying-Shu; Liu, Yu-Lun; Chiou, Chien-Shun

    2014-03-01

    Food sold over the internet is an emerging business that also presents a concern with regard to food safety. A nationwide foodborne disease outbreak associated with sandwiches purchased from an online shop in July 2010 is reported. Consumers were telephone interviewed with a structured questionnaire and specimens were collected for etiological examination. A total of 886 consumers were successfully contacted and completed the questionnaires; 36.6% had become ill, with a median incubation period of 18 h (range, 6-66 h). The major symptoms included diarrhea (89.2%), abdominal pain (69.8%), fever (47.5%), headache (32.7%), and vomiting (17.3%). Microbiological laboratories isolated Salmonella enterica serovar Enteritidis, Salmonella Virchow, Staphylococcus aureus, Bacillus cereus, and enterotoxigenic Escherichia coli from the contaminated sandwiches, Salmonella Enteritidis and Salmonella Virchow from the patients, and Salmonella Enteritidis and Staphylococcus aureus from food handlers. Pulsed-field gel electrophoresis genotyping suggested a common origin of Salmonella bacteria recovered from the patients, food, and a food handler. Among the pathogens detected, the symptoms and incubation period indicated that Salmonella, likely of egg origin, was the probable causative agent of the outbreak. This outbreak illustrates the importance of meticulous hygiene practices during food preparation and temperature control during food shipment and the food safety challenges posed by online food-shopping services.

  5. Characteristics of rural leptospirosis patients admitted to referral hospitals during the 2008 leptospirosis outbreak in Sri Lanka: implications for developing public health control measures.

    PubMed

    Agampodi, Suneth B; Nugegoda, Dhanaseela B; Thevanesam, Vasanthi; Vinetz, Joseph M

    2015-01-01

    To determine the exposure risk factors of highly endemic rural leptospirosis in tropical setting, we conducted a prospective, hospital-based case control study in Sri Lanka. A conceptual hierarchy of variables was used to analyze the data. Case patients included 38 (34%) females and 73 (66%) males with a mean age of 36 yr (SD 12.7 yr). Using piped, chlorinated water for drinking/general purposes (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.16-0.67), paddy fields in the vicinity of home (OR 1.77, 95% CI 1.06-2.97), sighting dogs at home yard/dog ownership (OR 1.79, 95% CI 1.11-2.91), sighting cattle at home yard/cattle ownership (OR 1.69, 95% CI 1.00-2.84), and work in a paddy field (OR 3.02, 95% CI 1.68, 5.41) were the main predictors of leptospirosis among febrile patients. In high endemic tropical settings with rural leptospirosis, risk factors in residential environments, rather than individual exposures, seemed to play a major role in leptospirosis disease transmission.

  6. Characteristics of Rural Leptospirosis Patients Admitted to Referral Hospitals during the 2008 Leptospirosis Outbreak in Sri Lanka: Implications for Developing Public Health Control Measures

    PubMed Central

    Agampodi, Suneth B.; Nugegoda, Dhanaseela B.; Thevanesam, Vasanthi; Vinetz, Joseph M.

    2015-01-01

    To determine the exposure risk factors of highly endemic rural leptospirosis in tropical setting, we conducted a prospective, hospital-based case control study in Sri Lanka. A conceptual hierarchy of variables was used to analyze the data. Case patients included 38 (34%) females and 73 (66%) males with a mean age of 36 yr (SD 12.7 yr). Using piped, chlorinated water for drinking/general purposes (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.16–0.67), paddy fields in the vicinity of home (OR 1.77, 95% CI 1.06–2.97), sighting dogs at home yard/dog ownership (OR 1.79, 95% CI 1.11–2.91), sighting cattle at home yard/cattle ownership (OR 1.69, 95% CI 1.00–2.84), and work in a paddy field (OR 3.02, 95% CI 1.68, 5.41) were the main predictors of leptospirosis among febrile patients. In high endemic tropical settings with rural leptospirosis, risk factors in residential environments, rather than individual exposures, seemed to play a major role in leptospirosis disease transmission. PMID:25331809

  7. Genomics and outbreaks: foot and mouth disease.

    PubMed

    Freimanis, G L; Di Nardo, A; Bankowska, K; King, D J; Wadsworth, J; Knowles, N J; King, D P

    2016-04-01

    Foot and mouth disease virus (FMDV) is an animal pathogen of global economic significance. Identifying the sources of outbreaks plays an important role in disease control; however, this can be confounded by the ease with which FMDV can spread via movement of infected livestock and animal products, aerosols or fomites, e.g. contaminated persons and objects. As sequencing technologies have advanced, this review highlights the uses of viral genomic data in helping to understand the global distribution and transboundary movements of FMDV, and the role that these approaches have played in control and surveillance programmes. The recent application of next-generation sequencing platforms to address important epidemiological and evolutionary challenges is discussed with particular reference to the advent of 'omics' technologies.

  8. Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital

    PubMed Central

    Matt, Benedikt; Mitteregger, Dieter; Renner, Sabine; Presterl, Elisabeth; Assadian, Ojan; Diab-Elschahawi, Magda

    2014-01-01

    Background: The aim of this study was to characterise the epidemiology of P. aeruginosa isolated from cystic fibrosis (CF) patients at the Vienna General Hospital (VGH) by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols. Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for P. aeruginosa during the study period. Fifty P. aeruginosa isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab® method. Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each. Nine patients presented with two or more phenotypically diverse P. aeruginosa isolates. In five of these cases the retrieved isolates belonged to the same genotype. Conclusion: The broad genetic heterogeneity of P. aeruginosa in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire P. aeruginosa from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of P. aeruginosa among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population. PMID:25285264

  9. Rubella outbreak in the union territory of Chandigarh, North India.

    PubMed

    Singh, Mini P; Kumar, Archit; Gautam, Neha; Khurana, Jasmine; Gupta, Madhu; Ratho, Radha Kanta

    2015-02-01

    Rubella virus outbreaks usually occur when a large numbers of susceptible individuals accumulate. The disease presents clinically with fever and maculopapular rash. The present study reports the investigation of rubella outbreak in a modern and well-planned village near Chandigarh, North India. The blood samples were collected from 39 cases with febrile rash and from 15 age and sex matched healthy controls residing in the same locality and subjected for the detection of Rubella IgM and IgG antibodies by Enzyme linked immunosorbent assay. The throat swabs, urine and blood samples from acute cases were also collected and subjected to RT-PCR using the primers targeting the E1 region. The genetic characterization of the rubella virus was carried out to identify the circulating genotypes. In the present outbreak, 13 laboratory confirmed cases were reported. Rubella IgM antibodies were detected in 12/39 (30.7%) patients. Rubella RNA could be detected in 83.3% (5/6) of urine, 22.2% (2/9) of throat swabs, and 8.3% (1/12) of blood samples. The rubella genotype responsible for the present outbreak was identified as genotype 1a. This outbreak highlights the need for the introduction of rubella vaccine in the National Immunization Programme of India to prevent outbreaks and to aim towards the eradication of this disease. This study reports the presence of genotype 1a in North India for the first time and stresses the need for further molecular work to identify the circulating strains of the virus.

  10. An investigation into the first outbreak of African swine fever in the Republic of Mauritius.

    PubMed

    Lubisi, B A; Dwarka, R M; Meenowa, D; Jaumally, R

    2009-06-01

    Outbreaks of African swine fever (ASF) have been reported from many countries, particularly in Sub-Saharan Africa, but until 2007 the disease had never been reported from the Republic of Mauritius. This is the first report describing field epidemiological and laboratory investigations into the outbreak of the lethal pig disease on the island. The official index case displayed clinical and necropsy signs suggestive of ASF. Serological and agent identification methods used to confirm and investigate the outbreak yielded negative and a few positive results respectively. Phylogenetic analysis based on DNA sequencing clustered the outbreak strain within genotype II viruses. The outbreak was controlled by modified stamping out and risk assessment revealed the possibility of disease endemicity in the country.

  11. A call to action to enhance filovirus disease outbreak preparedness and response.

    PubMed

    Roddy, Paul

    2014-09-30

    The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention-Atlanta, and others.

  12. 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

  13. 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.

  14. 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

  15. Contagious Comments: What Was the Online Buzz About the 2011 Quebec Measles Outbreak?

    PubMed Central

    Pereira, Jennifer A.; Quach, Susan; Dao, Huy Hao; Kwong, Jeffrey C.; Deeks, Shelley L.; Crowcroft, Natasha S.; Quan, Sherman D.; Guay, Maryse

    2013-01-01

    Background Although interruption of endemic measles was achieved in the Americas in 2002, Quebec experienced an outbreak in 2011 of 776 reported cases; 80% of these individuals had not been fully vaccinated. We analyzed readers’ online responses to Canadian news articles regarding the outbreak to better understand public perceptions of measles and vaccination. Methods We searched Canadian online English and French news sites for articles posted between April 2011 and March 2012 containing the words “measles” and “Quebec”. We included articles that i) concerned the outbreak or related vaccination strategies; and ii) generated at least ten comments. Two English and two bilingual researchers coded the unedited comments, categorizing codes to allow themes to emerge. Results We analyzed 448 comments from 188 individuals, in response to three French articles and six English articles; 112 individuals expressed positive perceptions of measles vaccination (2.2 comments/person), 38 were negative (4.2 comments/person), 11 had mixed feelings (1.5 comments/person), and 27 expressed no opinion (1.1 comments/person). Vaccine-supportive themes involved the success of vaccination in preventing disease spread, societal responsibility to vaccinate for herd immunity, and refutation of the autism link. Those against measles vaccination felt it was a personal rather than societal choice, and conveyed a distrust of vaccine manufacturers, believing that measles infection is not only safe but safer than vaccination. Commenters with mixed feelings expressed uncertainty of the infection’s severity, and varied in support of all vaccines based on perceived risk/benefit ratios. Conclusion The anti-vaccine minority’s volume of comments translates to a disproportionately high representation on online boards. Public health messages should address concerns by emphasizing that immunization is always a personal choice in Canada, and that the pharmaceutical industry is strictly

  16. An outbreak of Paederus dermatitis in a primary school, Terengganu, Malaysia.

    PubMed

    Rahmah, E; Norjaiza, M J

    2008-06-01

    Outbreaks of Paederus dermatitis have been reported in several Asia-Pacific countries when rove beetles (genus Paederus) are accidentally brushed or crushed on the skin, releasing haemolymph pederin. An investigation was conducted in a school to ascertain the causative agent, establish the case definition, epidemiological characterisation of cases, entomological and environmental survey and data analysis. This outbreak occurred among 36 schoolchildren attending a night tuition class conducted by their teacher. Dermatitis developed within 24 hours in 33/37 (89.2%) cases with itchiness as the first presenting symptom in 87.9% of cases. Periorbital oedema and erythematous-vesicular plaques on the upper extremities were seen in 57.6% of cases, on the back (36.4%) and on the nape (24.2%). Signs and symptoms were present 12 hours after exposure in 66.7% of cases with burning sensation within four hours in 9.1%. Seven cases received out-patient treatment. Thirty cases (90.9%) recalled exposure to Paederus fuscipes with 28 (84.8%) cases admitting crushing or brushing the insects. (Relative risk = 2.2; 95% CI: 1.2; 4.2). The school with fluorescent lighting, was located next to paddy fields. P. fuscipes was easily found in the paddy fields and along the school corridors. This strongly supports it as the likely causative agent for the dermatitis. Boarding the ventilation panes and use of insect spray were successfully implemented to control the outbreak. Increased awareness of this condition is important to prevent misdiagnosis.

  17. The Driving Force for 2014 Dengue Outbreak in Guangdong, China

    PubMed Central

    Yakob, Laith; Zhu, Huai-Ping; Jin, Zhen; Zhang, Wen-Yi

    2016-01-01

    Dengue fever has rapidly spread in recent decades to become the most globally expansive viral vector-borne disease. In mainland China, a number of dengue outbreaks have been reported since 1978, but the worst epidemic in decades, involving 45230 cases and 76 imported cases, resulting in six deaths in Guangdong province, emerged in 2014. Reasons for this ongoing surge in dengue, both imported and autochthonous, are currently unclear and demand urgent investigation. Here, a seasonally-driven dynamic epidemiological model was used to simulate dengue transmission data recorded from the unprecedented outbreak. Sensitivity analysis demonstrate that delayed mosquito control, the continuous importations between the end of April to the early of July, the transmission of asymptomatic dengue infections, and the abnormally high precipitation from May to August might be the causal factors for the unprecedented outbreak. Our results suggested that the earlier and more frequent control measures in targeting immature and adult mosquitoes were effective in preventing larger outbreaks, and enhanced frontier health and quarantine from the end of April to the early of July for international communications and travelers. PMID:27861514

  18. Media impact switching surface during an infectious disease outbreak

    NASA Astrophysics Data System (ADS)

    Xiao, Yanni; Tang, Sanyi; Wu, Jianhong

    2015-01-01

    There are many challenges to quantifying and evaluating the media impact on the control of emerging infectious diseases. We modeled such media impacts using a piecewise smooth function depending on both the case number and its rate of change. The proposed model was then converted into a switching system, with the switching surface determined by a functional relationship between susceptible populations and different subgroups of infectives. By parameterizing the proposed model with the 2009 A/H1N1 influenza outbreak data in the Shaanxi province of China, we observed that media impact switched off almost as the epidemic peaked. Our analysis implies that media coverage significantly delayed the epidemic's peak and decreased the severity of the outbreak. Moreover, media impacts are not always effective in lowering the disease transmission during the entire outbreak, but switch on and off in a highly nonlinear fashion with the greatest effect during the early stage of the outbreak. The finding draws the attention to the important role of informing the public about `the rate of change of case numbers' rather than `the absolute number of cases' to alter behavioral changes, through a self-adaptive media impact switching on and off, for better control of disease transmission.

  19. Media impact switching surface during an infectious disease outbreak

    PubMed Central

    Xiao, Yanni; Tang, Sanyi; Wu, Jianhong

    2015-01-01

    There are many challenges to quantifying and evaluating the media impact on the control of emerging infectious diseases. We modeled such media impacts using a piecewise smooth function depending on both the case number and its rate of change. The proposed model was then converted into a switching system, with the switching surface determined by a functional relationship between susceptible populations and different subgroups of infectives. By parameterizing the proposed model with the 2009 A/H1N1 influenza outbreak data in the Shaanxi province of China, we observed that media impact switched off almost as the epidemic peaked. Our analysis implies that media coverage significantly delayed the epidemic's peak and decreased the severity of the outbreak. Moreover, media impacts are not always effective in lowering the disease transmission during the entire outbreak, but switch on and off in a highly nonlinear fashion with the greatest effect during the early stage of the outbreak. The finding draws the attention to the important role of informing the public about ‘the rate of change of case numbers' rather than ‘the absolute number of cases' to alter behavioral changes, through a self-adaptive media impact switching on and off, for better control of disease transmission. PMID:25592757

  20. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water United States, 2007-2008

    EPA Science Inventory

    Problem/Condition: Since 1971, the Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists have maintained a collaborative Waterborne Disease and Outbreak Surveillance System (WBDOS...

  1. Modeling Baseline Shifts in Multivariate Disease Outbreak Detection

    PubMed Central

    Que, Jialan; Tsui, Fu-Chiang

    2013-01-01

    Objective Outbreak detection algorithms monitoring only disease-relevant data streams may be prone to false alarms due to baseline shifts. In this paper, we propose a Multinomial-Generalized-Dirichlet (MGD) model to adjust for baseline shifts. Introduction Population surges or large events may cause shift of data collected by biosurveillance systems [1]. For example, the Cherry Blossom Festival brings hundreds of thousands of people to DC every year, which results in simultaneous elevations in multiple data streams (Fig. 1). In this paper, we propose an MGD model to accommodate the needs of dealing with baseline shifts. Methods Existing multivariate algorithms only model disease-relevant data streams (e.g., anti-fever medication sales or patient visits with constitutional syndrome for detection of flu outbreak). On the contrary, we also incorporate a non-disease-relevant data stream as a control factor. We assume that the counts from all data streams follow a Multinomial distribution. Given this distribution, the expected value of the distribution parameter is not subject to change during a baseline shift; however, it has to change in order to model an outbreak. Therefore, this distribution inherently adjusts for the baseline shifts. In addition, we use the generalized Dirichlet (GD) distribution to model the parameter, since GD distribution is one of the conjugate prior of Multinomial [2]. We call this model the Multinomial-Generalized-Dirichlet (MGD) model. Results We applied MGD model in our previous proposed Rank-Based Spatial Clustering (MRSC) algorithm [3]. We simulated both outbreak cases and baseline shift phenomena. The experiment includes two groups of data sets. The first includes the data sets only injected with outbreak cases, and the second includes the ones with both outbreak cases and baseline shifts. We apply MRSC algorithm and a reference method, the Multivariate Bayesian Scan Statistic (MBSS) algorithm (which only analyzes the disease

  2. 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.

  3. 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

  4. Dissecting Japan's Dengue Outbreak in 2014

    PubMed Central

    Quam, Mikkel B.; Sessions, October; Kamaraj, Uma Sangumathi; Rocklöv, Joacim; Wilder-Smith, Annelies

    2016-01-01

    Despite Japan's temperate climate, a dengue outbreak occurred in Tokyo for the first time in over 70 years in 2014. We dissected this dengue outbreak based on phylogenetic analysis, travel interconnectivity, and environmental drivers for dengue epidemics. Comparing the available dengue virus 1 (DENV1) E gene sequence from this outbreak with 3,282 unique DENV1 sequences in National Center for Biotechnology Information suggested that the DENV might have been imported from China, Indonesia, Singapore, or Vietnam. With travelers arriving into Japan, Guangzhou (China) may have been the source of DENV introduction, given that Guangzhou also reported a large-scale dengue outbreak in 2014. Coinciding with the 2014 outbreak, Tokyo's climate conditions permitted the amplification of Aedes vectors and the annual peak of vectorial capacity. Given suitable vectors and climate conditions in addition to increasing interconnectivity with endemic areas of Asia, Tokyo's 2014 outbreak did not come as a surprise and may foretell more to come. PMID:26711518

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

    PubMed Central

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

    2016-01-01

    Background 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. Methods 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. Results 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). Conclusions 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. PMID:27566873

  6. Retrospective measles outbreak investigation: Sudan, 2004.

    PubMed

    Coronado, Fátima; Musa, Nisreen; El Tayeb, El Sayed Ahmed; Haithami, Salah; Dabbagh, Alya; Mahoney, Frank; Nandy, Robin; Cairns, Lisa

    2006-10-01

    Recent population-based studies of measles incidence and deaths in Sudan are not available. To determine the epidemiology and case-fatality rate (CFR) of measles, we conducted a retrospective outbreak investigation in two states in northern Sudan. Of 1144 case-patients identified, 92% were <15 years; 48.6% were vaccinated; and 62% received vitamin A before illness. Ten measles-associated deaths were identified (CFR 0.9%; 95% confidence interval 0.16-1.91). CFR determined by this investigation is lower than expected for the region but remains 10 times higher than that in developed countries. Measles control should be strengthened by improving vaccine coverage, measles surveillance and case-management.

  7. Clostridium difficile outbreaks: prevention and treatment strategies

    PubMed Central

    Martinez, Fernando J; Leffler, Daniel A; Kelly, Ciaran P

    2012-01-01

    The incidence and severity of Clostridium difficile infection (CDI) have increased dramatically over the past decade. Its treatment, however, has largely remained the same with the exception of oral vancomycin use as a first-line agent in severe disease. From 1999 to 2004, 20,642 deaths were attributed to CDI in the United States, almost 7 times the rate of all other intestinal infections combined. Worldwide, several major CDI outbreaks have occurred, and many of these were associated with the NAP1 strain. This ‘epidemic’ strain has contributed to the rising incidence and mortality of CDI. The purpose of this article is to review the current management, treatment, infection control, and prevention strategies that are needed to combat this increasingly morbid disease. PMID:22826646

  8. Synthetic peptide vaccine against Taenia solium pig cysticercosis: successful vaccination in a controlled field trial in rural Mexico.

    PubMed

    Huerta, M; de Aluja, A S; Fragoso, G; Toledo, A; Villalobos, N; Hernández, M; Gevorkian, G; Acero, G; Díaz, A; Alvarez, I; Avila, R; Beltrán, C; Garcia, G; Martinez, J J; Larralde, C; Sciutto, E

    2001-10-12

    Taenia solium cysticercosis seriously affects human health when localised in the central nervous system (CNS) and causes great economic loss in pig husbandry in rural areas of endemic countries. Increasing the resistance to the parasite in the obligatory host pig may help in curbing transmission. Three synthetic peptides based on protein sequences of the murine parasite Taenia crassiceps, which had previously been shown to induce protection in mice against homologous challenge, were tested as a vaccine against T. solium cysticercosis in pigs. Vaccinated and unvaccinated piglets (240 in all) were distributed in pairs among the peasants' households of two rural villages in Mexico in which 14% of the native pigs were cysticercotic. Ten to twelve months later, the effect of vaccination was evaluated at necropsy. Vaccination decreased the total number of T. solium cysticerci (98.7%) and reduced the prevalence (52.6%). The natural challenge conditions used in this field trial strengthen the likelihood of successful transmission control to both pig and human through a large-scale pig vaccination program. We believe this is a major contribution in anticysticercosis vaccine development as these rather simple yet protective peptides are potentially more cost-effective to produce and less variable in results than antigens that are more complex.

  9. Impact of mating behaviour on the success of malaria control through a single inundative release of transgenic mosquitoes.

    PubMed

    Boëte, C; Agusto, F B; Reeves, R G

    2014-04-21

    Transgenic mosquitoes are a potential tool for the control or eradication of insect-vectored diseases. For malaria, one possible strategy relies on the introduction of malaria-refractory transgenes into wild Anopheles mosquito populations that would limit their capacity to transmit the disease. The success of such an approach obviously depends on a variety of factors. By developing a model that integrates both population genetics and epidemiology, we explore how mosquito mating preferences and the cost and efficacy of refractoriness affects the long-term prevalence of malaria in humans subsequent to a single generation inundative release of male transgenic mosquitoes. As may be intuitively expected, mating discrimination by wild-type individuals against transgenic ones generally reduces the probability that transgenes become stably established at a high frequency in mosquito populations. We also show that in circumstances where transgenic individuals exhibit some degree of discrimination against wild-type individuals, this can favour the spread of refractory alleles and lead to a significant reduction in malaria prevalence in the human population (if the efficacy of a dominant refractory mechanism exceeds at least 75%). The existence of such a non-intuitive outcome highlights the practical value of increasing the understanding of Anopheles mating preferences in the wild as a means to harness them in the implementation of population replacement approaches. Potential strategies by which previously described mating preferences of Anopheles gambiae populations could be exploited to manipulate the mate choice of transgenic release stocks are discussed.

  10. Enhanced performance of PbS-sensitized solar cells via controlled successive ionic-layer adsorption and reaction.

    PubMed

    Abbas, Muhammad A; Basit, Muhammad A; Park, Tae Joo; Bang, Jin Ho

    2015-04-21

    Despite the potential of PbS quantum dots (QDs) as sensitizers for quantum-dot-sensitized solar cells (QDSSCs), achieving a high photocurrent density over 30 mA cm(-2) remains a challenging task in PbS-sensitized solar cells. In contrast to previous attempts, where Hg(2+)-doping or multi-step post-treatment is necessary, we are capable of achieving a high photocurrent exceeding 30 mA cm(-2) simply by manipulating the successive ionic layer adsorption and reaction (SILAR) method. We show that controlling temperature at which SILAR is performed is critical to obtain a higher and more uniform coverage of PbS QDs over a mesoporous TiO2 film. The deposition of a CdS inter-layer between TiO2 and PbS is found to be an effective means of ensuring high photocurrent and stability. Not only does this modification improve the light absorption capability of the photoanode, but it also has a significant effect on charge recombination and electron injection efficiency at the PbS/TiO2 interface according to our in-depth study using electrochemical impedance spectroscopy (EIS). The implication of subtle changes in the interfacial events via modified SILAR conditions for PbS-sensitized solar cells is discussed.

  11. Emergence of salsa and guacamole as frequent vehicles of foodborne disease outbreaks in the United States, 1973-2008.

    PubMed

    Kendall, Magdalena E; Mody, Rajal K; Mahon, Barbara E; Doyle, Michael P; Herman, Karen M; Tauxe, Robert V

    2013-04-01

    Fresh salsa and guacamole often contain diced raw produce, are often made in large batches, and are often poorly refrigerated, which may make them prone to contamination that can cause foodborne illness. The safety of salsa and guacamole is increasingly important as these foods gain popularity. Since 1973, local, state, and territorial health departments have voluntarily reported foodborne disease outbreaks to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System (FDOSS) using a standard reporting form. FDOSS used paper-based reporting for 1973-1997 and switched to electronic reporting for 1998-2008. We reviewed all reports of outbreaks during 1973-2008 in which salsa or guacamole was reported as a vehicle. We found 136 outbreaks in which salsa or guacamole was reported as a possible vehicle, which resulted in 5,658 illnesses. Of these 136 salsa- or guacamole-associated (SGA) outbreaks additional possible food vehicles were reported for 33 (24%) outbreaks. There were no SGA outbreaks reported before 1984. Among reported outbreaks, most were caused by norovirus (24%), nontyphoidal Salmonella (19%), and Shigella (7%). Eighty-four percent of outbreaks were caused by foods prepared in restaurants or delis; of these, 19% reported ill foodworkers, and 29% reported improper storage as possible contributing factors. Among all foodborne disease outbreaks with a reported food vehicle during 1984-1997, 26 (0.9%) of 2,966 outbreaks were SGA, and during 1998-2008, 110 (1.4%) of 7,738 outbreaks were SGA. The number of reported foodborne disease outbreaks attributable to salsa or guacamole increased in the United States from 1984 to 2008, especially in later years, and especially in restaurants. Fresh salsa and guacamole require careful preparation and storage. Focused prevention strategies should reduce the risk of illness and ensure that these foods are enjoyed safely.

  12. Evaluation of an operational malaria outbreak identification and response system in Mpumalanga Province, South Africa

    PubMed Central

    Coleman, Marlize; Coleman, Michael; Mabuza, Aaron M; Kok, Gerdalize; Coetzee, Maureen; Durrheim, David N

    2008-01-01

    Background and objective To evaluate the performance of a novel malaria outbreak identification system in the epidemic prone rural area of Mpumalanga Province, South Africa, for timely identification of malaria outbreaks and guiding integrated public health responses. Methods Using five years of historical notification data, two binomial thresholds were determined for each primary health care facility in the highest malaria risk area of Mpumalanga province. Whenever the thresholds were exceeded at health facility level (tier 1), primary health care staff notified the malaria control programme, which then confirmed adequate stocks of malaria treatment to manage potential increased cases. The cases were followed up at household level to verify the likely source of infection. The binomial thresholds were reviewed at village/town level (tier 2) to determine whether additional response measures were required. In addition, an automated electronic outbreak identification system at town/village level (tier 2) was integrated into the case notification database (tier 3) to ensure that unexpected increases in case notification were not missed. The performance of these binomial outbreak thresholds was evaluated against other currently recommended thresholds using retrospective data. The acceptability of the system at primary health care level was evaluated through structured interviews with health facility staff. Results Eighty four percent of health facilities reported outbreaks within 24 hours (n = 95), 92% (n = 104) within 48 hours and 100% (n = 113) within 72 hours. Appropriate response to all malaria outbreaks (n = 113, tier 1, n = 46, tier 2) were achieved within 24 hours. The system was positively viewed by all health facility staff. When compared to other epidemiological systems for a specified 12 month outbreak season (June 2003 to July 2004) the binomial exact thresholds produced one false weekly outbreak, the C-sum 12 weekly outbreaks and the mean + 2 SD nine false

  13. Epidemiology of an outbreak of head lice in Georgia.

    PubMed

    Slonka, G F; McKinley, T W; McCroan, J E; Sinclair, S P; Schultz, M G; Hicks, F; Hill, N

    1976-09-01

    An outbreak of head lice infestation (pediculosis) occurred in elementary school children in Barrow County, Georgia, in January 1974. An investigation was initiated to define the magnitude of the outbreak, determine factors that contribute to transmission, and disseminate information on control. All elementary school children in the county were examined for head lice and answered a questionnaire. Fifty-three (3%) of 1,783 white pupils were infested, but none of the 500 black pupils was infested. Distribution of infestation in the white pupils was influenced by grade, bed-sharing, socioeconomic status, infestation of other family members, crowding in the home, and family size; distribution was not influenced by hair length or the sex of the pupil. Recommendations for control based on the results of the investigation included procedures for identifying and processing cases, distributing free pediculicides, continuing surveillance, educating school personnel and parents on how to control the parasite.

  14. Review of fungal outbreaks and infection prevention in healthcare settings during construction and renovation.

    PubMed

    Kanamori, Hajime; Rutala, William A; Sickbert-Bennett, Emily E; Weber, David J

    2015-08-01

    Hospital construction and renovation activities are an ever-constant phenomenon in healthcare facilities, causing dust contamination and possible dispersal of fungal spores. We reviewed fungal outbreaks that occurred during construction and renovation over the last 4 decades as well as current infection prevention strategies and control measures. Fungal outbreaks still occur in healthcare settings, especially among patients with hematological malignancies and those who are immunocompromised. The causative pathogens of these outbreaks were usually Aspergillus species, but Zygomycetes and other fungi were occasionally reported. Aspergillus most commonly caused pulmonary infection. The overall mortality of construction/renovation-associated fungal infection was approximately 50%. The minimal concentration of fungal spores by air sampling for acquisition of fungal infections remains to be determined. Performing infection control risk assessments and implementing the recommended control measures is essential to prevent healthcare-associated fungal outbreaks during construction and renovation.

  15. Repetitive dengue outbreaks in East Africa: A proposed phased mitigation approach may reduce its impact.

    PubMed

    Baba, Marycelin; Villinger, Jandouwe; Masiga, Daniel K

    2016-05-01

    Dengue outbreaks have persistently occurred in eastern African countries for several decades. We assessed each outbreak to identify risk factors and propose a framework for prevention and impact mitigation. Seven out of ten countries in eastern Africa and three islands in the Indian Ocean have experienced dengue outbreaks between 1823 and 2014. Major risk factors associated with past dengue outbreaks include climate, virus and vector genetics and human practices. Appropriate use of dengue diagnostic tools and their interpretation are necessary for both outbreak investigations and sero-epidemiological studies. Serosurvey findings during inter-epidemic periods have not been adequately utilised to prevent re-occurrence of dengue outbreaks. Local weather variables may be used to predict dengue outbreaks, while entomological surveillance can complement other disease-mitigation efforts during outbreaks and identify risk-prone areas during inter-epidemic periods. The limitations of past dengue outbreak responses and the enormous socio-economic impacts of the disease on human health are highlighted. Its repeated occurrence in East Africa refutes previous observations that susceptibility may depend on race. Alternate hypotheses on heterotypic protection among flaviviruses may not be applied to all ecologies. Prevention and mitigation of severe dengue outbreaks should necessarily consider the diverse factors associated with their occurrence. Implementation of phased dengue mitigation activities can enforce timely and judicious use of scarce resources, promote environmental sanitation, and drive behavioural change, hygienic practices and community-based vector control. Understanding dengue epidemiology and clinical symptoms, as determined by its evolution, are significant to preventing future dengue epidemics.

  16. Alarm Variables for Dengue Outbreaks: A Multi-Centre Study in Asia and Latin America

    PubMed Central

    Bowman, Leigh R.; Tejeda, Gustavo S.; Coelho, Giovanini E.; Sulaiman, Lokman H.; Gill, Balvinder S.; McCall, Philip J.; Olliaro, Piero L.; Ranzinger, Silvia R.; Quang, Luong C.; Ramm, Ronald S.; Kroeger, Axel; Petzold, Max G.

    2016-01-01

    Background Worldwide, dengue is an unrelenting economic and health burden. Dengue outbreaks have become increasingly common, which place great strain on health infrastructure and services. Early warning models could allow health systems and vector control programmes to respond more cost-effectively and efficiently. Methodology/Principal Findings The Shewhart method and Endemic Channel were used to identify alarm variables that may predict dengue outbreaks. Five country datasets were compiled by epidemiological week over the years 2007–2013. These data were split between the years 2007–2011 (historic period) and 2012–2013 (evaluation period). Associations between alarm/ outbreak variables were analysed using logistic regression during the historic period while alarm and outbreak signals were captured during the evaluation period. These signals were combined to form alarm/ outbreak periods, where 2 signals were equal to 1 period. Alarm periods were quantified and used to predict subsequent outbreak periods. Across Mexico and Dominican Republic, an increase in probable cases predicted outbreaks of hospitalised cases with sensitivities and positive predictive values (PPV) of 93%/ 83% and 97%/ 86% respectively, at a lag of 1–12 weeks. An increase in mean temperature ably predicted outbreaks of hospitalised cases in Mexico and Brazil, with sensitivities and PPVs of 79%/ 73% and 81%/ 46% respectively, also at a lag of 1–12 weeks. Mean age was predictive of hospitalised cases at sensitivities and PPVs of 72%/ 74% and 96%/ 45% in Mexico and Malaysia respectively, at a lag of 4–16 weeks. Conclusions/Significance An increase in probable cases was predictive of outbreaks, while meteorological variables, particularly mean temperature, demonstrated predictive potential in some countries, but not all. While it is difficult to define uniform variables applicable in every country context, the use of probable cases and meteorological variables in tailored early warning

  17. Dengue outbreak--Federated States of Micronesia, 2012-2013.

    PubMed

    2013-07-19

    On September 26, 2012, a woman aged 35 years from Kosrae in the Federated States of Micronesia (FSM) was hospitalized with fever, headache, muscle pain, vomiting, leukopenia, and thrombocytopenia. A rapid diagnostic test (RDT) (Dengue Duo, Standard Diagnostics Inc.) was positive for dengue virus (DENV) nonstructural protein-1 (NS1). During the next week, seven more persons with suspected dengue were tested with the RDT, of whom three were RDT-positive for NS1 or anti-DENV immunoglobulin M (IgM). During October, the Kosrae State Department of Health Services, with support from the FSM Department of Health and Social Affairs and the World Health Organization (WHO), responded to the outbreak with enhanced surveillance, training in clinical management, analysis of hospital surge capacity, a rapid mosquito survey to identify species and distributions, and control measures. By March 14, 2013, approximately 3.7% of Kosrae State residents had been hospitalized with suspected dengue. The outbreak consumed scarce medical and public health services, including outpatient, inpatient, and laboratory services, resulting in redirection of human and material resources from other important medical and public health activities. Because the health consequences of dengue can be substantial in resource-limited settings, Pacific Island nations might wish to consider preparedness measures for dengue outbreaks such as developing and testing outbreak response plans and ensuring adequate capacity for epidemiologic surveillance and laboratory testing.

  18. [A report of outbreaks of pulmonary tuberculosis in two bars].

    PubMed

    Ishibatake, H; Onizuka, R

    1997-11-01

    We experienced small outbreaks of M. tuberculosis infection in two bars. 9 patients were diagnosed as tuberculosis by identifying M. tuberculosis from their sputa. Six of them were regular customers or employees of the bar, one of them was a family members. Each outbreak within the two bars was suspected of the common source of infection, because one patient was a regular customer of the both bars. The analysis of restriction fragment length polymorphism (RFLP) was done on 5 strains of M. tuberculosis which were isolated from five of 9 patients. The result unexpectedly showed that 5 isolates were classified into 3 groups. Within each group, identical fingerprints were shown. It does mean that each outbreak in two bars was originated from independent source. There was also one relapsed case of tuberculosis. He was suspected of relapsed tuberculosis after a period of 7 years because of the similarity of drug resistance compared with his primary tuberculosis. It was cleared up that 3 different strains of M. tuberculosis were concerned with these outbreaks in the two bars. In this case, almost all patients were heavy drinkers, however, liver dysfunction and malnutrition were not recognized among them. These experiences indicate that a place like bar may be a space of infection of M. tuberculosis. We should always keep in mind a spread of tuberculosis in a place like a bar as one of problems in tuberculosis control.

  19. Molecular Investigation into a Malaria Outbreak in Cusco, Peru: Plasmodium falciparum BV1 Lineage is Linked to a Second Outbreak in Recent Times.

    PubMed

    Okoth, Sheila Akinyi; Chenet, Stella M; Arrospide, Nancy; Gutierrez, Sonia; Cabezas, Cesar; Matta, Jose Antonio; Udhayakumar, Venkatachalam

    2016-01-01

    In November 2013, a Plasmodium falciparum malaria outbreak of 11 cases occurred in Cusco, southern Peru, where falciparum malaria had not been reported since 1946. Although initial microscopic diagnosis reported only Plasmodium vivax infection in each of the specimens, subsequent examination by the national reference laboratory confirmed P. falciparum infection in all samples. Molecular typing of four available isolates revealed identity as the B-variant (BV1) strain that was responsible for a malaria outbreak in Tumbes, northern Peru, between 2010 and 2012. The P. falciparum BV1 strain is multidrug resistant, can escape detection by PfHRP2-based rapid diagnostic tests, and has contributed to two malaria outbreaks in Peru. This investigation highlights the importance of accurate species diagnosis given the potential for P. falciparum to be reintroduced to regions where it may have been absent. Similar molecular epidemiological investigations can track the probable source(s) of outbreak parasite strains for malaria surveillance and control purposes.

  20. Molecular Investigation into a Malaria Outbreak in Cusco, Peru: Plasmodium falciparum BV1 Lineage is Linked to a Second Outbreak in Recent Times

    PubMed Central

    Okoth, Sheila Akinyi; Chenet, Stella M.; Arrospide, Nancy; Gutierrez, Sonia; Cabezas, Cesar; Matta, Jose Antonio; Udhayakumar, Venkatachalam

    2016-01-01

    In November 2013, a Plasmodium falciparum malaria outbreak of 11 cases occurred in Cusco, southern Peru, where falciparum malaria had not been reported since 1946. Although initial microscopic diagnosis reported only Plasmodium vivax infection in each of the specimens, subsequent examination by the national reference laboratory confirmed P. falciparum infection in all samples. Molecular typing of four available isolates revealed identity as the B-variant (BV1) strain that was responsible for a malaria outbreak in Tumbes, northern Peru, between 2010 and 2012. The P. falciparum BV1 strain is multidrug resistant, can escape detection by PfHRP2-based rapid diagnostic tests, and has contributed to two malaria outbreaks in Peru. This investigation highlights the importance of accurate species diagnosis given the potential for P. falciparum to be reintroduced to regions where it may have been absent. Similar molecular epidemiological investigations can track the probable source(s) of outbreak parasite strains for malaria surveillance and control purposes. PMID:26483121

  1. The Stafford outbreak of Legionnaires' disease

    PubMed Central

    O'Mahony, M. C.; Stanwell-Smith, R. E.; Tillett, H. E.; Harper, D.; Hutchison, J. G. P.; Farrell, I. D.; Hutchinson, D. N.; Lee, J. V.; Dennis, P. J.; Duggal, H. V.; Scully, J. A.; Denne, C.

    1990-01-01

    that staff were exposed to low doses of contaminated aerosol over several months. Control measures are described, but it was later apparent that the outbreak had ended before these interventions were introduced. The investigations revealed faults in the design of the ventilation system. PMID:2347381

  2. The Stafford outbreak of Legionnaires' disease.

    PubMed

    O'Mahony, M C; Stanwell-Smith, R E; Tillett, H E; Harper, D; Hutchison, J G; Farrell, I D; Hutchinson, D N; Lee, J V; Dennis, P J; Duggal, H V

    1990-06-01

    that staff were exposed to low doses of contaminated aerosol over several months. Control measures are described, but it was later apparent that the outbreak had ended before these interventions were introduced. The investigations revealed faults in the design of the ventilation system.

  3. Comparison of the success of root canal therapy in HIV/AIDS patients and non-infected controls.

    PubMed

    Alley, Bradley S; Buchanan, Trenton H; Eleazer, Paul D

    2008-01-01

    This study compared the rate of successful endodontic treatments between two cohorts of patients with similar teeth, one group with HIV/AIDS and one without. A retrospective chart review was performed on two cohorts, with 50 teeth in each cohort. There was no statistically significant difference in endodontic success between the two groups. The failure groups were small, with no significant trends.

  4. Forecasting seasonal outbreaks of influenza

    PubMed Central

    Shaman, Jeffrey; Karspeck, Alicia

    2012-01-01

    Influenza recurs seasonally in temperate regions of the world; however, our ability to predict the timing, duration, and magnitude of local seasonal outbreaks of influenza remains limited. Here we develop a framework for initializing real-time forecasts of seasonal influenza outbreaks, using a data assimilation technique commonly applied in numerical weather prediction. The availability of real-time, web-based estimates of local influenza infection rates makes this type of quantitative forecasting possible. Retrospective ensemble forecasts are generated on a weekly basis following assimilation of these web-based estimates for the 2003–2008 influenza seasons in New York City. The findings indicate that real-time skillful predictions of peak timing can be made more than 7 wk in advance of the actual peak. In addition, confidence in those predictions can be inferred from the spread of the forecast ensemble. This work represents an initial step in the development of a statistically rigorous system for real-time forecast of seasonal influenza. PMID:23184969

  5. Forecasting seasonal outbreaks of influenza.

    PubMed

    Shaman, Jeffrey; Karspeck, Alicia

    2012-12-11

    Influenza recurs seasonally in temperate regions of the world; however, our ability to predict the timing, duration, and magnitude of local seasonal outbreaks of influenza remains limited. Here we develop a framework for initializing real-time forecasts of seasonal influenza outbreaks, using a data assimilation technique commonly applied in numerical weather prediction. The availability of real-time, web-based estimates of local influenza infection rates makes this type of quantitative forecasting possible. Retrospective ensemble forecasts are generated on a weekly basis following assimilation of these web-based estimates for the 2003-2008 influenza seasons in New York City. The findings indicate that real-time skillful predictions of peak timing can be made more than 7 wk in advance of the actual peak. In addition, confidence in those predictions can be inferred from the spread of the forecast ensemble. This work represents an initial step in the development of a statistically rigorous system for real-time forecast of seasonal influenza.

  6. Nitrogen availability as a control mechanism of secondary succession within a semiarid shrubland ecosystem. Final report, October 1, 1990--June 27, 1992

    SciTech Connect

    Redente, E.F.; McLendon, T.

    1992-09-25

    Three experiments were conducted within a semiarid shrubland to test the role of nitrogen availability as a control mechanism in secondary succession. Secondary succession patterns were documented for seven years and effects of increased and decreased N availability levels, fumigation, and competition by early-seral species were tested. Differential responses by seral species were determined and related to successional patterns. Nitrogen availability was found to be a primary mechanism controlling the rate of succession. Relative growth rate was an important factor determining which species initially dominated and N availability became the primary control factor by the third year. As N availability increased, the rate of succession decreased. Conversely, as N availability was decreased, the rate of succession increased. The abundance of annuals was increased and abundance of perennials decreased by increased N availability. Tissue N concentration was related to lifeform and seral position, and these relationships were important in the transition from early- to mid-seral stages. Decomposer subsystem dynamics were correlated with seral community dynamics. The effect of fumigation was minimized by initially planting with late-seral species. A conceptual model of secondary succession is presented based on N availability, relative growth rate, lifeform, and decomposition dynamics.

  7. Impact of sideways and bottom-up control factors on bacterial community succession over a tidal cycle.

    PubMed

    Chauhan, Ashvini; Cherrier, Jennifer; Williams, Henry N

    2009-03-17

    In aquatic systems, bacterial community succession is a function of top-down and bottom-up factors, but little information exists on "sideways" controls, such as bacterial predation by Bdellovibrio-like organisms (BLOs), which likely impacts nutrient cycling within the microbial loop and eventual export to higher trophic groups. Here we report transient response of estuarine microbiota and BLO spp. to tidal-associated dissolved organic matter supply in a river-dominated estuary, Apalachicola Bay, Florida. Both dissolved organic carbon and dissolved organic nitrogen concentrations oscillated over the course of the tidal cycle with relatively higher concentrations observed at low tide. Concurrent with the shift in dissolved organic matter (DOM) supply at low tide, a synchronous increase in numbers of bacteria and predatorial BLOs were observed. PCR-restriction fragment length polymorphism of small subunit rDNA, cloning, and sequence analyses revealed distinct shifts such that, at low tide, significantly higher phylotype abundances were observed from gamma-Proteobacteria, delta-Proteobacteria, Bacteroidetes, and high G+C gram-positive bacteria. Conversely, diversity of alpha-Proteobacteria, beta-Proteobacteria, and Chlamydiales-Verrucomicrobia group increased at high tides. To identify metabolically active BLO guilds, tidal microcosms were spiked with six (13)C-labeled bacteria as potential prey and studied using an adaptation of stable isotope probing. At low tide, representative of higher DOM and increased prey but lower salinity, BLO community also shifted such that mesohaline clusters I and VI were more active; with an increased salinity at high tide, halotolerant clusters III, V, and X were predominant. Eventually, (13)C label was identified from higher micropredators, indicating that trophic interactions within the estuarine microbial food web are potentially far more complex than previously thought.

  8. War diseases revealed by the social media: massive leishmaniasis outbreak in the Syrian Spring.

    PubMed

    Alasaad, Samer

    2013-04-12

    Social media introduce pivotal changes to communication between individuals, organizations and communities. A clear example of the power of social media is the spread of the revolutionary outbreaks in the Arabic countries during 2011, where people used Facebook, YouTube and Skype to communicate, organise meetings and protest actions. Here I report how Doctor-Activists use these social media as an alarm system for 'war disease' outbreaks in the Syrian Spring. Social media are used as an alarm system to attract the attention of international organizations, which should assume their responsibilities and play their part in controlling the outbreak of such war diseases.

  9. [Significance of Salmonella enteritidis in outbreaks of diseases transmitted by foods in Argentina, 1986-1988].

    PubMed

    Eiguer, T; Caffer, M I; Fronchkowsky, G B

    1990-01-01

    This paper reports on the outbreaks of food-borne-diseases due to Salmonella Enteritidis which occurred in Argentina between 1986 and 1988. In 39 registered episodes 210 strains were isolated from human feces (28 outbreaks) and 59 from food (23 outbreaks). More than 2,500 people in different provinces were affected, the chief characteristics of the clinical picture being the gravity of the symptoms (high temperature, vomiting, diarrhea and severe dehydration). The main source of infection was related to raw eggs, eaten in the form of home-made mayonnaise. It is considered necessary to carry out an effective control of poultry products, as well as a permanent surveillance of salmonellosis.

  10. An institutional outbreak of leptospirosis in Chennai, South India.

    PubMed

    Ramakrishnan, R; Patel, M S; Gupte, M D; Manickam, P; Venkataraghavan, S

    2003-03-01

    The emergence of an outbreak of leptospirosis in a nurses' hostel in Chennai presented a challenge to identify and control the source of the outbreak. Sixty-nine residents and staff members were interviewed to assess exposure factors. Blood samples from the acute and convalescent patients were tested with the Microscopic Agglutination Test using the serovars prevalent in Chennai. Polymerase Chain Reaction (PCR) was conducted on serum and water samples. Based on preliminary investigation, control measures with standard hygienic measures were instituted. The attack rate was 35%. The epidemic curve suggested continuous or intermittent exposure to infection over a five-week period. Twenty residents (three asymptomatic) developed laboratory confirmed Leptospira icterohemorrhagiae. Residents collected water from an underground storage tank that was filled twice weekly from a mobile water tanker with a bucket on a rope, and the tank was usually left open. PCR tests confirmed the presence of leptospires from this water. Other control measures included cleaning the large backyard with its many stray dogs and rats, chlorinating water supplies, boiling drinking water and health education. No further cases occurred twelve days after implementing control measures. Access to clean water, not only for drinking but also for bathing, brushing and washing is essential to prevent water-borne outbreaks.

  11. Incentives for Reporting Infectious Disease Outbreaks

    ERIC Educational Resources Information Center

    Malani, Anup; Laxminarayan, Ramanan

    2011-01-01

    The global spread of diseases such as swine flu and SARS highlights the difficult decision governments face when presented with evidence of a local outbreak. Reporting the outbreak may bring medical assistance but is also likely to trigger trade sanctions by countries hoping to contain the disease. Suppressing the information may avoid trade…

  12. Molecular Diagnostic Analysis of Outbreak Scenarios

    ERIC Educational Resources Information Center

    Morsink, M. C.; Dekter, H. E.; Dirks-Mulder, A.; van Leeuwen, W. B.

    2012-01-01

    In the current laboratory assignment, technical aspects of the polymerase chain reaction (PCR) are integrated in the context of six different bacterial outbreak scenarios. The "Enterobacterial Repetitive Intergenic Consensus Sequence" (ERIC) PCR was used to analyze different outbreak scenarios. First, groups of 2-4 students determined optimal…

  13. Roots, Not Parachutes: Research Collaborations Combat Outbreaks

    PubMed Central

    Yozwiak, Nathan L.; Happi, Christian T.; Grant, Donald S.; Schieffelin, John S.; Garry, Robert F.; Sabeti, Pardis C.; Andersen, Kristian G.

    2016-01-01

    Summary Recent infectious disease epidemics illustrate how health systems failures anywhere can create disease vulnerabilities everywhere. We must therefore prioritize investments in health care infrastructure in outbreak-prone regions of the world. We describe how ‘rooted’ research collaborations can establish capacity for pathogen surveillance and facilitate rapid outbreak responses. PMID:27368093

  14. Nonlinear predictive control of a boiler-turbine unit: A state-space approach with successive on-line model linearisation and quadratic optimisation.

    PubMed

    Ławryńczuk, Maciej

    2017-03-01

    This paper details development of a Model Predictive Control (MPC) algorithm for a boiler-turbine unit, which is a nonlinear multiple-input multiple-output process. The control objective is to follow set-point changes imposed on two state (output) variables and to satisfy constraints imposed on three inputs and one output. In order to obtain a computationally efficient control scheme, the state-space model is successively linearised on-line for the current operating point and used for prediction. In consequence, the future control policy is easily calculated from a quadratic optimisation problem. For state estimation the extended Kalman filter is used. It is demonstrated that the MPC strategy based on constant linear models does not work satisfactorily for the boiler-turbine unit whereas the discussed algorithm with on-line successive model linearisation gives practically the same trajectories as the truly nonlinear MPC controller with nonlinear optimisation repeated at each sampling instant.

  15. Environmental swabs as a tool in norovirus outbreak investigation, including outbreaks on cruise ships.

    PubMed

    Boxman, Ingeborg L A; Dijkman, Remco; te Loeke, Nathalie A J M; Hägele, Geke; Tilburg, Jeroen J H C; Vennema, Harry; Koopmans, Marion

    2009-01-01

    In this study, we investigated whether environmental swabs can be used to demonstrate the presence of norovirus in outbreak settings. First, a procedure was set up based on viral RNA extraction using guanidium isothiocyanate buffer and binding of nucleic acids to silica. Subsequently, environmental swabs were taken at 23 Dutch restaurants and four cruise ships involved in outbreaks of gastroenteritis. Outbreaks were selected based on clinical symptoms consistent with viral gastroenteritis and time between consumption of suspected food and onset of clinical symptoms (>12 h). Norovirus RNA was demonstrated by real-time reverse transcriptase PCR in 51 of 86 (59%) clinical specimens from 12 of 14 outbreaks (86%), in 13 of 90 (14%) food specimens from 4 of 18 outbreaks (22%), and in 48 of 119 (40%) swab specimens taken from 14 of 27 outbreaks (52%). Positive swab samples agreed with positive clinical samples in seven outbreaks, showing identical sequences. Furthermore, norovirus was detected on swabs taken from kitchen and bathroom surfaces in five outbreaks in which no clinical samples were collected and two outbreaks with negative fecal samples. The detection rate was highest for outbreaks associated with catered meals and lowest for restaurant-associated outbreaks. The use of environmental swabs may be a useful tool in addition to testing of food and clinical specimens, particularlywhen viral RNA is detected on surfaces used for food preparation.

  16. An outbreak of acute infectious nonbacterial gastroenteritis in a high school in Maryland.

    PubMed Central

    Gross, T P; Conde, J G; Gary, G W; Harting, D; Goeller, D; Israel, E

    1989-01-01

    An outbreak of acute infectious nonbacterial gastroenteritis (AING) occurred in a high school in Maryland in 1984. Thirty-six percent of students surveyed met the case definition of gastroenteritis, as did 24 percent of school employees. Eating lunch in the cafeteria on January 30 was significantly associated with illness. After controlling for other food items consumed during the January 30 lunch, only the sandwiches were significantly associated with illness, but the source of the contamination was not identified. Four of 17 serum pairs from sick students and none of the 8 serum pairs from exposed controls (a nonsignificant difference) showed at least a 4-fold rise in antibody titre to Norwalk virus between acute- and convalescent-phase specimens. This outbreak of AING is believed to be the first to implicate epidemiologically sandwiches as vehicles of transmission. The outbreak highlights the need for investigators to look for a viral etiology in gastroenteritis outbreaks. PMID:2539604

  17. Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014.

    PubMed

    Haviari, Skerdi; Cassier, Pierre; Dananché, Cédric; Hulin, Monique; Dauwalder, Olivier; Rouvière, Olivier; Bertrand, Xavier; Perraud, Michel; Bénet, Thomas; Vanhems, Philippe

    2016-08-01

    We report an outbreak of healthcare-associated prostatitis involving rare environmental pathogens in immunocompetent patients undergoing transrectal prostate biopsies at Hôpital Édouard Herriot (Lyon, France) during August 13-October 10, 2014. Despite a fluoroquinolone-based prophylaxis, 5 patients were infected with Achromobacter xylosoxidans and 3 with Ochrobactrum anthropi, which has not been reported as pathogenic in nonimmunocompromised persons. All patients recovered fully. Analysis of the outbreak included case investigation, case-control study, biopsy procedure review, microbiologic testing of environmental and clinical samples, and retrospective review of hospital records for 4 years before the outbreak. The cases resulted from asepsis errors during preparation of materials for the biopsies. A low-level outbreak involving environmental bacteria was likely present for years, masked by antimicrobial drug prophylaxis and a low number of cases. Healthcare personnel should promptly report unusual pathogens in immunocompetent patients to infection control units, and guidelines should explicitly mention asepsis during materials preparation.

  18. [An outbreak of scabies in a tertiary-care hospital from a crusted scabies case].

    PubMed

    Elgueta N, Andrea; Parada E, Yolanda; Guzmán G, Wilma; Molina C, Paula; González A, Patricia

    2007-08-01

    In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.

  19. [Outbreaks of Measles in Andalusia, Spain, during the Period 2010-2015].

    PubMed

    Montaño Remacha, Carmen; Gallardo García, Virtudes; Mochón Ochoa, M Mar; García Fernández, Marcelino; Mayoral Cortés, José María; Ruiz Fernández, Josefa

    2015-01-01

    The Andalusian Surveillance Epidemiological System (SVEA) controls and investigates any notification of measles or any other communicable disease. The aim of this article is to describe the epidemiological characteristics of measles outbreaks occurred in Andalusia in the last five years (2010-2015) and their control measures. In this period three outbreaks were reported: the first one started in Granada in 2010 in a community of objectors to vaccination. Control measures of measles protocol of SVEA were adopted (case isolation, identification and contacts immunization), including judicial measures among the group who refused the vaccination. The second outbreak started in Seville in 2011 in an "area in need of social transformation" and it spread throughout the region. The routine vaccination coverage review was introduced within the surveillance system after those outbreaks, identifying the most vulnerable people. During the first six months of 2015, a small outbreak, of 15 cases, occurred in Granada. The outbreak was controlled mainly due to the early intervention, the health measures adopted in the schools and health centres involved and the high vaccination coverage achieved in the population.

  20. Norovirus outbreak associated with a hotel in the west of Ireland, 2006.

    PubMed

    Michel, A; Fitzgerald, R; Whyte, D; Fitzgerald, A; Beggan, E; O'Connell, N; Greally, T

    2007-07-01

    An outbreak of gastrointestinal disease (nausea, vomiting or diarrhoea) occurred among a party of wedding guests, staff and other guests in a hotel in the west of Ireland, in October 2006. Upon notification, a multi-disciplinary outbreak control team was convened to investigate and control the outbreak. In all, 98 people were ascertained ill. The median duration of illness was 48 hours. The attack rate ranged between 48 and 85%. The hotel voluntarily notified health authorities and co-operated fully with investigation and control measures. Strict prevention and control measures were instituted promptly, including air ventilation, enhanced hand hygiene, isolation of cases, temporary "cooked food only", temporary alternative accommodation and specialised cleaning. Three cases of norovirus infection were laboratory-confirmed. There was no evidence of food- or water-borne transmission. Clinical and epidemiological findings indicated person-to-person transmission of norovirus. This report highlights the potential for large social gatherings to facilitate the spread of viral gastroenteritis by person-to-person transmission and via contaminated environment. Effective community management of this outbreak appears to have prevented its having an impact on local acute hospital services. The authors conclude that in addition to the existing national guidelines on the management of outbreaks of norovirus in healthcare settings, agreed guidelines for the management of norovirus outbreaks in the hotel and tourism industry are needed in Ireland.

  1. Overview of the 2007 Australian outbreak of equine influenza.

    PubMed

    Webster, W R

    2011-07-01

    In August 2007 equine influenza (EI) was diagnosed in Australia's horse population following the failure to contain infection in quarantine after the importation of one or more infected horses. The response had many unique features, and addressed financial, social, economic, human and animal health, trade and recovery issues. The outbreak and the associated control measures had a vast impact on individual horse owners, the horse industry and associated sectors in both infected and uninfected states.

  2. Influence of recent bark beetle outbreak on fire severity and postfire tree regeneration in montane Douglas-fir forests.

    PubMed

    Harvey, Brian J; Donato, Daniel C; Romme, William H; Turner, Monica G

    2013-11-01

    Understanding how disturbances interact to shape ecosystems is a key challenge in ecology. In forests of western North America, the degree to which recent bark beetle outbreaks and subsequent fires may be linked (e.g., outbreak severity affects fire severity) and/ or whether these two disturbances produce compound effects on postfire succession is of widespread interest. These interactions remain unresolved, largely because field data from actual wildfires following beetle outbreaks are lacking. We studied the 2008 Gunbarrel Fire, which burned 27 200 ha in Douglas-fir (Pseudotsuga menziesii) forests that experienced a bark beetle outbreak 4-13 years prefire ("gray stage," after trees have died and needles have dropped), to determine whether outbreak severity influenced subsequent fire severity and postfire tree regeneration. In 85 sample plots we recorded prefire stand structure and outbreak severity; multiple measures of canopy and forest-floor fire severity; and postfire tree seedling density. Prefire outbreak severity was not related to any measure of fire severity except for mean bole scorch, which declined slightly with increasing outbreak severity. Instead, fire severity varied with topography and burning conditions (proxy for weather at time of fire). Postfire Douglas-fir regeneration was low, with tree seedlings absent in 65% of plots. Tree seedlings were abundant in plots of low fire severity that also had experienced low outbreak severity (mean = 1690 seedlings/ha), suggesting a dual filter on tree regeneration. Although bark beetles and fire collectively reduced live basal area to < 5% and increased snag density to > 2000% of pre-outbreak levels, the lack of relationship between beetle outbreak and fire severity suggests that these disturbances were not linked. Nonetheless, effects on postfire tree regeneration suggest compound disturbance interactions that contribute to the structural heterogeneity characteristic of mid/lower montane forests.

  3. Analyses of the contributing factors associated with foodborne outbreaks in school settings (2000-2010).

    PubMed

    Venuto, Margaret; Garcia, Kristin

    2015-03-01

    State-reported school foodborne outbreaks account for about 3.8% (n = 464) of all outbreaks and 8.2% (n = 20,667) of all illnesses reported to the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System. Of 464 school foodborne outbreaks, 122 (26%) outbreaks, 7,603 illnesses, and 301 reported food safety errors met the criteria for inclusion in the analyses. The purpose of the authors' study was to examine the role of contributing factors in school foodborne outbreaks. Contamination factors accounted for the greatest proportion (49.2%) of outbreaks involving some level of food handling interaction by a school food service worker, followed by proliferation (34.9%) and survival factors (15.9%). Over 56% of all illnesses were associated with norovirus and food service worker practices. The results of these analyses highlight the importance of effective food safety education programs that focus on the role of contributing factors and prevention of foodborne disease from food safety errors.

  4. Whole-Genome Analysis of Exserohilum rostratum from an Outbreak of Fungal Meningitis and Other Infections

    PubMed Central

    Hurst, Steven; Gade, Lalitha; Frace, Michael A.; Hilsabeck, Remy; Schupp, James M.; Gillece, John D.; Roe, Chandler; Smith, David; Keim, Paul; Lockhart, Shawn R.; Changayil, Shankar; Weil, M. Ryan; MacCannell, Duncan R.; Brandt, Mary E.; Engelthaler, David M.

    2014-01-01

    Exserohilum rostratum was the cause of most cases of fungal meningitis and other infections associated with the injection of contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC). Until this outbreak, very few human cases of Exserohilum infection had been reported, and very little was known about this dematiaceous fungus, which usually infects plants. Here, we report using whole-genome sequencing (WGS) for the detection of single nucleotide polymorphisms (SNPs) and phylogenetic analysis to investigate the molecular origin of the outbreak using 22 isolates of E. rostratum retrieved from 19 case patients with meningitis or epidural/spinal abscesses, 6 isolates from contaminated NECC vials, and 7 isolates unrelated to the outbreak. Our analysis indicates that all 28 isolates associated with the outbreak had nearly identical genomes of 33.8 Mb. A total of 8 SNPs were detected among the outbreak genomes, with no more than 2 SNPs separating any 2 of the 28 genomes. The outbreak genomes were separated from the next most closely related control strain by ∼136,000 SNPs. We also observed significant genomic variability among strains unrelated to the outbreak, which may suggest the possibility of cryptic speciation in E. rostratum. PMID:24951807

  5. Outbreak of hepatitis A infection associated with the consumption of frozen berries, Ireland, 2013--linked to an international outbreak.

    PubMed

    Fitzgerald, M; Thornton, L; O'Gorman, J; O'Connor, L; Garvey, P; Boland, M; Part, A M; Rogalska, J; Coughlan, H; MacDiarmada, J; Heslin, J; Canny, M; Finnegan, P; Moran, J; O'Flanagan, D

    2014-10-30

    In May 2013, a European alert was issued regarding a hepatitis A virus (HAV) outbreak in Italy. In June 2013, HAV subgenotype IA with an identical sequence was identified in Ireland in three cases who had not travelled to Italy. The investigation consisted of descriptive epidemiology, a case-control study, microbiological testing of human and food specimens, molecular typing of positive specimens and food traceback. We identified 21 outbreak cases (14 confirmed primary cases) with symptom onset between 31 January and 11 October 2013. For the case-control study, we recruited 11 confirmed primary cases and 42 matched controls. Cases were more likely than controls to have eaten berry cheesecake (matched odds ratio (mOR): 12; 95% confidence interval (CI): 1.3-114), whole frozen berries (mOR: 9.5; 95% CI: 1.0-89), yoghurt containing frozen berries (mOR: 6.6, 95% CI: 1.2-37) or raw celery (mOR: 4; 95% CI: 1.2-16). Among cases, 91% had consumed at least one of four products containing frozen berries (mOR: 12; 95% CI: 1.5-94). Sixteen food samples tested were all negative for HAV. As products containing frozen berries were implicated in the outbreak, the public were advised to heat-treat frozen berries before consumption.

  6. Bacillus cereus infection outbreak in captive psittacines.

    PubMed

    Godoy, S N; Matushima, E R; Chaves, J Q; Cavados, C F G; Rabinovitch, L; Teixeira, R H F; Nunes, A L V; Melville, P; Gattamorta, M A; Vivoni, A M

    2012-12-28

    This study reports an uncommon epizootic outbreak of Bacillus cereus that caused the sudden death of 12 psittacines belonging to the species Anodorhynchus hyacinthinus (1 individual), Diopsittaca nobilis (1 individual), Ara severa (1 individual) and Ara ararauna (9 individuals) in a Brazilian zoo. Post-mortem examination of the animals reveled extensive areas of lung hemorrhage, hepatic congestion, hemorrhagic enteritis and cardiac congestion. Histopathological examination of the organs showed the presence of multiple foci of vegetative cells of Gram-positive bacilli associated with discrete and moderate mononuclear inflammatory cell infiltrate. Seventeen B. cereus strains isolated from blood and sterile organs of nine A. ararauna were analyzed in order to investigate the genetic diversity (assessed by Rep-PCR) and toxigenic profiles (presence of hblA, hblC and hblD; nheA, nheB and nheC as well as cytK, ces and entFM genes) of such strains. Amplification of genomic DNA by Rep-PCR of B. cereus strains generated two closely related profiles (Rep-PCR types A and B) with three bands of difference. All strains were classified as belonging to the toxigenic profile I which contained HBL and NHE gene complexes, entFM and cytK genes. Altogether, microbiological and histopathological findings and the evidence provided by the success of the antibiotic prophylaxis, corroborate that B. cereus was the causative agent of the infection that killed the birds.

  7. Neglected disease in mentally ill patients: Major tuberculosis outbreak in a psychiatric hospital.

    PubMed

    Zmak, Ljiljana; Obrovac, Mihaela; Lovric, Zvjezdana; Jankovic Makek, Mateja; Katalinic Jankovic, Vera

    2017-04-01

    As tuberculosis incidence decreases, the possibility of overlooking the disease increases, especially in vulnerable populations. We describe here a major tuberculosis outbreak among mentally ill patients in Croatia, focusing on 1 regional hospital where most patients were hospitalized. The outbreak emphasizes the vulnerability of mentally ill patients to tuberculosis infection and the complexity of infection control measures in psychiatric institutions. The awareness of tuberculosis in these settings should be maintained to interrupt prolonged exposure and avoid unnecessary infection.

  8. Analysis of foodborne disease outbreaks for improvement of food safety programs in Seoul, Republic of Korea, from 2002 to 2006.

    PubMed

    Lee, Jib Ho; Lee, Joon-Hak; Kim, Moo Sang; Park, Seog Gee

    2009-03-01

    Foodborne disease (FBD) is a common food safety problem in Seoul, Republic of Korea. To identify target areas for improvement of the food safety programs, FBD outbreaks from 2002 to 2006 were analyzed with regard to facility, monthly occurrences, and causative agents. A total of 147 FBD outbreaks were reported, with an average of 29.4 FBD outbreaks per year and 49 cases per outbreak. Restaurants and school lunches were two main facilities associated with 76.2% of the outbreaks. A majority of FBD cases (73.1%) were from school lunches. The highest number of outbreaks and cases occurred in June, followed by March. Among the seven identified causative agents, norovirus was the most significant in the number of outbreaks and cases. Among the outbreaks and cases with causative agents identified, norovirus and Staphylococcus aureus were responsible for 61.7% of outbreaks and 81.5% of cases. The analysis indicates that the efficiency of current food safety programs could be enhanced if critical control points in school lunch programs are identified and incorporated in the training and inspection. Identifying risk factors for contamination of norovirus and Staphylococcus aureus would also be beneficial.

  9. 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 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. PMID:26536232

  10. Molecular epidemiology of Mycoplasma hyopneumoniae from outbreaks of enzootic pneumonia in domestic pig and the role of wild boar.

    PubMed

    Kuhnert, Peter; Overesch, Gudrun

    2014-11-07

    Mycoplasma hyopneumoniae is the major cause of enzootic pneumonia (EP) in domestic pigs, a disease with low mortality but high morbidity, having a great economic impact for producers. In Switzerland EP has been successfully eradicated, however, sporadic outbreaks are observed with no obvious source. Besides the possibility of recurrent outbreaks due to persisting M. hyopneumoniae strains within the pig population, there is suspicion that wild boars might introduce M. hyopneumoniae into swine herds. To elucidate possible links between domestic pig and wild boar, epidemiological investigations of recent EP outbreaks were initiated and lung samples of pig and wild boar were tested for the presence of specific genotypes by multilocus sequence typing (MLST). Despite generally different genotypes in wild boar, outbreak strains could be found in geographically linked wild boar lungs after, but so far not before the outbreak. Recurrent outbreaks in a farm were due to the same strain, indicating unsuccessful sanitation rather than reintroduction by wild boar. In another case outbreaks in six different farms were caused by the same strain never found in wild boar, confirming spread between farms due to hypothesized animal transport. Results indicate the presence of identical lineages of wild boar and domestic pig strains, and possible transmission of M. hyopneumoniae between wild boar and pig. However, the role of wild boar might be rather one as a recipient than a transmitter. More important than contact to wild boar for sporadic outbreaks in Switzerland is apparently persistence of M. hyopneumoniae within a farm as well as transmission between farms.

  11. Norovirus genotypes implicated in two oyster-related illness outbreaks in Ireland.

    PubMed

    Rajko-Nenow, P; Keaveney, S; Flannery, J; McINTYRE, A; Doré, W

    2014-10-01

    We investigated norovirus (NoV) concentrations and genotypes in oyster and faecal samples associated with two separate oyster-related outbreaks of gastroenteritis in Ireland. Quantitative analysis was performed using real-time quantitative reverse transcription polymerase chain reaction and phylogenetic analysis was conducted to establish the NoV genotypes present. For both outbreaks, the NoV concentration in oysters was >1000 genome copies/g digestive tissue and multiple genotypes were identified. In faecal samples, GII.13 was the only genotype detected for outbreak 1, whereas multiple genotypes were detected in outbreak 2 following the application of cloning procedures. While various genotypes were identified in oyster samples, not all were successful in causing infection in consumers. In outbreak 2 NoV GII.1 was identified in all four faecal samples analysed and NoV GII concentrations in faecal samples were >108 copies/g. This study demonstrates that a range of NoV genotypes can be present in highly contaminated oysters responsible for gastroenteritis outbreaks.

  12. Acceptance of Vaccinations in Pandemic Outbreaks: A Discrete Choice Experiment

    PubMed Central

    Determann, Domino; Korfage, Ida J.; Lambooij, Mattijs S.; Bliemer, Michiel; Richardus, Jan Hendrik; Steyerberg, Ewout W.; de Bekker-Grob, Esther W.

    2014-01-01

    Background Preventive measures are essential to limit the spread of new viruses; their uptake is key to their success. However, the vaccination uptake in pandemic outbreaks is often low. We aim to elicit how disease and vaccination characteristics determine preferences of the general public for new pandemic vaccinations. Methods In an internet-based discrete choice experiment (DCE) a representative sample of 536 participants (49% participation rate) from the Dutch population was asked for their preference for vaccination programs in hypothetical communicable disease outbreaks. We used scenarios based on two disease characteristics (susceptibility to and severity of the disease) and five vaccination program characteristics (effectiveness, safety, advice regarding vaccination, media attention, and out-of-pocket costs). The DCE design was based on a literature review, expert interviews and focus group discussions. A panel latent class logit model was used to estimate which trade-offs individuals were willing to make. Results All above mentioned characteristics proved to influence respondents’ preferences for vaccination. Preference heterogeneity was substantial. Females who stated that they were never in favor of vaccination made different trade-offs than males who stated that they were (possibly) willing to get vaccinated. As expected, respondents preferred and were willing to pay more for more effective vaccines, especially if the outbreak was more serious (€6–€39 for a 10% more effective vaccine). Changes in effectiveness, out-of-pocket costs and in the body that advises the vaccine all substantially influenced the predicted uptake. Conclusions We conclude that various disease and vaccination program characteristics influence respondents’ preferences for pandemic vaccination programs. Agencies responsible for preventive measures during pandemics can use the knowledge that out-of-pocket costs and the way advice is given affect vaccination uptake to improve

  13. Effectiveness and timing of vaccination during school measles outbreak.

    PubMed

    Bonačić Marinović, Axel Antonio; Swaan, Corien; Wichmann, Ole; van Steenbergen, Jim; Kretzschmar, Mirjam

    2012-09-01

    Despite high vaccination coverage in most European countries, large community outbreaks of measles do occur, normally clustered around schools and resulting from suboptimal vaccination coverage. To determine whether or when it is worth implementing outbreak-response vaccination campaigns in schools, we used stochastic outbreak models to reproduce a public school outbreak in Germany, where no vaccination campaign was implemented. We assumed 2 scenarios covering the baseline vaccination ratio range (91.3%-94.3%) estimated for that school and computed outbreaks assuming various vaccination delays. In one scenario, reacting (i.e., implementing outbreak-response vaccination campaigns) within 12-24 days avoided large outbreaks and reacting within 50 days reduced outbreak size. In the other scenario, reacting within 6-14 days avoided large outbreaks and reacting within 40 days reduced the outbreak size. These are realistic time frames for implementing school outbreak response vaccination campaigns. High baseline vaccination ratios extended the time needed for effective response.

  14. Alcohol Abuse/Dependence Symptoms Among Hospital Employees Exposed to a SARS Outbreak

    PubMed Central

    Wu, Ping; Liu, Xinhua; Fang, Yunyun; Fan, Bin; Fuller, Cordelia J.; Guan, Zhiqiang; Yao, Zhongling; Kong, Junhui; Lu, Jin; Litvak, Iva J.

    2008-01-01

    Aims: The aim of this study was to examine alcohol abuse/dependence symptoms among hospital employees exposed to a severe acute respiratory syndrome (SARS) outbreak, and the relationship between types of exposure to the SARS outbreak and subsequent alcohol abuse/dependence symptoms. Methods: A survey was conducted among 549 randomly selected hospital employees in Beijing, China, concerning the psychological impact of the 2003 SARS outbreak. Subjects were assessed on sociodemographic factors and types of exposure to the outbreak, and on symptoms of post-traumatic stress (PTS), alcohol abuse/dependence and depression. Results: Current alcohol abuse/dependence symptom counts 3 years after the outbreak were positively associated with having been quarantined, or worked in high-risk locations such as SARS wards, during the outbreak. However, having had family members or friends contract, SARS was not related to alcohol abuse/dependence symptom count. Symptoms of PTS and of depression, and having used drinking as a coping method, were also significantly associated with increased alcohol abuse/dependence symptoms. The relationship between outbreak exposure and alcohol abuse/dependence symptom count remained significant even when sociodemographic and other factors were controlled for. When the intrusion, avoidance and hyperarousal PTS symptom clusters were entered into the model, hyperarousal was found to be significantly associated with alcohol abuse/dependence symptoms. Conclusions: Exposure to an outbreak of a severe infectious disease can, like other disaster exposures, lead not only to PTSD but also to other psychiatric conditions, such as alcohol abuse/dependence. The findings will help policy makers and health professionals to better prepare for potential outbreaks of diseases such as SARS or avian flu. PMID:18790829

  15. An outbreak of invasive fusariosis in a children's cancer hospital.

    PubMed

    Litvinov, Nadia; da Silva, Mariama Tomaz N; van der Heijden, Inneke M; Graça, Mariana G; Marques de Oliveira, Larissa; Fu, Liang; Giudice, Mauro; Zilda de Aquino, Maria; Odone-Filho, Vicente; Marques, Heloisa Helena; Costa, Silvia F; Levin, Anna S

    2015-03-01

    Fusarium is considered an emerging pathogen, and there are few reports of fusariosis in children. The objective of this study was to describe an outbreak of invasive fusariosis in a children's cancer hospital. A neutropenic 17-year-old male patient hospitalized for 10 days for a relapse of acute myeloid leukaemia, under chemotherapy, presented fever without any other symptoms; a thoracic computerized tomography showed bilateral pulmonary nodules. During voriconazole treatment, 1-cm reddened and painful subcutaneous nodules appeared on arms and legs and the culture of a skin biopsy revealed F. solani. Another case occurred 11 days later and started an outbreak investigation. Water samples for cultures were collected from taps, showers and water reservoirs. Air from all patient rooms was sampled. Faucets and the drains of sinks and showers were swabbed and cultured. Environmental and clinical isolates were typed. There were 10 confirmed cases of infection caused by Fusarium spp. F. oxysporum and F. solani were isolated from water, swabs and air in patient rooms. Many control measures were instituted, but the outbreak was only controlled 1 year after the first case, when water filters filtering 0.2 μm were installed at the exit of all faucets and showers in all patient rooms (points-of-use). Typing demonstrated that clinical isolates of F. oxysporum were similar to those of the environment. In conclusion, to our knowledge this is the first reported outbreak of invasive fusariosis in children with oncohaematologic disease. It was controlled using 0.2-μm filters in all tap faucets and showers.

  16. A Randomized Controlled Trial of the First Step to Success Early Intervention: Demonstration of Program Efficacy Outcomes in a Diverse, Urban School District

    ERIC Educational Resources Information Center

    Walker, Hill M.; Seeley, John R.; Small, Jason; Severson, Herbert H.; Graham, Bethany A.; Feil, Edward G.; Serna, Loretta; Golly, Annemieke M.; Forness, Steven R.

    2009-01-01

    This article reports on a randomized controlled trial of the First Step to Success early intervention that was conducted over a 4-year period in Albuquerque Public Schools. First Step is a selected intervention for students in Grades 1 through 3 with externalizing behavior problems, and it addresses secondary prevention goals and objectives. It…

  17. Locus of Control & Motivation Strategies for Learning Questionnaire: Predictors of Student Success on the ATI Comprehensive Predictor Exam & NCLEX-RN Examination

    ERIC Educational Resources Information Center

    Carpenter, Jane H.

    2011-01-01

    The two purposes of this study were to determine whether locus of control (LOC) was predictive of how a student would perform on the ATI Comprehensive Predictor Exam and the NCLEX-RN, and if the Motivated Strategies for Learning Questionnaire (MSLQ) provided information that would help determine predictors of success on these two exams. The study…

  18. An Investigation into the Academic Success of Prospective Teachers in Terms of Learning Strategies, Learning Styles and the Locus of Control

    ERIC Educational Resources Information Center

    Akça, Figen

    2013-01-01

    The present research aims to investigate the relationship between the learning strategies, learning styles, the locus of control and the academic success of prospective teachers. The study group consists of 198 university students in various departments at the Uludag University Faculty of Education. Research data were collected with the Locus of…

  19. An Investigation into the Self-Handicapping Behaviors of Undergraduates in Terms of Academic Procrastination, the Locus of Control and Academic Success

    ERIC Educational Resources Information Center

    Akça, Figen

    2012-01-01

    The aim of this study was to investigate the relationship between self-handicapping, academic procrastination, the locus of control and academic success. The aim was also to determine whether these variables predicted self-handicapping behavior. The population of the study consisted of 263 undergraduates studying in different departments of the…

  20. Successful use of Bruton's kinase inhibitor, ibrutinib, to control paraneoplastic pemphigus in a patient with paraneoplastic autoimmune multiorgan syndrome and chronic lymphocytic leukaemia.

    PubMed

    Lee, Andrew; Sandhu, Suneet; Imlay-Gillespie, Louise; Mulligan, Stephen; Shumack, Stephen

    2017-03-13

    We present the case of a 51-year-old man who developed paraneoplastic pemphigus (PNP) in the context of chronic lymphocytic leukemia (CLL). His CLL was successfully controlled with ibrutinib. Concurrently, there was significant improvement of his PNP, suggesting that ibrutinib may be a very useful addition to the treatment options in this potentially life-threatening autoimmune disorder.

  1. Environmental indicators for human norovirus outbreaks.

    PubMed

    Shamkhali Chenar, Shima; Deng, Zhiqiang

    2017-02-01

    Norovirus is the most common cause of outbreaks of non-bacterial gastroenteritis in human. While the winter seasonality of norovirus outbreaks has been widely reported, the association between norovirus outbreak epidemics and environmental factors remains not fully understood. This literature review is intended to improve understanding of environmental factors governing norovirus outbreaks and how the factors affect norovirus transmission. To that end, a large number of studies (67) from countries around the world were critically reviewed and discussed. Results of the literature review show that temperature, humidity, and rainfall are the most important environmental variables governing the norovirus epidemic cycle. It was found that low temperature between -6.6 and 20 °C, relative humidity between 10 and 66 %, and rainfall from 1 day to 3 months before an outbreak are effective ranges of the environmental factors, which favor the prevalence of norovirus. Some other environmental factors might have an association with the cycle of norovirus epidemics. However, further investigations are needed to understand effects of the other factors on norovirus incidence. The findings of this literature review improve our understanding of the relationship between norovirus outbreaks and environmental factors and provide the direction for future research on norovirus outbreaks.

  2. Epidemiological investigation of the central Scotland outbreak of Escherichia coli O157 infection, November to December 1996.

    PubMed Central

    Cowden, J. M.; Ahmed, S.; Donaghy, M.; Riley, A.

    2001-01-01

    On Friday, 22 November 1996, the microbiologist at a hospital in Lanarkshire, Scotland, identified presumptive Escherichia coli O157 in faecal specimens submitted by three patients with bloody diarrhoea, and confirmed its presence in one. Over the next 6 h, 12 more potential cases were identified. Investigations first indicated then confirmed a single food premises as the source of infection. Effective control measures were applied promptly. The outbreak was declared over on 20 January 1997, by which time 512 cases had been identified, and infection with the outbreak strain confirmed in 279. Twenty deaths occurred in cases during the outbreak and there were two more in cases during 1997. Seventeen of these deaths resulted from the outbreak. This paper describes the outbreak's epidemiological investigation, referring to other investigations, and control measures, where appropriate. PMID:11467789

  3. A norovirus outbreak related to contaminated surfaces.

    PubMed

    Repp, Kimberly K; Hostetler, Trevor P; Keene, William E

    2013-07-15

    We investigated an outbreak of norovirus infection affecting 12 of 16 auto dealership employees (75%) subsequent to a staff meeting. Take-out sandwiches initially seemed the likely source, but a cohort study found no association between illness and food consumption. Employees reported seeing a toddler with diarrhea in a dealership restroom shortly before the luncheon. Indistinguishable norovirus was isolated from employees and the child (genotype GII6.C) and from a diaper-changing station in the restroom (genogroup GII). Counterintuitively, this point-source outbreak following a meal was caused by environmental exposures, not food. Environmental exposures should be considered even in routine outbreak investigations.

  4. An outbreak of foodborne botulism in Taiwan.

    PubMed

    Tseng, Chun-Kai; Tsai, Chon-Haw; Tseng, Chun-Hung; Tseng, Yu-Chi; Lee, Fang-Yi; Huang, Wei-Shih

    2009-01-01

    Botulism is a rare but serious paralytic disease caused by botulinum toxin. We report an outbreak of type B botulism in Taiwan in 2006. There were five cases involved in this outbreak. They present ileus and acute cranial nerve dysfunction including dysphagia and blurred vision. One of them had severe neurologic impairment and required mechanical ventilatory support. No patient received antitoxin administration because of delayed diagnosis. The food specimen revealed positive botulism toxin B. There were no fatalities. Consumption of fermented food was significantly associated with this outbreak. We also reviewed the characteristics of cases with botulism in Taiwan since 1985.

  5. Food-borne outbreak of Giardia lamblia.

    PubMed

    Porter, J D; Gaffney, C; Heymann, D; Parkin, W

    1990-10-01

    An outbreak of giardiasis occurred following a family party for 25 persons. Nine who had eaten fruit salad became ill, compared with one who had not eaten the salad (Relative Risk = 7.4, 95% CI = 1.4, 169.3). The fruit salad preparer had a diapered child and a pet rabbit at home who were both positive for Giardia lamblia. This outbreak emphasizes the importance of good hygienic practices in food preparation and the possibility of domestic-animal-to-person transmission in Giardia outbreaks.

  6. Food-borne outbreak of Giardia lamblia.

    PubMed Central

    Porter, J D; Gaffney, C; Heymann, D; Parkin, W

    1990-01-01

    An outbreak of giardiasis occurred following a family party for 25 persons. Nine who had eaten fruit salad became ill, compared with one who had not eaten the salad (Relative Risk = 7.4, 95% CI = 1.4, 169.3). The fruit salad preparer had a diapered child and a pet rabbit at home who were