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Sample records for periodic outbreaks result

  1. A large outbreak of Listeria monocytogenes infection with short incubation period in a tertiary care hospital.

    Science.gov (United States)

    Johnsen, Bjørn Odd; Lingaas, Egil; Torfoss, Dag; Strøm, Erik H; Nordøy, Ingvild

    2010-12-01

    Listeria monocytogenes is a foodborne pathogen with a high mortality rate. We report a large, nosocomial outbreak of Listeria monocytogenes infection. Patients with L. monocytogenes isolated from a sterile site, or from faeces when diarrhoea and fever were present, were included. Clinical data were collected from the patient records. The incubation period was calculated as the time between exposure and start of symptoms. Seventeen patients (11 women, median age 64 years) were infected of whom 15 patients were at increased risk for listeriosis. Eleven patients received empiric antibiotic treatment, eight of them with cephalosporins. Three patients died with a resulting mortality rate of 18%. The source of the outbreak was a Camembert cheese made from pasteurised milk containing up to 360 million colony forming units per portion. The median incubation period was 3-4 days. The incubation period in this outbreak was significantly shorter than previously reported, a fact that may be due to the high number of ingested bacteria. Furthermore, food restrictions in hospitals seem warranted, as do treatment with antibiotics effective against L. monocytogenes in at-risk populations. Copyright © 2010 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  2. A simple model to quantitatively account for periodic outbreaks of the measles in the Dutch Bible Belt

    Science.gov (United States)

    Bier, Martin; Brak, Bastiaan

    2015-04-01

    In the Netherlands there has been nationwide vaccination against the measles since 1976. However, in small clustered communities of orthodox Protestants there is widespread refusal of the vaccine. After 1976, three large outbreaks with about 3000 reported cases of the measles have occurred among these orthodox Protestants. The outbreaks appear to occur about every twelve years. We show how a simple Kermack-McKendrick-like model can quantitatively account for the periodic outbreaks. Approximate analytic formulae to connect the period, size, and outbreak duration are derived. With an enhanced model we take the latency period in account. We also expand the model to follow how different age groups are affected. Like other researchers using other methods, we conclude that large scale underreporting of the disease must occur.

  3. Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999-2001

    NARCIS (Netherlands)

    van den Broek, P. J.; Arends, J.; Bernards, A. T.; De Brauwer, E.; Mascini, E. M.; van der Reijden, T. J. K.; Spanjaard, L.; Thewessen, E. A. P. M.; van der Zee, A.; van Zeijl, J. H.; Dijkshoorn, L.

    An increase in the number of outbreaks of Acinetobacter infection was notified in The Netherlands during 1999-2001. The present study compared the outbreaks at the species and strain levels, and analysed the epidemiology and control measures at the different locations. For each institute, three

  4. Hepatitis A virus strains circulating during 1997-2015 in Campania, a Southern Italy region with periodic outbreaks.

    Science.gov (United States)

    Costantino, Angela; Coppola, Nicola; Spada, Enea; Bruni, Roberto; Taffon, Stefania; Equestre, Michele; Marcantonio, Cinzia; Sagnelli, Caterina; Dell'Isola, Chiara; Tosone, Grazia; Mascolo, Silvia; Sagnelli, Evangelista; Ciccaglione, Anna Rita

    2017-11-01

    In Italy, the incidence of hepatitis A has progressively declined over the last 30 years, though not homogeneously throughout the country. In Campania, Southern Italy, high annual incidence rates have been reported and several periodic outbreaks have occurred. To investigate the phylogenetic and epidemiologic relationships among HAV strains circulating in Campania over the period 1997-2015, 87 hepatitis A cases were investigated. The most frequent risk factor was the consumption of raw/undercooked shellfish (75/87, 86.2%). During 1997-2002 most viral strains were subtype IA (16/23, 70%); the phylogenetic pattern suggests that the incidence peaks observed in 2000-2001 had likely been caused by multiple strains. During a large 2004 outbreak, almost all viral variants were subtype IB (38/41, 93%); most of them (22/38, 58%) were recognized to be one of two main strains (differing for just a single nucleotide), the remaining sequences were strictly related variants. In 2014/2015, only IA strains were observed; two phylogenetically related but distinct strains were responsible, respectively, for a small cluster in 2014 and an outbreak in 2015. In each outbreak, several strains unrelated to those responsible for most cases were detected in a minority of patients, documenting a background of sporadic cases occurring even in the course of outbreaks; some of them proved to be identical to strains detected 11-14 years previously. Overall, the data suggest that several related and unrelated HAV strains have endemically circulated over the last 15 years in Campania, with some strains gaining epidemic transmission likely because of a local combination of multiple factors, including inadequate waste water purification and dietary habits. © 2017 Wiley Periodicals, Inc.

  5. Wildlife Reservoirs of Canine Distemper Virus Resulted in a Major Outbreak in Danish Farmed Mink (Neovison vison)

    DEFF Research Database (Denmark)

    Trebbien, Ramona; Chriél, Mariann; Struve, Tina

    2014-01-01

    A major outbreak of canine distemper virus (CDV) in Danish farmed mink (Neovison vison) started in the late summer period of 2012. At the same time, a high number of diseased and dead wildlife species such as foxes, raccoon dogs, and ferrets were observed. To track the origin of the outbreak virus...

  6. Natural disaster-induced environmental migration from the Indian subcontinent resulting in malaria outbreak in Greece

    Science.gov (United States)

    Mavrouli, Maria; Mavroulis, Spyridon; Piperaki, Evangelia-Theofano; Hadjichristodoulou, Christos; Tsakris, Athanassios

    2017-04-01

    Extreme hydrometeorological disasters such as floods and hurricanes can severely damage human life, natural and built environment and economic development. Consequently, they can result in environmental migration (EM). In case of infectious disease (ID) outbreaks during the post-disaster period and subsequent EM, environmental refugees from endemic regions serve as ID carriers to their new residence sites altering the spatial ID distribution and incidence. The continuous massive influx of environmental refugees from malaria endemic regions to non-endemic ones can build up a parasite reservoir among naive host populations. Initially, serum specimens were collected in 2012 from asymptomatic individuals, 298 Greeks and 721 immigrants residing in areas of documented local malaria transmission in Laconia (Southern Peloponnese) and in Eastern Attica, Greece. Sera were tested for antibodies against Plasmodium vivax and P. falciparum using the Malaria-Ab ELISA (IBL International GMBH, Hamburg, Germany). Taking into account that Greece has been declared malaria free by the WHO since 1974, we conducted an extensive and systematic literature review related to natural disasters leading among others to increased malaria risk in Indian Subcontinent and respective forced EM in order to detect relative possible causes of reintroduction and localized outbreaks of malaria in Greece. Regarding the country of origin, information was available for 685 (95%) of the 721 immigrants. Of the 678 immigrants from Indian Subcontinent, 627 (92.5%) originated from Pakistan, 24 (3.53%) Afghanistan, 24 (3.53%) India and 3 (0.44%) Bangladesh. Of the 721 immigrants, 582 and 124 resided in Laconia and Eastern Attica respectively. Seventy-one immigrants residing in Laconia and 14 in Eastern Attica were positive for antimalarial antibodies, while none of the 298 Greeks residing in Laconia (N=248) and Attica (N=50) was found positive. Based on already published scientific data, Pakistan has been exposed

  7. Predominance and high antibiotic resistance of the emerging Clostridium difficile genotypes NAPCR1 and NAP9 in a Costa Rican hospital over a 2-year period without outbreaks.

    Science.gov (United States)

    López-Ureña, Diana; Quesada-Gómez, Carlos; Montoya-Ramírez, Mónica; del Mar Gamboa-Coronado, María; Somogyi, Teresita; Rodríguez, César; Rodríguez-Cavallini, Evelyn

    2016-05-11

    Clostridium difficile is the major causative agent of nosocomial antibiotic-associated diarrhea. In a 2009 outbreak of C. difficile-associated diarrhea that was recorded in a major Costa Rican hospital, the hypervirulent NAP1 strain (45%) predominated together with a local genotype variant (NAPCR1, 31%). Both strains were fluoroquinolone-resistant and the NAPCR1 genotype, in addition, was resistant to clindamycin and rifampicin. We now report on the genotypes and antibiotic susceptibilities of 68 C. difficile isolates from a major Costa Rican hospital over a 2-year period without outbreaks. In contrast to our previous findings, no NAP1 strains were detected, and for the first time in a Costa Rican hospital, a significant fraction of the isolates were NAP9 strains (n=14, 21%). The local NAPCR1 genotype remained prevalent (n=18, 26%) and coexisted with 14 strains (21%) of classic hospital NAP types (NAP2, NAP4, and NAP6), eight new genotypes (12%), four environmental strains classified as NAP10 or NAP11 (6%), three strains without NAP designation (4%) and seven non-toxigenic strains (10%). All 68 strains were resistant to ciprofloxacin, 88% were resistant to clindamycin and 50% were resistant to moxifloxacin and rifampicin. Metronidazole and vancomycin susceptibilities were universal. The NAPCR1 and NAP9 strains, which have been associated with more severe clinical infections, were more resistant to antibiotics than the other strains. Altogether, our results confirm that the epidemiology of C. difficile infection is dynamic and that A(-)B(+) strains from the NAP9 type are on the rise not only in the developed world. Moreover, our results reveal that the local NAPCR1 strains still circulate in the country without causing outbreaks but with equally high antibiotic-resistance rates and levels.

  8. Incentives for reporting disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Ramanan Laxminarayan

    Full Text Available BACKGROUND: Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines. METHODS: We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO. FINDINGS: We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased. INTERPRETATION: These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.

  9. Recovery potential of a western lowland gorilla population following a major Ebola outbreak: results from a ten year study.

    Science.gov (United States)

    Genton, Céline; Cristescu, Romane; Gatti, Sylvain; Levréro, Florence; Bigot, Elodie; Caillaud, Damien; Pierre, Jean-Sébastien; Ménard, Nelly

    2012-01-01

    Investigating the recovery capacity of wildlife populations following demographic crashes is of great interest to ecologists and conservationists. Opportunities to study these aspects are rare due to the difficulty of monitoring populations both before and after a demographic crash. Ebola outbreaks in central Africa have killed up to 95% of the individuals in affected western lowland gorilla (Gorilla gorilla gorilla) populations. Assessing whether and how fast affected populations recover is essential for the conservation of this critically endangered taxon. The gorilla population visiting Lokoué forest clearing, Odzala-Kokoua National Park, Republic of the Congo, has been monitored before, two years after and six years after Ebola affected it in 2004. This allowed us to describe Ebola's short-term and long-term impacts on the structure of the population. The size of the population, which included around 380 gorillas before the Ebola outbreak, dropped to less than 40 individuals after the outbreak. It then remained stable for six years after the outbreak. However, the demographic structure of this small population has significantly changed. Although several solitary males have disappeared, the immigration of adult females, the formation of new breeding groups, and several birth events suggest that the population is showing potential to recover. During the outbreak, surviving adult and subadult females joined old solitary silverbacks. Those females were subsequently observed joining young silverbacks, forming new breeding groups where they later gave birth. Interestingly, some females were observed joining silverbacks that were unlikely to have sired their infant, but no infanticide was observed. The consequences of the Ebola outbreak on the population structure were different two years and six years after the outbreak. Therefore, our results could be used as demographic indicators to detect and date outbreaks that have happened in other, non-monitored gorilla

  10. Recovery potential of a western lowland gorilla population following a major Ebola outbreak: results from a ten year study.

    Directory of Open Access Journals (Sweden)

    Céline Genton

    Full Text Available Investigating the recovery capacity of wildlife populations following demographic crashes is of great interest to ecologists and conservationists. Opportunities to study these aspects are rare due to the difficulty of monitoring populations both before and after a demographic crash. Ebola outbreaks in central Africa have killed up to 95% of the individuals in affected western lowland gorilla (Gorilla gorilla gorilla populations. Assessing whether and how fast affected populations recover is essential for the conservation of this critically endangered taxon. The gorilla population visiting Lokoué forest clearing, Odzala-Kokoua National Park, Republic of the Congo, has been monitored before, two years after and six years after Ebola affected it in 2004. This allowed us to describe Ebola's short-term and long-term impacts on the structure of the population. The size of the population, which included around 380 gorillas before the Ebola outbreak, dropped to less than 40 individuals after the outbreak. It then remained stable for six years after the outbreak. However, the demographic structure of this small population has significantly changed. Although several solitary males have disappeared, the immigration of adult females, the formation of new breeding groups, and several birth events suggest that the population is showing potential to recover. During the outbreak, surviving adult and subadult females joined old solitary silverbacks. Those females were subsequently observed joining young silverbacks, forming new breeding groups where they later gave birth. Interestingly, some females were observed joining silverbacks that were unlikely to have sired their infant, but no infanticide was observed. The consequences of the Ebola outbreak on the population structure were different two years and six years after the outbreak. Therefore, our results could be used as demographic indicators to detect and date outbreaks that have happened in other, non

  11. Household responses to school closure resulting from outbreak of influenza B, North Carolina.

    Science.gov (United States)

    Johnson, April J; Moore, Zack S; Edelson, Paul J; Kinnane, Lynda; Davies, Megan; Shay, David K; Balish, Amanda; McCarron, Meg; Blanton, Lenee; Finelli, Lyn; Averhoff, Francisco; Bresee, Joseph; Engel, Jeffrey; Fiore, Anthony

    2008-07-01

    School closure is a proposed strategy for reducing influenza transmission during a pandemic. Few studies have assessed how families respond to closures, or whether other interactions during closure could reduce this strategy's effect. Questionnaires were administered to 220 households (438 adults and 355 children) with school-age children in a North Carolina county during an influenza B virus outbreak that resulted in school closure. Closure was considered appropriate by 201 (91%) households. No adults missed work to solely provide childcare, and only 22 (10%) households required special childcare arrangements; 2 households incurred additional costs. Eighty-nine percent of children visited at least 1 public location during the closure despite county recommendations to avoid large gatherings. Although behavior and attitudes might differ during a pandemic, these results suggest short-term closure did not cause substantial hardship for parents. Pandemic planning guidance should address the potential for transmission in public areas during school closure.

  12. Toxigenic Vibrio cholerae O1 in vegetables and fish raised in wastewater irrigated fields and stabilization ponds during a non-cholera outbreak period in Morogoro, Tanzania

    DEFF Research Database (Denmark)

    Hounmanou, Yaovi M G; Mdegela, Robinson H; Dougnon, Tamègnon V

    2016-01-01

    gene (tcpA) and the haemolysin gene (hlyA). RESULTS: The prevalence of V. cholerae in wastewater, vegetables and fish was 36.7, 21.7 and 23.3 %, respectively. Two isolates from fish gills were V. cholerae O1 and tested positive for ctx and tcpA. One of these contained in addition the hlyA gene while......BACKGROUND: Cholera, one of the world's deadliest infectious diseases, remains rampant and frequent in Tanzania and thus hinders existing control measures. The present study was undertaken to evaluate the occurrence of toxigenic Vibrio cholerae O1 in wastewater, fish and vegetables during a non......-outbreak period in Morogoro, Tanzania. METHODS: From October 2014 to February 2015, 60 wastewater samples, 60 fish samples from sewage stabilization ponds and 60 wastewater irrigated vegetable samples were collected. Samples were cultured for identification of V. cholerae using conventional bacteriological...

  13. Spatiotemporal clustering, climate periodicity, and social-ecological risk factors for dengue during an outbreak in Machala, Ecuador, in 2010.

    Science.gov (United States)

    Stewart-Ibarra, Anna M; Muñoz, Ángel G; Ryan, Sadie J; Ayala, Efraín Beltrán; Borbor-Cordova, Mercy J; Finkelstein, Julia L; Mejía, Raúl; Ordoñez, Tania; Recalde-Coronel, G Cristina; Rivero, Keytia

    2014-11-25

    Dengue fever, a mosquito-borne viral disease, is a rapidly emerging public health problem in Ecuador and throughout the tropics. However, we have a limited understanding of the disease transmission dynamics in these regions. Previous studies in southern coastal Ecuador have demonstrated the potential to develop a dengue early warning system (EWS) that incorporates climate and non-climate information. The objective of this study was to characterize the spatiotemporal dynamics and climatic and social-ecological risk factors associated with the largest dengue epidemic to date in Machala, Ecuador, to inform the development of a dengue EWS. The following data from Machala were included in analyses: neighborhood-level georeferenced dengue cases, national census data, and entomological surveillance data from 2010; and time series of weekly dengue cases (aggregated to the city-level) and meteorological data from 2003 to 2012. We applied LISA and Moran's I to analyze the spatial distribution of the 2010 dengue cases, and developed multivariate logistic regression models through a multi-model selection process to identify census variables and entomological covariates associated with the presence of dengue at the neighborhood level. Using data aggregated at the city-level, we conducted a time-series (wavelet) analysis of weekly climate and dengue incidence (2003-2012) to identify significant time periods (e.g., annual, biannual) when climate co-varied with dengue, and to describe the climate conditions associated with the 2010 outbreak. We found significant hotspots of dengue transmission near the center of Machala. The best-fit model to predict the presence of dengue included older age and female gender of the head of the household, greater access to piped water in the home, poor housing condition, and less distance to the central hospital. Wavelet analyses revealed that dengue transmission co-varied with rainfall and minimum temperature at annual and biannual cycles, and we

  14. Wildlife Reservoirs of Canine Distemper Virus Resulted in a Major Outbreak in Danish Farmed Mink (Neovison vison)

    Science.gov (United States)

    Trebbien, Ramona; Chriel, Mariann; Struve, Tina; Hjulsager, Charlotte Kristiane; Larsen, Gitte; Larsen, Lars Erik

    2014-01-01

    A major outbreak of canine distemper virus (CDV) in Danish farmed mink (Neovison vison) started in the late summer period of 2012. At the same time, a high number of diseased and dead wildlife species such as foxes, raccoon dogs, and ferrets were observed. To track the origin of the outbreak virus full-length sequencing of the receptor binding surface protein hemagglutinin (H) was performed on 26 CDV's collected from mink and 10 CDV's collected from wildlife species. Subsequent phylogenetic analyses showed that the virus circulating in the mink farms and wildlife were highly identical with an identity at the nucleotide level of 99.45% to 100%. The sequences could be grouped by single nucleotide polymorphisms according to geographical distribution of mink farms and wildlife. The signaling lymphocytic activation molecule (SLAM) receptor binding region in most viruses from both mink and wildlife contained G at position 530 and Y at position 549; however, three mink viruses had an Y549H substitution. The outbreak viruses clustered phylogenetically in the European lineage and were highly identical to wildlife viruses from Germany and Hungary (99.29% – 99.62%). The study furthermore revealed that fleas (Ceratophyllus sciurorum) contained CDV and that vertical transmission of CDV occurred in a wild ferret. The study provides evidence that wildlife species, such as foxes, play an important role in the transmission of CDV to farmed mink and that the virus may be maintained in the wild animal reservoir between outbreaks. PMID:24454897

  15. Wildlife reservoirs of canine distemper virus resulted in a major outbreak in Danish farmed mink (Neovison vison.

    Directory of Open Access Journals (Sweden)

    Ramona Trebbien

    Full Text Available A major outbreak of canine distemper virus (CDV in Danish farmed mink (Neovison vison started in the late summer period of 2012. At the same time, a high number of diseased and dead wildlife species such as foxes, raccoon dogs, and ferrets were observed. To track the origin of the outbreak virus full-length sequencing of the receptor binding surface protein hemagglutinin (H was performed on 26 CDV's collected from mink and 10 CDV's collected from wildlife species. Subsequent phylogenetic analyses showed that the virus circulating in the mink farms and wildlife were highly identical with an identity at the nucleotide level of 99.45% to 100%. The sequences could be grouped by single nucleotide polymorphisms according to geographical distribution of mink farms and wildlife. The signaling lymphocytic activation molecule (SLAM receptor binding region in most viruses from both mink and wildlife contained G at position 530 and Y at position 549; however, three mink viruses had an Y549H substitution. The outbreak viruses clustered phylogenetically in the European lineage and were highly identical to wildlife viruses from Germany and Hungary (99.29% - 99.62%. The study furthermore revealed that fleas (Ceratophyllus sciurorum contained CDV and that vertical transmission of CDV occurred in a wild ferret. The study provides evidence that wildlife species, such as foxes, play an important role in the transmission of CDV to farmed mink and that the virus may be maintained in the wild animal reservoir between outbreaks.

  16. Results of mammographic examinations within a period of three years

    International Nuclear Information System (INIS)

    Meiers-Lange, K.

    Within the period of three years 5.811 mammographies were made. Mastopathies were found to occur very frequently. Report on the results of operative diagnosis and the rehability of a diagnosis obtained by mammography. (MR) [de

  17. Pesticide Residues, Results from the period 2004-2011

    DEFF Research Database (Denmark)

    Petersen, Annette; Jensen, Bodil Hamborg; Andersen, Jens Hinge

    The present report presents the results from the 2004-2011 period of the monitoring programmes conducted by The Danish Veterinary and Food Administration. The programmes included commodities of fruit, vegetable, cereals and animal origin using random sampling from food on the Danish market. Since...... the beginning of the 1960, Denmark has monitored fruit and vegetables for pesticides residues. For the periods 1993-1997 and 1998-2003, results were collated and the dietary exposure was calculated. In this report data for the analyses carried out in the period 2004-2011 are reported as well as the exposure...

  18. First reported outbreak of severe spirorchiidiasis in Emys orbicularis, probably resulting from a parasite spillover event.

    Science.gov (United States)

    Iglesias, Raúl; García-Estévez, José M; Ayres, César; Acuña, Antonio; Cordero-Rivera, Adolfo

    2015-02-10

    The importance of disease-mediated invasions and the role of parasite spillover as a substantial threat to the conservation of global biodiversity are now well known. Although competition between invasive sliders Trachemys scripta elegans and indigenous European turtles has been extensively studied, the impact of this invasive species on diseases affecting native populations is poorly known. During winter 2012-2013 an unusual event was detected in a population of Emys orbicularis (Linnaeus, 1758) inhabiting a pond system in Galicia (NW Spain). Most turtles were lethargic and some had lost mobility of limbs and tail. Necropsies were performed on 11 turtles that were found dead or dying at this site. Blood flukes belonging to the species Spirorchis elegans were found inhabiting the vascular system of 3 turtles, while numerous fluke eggs were trapped in the vascular system, brain, lung, heart, liver, kidney, spleen, and/or gastrointestinal tissues of all necropsied animals. Characteristic lesions included miliary egg granulomas, which were mostly found on serosal surfaces, particularly of the small intestine, as well as endocarditis, arteritis, and thrombosis. The most probable cause of death in the 3 turtle specimens which were also examined histologically was a necrotic enteritis with secondary bacterial infection associated with a massive egg embolism. The North American origin of S. elegans, the absence of prior recorded epizootics in the outbreak area, and the habitual presence of its type host, the highly invasive red-eared slider, in this area suggest a new case of parasite spillover resulting in a severe emerging disease.

  19. H5N2 Highly Pathogenic Avian Influenza Viruses from the US 2014-2015 outbreak have an unusually long pre-clinical period in turkeys.

    Science.gov (United States)

    Spackman, Erica; Pantin-Jackwood, Mary J; Kapczynski, Darrell R; Swayne, David E; Suarez, David L

    2016-11-22

    From December 2014 through June 2015, the US experienced the most costly highly pathogenic avian influenza (HPAI) outbreak to date. Most cases in commercial poultry were caused by an H5N2 strain which was a reassortant with 5 Eurasian lineage genes, including a clade 2.3.4.4 goose/Guangdong/1996 lineage hemagglutinin, and 3 genes from North American wild waterfowl low pathogenicity avian influenza viruses. The outbreak primarily affected turkeys and table-egg layer type chickens. Three isolates were selected for characterization in turkeys: the US index isolate from December 2014 (A/northern pintail/WA/40964/2014), and two poultry isolates from April 2015 (A/chicken/IA/13388/2015 and A/turkey/MN/12528/2015). Four week old broad-breasted white turkeys were inoculated with one of three doses (10 2 , 10 4 or 10 6 50% egg infectious doses [EID 50 ] per bird) of each of the isolates to evaluate infectious dose and pathogenesis. The mean bird infectious dose of A/northern pintail/WA/40964/2014 and A/turkey/MN/12528/2015 was 10 5 EID 50 per bird, but was 10 3 EID 50 per bird for A/chicken/IA/13388/2015, suggesting the latter had greater adaptation to gallinaceous birds. All three isolates had unusually long mean death time of 5.3-5.9 days post challenge, and the primary clinical signs were severe lethargy and neurological signs which started no more than 24 h before death (the average pre-clinical period was 4 days). Infected turkeys also shed high levels of virus by both the oropharyngeal and cloacal routes. The unusually long mean death times, high levels of virus in feces, and increased adaptation of the later viruses may have contributed to the rapid spread of the virus during the peak of the outbreak.

  20. Meteorological results of monsoon-88 Expedition (pre-monsoon period)

    Digital Repository Service at National Institute of Oceanography (India)

    Sadhuram, Y.; Krishnamurthy, L.; Babu, M.T.

    Mean atmospheric circulation, moisture budget and net heat exchange were studied during a pre-monsoon period (18th March to 3rd May, 1988), making use of the data collected on board "Akademik Korolev" in the central equatorial and southern Arabian...

  1. New fixed and periodic point results on cone metric spaces

    Directory of Open Access Journals (Sweden)

    Ghasem Soleimani Rad

    2014-05-01

    Full Text Available In this paper, several xed point theorems for T-contraction of two maps on cone metric spaces under normality condition are proved. Obtained results extend and generalize well-known comparable results in the literature.

  2. Further results on periods and period doubling for iterates of the trapezoic function

    International Nuclear Information System (INIS)

    Beyer, W.A.; Stein, P.R.

    1982-01-01

    The trapezoidal function lambda f/sub e/(x), is defined for fixed e element of (0,1] and for lambda element of [1,2] by lambda f/sub e/ (x) = lambda for /x-1/< 1-e and lambda f/sub e/(x) = lambda(1-/x-1/)/(1-e) for 1 greater than or equal to /x-1/greater than or equal to 1-e. For a fixed e, this is a one parameter family of endomorphisms of the interval [0,2]. The structure of the periods (or cycles) of these mappings is studied. In addition, the metric properties of the corresponding bifurcation diagrams are considered; in particular, the rate of convergence of a sequence of bifurcation points in the (x,lambda) plane is studied. It is shown to be different from that found by Feigenbaum and others for mappings which are not flat at the top. The limiting case e = 1 is of special interest. For cycles and containing a point x element of[e,2-e], the period quadruplicates instead of doubling as it does in the usual case

  3. Short-Period Binary Stars: Observations, Analyses, and Results

    CERN Document Server

    Milone, Eugene F; Hobill, David W

    2008-01-01

    Short-period binaries run the gamut from widely separated stars to black-hole pairs; in between are systems that include neutron stars and white dwarfs, and partially evolved systems such as tidally distorted and over-contact systems. These objects represent stages of evolution of binary stars, and their degrees of separation provide critical clues to how their evolutionary paths differ from that of single stars. The widest and least distorted systems provide astronomers with the essential precise data needed to study all stars: mass and radius. The interactions of binary star components, on the other hand, provide a natural laboratory to observe how the matter in these stars behaves under different and often varying physical conditions. Thus, cataclysmic variables with and without overpoweringly strong magnetic fields, and stars with densities from that found in the Sun to the degenerate matter of white dwarfs and the ultra-compact states of neutron stars and black holes are all discussed. The extensive inde...

  4. Highlighting the complexities of a groundwater pilot study during an avian influenza outbreak: Methods, lessons learned, and select contaminant results

    Science.gov (United States)

    Hubbard, Laura E.; Kolpin, Dana W.; Fields, Chad L.; Hladik, Michelle L.; Iwanowicz, Luke

    2017-01-01

    The highly pathogenic avian influenza (H5N2) outbreak in the Midwestern United States (US) in 2015 was historic due to the number of birds and poultry operations impacted and the corresponding economic loss to the poultry industry and was the largest animal health emergency in US history. The U.S. Geological Survey (USGS), with the assistance of several state and federal agencies, aided the response to the outbreak by developing a study to determine the extent of virus transport in the environment. The study goals were to: develop the appropriate sampling methods and protocols for measuring avian influenza virus (AIV) in groundwater, provide the first baseline data on AIV and outbreak- and poultry-related contaminant occurrence and movement into groundwater, and document climatological factors that may have affected both survival and transport of AIV to groundwater during the months of the 2015 outbreak. While site selection was expedient, there were often delays in sample response times due to both relationship building between agencies, groups, and producers and logistical time constraints. This study's design and sampling process highlights the unpredictable nature of disease outbreaks and the corresponding difficulty in environmental sampling of such events. The lessons learned, including field protocols and approaches, can be used to improve future research on AIV in the environment.

  5. Highlighting the complexities of a groundwater pilot study during an avian influenza outbreak: Methods, lessons learned, and select contaminant results.

    Science.gov (United States)

    Hubbard, Laura E; Kolpin, Dana W; Fields, Chad L; Hladik, Michelle L; Iwanowicz, Luke R

    2017-10-01

    The highly pathogenic avian influenza (H5N2) outbreak in the Midwestern United States (US) in 2015 was historic due to the number of birds and poultry operations impacted and the corresponding economic loss to the poultry industry and was the largest animal health emergency in US history. The U.S. Geological Survey (USGS), with the assistance of several state and federal agencies, aided the response to the outbreak by developing a study to determine the extent of virus transport in the environment. The study goals were to: develop the appropriate sampling methods and protocols for measuring avian influenza virus (AIV) in groundwater, provide the first baseline data on AIV and outbreak- and poultry-related contaminant occurrence and movement into groundwater, and document climatological factors that may have affected both survival and transport of AIV to groundwater during the months of the 2015 outbreak. While site selection was expedient, there were often delays in sample response times due to both relationship building between agencies, groups, and producers and logistical time constraints. This study's design and sampling process highlights the unpredictable nature of disease outbreaks and the corresponding difficulty in environmental sampling of such events. The lessons learned, including field protocols and approaches, can be used to improve future research on AIV in the environment. Published by Elsevier Inc.

  6. Forecasting rodent outbreaks in Africa

    DEFF Research Database (Denmark)

    Leirs, Herwig; Verhagen, Ron; Verheyen, Walter

    1996-01-01

    1. Rainfall data were collated for years preceding historical outbreaks of Mastomys rats in East Africa in order to test the hypothesis that such outbreaks occur after long dry periods. 2. Rodent outbreaks were generally not preceded by long dry periods. 3. Population dynamics of Mastomys...... natalensis rats in Tanzania are significantly affected by the distribution of rainfall during the rainy season. 4. All previous rodent outbreaks in Tanzania were preceded by abundant rainfall early in the rainy season, i.e, towards the end of the year. 5. A flow chart is constructed to assess the likelihood...

  7. Fitting outbreak models to data from many small norovirus outbreaks

    Directory of Open Access Journals (Sweden)

    Eamon B. O’Dea

    2014-03-01

    Full Text Available Infectious disease often occurs in small, independent outbreaks in populations with varying characteristics. Each outbreak by itself may provide too little information for accurate estimation of epidemic model parameters. Here we show that using standard stochastic epidemic models for each outbreak and allowing parameters to vary between outbreaks according to a linear predictor leads to a generalized linear model that accurately estimates parameters from many small and diverse outbreaks. By estimating initial growth rates in addition to transmission rates, we are able to characterize variation in numbers of initially susceptible individuals or contact patterns between outbreaks. With simulation, we find that the estimates are fairly robust to the data being collected at discrete intervals and imputation of about half of all infectious periods. We apply the method by fitting data from 75 norovirus outbreaks in health-care settings. Our baseline regression estimates are 0.0037 transmissions per infective-susceptible day, an initial growth rate of 0.27 transmissions per infective day, and a symptomatic period of 3.35 days. Outbreaks in long-term-care facilities had significantly higher transmission and initial growth rates than outbreaks in hospitals.

  8. H5N2 Highly Pathogenic Avian Influenza Viruses from the US 2014-2015 outbreak have an unusually long pre-clinical period in turkeys

    OpenAIRE

    Spackman, Erica; Pantin-Jackwood, Mary J.; Kapczynski, Darrell R.; Swayne, David E.; Suarez, David L.

    2016-01-01

    Background From December 2014 through June 2015, the US experienced the most costly highly pathogenic avian influenza (HPAI) outbreak to date. Most cases in commercial poultry were caused by an H5N2 strain which was a reassortant with 5 Eurasian lineage genes, including a clade 2.3.4.4 goose/Guangdong/1996 lineage hemagglutinin, and 3 genes from North American wild waterfowl low pathogenicity avian influenza viruses. The outbreak primarily affected turkeys and table-egg layer type chickens. T...

  9. Contagious equine metritis in Portugal: A retrospective report of the first outbreak in the country and recent contagious equine metritis test results

    Directory of Open Access Journals (Sweden)

    T. Rocha

    2016-12-01

    Full Text Available Contagious equine metritis (CEM, a highly contagious bacterial venereal infection of equids, caused by Taylorella equigenitalis, is of major international concern, causing short-term infertility in mares. Portugal has a long tradition of horse breeding and exportation and until recently was considered CEM-free. However, in 2008, T. equigenitalis was isolated at our laboratory from a recently imported stallion and 2 mares from the same stud. Following this first reported outbreak, the Portuguese Veterinary Authority (DGVA performed mandatory testing on all remaining equines at the stud (n=30, resulting in a further 4 positive animals. All positive animals were treated and subsequently tested negative for T. equigenitalis. Since this outbreak, over 2000 genital swabs from Portuguese horses have been tested at our laboratory, with no further positive animals identified. The available data suggests that this CEM outbreak was an isolated event and we have no further evidence of CEM cases in Portugal, however, an extended and wider epidemiological study would be needed to better evaluate the incidence of the disease in Portuguese horses.

  10. A Study of 279 General Outbreaks of Gastrointestinal Infection in the North-East Region of England

    Science.gov (United States)

    Tebbutt, Grahame M.; Wilson, Deborah; Holtby, Ian

    2009-01-01

    All outbreaks of infectious intestinal disease reported to the authorities were entered on a computer database with outbreak control teams being established to investigate larger or more significant incidents. The outbreak database and, when set up, the notes of outbreak team meetings were examined for the 279 outbreaks reported in a three-year period (2003–2005). Faeces specimens submitted as part of an outbreak were examined for microbial pathogens and the results cross-matched to the outbreak number. Almost half of the general outbreaks reported (137) occurred in long-term care facilities for the elderly, 51 outbreaks were recorded in hospitals and 31 occurred in the wider community. In 76 outbreaks no specimen was logged. A microbial cause was confirmed in about one-third of outbreaks, with noroviruses being the most common (19%). Salmonellas accounted for 12 of the 21 community outbreaks linked to social events and all were foodborne. Suggestions for improving notification and surveillance are discussed. PMID:19440398

  11. Failure of Quality Control Measures To Prevent Reporting of False Resistance to Imipenem, Resulting in a Pseudo-Outbreak of Imipenem-Resistant Pseudomonas aeruginosa

    Science.gov (United States)

    Carmeli, Yehuda; Eichelberger, Karen; Soja, Don; Dakos, Joanna; Venkataraman, Lata; DeGirolami, Paola; Samore, Matthew

    1998-01-01

    False results showing an outbreak of Pseudomonas aeruginosa with resistance to imipenem were traced to a defective lot of microdilution MIC testing panels. These panels contained two- to threefold lower concentrations of imipenem than expected and resulted in artifactual two- to fourfold increases in MICs of imipenem. The quality-control MIC results for Pseudomonas aeruginosa ATCC 27853 were 4 μg/ml, the highest value within the range recommended by the National Committee for Clinical Laboratory Standards. We recommend that this value be considered out of the quality-control range. PMID:9466787

  12. New results of almost periodic solutions for cellular neural networks with mixed delays

    International Nuclear Information System (INIS)

    Zhao Weirui; Zhang Huanshui

    2009-01-01

    In this paper, for cellular neural networks with mixed delays, we prove some new results on the existence of almost periodic solutions by contraction principle. The global exponential stability of almost periodic solutions is discussed further, and conditions for exponential convergence are given. The conditions we obtained are weaker than the previously known ones and can be easily reduced to several special cases.

  13. Surveillance for foodborne disease outbreaks - United States, 1998-2008.

    Science.gov (United States)

    Gould, L Hannah; Walsh, Kelly A; Vieira, Antonio R; Herman, Karen; Williams, Ian T; Hall, Aron J; Cole, Dana

    2013-06-28

    Foodborne diseases cause an estimated 48 million illnesses each year in the United States, including 9.4 million caused by known pathogens. Foodborne disease outbreak surveillance provides valuable insights into the agents and foods that cause illness and the settings in which transmission occurs. CDC maintains a surveillance program for collection and periodic reporting of data on the occurrence and causes of foodborne disease outbreaks in the United States. This surveillance system is the primary source of national data describing the numbers of illnesses, hospitalizations, and deaths; etiologic agents; implicated foods; contributing factors; and settings of food preparation and consumption associated with recognized foodborne disease outbreaks in the United States. 1998-2008. The Foodborne Disease Outbreak Surveillance System collects data on foodborne disease outbreaks, defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Public health agencies in all 50 states, the District of Columbia, U.S. territories, and Freely Associated States have primary responsibility for identifying and investigating outbreaks and use a standard form to report outbreaks voluntarily to CDC. During 1998-2008, reporting was made through the electronic Foodborne Outbreak Reporting System (eFORS). During 1998-2008, CDC received reports of 13,405 foodborne disease outbreaks, which resulted in 273,120 reported cases of illness, 9,109 hospitalizations, and 200 deaths. Of the 7,998 outbreaks with a known etiology, 3,633 (45%) were caused by viruses, 3,613 (45%) were caused by bacteria, 685 (5%) were caused by chemical and toxic agents, and 67 (1%) were caused by parasites. Among the 7,724 (58%) outbreaks with an implicated food or contaminated ingredient reported, 3,264 (42%) could be assigned to one of 17 predefined commodity categories: fish, crustaceans, mollusks, dairy, eggs, beef, game, pork, poultry, grains/beans, oils

  14. Emergence of chikungunya seropositivity in healthy Malaysian adults residing in outbreak-free locations: Chikungunya seroprevalence results from the Malaysian Cohort

    Science.gov (United States)

    2013-01-01

    Background In 1998, Malaysia experienced its first chikungunya virus (CHIKV) outbreak in the suburban areas followed by another two in 2006 (rural areas) and 2008 (urban areas), respectively. Nevertheless, there is still a lack of documented data regarding the magnitude of CHIKV exposure in the Malaysian population. The aim of this study was to determine the extent of chikungunya virus infection in healthy Malaysian adults residing in outbreak-free locations. Methods A cross sectional study of chikungunya (CHIK) seroprevalence was carried out in 2009 amongst The Malaysian Cohort participants living in four states (Kuala Lumpur, Selangor, Pahang and Negeri Sembilan). A total of 945 participants were randomly identified for the study. Potential risk factors for CHIK infection were determined via questionnaires, and IgG antibodies against CHIK were detected by an enzyme-linked immunosorbent assay. Logistic regression identified risk factors associated with CHIK seropositivity, while geographical information system was used for visual and spatial analysis. Results From the 945 serum samples tested, 5.9% was positive for CHIK IgG. Being male, Malay, rural occupancy and Negeri Sembilan residency were identified as univariate predictors for CHIK seropositivity, while multivariate analysis identified being male and rural occupancy as risk factors. Conclusions This study provided evidence that CHIK is slowly emerging in Malaysia. Although the current baseline seroprevalence is low in this country, increasing number of CHIK cases reported to the Malaysia Ministry of Health imply the possibility of CHIK virus becoming endemic in Malaysia. PMID:23379541

  15. Selection tool for foodborne norovirus outbreaks.

    Science.gov (United States)

    Verhoef, Linda P B; Kroneman, Annelies; van Duynhoven, Yvonne; Boshuizen, Hendriek; van Pelt, Wilfrid; Koopmans, Marion

    2009-01-01

    Detection of pathogens in the food chain is limited mainly to bacteria, and the globalization of the food industry enables international viral foodborne outbreaks to occur. Outbreaks from 2002 through 2006 recorded in a European norovirus surveillance database were investigated for virologic and epidemiologic indicators of food relatedness. The resulting validated multivariate logistic regression model comparing foodborne (n = 224) and person-to-person (n = 654) outbreaks was used to create a practical web-based tool that can be limited to epidemiologic parameters for nongenotyping countries. Non-genogroup-II.4 outbreaks, higher numbers of cases, and outbreaks in restaurants or households characterized (sensitivity = 0.80, specificity = 0.86) foodborne outbreaks and reduced the percentage of outbreaks requiring source-tracing to 31%. The selection tool enabled prospectively focused follow-up. Use of this tool is likely to improve data quality and strain typing in current surveillance systems, which is necessary for identification of potential international foodborne outbreaks.

  16. Disease Outbreak News

    Science.gov (United States)

    ... MERS-CoV) Pandemic (H1N1) 2009 Influenza at the Human-Animal Interface (HAI) Related documents WHO outbreak communication guide 2008 WHO outbreak communications guidelines Outbreak communication: ...

  17. Outbreaks of paralytic poliomyelitis during 1996-2012: the changing epidemiology of a disease in the final stages of eradication.

    Science.gov (United States)

    Mach, Ondrej; Tangermann, Rudolf H; Wassilak, Steve G; Singh, Simarjit; Sutter, Roland W

    2014-11-01

    Despite substantial progress toward eradication of poliomyelitis, the risk of poliomyelitis outbreaks resulting from virus importations into polio-free areas persists. We reviewed the changing epidemiology of outbreaks in the final stages of the eradication initiative. Available literature on outbreaks of poliomyelitis caused by wild polioviruses between 1996 and 2012 was reviewed. During this period, there were 22 outbreaks involving 39 countries. Outbreaks ranged in size from 1 to 1335 cases. These outbreaks caused 4571 cases, representing 21% of all cases reported during this period. Five outbreaks involved multiple countries. In 76% of outbreaks (16/21) with a known age distribution, cases concentrated among children aged poliomyelitis had not occurred for many years. The changing epidemiology, with cases and higher case-fatality ratios among adults, increased the severity of these outbreaks. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. Human angiostrongyliasis outbreak in Dali, China.

    Directory of Open Access Journals (Sweden)

    Shan Lv

    Full Text Available BACKGROUND: Several angiostrongyliasis outbreaks have been reported in recent years but the disease continues to be neglected in public health circles. We describe an outbreak in Dali, southwest China in order to highlight some key problems for the control of this helminth infection. METHODOLOGY/PRINCIPAL FINDINGS: All available medical records of suspected angiostrongyliasis patients visiting hospitals in Dali in the period 1 October 2007-31 March 2008 were reviewed, and tentative diagnoses of varying strengths were reached according to given sets of criteria. Snails collected from local markets, restaurants and natural habitats were also screened for the presence of Angiostrongylus cantonensis. A total of 33 patients met criteria for infection, and 11 among them were classified as clinically confirmed. An additional eight patients were identified through a surveillance system put in operation in response to the outbreak. The epidemic lasted for 8 months with its peak in February 2008. Of the 33 patients, 97.0% complained of severe headache. 84.8% patients had high eosinophil cell counts either in the peripheral blood or in cerebrospinal fluid (CSF. Three-quarters of the patients were treated with a combination of albendazole and corticosteroids, resulting in significantly improved overall conditions. Twenty-two patients reported the consumption of raw or undercooked snails prior to the onset of the symptoms, and approximately 1.0% of the Pomacea canaliculata snails on sale were found to be infected with A. cantonensis. The snails were also found in certain habitats around Dali but no parasites were detected in these populations. CONCLUSIONS/SIGNIFICANCE: The import and sale of infected P. canaliculata is the likely trigger for this angiostrongyliasis outbreak. Awareness of angiostrongyliasis must be raised, and standardized diagnosis and treatment are needed in order to provide clinicians with a guide to address this disease. Health education

  19. Human angiostrongyliasis outbreak in Dali, China.

    Science.gov (United States)

    Lv, Shan; Zhang, Yi; Chen, Shao-Rong; Wang, Li-Bo; Fang, Wen; Chen, Feng; Jiang, Jin-Yong; Li, Yuan-Lin; Du, Zun-Wei; Zhou, Xiao-Nong

    2009-09-22

    Several angiostrongyliasis outbreaks have been reported in recent years but the disease continues to be neglected in public health circles. We describe an outbreak in Dali, southwest China in order to highlight some key problems for the control of this helminth infection. All available medical records of suspected angiostrongyliasis patients visiting hospitals in Dali in the period 1 October 2007-31 March 2008 were reviewed, and tentative diagnoses of varying strengths were reached according to given sets of criteria. Snails collected from local markets, restaurants and natural habitats were also screened for the presence of Angiostrongylus cantonensis. A total of 33 patients met criteria for infection, and 11 among them were classified as clinically confirmed. An additional eight patients were identified through a surveillance system put in operation in response to the outbreak. The epidemic lasted for 8 months with its peak in February 2008. Of the 33 patients, 97.0% complained of severe headache. 84.8% patients had high eosinophil cell counts either in the peripheral blood or in cerebrospinal fluid (CSF). Three-quarters of the patients were treated with a combination of albendazole and corticosteroids, resulting in significantly improved overall conditions. Twenty-two patients reported the consumption of raw or undercooked snails prior to the onset of the symptoms, and approximately 1.0% of the Pomacea canaliculata snails on sale were found to be infected with A. cantonensis. The snails were also found in certain habitats around Dali but no parasites were detected in these populations. The import and sale of infected P. canaliculata is the likely trigger for this angiostrongyliasis outbreak. Awareness of angiostrongyliasis must be raised, and standardized diagnosis and treatment are needed in order to provide clinicians with a guide to address this disease. Health education campaigns could limit the risk, and a hospital-based surveillance system should be

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

    Science.gov (United States)

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

    2010-08-01

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

  1. Planetary period oscillations in Saturn's magnetosphere: New results from the F-ring and proximal orbits

    Science.gov (United States)

    Provan, G.; Cowley, S. W. H.; Bunce, E. J.; Hunt, G. J.; Dougherty, M. K.

    2017-12-01

    We investigate planetary period oscillations (PPOs) in Saturn's magnetosphere using Cassini magnetic field data during the high cadence ( 7 days) F-ring and proximal orbits. Previous results have shown that there are two PPO systems, one in each hemisphere. Both PPO periods show seasonal dependence, and since mid-2014 the Northern PPO period has been 10.8 h and the Southern PPO period 10.7 h. The beat period of the two oscillations is 45 days. Previous results demonstrated that in the Northern (Southern) polar region only pure Northern (Southern) oscillations can be observed, whilst in the equatorial region both oscillations are present and constructively and destructively interfere over the beat-cycle of the two oscillations. The PPOs are believed to be driven by twin-cell convection patterns in the polar ionosphere/thermosphere regions, with two systems of field-aligned currents transmitting the PPO flows to the magnetospheric plasma.The F-ring and proximal orbits uniquely observe the PPOs over 6 orbits during each PPO beat cycle. This high-cadence data demonstrates that over a beat cycle both the periods and amplitudes of the PPO observed within the each polar region are modulated by the PPO system from the opposite hemisphere. When the two oscillations are in phase (anti-phase) the `drag' of one system on the other acts to decrease (increase) the amplitude of the oscillations and the two PPO periods diverge (converge). We present a theoretical model showing that this coupling is due to the PPO flows from one hemisphere not just being communicated to the magnetosphere as previously assumed, but also to the opposite hemisphere. The result is inter-hemispheric coupling of the PPO flow systems within the ionosphere/thermosphere system, so that the northern PPO system drives a northern twin-cell convection pattern in the southern hemisphere, and vice versa, thus leading to the observed polar modulations of the PPOs.We will also present PPO phase models determined

  2. Disneyland Measles Outbreak

    OpenAIRE

    Palladino, Erica

    2015-01-01

    This media information sheet analyzes print and online coverage of the 2015 Disneyland measles outbreak. The frameworks that the media used to report on the outbreak presented vaccination as the only viable option from preventing the spread of measles. Reporting also failed to mention that the 2015 Disneyland measles outbreak was smaller than U.S. measles outbreaks in 2013 and 2014.

  3. Tres brotes de brucelosis investigados en un año de vigilancia de salud laboral en Ciudad Real Three outbreaks of brucellosis in a one-year period investigated by the occupational health service in Ciudad Real (Spain

    Directory of Open Access Journals (Sweden)

    Juan Castell Monsalve

    2009-12-01

    Full Text Available Presentamos 3 brotes investigados por nuestro servicio de salud laboral en el periodo de 1 año. Dos de ellos, con 2 casos cada uno, en sendas queserías industriales, y el tercero en un laboratorio pecuario perteneciente a la administración autonómica, también con 2 casos. En las 2 queserías se encontraron numerosas oportunidades para que los trabajadores pudieran haberse infectado; se consideró como de mayor riesgo la zona de descarga de leche, y la no utilización de equipos de protección individual por los trabajadores, las deficiencias en los laboratorios y la falta de separación efectiva de las dependencias fueron también potencials factores de riesgo. Respecto al laboratorio pecuario, se hallaron al menos 13 deficiencias importantes que permitían la fácil transmisión del agente infeccioso. En España, el riesgo de adquirir una infección por Brucella en laboratorios o industrias queseras es importante, y las condiciones y medidas para evitarlo que actualmente existen no son efectivas.We describe 3 outbreaks of brucellosis investigated by our Occupational Health Service in a 1-year period. Two of these outbreaks, with 2 cases each, occurred in 2 cheese factories and the third outbreak, also with 2 cases, occurred in a cattle laboratory belonging to the local government. In both cheese factories, numerous opportunities for the workers to become infected were found. The greatest risk was considered to be the area for unloading milk, while failure to use personal protection equipment by workers, deficiencies in the laboratories, and the lack of effective separation between areas were also potential risk factors. In the cattle laboratory, we found at least 13 major risk factors that could allow brucellosis transmission. In Spain, there is a substantial risk of Brucella infection in laboratories or dairy factories and current preventive measures are ineffective.

  4. DYANA campaign results on long-period atmospheric waves over Thumba and Balasore

    Science.gov (United States)

    Reddi, C. Raghava; Rajeev, K.; Nair, S. Muraleedharan; Subbaraya, B. H.; Rama, G. V.; Appu, K. S.; Narayanan, V.; Apparao, B. V.; Chakravarty, S. C.; Nagpal, O. P.; Perov, S. P.; Kokin, G. A.

    1994-12-01

    The variation with altitude of the spectral amplitudes of the long period waves in the middle atmospheric zonal and meridional wind over Thumba (8.5°N, 76.9°E) and Balasore (21.5°N, 86.9°E) have shown clearly the enhanced dissipation of the atmospheric waves in the lower stratosphere and near the stratopause. The amplitudes are, in general, large for the lower frequency ( <0.1 cycles/day) waves in the troposphere. While propagating through the tropopause into the stratosphere and above, waves with periods in the range of 5-10 days suffer less attenuation. The dissipation of the atmospheric waves is found to be relatively large for frequencies below 0.1 cycles/day. The results are compared with earlier observational studies and theoretical computations on the propagation of equatorial waves through the middle atmosphere.

  5. Evolutionary History and Phylogeography of Rabies Viruses Associated with Outbreaks in Trinidad

    OpenAIRE

    Seetahal, Janine F. R.; Velasco-Villa, Andres; Allicock, Orchid M.; Adesiyun, Abiodun A.; Bissessar, Joseph; Amour, Kirk; Phillip-Hosein, Annmarie; Marston, Denise A.; McElhinney, Lorraine M.; Shi, Mang; Wharwood, Cheryl-Ann; Fooks, Anthony R.; Carrington, Christine V. F.

    2013-01-01

    Bat rabies is an emerging disease of public health significance in the Americas. The Caribbean island of Trinidad experiences periodic outbreaks within the livestock population. We performed molecular characterisation of Trinidad rabies virus (RABV) and used a Bayesian phylogeographic approach to investigate the extent to which outbreaks are a result of in situ evolution versus importation of virus from the nearby South American mainland. Trinidadian RABV sequences were confirmed as bat varia...

  6. Communications with Mars During Periods of Solar Conjunction: Initial Study Results

    Science.gov (United States)

    Morabito, D.; Hastrup, R.

    2001-07-01

    During the initial phase of the human exploration of Mars, a reliable communications link to and from Earth will be required. The direct link can easily be maintained during most of the 780-day Earth-Mars synodic period. However, during periods in which the direct Earth-Mars link encounters increased intervening charged particles during superior solar conjunctions of Mars, the resultant effects are expected to corrupt the data signals to varying degrees. The purpose of this article is to explore possible strategies, provide recommendations, and identify options for communicating over this link during periods of solar conjunctions. A significant improvement in telemetry data return can be realized by using the higher frequency 32 GHz (Ka-band), which is less susceptible to solar effects. During the era of the onset of probable human exploration of Mars, six superior conjunctions were identified from 2015 to 2026. For five of these six conjunctions, where the signal source is not occulted by the disk of the Sun, continuous communications with Mars should be achievable. Only during the superior conjunction of 2023 is the signal source at Mars expected to lie behind the disk of the Sun for about one day and within two solar radii (0. 5 deg) for about three days.

  7. Surveillance for waterborne disease outbreaks associated with drinking water---United States, 2007--2008.

    Science.gov (United States)

    Brunkard, Joan M; Ailes, Elizabeth; Roberts, Virginia A; Hill, Vincent; Hilborn, Elizabeth D; Craun, Gunther F; Rajasingham, Anu; Kahler, Amy; Garrison, Laurel; Hicks, Lauri; Carpenter, Joe; Wade, Timothy J; Beach, Michael J; Yoder Msw, Jonathan S

    2011-09-23

    are used to establish research priorities, which can lead to improved water quality regulation development. Approximately two thirds of the outbreaks associated with untreated ground water reported during the 2007--2008 surveillance period occurred in public water systems. When fully implemented, the GWR that was promulgated in 2006 is expected to result in decreases in ground water outbreaks, similar to the decreases observed in surface water outbreaks after enactment of the Surface Water Treatment Rule in 1974 and its subsequent amendments. One third of drinking water--associated outbreaks occurred in building premise plumbing systems outside the jurisdiction of water utility management and EPA regulations; Legionella spp. accounted for >90% of these outbreaks, indicating that greater attention is needed to reduce the risk for legionellosis in building plumbing systems. Finally, a large communitywide drinking water outbreak occurred in 2008 in a public water system associated with a distribution system deficiency, underscoring the importance of maintaining and upgrading drinking water distribution system infrastructure to provide safe water and protect public health.

  8. Polio outbreak investigation and response in Somalia, 2013.

    Science.gov (United States)

    Kamadjeu, Raoul; Mahamud, Abdirahman; Webeck, Jenna; Baranyikwa, Marie Therese; Chatterjee, Anirban; Bile, Yassin Nur; Birungi, Julianne; Mbaeyi, Chukwuma; Mulugeta, Abraham

    2014-11-01

    For >2 decades, conflicts and recurrent natural disasters have maintained Somalia in a chronic humanitarian crisis. For nearly 5 years, 1 million children polio once again. A case of acute flaccid paralysis (AFP) was defined as a child Polio cases were defined as AFP cases with stool specimens positive for WPV. From 9 May to 31 December 2013, 189 cases of WPV type 1 (WPV1) were reported from 46 districts of Somalia; 42% were from Banadir region (Mogadishu), 60% were males, and 93% were polio cases belonged to cluster N5A, which is known to have been circulating in northern Nigeria since 2011. In response to the outbreak, 8 supplementary immunization activities were conducted with oral polio vaccine (OPV; trivalent OPV was used initially, followed subsequently by bivalent OPV) targeting various age groups, including children aged polio outbreak erupted after a polio-free period of >6 years (the last case was reported in March 2007). Somalia interrupted indigenous WPV transmission in 2002, was removed from the list of polio-endemic countries a year later, and has since demonstrated its ability to control polio outbreaks resulting from importation. This outbreak reiterates that the threat of large polio outbreaks resulting from WPV importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  9. An outbreak of Salmonella gastroenteritis in an urban jail.

    Science.gov (United States)

    Alcabes, P; O'Sullivan, B; Nadal, E; Mouzon, M

    1988-12-01

    An outbreak of gastroenteritis in New York City's largest jail involved 145 cases over a two-month period. The outbreak was unusual in that two Salmonella strains (serogroups B and D) were involved. Management of the outbreak involved screening kitchen workers by culture of stool samples, and education regarding personal hygiene. Obstacles to investigation and management of the outbreak arose out of the special nature of the jail environment; these included jurisdictional problems and high turnover of the inmate population.

  10. Clinical characteristics of acute hepatitis A outbreak in Taiwan, 2015-2016: observations from a tertiary medical center.

    Science.gov (United States)

    Chen, Nan-Yu; Liu, Zhuo-Hao; Shie, Shian-Sen; Chen, Tsung-Hsing; Wu, Ting-Shu

    2017-06-20

    Acute hepatitis A is a fecal-oral transmitted disease related to inadequate sanitary conditions. In addition to its traditional classification, several outbreaks in the men who have sex with men (MSM) population have resulted in acute hepatitis A being recognized as a sexually transmitted disease. However, few studies have clarified the clinical manifestations in these outbreaks involving the MSM population. Beginning in June 2015, there was an outbreak of acute hepatitis A involving the MSM population in Northern Taiwan. We conducted a 15-year retrospective study by recruiting 207 patients with the diagnosis of acute hepatitis A that included the pre-outbreak (January 2001 to May 2015) and outbreak (June 2015 to August 2016) periods in a tertiary medical center in Northern Taiwan. Using risk factors, comorbidities, presenting symptoms, laboratory test results and imaging data, we aimed to evaluate the clinical significance of acute hepatitis A in the MSM population, where human immunodeficiency virus (HIV) coinfection is common. There was a higher prevalence of reported MSM (p hepatitis A during the outbreak period. The outbreak population had more prominent systemic symptoms, was more icteric with a higher total bilirubin level (p hepatitis A relapse. The clinical course of acute hepatitis A during an outbreak involving the MSM and HIV-positive population is more symptomatic and protracted than in the general population.

  11. The comparative analysis of results of surgical treatment of myasthenia in the remote periods of disease

    Directory of Open Access Journals (Sweden)

    L. Zaslavsky

    2016-01-01

    Full Text Available Based on long-term follow-up to perform comparative analysis of long-term results of surgical treatment of myasthenia. A retrospective analysis of long-term results of surgical treatment of 146 patients with myasthenia has been carried out. We used the modified Keynes classification to estimate the severity of myasthenia and to summarize the data relating to therapy volume and treatment results. In dependence on the type of thymus lesion patients were divided into two groups. Thymus hyperplasia was verified at — 106 (72.6 % patients, tumor lesion of the thymus gland (thymoma — at 40 (27.4 % ones. The results were estimated in the following periods after thymectomy: 1—2 years, 3—4 years, 5—6 years, 7 — 9 years, 10—14 years, and over 15 years. Short- and longterm results of surgical treatment of myasthenia for the patients without tumor lesions of the thymus gland were significantly better. Positive effects of surgical treatment of myasthenia in patients with hyperplasia are observed after 1 year of surgery (p = 0.0023, and the best results are observed after 5 — 6 year of the disease, then after 7 — 9 year one notes some deterioration of state (p = 0.026. In the myasthenia patients with thymoma one notes the similar trends in dynamics of state, but in general, the results are significantly (p = 0.042 badly than in the group of the patients with hyperplasia. Starting from the first year after operation treatment the patients with myasthenia with thymus hyperplasia have statistically significant (p = 0.048 decrease of average doses of glucocorticoids, and anticholinesterase drugs. The statistically best treatment results were noted for the patients operated at the first year of the disease. Positive result of surgical treatment of myasthenia is noted both in the short- and long-term period and at thymomas. In the group of patients with thymoma one has noted significantly badly results in comparison with group of hyperplasia. It is

  12. Mitigating Infectious Disease Outbreaks

    Science.gov (United States)

    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.

  13. The use of local concentrated heat versus topical acyclovir for a herpes labialis outbreak: results of a pilot study under real life conditions

    Directory of Open Access Journals (Sweden)

    Wohlrab J

    2013-11-01

    Full Text Available Johannes Wohlrab,1 Franziska Voß,2 Christian Müller,2 Lars C Brenn21Department of Dermatology and Venereology, Martin Luther University of Halle-Wittenberg, Halle, 2Department of Medical Science and Operations, Riemser Pharma GmbH, Greifswald, GermanyBackground: Frequent outbreak of herpes labialis can affect quality of life by prodromes like burning, itching, and swelling. Topical applied preparations aim to shorten the duration of symptoms, inhibit the virus replication and/or accelerate the healing process. Local concentrated heat (LCH can reduce burning, itching, or swelling of the skin by influence of mechano-heat sensitive afferent neurons.Patients and methods: To examine the effectiveness of two different topical applications (LCH versus topical acyclovir [TACV] under real life conditions, we conducted a prospective, observational, reference-controlled cohort pilot study with 103 patients. Occurrence of prodromal burning, itching, swelling, and quality of life were assessed.Results: The LCH observation group (OG showed a significantly faster improvement in all symptoms after 1-day of application than the TACV OG. The burden and duration of disease was lower and shorter in the LCH OG than in the TACV OG.Conclusions: The prodromal symptoms in recurrent herpes labialis were attenuated more effectively by LCH than by TACV.Keywords: herpes labialis, local concentrated heat, acyclovir

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

    Science.gov (United States)

    Newkirk, Ryan; Hedberg, Craig; Bender, Jeff

    2011-03-01

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

  15. First archaeointensity results from the historical period of Cambodia, Southeast Asia

    Science.gov (United States)

    Higa, J. T.; Cai, S.; Tauxe, L.; Hendrickson, M.

    2017-12-01

    Understanding variations of the geomagnetic field has applications regarding the behavior of the Earth's outer core, dating of archeological artifacts, and the phenomenon that shields life from solar radiation. However, archaeointensity studies of the Holocene have been mostly limited to localities in Europe and the Middle East; archaeomagnetic surveys from Southeast Asia are almost non-existent. This investigation aims to establish a secular variation curve of geomagnetic field intensity for Cambodia. We sampled ancient iron smelting mounds from the Khmer Empire, located in present day Cambodia, and are analyzing them for paleointensity. The specimens are thought to be from the historical period, likely between 1000-1500 CE. Our samples, which include furnace fragments, iron slag, and ceramic tuyères, contain magnetic minerals that record the paleointensity of Earth's magnetic field at the time it was fired. Using the IZZI paleointensity method (Yu et al., 2004), which gradually replaces the sample's natural remanent magnetization with a thermal remanent magnetization obtained in a known lab field, we can determine the geomagnetic intensities preserved in these specimens. Based on our preliminary experiments, the tuyères, and perhaps also the fresh slag, will in all likelihood yield the most ideal results. Following additional measurements from these best-fit samples, we will determine the paleointensities of Cambodia for the time period from which the artifacts originated. This will commence the establishment of regional geomagnetic reference curves in Southeast Asia and also improve the global model.

  16. Environmental radiation monitoring results for the period 1989-1999 in NAPS region using TLDs

    International Nuclear Information System (INIS)

    Basu, A.S.; Chougaonkar, M.P.; Mayya, Y.S.; Sadasivan, S.; Sharma, L.N.

    2001-06-01

    In this report, we present the results of environmental gamma radiation levels monitored around NAPS region using TLDs. The report gives quarterly environmental radiation monitoring data obtained during the period 1989-'99; i.e. during the operating phase of the reactor. Twenty eight TLD locations were selected within a radius of twenty six km. of which six were within the exclusion zone (radius 1.6 km). The mean gamma radiation level within the exclusion zone has been evaluated as 111 ± 6.6 mR/year and that for locations beyond the exclusion zone as 140 ± 14 mR/year. As these values are well within the corresponding pre-operational general background value of 142 ± 30 mR/year (Basu et. al 1989), it is concluded that the reactor operations have not contributed to any increase in the gamma radiation levels in the environs of the NAPS region. (author)

  17. Ecological consequences of mountain pine beetle outbreaks for wildlife in western North American forests

    Science.gov (United States)

    Saab, Victoria A.; Latif, Quresh S.; Rowland, Mary M.; Johnson, Tracey N.; Chalfoun, Anna D.; Buskirk, Steven W.; Heyward, Joslin E.; Dresser, Matthew A.

    2014-01-01

    outbreaks on red squirrels (Tamiasciurus hudsonicus). However, there is evidence that red squirrels can persist after an outbreak under some conditions, e.g., when nonhost tree species are present. For small mammal species associated with forest understories, responses may be most pronounced during the postepidemic period (>6 years after the peak of beetle-induced tree mortality) when snags fall to produce coarse woody debris. Postoutbreak salvage logging studies (n = 6) reported results that lacked consensus. Postoutbreak salvage logging may have an impact on fewer wildlife species than postfire salvage logging, probably because only host-specific tree species are removed after beetle outbreaks.

  18. Periodic lateralized epileptiform discharges can survive anesthesia and result in asymmetric drug-induced burst suppression

    Directory of Open Access Journals (Sweden)

    Edward C. Mader Jr.

    2017-02-01

    Full Text Available Drug-induced burst suppression (DIBS is bihemispheric and bisymmetric in adults and older children. However, asymmetric DIBS may occur if a pathological process is affecting one hemisphere only or both hemispheres disproportionately. The usual suspect is a destructive lesion; an irritative or epileptogenic lesion is usually not invoked to explain DIBS asymmetry. We report the case of a 66-year-old woman with new-onset seizures who was found to have a hemorrhagic cavernoma and periodic lateralized epileptiform discharges (PLEDs in the right temporal region. After levetiracetam and before anesthetic antiepileptic drugs (AEDs were administered, the electroencephalogram (EEG showed continuous PLEDs over the right hemisphere with maximum voltage in the posterior temporal region. Focal electrographic seizures also occurred occasionally in the same location. Propofol resulted in bihemispheric, but not in bisymmetric, DIBS. Remnants or fragments of PLEDs that survived anesthesia increased the amplitude and complexity of the bursts in the right hemisphere leading to asymmetric DIBS. Phenytoin, lacosamide, ketamine, midazolam, and topiramate were administered at various times in the course of EEG monitoring, resulting in suppression of seizures but not of PLEDs. Ketamine and midazolam reduced the rate, amplitude, and complexity of PLEDs but only after producing substantial attenuation of all burst components. When all anesthetics were discontinued, the EEG reverted to the original preanesthesia pattern with continuous non-fragmented PLEDs. The fact that PLEDs can survive anesthesia and affect DIBS symmetry is a testament to the robustness of the neurodynamic processes underlying PLEDs.

  19. Comparison of Early-period Results of Nasal Splint and Merocel Nasal Packs in Septoplasty

    Science.gov (United States)

    Bingöl, Fatih; Budak, Ali; Şimşek, Eda; Kılıç, Korhan; Bingöl, Buket Özel

    2017-01-01

    Objective Several types of nasal packs are used postoperatively in septoplasty. In this study, we compared two commonly used nasal packing materials, the intranasal septal splint with airway and Merocel tampon, in terms of pain, bleeding, nasal obstruction, eating difficulties, discomfort in sleep, and pain and bleeding during removal of packing in the early period. Methods The study group included 60 patients undergoing septoplasty. Patients were divided into two groups (n=30 in each group). An intranasal splint with airway was used for the patients in the first group after septoplasty, while Merocel nasal packing was used for the second group. Patients were investigated in terms of seven different factors - pain, bleeding while the tampon was in place, nasal obstruction, eating difficulties, night sleep, pain during removal of the nasal packing, and bleeding after removal of packing. Results There was no statistically significant difference between the groups in terms of pain 24 hours after operation (p=0.05), while visual analog scale (VAS) scores for nasal obstruction, night sleep, eating difficulties, and pain during packing removal were lower in the nasal splint group with a statistically significant difference (p<0.05). There was no statistically significant difference between the groups in terms of postoperative bleeding (p=0.23). Significantly less bleeding occurred during removal of the packing in the nasal splint group (p<0.05). Conclusion Our study indicates that the nasal splint was more comfortable and effective in terms of causing lesser bleeding and pain during removal of packing. PMID:29392071

  20. Extensive sequence divergence among bovine respiratory syncytial viruses isolated during recurrent outbreaks in closed herds

    DEFF Research Database (Denmark)

    Larsen, Lars Erik; Tjørnehøj, Kirsten; Viuff, B.

    2000-01-01

    and veal calf production units) in different years and from all confirmed outbreaks in Denmark within a short period. The results showed that identical viruses were isolated within a herd during outbreaks and that viruses from recurrent infections varied by up to 11% in sequence even in closed herds......The nucleotides coding for the extracellular part of the G glycoprotein and the full SH protein of bovine respiratory syncytial virus (BRSV) were sequenced from viruses isolated from numerous outbreaks of BRSV infection. The isolates included viruses isolated from the same herd (closed dairy farms....... It is possible that a quasispecies variant swarm of BRSV persisted in some of the calves in each herd and that a new and different highly fit virus type (master and consensus sequence) became dominant and spread from a single animal in connection with each new outbreak. Based on the high level of diversity...

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

    Science.gov (United States)

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

    2018-03-01

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

  2. Two listeria outbreaks caused by smoked fish consumption-using whole-genome sequencing for outbreak investigations

    DEFF Research Database (Denmark)

    Gillesberg Lassen, S.; Ethelberg, S.; Björkman, J. T.

    2016-01-01

    low-intensity, extended time-period outbreaks and link them to food products from two different contaminated production facilities with sufficient strength for food authorities to intervene on. Cold smoked and gravad fish constitute risk products and may be responsible for more listeriosis cases than......Listeria monocytogenes may contaminate and persist in food production facilities and cause repeated, seemingly sporadic, illnesses over extended periods of time. We report on the investigation of two such concurrent outbreaks. We compared patient isolates and available isolates from foods and food...... polymorphism differences. We performed routine food consumption interviews of L. monocytogenes patients and compared outbreak cases with sporadic cases. Two outbreaks were defined, each consisting of ten outbreak cases in the period 2013-15. Seven outbreak cases and a fetus in gestational week 38 died...

  3. Biology and outbreaks of Microdiprion pallipes (Hymenoptera; Diprionidae) in Sweden

    Energy Technology Data Exchange (ETDEWEB)

    Olofsson, E. (Swedish Univ. of Agricultural Sciences, Uppsala (Sweden). Dept. of Entomology)

    1994-01-01

    During outbreaks, Microdiprion pallipes (Fall.) is the most destructive of the pine sawflies in Sweden. Its distribution includes most provinces, but damaging outbreaks have until recently occurred only in two inland areas in northern Sweden. These areas are characterised by high elevation, a harsh climate, and slow tree growth. The four recorded outbreak periods showed a 10 year periodicity. Outside these areas, a lesser outbreak occurred in 1988 to 1990, on the east coast (province of Uppland). Outbreak patterns, life history variation, and mortality factors were studied. Factors that may explain the distribution of outbreaks and the population patterns were identified.Experimental and observational evidence on the potential of various factors to influence fecundity, dispersal, and survival was evaluated. In the outbreak areas, there were few major population factors. Parasitism by Rhorus substitutor (Thunb.) was the largest cause of larval mortality and the only important density-dependent mortality factor. The different diapause strategies of M. pallipes and R. substitutor may contribute to stabilize this system. Different flight periods of the host and the parasitoid may explain a possible correlation between weather and outbreaks. Elsewhere in Sweden, where low population densities prevail, there may be similarities in population processes between M. pallipes and the other widely distributed diprionids with solitary larvae, which never have attained outbreak densities in Sweden. Interactions with other diprionids through shared natural enemies may be an important population process and may influence the distribution of outbreaks. 37 refs, 4 figs, 11 tabs

  4. Management of Nosocomial Scabies, an Outbreak of Occupational Disease

    NARCIS (Netherlands)

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

    Background The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. Methods We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. Results The

  5. Characteristics of Clusters of Salmonella and Escherichia coli O157 Detected by Pulsed-Field Gel Electrophoresis that Predict Identification of Outbreaks.

    Science.gov (United States)

    Jones, Timothy F; Sashti, Nupur; Ingram, Amanda; Phan, Quyen; Booth, Hillary; Rounds, Joshua; Nicholson, Cyndy S; Cosgrove, Shaun; Crocker, Kia; Gould, L Hannah

    2016-12-01

    Molecular subtyping of pathogens is critical for foodborne disease outbreak detection and investigation. Many clusters initially identified by pulsed-field gel electrophoresis (PFGE) are not confirmed as point-source outbreaks. We evaluated characteristics of clusters that can help prioritize investigations to maximize effective use of limited resources. A multiagency collaboration (FoodNet) collected data on Salmonella and Escherichia coli O157 clusters for 3 years. Cluster size, timing, extent, and nature of epidemiologic investigations were analyzed to determine associations with whether the cluster was identified as a confirmed outbreak. During the 3-year study period, 948 PFGE clusters were identified; 849 (90%) were Salmonella and 99 (10%) were E. coli O157. Of those, 192 (20%) were ultimately identified as outbreaks (154 [18%] of Salmonella and 38 [38%] of E. coli O157 clusters). Successful investigation was significantly associated with larger cluster size, more rapid submission of isolates (e.g., for Salmonella, 6 days for outbreaks vs. 8 days for nonoutbreaks) and PFGE result reporting to investigators (16 days vs. 29 days, respectively), and performance of analytic studies (completed in 33% of Salmonella outbreaks vs. 1% of nonoutbreaks) and environmental investigations (40% and 1%, respectively). Intervals between first and second cases in a cluster did not differ significantly between outbreaks and nonoutbreaks. Molecular subtyping of pathogens is a rapidly advancing technology, and successfully identifying outbreaks will vary by pathogen and methods used. Understanding criteria for successfully investigating outbreaks is critical for efficiently using limited resources.

  6. Rapid control of a methicillin resistant Staphylococcus aureus (MRSA) outbreak in a medical surgical intensive care unit (ICU).

    Science.gov (United States)

    Khan, Anjum; Lampitoc, Marianita; Salaripour, Maryam; McKernan, Patricia; Devlin, Roslyn; Muller, Matthew P

    2009-01-01

    Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can be prolonged and difficult to control. This report describes the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a 24-bed open-concept medical surgical intensive care unit with a baseline methicillin resistant Staphylococcus aureus acquisition rate of 1.5 cases per 1000 patient days. This institution's infection control policy mandates an outbreak investigation if two cases of hospital-acquired methicillin resistant Staphylococcus aureus colonization or infection are identified in an intensive care unit within a four-week period. In July 2007, methicillin resistant Staphylococcus aureus was identified in the sputum of two patients within a one-week period. Screening of all patients in the intensive care unit identified one additional case and a fourth case was identified from a clinical specimen before control measures were implemented. Initial control measures included healthcare worker education, enhanced surveillance, patient cohorting, and enhanced environmental cleaning. Despite these measures, three more cases occurred. All patients were then placed in contact isolation, healthcare workers were screened, and the nursing staff was cohorted. After two weeks without a case, two additional cases were identified. Decolonization of all positive patients was initiated. No further cases occurred over a five-week period and the outbreak was declared over. The outbreak resulted in nine cases of methicillin resistant Staphylococcus aureus colonization (n = 8) or infection (n = 1) over an 11-week period. Only one of 175 healthcare workers was colonized and it was not the outbreak strain. Early detection and the stepwise addition of infection control measures resulted in the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a medical surgical intensive care unit without unit closure. A low threshold of suspicion and

  7. A large outbreak of shigellosis commencing in an internally displaced population, Papua New Guinea, 2013

    Directory of Open Access Journals (Sweden)

    Edwin Benny

    2014-09-01

    Full Text Available Objective: The objective of this study was to investigate a large outbreak of shigellosis in Papua New Guinea that began in a camp for internally displaced persons before spreading throughout the general community. Methods: Outbreak mitigation strategies were implemented in the affected area to curtail the spread of the disease. Data were collected from the surveillance system and analysed by time, place and person. Rectal swab samples were tested by standard culture methods and real-time polymerase chain reaction to determine the etiology of the outbreak. Results: Laboratory analysis at two independent institutions established that the outbreak was caused by Shigella sp., with one strain further characterized as Shigella flexneri serotype 2. Approximately 1200 suspected cases of shigellosis were reported in a two-month period from two townships in Morobe Province, Papua New Guinea. The outbreak resulted in at least five deaths, all in young children. Discussion: This outbreak of shigellosis highlights the threat of enteric diseases to vulnerable populations such as internally displaced persons in Papua New Guinea, as has been observed in other global settings.

  8. Outbreaks of Invasive Kingella kingae Infections in Closed Communities.

    Science.gov (United States)

    Yagupsky, Pablo; Ben-Ami, Yael; Trefler, Ronit; Porat, Nurith

    2016-02-01

    To describe the results of the epidemiologic investigation of outbreaks of invasive Kingella kingae infections among attendees at daycare facilities located in 4 closed communities in Israel. The preschool-aged population of communities with clusters of Kingella cases had oropharyngeal cultures performed. K kingae isolates from infected patients and healthy contacts were genotyped by pulsed field gel electrophoresis to determine the spread of outbreak strains. The affected closed communities (3 military bases and 1 "kibbutz" commune) were characterized by tight social and family networks and intensive mingling. The outbreaks affected 9 of 51 attendees (attack rate: 17.6%) age 8-19 months (median: 12 months), within a 21-day period. Cases included skeletal system infections (n = 8) and bacteremia (n = 1); K kingae isolates were confirmed by the use of blood culture vials and selective media. Clinical presentation was mild and acute-phase reactants were usually normal or only moderately elevated. Thirty out of 55 (54.5%) asymptomatic children carried the outbreak strains. Analysis of the 3 clusters in which the entire preschool-aged population was cultured revealed that 31 of 71 (43.7%) children younger than 24 months of age were colonized with K kingae organisms compared with 8 of 105 (7.6%) older children (P presentation of invasive K kingae infections and the fastidious nature of the organism, a high index of suspicion and use of sensitive detection methods are recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Results of periodic radiohygienic survey of some agricultural products originated in Slovakia in the year 2005

    International Nuclear Information System (INIS)

    Missik, J.; Puskeiler, L.; Miklas, P.

    2006-01-01

    Among other periodic monitoring and surveillance programs of the State Veterinary and Food Administration of Slovak Republic there is also the program Radiohygienic surveillance of agricultural raw, semi-, and final products made in Slovakia. In the year 2005 six commodities were sampled giving a total of 160 samples analysed by HPGe spectrometry for the abundance of man-made radionuclides. Besides 137 Cs no other anthropogenic radionuclide was found in the samples of raw cow milk, raw sheep milk, beef, pork, wild boar, roe deer, red deer and wheat. Highest level of 137 Cs activity was found in the sample of wild boar (32.71 ± 1.88) Bq · kg -1 from the surroundings of Maly Sulin in the district Stara Lubovna. (authors)

  10. Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010

    Science.gov (United States)

    Rieckmann, Andreas; Tamason, Charlotte C.; Gurley, Emily S.; Rod, Naja Hulvej; Jensen, Peter Kjær Mackie

    2018-01-01

    Abstract. Cholera outbreaks in Africa have been attributed to both droughts and floods, but whether the risk of a cholera outbreak is elevated during droughts is unknown. We estimated the risk of cholera outbreaks during droughts and floods compared with drought- and flood-free periods in 40 sub-Saharan African countries during 1990–2010 based on data from Emergency Events Database: the Office of Foreign Disaster Assistance /Centre for Research on the Epidemiology of Disasters International Disaster Database (www.emdat.be). A cholera outbreak was registered in one of every three droughts and one of every 15 floods. We observed an increased incidence rate of cholera outbreaks during drought periods (incidence rate ratio [IRR] = 4.3, 95% confidence interval [CI] = 2.9–7.2) and during flood periods (IRR = 144, 95% CI = 101–208) when compared with drought/flood-free periods. Floods are more strongly associated with cholera outbreaks, yet the prevalence of cholera outbreaks is higher during droughts because of droughts’ long durations. The results suggest that droughts in addition to floods call for increased cholera preparedness. PMID:29512484

  11. Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010.

    Science.gov (United States)

    Rieckmann, Andreas; Tamason, Charlotte C; Gurley, Emily S; Rod, Naja Hulvej; Jensen, Peter Kjær Mackie

    2018-03-05

    An increased risk for cholera was witnessed during both droughts and floods in sub-Saharan Africa; these findings call for increased preparedness and surveillance during droughts in addition to floods. Cholera outbreaks in Africa have been attributed to both droughts and floods, but whether the risk of a cholera outbreak is elevated during droughts is unknown. We estimated the risk of cholera outbreaks during droughts and floods compared with drought- and flood-free periods in 40 sub-Saharan African countries during 1990-2010 based on data from EM-DAT: the OFDA/CRED International Disaster Database (www.emdat.be). A cholera outbreak was registered in one of every three droughts and one of every 15 floods. We observed an increased incidence rate of cholera outbreaks during drought periods (IRR = 4.3, 95% confidence interval [CI] = 2.9-7.2) and during flood periods (IRR = 144, 95% CI = 101-208) when compared with drought/flood-free periods. Floods are more strongly associated with cholera outbreaks, yet the prevalence of cholera outbreaks is higher during droughts because of droughts' long durations. The results suggest that droughts in addition to floods call for increased cholera preparedness.

  12. Polar cap ion beams during periods of northward IMF: Cluster statistical results

    Directory of Open Access Journals (Sweden)

    R. Maggiolo

    2011-05-01

    Full Text Available Above the polar caps and during prolonged periods of northward IMF, the Cluster satellites detect upward accelerated ion beams with energies up to a few keV. They are associated with converging electric field structures indicating that the acceleration is caused by a quasi-static field-aligned electric field that can extend to altitudes higher than 7 RE (Maggiolo et al., 2006; Teste et al., 2007. Using the AMDA science analysis service provided by the Centre de Données de la Physique des Plasmas, we have been able to extract about 200 events of accelerated upgoing ion beams above the polar caps from the Cluster database. Most of these observations are taken at altitudes lower than 7 RE and in the Northern Hemisphere. We investigate the statistical properties of these ion beams. We analyze their geometry, the properties of the plasma populations and of the electric field inside and around the beams, as well as their dependence on solar wind and IMF conditions. We show that ~40 % of the ion beams are collocated with a relatively hot and isotropic plasma population. The density and temperature of the isotropic population are highly variable but suggest that this plasma originates from the plasma sheet. The ion beam properties do not change significantly when the isotropic, hot background population is present. Furthermore, during one single polar cap crossing by Cluster it is possible to detect upgoing ion beams both with and without an accompanying isotropic component. The analysis of the variation of the IMF BZ component prior to the detection of the beams indicates that the delay between a northward/southward turning of IMF and the appearance/disappearance of the beams is respectively ~2 h and 20 min. The observed electrodynamic characteristics of high altitude polar cap ion beams suggest that they are closely connected to polar cap auroral arcs. We discuss the implications of these Cluster observations above the polar cap on the magnetospheric

  13. Determining Factors and Critical Periods in the Formation of Eating Habits: Results from the Habeat Project.

    Science.gov (United States)

    Issanchou, Sylvie

    2017-01-01

    Eating habits form early during childhood and are likely to track until the beginning of adulthood. Thus, understanding the formation of eating habits is important. Consequently, the population targeted in the European project Habeat comprised infants and young children up to 6 years of age. Habeat mainly focused on the qualitative dimension of eating habits with a particular attention on vegetables and to a lesser extent on fruit. Food intake of young children was also studied in 2 challenging situations where overeating may occur and the relation between children's behaviour and feeding parental practices was examined. Key Messages: Habeat found evidence that breastfeeding may facilitate the consumption of vegetables and fruit and a greater variety of healthy foods in later childhood. Introduction of a variety of vegetables at the beginning of the complementary feeding period increases later acceptance of novel foods. Repeated exposure is a powerful mechanism to increase children's intake of a novel vegetable in infants and young children. Offering energy-dense snacks before or after meals should be avoided. Moreover, food should be offered to children in response to their feelings of hunger, and not used as reward for a good behaviour or for any other reason. © 2017 S. Karger AG, Basel.

  14. A large outbreak of shigellosis commencing in an internally displaced population, Papua New Guinea, 2013.

    Science.gov (United States)

    Benny, Edwin; Mesere, Kelly; Pavlin, Boris I; Yakam, Logan; Ford, Rebecca; Yoannes, Mition; Kisa, Debbie; Abdad, Mohammad Y; Menda, Lincoln; Greenhill, Andrew R; Horwood, Paul F

    2014-01-01

    The objective of this study was to investigate a large outbreak of shigellosis in Papua New Guinea that began in a camp for internally displaced persons before spreading throughout the general community. Outbreak mitigation strategies were implemented in the affected area to curtail the spread of the disease. Data were collected from the surveillance system and analysed by time, place and person. Rectal swab samples were tested by standard culture methods and real-time polymerase chain reaction to determine the etiology of the outbreak. Laboratory analysis at two independent institutions established that the outbreak was caused by Shigella sp., with one strain further characterized as Shigella flexneri serotype 2. Approximately 1200 suspected cases of shigellosis were reported in a two-month period from two townships in Morobe Province, Papua New Guinea. The outbreak resulted in at least five deaths, all in young children. This outbreak of shigellosis highlights the threat of enteric diseases to vulnerable populations such as internally displaced persons in Papua New Guinea, as has been observed in other global settings.

  15. Publication Trend of Clinical Trials with Negative Results Funded by Pharmaceutical Industries for the 2007-2012 Period

    Directory of Open Access Journals (Sweden)

    Evert A. Jiménez-Cotes

    2015-01-01

    Full Text Available Abstract: Objective: To evaluate the results of clinical trials financed by the pharmaceutical industries during the period 2007-2012 in a general medical journal. Materials and methods: We performed an observational cross sectional study where originals clinical trials financed by the pharmaceutical industry published between 2007 and 2012 in the journal The New England Journal of Medicine (http://www.nejm.org were reviewed. Trend Chi2 test was used to evaluate the results of studies over the years. A database was created with different variables, identifying the number of publications and the period of greater publishing negatives studies, as well as the medical specialty and pharmaceutical industry funding. Results: 321 clinical trials were analyzed. The Odds Ratio was calculated for each year evaluated, finding a Chi2 of linear trend in negatives studies of 2.91 with value p 0.08 and positive studies of 1.16 with value p 0.28. It was found that in the period 2007-2009 123 studies were published, 40 % of which presented negative results; unlike the 2010-2012 period in which 198 clinical trials where published, 142 of them, showed positive results, OR 1.68, 95 % CI (1.02-2.78 value p 0.03. The highest figures of negative results were published in 2007: 44.7 %. Conclusions: A progressive decrease in the number of publications with annual general negative results has been observed. A statistically significant difference in the publication of negative studies per year was not found between the periods 2007-2012. The medical specialty that showed the largest number of total and negative publications in both periods was cardiology. The pharmaceutical industry that sponsored most total clinical trials with negative results in both periods did so through Merck, Glaxo SmithKline, and Sanofi-Aventis. 50% of neurology publications showed negative results.

  16. Operation results of 3-rd generation nuclear fuel WWER-440 in initial period

    International Nuclear Information System (INIS)

    Adeev, V.; Panov, A.

    2011-01-01

    On unit 4 of Kola NPP trial operation of 3-rd generation's fuel began in 2010. Fuel assemblies of 3-rd generation (FA-3) have a number of design features that provide better operational characteristics. Concise description of a design and the basic advantages of fuel of 3-rd generation are described in articles. Increasing of efficiency of nuclear fuel usage will be achieved by reduction of the parasitic capture of thermal neutrons in constructional materials (weight of zirconium is reduced), optimization of uranium-water relation (increase in fuel elements step), increasing of uranium loading (usage of fuel pellets with increased diameter and without central hole in them). By results of trial operation mass transition to use of given type of assemblies in WWER-440 is possible. This report presents the basic outcomes of the trial operation, a brief survey of the obtained data. The basic characteristics of the reactor core with fuel of 3-rd generation are resulted in work. (authors)

  17. Willingness to pay for an Ebola vaccine during the 2014-2016 ebola outbreak in West Africa: Results from a U.S. National sample.

    Science.gov (United States)

    Painter, Julia E; von Fricken, Michael E; Viana de O Mesquita, Suyane; DiClemente, Ralph J

    2018-01-15

    The 2014-2016 Ebola virus outbreak in West Africa led to advances in the development of vaccines against Ebola. This study examined factors associated with willingness to pay for an Ebola vaccine among a U.S. national sample during the recent Ebola outbreak. From April 30-May 8, 2015, a national survey was conducted using the GfK Group's KnowlegePanel®. Main outcome measures included willingness to pay at least $1; more than $50; and more than $100 for an Ebola vaccine. Analyses were conducted using weighted multivariable logistic regression. Among participants (N = 1,447), 583 (40.3%) would not pay for an Ebola vaccine; 864 (59.7%) would pay at least $1. Among those willing to pay at least $1: 570 (66.0%) would pay $1-50; 174 (20.1%) would pay $51-100; and 120 (13.9%) would pay more than $100. Willingness to pay at least $1 for an Ebola vaccine was associated with international travel; interest in getting an Ebola vaccine; and beliefs that the U.S. government should spend money to control Ebola and assume worldwide leadership in confronting emerging epidemics. Willingness to pay more than $50 was associated with similar variables. Willingness to pay more than $100 was associated with international travel; interest in getting an Ebola vaccine; information seeking; and beliefs that the U.S. government should assume worldwide leadership in confronting emerging epidemics. International travel and interest in an Ebola vaccine were key predictors of willingness to pay across all price points. Understanding willingness to pay for vaccines against emerging infectious diseases remains critical.

  18. Early Period Results and Clinical Characteristics of Upper Gastrointestinal Endoscopy in Sivrihisar State Hospital

    Directory of Open Access Journals (Sweden)

    Ozgur Turk

    2014-12-01

    Full Text Available Aim: Our aim was to identify the characteristics of the patient that performed upper gastrointestinal endoscopy in a new established endoscopy unit of a state hospital. We want to present the spectrum of gastrointestinal diseases in our hospitals region. Material and Method: We analyzed patients upper endoscopy results according to age, sex, complaints, clinical characteristics, type of anesthesia, and the necessity of biopsy. We reviewed 256 patients data between 2013 December-2014 July. All endoscopies were performed by same surgeon. Results: The highest complaint was epigastric pain (n=112, 43, 8%. Other complaints were followed as dyspepsia (n=84, 32.8%, heartburn (n=42, 16.4%, nausea (n=4, 1.6%, vomiting (n=2, 0.8%, dysphagia (n=6, 2.3%. We determined 218 gastritis (85.2%, 64 hiatal hernia (25%, 120 esophagitis (46.9%, 76 duodenitis (29.7%, 4 gastric ulcer (1.6%, 18 duodenal ulcers (7%, 20 bile reflux (7.8%, 26 Gastro esophageal reflux disease (GERD in patients (10.2%. 10 patients reported as normal (3.9%. Biopsy was performed in 186 of the patients. Discussion: Endoscopy can become an early diagnostic examination by increasing the availability of endoscopy. Also alarm symptoms should not be ignored and endoscopy should perform immediately in symptomatic patients. As an early result of upper gastrointestinal endoscopies that performed in this study; gastritis, esophagitis, duodenitis and hiatal hernia are common gastrointestinal diseases in our region.

  19. Amphetamines and cannabinoids testing in hair: Evaluation of results from a two-year period.

    Science.gov (United States)

    Burgueño, María José; Alonso, Amaya; Sánchez, Sergio

    2016-08-01

    This paper presents an overview of a set of amphetamines and cannabinoids tests performed on head hair samples from the Medico-Legal sector at the Madrid Department of the Spanish National Institute of Toxicology and Forensic Sciences during the years 2013 and 2014. The hair samples were tested for five stimulant phenylalkylamine derivatives -amphetamine (AP), methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxy-amphetamine (MDA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA)- and/or two cannabinoids-Δ(9)-tetrahydrocannabinol (THC) and cannabinol (CBN)- by gas chromatography equipped with mass spectrometry detection in selected-ion monitoring mode, applying a method accredited to ISO/IEC 17025 standards. The test results were interpreted according to the confirmation cut-offs proposed by the Society of Hair Testing (SoHT) to identify chronic drug use. The ratios of positive results were studied in relation to gender, age, hair colour, dyeing and length of the tested samples to assess the independence from these variables or the association with them. Low, medium and high ranges of concentration were also estimated for each drug. 21.94% of the 2954 hair samples tested for phenylalkylamine derivatives were positive for one or more substances. 16.38% of the samples were positive for AP, 12.09% for MDMA and only 0.44% for MA. 6.60% of the tested samples were positive for AP/MDMA combination. A total of 3178 samples were tested for cannabinoids, resulting in 53.40% positive for THC and CBN. Simultaneous tests for phenylalkylamine derivatives and cannabinoids were performed in 2931 of the samples; 14.94% of them were positive for THC, CBN, and one or more amphetamines. According to the results from the statistical analysis, the use of THC and MDMA vary with age and gender among the Medico-Legal sector in an extended area of Spain, while the use of AP appears to be independent of these variables. On the other hand, the results of THC in

  20. Some results of periodical analysis of the behavior of unit 4 at the Dukovany NPP - II

    International Nuclear Information System (INIS)

    Jirsa, P.

    1993-01-01

    The results of a detailed spectral analysis of noise signals recorded at the unit 4 reactor of the Dukovany NPP during and after the start-up stage are presented. The changes in the noise source signal spectra during the start-up and in normal operation were evaluated by multidimensional autoregression analysis. The temperature dependence of the signal spectra peaks from individual detectors is described. The sources of the peaks at 27.9 and 37 Hz during normal operation were identified as standing pressure waves in the primary circuit of the reactor. 3 tabs., 23 figs., 6 refs

  1. Research on the maximum utilization of PSR (Periodic Safety Review) results

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Myung; Lee, Jae Kyung; Ahn, Jin Chul; Kim, G. U.; Ryu, Y. S.; Lee, G. B.; Park, D. H. [Chungju Univ., Cheongju (Korea, Republic of)

    2002-03-15

    This is the final report of 'research on the maximum utilization of PSR results' focused on linkage strategy of PSR with continued operation over design life of operating NPP. Study was mace mainly on the analysis of current status of continued operation over plant design life in foreign countries, analysis of domestic PSR implementation status and establishment of basic strategy for linking PSR with continued operation. The results of the study performed so far can be summarized as below, the recent worldwide trend of promoting efficiency of NPP operation is focused on life extension of the plants rather than building of new. Considering the fact that some developed countries have already implemented the plant life extension and not a few countries at least have invested a good amount of fund for R and D of plant life management, we can not disregard the owner's request for review of life extension application without any reasonable description. As a result of investigation and analysis for the current status of continued operation over plant design life in foreign countries, it is concluded that most countries tend to link PSR with continued operation over plant design life and the extended operation has already been implemented in some developed countries. From the point, it turned out to be more desirable to couple those two systems for continued operation over plant design life of Korean NPP. A less than 7 years left until the end of design life for the oldest NPP Kori unit 1, it is strongly recommended to establish institutional frame including a legal basis and regulatory guidelines for continued operation over plant design life before long. For the prioritization methods of corrective actions in consideration of safety significance of shortcomings picked up from PSR, some related systems are reviewed including IAEA guidelines, PSR implementation experience of UK and US prioritization system for GSI (Generic Safety Issue). Basic principles are

  2. He+ dominance in the plasmasphere during geomagnetically disturbed periods: 1. Observational results

    Directory of Open Access Journals (Sweden)

    C. R. Wilford

    Full Text Available Observations made by the DMSP F10 satellite during the recovery phase from geomagnetic disturbances in June 1991 show regions of He+ dominance around 830 km altitude at 09:00 MLT. These regions are co-located with a trough in ionisation observed around 55° in the winter hemisphere. Plasma temperature and concentration observations made during the severe geomagnetic storm of 24 March 1991 are used as a case study to determine the effects of geomagnetic disturbances along the orbit of the F10 satellite. Previous explanations for He+ dominance in this trough region relate to the part of the respective flux tubes that is in darkness. Such conditions are not relevant for this study, since the whole of the respective flux tubes are sunlit. A new mechanism is proposed to explain the He+ dominance in the trough region. This mechanism is based on plasma transport and chemical reaction effects in the F-region and topside ionosphere, and on the time scales for such chemical reactions. Flux tubes previously depleted by geomagnetic storm effects refill during the recovery phase from the ionosphere as a result of pressure differences along the flux tubes. Following a geomagnetic disturbance, the He+ ion recovers quickly via the rapid photoionisation of neutral helium, in the F-region and the topside. The recovery of the O+ and H+ ions is less rapid. This is proposed as a result of the respective charge exchange reactions with neutral atomic hydrogen and oxygen. Preliminary model calculations support the proposed mechanism.Key words. Magnetospheric physics (storms and sub-storms, plasmasphere

  3. EPIDEMIOLOGY OF CHOLERA OUTBREAK IN KAMPALA ...

    African Journals Online (AJOL)

    hi-tech

    77 No. 7 July 2000. EPIDEMIOLOGY OF CHOLERA OUTBREAK IN KAMPALA, UGANDA ... spread much (106 cases in 1995), resulting in a low level of immunity ... An intensive social ... development of a network of community health workers,.

  4. Outbreaks of infections associated with drug diversion by US health care personnel.

    Science.gov (United States)

    Schaefer, Melissa K; Perz, Joseph F

    2014-07-01

    To summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions. We reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation. We identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing. These outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to

  5. Climate Teleconnections and Recent Patterns of Human and Animal Disease Outbreaks

    Science.gov (United States)

    Anyamba, Assaf; Linthicum, Kenneth J.; Small, Jennifer L.; Collins, Katherine M.; Tucker, Compton J.; Pak, Edwin W.; Britch, Seth C.; Eastman, James Ronald; Pinzon, Jorge E.; Russell, Kevin L.

    2011-01-01

    Recent clusters of outbreaks of mosquito-borne diseases (Rift Valley fever and chikungunya) in Africa and parts of the Indian Ocean islands illustrate how interannual climate variability influences the changing risk patterns of disease outbreaks. Extremes in rainfall (drought and flood) during the period 2004 - 2009 have privileged different disease vectors. Chikungunya outbreaks occurred during the severe drought from late 2004 to 2006 over coastal East Africa and the western Indian Ocean islands and in the later years India and Southeast Asia. The chikungunya pandemic was caused by a Central/East African genotype that appears to have been precipitated and then enhanced by global-scale and regional climate conditions in these regions. Outbreaks of Rift Valley fever occurred following excessive rainfall period from late 2006 to late 2007 in East Africa and Sudan, and then in 2008 - 2009 in Southern Africa. The shift in the outbreak patterns of Rift Valley fever from East Africa to Southern Africa followed a transition of the El Nino/Southern Oscillation (ENSO) phenomena from the warm El Nino phase (2006-2007) to the cold La Nina phase (2007-2009) and associated patterns of variability in the greater Indian Ocean basin that result in the displacement of the centres of above normal rainfall from Eastern to Southern Africa. Understanding the background patterns of climate variability both at global and regional scale and their impacts on ecological drivers of vector borne-diseases is critical in long-range planning of appropriate response and mitigation measures.

  6. Rift Valley Fever Outbreaks in Mauritania and Related Environmental Conditions

    Directory of Open Access Journals (Sweden)

    Cyril Caminade

    2014-01-01

    Full Text Available Four large outbreaks of Rift Valley Fever (RVF occurred in Mauritania in 1998, 2003, 2010 and 2012 which caused lots of animal and several human deaths. We investigated rainfall and vegetation conditions that might have impacted on RVF transmission over the affected regions. Our results corroborate that RVF transmission generally occurs during the months of September and October in Mauritania, similarly to Senegal. The four outbreaks were preceded by a rainless period lasting at least a week followed by heavy precipitation that took place during the second half of the rainy season. First human infections were generally reported three to five weeks later. By bridging the gap between meteorological forecasting centers and veterinary services, an early warning system might be developed in Senegal and Mauritania to warn decision makers and health services about the upcoming RVF risk.

  7. Faster Detection of Poliomyelitis Outbreaks to Support Polio Eradication.

    Science.gov (United States)

    Blake, Isobel M; Chenoweth, Paul; Okayasu, Hiro; Donnelly, Christl A; Aylward, R Bruce; Grassly, Nicholas C

    2016-03-01

    As the global eradication of poliomyelitis approaches the final stages, prompt detection of new outbreaks is critical to enable a fast and effective outbreak response. Surveillance relies on reporting of acute flaccid paralysis (AFP) cases and laboratory confirmation through isolation of poliovirus from stool. However, delayed sample collection and testing can delay outbreak detection. We investigated whether weekly testing for clusters of AFP by location and time, using the Kulldorff scan statistic, could provide an early warning for outbreaks in 20 countries. A mixed-effects regression model was used to predict background rates of nonpolio AFP at the district level. In Tajikistan and Congo, testing for AFP clusters would have resulted in an outbreak warning 39 and 11 days, respectively, before official confirmation of large outbreaks. This method has relatively high specificity and could be integrated into the current polio information system to support rapid outbreak response activities.

  8. Outbreaks and Investigations

    Science.gov (United States)

    ... Who Gets Fungal Infections? People living with HIV/AIDS Organ Transplant Patients Cancer Patients Hospitalized Patients Stem Cell Transplant Patients Medications that Weaken Your Immune System Outbreaks Rhizopus Investigation CDC at Work Global Fungal Diseases Cryptococcal Meningitis ...

  9. Investigating Listeria Outbreaks

    Centers for Disease Control (CDC) Podcasts

    Dr. Emily Cartwright, Infectious Disease fellow at Emory University and former EIS Officer with CDC’s Division of Foodborne, Waterborne, and Environmental Diseases discusses foodborne Listeria outbreaks.

  10. National Outbreak Reporting System

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Outbreak Reporting System (NORS) is a web-based platform designed to support reporting to CDC by local, state, and territorial health departments in the...

  11. Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT).

    Science.gov (United States)

    Hoertel, Nicolas; López, Saioa; Peyre, Hugo; Wall, Melanie M; González-Pinto, Ana; Limosin, Frédéric; Blanco, Carlos

    2015-02-01

    Whether there are systematic differences in depression symptom expression during pregnancy, the postpartum period and outside these periods (i.e., outside the peripartum period) remains debated. The aim of this study was to use methods based on item response theory (IRT) to examine, after equating for depression severity, differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) in women of childbearing age (i.e., aged 18-50) during pregnancy, the postpartum period and outside the peripartum period. We conducted these analyses using a large, nationally representative sample of women of childbearing age from the United States (n = 11,256) who participated in the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The overall 12-month prevalence of all depressive criteria (except for worthlessness/guilt) was significantly lower in pregnant women than in women of childbearing age outside the peripartum period, whereas the prevalence of all symptoms (except for "psychomotor symptoms") was not significantly different between the postpartum and the nonperipartum group. There were no clinically significant differences in the endorsement rates of symptoms of MDE by pregnancy status when equating for levels of depression severity. This study suggests that the clinical presentation of depressive symptoms in women of childbearing age does not differ during pregnancy, the postpartum period and outside the peripartum period. These findings do not provide psychometric support for the inclusion of the peripartum onset specifier for major depressive disorder in the DSM-5. © 2014 Wiley Periodicals, Inc.

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

    Science.gov (United States)

    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.

  13. Nosocomial outbreak of cryptosporidiosis in AIDS patients

    DEFF Research Database (Denmark)

    Ravn, Pernille; Lundgren, Jens Dilling; Kjaeldgaard, P

    1991-01-01

    admitted as inpatients during the transmission period of the outbreak (20 June-14 August), of whom 18 (17 with AIDS, one with AIDS related complex), developed cryptosporidiosis. Two further HIV negative subjects (one departmental secretary, one visiting relative) developed cryptosporidiosis. MAIN OUTCOME...

  14. Predicting Rift Valley Fever Inter-epidemic Activities and Outbreak Patterns: Insights from a Stochastic Host-Vector Model.

    Directory of Open Access Journals (Sweden)

    Sansao A Pedro

    2016-12-01

    Full Text Available Rift Valley fever (RVF outbreaks are recurrent, occurring at irregular intervals of up to 15 years at least in East Africa. Between outbreaks disease inter-epidemic activities exist and occur at low levels and are maintained by female Aedes mcintoshi mosquitoes which transmit the virus to their eggs leading to disease persistence during unfavourable seasons. Here we formulate and analyse a full stochastic host-vector model with two routes of transmission: vertical and horizontal. By applying branching process theory we establish novel relationships between the basic reproduction number, R0, vertical transmission and the invasion and extinction probabilities. Optimum climatic conditions and presence of mosquitoes have not fully explained the irregular oscillatory behaviour of RVF outbreaks. Using our model without seasonality and applying van Kampen system-size expansion techniques, we provide an analytical expression for the spectrum of stochastic fluctuations, revealing how outbreaks multi-year periodicity varies with the vertical transmission. Our theory predicts complex fluctuations with a dominant period of 1 to 10 years which essentially depends on the efficiency of vertical transmission. Our predictions are then compared to temporal patterns of disease outbreaks in Tanzania, Kenya and South Africa. Our analyses show that interaction between nonlinearity, stochasticity and vertical transmission provides a simple but plausible explanation for the irregular oscillatory nature of RVF outbreaks. Therefore, we argue that while rainfall might be the major determinant for the onset and switch-off of an outbreak, the occurrence of a particular outbreak is also a result of a build up phenomena that is correlated to vertical transmission efficiency.

  15. Swine flu - A pandemic outbreak

    Directory of Open Access Journals (Sweden)

    Jini George

    Full Text Available Hippocrates had described influenza like outbreak in 412 B.C. and since then repeated influenza like epidemics and pandemics have been recorded in recent times. One of the greatest killers of all time was the pandemic of swine flu (Spanish flu of 1918-1919, when 230 million people died. Annual influenza epidemics are estimated to affect 5–15% of the global population, resulting in severe illness in 3–5 million patients causing 250,000–500,000 deaths worldwide. Severe illness and deaths occur mainly in the high-risk populations of infants, the elderly and chronically ill patients. The 2009 outbreak of swine flu is thought to be a mutation more specifically a reassortment of four known strains of influenza A virus subtype H1N1; one endemic in humans, one endemic in birds, and two endemic in pigs. WHO officially declared the outbreak to be a pandemic on June 11, 2009, but stressed that the new designation was a result of the global "spread of the virus," not its severity. [Vet World 2009; 2(12.000: 472-474

  16. Results of evaluation of periodic safety review for No. 1 plant in Mihama Power Station, Kansai Electric Power Co., Inc

    International Nuclear Information System (INIS)

    1994-01-01

    No. 1 plant in Mihama Power Station started the commercial power generation in November, 1970, and has continued the operation for more than 23 years. During this period, the counter measures to troubles, periodic inspections and the maintenance by the electric power company have been carried out. These states of No. 1 plant in Mihama Power Station for more than 23 years are to be recollected from the view-points of the comprehensive evaluation of operation experiences and the reflection of latest technological knowledge, and the safety and reliability are to be further improved in the periodic safety review. Agency of Natural Resources and Energy evaluated the report of the periodic safety review for No. 1 plant in Mihama Power Station made by Kansai Electric Power Co., and summarized the results. The course of the evaluation of the report is shown. The facility utilization factor is 43.3% on the average of about 23 years, but in the last 10 years, it was improved to 69.4%. In the last five years, the rate of occurrence of unexpected shutoff was 0.6 times/year. These are the results of preventive maintenance and the improvement of the facilities and operation management. Operation management, maintenance management, fuel management, radiation control, and radioactive waste management have been carried out properly. The work plan for preventing disasters was established, and the experience of troubles and the latest technological knowledge were well reflected to improve the safety. (K.I.)

  17. [Waterborne diseases outbreaks in the Czech Republic, 1995-2005].

    Science.gov (United States)

    Kozísek, F; Jeligová, H; Dvoráková, A

    2009-08-01

    Despite considerable advances in drinking water safety assurance and adherence to the public health standards, waterborne diaseases outbreaks have still been observed even in industrialized countries. The study objective was to map such outbreaks in the Czech Republic in 1995-2005. In this study, an outbreak is the occurrence of more cases of disease than normally expected within a specific place over a given period of time and a waterborne disease is a disease where water is the vehicle or source of infection. The data on waterborne outbreaks was obtained from the EPIDAT database (national infectious diseases reporting system) information provided by epidemiologists of all regional public health authorities and the National Reference Laboratory for Legionella. In 1995 - 2005, 33 outbreaks with water indicated as the route of transmission were recorded in the Czech Republic. The leading cause was unsafe drinking water (27 outbreaks), mainly from wells (19 outbreaks); nevertheless, the most serious consequences were observed in two outbreaks caused by microbiologically contaminated hot water. Other sources of waterborne infection were mineral water springs, a swimming pool and a brook. The total of reported cases of waterborne diseases was 1655, 356 hospitalisations and ten deaths due to legionellosis were recorded. The highest number of outbreaks (7) as well as the highest number of cases (841) were reported in 1997. Comparison of two five-year periods, i.e. 1996-2000 and 2001-2005, showed a nearly one third decrease in the total of outbreaks and a half reduction in the total of cases in the latter. In view of the limited length of monitoring, it is not possible to say with certainty whether it is a random distribution or an actual trend. Almost two thirds of cases were diagnosed as acute gastroenteritis of probable infectious origin and other frequent waterborne diseases were viral hepatitis A and bacillary dysentery. When analyzing the described outbreaks, it

  18. A statistical model of the international spread of wild poliovirus in Africa used to predict and prevent outbreaks.

    Directory of Open Access Journals (Sweden)

    Kathleen M O'Reilly

    2011-10-01

    Full Text Available Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 2003-2009, and have limited the ability of the program to focus on endemic countries. A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication.Children with poliomyelitis in Africa from 1 January 2003 to 31 December 2010 were identified through routine surveillance of cases of acute flaccid paralysis, and separate outbreaks associated with importation of wild-type poliovirus were defined using the genetic relatedness of these viruses in the VP1/2A region. Potential explanatory variables were examined for their association with the number, size, and duration of poliomyelitis outbreaks in 6-mo periods using multivariable regression analysis. The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. A total of 142 genetically distinct outbreaks of poliomyelitis were recorded in 25 African countries, resulting in 1-228 cases (median of two cases. The estimated number of people arriving from infected countries and <5-y childhood mortality were independently associated with the number of outbreaks. Immunisation coverage based on the reported vaccination history of children with non-polio acute flaccid paralysis was associated with the duration and size of each outbreak, as well as the number of outbreaks. Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%.Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries. From 1 January 2010 to 30 June 2011, reduced transmission in Nigeria and increased incidence in reinfected

  19. Syndromic surveillance for local outbreaks of lower-respiratory infections: would it work?

    Directory of Open Access Journals (Sweden)

    Cees C van den Wijngaard

    2010-04-01

    knowledge this is the first study that systematically evaluates the performance of space-time syndromic surveillance with nationwide high coverage data over a longer period. The results show that syndromic surveillance can detect local LRI-outbreaks in a timely manner, independent of laboratory-based outbreak detection. Furthermore, since comparatively few new clusters per year were observed that would prompt investigation, syndromic hospital-surveillance could be a valuable tool for detection of local LRI-outbreaks.

  20. Protracted outbreak of S. Enteritidis PT 21c in a large Hamburg nursing home

    Directory of Open Access Journals (Sweden)

    Domke Paul-Gerhard

    2007-09-01

    Full Text Available Abstract Background During August 2006, a protracted outbreak of Salmonella (S. Enteritidis infections in a large Hamburg nursing home was investigated. Methods A site visit of the home was conducted and food suppliers' premises tested for Salmonella. Among nursing home residents a cohort study was carried out focusing on foods consumed in the three days before the first part of the outbreak. Instead of relying on residents' memory, data from the home's patient food ordering system was used as exposure data. S. Enteritidis isolates from patients and suspected food vehicles were phage typed and compared. Results Within a population of 822 nursing home residents, 94 case patients among residents (1 fatality and 17 among staff members were counted 6 through 29 August. The outbreak peaked 7 through 9 August, two days after a spell of very warm summer weather. S. Enteritidis was consistently recovered from patients' stools throughout the outbreak. Among the food items served during 5 through 7 August, the cohort study pointed to afternoon cake on all three days as potential risk factors for disease. Investigation of the bakery supplying the cake yielded S. Enteritidis from cakes sampled 31 August. Comparison of the isolates by phage typing demonstrated both isolates from patients and the cake to be the exceedingly rare phage type 21c. Conclusion Cake (various types served on various days contaminated with S. Enteritidis were the likely vehicle of the outbreak in the nursing home. While the cakes were probably contaminated with low pathogen dose throughout the outbreak period, high ambient summer temperatures and failure to keep the cake refrigerated led to high pathogen dose in cake on some days and in some of the housing units. This would explain the initial peak of cases, but also the drawn out nature of the outbreak with cases until the end of August. Suggestions are made to nursing homes, aiding in outbreak prevention. Early outbreak detection is

  1. Identifying the pattern of molecular evolution for Zaire ebolavirus in the 2014 outbreak in West Africa.

    Science.gov (United States)

    Liu, Si-Qing; Deng, Cheng-Lin; Yuan, Zhi-Ming; Rayner, Simon; Zhang, Bo

    2015-06-01

    The current Ebola virus disease (EVD) epidemic has killed more than all previous Ebola outbreaks combined and, even as efforts appear to be bringing the outbreak under control, the threat of reemergence remains. The availability of new whole-genome sequences from West Africa in 2014 outbreak, together with those from the earlier outbreaks, provide an opportunity to investigate the genetic characteristics, the epidemiological dynamics and the evolutionary history for Zaire ebolavirus (ZEBOV). To investigate the evolutionary properties of ZEBOV in this outbreak, we examined amino acid mutations, positive selection, and evolutionary rates on the basis of 123 ZEBOV genome sequences. The estimated phylogenetic relationships within ZEBOV revealed that viral sequences from the same period or location formed a distinct cluster. The West Africa viruses probably derived from Middle Africa, consistent with results from previous studies. Analysis of the seven protein regions of ZEBOV revealed evidence of positive selection acting on the GP and L genes. Interestingly, all putatively positive-selected sites identified in the GP are located within the mucin-like domain of the solved structure of the protein, suggesting a possible role in the immune evasion properties of ZEBOV. Compared with earlier outbreaks, the evolutionary rate of GP gene was estimated to significantly accelerate in the 2014 outbreak, suggesting that more ZEBOV variants are generated for human to human transmission during this sweeping epidemic. However, a more balanced sample set and next generation sequencing datasets would help achieve a clearer understanding at the genetic level of how the virus is evolving and adapting to new conditions. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Nina Katharina Stock

    Full Text Available 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.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.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.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.

  3. Salmonellosis outbreak due to chicken contact leading to a foodborne outbreak associated with infected delicatessen workers.

    Science.gov (United States)

    Hedican, Erin; Miller, Ben; Ziemer, Brian; LeMaster, Pam; Jawahir, Selina; Leano, Fe; Smith, Kirk

    2010-08-01

    Salmonella is the most common bacterial cause of foodborne outbreaks in the United States. Starting in June 2007, investigation of a cluster of Salmonella Montevideo cases with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns resulted in the identification of an outbreak associated with contact with chickens purchased from a single hatchery. Nine Minnesota cases from May through August 2007 were part of this outbreak. Cases with the outbreak PFGE pattern of Salmonella Montevideo continued to occur in Minnesota after August, but none of these cases reported chicken contact. The majority of these cases resided in the same town in rural Minnesota. Routine interviews revealed that all cases from these counties purchased groceries from the same local grocery store, with two specifically reporting consuming items from the grocery store delicatessen in the week before illness. As a result, an investigation into the delicatessen was initiated. Illness histories and stool samples were collected from all delicatessen employees, and food and environmental samples were collected. None of the employees reported experiencing recent gastrointestinal symptoms, but the outbreak PFGE subtype of Salmonella Montevideo was identified from stool from two food workers. Food and environmental samples collected tested negative for Salmonella. One of the positive employees reported having chickens at home, but the animals did not test positive for Salmonella. The positive food workers were excluded from work until they had two consecutive negative stool cultures for Salmonella. There was no evidence of ongoing transmission thereafter. This was an outbreak of Salmonella Montevideo infections that began as an animal-contact-associated outbreak which subsequently resulted in a foodborne outbreak associated with infected food workers. These outbreaks illustrate the complex epidemiology of salmonellosis.

  4. Results of the ARN participation in the quality assessment program of the EML-DOE during period 2000-2001

    International Nuclear Information System (INIS)

    Equillor, Hugo E.; Serdeiro, Nelida H.; Fernandez, Jorge A.; Gavini, Ricardo M.; Grinman, Ana D.R.; Lewis, Esther C.; Medici, Marcela A.; Palacios, Miguel A.; Diodati, Jorge M.

    2003-01-01

    The Nuclear Regulatory Authority (ARN) participates every six months in the Quality Assessment Program (QAP), carried out by the Environmental Measurements Laboratory - United States Department Of Energy (EML-USDOE). The aim of this participation is to assess the quality of the radiochemical determinations and alpha, beta, gamma measurements, that ARN realises routinely. The analysed matrix are: water, filter, soil and vegetable. In the present work, the results of the ARN participation in the last four intercomparisons, period 2000-2001, are detailed and analysed statistically. The results are compared with obtained ones by all the laboratories. (author)

  5. An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Swapna Mali

    2017-01-01

    Full Text Available Introduction: Burkholderia cepacia complex (Bcc has emerged as a serious nosocomial pathogen worldwide especially in patients with indwelling catheters and cystic fibrosis. Bcc is a common contaminant of pharmaceutical products. We describe an outbreak of Bcc bacteraemia amongst children admitted in Paediatric Intensive Care Unit (PICU and paediatric ward at a tertiary care hospital, Mumbai, in Western India. Materials and Methods: Blood culture samples from paediatric patients yielded growth of non-fermenting, oxidase positive, motile, Gram negative bacilli (NFGNB (76/909 over a period of 8 months. Based on conventional biochemical tests and antimicrobial susceptibility testing, these isolates were provisionally identified as Bcc. The increased, repeated and continued isolation of Bcc alerted the possibility of an outbreak confined to PICU and paediatric ward. Active surveillance was undertaken to trace the source and contain the outbreak. Isolates were subjected to recA polymerase chain reaction (PCR and Expanded multilocus sequence typing (EMLST. Results: Surveillance revealed the presence of Bcc on the upper surface of rubber stopper of sealed multidose amikacin vials. Isolates from blood culture and rubber stoppers were confirmed as Bcc by recA PCR. EMLST revealed that these isolates shared an identical novel sequence type 824 proving clonality. Timely interventions instituted led to control of the outbreak. Conclusion: This study highlights the importance of identification and molecular characterization of Bcc to establish its role in infection and outbreak.

  6. Outbreak of food poisoning in a working men's hostel: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Vikram Singh Grewal

    2017-01-01

    Full Text Available Introduction: Food poisoning is an acute gastroenteritis caused by ingestion of food or drink contaminated with either living bacteria or their toxins or inorganic chemical substances and poisons derived from plants and animals, commonly occurring as explosive outbreaks. The authors investigated an outbreak of food poisoning reported from a working men's hostel in urban area of Pune, Maharashtra. Materials and Methods: A retrospective cohort study design was adopted to investigate the outbreak. Of the total 170 members, 68 had symptoms of food poisoning. Remaining 102 unexposed members were also interviewed as part of the study. Data for environmental and laboratory parameters were also collected. Results: The point source outbreak indicated cooked chicken as the source with a risk ratio of 3.34 (95% confidence interval: 2.02–5.54 and attributable fraction for chicken was 75.3%. As is the case with 70% of food poisoning outbreaks, laboratory confirmation of causative organism could not be established, due to lack of specimens. However, the clinicoepidemiological profile of the patients displays a median incubation period of 8 h (range 5–17 h, along with the clinical symptomatology of a self-limiting disease of diarrhea, abdominal cramps, and nausea; suggested the implicating organisms to be either Clostridium perfringens or Bacillus cereus. Conclusion: The defaulting environmental parameters of compromised sanitary conditions, inadequate storage in refrigerator, improper storage of raw food, and unsafe cooking practices were enhancing factors, which need to be mandatorily addressed in bulk cooking.

  7. Five-year healing results of radiotherapy in 4347 uterine cervix cancers treated within the period of 1928 to 1977

    International Nuclear Information System (INIS)

    Tschakert, H.

    1986-01-01

    The author presents the five-year healing results of 4347 uterine cervix cancers treated at our Radiotherapeutic Institute within the years of 1928 to 1977. The part of patients irradiated postoperatively increased by 30% during this period, and the average age of patients at the beginning of their disease increased by almost seven years. The overall five-year healing results increased from 47 to 60% during this half of a century, especially the prognosis of stage II and III was considerably improved. With almost the same rate of radiogenic side effects, the incidence of recurrences could be reduced by 50%. The healing results achieved by us in uterine cervix cancer during the last ten years under report correspond well with the healing results of other radiotherapeutic hospitals. Even when compared to the most recent reports on the success achieved by afterloading techniques, there is not much difference to our recent results obtained with radium brachytherapy. (orig.) [de

  8. Planning for smallpox outbreaks

    Science.gov (United States)

    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.

  9. A waterborne outbreak of multiple diarrhoeagenic Escherichia coli infections associated with drinking water at a school camp

    Directory of Open Access Journals (Sweden)

    Jungsun Park

    2018-01-01

    Conclusions: This outbreak points to the importance of drinking water quality management in group facilities where underground water is used and emphasizes the need for periodic sanitation and inspection to prevent possible waterborne outbreaks.

  10. Potential for epidemic take-off from the primary outbreak farm via livestock movements

    Science.gov (United States)

    2011-01-01

    Background We consider the potential for infection to spread in a farm population from the primary outbreak farm via livestock movements prior to disease detection. We analyse how this depends on the time of the year infection occurs, the species transmitting, the length of infectious period on the primary outbreak farm, location of the primary outbreak, and whether a livestock market becomes involved. We consider short infectious periods of 1 week, 2 weeks and 4 weeks, characteristic of acute contagious livestock diseases. The analysis is based on farms in Scotland from 1 January 2003 to 31 July 2007. Results The proportion of primary outbreaks from which an acute contagious disease would spread via movement of livestock is generally low, but exhibits distinct annual cyclicity with peaks in May and August. The distance that livestock are moved varies similarly: at the time of the year when the potential for spread via movements is highest, the geographical spread via movements is largest. The seasonal patterns for cattle differ from those for sheep whilst there is no obvious seasonality for pigs. When spread via movements does occur, there is a high risk of infection reaching a livestock market; infection of markets can amplify disease spread. The proportion of primary outbreaks that would spread infection via livestock movements varies significantly between geographical regions. Conclusions In this paper we introduce a set-up for analysis of movement data that allows for a generalized assessment of the risk associated with infection spreading from a primary outbreak farm via livestock movements, applying this to Scotland, we assess how this risk depends upon the time of the year, species transmitting, location of the farm and other factors. PMID:22115121

  11. Therapeutic results and safety of postoperative radiotherapy for keloid after repeated Cesarean section in immediate postpartum period

    International Nuclear Information System (INIS)

    Kim Ju Ree; Lee, Sang Hoon

    2012-01-01

    To evaluate the effectiveness and safety of postoperative radiotherapy for the treatment of keloid scars administered immediately after Cesarean section. A total of 26 postpartum patients with confirmed keloids resulting from previous Cesarean sections received either 12 or 15 Gy radiotherapy. The radiotherapy was divided into three 6 MeV electron beam fractions administered during the postpartum period immediately following the fi nal Cesarean section. To evaluate ovarian safety, designated doses of radiation were estimated at the calculated depth of the ovaries using a solid plate phantom and an ionization chamber with the same lead cutout as was used for the treatment of Cesarean section operative scars and a tissue equivalent bolus. In total, the control rate was 77% (20 patients), while six (23%) developed focally elevated keloids (ranging from 0.5 to 2 cm in length) in the middle of the primary abdominal scar. Five patients experienced mild hyperpigmentation. Nonetheless, most patients (96%) were satisfied with the treatment results. The estimated percentage of the applied radiation doses that reached the calculated depth of the ovaries ranged from 0.0033% to 0.0062%. When administered during the immediate postpartum period, postoperative electron beam radiotherapy for repeated Cesarean section scars is generally safe and produces good cosmetic results with minimal toxicity.

  12. Therapeutic results and safety of postoperative radiotherapy for keloid after repeated Cesarean section in immediate postpartum period

    Energy Technology Data Exchange (ETDEWEB)

    Kim Ju Ree; Lee, Sang Hoon [Cheil General Hospital and Women' s Healthcare Center, Kwandong University College of Medicine, Seoul (Korea, Republic of)

    2012-06-15

    To evaluate the effectiveness and safety of postoperative radiotherapy for the treatment of keloid scars administered immediately after Cesarean section. A total of 26 postpartum patients with confirmed keloids resulting from previous Cesarean sections received either 12 or 15 Gy radiotherapy. The radiotherapy was divided into three 6 MeV electron beam fractions administered during the postpartum period immediately following the fi nal Cesarean section. To evaluate ovarian safety, designated doses of radiation were estimated at the calculated depth of the ovaries using a solid plate phantom and an ionization chamber with the same lead cutout as was used for the treatment of Cesarean section operative scars and a tissue equivalent bolus. In total, the control rate was 77% (20 patients), while six (23%) developed focally elevated keloids (ranging from 0.5 to 2 cm in length) in the middle of the primary abdominal scar. Five patients experienced mild hyperpigmentation. Nonetheless, most patients (96%) were satisfied with the treatment results. The estimated percentage of the applied radiation doses that reached the calculated depth of the ovaries ranged from 0.0033% to 0.0062%. When administered during the immediate postpartum period, postoperative electron beam radiotherapy for repeated Cesarean section scars is generally safe and produces good cosmetic results with minimal toxicity.

  13. Some results about the global attractivity of bounded solutions of difference equations with applications to periodic solutions

    International Nuclear Information System (INIS)

    Dehghan, Mehdi; Mazrooei-Sebdani, Reza

    2007-01-01

    We obtain some results about the global attractivity of bounded solutions of difference equation x n+1 =f(x n ,x n-1 ,...,x n-k ), n=0,1,... where f is non-increasing or non-decreasing in each argument and every point in I is an equilibrium point of above equation where I is an invariant interval for this equation. By our results we prove that when k is an odd positive integer and p>=1 is a real number, every positive solution ofx n+1 =p+x n-k 1+x n ,n=0,1,...converges to a period-two solution of this equation. We also apply our results to the rational difference equationx n+1 =1+x n-2k+1 x n-2l ,n=0,1,...where k,l-bar {0,1,...}, and we show that every positive solution of this equation converges to a period-two solution of this equation

  14. Responding to Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2009-04-27

    In this podcast, a team of CDC specialists travels to Uganda and tracks the source of an Ebola outbreak where CDC scientists are studying bats for clues to the Ebola mystery.  Created: 4/27/2009 by National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED).   Date Released: 4/27/2009.

  15. Investigating Listeria Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2013-01-04

    Dr. Emily Cartwright, Infectious Disease fellow at Emory University and former EIS Officer with CDC’s Division of Foodborne, Waterborne, and Environmental Diseases discusses foodborne Listeria outbreaks.  Created: 1/4/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 1/8/2013.

  16. Foodborne Norovirus Outbreaks

    Centers for Disease Control (CDC) Podcasts

    2012-09-17

    Dr. Aron Hall, a CDC epidemiologist specializing in noroviruses, discusses foodborne norovirus outbreaks.  Created: 9/17/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID); National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 9/17/2012.

  17. Hepatitis A outbreaks in the vaccination era in Catalonia, Spain.

    Science.gov (United States)

    Martínez, Ana; Broner, Sonia; Torner, Nuria; Godoy, Pere; Batalla, Joan; Alvarez, Josep; Barrabeig, Irene; Camps, Neus; Carmona, Gloria; Minguell, Sofía; Sala, Rosa; Caylà, Joan; Domínguez, Angela

    2011-01-01

    Hepatitis A outbreaks have a major impact on public health services and involve case investigation and intervention measures to susceptible contacts. At the end of 1998 a universal vaccination program with a combined hepatitis A+B vaccine was started in Catalonia (Spain) in 12-years-old preadolescents. The objective of this study was to compare the characteristics of hepatitis A outbreaks in the periods before and after the introduction of the preadolescent vaccination program and to estimate the preventable fraction of cases associated to outbreaks. The incidence rates of outbreaks, cases and hospitalization associated with each outbreak were calculated. Two periods were considered: before (1991-1998) and after (2000-2007) the introduction of mass vaccination. The preventable fraction and 95% confidence intervals (CI) of cases associated with outbreaks was calculated. The rate of associated cases with outbreaks was higher in the period before the vaccination program than in the post vaccination period (1.53 per 100,000 person-year vs 1.12 ; pcases associated to outbreaks was 19.6%(95%CI 6.7-32.5) in the 0-4 years group and 16.7% (95% CI 6.0-27.5) in the 5-14 years group, but the highest figure (38.6%; 95%CI 21.3-55.9) was observed in the 15-24 years age group. The estimated proportion of cases associated with outbreaks that would theoretically have been prevented with the vaccination program suggests that substantial benefits have been obtained in Catalonia in people aged less than 25 years.

  18. Characteristics of pertussis outbreaks in Catalonia, Spain, 1997 to 2010.

    Science.gov (United States)

    Crespo, Inma; Broner, Sonia; Soldevila, Núria; Martínez, Ana; Godoy, Pere; Sala-Farré, Maria-Rosa; Company, Maria; Rius, Cristina; Domínguez, Angela; Group Of Catalonia, The Pertussis Working

    2015-01-01

    In Catalonia, pertussis outbreaks must be reported to the Department of Health. This study analyzed pertussis outbreaks between 1997 and 2010 in general and according to the characteristics of the index cases. The outbreak rate, hospitalization rate and incidence of associated cases and their 95%CI were calculated. Index cases were classified in two groups according to age (<15 years and ≥15 years) and the vaccine type received: whole cell vaccine (DTwP) or acellular vaccine (DTaP). During the study period, 230 outbreaks were reported. The outbreak rate was 2.43 × 10(-6) persons-year, and outbreaks ranged from 2 to 32 cases, with a median duration of 18 days. There were 771 associated cases, with an incidence rate of 0.8 × 10(-5) persons-year.   After classifying outbreaks according to the age of the index case, 126 outbreaks (1.3 × 10(-6) persons-year) had an index case aged <15 y and 87 (0.87 × 10(-6) person-year) had an index case aged ≥15 y (RR = 1.44, 95%CI 1.10-1.90; P = 0.007). Between 2003 and 2010, after the introduction of the acellular vaccine, the index case was vaccinated with DTwP vaccine in 25 outbreaks (0.43 × 10(-6) persons-year) and with DTaP vaccine in 32 outbreaks (0.55 × 10(-6) person-year) (RR = 0.78, 95%CI 0.46-1.31; P = 0.35). Of cases, 37.2% were correctly vaccinated, suggesting waning immunity of pertussis vaccine protection and endogenous circulation of pertussis. A greater number of outbreaks had an index case aged <15 y. No changes in the disease incidence, associated cases and hospitalization rate were observed after the introduction of DTaP.

  19. Management of Animal Botulism Outbreaks: From Clinical Suspicion to Practical Countermeasures to Prevent or Minimize Outbreaks

    DEFF Research Database (Denmark)

    Anniballi, Fabrizio; Fiore, Alfonsina; Löfström, Charlotta

    2013-01-01

    and economic concern because of its high mortality rate. Moreover, meat or other products from affected animals entering the food chain may result in a public health problem. To this end, early diagnosis is crucial to define and apply appropriate veterinary public health measures. Clinical diagnosis is based...... outbreaks. In this article we outline all phases of management of animal botulism outbreaks occurring in wet wild birds, poultry, cattle, horses, and fur farm animals....

  20. Measles & rubella outbreaks in Maharashtra State, India

    Science.gov (United States)

    Vaidya, Sunil R.; Kamble, Madhukar B.; Chowdhury, Deepika T.; Kumbhar, Neelakshi S.

    2016-01-01

    Background & objectives: Under the outbreak-based measles surveillance in Maharashtra State the National Institute of Virology at Pune receives 3-5 serum samples from each outbreak and samples from the local hospitals in Pune for laboratory diagnosis. This report describes one year data on the measles and rubella serology, virus isolation and genotyping. Methods: Maharashtra State Health Agencies investigated 98 suspected outbreaks between January-December 2013 in the 20 districts. Altogether, 491 serum samples were received from 20 districts and 126 suspected cases from local hospitals. Samples were tested for the measles and rubella IgM antibodies by commercial enzyme immunoassay (EIA). To understand the diagnostic utility, a subset of serum samples (n=53) was tested by measles focus reduction neutralization test (FRNT). Further, 37 throat swabs and 32 urine specimens were tested by measles reverse transcription (RT)-PCR and positive products were sequenced. Virus isolation was performed in Vero hSLAM cells. Results: Of the 98 suspected measles outbreaks, 61 were confirmed as measles, 12 as rubella and 21 confirmed as the mixed outbreaks. Four outbreaks remained unconfirmed. Of the 126 cases from the local hospitals, 91 were confirmed for measles and three for rubella. Overall, 93.6 per cent (383/409) confirmed measles cases were in the age group of 0-15 yr. Measles virus was detected in 18 of 38 specimens obtained from the suspected cases. Sequencing of PCR products revealed circulation of D4 (n=9) and D8 (n=9) strains. Four measles viruses (three D4 & one D8) were isolated. Interpretation & conclusions: Altogether, 94 measles and rubella outbreaks were confirmed in 2013 in the State of Maharasthra indicating the necessity to increase measles vaccine coverage in the State. PMID:27121521

  1. Climate teleconnections and recent patterns of human and animal disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Assaf Anyamba

    2012-01-01

    Full Text Available Recent clusters of outbreaks of mosquito-borne diseases (Rift Valley fever and chikungunya in Africa and parts of the Indian Ocean islands illustrate how interannual climate variability influences the changing risk patterns of disease outbreaks. Although Rift Valley fever outbreaks have been known to follow periods of above-normal rainfall, the timing of the outbreak events has largely been unknown. Similarly, there is inadequate knowledge on climate drivers of chikungunya outbreaks. We analyze a variety of climate and satellite-derived vegetation measurements to explain the coupling between patterns of climate variability and disease outbreaks of Rift Valley fever and chikungunya.We derived a teleconnections map by correlating long-term monthly global precipitation data with the NINO3.4 sea surface temperature (SST anomaly index. This map identifies regional hot-spots where rainfall variability may have an influence on the ecology of vector borne disease. Among the regions are Eastern and Southern Africa where outbreaks of chikungunya and Rift Valley fever occurred 2004-2009. Chikungunya and Rift Valley fever case locations were mapped to corresponding climate data anomalies to understand associations between specific anomaly patterns in ecological and climate variables and disease outbreak patterns through space and time. From these maps we explored associations among Rift Valley fever disease occurrence locations and cumulative rainfall and vegetation index anomalies. We illustrated the time lag between the driving climate conditions and the timing of the first case of Rift Valley fever. Results showed that reported outbreaks of Rift Valley fever occurred after ∼3-4 months of sustained above-normal rainfall and associated green-up in vegetation, conditions ideal for Rift Valley fever mosquito vectors. For chikungunya we explored associations among surface air temperature, precipitation anomalies, and chikungunya outbreak locations. We found

  2. Environmental radiation monitoring results for the period 1984-95 in and around Variable Energy Cyclotron Centre, Calcutta

    International Nuclear Information System (INIS)

    Basu, A.S.; Khasnabis, B.K.; Bar, M.

    1997-04-01

    Variable Energy Cyclotron (VEC) located at Bidhan Nagar, Calcutta is being used for accelerating charged particles and does not contribute to any radioactive releases to the environment. However, it being a nuclear facility, the area surrounding the facility is being routinely monitored for background radiation exposure using thermoluminescent dosimeters. This report gives the summary of the results of the survey carried out over a period of 12 years, 1984-1995. It is observed that the general radiation background in areas far removed from the facility (up to 25 km) is higher than that existing within the boundaries of VEC centre (160±21 mR/year as against 121±20 mR/year)

  3. NewCo: Results for the period ended August 31, 2017 for the purpose of implementing tax consolidation

    International Nuclear Information System (INIS)

    Jugean, Anne-Sophie

    2017-01-01

    NewCo is the temporary name of the entity which combines all of the operations of AREVA related to the nuclear fuel cycle, whose legal name is New AREVA Holding. The NewCo capital increase reserved for the French State in the amount of 2.5 billion euro was completed on July 26, 2017. This operation resulted in AREVA SA's holding in NewCo's capital being reduced from 100% to 44.4% and, accordingly, led to the removal of the NewCo sub-group from the scope of the consolidated tax group initially created around AREVA SA. Consequently, and in order to establish the scope of the French tax consolidation group around NewCo from September 1, 2017, NewCo's Combined Shareholders' Meeting of July 27, 2017 resolved to temporarily modify the closing date of the fiscal year by setting an early closing of August 31, 2017 for the fiscal year opened January 1, 2017 (period lasting eight months), with a return to the closing date of 31 December as of the fiscal period starting September 1, 2017 (period lasting four months). In this context, NewCo has prepared the statutory and consolidated financial statements for the year opened January 1, 2017 and ended August 31, 2017. These financial statements were approved by NewCo's Board of Directors. At the closing on December 31, 2017, NewCo will draw up statutory and consolidated financial statements for the period from September 1, 2017 to December 31, 2017. Consolidated financial statements as of December 31, 2017 covering the full year 2017, i.e. a period of 12 months, will also be prepared on a voluntary basis. All the financial statements prepared by NewCo in respect of 2017 will be approved at a single General Meeting to be held in May 2018. A request to extend the deadline for the Annual Ordinary General Meeting called to approve NewCo's financial statements for the period ended August 31, 2017, will be made to the President of the Nanterre Commercial Court. NewCo's net income at August 31, 2017 was chiefly impacted, compared with

  4. [Field epidemiological study on a varicella outbreak among schoolchildren in Shenzhen].

    Science.gov (United States)

    Zheng, Qing-ming; Zeng, Hua-tang; Wang, Tie-qiang; Liu, Yi; Wang, Guang-li; Mei, Shu-jiang; Zhang, Shun-xiang

    2013-09-01

    Both epidemiologic characteristics and transmission mode of a varicella outbreak among schoolchildren in Shenzhen city were studied and related control measures were discussed. Case definition was established. Case-finding and face-to-face investigation were conducted, followed by analysis on distributions of time, place and persons of the outbreak. Association between possible modes of transmission and the outbreak was explored. Retrospective cohort study was carried out. The overall attack rate of this outbreak was 4.4% (122 of 2742). The attack rate among primary schoolchildren(8.3%, 118/1419)was higher than that in the middle-school children(0.3%, 4/1323). There were no statistically significant differences on the attack rates between male and female students. A total of 22 classes from the 9 grades were affected by this outbreak and the aggregation of varicella cases was found in classes. The highest attack rates was found in the students of fifth grade(23.7%), followed by from the third grade (13.4%). The main transmission mode appeared to be close personal contact. The outbreak, with four peaks of incidence, lasted 72 days. Data from the investigation suggested that the primary case was introduced into the school during military training involved by the students. Activities related to physical examination for all the schoolchildren seemed to have contributed to the spread of this disease among classes. Delayed isolation of cases appeared to be the major factor causing the spread of disease among classes. Intensive off-school activities or free community bus for children did not seem to be associated with the spreading of the disease. 52.5% (64/122) of the cases had received one-dose of varicella vaccine, with the median of onset after the vaccination as 7 years. The results demonstrated that one single-dose vaccine or long vaccination period were factors related to the insufficient immunity that causing the outbreak of disease. Varicella outbreak has been

  5. Statistics of severe tornadoes and severe tornado outbreaks

    Directory of Open Access Journals (Sweden)

    B. D. Malamud

    2012-09-01

    Full Text Available The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider severe tornadoes, which we define as L≥10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database. We find that for the period 1982–2011, for individual severe tornadoes (L≥10 km: (i There is a strong linear scaling between the number of severe tornadoes in a year and their total path length in that year. (ii The cumulative frequency path length data suggests that, not taking into account any changing trends over time, we would expect in a given year (on average one severe tornado with a path length L≥115 km and in a decade (on average one severe tornado with a path length L≥215 km. (iii The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20<L<200 km, is well approximated by an inverse power-law relationship with exponent near 3. We then take the total path length of severe tornadoes in a convective day (12:00–12:00 UTC, LD, as a measure of the strength of a 24-h USA tornado outbreak. We find that: (i For 1982–2011, the number of severe tornadoes in a USA convective day outbreak has a strong power-law relationship (exponent 0.80 on the convective day total path length, LD. (ii For 1952–2011, the cumulative frequency path length data for severe tornado outbreaks suggests that we would expect in a given year (on average one daily severe tornado outbreak with total path length LD≥480 km and in a decade (on average one daily severe tornado outbreak with a total path length LD≥1200 km. (iii For 1982–2011, the noncumulative frequency-length statistics of tornado

  6. Using demographic characteristics of populations to detect spatial fragmentation following suspected ebola outbreaks in great apes.

    Science.gov (United States)

    Genton, Céline; Cristescu, Romane; Gatti, Sylvain; Levréro, Florence; Bigot, Elodie; Motsch, Peggy; Le Gouar, Pascaline; Pierre, Jean-Sébastien; Ménard, Nelly

    2017-09-01

    Demographic crashes due to emerging diseases can contribute to population fragmentation and increase extinction risk of small populations. Ebola outbreaks in 2002-2004 are suspected to have caused a decline of more than 80% in some Western lowland gorilla (Gorilla gorilla gorilla) populations. We investigated whether demographic indicators of this event allowed for the detection of spatial fragmentation in gorilla populations. We collected demographic data from two neighbouring populations: the Lokoué population, suspected to have been affected by an Ebola outbreak (followed from 2001 to 2014), and the Romani population, of unknown demographic status before Ebola outbreaks (followed from 2005 to 2014). Ten years after the outbreak, the Lokoué population is slowly recovering and the short-term demographic indicators of a population crash were no longer detectable. The Lokoué population has not experienced any additional demographic perturbation over the past decade. The Romani population did not show any of the demographic indicators of a population crash over the past decade. Its demographic structure remained similar to that of unaffected populations. Our results highlighted that the Ebola disease could contribute to fragmentation of gorilla populations due to the spatially heterogeneous impact of its outbreaks. The demographic structure of populations (i.e., age-sex and group structure) can be useful indicators of a possible occurrence of recent Ebola outbreaks in populations without known history, and may be more broadly used in other emerging disease/species systems. Longitudinal data are critical to our understanding of the impact of emerging diseases on wild populations and their conservation. © 2017 Wiley Periodicals, Inc.

  7. Adverse incidents resulting in exposure to body fluids at a UK dental teaching hospital over a 6-year period

    Directory of Open Access Journals (Sweden)

    Hughes A

    2012-10-01

    Full Text Available A Hughes,1 L Davies,1 R Hale,1 JE Gallagher21Kings College Hospital NHS Foundation Trust, 2King's College London Dental Institute, London, United KingdomBackground: The safety and protection of patients and health care workers is of paramount importance in dentistry, and this includes students in training who provide clinical care. Given the nature of dental care, adverse incidents can and do occur, exposing health care workers to body fluids and putting them at risk of infection, including contracting a blood-borne virus. The aim of this research was to analyze trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital from 2005 to 2010.Methods: Descriptive analysis of trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital over a six-year period was undertaken in relation to the level of outpatient and day surgery activity.Results: In total, 287 incidents were reported over a six-year period, which amounted to 0.039% of outpatient or day surgery appointments. Nearly three quarters of all the incidents (n = 208, 72% took place during treatment or whilst clearing away after the appointment. The most frequent incidents were associated with administration of local anesthetic (n = 63, 22%, followed by burs used in dental hand pieces (n = 51, 18%.Conclusion: This research confirms that adverse incidents are a feature of dental hospitals and reports the common sources. The importance of accurate and consistent reporting of data to ensure that these issues are monitored to inform action and reduce risks to staff, students, and patients are highlighted.Keywords: risk management, blood-borne virus, dental hospital, body fluids exposure, adverse event reporting

  8. Estimated Cost to a Restaurant of a Foodborne Illness Outbreak.

    Science.gov (United States)

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

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

  9. Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report

    Directory of Open Access Journals (Sweden)

    Mohammed A. Soghaier

    2013-10-01

    Full Text Available Summary: Introduction: Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF, which is considered to be a very serious illness. Yellow Fever (YF outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. Objective: To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. Methodology: >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. Results: The field investigation confirmed the outbreak and identified its cause to be YF. Conclusion: National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs are usually very high among the index cases. Keywords: Yellow Fever, Sudan, Darfur, VHFs, Soghaier

  10. Mass-balance modelling results of groundwater data collected at Olkiluoto over the period 2004-2007

    Energy Technology Data Exchange (ETDEWEB)

    Partamies, S. [VTT Technical Research Centre of Finland, Espoo (Finland); Pitkaenen, P.

    2014-02-15

    Olkiluoto has been selected as a repository site for final disposal of spent nuclear waste produced in Finland. An understanding of the hydrogeochemical groundwater conditions and their evolution is essential in evaluating the long-term safety of the repository. The performance of technical barriers and the migration of potentially released radionuclides depend on the chemical conditions. A prerequisite for understanding these factors is the ability to specify the water-rock interactions, which control chemical conditions in the groundwater. The objective of this study is to present mass-balance studies of the samples collected over the period 2004 - 2007. A total of 178 groundwater samples have been collected over this period (84 groundwater observation tubes, 88 from deep multipackered boreholes and 6 from the ONKALO) which provided a comprehensive dataset on dissolved chemical species and isotopes. The PHREEQC program was used in the mass-balance calculations in order to develop geochemical interpretations of water-rock interactions, isotope-chemical evolution and the mixing of palaeowater types. A model of the hydrogeochemical evolution in different parts of the crystalline bedrock at Olkiluoto has been created and the significance of chemical reactions and groundwater mixing along different flow paths calculated. The changes in hydrogeochemical interpretations and chemical and isotopic calculations indicate that pH seems to be dominantly controlled by thermodynamic equilibrium with calcite in fractures and there are indications that this process may also occur in the overburden layer. Oxic redox conditions, prevailing in recharging groundwater, change abruptly to sulphidic conditions close to the surface, generally in the overburden. The results from the mass-balance calculations correspond and support the earlier conceptions of groundwater mixing, the origin of salinity and the hydrogeochemical evolution. The fractions of glacial meltwater indicated in these

  11. Mass-balance modelling results of groundwater data collected at Olkiluoto over the period 2004-2007

    International Nuclear Information System (INIS)

    Partamies, S.; Pitkaenen, P.

    2014-02-01

    Olkiluoto has been selected as a repository site for final disposal of spent nuclear waste produced in Finland. An understanding of the hydrogeochemical groundwater conditions and their evolution is essential in evaluating the long-term safety of the repository. The performance of technical barriers and the migration of potentially released radionuclides depend on the chemical conditions. A prerequisite for understanding these factors is the ability to specify the water-rock interactions, which control chemical conditions in the groundwater. The objective of this study is to present mass-balance studies of the samples collected over the period 2004 - 2007. A total of 178 groundwater samples have been collected over this period (84 groundwater observation tubes, 88 from deep multipackered boreholes and 6 from the ONKALO) which provided a comprehensive dataset on dissolved chemical species and isotopes. The PHREEQC program was used in the mass-balance calculations in order to develop geochemical interpretations of water-rock interactions, isotope-chemical evolution and the mixing of palaeowater types. A model of the hydrogeochemical evolution in different parts of the crystalline bedrock at Olkiluoto has been created and the significance of chemical reactions and groundwater mixing along different flow paths calculated. The changes in hydrogeochemical interpretations and chemical and isotopic calculations indicate that pH seems to be dominantly controlled by thermodynamic equilibrium with calcite in fractures and there are indications that this process may also occur in the overburden layer. Oxic redox conditions, prevailing in recharging groundwater, change abruptly to sulphidic conditions close to the surface, generally in the overburden. The results from the mass-balance calculations correspond and support the earlier conceptions of groundwater mixing, the origin of salinity and the hydrogeochemical evolution. The fractions of glacial meltwater indicated in these

  12. Simple visit behavior unifies complex Zika outbreaks

    Directory of Open Access Journals (Sweden)

    P.D. Manrique

    2017-12-01

    Full Text Available New outbreaks of Zika in the U.S. are imminent. Human nature dictates that many individuals will continue to revisit affected ‘Ground Zero’ patches, whether out of choice, work or family reasons − yet this feature is missing from traditional epidemiological analyses. Here we show that this missing visit-revisit mechanism is by itself capable of explaining quantitatively the 2016 human Zika outbreaks in all three Ground Zero patches. Our findings reveal counterintuitive ways in which this human flow can be managed to tailor any future outbreak’s duration, severity and time-to-peak. Effective public health planning can leverage these results to impact the evolution of future outbreaks via soft control of the overall human flow, as well as to suggest best-practice visitation behavior for local residents.

  13. An Outbreak of Foodborne Botulism in Ontario

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    Mona R Loutfy

    2003-01-01

    Full Text Available Botulism is a rare paralytic illness resulting from a potent neurotoxin produced by Clostridium botulinum. Botulism in Canada is predominately due to C botulinum type E and affects mainly the First Nations and Inuit populations. The most recent outbreak of botulism in Ontario was in Ottawa in 1991 and was caused by C botulinum type A. We report an outbreak of foodborne type B botulism in Ontario, which implicated home-canned tomatoes. The outbreak was characterized by mild symptoms in two cases and moderately severe illness in one case. The investigation shows the importance of considering the diagnosis of botulism in patients presenting with cranial nerve and autonomic dysfunction, especially when combined with gastrointestinal complaints; it also highlights the importance of proper home canning technique.

  14. Decontamination in preparation for dismantlement - AREVA's chemical decontamination technologies, projects performed and results obtained in the period 2011-2016

    International Nuclear Information System (INIS)

    Topf, C.; Sempere Belda, L.

    2017-01-01

    As a consequence of the nuclear phase-out decreed by the German government, several nuclear power plants in the country have already ceased operation. The remaining ones will cease operation by 2022. This has turned Germany into one of the most active regions worldwide in the field of nuclear decommissioning, with new and emerging technologies being deployed on the field, and already preexisting technologies being put to the test, optimized and developed into full maturity. The chemistry services division of AREVA GmbH has already performed 5 Full System Decontaminations (FSD) in preparation for decommissioning in this period - three in PWRs and two in BWRs - along with other international projects of relevance for decommissioning operations. During a FSD, the complete primary circuit of a nuclear power plant including auxiliary systems is subject to a chemical treatment; designed to remove radioactive matter accumulated onto system surfaces during operation. Through the effective removal of this radioactive accumulations contact dose rates on the different components of the primary circuit can be consistently reduced by factors larger than 50. This results in much lower ambient dose rates and, hence, in very significant dose savings for subsequent decommissioning activities. Additionally, dismantlement operations of large components are considerably simplified and can be performed under conditions that wouldn't have been possible before. The project specific objectives and challenges, the technologies employed, and the results obtained are presented and commented here. (authors)

  15. Hydrogen outbreak of Zirconium Molybdate Hihydrate

    International Nuclear Information System (INIS)

    Miura, Yasuhiko; Fukuda, Kazuhiro; Ochi, Eiji

    2008-01-01

    JNFL is planning to construct a facility for enclosing the hull and end pieces produced due to reprocessing of spent fuel into stainless canisters after compressing, while those hull and end pieces enclosed into the stainless canisters are called 'compressed hulls'. Since the compressed hulls contain moisture absorbent Zirconium Molybdate Hihydrate accompanying hull and end pieces, there is a risk of outbreak of radiolysisradiolysis gas such as hydrogen, etc. by radiolysisradiolysis. This report intends to state the result of radiation irradiation experiment with the purpose of examining the volume of hydrogen outbreak from Zirconium Molybdate Hihydrate of the compressed hulls. (author)

  16. Epidemiology of two large measles virus outbreaks in Catalonia

    Science.gov (United States)

    Torner, Núria; Anton, Andres; Barrabeig, Irene; Lafuente, Sara; Parron, Ignasi; Arias, César; Camps, Neus; Costa, Josep; Martínez, Ana; Torra, Roser; Godoy, Pere; Minguell, Sofia; Ferrús, Glòria; Cabezas, Carmen; Domínguez, Ángela; Elimination Program Surveillance Network of Spain, the Measles

    2013-01-01

    Measles cases in the European Region have been increasing in the last decade; this illustrates the challenge of what we are now encountering in the form of pediatric preventable diseases. In Catalonia, autochthonous measles was declared eliminated in the year 2000 as the result of high measles-mumps-rubella vaccine (MMR) coverage for first and second dose (15 mo and 4 y) since the mid-1990s. From then on, sporadic imported cases and small outbreaks appeared, until in 2006–2007 a large measles outbreak affecting mostly unvaccinated toddlers hit the Barcelona Health Region. Consequently, in January 2008, first dose administration of MMR was lowered from 15 to 12 mo of age. A new honeymoon period went by until the end of 2010, when several importations of cases triggered new sustained transmission of different wild measles virus genotypes, but this time striking young adults. The aim of this study is to show the effect of a change in MMR vaccination schedule policy, and the difference in age incidence and hospitalization rates of affected individuals between both outbreaks. Epidemiologic data were obtained by case interviews and review of medical records. Samples for virological confirmation and genotyping of cases were collected as established in the Measles Elimination plan guidelines. Incidence rate (IR), rate ratio (RR) and their 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 in the 2010 outbreak and 381 in the 2006–2007 outbreak; mean age 20 y (SD 14.8 y; 3 mo to 51 y) vs. 15 mo (SD 13.1 y; 1 mo to 50 y). Highest proportion of cases was set in ≥ 25 y (47%) vs. 24.2% in 2006 (p < 0.001). Differences in IR for ≤ 15 mo (49/100,000 vs. 278.2/100,000; RR: 3,9; 95%CI 2,9–5.4) and in overall HR 29.8% vs. 15.7% were all statistically significant (p < 0.001). The change of the month of age for the administration of the first MMR dose proved successful to

  17. Molecular characterisation of human Shiga toxin-producing Escherichia coli O26 strains: results of an outbreak investigation, Romania, February to August 2016.

    Science.gov (United States)

    Usein, Codruţa-Romaniţa; Ciontea, Adriana Simona; Militaru, Cornelia Mãdãlina; Condei, Maria; Dinu, Sorin; Oprea, Mihaela; Cristea, Daniela; Michelacci, Valeria; Scavia, Gaia; Zota, Lavinia Cipriana; Zaharia, Alina; Morabito, Stefano

    2017-11-01

    IntroductionAt the beginning of 2016, an increase in paediatric haemolytic uremic syndrome (HUS) cases was observed in Romania. The microbiological investigations allowed isolation of Shiga toxin-producing Escherichia coli (STEC) O26 as the causative agent from most cases. Methods: An enhanced national surveillance of HUS and severe diarrhoea was established across the country following the identification of the first cases and was carried out until August 2016. A total of 15 strains were isolated from 10 HUS and five diarrhoea cases. Strains were characterised by virulence markers (i.e. stx type/subtype, eae , ehxA genes), phylogroup, genetic relatedness and clonality using PCR-based assays, PFGE and multilocus sequence typing (MLST). The first six strains were further characterised by whole genome sequencing (WGS). Results: Five PCR-defined genotypes were distinguished. All strains from HUS cases harboured stx2a and eae , with or without stx1a , while strains from diarrhoea cases carried exclusively stx1a and eae genes. PFGE resolved strains into multiple pulsotypes, compatible with a certain geographic segregation of the cases, and strains were assigned to phylogroup B1 and sequence type (ST) 21. WGS confirmed the results of conventional molecular methods, brought evidence of O26:H11 serotype, and complemented the virulence profiles. Discussion/conclusion: This first description of STEC O26 strains from cases in Romania showed that the isolates belonged to a diverse population. The virulence content of most strains highlighted a high risk for severe outcome in infected patients. Improving the national surveillance strategy for STEC infections in Romania needs to be further considered.

  18. Analytical results on the periodically driven damped pendulum. Application to sliding charge-density waves and Josephson junctions

    International Nuclear Information System (INIS)

    Azbel, M.Y.; Bak, P.

    1984-01-01

    The differential equation epsilonphi-dieresis+phi-dot-(1/2)α sin(2phi) = I+summation/sub n/ = -infinity/sup infinity/A/sub n/delta(t-t/sub n/) describing the periodically driven damped pendulum is analyzed in the strong damping limit epsilon<<1, using first-order perturbation theory. The equation may represent the motion of a sliding charge-density wave (CDW) in ac plus dc electric fields, and the resistively shunted Josephson junction driven by dc and microwave currents. When the torque I exceeds a critical value the pendulum rotates with a frequency ω. For infinite damping, or zero mass (epsilon = 0), the equation can be transformed to the Schroedinger equation of the Kronig-Penney model. When A/sub n/ is random the pendulum exhibits chaotic motion. In the regular case A/sub n/ = A the frequency ω is a smooth function of the parameters, so there are no phase-locked subharmonic plateaus in the ω(I) curve, or the I-V characteristics for the CDW or Josephson-junction systems. For small nonzero epsilon the return map expressing the phase phi(t/sub n/+1) as a function of the phase phi(t/sub n/) is a one-dimensional circle map. Applying known analytical results for the circle map one finds narrow subharmonic plateaus at all rational frequencies, in agreement with experiments on CDW systems

  19. Results of breast cancer screening with mammography carried out in Koriyama City over a three-year period (2001- 2003)

    International Nuclear Information System (INIS)

    Yoshida, Hatsuo; Iwanami, Hiroshi; Urazumi, Koujirou

    2005-01-01

    In 2001, biennial breast cancer screening with mammography was started in Koriyama City for women aged 40 years or over. The screening involved both physical examination, including inspection and palpation, and mammography performed separately. Women with abnormal findings on physical examination were recalled, while those without such findings underwent medio-lateral oblique projection mammography. There were a total of 15,246 responders during the three-year period 2001 -2003. The recall rate after physical examination was 3.1% and breast cancer was detected in 25 women (0.16%). For 13,310 women who underwent mammography, the recall rate was 3.9% and 25 breast cancers (0.18%) were detected. Combining these two subgroups, the overall recall rate was 6.5%, the cancer detection rate was 0.33%, the ratio of cancers detected among women who were asked to attend for a recall examination was 5.0%, and the ratio of cancers detected among women who underwent a recall examination was 5.6%. Early cancers detected at Stage 0 or 1 comprised 32 (64%), and lymph node metastasis was positive in 12 women (24%). Thus the results of our screening reached satisfactory levels in terms of the five items proposed by the Breast Imaging Reporting and Data System of the American Radiology Association. In order to further increase the quality of breast cancer screening, proper determination of categories at mammography reading and standardization of recall examination techniques, including histopathological study, are required. (author)

  20. Impact of Costing and Cost Analysis Methods on the Result of the Period: Methods Based on Full Cost Theory

    Directory of Open Access Journals (Sweden)

    Toma Maria

    2017-01-01

    In light of the above, in the present paper we have proposed that objectives, to approach the methods of calculating full costs (economic or traditional, and comparing them to determine the effect they have on the outcome of the period.

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

    Science.gov (United States)

    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.

  2. Molecular Characterization of Two Major Dengue Outbreaks in Costa Rica.

    Science.gov (United States)

    Soto-Garita, Claudio; Somogyi, Teresita; Vicente-Santos, Amanda; Corrales-Aguilar, Eugenia

    2016-07-06

    Dengue virus (DENV) (Flavivirus, Flaviviridae) is a reemerging arthropod-borne virus with a worldwide circulation, transmitted mainly by Aedes aegypti and Aedes albopictus mosquitoes. Since the first detection of its main transmitting vector in 1992 and the invasion of DENV-1 in 1993, Costa Rica has faced dengue outbreaks yearly. In 2007 and 2013, Costa Rica experienced two of the largest outbreaks in terms of total and severe cases. To provide genetic information about the etiologic agents producing these outbreaks, we conducted phylogenetic analysis of viruses isolated from human samples. A total of 23 DENV-1 and DENV-2 sequences were characterized. These analyses signaled that DENV-1 genotype V and DENV-2 American/Asian genotype were circulating in those outbreaks. Our results suggest that the 2007 and 2013 outbreak viral strains of DENV-1 and DENV-2 originated from nearby countries and underwent in situ microevolution. © The American Society of Tropical Medicine and Hygiene.

  3. Is Young Adulthood a Critical Period for Suicidal Behavior among Sexual Minorities? Results from a US National Sample.

    Science.gov (United States)

    Fish, Jessica N; Rice, Cara E; Lanza, Stephanie T; Russell, Stephen T

    2018-03-29

    The developmental timing of suicide-related disparities between heterosexuals and sexual minorities (i.e., lesbian/gay and bisexual (LGB) people) is an understudied area that has critical prevention implications. In addition to developmentally situated experiences that shape risk for suicidality in the general population, sexual minorities also experience unique social stressors (e.g., anti-LGB stigma) that may alter their risk for suicidal behavior at different ages. Using a nationally representative US sample of adults, we assessed age-varying rates of suicidal behavior among heterosexuals and sexual minorities ages 18 to 60 and the age-varying association between anti-LGB discrimination and suicidal behavior. We also tested whether these age-varying prevalences and associations differed for men and women and for sexual minorities who did and did not endorse a sexual minority identity. Results indicate a critical period for suicide behavior risk for sexual minorities during young adulthood, with the highest rates of risk at age 18 followed by a steady decline until the early 40s. Disparities were particularly robust for sexual minorities who identified as lesbian, gay, or bisexual. This pattern was present for both men and women, though sexual minority women in their 30s were more likely to report suicidal behavior than heterosexuals and sexual minority men. Sexual minorities who experienced anti-LGB discrimination were more likely to report suicidal behavior, but the significance of this association was limited to those under 30. The effect of discrimination on suicidal behavior was stronger among young adult sexual minority men, relative to sexual minority women, but was present for a wider age range for sexual minority women (until age 30) relative to sexual minority men (until age 25).

  4. Dynamics of epidemics outbreaks in heterogeneous populations

    Science.gov (United States)

    Brockmann, Dirk; Morales-Gallardo, Alejandro; Geisel, Theo

    2007-03-01

    The dynamics of epidemic outbreaks have been investigated in recent years within two alternative theoretical paradigms. The key parameter of mean field type of models such as the SIR model is the basic reproduction number R0, the average number of secondary infections caused by one infected individual. Recently, scale free network models have received much attention as they account for the high variability in the number of social contacts involved. These models predict an infinite basic reproduction number in some cases. We investigate the impact of heterogeneities of contact rates in a generic model for epidemic outbreaks. We present a system in which both the time periods of being infectious and the time periods between transmissions are Poissonian processes. The heterogeneities are introduced by means of strongly variable contact rates. In contrast to scale free network models we observe a finite basic reproduction number and, counterintuitively a smaller overall epidemic outbreak as compared to the homogeneous system. Our study thus reveals that heterogeneities in contact rates do not necessarily facilitate the spread to infectious disease but may well attenuate it.

  5. Concomitant outbreaks of yellow fever and hepatitis E virus in Darfur States, Sudan, 2012.

    Science.gov (United States)

    Ahmed, Sarah S; Soghaier, Mohammed A; Mohammed, Sozan; Khogali, Hayat S; Osman, Muntasir M; Abdalla, Abdalla M

    2016-01-31

    Yellow fever (YF) is a vector-borne disease transmitted to humans by infected Aedes mosquitoes, while hepatitis E virus (HEV) is a waterborne disease that is transmitted through the fecal-oral route. Both diseases have very close clinical presentation, namely fever, jaundice, malaise, and dark urine; they differ in severity and outcome. In this cross-sectional, laboratory-based study, an attempt was made to measure the correlation of concomitant YF and HEV infection in Darfur States during the previous YF outbreak in 2012. Results found concomitant outbreaks of YF and HEV at the same time with very weak statistical correlation between the two infections during the outbreak period, with Cramer's V correlation 0.05 and insignificant p value of 0.86. This correlation indicates that clinicians and care providers in tropical areas have to deal with clinical case definitions used for disease surveillance very carefully since prevalence of HEV infection is relatively common and this increases the possibility of misclassification and missing YF cases, particularly initial index cases, in a season or outbreak.

  6. Comparison of Statistical Algorithms for the Detection of Infectious Disease Outbreaks in Large Multiple Surveillance Systems

    Science.gov (United States)

    Farrington, C. Paddy; Noufaily, Angela; Andrews, Nick J.; Charlett, Andre

    2016-01-01

    A large-scale multiple surveillance system for infectious disease outbreaks has been in operation in England and Wales since the early 1990s. Changes to the statistical algorithm at the heart of the system were proposed and the purpose of this paper is to compare two new algorithms with the original algorithm. Test data to evaluate performance are created from weekly counts of the number of cases of each of more than 2000 diseases over a twenty-year period. The time series of each disease is separated into one series giving the baseline (background) disease incidence and a second series giving disease outbreaks. One series is shifted forward by twelve months and the two are then recombined, giving a realistic series in which it is known where outbreaks have been added. The metrics used to evaluate performance include a scoring rule that appropriately balances sensitivity against specificity and is sensitive to variation in probabilities near 1. In the context of disease surveillance, a scoring rule can be adapted to reflect the size of outbreaks and this was done. Results indicate that the two new algorithms are comparable to each other and better than the algorithm they were designed to replace. PMID:27513749

  7. Characteristics of wild polio virus outbreak investigation and response in Ethiopia in 2013-2014: implications for prevention of outbreaks due to importations.

    Science.gov (United States)

    Tegegne, Ayesheshem Ademe; Braka, Fiona; Shebeshi, Meseret Eshetu; Aregay, Aron Kassahun; Beyene, Berhane; Mersha, Amare Mengistu; Ademe, Mohammed; Muhyadin, Abdulahi; Jima, Dadi; Wyessa, Abyot Bekele

    2018-01-05

    Ethiopia joined the Global Polio Eradication Initiative (GPEI) in 1996, and by the end of December 2001 circulation of indigenous Wild Polio Virus (WPV) had been interrupted. Nonetheless, the country experienced multiple importations during 2004-2008, and in 2013. We characterize the 2013 outbreak investigations and response activities, and document lessons learned. The data were pulled from different field investigation reports and from the national surveillance database for Acute Flaccid Paralysis (AFP). In 2013, a WPV1 outbreak was confirmed following importation in Dollo zone of the Somali region, which affected three Woredas (Warder, Geladi and Bokh). Between July 10, 2013, and January 5, 2014, there were 10 children paralyzed due to WPV1 infection. The majorities (7 of 10) were male and below 5 years of age, and 7 of 10 cases was not vaccinated, and 72% (92/129) of < 5 years of old children living in close proximity with WPV cases had zero doses of oral polio vaccine (OPV). The travel history of the cases showed that seven of the 10 cases had contact with someone who had traveled or had a travel history prior to the onset of paralysis. Underserved and inaccessibility of routine immunization service, suboptimal surveillance sensitivity, poor quality and inadequate supplemental immunization were the most crucial gaps identified during the outbreak investigations. Prior to the 2013 outbreak, Ethiopia experienced multiple imported polio outbreaks following the interruption of indigenous WPV in December 2001. The 2013 outbreak erupted due to massive population movement and was fueled by low population immunity as a result of low routine immunization and supplemental Immunization coverage and quality. In order to avert future outbreaks, it is critical that surveillance sensitivity be improved by establishing community-based surveillance systems and by assigning surveillance focal points at all level particularly in border areas. In addition, it is vital to set

  8. Serological evidence of asymptomatic infections during Escherichia coli O104:H4 outbreak in Germany in 2011.

    Directory of Open Access Journals (Sweden)

    Yanina Balabanova

    Full Text Available INTRODUCTION: The largest known outbreak caused by a rare hybrid strain of Shiga toxin-producing E.coli (STEC and enteroaggregative E. coli (EAEC (E.coli O104:H4 of serotype O104:H4 occurred in Germany in 2011. Fenugreek sprouts acted as a transmission vehicle and were widely consumed in the outbreak area at the time of the epidemic. In total 3,842 people developed a clinical illness caused by this strain; however the rates of asymptomatic infections remain unclear. We aimed to develop a serological assay for detection of E.coli O104 LPS specific antibodies and to establish the post-outbreak levels of seropositivity among people with documented exposure to contaminated sprouts. RESULTS AND DISCUSSION: Developed serological assays (ELISA with 84% sensitivity, 63% specificity and Western Blot with 100% sensitivity, 82.5% specificity identified 33% (16/49 level of asymptomatic infection. Relatively small sample size and a significant time- lapse between the onset of symptoms and serum samples collection (appr. 8 weeks might explain the assay variability. No association was found between clinical or demographic characteristics and assay positivity. Larger studies are needed to understand the complexity of human immune response and factors influencing development of clinical symptoms. Development of intra-outbreak research plans will substantially aid the conduct of more thorough scientific investigation during an outbreak period.

  9. First Kepler results on compact pulsators - V. Slowly pulsating subdwarf B stars in short-period binaries

    DEFF Research Database (Denmark)

    Kawaler, Stephen D.; Reed, Michael D.; Østensen, Roy H.

    2010-01-01

    of sdB stars with a close M-dwarf companion with orbital periods of less than half a day. Because the orbital period is so short, the stars should be in synchronous rotation, and if so, the rotation period should imprint itself on the multiplet structure of the pulsations. However, we do not find clear......The survey phase of the Kepler Mission includes a number of hot subdwarf B (sdB) stars to search for non-radial pulsations. We present our analysis of two sdB stars that are found to be g-mode pulsators of the V1093 Her class. These two stars also display the distinct irradiation effect typical...... evidence for such rotational splitting. Though the stars do show some frequency spacings that are consistent with synchronous rotation, they also display multiplets with splittings that are much smaller. Longer-duration time series photometry will be needed to determine if those small splittings...

  10. An outbreak of meningococcal meningitis in Gauteng, Spring 1996 ...

    African Journals Online (AJOL)

    Objective. To describe a Neisseri.a meningitidis outbreak in Gauteng during the period 1 July to 31 December 1996. Design. A descriptive study. Setting. Patients with meningococcal meningitis in Gauteng who had been diagnosed by laboratory means, or notified during the period 1 July to 31 December 1996.

  11. Nosocomial outbreak of cryptosporidiosis in AIDS patients

    DEFF Research Database (Denmark)

    Ravn, Pernille; Lundgren, Jens Dilling; Kjaeldgaard, P

    1991-01-01

    OBJECTIVE--To describe a nosocomial outbreak of cryptosporidiosis during four months after June 1989. SETTING--A department of infectious diseases in Copenhagen, seeing about half the patients with AIDS in Denmark. SUBJECTS--73 HIV antibody negative subjects and 60 antibody positive subjects...... admitted as inpatients during the transmission period of the outbreak (20 June-14 August), of whom 18 (17 with AIDS, one with AIDS related complex), developed cryptosporidiosis. Two further HIV negative subjects (one departmental secretary, one visiting relative) developed cryptosporidiosis. MAIN OUTCOME...... out ice for cold drinks. The mean incubation time was at least 13 days-that is, twice that in HIV-negative patients. Of the 18 patients with AIDS who developed cryptosporidiosis, five recovered, two were symptomless carriers, three died of unrelated causes, and eight died after prolonged diarrhoea...

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

    Science.gov (United States)

    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

  13. Gastroenteritis outbreaks on cruise ships

    DEFF Research Database (Denmark)

    Mouchtouri, Varvara A; Verykouki, Eleni; Zamfir, Dumitru

    2017-01-01

    When an increased number of acute gastroenteritis (AG) cases is detected among tourists staying at the same accommodation, outbreak management plans must be activated in a timely manner to prevent large outbreaks. Syndromic surveillance data collected between 1 January 2010 and 31 December 2013...

  14. External foam and the post-mortem period in freshwater drowning; results from a retrospective study in Amsterdam, the Netherlands.

    Science.gov (United States)

    Reijnen, G; Buster, M C; Vos, P J E; Reijnders, U J L

    2017-11-01

    Determining the time of death of bodies recovered from water can be difficult. A feature of drowning is the presence of external foam. This study describes the presence of external foam in relation to the post-mortem period. The study utilizes a database of death reports dated between January 2011 and July 2016. For bodies recovered from fresh water, the presence or absence of external foam was noted. In this study, 112 death reports are included. Of these reports, 18 mentioned external foam, which account for 16.1% of the entire study population. In the population with a post-mortem period of less than 24 h, external foam was detected in 27.7% of cases. All 18 incidents with external foam had an estimated post-mortem period of less than 24 h. In our study, external foam was only present in freshwater drowning cases with a post-mortem period of less than 24 h. Based on this finding, the presence of external foam may be useful as an additional indicator when estimating the time of death in freshwater drowning. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  15. Impact of Costing and Cost Analysis Methods on the Result of the Period: Methods Based on Partial Cost Theory

    Directory of Open Access Journals (Sweden)

    Toma Maria

    2017-01-01

    Looking from this perspective, in the present paper we have proposed that objectives, to approach the full cost calculation methods based on partial costs (direct-costing on the product or direct-costing evolved, and comparing them to determine the effect they have on the outcome of the period.

  16. The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014.

    Science.gov (United States)

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

    2016-01-01

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

  17. Disruption of predicted dengue virus type 3 major outbreak cycle coincided with switching of the dominant circulating virus genotype.

    Science.gov (United States)

    Tan, Kim-Kee; Zulkifle, Nurul-Izzani; Abd-Jamil, Juraina; Sulaiman, Syuhaida; Yaacob, Che Norainon; Azizan, Noor Syahida; Che Mat Seri, Nurul Asma Anati; Samsudin, Nur Izyan; Mahfodz, Nur Hidayana; AbuBakar, Sazaly

    2017-10-01

    Dengue is hyperendemic in most of Southeast Asia. In this region, all four dengue virus serotypes are persistently present. Major dengue outbreak cycle occurs in a cyclical pattern involving the different dengue virus serotypes. In Malaysia, since the 1980s, the major outbreak cycles have involved dengue virus type 3 (DENV3), dengue virus type 1 (DENV1) and dengue virus type 2 (DENV2), occurring in that order (DENV3/DENV1/DENV2). Only limited information on the DENV3 cycles, however, have been described. In the current study, we examined the major outbreak cycle involving DENV3 using data from 1985 to 2016. We examined the genetic diversity of DENV3 isolates obtained during the period when DENV3 was the dominant serotype and during the inter-dominant transmission period. Results obtained suggest that the typical DENV3/DENV1/DENV2 cyclical outbreak cycle in Malaysia has recently been disrupted. The last recorded major outbreak cycle involving DENV3 occurred in 2002, and the expected major outbreak cycle involving DENV3 in 2006-2012 did not materialize. DENV genome analyses revealed that DENV3 genotype II (DENV3/II) was the predominant DENV3 genotype (67%-100%) recovered between 1987 and 2002. DENV3 genotype I (DENV3/I) emerged in 2002 followed by the introduction of DENV3 genotype III (DENV3/III) in 2008. These newly emerged DENV3 genotypes replaced DENV3/II, but there was no major upsurge of DENV3 cases that accompanied the emergence of these viruses. DENV3 remained in the background of DENV1 and DENV2 until now. Virus genome sequence analysis suggested that intrinsic differences within the different dengue virus genotypes could have influenced the transmission efficiency of DENV3. Further studies and continuous monitoring of the virus are needed for better understanding of the DENV transmission dynamics in hyperendemic regions. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. How Will Climate Change Impact Cholera Outbreaks?

    Science.gov (United States)

    Nasr Azadani, F.; Jutla, A.; Rahimikolu, J.; Akanda, A. S.; Huq, A.; Colwell, R. R.

    2014-12-01

    Environmental parameters associated with cholera are well documented. However, cholera continues to be a global public health threat. Uncertainty in defining environmental processes affecting growth and multiplication of the cholera bacteria can be affected significantly by changing climate at different temporal and spatial scales, either through amplification of the hydroclimatic cycle or by enhanced variability of large scale geophysical processes. Endemic cholera in the Bengal Delta region of South Asia has a unique pattern of two seasonal peaks and there are associated with asymmetric and episodic variability in river discharge. The first cholera outbreak in spring is related with intrusion of bacteria laden coastal seawater during low river discharge. Cholera occurring during the fall season is hypothesized to be associated with high river discharge related to a cross-contamination of water resources and, therefore, a second wave of disease, a phenomenon characteristic primarily in the inland regions. Because of difficulties in establishing linkage between coarse resolutions of the Global Climate Model (GCM) output and localized disease outbreaks, the impact of climate change on diarrheal disease has not been explored. Here using the downscaling method of Support Vector Machines from HADCM3 and ECHAM models, we show how cholera outbreak patterns are changing in the Bengal Delta. Our preliminary results indicate statistically significant changes in both seasonality and magnitude in the occurrence of cholera over the next century. Endemic cholera is likely to transform into epidemic forms and new geographical areas will be at risk for cholera outbreaks.

  19. PG 0308 + 096 and PG 1026 + 002 - Two new short period binary stars resulting from common-envelope evolution

    Science.gov (United States)

    Saffer, Rex A.; Wade, Richard A.; Liebert, James; Green, Richard F.; Sion, Edward M.; Bechtold, J.; Foss, Diana; Kidder, K.

    1993-01-01

    Ultraviolet spectroscopy, optical spectroscopy, and spectrophotometry have been used to study the excess UV stars PG 0308 + 096 and PG 1026 + 002. Both objects are short-period binary systems, each containing a DA white dwarf star and a dM star. Orbital periods of approximately 0.284 day for PG 0308 + 096, and aproximately 0.597 day for PG 1026, have been found by spectroscopic analysis of the H-alpha emission line. Ly-alpha and Balmer line profile fitting were used to estimate the mass of white dwarf stars; mass estimates for the dM stars are based on their spectral types. The orbital inclinations are derived from these masses, the periods, and amplitudes of the H-alpha radial velocity curves. The equivalent width of the H-alpha emission line, in each binary system, varies with the orbital phase in such a manner as to imply that it arises, in large part at least, from the hemisphere of the M star that faces the white dwarf star.

  20. outbreak of hepatitis 'E' in risalpur garrison

    International Nuclear Information System (INIS)

    Sharif, T.B.; Tariq, W.U.Z.

    2007-01-01

    Hepatitis E virus is an RNA virus. It results in epidemics/outbreaks in geographical areas lacking clean water and sanitation. It is excreted in stools and is enterically transmitted (faeco-oral route). The clinical picture resembles other acute hepatitis and diagnosis is clinched by detecting anti-HEV IgM in infected individuals. It is a self-limiting disease and does not progress to chronicity. There is no vaccine available so far, to confer immunity against HEV infection. HEV is endemic in many parts of the world and has resulted in many epidemics / outbreaks worldwide. It is also endemic in Pakistan and epidemics / outbreaks have generally been under reported. To establish the cause of outbreak Blood samples of the patients (n=195), admitted in isolation ward were collected aseptically for routine baseline investigations and hepatitis screening. Separate blood samples were sent to Armed Forces Institute of pathology (AFIP), Rawalpindi for detection of antibodies to hepatitis E virus (Anti HEV IgM). Water samples collected during the outbreak were tested by multiple tube technique. MPN (Most Probable Number) method was used to determine faecal coliform bacteria per 100 ml of water sample. All the patients (n=195) on admission had raised ALT (Alanine Aminotransferase) levels along with hyperbilirubinemia, 37% had raised TLC with polymorphonuclear response. None had HBsAg (Hepatitis B surface antign) or anti-HCV (antibodies to hepatitis C virus), 23% had prolonged PT (Prothrombin Time). Samples despatched to AFIP Rawalpindi confirmed the presence of anti-HEV IgM. Follow up analysis revealed many fold increase in ALT levels. Average stay in the Hospital was 23.6 days per patient. All the water samples were declared unfit for drinking due to high coliform count. At present, no vaccine is available to protect against HEV infection. Mainstay for prevention and occurrence is to formulate cost-effective strategies for improvement of self/environmental hygiene and

  1. The effects of a western spruce budworm outbreak on the dead wood component in relation to ownership in forests of eastern Oregon

    Science.gov (United States)

    David. Azuma

    2010-01-01

    Forest Inventory and Analysis data were used to investigate the effects of a severe western spruce budworm outbreak on the dead wood component of forests in 11 counties of eastern Oregon for two time periods. The ownership and the level of damage (as assessed by aerial surveys) affected the resulting down woody material and standing dead trees. The pattern of coarse...

  2. Role of Food Handlers in Norovirus Outbreaks in London and South East England, 2013 to 2015.

    Science.gov (United States)

    Rumble, C; Addiman, S; Balasegaram, S; Chima, K; Ready, D; Heard, J; Alexander, E

    2017-02-01

    Outbreaks caused by norovirus infection are common and occur throughout the year. Outbreaks can be related to food outlets either through a contaminated food source or an infected food handler. Both asymptomatic and symptomatic food handlers are potentially implicated in outbreaks, but evidence of transmission is limited. To understand potential food handler transmission in outbreak scenarios, epidemiological and microbiological data on possible and confirmed norovirus outbreaks reported in London and South East England in a 2-year period were reviewed. One hundred eighty-six outbreaks were associated with a food outlet or registered caterer in this period. These occurred throughout the year with peaks in quarter 1 of study years. A case series of 17 outbreaks investigated by the local field epidemiological service were evaluated further, representing more than 606 cases. In five outbreaks, symptomatic food handlers were tested and found positive for norovirus. In four outbreaks, symptomatic food handlers were not tested. Asymptomatic food handlers were tested in three outbreaks but positive for norovirus in one only. Environmental sampling did not identify the causative agent conclusively in any of the outbreaks included in this analysis. Food sampling identified norovirus in one outbreak. Recommendations from this study include for outbreak investigations to encourage testing of symptomatic food handlers and for food and environmental samples to be taken as soon as possible. In addition, sampling of asymptomatic food handlers should be considered when possible. However, in light of the complexity in conclusively identifying a source of infection, general measures to improve hand hygiene are recommended, with specific education among food handlers about the potential for foodborne pathogen transmission during asymptomatic infection, as well as reinforcing the importance of self-exclusion from food handling activities when symptomatic.

  3. Longitudinal study of Senecavirus a shedding in sows and piglets on a single United States farm during an outbreak of vesicular disease.

    Science.gov (United States)

    Tousignant, Steven J P; Bruner, Laura; Schwartz, Jake; Vannucci, Fabio; Rossow, Stephanie; Marthaler, Douglas G

    2017-08-31

    The study highlights the shedding pattern of Senecavirus A (SVA) during an outbreak of vesicular disease in a sow farm from the South-central Minnesota, USA. In this study, 34 individual, mixed parity sows with clinical signs of vesicular lesions and 30 individual piglets from 15 individual litters from sows with vesicular lesions were conveniently selected for individual, longitudinal sampling. Serum, tonsil, rectal, and vesicular swabs were collected on day1 post outbreak, and then again at 1, 2, 3, 4, 6, and 9 weeks post outbreak. Samples were tested at the University of Minnesota Veterinary Diagnostic Laboratory for SVA via Real Time Polymerase Chain Reaction (RT-PCR) RESULTS: In sows, vesicular lesions had the highest concentration of SVA, but had the shortest duration of detection lasting only 2 weeks. Viremia was detected for 1 week post outbreak, and quickly declined thereafter. SVA was detected at approximately the same frequency for both tonsil and rectal swabs with the highest percentage of SVA positive samples detected in the first 6 weeks post outbreak. In suckling piglets, viremia quickly declined 1 week post outbreak and was prevalent in low levels during the first week after weaning (4 weeks post outbreak) and was also detected in piglets that were co-mingled from a SVA negative sow farm. Similar to sows, SVA detection on rectal and tonsil swabs in piglets lasted approximately 6 weeks post outbreak. The study illustrates the variation of SVA shedding patterns in different sample types over a 9 week period in sows and piglets, and suggests the potential for viral spread between piglets at weaning.

  4. Generalized model development for a cryo-adsorber and 1-D results for the isobaric refueling period

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, V. Senthil [India Science Lab, General Motors Global R and D, Creator Building, International Technology Park, Bangalore 560066 (India); Kumar, Sudarshan [Chemical Sciences and Material Systems Lab, General Motors Global R and D, Warren Technical Center Campus, 30500 Mound Road, Warren, MI 48090 (United States)

    2010-04-15

    We have developed 3-D model equations for a cryo-adsorption hydrogen storage tank, where the energy balance accommodates the temperature and pressure variation of all the thermodynamic properties. We then reduce the 3-D model to the 1-D isobaric system and study the isobaric refueling period, for simplified geometry and charging conditions. The hydrogen capacity evolution predicted by the 1-D axial bed model is significantly different than that predicted by the lumped-parameter model because of the presence of sharp temperature gradients during refueling. The 1-D model predicts a higher hydrogen capacity than the lumped-parameter model. This observation can be rationalized by the fact that a bed with temperature gradients on equilibration should desorb gas, whenever the adsorbed phase entropy is lower than the gas phase entropy. The 1-D analysis of the isobaric refueling period does not show any significant difference in hydrogen capacity evolution among the axial, single and multicartridge annular bed designs. Hence, a multicartridge annular design, though giving a slightly lower pressure drop, does not offer any heat and mass transfer enhancement over the single cartridge design. And, the single cartridge annular design appears to be optimal. (author)

  5. Foodborne Outbreaks Reported to the U.S. Food Safety and Inspection Service, Fiscal Years 2007 through 2012.

    Science.gov (United States)

    Robertson, Kis; Green, Alice; Allen, Latasha; Ihry, Timothy; White, Patricia; Chen, Wu-San; Douris, Aphrodite; Levine, Jeoffrey

    2016-03-01

    The U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) works closely with federal, state, and local public health partners to investigate foodborne illness outbreaks associated with its regulated products. To provide insight into outbreaks associated with meat and poultry, outbreaks reported to FSIS during fiscal years 2007 through 2012 were evaluated. Outbreaks were classified according to the strength of evidence linking them to an FSIS-regulated product and by their epidemiological, etiological, and vehicle characteristics. Differences in outbreak characteristics between the period 2007 through 2009 and the period 2010 through 2012 were assessed using a chi-square test or Mann-Whitney U test. Of the 163 reported outbreaks eligible for analysis, 89 (55%) were identified as possibly linked to FSIS-regulated products and 74 (45%) were definitively linked to FSIS-regulated products. Overall, these outbreaks were associated with 4,132 illnesses, 772 hospitalizations, and 19 deaths. Shiga toxin-producing Escherichia coli was associated with the greatest proportion of reported outbreaks (55%), followed by Salmonella enterica (34%) and Listeria monocytogenes (7%). Meat and poultry products commercially sold as raw were linked to 125 (77%) outbreaks, and of these, 105 (80%) involved beef. Over the study period, the number of reported outbreaks definitively linked to FSIS-regulated products (P = 0.03) declined, while the proportion of culture-confirmed cases (P = 0.0001) increased. Our findings provide insight into the characteristics of outbreaks associated with meat and poultry products.

  6. An outbreak of epidemic keratoconjunctivitis at an outpatient ophthalmology clinic

    Directory of Open Access Journals (Sweden)

    Timothy J Doyle

    2010-12-01

    Full Text Available Epidemic keratoconjunctivitis (EKC is an acute eye infection caused by adenovirus. We investigated an outbreak of EKC at an outpatient ophthalmology practice in the context of a suspected community wide increase in EKC activity. A site visit was made to the facility reporting the outbreak. A line list was created of patients clinically diagnosed with EKC at the practice during the previous 5 months. A questionnaire was faxed to all other licensed ophthalmologists in the county regarding recent EKC activity in their facility. Descriptive data analyses were conducted. The outbreak facility reported 37 patients clinically diagnosed with EKC during the previous 5 months. In addition, the single ophthalmologist at the practice also had symptoms compatible with EKC during the outbreak period. Specimens were collected on 4 patients and all were positive for adenovirus serotype 8. Forty percent of ophthalmologists surveyed in the county saw at least one EKC patient in the previous 3 months, and 20% reported a perceived increase in EKC activity in recent months over normal seasonal patterns. The outbreak at the facility likely began as part of a widespread community increase in EKC that may have been amplified at the facility through nosocomial transmission. Medical providers experiencing increases in EKC activity above seasonally expected norms should contact their public health department for assistance with etiologic diagnoses and outbreak control.

  7. A Gastroenteritis Outbreak Caused by Noroviruses in Greece

    Directory of Open Access Journals (Sweden)

    Yiannis Alamanos

    2011-08-01

    Full Text Available In June 2006, an outbreak alert regarding cases of acute gastroenteritis in a region in North Eastern Greece (population 100,882 inhabitants, triggered investigations to guide control measures. The outbreak started the first days of June, and peaked in July. A descriptive epidemiological study, a virological characterization of the viral agent identified from cases as well as a phylogenetic analysis was performed. From June 5 to September 3, 2006 (weeks 23–44, 1,640 cases of gastroenteritis (45.2% male and 54.8% female, aged 3 months to 89 years were reported. The overall attack rate for the period was 16.3 cases/1,000 inhabitants. About 57% of cases observed were under the age of 15 years. Αnalysis of faecal samples identified Norovirus GII strains. Fifteen different Norovirus GII strains were recorded, presenting a homology of 94.8% (86–97% to GII strains obtained from GenBank. The long duration of the outbreak suggests an important role of person-to-person transmission, while the emergence of the outbreak was possibly due to contaminated potable water, although no viruses were detected in any tested water samples. This outbreak underscores the need for a national surveillance system for acute non-bacterial gastroenteritis outbreaks.

  8. Regional outbreak of staphylococcal scalded skin syndrome in healthy children

    Directory of Open Access Journals (Sweden)

    Hyun Jeong Do

    2010-01-01

    Full Text Available Purpose : Staphylococcal scalded skin syndrome (SSSS is a relatively uncommon superficial blistering skin disease that is due to Staphylococcus aureus. We had experienced a regional outbreak of SSSS over 3 years in healthy children. Methods : We retrospectively reviewed the medical records of those patients diagnosed as SSSS. Most of neonatal cases were nosocomial infections and excluded from the analysis. The clinical features, laboratory findings, the isolation and antibiotic resistance of S. aureus, the antibiotic management and other supportive treatments were analyzed. Results : Fifty-five patients with SSSS were admitted to our hospital from October 2001 to September 2004. The median age of patients was 3.0 years. Of the 55 patients, 9 were the generalized type, 13 were the intermediate type and 33 were the scarletiniform rash. All the patients were living in neighborhood of the Jinju area. S. aureus were isolated from 9 of the patients and all of the isolated S. aureus were methicillin resistant. All the patients except two were treated with intravenous flocloxacillin or nafcillin and/or cefotaxime. All the patients recovered during the follow-up period of 2 to 3 weeks. Conclusion : We experienced a regional outbreak of SSSS in previous healthy children. Further study for finding the carriers of S. aureus caused SSSS and preventing the spread of this disease is needed. Additionally, guidelines for treating SSSS due to methicillin resistant S. aureus should be established.

  9. Building test data from real outbreaks for evaluating detection algorithms.

    Science.gov (United States)

    Texier, Gaetan; Jackson, Michael L; Siwe, Leonel; Meynard, Jean-Baptiste; Deparis, Xavier; Chaudet, Herve

    2017-01-01

    Benchmarking surveillance systems requires realistic simulations of disease outbreaks. However, obtaining these data in sufficient quantity, with a realistic shape and covering a sufficient range of agents, size and duration, is known to be very difficult. The dataset of outbreak signals generated should reflect the likely distribution of authentic situations faced by the surveillance system, including very unlikely outbreak signals. We propose and evaluate a new approach based on the use of historical outbreak data to simulate tailored outbreak signals. The method relies on a homothetic transformation of the historical distribution followed by resampling processes (Binomial, Inverse Transform Sampling Method-ITSM, Metropolis-Hasting Random Walk, Metropolis-Hasting Independent, Gibbs Sampler, Hybrid Gibbs Sampler). We carried out an analysis to identify the most important input parameters for simulation quality and to evaluate performance for each of the resampling algorithms. Our analysis confirms the influence of the type of algorithm used and simulation parameters (i.e. days, number of cases, outbreak shape, overall scale factor) on the results. We show that, regardless of the outbreaks, algorithms and metrics chosen for the evaluation, simulation quality decreased with the increase in the number of days simulated and increased with the number of cases simulated. Simulating outbreaks with fewer cases than days of duration (i.e. overall scale factor less than 1) resulted in an important loss of information during the simulation. We found that Gibbs sampling with a shrinkage procedure provides a good balance between accuracy and data dependency. If dependency is of little importance, binomial and ITSM methods are accurate. Given the constraint of keeping the simulation within a range of plausible epidemiological curves faced by the surveillance system, our study confirms that our approach can be used to generate a large spectrum of outbreak signals.

  10. Building test data from real outbreaks for evaluating detection algorithms.

    Directory of Open Access Journals (Sweden)

    Gaetan Texier

    Full Text Available Benchmarking surveillance systems requires realistic simulations of disease outbreaks. However, obtaining these data in sufficient quantity, with a realistic shape and covering a sufficient range of agents, size and duration, is known to be very difficult. The dataset of outbreak signals generated should reflect the likely distribution of authentic situations faced by the surveillance system, including very unlikely outbreak signals. We propose and evaluate a new approach based on the use of historical outbreak data to simulate tailored outbreak signals. The method relies on a homothetic transformation of the historical distribution followed by resampling processes (Binomial, Inverse Transform Sampling Method-ITSM, Metropolis-Hasting Random Walk, Metropolis-Hasting Independent, Gibbs Sampler, Hybrid Gibbs Sampler. We carried out an analysis to identify the most important input parameters for simulation quality and to evaluate performance for each of the resampling algorithms. Our analysis confirms the influence of the type of algorithm used and simulation parameters (i.e. days, number of cases, outbreak shape, overall scale factor on the results. We show that, regardless of the outbreaks, algorithms and metrics chosen for the evaluation, simulation quality decreased with the increase in the number of days simulated and increased with the number of cases simulated. Simulating outbreaks with fewer cases than days of duration (i.e. overall scale factor less than 1 resulted in an important loss of information during the simulation. We found that Gibbs sampling with a shrinkage procedure provides a good balance between accuracy and data dependency. If dependency is of little importance, binomial and ITSM methods are accurate. Given the constraint of keeping the simulation within a range of plausible epidemiological curves faced by the surveillance system, our study confirms that our approach can be used to generate a large spectrum of outbreak

  11. 42 CFR 476.96 - Review period and reopening of initial denial determinations and changes as a result of DRG...

    Science.gov (United States)

    2010-10-01

    ... determinations and changes as a result of DRG validations. 476.96 Section 476.96 Public Health CENTERS FOR... initial denial determinations and changes as a result of DRG validations. (a) General timeframe. A QIO or... initial denial determination or a change as a result of a DRG validation. (b) Extended timeframes. (1) An...

  12. Two different epidemiological scenarios of border disease in the populations of Pyrenean chamois (Rupicapra p. pyrenaica after the first disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Laura Fernández-Sirera

    Full Text Available Since 2001 several outbreaks of a new disease associated with Border disease virus (BDV infection have caused important declines in Pyrenean chamois (Rupicapra pyrenaica populations in the Pyrenees. The goal of this study was to analyze the post-outbreak BDV epidemiology in the first two areas affected by disease with the aim to establish if the infection has become endemic. We also investigated if BDV infected wild and domestic ruminants sharing habitat with chamois. Unexpectedly, we found different epidemiological scenarios in each population. Since the disease outbreaks, some chamois populations recuperated quickly, while others did not recover as expected. In chamois from the first areas, prevalence was high (73.47% and constant throughout the whole study period and did not differ between chamois born before and after the BDV outbreak; in all, BDV was detected by RT-PCR in six chamois. In the other areas, prevalence was lower (52.79% and decreased during the study period; as well, prevalence was significantly lower in chamois born after the disease outbreak. No BDV were detected in this population. A comparative virus neutralisation test performed with four BDV strains and one Bovine viral diarrhoea virus (BVDV strain showed that all the chamois had BDV-specific antibodies. Pestivirus antibodies were detected in all the rest of analyzed species, with low prevalence values in wild ruminants and moderate values in domestic ruminants. No viruses were detected in these species. These results confirm the hypothesis that outbreaks of BDV infection only affect the Pyrenean chamois, although other wild ruminants can occasionally be infected. In conclusion, two different scenarios have appeared since the first border disease outbreaks in Pyrenean chamois: on the one hand frequent BDV circulation with possible negative impact on population dynamics in some areas and on the other, lack of virus circulation and quick recovery of the chamois population.

  13. An outbreak of hospital-acquired Pseudomonas aeruginosa infection caused by contaminated bottled water in intensive care units.

    Science.gov (United States)

    Eckmanns, T; Oppert, M; Martin, M; Amorosa, R; Zuschneid, I; Frei, U; Rüden, H; Weist, K

    2008-05-01

    This study describes an outbreak of Pseudomonas aeruginosa infections caused by contaminated bottled still water (BSW) in six intensive care units (ICUs) of a German university hospital. Clinical and environmental samples from these units were cultured and genotyped by amplified fragment-length polymorphism and pulsed-field gel electrophoresis analysis. Microbiological results were reviewed on a weekly basis to determine the number of P. aeruginosa infections and colonisations of ICU patients. Clinical specimens from 19 ICU patients--15 infections and four colonisations--yielded the same strain of P. aeruginosa. Furthermore, four of 103 environmental samples also yielded P. aeruginosa. However, only a P. aeruginosa strain isolated from unopened BSW was genetically identical to the P. aeruginosa strain isolated from the patients. In the 42-week period before the outbreak, the mean weekly number of new ICU patients infected or colonised with P. aeruginosa was 46.9 (95% CI 40.7-53.1)/1000 bed-days. During the 6-week period of the outbreak, the weekly number of new patients with P. aeruginosa was 88.9 (95% CI 54.3-122.2)/1000 bed-days. This number returned to the previous level after removal of the BSW. Thus, the microbiological and epidemiological findings revealed that the outbreak was related to BSW contaminated with P. aeruginosa. It was concluded that all untested BSW should be removed from ICUs.

  14. Severe Dengue Fever Outbreak in Taiwan.

    Science.gov (United States)

    Wang, Sheng-Fan; Wang, Wen-Hung; Chang, Ko; Chen, Yen-Hsu; Tseng, Sung-Pin; Yen, Chia-Hung; Wu, Deng-Chyang; Chen, Yi-Ming Arthur

    2016-01-01

    Dengue fever (DF) is a vector-borne disease caused by dengue viruses (DENVs). Epidemic dengue occurs intermittently in Taiwan. In 2014, Taiwan experienced its largest DF outbreak. There were 15,732 DF cases reported. There were a total of 136 dengue hemorrhagic fever (DHF) cases, of which 20 resulted in death. Most DF cases were reported in southern Taiwan. A total of 15,043 (96%) cases were from Kaohsiung, a modern city in southern Taiwan. This report reviews DF epidemics in Taiwan during 2005-2014. The correlation between DF and DHF along with temperature and precipitation were conjointly examined. We conclude that most dengue epidemics in Taiwan resulted from imported DF cases. Results indicate three main factors that may have been associated with this DF outbreak in Kaohsiung: an underground pipeline explosion combined with subsequent rainfall and higher temperature. These factors may have enhanced mosquito breeding activity, facilitating DENV transmission. © The American Society of Tropical Medicine and Hygiene.

  15. An outbreak of Vibrio cholerae in Vikas Nagar, Chandigarh, India

    Directory of Open Access Journals (Sweden)

    Sonia Puri

    2014-01-01

    Full Text Available Background : On 1 July 2012, a large number of cases of acute diarrheal episodes were reported in Vikas Nagar, Chandigarh. A rapid response team was sent to investigate this outbreak on 3 July 2012. Aim : To determine the reasons for the outbreak and to focus on the identification of a gap in the management of the epidemic by applying remedial measures in the Vibrio cholera outbreak in the Vikas Nagar area of Chandigarh district. Materials and Methods : A house-to-house survey of 2765 houses was performed with 20 teams of Auxillary Nurse Midwife ANM/Anganwadi workers. Information regarding age, sex, place of residence, occupation, date of onset and treatment history and laboratory finding were collected. Environmental investigation and laboratory investigation of the stool samples were also performed. As the study was conducted during an emergency response to the outbreak, and was designed to provide information to orient the public health response, ethical approval was not required. Remedial measures were implemented. Results : A total of 1875 patients reported to the various health facilities of the Vikas Nagar area with complaints of increased frequency of loose watery diarrhea and a few had vomiting episodes during the time period of 1 - 14 July 2012. Four deaths were reported. Three hundred eighteen (318 cases were found in the house-to-house survey of 2765 houses of the area. Twenty-six percent of the cases were in the age group of 1800 MPN/100 mL was reported from 10 water samples. Investigations revealed that the epidemic was waterborne. Leakages in the pipes were found at many places leading to mixing of water with drainage, and water samples collected from the houses of the cases were found to be positive for Vibrio cholerae. Conclusion : Among the identified gaps, delays in the initiation of the investigation of the epidemic and pipe leakages were the most important. In India, waterborne epidemics are usual occurrences during the year

  16. Tornado outbreak variability follows Taylor's power law of fluctuation scaling and increases dramatically with severity.

    Science.gov (United States)

    Tippett, Michael K; Cohen, Joel E

    2016-02-29

    Tornadoes cause loss of life and damage to property each year in the United States and around the world. The largest impacts come from 'outbreaks' consisting of multiple tornadoes closely spaced in time. Here we find an upward trend in the annual mean number of tornadoes per US tornado outbreak for the period 1954-2014. Moreover, the variance of this quantity is increasing more than four times as fast as the mean. The mean and variance of the number of tornadoes per outbreak vary according to Taylor's power law of fluctuation scaling (TL), with parameters that are consistent with multiplicative growth. Tornado-related atmospheric proxies show similar power-law scaling and multiplicative growth. Path-length-integrated tornado outbreak intensity also follows TL, but with parameters consistent with sampling variability. The observed TL power-law scaling of outbreak severity means that extreme outbreaks are more frequent than would be expected if mean and variance were independent or linearly related.

  17. Epidemiology and genotype analysis of sapovirus associated with gastroenteritis outbreaks in Alberta, Canada: 2004-2007.

    Science.gov (United States)

    Pang, Xiaoli L; Lee, Bonita E; Tyrrell, Gregory J; Preiksaitis, Jutta K

    2009-02-15

    This study describes the epidemiology and circulating strains of sapovirus associated with gastroenteritis outbreaks in Alberta, Canada, from 2004 to 2007. Sapovirus was an important cause of gastroenteritis outbreaks, accounting for 43 (17.6%) of 244 outbreaks in which all samples tested were negative for norovirus. All 4 human sapovirus genotypes, GI, GII, GIV, and GV, were found in samples during these outbreaks. The greatest amount of sapovirus-associated outbreak activity occurred in 2007, after the emergence of genotype GIV in December 2006. The majority of sapovirus-associated outbreaks in Alberta during this period (27 [62.8%] of 43) occurred in hospitals, community long-term care facilities, and senior lodges. Adults>65 years of age were the age group most commonly affected.

  18. Tularemia Outbreaks and Common Vole (Microtus arvalis) Irruptive Population Dynamics in Northwestern Spain, 1997-2014.

    Science.gov (United States)

    Luque-Larena, Juan José; Mougeot, François; Roig, Dolors Vidal; Lambin, Xavier; Rodríguez-Pastor, Ruth; Rodríguez-Valín, Elena; Anda, Pedro; Escudero, Raquel

    2015-09-01

    During the last decades, large tularemia outbreaks in humans have coincided in time and space with population outbreaks of common voles in northwestern Spain, leading us to hypothesize that this rodent species acts as a key spillover agent of Francisella tularensis in the region. Here, we evaluate for the first time a potential link between irruptive vole numbers and human tularemia outbreaks in Spain. We compiled vole abundance estimates obtained through live-trapping monitoring studies and official reports of human tularemia cases during the period 1997-2014. We confirm a significant positive association between yearly cases of tularemia infection in humans and vole abundance. High vole densities during outbreaks (up to 1000 voles/hectare) may therefore enhance disease transmission and spillover contamination in the environment. If this ecological link is further confirmed, the apparent multiannual cyclicity of common vole outbreaks might provide a basis for forecasting the risk of tularemia outbreaks in northwestern Spain.

  19. Legionnaires' Disease Outbreaks and Cooling Towers, New York City, New York, USA.

    Science.gov (United States)

    Fitzhenry, Robert; Weiss, Don; Cimini, Dan; Balter, Sharon; Boyd, Christopher; Alleyne, Lisa; Stewart, Renee; McIntosh, Natasha; Econome, Andrea; Lin, Ying; Rubinstein, Inessa; Passaretti, Teresa; Kidney, Anna; Lapierre, Pascal; Kass, Daniel; Varma, Jay K

    2017-11-01

    The incidence of Legionnaires' disease in the United States has been increasing since 2000. Outbreaks and clusters are associated with decorative, recreational, domestic, and industrial water systems, with the largest outbreaks being caused by cooling towers. Since 2006, 6 community-associated Legionnaires' disease outbreaks have occurred in New York City, resulting in 213 cases and 18 deaths. Three outbreaks occurred in 2015, including the largest on record (138 cases). Three outbreaks were linked to cooling towers by molecular comparison of human and environmental Legionella isolates, and the sources for the other 3 outbreaks were undetermined. The evolution of investigation methods and lessons learned from these outbreaks prompted enactment of a new comprehensive law governing the operation and maintenance of New York City cooling towers. Ongoing surveillance and program evaluation will determine if enforcement of the new cooling tower law reduces Legionnaires' disease incidence in New York City.

  20. Hepatitis A outbreak on a floating restaurant in Florida, 1986.

    Science.gov (United States)

    Lowry, P W; Levine, R; Stroup, D F; Gunn, R A; Wilder, M H; Konigsberg, C

    1989-01-01

    In April and May 1986, the largest reported foodborne outbreak of hepatitis A in Florida state history occurred among patrons and employees of a floating restaurant. A total of 103 cases (97 patrons and six employees) were identified. The exposure period lasted 31 days (March 20-April 19), making this the most prolonged hepatitis A outbreak to occur in a restaurant that to date has been reported to the Centers for Disease Control. The exposure period was divided into time intervals (peak, early, late, and total) for calculation of food-specific attack rates. The authors showed that green salad was an important vehicle of transmission for each phase of the exposure period, with the highest adjusted odds ratio for the three-day peak exposure interval (March 28-30), 6.8 (p = 0.001). Non-salad pantry items and mixed bar drinks were also identified as vehicles of transmission; both were more important during the early interval of the exposure period than during the late interval. Two of six infected employees worked in the pantry and may have sequentially infected patrons. Though rare, this outbreak suggests that hepatitis A infection among employees may allow for transmission to patrons for prolonged periods of time. Prevention of such outbreaks requires prompt reporting of ill patrons with rapid identification of infected employees and correction of food handling practices.

  1. Reported waterborne outbreaks of gastrointestinal disease in Australia are predominantly associated with recreational exposure.

    Science.gov (United States)

    Dale, Katie; Kirk, Martyn; Sinclair, Martha; Hall, Robert; Leder, Karin

    2010-10-01

    To examine the frequency and circumstances of reported waterborne outbreaks of gastroenteritis in Australia. Examination of data reported to OzFoodNet between 2001 and 2007. During these seven years, 6,515 gastroenteritis outbreaks were reported to OzFoodNet, most of which were classified as being transmitted person-to-person or from an unknown source. Fifty-four (0.83%) outbreaks were classified as either 'waterborne' or 'suspected waterborne', of which 78% (42/54) were attributed to recreational water and 19% (10/54) to drinking water. Of the drinking water outbreaks, implicated pathogens were found on all but one occasion and included Salmonella sp. (five outbreaks), Campylobacter jejuni (three outbreaks) and Giardia (one outbreak). There have been few waterborne outbreaks detected in Australia, and most of those reported have been associated with recreational exposure. However, there are difficulties in identifying and categorising gastroenteritis outbreaks, as well as in obtaining microbiological and epidemiological evidence, which can result in misclassification or underestimation of water-associated events. Gastroenteritis surveillance data show that, among reported water-associated gastroenteritis outbreaks in Australia, recreational exposure is currently more common than a drinking water source. However, ongoing surveillance for waterborne outbreaks is important, especially as drought conditions may necessitate replacement of conventional drinking water supplies with alternative water sources, which could incur potential for new health risks. © 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.

  2. The HyMeX Special Observation Period in Central Italy: precipitation measurements, retrieval techniques and preliminary results

    Science.gov (United States)

    Silvio Marzano, Frank; Baldini, Luca; Picciotti, Errico; Colantonio, Matteo; Barbieri, Stefano; Di Fabio, Saverio; Montopoli, Mario; Vulpiani, Gianfranco; Roberto, Nicoletta; Adirosi, Elisa; Gorgucci, Eugenio; Anagnostou, Marios N.; Kalogiros, John; Anagnostou, Emmanouil N.; Ferretti, Rossella; Gatlin, Patrick.; Wingo, Matt; Petersen, Walt

    2013-04-01

    The Mediterranean area concentrates the major natural risks related to the water cycle, including heavy precipitation and flash-flooding during the fall season. The capability to predict such high-impact events remains weak because of the contribution of very fine-scale processes and their non-linear interactions with the larger scale processes. These societal and science issues motivate the HyMeX (Hydrological cycle in the Mediterranean Experiment, http://www.hymex.org/) experimental programme. HyMeX aims at a better quantification and understanding of the water cycle in the Mediterranean with emphasis on intense events. The observation strategy of HyMEX is organized in a long-term (4 years) Enhanced Observation Periods (EOP) and short-term (2 months) Special Observation Periods (SOP). HyMEX has identified 3 main Mediterranean target areas: North-West (NW), Adriatic (A) and South-East (SE). Within each target area several hydrometeorological sites for heavy rainfall and flash flooding have been set up. The hydrometeorological site in Central Italy (CI) is interested by both western and eastern fronts coming from the Atlantic Ocean and Siberia, respectively. Orographic precipitations play an important role due to the central Apennine range, which reaches nearly 3000 m (Gran Sasso peak). Moreover, convective systems commonly develop in CI during late summer and beginning of autumn, often causing localized hailstorms with cluster organized cells. Western fronts may heavily hit the Tiber basin crossing large urban areas (Rome), whereas eastern fronts can cause flash floods along the Adriatic coastline. Two major basins are involved within CI region: Tiber basin (1000 km long) and its tributary Aniene and the Aterno-Pescara basin (300 km long). The first HyMeX SOP1.1 was carried out from Sept. till Nov. 2012 in the NW target area. The Italian SOP1.1 was coordinated by the Centre of Excellence CETEMPS, University of L'Aquila, a city located in the CI heart. The CI area

  3. The unprecedented 2014 Legionnaires' disease outbreak in Portugal: atmospheric driving mechanisms

    Science.gov (United States)

    Russo, Ana; Gouveia, Célia M.; Soares, Pedro M. M.; Cardoso, Rita M.; Mendes, Manuel T.; Trigo, Ricardo M.

    2018-03-01

    A large outbreak of Legionnaires' disease occurred in November 2014 nearby Lisbon, Portugal. This epidemic infected 377 individuals by the Legionella pneumophila bacteria, resulting in 14 deaths. The primary source of transmission was contaminated aerosolized water which, when inhaled, lead to atypical pneumonia. The unseasonably warm temperatures during October 2014 may have played a role in the proliferation of Legionella species in cooling tower systems. The episode was further exacerbated by high relative humidity and a thermal inversion which limited the bacterial dispersion. Here, we analyze if the Legionella outbreak event occurred during a situation of extreme potential recirculation and/or stagnation characteristics. In order to achieve this goal, the Allwine and Whiteman approach was applied for a hindcast simulation covering the affected area during a near 20-year long period (1989-2007) and then for an independent period covering the 2014 event (15 October to 13 November 2014). The results regarding the average daily critical transport indices for the 1989-2007 period clearly indicate that the airshed is prone to stagnation as these events have a dominant presence through most of the study period (42%), relatively to the occurrence of recirculation (18%) and ventilation (17%) events. However, the year of 2014 represents an exceptional year when compared to the 1989-2007 period, with 53 and 33% of the days being classified as under stagnation and recirculation conditions, respectively.

  4. The unprecedented 2014 Legionnaires' disease outbreak in Portugal: atmospheric driving mechanisms.

    Science.gov (United States)

    Russo, Ana; Gouveia, Célia M; Soares, Pedro M M; Cardoso, Rita M; Mendes, Manuel T; Trigo, Ricardo M

    2018-03-23

    A large outbreak of Legionnaires' disease occurred in November 2014 nearby Lisbon, Portugal. This epidemic infected 377 individuals by the Legionella pneumophila bacteria, resulting in 14 deaths. The primary source of transmission was contaminated aerosolized water which, when inhaled, lead to atypical pneumonia. The unseasonably warm temperatures during October 2014 may have played a role in the proliferation of Legionella species in cooling tower systems. The episode was further exacerbated by high relative humidity and a thermal inversion which limited the bacterial dispersion. Here, we analyze if the Legionella outbreak event occurred during a situation of extreme potential recirculation and/or stagnation characteristics. In order to achieve this goal, the Allwine and Whiteman approach was applied for a hindcast simulation covering the affected area during a near 20-year long period (1989-2007) and then for an independent period covering the 2014 event (15 October to 13 November 2014). The results regarding the average daily critical transport indices for the 1989-2007 period clearly indicate that the airshed is prone to stagnation as these events have a dominant presence through most of the study period (42%), relatively to the occurrence of recirculation (18%) and ventilation (17%) events. However, the year of 2014 represents an exceptional year when compared to the 1989-2007 period, with 53 and 33% of the days being classified as under stagnation and recirculation conditions, respectively.

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

    Science.gov (United States)

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

    2017-10-13

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

  6. An outbreak of Burkholderia stabilis colonization in a nasal ward.

    Science.gov (United States)

    Wang, Lijun; Wang, Mei; Zhang, Junyi; Wu, Wei; Lu, Yuan; Fan, Yanyan

    2015-04-01

    The aim of this study was to describe an outbreak of Burkholderia stabilis colonization among patients in a nasal ward. Multilocus sequence typing (MLST) was used for the molecular typing of B. stabilis isolates. Microbiological records were reviewed to delineate the colonization outbreak period. One hundred seventy-one cultures of environment and equipment samples from the nasal ward were performed to trace the source of contamination. Infection control measures were taken in order to end the outbreak. All B. stabilis isolates were identified as a new MLST type, ST821. A total of 53 patients carried this B. stabilis in the nasal ward between March and September 2013, which was defined as the outbreak period. The source of the colonization was not determined because all environment cultures were negative for Burkholderia cepacia complex. No further B. stabilis carriers have been found in the ward since the implementation of interventions. Attention must be paid to asymptomatic colonization in order to identify outbreaks early. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia.

    Science.gov (United States)

    Belda, Ketema; Tegegne, Ayesheshem Ademe; Mersha, Amare Mengistu; Bayenessagne, Mekonnen Getahun; Hussein, Ibrahim; Bezabeh, Belay

    2017-01-01

    Despite the increase of immunization coverage (administrative) of measles in the country, there are widespread outbreaks of measles. In this respect, we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone, Oromia region, to identify the contributing factors that lead to the protracted outbreak of measles. We used a cross-sectional study design to investigate a measles outbreak in Guji zone, Oromia region. Data entry and analysis was performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel. In three months' time a total of 1059 suspected cases and two deaths were reported from 9 woredas affected by a measles outbreak in Guji zone. The cumulative attack rate of 81/100,000 population and case fatality ratio of 0.2% was recorded. Of these, 821 (77.5%) cases were measles vaccine. Although, all age groups were affected under five years old were more affected 495 (48%) than any other age groups. In response to the outbreak, an outbreak response immunization was organized at the 11th week of the epidemic, when the epidemic curve started to decline. 6 months to14 years old were targeted for outbreak response immunization and the overall coverage was 97 % (range: 90-103%). Case management with vitamin A supplementation, active case search, and health education was some of the activities carried out to curb the outbreak. We conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas, low community awareness in utilization of immunization service, inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak that's triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak, which as a result outbreak response immunization were delayed. We recommend establishing

  8. Functional results following fractures of the proximal humerus. A controlled clinical study comparing two periods of immobilization

    DEFF Research Database (Denmark)

    Kristiansen, B; Angermann, P; Larsen, T K

    1989-01-01

    In order to compare 1 and 3 weeks of immobilization following proximal humeral fractures a prospective controlled trial was performed in 85 patients. Clinical follow-up according to the Neer assessment system was done after 1, 3, 6, 12, and 24 months. One week of immobilization resulted in a better...

  9. RESULTS OF IMPLEMENTATION OF TARGET PROGRAMS ON RADIATION ACCIDENT REMEDIATION FOR THE PERIOD TO 2010 AND PROSPECTS OF FURTHER ACTIVITIES

    Directory of Open Access Journals (Sweden)

    T. A. Marchenko

    2008-01-01

    Full Text Available The report contains information about measures undertaken by the Ministry of Civil Defense and Emergencies of the Russian Federation in the framework of implementation of the state policy in the field of radiation accidents remediation. Results of works realized in the framework of target programs on remediation of radiation accidents at Chernobyl NPP and Production Association MAYAK, and on problems caused by nuclear weapon tests at Seminalatinsk test site are presented.

  10. A Short Overview of Ebola Outbreak

    Directory of Open Access Journals (Sweden)

    Masumeh Saeidi

    2014-10-01

    Full Text Available   Ebola virus disease (formerly known as Ebola haemorrhagic fever is a severe, often fatal illness, with a death rate of up to 90%. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees. Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan. The origin of the virus is unknown but fruit bats (Pteropodidae are considered the likely host of the Ebola virus, based on available evidence. In the current outbreak in West Africa, the majority of cases in humans have occurred as a result of human-to-human transmission. Infection occurs from direct contact through broken skin or mucous membranes with the blood, or other bodily fluids or secretions (stool, urine, saliva, semen of infected people.

  11. Re-emergence of dengue virus serotype 2 strains in the 2013 outbreak in Nepal

    Science.gov (United States)

    Gupta, Birendra Prasad; Singh, Sneha; Kurmi, Roshan; Malla, Rajani; Sreekumar, Easwaran; Manandhar, Krishna Das

    2015-01-01

    Background & objectives: Epidemiological interventions and mosquito control are the available measures for dengue control. The former approach uses serotype and genetic information on the circulating virus strains. Dengue has been frequently reported from Nepal, but this information is mostly lacking. The present study was done to generate a comprehensive clinical and virological picture of a dengue outbreak in Nepal during 2013. Methods: A hospital-based study involving patients from five districts of Nepal was carried out. Demographic information, clinical details and dengue serological status were obtained. Viral RNA was characterized at the molecular level by reverse-transcription polymerase chain reaction (RT-PCR), nucleotide sequencing and phylogenetic analysis. Results: From among the 2340 laboratory-confirmed dengue cases during the study period, 198 patients consented for the study. Clinically they had fever (100%), headache (59.1%), rashes (18.2%), retro-orbital pain (30.3%), vomiting (15.1%), joint pain (28.8%) and thrombocytopenia (74.3%). Fifteen (7.5%) of them had mucosal bleeding manifestations, and the rest were uncomplicated dengue fever. The patients were mostly adults with a mean age of 45.75 ± 38.61 yr. Of the 52 acute serum samples tested, 15 were positive in RT-PCR. The causative virus was identified as DENV serotype 2 belonging to the Cosmopolitan genotype. Interpretations & conclusions: We report here the involvement of DENV serotype 2 in an outbreak in Nepal in 2013. Earlier outbreaks in the region in 2010 were attributed to serotype 1 virus. As serotype shifts are frequently associated with secondary infections and severe disease, there is a need for enhancing surveillance especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in the region. PMID:26905233

  12. Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005–2010 period

    Directory of Open Access Journals (Sweden)

    Pribluda Victor S

    2012-06-01

    Full Text Available Abstract Background Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM programme has provided technical assistance to Amazon Malaria Initiative (AMI countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. Methods Trained personnel from the National Malaria Control Programmes (NMCPs, often in collaboration with country’s Official Medicine Control Laboratory (OMCL, developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC, were performed utilizing a portable mini-laboratory. Results Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines

  13. Analysis of the results of CAT of thorax with bronchiectasis protocol, period 2000-2001 Hospital Calderon Guardia

    International Nuclear Information System (INIS)

    Pacheco Segura, Maureen

    2003-01-01

    This investigation analyses the computerized axial tomography (CAT) of thorax with protocol of bronchiectasis. It was carried out in the Servicio de Radiologia e Imagenes Medicas of the Hospital Calderon Guardia, Costa Rica. The bronchiectasis is the abnormal permanent expansion of the bronchial tuber and is important to diagnose it because the patient can suffer of pulmonary infections, these can be accompanied by bronchial blood flow and hemoptysis. When they are disseminated can be associated with significant obstruction of the aerial tract. When they are gotten into focus can be confused with neoplasia and other diseases. From the bronchiectasis diagnosis it is used methods of image such as x-ray of thorax, bronchography and computerized axial tomography (CAT) of thorax, usually the diagnosis is confirmed by means of a computerized axial tomography (CAT); which is the image of election to establish the presence and extension of the bronchiectasis. In addition, this study analyzes the radiological clinical relation in the patients which were performed the computerized axial tomography (CAT) of thorax with protocol of bronchiectasis and it identifies the most suitable radiological technique to obtain a satisfactory result in the computerized axial tomography with protocol of bronchiectasis [es

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

    Science.gov (United States)

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

    2017-03-01

    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. 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. A total of 40 stakeholders were included in the study. Health workers and community members reported longer waiting times at hospitals due to the increased number of patients receiving care for dengue-related symptoms. Health workers and hospital administrators reported that there were no major interruptions in access to care. Overall financial impact of dengue outbreaks on households was greatest for low-income families. Despite prevention and control campaigns implemented between outbreak periods, various stakeholders reported that dengue prevention and control efforts performed by municipal authorities remained insufficient, suggesting that efforts should be reinforced and better

  15. Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005-2010 period.

    Science.gov (United States)

    Pribluda, Victor S; Barojas, Adrian; Añez, Arletta; López, Cecilia G; Figueroa, Ruth; Herrera, Roxana; Nakao, Gladys; Nogueira, Fernando Ha; Pianetti, Gerson A; Povoa, Marinete M; Viana, Giselle Mr; Gomes, Margarete S Mendonça; Escobar, Jose P; Sierra, Olga L Muñoz; Norena, Susana P Rendon; Veloz, Raúl; Bravo, Marcy Silva; Aldás, Martha R; Hindssemple, Alison; Collins, Marilyn; Ceron, Nicolas; Krishnalall, Karanchand; Adhin, Malti; Bretas, Gustavo; Hernandez, Nelly; Mendoza, Marjorie; Smine, Abdelkrim; Chibwe, Kennedy; Lukulay, Patrick; Evans, Lawrence

    2012-06-15

    Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistance to Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with country's Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory. Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines from seven AMI countries was evaluated, mostly

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

    Science.gov (United States)

    Curran, Evonne T

    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.

  17. A comparison of outbreak dynamics of the spruce bark beetle in Sweden and the mountain pine beetle in Canada (Curculionidae: Scolytinae)

    OpenAIRE

    Kärvemo, Simon; Schroeder, Leif Martin

    2010-01-01

    The European spruce bark beetle (Ips typographus) and the North American mountain pine beetle (Dendroctonus ponderosae) may kill millions of trees during outbreak periods. Both species have also experienced large outbreaks in recent years. But the magnitude of the outbreaks of D. ponderosae is much larger. In this review we compare the outbreak history of I. typographus in Sweden with D. ponderosae in British Columbia in Canada. We also discuss some possible explanations for the difference in...

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

    Science.gov (United States)

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

    2015-07-01

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

  19. Epidemiological investigation of nosocomial outbreak of staphylococcal skin diseases in neonatal ward.

    Science.gov (United States)

    Kurlenda, J; Grinholc, M; Krzysztoń-Russjan, J; Wiśniewska, K

    2009-05-01

    During a 1-month period, eight neonates developed staphylococcal skin disease diagnosed as a bullous impetigo in the maternity unit of the Provincial Hospital in Gdansk. An epidemiological investigation based on phenotyping and genotyping methods was performed. All neonates involved in the outbreak, their mothers and 15 staff members were screened for carriage of Staphylococcus aureus by nasal swabs. Isolated strains were compared with strains cultured from affected skin and purulent conjunctiva of infected newborns. Isolates were analyzed for the presence of the etA and etB genes using polymerase chain reaction and genotyped by pulsed-field gel electrophoresis (PFGE) and coa gene polymorphism. The analyzed S. aureus strains were methicillin-sensitive and could be divided into two groups according to antibiotyping, phage typing, coa polymorphism and PFGE pattern. The first group consisted of etA and etB negative strains, and the second one involved only the etB positive ones. Our results have shown that there were two different clusters of infection caused by two populations of S. aureus strains. Among the 15 medical staff members screened we have found seven carriers. However, phage typing revealed that distinct strains unrelated to the outbreak isolates were carried. Although we have not been able to establish the source of bacteria involved in the outbreak, our results suggest that for both groups, mothers could be the source of the infecting strains.

  20. Outbreak of Enterovirus - 71 Meningitis in Calicut

    Directory of Open Access Journals (Sweden)

    CK Sasidharan

    2016-04-01

    Full Text Available Objective: Enterovirus 71(EV 71 causes wide spectrum of infections ranging from asymptomatic conditions to clinical syndromes like diarrhea, rash, hand-foot-and mouth disease (HFMD, herpangina, aseptic meningitis, encephalitis, myocarditis, acute flaccid paralysis, bulbar and brainstem encephalitis Guillain Barre syndrome, pulmonary haemorrhage. This study deals with an outbreak of aseptic meningitis in children caused by EV 71 virus. Methods: The authors report an outbreak of aseptic meningitis in children in and around Calicut in June 2008. Clinical and laboratory study was done in collaboration with National Centre for Disease Control, New Delhi. 149 children with aseptic meningitis were studied and followed up from June 2008 to May 2009. Result: All children had clinical features suggestive of aseptic meningitis and serology showed the rising antibody titre against EV 71 virus infection. CSF analysis also showed four fold rise in antibodies in one and ≥ 1:2 neutralising antibodies titer against EV- 71 in four samples indicating meningitis due to EV-71. Conclusion: EV 71 was identified as the causative agent of the outbreak of aseptic meningitis in the study and the fact that the EV 71 infection has evolved from minor illness like HFMD to major illness like aseptic meningitis from the same locality is truly alarming.

  1. The use of a Psoroptes ovis serodiagnostic test for the analysis of a natural outbreak of sheep scab

    Directory of Open Access Journals (Sweden)

    Burgess Stewart TG

    2012-01-01

    Full Text Available Abstract Background Sheep scab is a highly contagious disease of sheep caused by the ectoparasitic mite Psoroptes ovis. The disease is endemic in the UK and has significant economic impact through its effects on performance and welfare. Diagnosis of sheep scab is achieved through observation of clinical signs e.g. itching, pruritis and wool loss and ultimately through the detection of mites in skin scrapings. Early stages of infestation are often difficult to diagnose and sub-clinical animals can be a major factor in disease spread. The development of a diagnostic assay would enable farmers and veterinarians to detect disease at an early stage, reducing the risk of developing clinical disease and limiting spread. Methods Serum samples were obtained from an outbreak of sheep scab within an experimental flock (n = 480 (3 samples each from 160 sheep allowing the assessment, by ELISA of sheep scab specific antibody prior to infestation, mid-outbreak (combined with clinical assessment and post-treatment. Results Analysis of pre-infestation samples demonstrated low levels of potential false positives (3.8%. Of the 27 animals with clinical or behavioural signs of disease 25 tested positive at the mid-outbreak sampling period, however, the remaining 2 sheep tested positive at the subsequent sampling period. Clinical assessment revealed the absence of clinical or behavioural signs of disease in 132 sheep, whilst analysis of mid-outbreak samples showed that 105 of these clinically negative animals were serologically positive, representing potential sub-clinical infestations. Conclusions This study demonstrates that this ELISA test can effectively diagnose sheep scab in a natural outbreak of disease, and more importantly, highlights its ability to detect sub-clinically infested animals. This ELISA, employing a single recombinant antigen, represents a major step forward in the diagnosis of sheep scab and may prove to be critical in any future control

  2. Groundwater-quality data in 12 GAMA study units: Results from the 2006–10 initial sampling period and the 2008–13 trend sampling period, California GAMA Priority Basin Project

    Science.gov (United States)

    Mathany, Timothy M.

    2017-03-09

    constituents (volatile organic compounds, pesticides, and pesticide degradates), constituents of special interest (perchlorate and 1,2,3-trichloropropane), and natural inorganic constituents (nutrients, major and minor ions, and trace elements). Isotopic tracers (tritium, carbon-14, and stable isotopes of hydrogen and oxygen in water) also were measured to help identify processes affecting groundwater quality and the sources and ages of the sampled groundwater. More than 200 constituents and water-quality indicators were measured during the trend sampling period.Quality-control samples (blanks, replicates, matrix-spikes, and surrogate compounds) were collected at about one-third of the trend sites, and the results for these samples were used to evaluate the quality of the data for the groundwater samples. On the basis of detections in laboratory and field blank samples collected by GAMA-PBP study units, including the 12 study units presented here, reporting levels for some groundwater results were adjusted in this report. Differences between replicate samples were mostly within acceptable ranges, indicating low variability in analytical results. Matrix-spike recoveries were largely within the acceptable range (70 to 130 percent).This study did not attempt to evaluate the quality of water delivered to consumers. After withdrawal, groundwater used for drinking water typically is treated, disinfected, and blended with other waters to achieve acceptable water quality. The comparison benchmarks used in this report apply to treated water that is served to the consumer, not to untreated groundwater. To provide some context for the results, however, concentrations of constituents measured in these groundwater samples were compared with benchmarks established by the U.S. Environmental Protection Agency and the State of California. Comparisons between data collected for this study and benchmarks for drinking water are for illustrative purposes only and are not indicative of compliance

  3. Water-borne epidemic outbreaks; Brotes epidemicos de transmision hidrica

    Energy Technology Data Exchange (ETDEWEB)

    Ciranda Larrea, F.B.; Hidalgo Garcia, E.; Peiro Callizo, E.F.; Herrero Alana, G.

    1995-12-31

    The control of water-transmitted infections is one of the key aims of any Public Heath-Care System. For this paper a descriptive epidemiologic analysis has been performed using data obtained through normalized forms as well as Annual Reports of Epidemiology Units and Veterinary Inspection Records. A total of 22 outbreaks have been recorded in the period of reference. Those outbreaks affected 2.263 people. The attack-rate was of 99 people affected for each 1000 ar risk. The main agents turned out to be Norwalk virus, Rotavirus and A-Hepatitis virus. The most important risk factor was undoubtedly the ingestion of untreated or not properly treated water. The improvement of water treatment and distribution systems, the increase in the population being supplied with potable water, along with the ease of the drought have caused a significant drop in the number of water-transmitted outbreaks. (Author)

  4. Outbreaks of forest defoliating insects in Japan, 1950-2000.

    Science.gov (United States)

    Kamata, N; Kamata, N

    2002-04-01

    In Japan, several forest-defoliating insects reach outbreak levels and cause serious defoliation. Stand mortality sometimes occurs after severe defoliation. However, in general, tree mortality caused by insect defoliation is low because of the prevailing moist climate in Japan. Evergreen conifers are more susceptible to tree mortality as a result of insect defoliation whereas deciduous broad-leaved trees are seldom killed. Insect defoliation occurs more frequently in man-made environments such as among shade trees, orchards, and plantations than in natural habitats. Outbreaks of some defoliators tend to occur in stands of a particular age: e.g. outbreaks of the pine caterpillar, Dendrolimus spectabilis Butler (Lepidoptera: Lasiocampidae) occur more frequently in young pine plantations. In contrast, defoliation caused by outbreaks of lepidopterous and hymenopterous pests in larch plantations is more frequent with stand maturation. There is a relationship between outbreaks of some defoliators and altitude above sea level. Most outbreaks of forest defoliators were terminated by insect pathogens that operated in a density-dependent fashion. Since the 1970s, Japan has been prosperous and can afford to buy timber from abroad. More recently, there has been an increasing demand for timber in Japan, that coincides with a huge demand internationally, so that the country will need to produce more timber locally in the future. The increasing pressure on the forestry industry to meet this demand will require more sophisticated methods of pest control coupled with more sustainable methods of silviculture.

  5. Early outbreak detection by linking health advice line calls to water distribution areas retrospectively demonstrated in a large waterborne outbreak of cryptosporidiosis in Sweden

    Directory of Open Access Journals (Sweden)

    Pär Bjelkmar

    2017-04-01

    Full Text Available Abstract Background In the winter and spring of 2011 a large outbreak of cryptosporidiosis occurred in Skellefteå municipality, Sweden. This study summarizes the outbreak investigation in terms of outbreak size, duration, clinical characteristics, possible source(s and the potential for earlier detection using calls to a health advice line. Methods The investigation included two epidemiological questionnaires and microbial analysis of samples from patients, water and other environmental sources. In addition, a retrospective study based on phone calls to a health advice line was performed by comparing patterns of phone calls between different water distribution areas. Results Our analyses showed that approximately 18,500 individuals were affected by a waterborne outbreak of cryptosporidiosis in Skellefteå in 2011. This makes it the second largest outbreak of cryptosporidiosis in Europe to date. Cryptosporidium hominis oocysts of subtype IbA10G2 were found in patient and sewage samples, but not in raw water or in drinking water, and the initial contamination source could not be determined. The outbreak went unnoticed to authorities for several months. The analysis of the calls to the health advice line provides strong indications early in the outbreak that it was linked to a particular water treatment plant. Conclusions We conclude that an earlier detection of the outbreak by linking calls to a health advice line to water distribution areas could have limited the outbreak substantially.

  6. Societal learning in epidemics: intervention effectiveness during the 2003 SARS outbreak in Singapore.

    Directory of Open Access Journals (Sweden)

    John M Drake

    Full Text Available BACKGROUND: Rapid response to outbreaks of emerging infectious diseases is impeded by uncertain diagnoses and delayed communication. Understanding the effect of inefficient response is a potentially important contribution of epidemic theory. To develop this understanding we studied societal learning during emerging outbreaks wherein patient removal accelerates as information is gathered and disseminated. METHODS AND FINDINGS: We developed an extension of a standard outbreak model, the simple stochastic epidemic, which accounts for societal learning. We obtained expressions for the expected outbreak size and the distribution of epidemic duration. We found that rapid learning noticeably affects the final outbreak size even when learning exhibits diminishing returns (relaxation. As an example, we estimated the learning rate for the 2003 outbreak of severe acute respiratory syndrome (SARS in Singapore. Evidence for relaxation during the first eight weeks of the outbreak was inconclusive. We estimated that if societal learning had occurred at half the actual rate, the expected final size of the outbreak would have reached nearly 800 cases, more than three times the observed number of infections. By contrast, the expected outbreak size for societal learning twice as effective was 116 cases. CONCLUSION: These results show that the rate of societal learning can greatly affect the final size of disease outbreaks, justifying investment in early warning systems and attentiveness to disease outbreak by both government authorities and the public. We submit that the burden of emerging infections, including the risk of a global pandemic, could be efficiently reduced by improving procedures for rapid detection of outbreaks, alerting public health officials, and aggressively educating the public at the start of an outbreak.

  7. Outbreaks Associated with Treated Recreational Water - United States, 2000-2014.

    Science.gov (United States)

    Hlavsa, Michele C; Cikesh, Bryanna L; Roberts, Virginia A; Kahler, Amy M; Vigar, Marissa; Hilborn, Elizabeth D; Wade, Timothy J; Roellig, Dawn M; Murphy, Jennifer L; Xiao, Lihua; Yates, Kirsten M; Kunz, Jasen M; Arduino, Matthew J; Reddy, Sujan C; Fullerton, Kathleen E; Cooley, Laura A; Beach, Michael J; Hill, Vincent R; Yoder, Jonathan S

    2018-05-18

    Outbreaks associated with exposure to treated recreational water can be caused by pathogens or chemicals in venues such as pools, hot tubs/spas, and interactive water play venues (i.e., water playgrounds). During 2000-2014, public health officials from 46 states and Puerto Rico reported 493 outbreaks associated with treated recreational water. These outbreaks resulted in at least 27,219 cases and eight deaths. Among the 363 outbreaks with a confirmed infectious etiology, 212 (58%) were caused by Cryptosporidium (which causes predominantly gastrointestinal illness), 57 (16%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms), and 47 (13%) by Pseudomonas (which causes folliculitis ["hot tub rash"] and otitis externa ["swimmers' ear"]). Investigations of the 363 outbreaks identified 24,453 cases; 21,766 (89%) were caused by Cryptosporidium, 920 (4%) by Pseudomonas, and 624 (3%) by Legionella. At least six of the eight reported deaths occurred in persons affected by outbreaks caused by Legionella. Hotels were the leading setting, associated with 157 (32%) of the 493 outbreaks. Overall, the outbreaks had a bimodal temporal distribution: 275 (56%) outbreaks started during June-August and 46 (9%) in March. Assessment of trends in the annual counts of outbreaks caused by Cryptosporidium, Legionella, or Pseudomonas indicate mixed progress in preventing transmission. Pathogens able to evade chlorine inactivation have become leading outbreak etiologies. The consequent outbreak and case counts and mortality underscore the utility of CDC's Model Aquatic Health Code (https://www.cdc.gov/mahc) to prevent outbreaks associated with treated recreational water.

  8. An outbreak of gastroenteritis caused by Salmonella enterica serotype Enteritidis traced to cream cakes

    Directory of Open Access Journals (Sweden)

    Kee Tai Goh

    2011-03-01

    Full Text Available Introduction: This paper describes the epidemiological, microbiological and environmental investigations conducted during an outbreak of Salmonella gastroenteritis in Singapore.Methods: A case-control study was undertaken to identify the vehicle of transmission. Microbiological testing was performed on faecal, food and environmental samples. Isolates of Salmonella were further characterized by phage typing and ribotyping.Results: There were 216 gastroenteritis cases reported from 20 November to 4 December 2007. The causative agent was identified as Salmonella enterica subspecies enterica serotype Enteritidis for 14 out of 20 cases tested. The vehicle of transmission was traced to cream cakes produced by a bakery and sold at its retail outlets (P < 0.001, OR = 143.00, 95% Cl = 27.23–759.10. More than two-thirds of the 40 Salmonella strains isolated from hospitalized cases, food samples and asymptomatic food handlers were of phage type 1; the others reacted but did not conform to any phage type. The phage types correlated well with their unique antibiograms. The ribotype patterns of 22 selected isolates tested were highly similar, indicating genetic relatedness. The dendrogram of the strains from the outbreak showed distinct clustering and correlation compared to the non-outbreak strains, confirming a common source of infection.Discussion: The cream cakes were likely contaminated by one of the ingredients used in the icing. Cross-contamination down the production line and subsequent storage of cakes at ambient temperatures for a prolonged period before consumption could have resulted in the outbreak.

  9. Epidemiology of Foot and Mouth Disease in Ethiopia: a Retrospective Analysis of District Level Outbreaks, 2007-2012.

    Science.gov (United States)

    Jemberu, W T; Mourits, M C M; Sahle, M; Siraw, B; Vernooij, J C M; Hogeveen, H

    2016-12-01

    This study aimed at determining the incidence, distribution, risk factors, and causal serotypes of foot and mouth disease (FMD) outbreaks in Ethiopia based on 5 years of retrospective outbreak data (September 2007 until August 2012). District level outbreak data were collected from 115 randomly selected districts using a questionnaire administered to district animal health officers. The national incidence of FMD outbreaks during the study period was 1.45 outbreaks per five district years. Outbreaks were geographically widespread affecting all major regional states in the country and were more frequent in the central, southern, and southeastern parts of the country. Neither long-term nor seasonal trends were observed in the incidence of outbreaks. A mixed effects logistic regression analysis revealed that the type of production system (market oriented system versus subsistence systems), presence of a major livestock market and/or route, and adjacency to a national parks or wildlife sanctuary were found to be associated with increased risk of outbreaks in the districts. FMD virus serotypes O, A, SAT 2, and SAT 1 were identified as the causal serotypes of the outbreaks during the study period. Whereas O was the dominant serotype, SAT 2 was the serotype that showed increase in relative frequency of occurrence. The estimated incidence of outbreaks is useful in assessing the economic impacts of the disease, and the identified risk factors provide important knowledge to target a progressive FMD control policy for Ethiopia. © 2015 Blackwell Verlag GmbH.

  10. Norovirus: U.S. Trends and Outbreaks

    Science.gov (United States)

    ... harvested from contaminated water and raspberries irrigated with contaminated water have caused norovirus outbreaks. Norovirus on Cruise Ships Over 90% of diarrheal disease outbreaks on cruise ships are caused by norovirus ( ...

  11. Reporting and Surveillance for Norovirus Outbreaks

    Science.gov (United States)

    ... Vaccine Surveillance Network (NVSN) Foodborne Diseases Active Surveillance Network (FoodNet) National Outbreak Reporting System (NORS) Estimates of Foodborne Illness in the United States CDC's Vessel Sanitation Program CDC Feature: Surveillance for Norovirus Outbreaks Top ...

  12. Clostridium perfringens in London, July 2009: two weddings and an outbreak.

    OpenAIRE

    Eriksen, J.; Zenner, D.; Anderson, S. R.; Grant, K.; Kumar, D.

    2010-01-01

    : Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer. The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyse possible associations b...

  13. Did the Ebola Outbreak Disrupt Immunisation Services? A Case Study from Liberia

    OpenAIRE

    Wesseh, C; Najjemba, R; Edwards, J; Owiti, P; Tweya, H; Bhat, P

    2017-01-01

    Setting: All health facilities providing routine immunisation services in Liberia. Objective: To compare the number of routine facility-based and outreach immunisations and measles cases before, during and after the Ebola outbreak. Design: A descriptive cross-sectional study. Results: Immunisation coverage for fully immunised children before the Ebola outbreak was 73%. Immunisation coverage for all antigens declined by half compared to baseline during the outbreak. These findings were similar...

  14. TOWARDS MODELING DISEASE OUTBREAK NOTIFICATION SYSTEMS

    OpenAIRE

    Farag Azzedin; Jaweed Yazdani,; Salahadin Adam; Mustafa Ghaleb

    2014-01-01

    Disease outbreak detection, monitoring and notification systems play an important role in assessing threats to public health since disease outbreaks are becoming increasingly common world-wide. There are several systems in use around the world, with coverage of national, international and global disease outbreaks. These systems use different taxonomies and classifications for the detection and prioritization of potential disease outbreaks. In this paper, we study and analyze th...

  15. Measles (Rubeola) Cases and Outbreaks

    Science.gov (United States)

    ... Address What’s this? Submit What's this? Submit Button Measles Cases and Outbreaks Language: English (US) Español (Spanish) ... Español: Casos y brotes de sarampión Number of measles cases by year since 2010 Measles cases per ...

  16. Outbreak of Sporotrichosis, Western Australia

    Science.gov (United States)

    Feeney, Kynan T.; Whittle, Amanda J.; Altman, Shelley A.; Speers, David J.

    2007-01-01

    A cluster of sporotrichosis cases occurred in the Busselton-Margaret River region of Western Australia from 2000 to 2003. Epidemiologic investigation and mycologic culture for Sporothrix schenckii implicated hay initially distributed through a commercial hay supplier as the source of the outbreak. Declining infection rates have occurred after various community measures were instigated. PMID:17953099

  17. Larval outbreaks in West Greenland

    DEFF Research Database (Denmark)

    Lund, Magnus; Raundrup, Katrine; Westergaard-Nielsen, Andreas

    2017-01-01

    effects of a larval outbreak in 2011 on vegetation productivity and CO2 exchange. We estimate a decreased carbon (C) sink strength in the order of 118–143 g C m−2, corresponding to 1210–1470 tonnes C at the Kobbefjord catchment scale. The decreased C sink was, however, counteracted the following years...

  18. Results of evaluation of periodic safety review for No. 1 plant in Fukushima No. 1 Nuclear Power Station, Tokyo Electric Power Co., Inc

    International Nuclear Information System (INIS)

    1994-01-01

    No. 1 plant in Fukushima No. 1 Nuclear Power Station started the commercial power generation in March, 1971, and has continued the operation for more than 23 years. During this period, the countermeasures to troubles, periodic inspections, and the maintenance by the electric power company have been carried out. These states are to be recollected from the viewpoints of the comprehensive evaluation of the operation experiences and the reflection of the latest technological knowledge, and the safety and reliability are to be further improved in the periodic safety review. Agency of Natural Resources and Energy evaluated the report of the periodic safety review for No. 1 plant in Fukushima No. 1 Nuclear Power Station, and summarized the results. The course of the evaluation of the report is shown. The facility utilization factor was 50.1% on the average of about 23 years, but in the last 10 years, it was improved to 59.7%. In the last five years, the rate of occurrence of unexpected shutdown was 0.4 times/year. These are the results of preventive maintenance and the improvement of the facilities and operation management. Operation management, maintenance management, fuel management, radiation control, radioactive waste management and the reflection of the experience of troubles and the latest technological knowledge to the improvement of safety have been carried out properly. The work plan for disaster prevention was established. (K.I.)

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

    Science.gov (United States)

    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

  20. First outbreak with MRSA in a Danish neonatal intensive care unit: risk factors and control procedures.

    Directory of Open Access Journals (Sweden)

    Benedicte Grenness Utke Ramsing

    Full Text Available 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 25(th-August 8(th 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.

  1. Mining the key predictors for event outbreaks in social networks

    Science.gov (United States)

    Yi, Chengqi; Bao, Yuanyuan; Xue, Yibo

    2016-04-01

    It will be beneficial to devise a method to predict a so-called event outbreak. Existing works mainly focus on exploring effective methods for improving the accuracy of predictions, while ignoring the underlying causes: What makes event go viral? What factors that significantly influence the prediction of an event outbreak in social networks? In this paper, we proposed a novel definition for an event outbreak, taking into account the structural changes to a network during the propagation of content. In addition, we investigated features that were sensitive to predicting an event outbreak. In order to investigate the universality of these features at different stages of an event, we split the entire lifecycle of an event into 20 equal segments according to the proportion of the propagation time. We extracted 44 features, including features related to content, users, structure, and time, from each segment of the event. Based on these features, we proposed a prediction method using supervised classification algorithms to predict event outbreaks. Experimental results indicate that, as time goes by, our method is highly accurate, with a precision rate ranging from 79% to 97% and a recall rate ranging from 74% to 97%. In addition, after applying a feature-selection algorithm, the top five selected features can considerably improve the accuracy of the prediction. Data-driven experimental results show that the entropy of the eigenvector centrality, the entropy of the PageRank, the standard deviation of the betweenness centrality, the proportion of re-shares without content, and the average path length are the key predictors for an event outbreak. Our findings are especially useful for further exploring the intrinsic characteristics of outbreak prediction.

  2. Reasons for and factors associated with issuing sickness certificates for longer periods than necessary: results from a nationwide survey of physicians

    Science.gov (United States)

    2013-01-01

    Background Physicians’ work with sickness certifications is an understudied field. Physicians’ experience of sickness certifying for longer periods than necessary has been previous reported. However, the extent and frequency of such sickness certification is largely unknown. The aims of this study were: a) to explore the frequency of sickness certifying for longer periods than necessary among physicians working in different clinical settings; b) to examine main reasons for issuing sickness certificates for longer periods than necessary; and c) to examine factors associated with unnecessary issued sickness certificates. Methods In 2008, all physicians living and working in Sweden (a total of 36,898) were sent an invitation to participate in a questionnaire study concerning their sick-listing practices. A total of 22,349 (60.6%) returned the questionnaire. In the current study, physicians reporting handling sickness certification consultations at least weekly were included in the analyses, a total of 12,348. Results The proportion of physicians reporting issuing sickness certificates for longer periods than actually necessary varied greatly between different types of clinics, with the highest frequency among those working at: occupational medicine, orthopedic, primary health care, and psychiatry clinics; and lowest among those working in: eye, dermatology, ear/nose/throat, oncology, surgery, and infection clinics. Logistic analyses showed that sickness certifying for longer periods than necessary due to limitations in the health care system was particularly common among physicians working at occupational medicine, orthopedic, and primary health care clinics. Sickness certifying for longer periods than necessary due to patient-related factors was much more common among physicians working at psychiatric clinics. In addition to differences between clinics, frequency of sickness certificates issued for longer periods than necessary varied by age, physicians

  3. Brown midrib corn silage fed during the peripartal period increased intake and resulted in a persistent increase in milk solids yield of Holstein cows.

    Science.gov (United States)

    Stone, W C; Chase, L E; Overton, T R; Nestor, K E

    2012-11-01

    the BMRCS treatment were likely because of a reduction in fill, whereas the increased intakes in the postpartum period in cows fed the BMRCS were either because of the higher intakes during the prepartum period or because of a reduction in fill limitations in the postpartum period. The carryover response in wk 4 to 15 may have resulted from cows that received BMRCS during the transition period being in a more positive nutrient balance than cows fed CCS. The results of this study indicate the importance that digestible NDF can have in transition diets and the long-term production responses that can occur when intake is increased in the transition period. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  4. Outbreak of tinea gladiatorum in wrestlers in Tehran (Iran

    Directory of Open Access Journals (Sweden)

    Bassiri-Jahromi Shahindokht

    2008-01-01

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

  5. A plague on five of your houses - statistical re-assessment of three pneumonic plague outbreaks that occurred in Suffolk, England, between 1906 and 1918

    Directory of Open Access Journals (Sweden)

    Egan Joseph R

    2010-10-01

    Full Text Available Abstract Background Plague is a re-emerging disease and its pneumonic form is a high priority bio-terrorist threat. Epidemiologists have previously analysed historical outbreaks of pneumonic plague to better understand the dynamics of infection, transmission and control. This study examines 3 relatively unknown outbreaks of pneumonic plague that occurred in Suffolk, England, during the first 2 decades of the twentieth century. Methods The Kolmogorov-Smirnov statistical test is used to compare the symptomatic period and the length of time between successive cases (i.e. the serial interval with previously reported values. Consideration is also given to the case fatality ratio, the average number of secondary cases resulting from each primary case in the observed minor outbreaks (termed Rminor, and the proportion of individuals living within an affected household that succumb to pneumonic plague via the index case (i.e. the household secondary attack rate (SAR. Results 2 of the 14 cases survived giving a case fatality ratio of 86% (95% confidence interval (CI = {57%, 98%}. For the 12 fatal cases, the average symptomatic period was 3.3 days (standard deviation (SD = 1.2 days and, for the 11 non index cases, the average serial interval was 5.8 days (SD = 2.0 days. Rminor was calculated to be 0.9 (SD = 1.0 and, in 2 households, the SAR was approximately 14% (95% CI = {0%, 58%} and 20% (95% CI = {1%, 72%}, respectively. Conclusions The symptomatic period was approximately 1 day longer on average than in an earlier study but the serial interval was in close agreement with 2 previously reported values. 2 of the 3 outbreaks ended without explicit public health interventions; however, non-professional caregivers were particularly vulnerable - an important public health consideration for any future outbreak of pneumonic plague.

  6. Modeling the spread of polio in an IPV-vaccinated population: lessons learned from the 2013 silent outbreak in southern Israel.

    Science.gov (United States)

    Yaari, Rami; Kaliner, Ehud; Grotto, Itamar; Katriel, Guy; Moran-Gilad, Jacob; Sofer, Danit; Mendelson, Ella; Miller, Elizabeth; Huppert, Amit; Anis, E; Kopel, E; Manor, Y; Mor, O; Shulman, L; Singer, R; Weil, M

    2016-06-23

    Polio eradication is an extraordinary globally coordinated health program in terms of its magnitude and reach, leading to the elimination of wild poliovirus (WPV) in most parts of the world. In 2013, a silent outbreak of WPV was detected in Israel, a country using an inactivated polio vaccine (IPV) exclusively since 2005. The outbreak was detected using environmental surveillance (ES) of sewage reservoirs. Stool surveys indicated the outbreak to be restricted mainly to children under the age of 10 in the Bedouin population of southern Israel. In order to curtail the outbreak, a nationwide vaccination campaign using oral polio vaccine (OPV) was conducted, targeting all children under 10. A transmission model, fitted to the results of the stool surveys, with additional conditions set by the ES measurements, was used to evaluate the prevalence of WPV in Bedouin children and the effectiveness of the vaccination campaign. Employing the parameter estimates of the model fitting, the model was used to investigate the effect of alternative timings, coverages and dosages of the OPV campaign on the outcome of the outbreak. The mean estimate for the mean reproductive number was 1.77 (95 % credible interval, 1.46-2.30). With seasonal variation, the reproductive number maximum range was between zero and six. The mean estimate for the mean infectious periods was 16.8 (8.6-24.9) days. The modeling indicates the OPV campaign was effective in curtailing the outbreak. The mean estimate for the attack rate in Bedouin children under 10 at the end of 2014 was 42 % (22-65 %), whereas without the campaign the mean projected attack rate was 57 % (35-74 %). The campaign also likely shortened the duration of the outbreak by a mean estimate of 309 (2-846) days. A faster initiation of the OPV campaign could have reduced the incidence of WPV even if a lower coverage was reached, at the risk of prolonging the outbreak. OPV campaigns are essential for interrupting WPV transmission, even in a

  7. Multiple origins of outbreak populations of a native insect pest in an agro-ecosystem.

    Science.gov (United States)

    Kobayashi, T; Sakurai, T; Sakakibara, M; Watanabe, T

    2011-06-01

    Native insects can become epidemic pests in agro-ecosystems. A population genetics approach was applied to analyze the emergence and spread of outbreak populations of native insect species. Outbreaks of the mirid bug, Stenotus rubrovittatus, have rapidly expanded over Japan within the last two decades. To characterize the outbreak dynamics of this species, the genetic structure of local populations was assessed using polymorphisms of the mtDNA COI gene and six microsatellite loci. Results of the population genetic analysis suggested that S. rubrovittatus populations throughout Japan were genetically isolated by geographic distance and separated into three genetic clusters occupying spatially segregated regions. Phylogeographic analysis indicated that the genetic structure of S. rubrovittatus reflected post-glacial colonization. Early outbreaks of S. rubrovittatus in the 1980s occurred independently of genetically isolated populations. The genetic structure of the populations did not fit the pattern of an outbreak expansion, and therefore the data did not support the hypothesis that extensive outbreaks were caused by the dispersal of specific pestiferous populations. Rather, the historical genetic structure prior to the outbreaks was maintained throughout the increase in abundance of the mirid bug. Our study indicated that changes in the agro-environment induced multiple outbreaks of native pest populations. This implies that, given suitable environmental conditions, local populations may have the potential to outbreak even without invasion of populations from other environmentally degraded areas.

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

    Science.gov (United States)

    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.

  9. The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg Outbreak in Angola.

    Directory of Open Access Journals (Sweden)

    Allen Grolla

    2011-05-01

    Full Text Available BACKGROUND: Marburg virus (MARV, a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF with the highest case fatality rate to date. METHODOLOGY/PRINCIPAL FINDINGS: A mobile laboratory unit (MLU was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. CONCLUSIONS/SIGNIFICANCE: The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.

  10. Whole genome sequencing versus traditional genotyping for investigation of a Mycobacterium tuberculosis outbreak: a longitudinal molecular epidemiological study.

    Directory of Open Access Journals (Sweden)

    Andreas Roetzer

    Full Text Available BACKGROUND: Understanding Mycobacterium tuberculosis (Mtb transmission is essential to guide efficient tuberculosis control strategies. Traditional strain typing lacks sufficient discriminatory power to resolve large outbreaks. Here, we tested the potential of using next generation genome sequencing for identification of outbreak-related transmission chains. METHODS AND FINDINGS: During long-term (1997 to 2010 prospective population-based molecular epidemiological surveillance comprising a total of 2,301 patients, we identified a large outbreak caused by an Mtb strain of the Haarlem lineage. The main performance outcome measure of whole genome sequencing (WGS analyses was the degree of correlation of the WGS analyses with contact tracing data and the spatio-temporal distribution of the outbreak cases. WGS analyses of the 86 isolates revealed 85 single nucleotide polymorphisms (SNPs, subdividing the outbreak into seven genome clusters (two to 24 isolates each, plus 36 unique SNP profiles. WGS results showed that the first outbreak isolates detected in 1997 were falsely clustered by classical genotyping. In 1998, one clone (termed "Hamburg clone" started expanding, apparently independently from differences in the social environment of early cases. Genome-based clustering patterns were in better accordance with contact tracing data and the geographical distribution of the cases than clustering patterns based on classical genotyping. A maximum of three SNPs were identified in eight confirmed human-to-human transmission chains, involving 31 patients. We estimated the Mtb genome evolutionary rate at 0.4 mutations per genome per year. This rate suggests that Mtb grows in its natural host with a doubling time of approximately 22 h (400 generations per year. Based on the genome variation discovered, emergence of the Hamburg clone was dated back to a period between 1993 and 1997, hence shortly before the discovery of the outbreak through epidemiological

  11. Investigation of an outbreak of Salmonella enteritidis gastroenteritis associated with consumption of eggs in a restaurant chain in Maryland.

    Science.gov (United States)

    Lin, F Y; Morris, J G; Trump, D; Tilghman, D; Wood, P K; Jackman, N; Israel, E; Libonati, J P

    1988-10-01

    Salmonella enteritidis ser. enteritidis was isolated from patrons and employees of three restaurants in a restaurant chain in Maryland during August and September 1985. Isolates from all three restaurants had identical plasmid profiles; this profile was present in 13 of 40 randomly selected S. enteritidis isolates received by the Maryland state health department laboratory during a comparable time period. The outbreak in one restaurant resulted in at least 71 illnesses, with 17 persons known to have been hospitalized. Scrambled eggs served on a "breakfast bar" were implicated as the vehicle of transmission in this restaurant, with eggs a possible vehicle in another of the three restaurants. The data point out the risks associated with improper handling of eggs in food service establishments, provide further evidence for the observed association between S. enteritidis and eggs in the northeastern United States, and demonstrate the utility of plasmid analysis in investigation of outbreaks involving common Salmonella serotypes.

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

    Science.gov (United States)

    2013-01-01

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

  13. Search Results | Page 26 | IDRC - International Development ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Results 251 - 260 of 8494 ... ... demand for health service delivery in the Middle East and North Africa. ... Strengthening response capacity to African infectious disease outbreaks. The 2014 Ebola outbreak in West Africa claimed the lives of tens of ...

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    International Development Research Centre (IDRC) Digital Library (Canada)

    Results 51 - 60 of 1913 ... IDRC-supported project influencing government policy in Kenya ... Strengthening response capacity to African infectious disease outbreaks. The 2014 Ebola outbreak in West Africa claimed the lives of tens of thousands ...

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    Results 271 - 280 of 8487 ... Strengthening response capacity to African infectious disease outbreaks. The 2014 Ebola outbreak in West Africa claimed the lives of tens of thousands ... of a global health institute in the Middle East and North Africa.

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    International Development Research Centre (IDRC) Digital Library (Canada)

    Results 61 - 70 of 1914 ... Strengthening response capacity to African infectious disease outbreaks. The 2014 Ebola outbreak in West Africa claimed the lives of tens of ... and the health SDGs: Building momentum in Eastern and Southern Africa.

  17. Synchronized oviposition triggered by migratory flight intensifies larval outbreaks of beet webworm.

    Directory of Open Access Journals (Sweden)

    Yun Xia Cheng

    Full Text Available Identifying the reproductive consequences of insect migration is critical to understanding its ecological and evolutionary significance. However, many empirical studies are seemingly contradictory, making recognition of unifying themes elusive and controversial. The beet webworm, Loxostege sticticalis L. is a long-range migratory pest of many crops in the northern temperate zone from 36 °N to 55 °N, with larval populations often exploding in regions receiving immigrants. In laboratory experiments, we examined (i the reproductive costs of migratory flight by tethered flight, and (ii the reproductive traits contributing to larval outbreaks of immigrant populations. Our results suggest that the beet webworm does not initiate migratory flight until the 2nd or 3rd night after emergence. Preoviposition period, lifetime fecundity, mating capacity, and egg hatch rate for adults that experienced prolonged flight after the 2nd night did not differ significantly from unflown moths, suggesting these traits are irrelevant to the severity of beet webworm outbreaks after migration. However, the period of first oviposition, a novel parameter developed in this paper measuring synchrony of first egg-laying by cohorts of post-migratory females, for moths flown on d 3 and 5 of adulthood was shorter than that of unflown moths, indicating a tightened time-window for onset of oviposition after migration. The resulting synchrony of egg-laying will serve to increase egg and subsequent larval densities. A dense population offers potential selective advantages to the individual larvae comprising it, whereas the effect from the human standpoint is intensification of damage by an outbreak population. The strategy of synchronized oviposition may be common in other migratory insect pests, such as locust and armyworm species, and warrants further study.

  18. The 2011 outbreak of African horse sickness in the African horse sickness controlled area in South Africa

    Directory of Open Access Journals (Sweden)

    John D. Grewar

    2013-11-01

    Full Text Available African horse sickness (AHS is a controlled animal disease in South Africa, and as a result of the high mortality rates experienced, outbreaks in the AHS controlled area in the Western Cape Province have a significant impact on affected properties as well as on the exportation of live horses from the AHS free zone in metropolitan Cape Town. An outbreak of AHS serotype 1 occurred in the surveillance zone of the AHS controlled area of the Western Cape during the summer of 2011. The epicentre of the outbreak was the town of Mamre in the magisterial district of Malmesbury and the outbreak was confined to a defined containment zone within this area by movement control of all equids and a blanket vaccination campaign. A total of 73 cases of AHS were confirmed during this outbreak, which included four confirmed subclinical cases. The morbidity rate for the outbreak was 16%with a mortality rate of 14%and a case fatality rate of 88%. Outbreak disease surveillance relied on agent identification using polymerase chain reaction (PCR-based assays, which is novel for an AHS outbreak in South Africa. The source of this outbreak was never confirmed although it is believed to be associated with the illegal movement of an infected animal into the Mamre area. This detailed description of the outbreak provides a sound scientific basis to assist decision making in future AHS outbreaks in the AHS controlled area of South Africa and in countries where AHS is an exotic or emerging disease.

  19. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016.

    Science.gov (United States)

    Wagenaar, Bradley H; Augusto, Orvalho; Beste, Jason; Toomay, Stephen J; Wickett, Eugene; Dunbar, Nelson; Bawo, Luke; Wesseh, Chea Sanford

    2018-02-01

    The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries.

  20. An outbreak of respiratory tularemia caused by diverse clones of Francisella tularensis.

    Science.gov (United States)

    Johansson, Anders; Lärkeryd, Adrian; Widerström, Micael; Mörtberg, Sara; Myrtännäs, Kerstin; Ohrman, Caroline; Birdsell, Dawn; Keim, Paul; Wagner, David M; Forsman, Mats; Larsson, Pär

    2014-12-01

    The bacterium Francisella tularensis is recognized for its virulence, infectivity, genetic homogeneity, and potential as a bioterrorism agent. Outbreaks of respiratory tularemia, caused by inhalation of this bacterium, are poorly understood. Such outbreaks are exceedingly rare, and F. tularensis is seldom recovered from clinical specimens. A localized outbreak of tularemia in Sweden was investigated. Sixty-seven humans contracted laboratory-verified respiratory tularemia. F. tularensis subspecies holarctica was isolated from the blood or pleural fluid of 10 individuals from July to September 2010. Using whole-genome sequencing and analysis of single-nucleotide polymorphisms (SNPs), outbreak isolates were compared with 110 archived global isolates. There were 757 SNPs among the genomes of the 10 outbreak isolates and the 25 most closely related archival isolates (all from Sweden/Finland). Whole genomes of outbreak isolates were >99.9% similar at the nucleotide level and clustered into 3 distinct genetic clades. Unexpectedly, high-sequence similarity grouped some outbreak and archival isolates that originated from patients from different geographic regions and up to 10 years apart. Outbreak and archival genomes frequently differed by only 1-3 of 1 585 229 examined nucleotides. The outbreak was caused by diverse clones of F. tularensis that occurred concomitantly, were widespread, and apparently persisted in the environment. Multiple independent acquisitions of F. tularensis from the environment over a short time period suggest that natural outbreaks of respiratory tularemia are triggered by environmental cues. The findings additionally caution against interpreting genome sequence identity for this pathogen as proof of a direct epidemiological link. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. Dengue disease outbreak definitions are implicitly variable

    Directory of Open Access Journals (Sweden)

    Oliver J. Brady

    2015-06-01

    Full Text Available Infectious diseases rarely exhibit simple dynamics. Outbreaks (defined as excess cases beyond response capabilities have the potential to cause a disproportionately high burden due to overwhelming health care systems. The recommendations of international policy guidelines and research agendas are based on a perceived standardised definition of an outbreak characterised by a prolonged, high-caseload, extra-seasonal surge. In this analysis we apply multiple candidate outbreak definitions to reported dengue case data from Brazil to test this assumption. The methods identify highly heterogeneous outbreak characteristics in terms of frequency, duration and case burden. All definitions identify outbreaks with characteristics that vary over time and space. Further, definitions differ in their timeliness of outbreak onset, and thus may be more or less suitable for early intervention. This raises concerns about the application of current outbreak guidelines for early warning/identification systems. It is clear that quantitatively defining the characteristics of an outbreak is an essential prerequisite for effective reactive response. More work is needed so that definitions of disease outbreaks can take into account the baseline capacities of treatment, surveillance and control. This is essential if outbreak guidelines are to be effective and generalisable across a range of epidemiologically different settings.

  2. Differential changes in serum uric acid concentrations in sibutramine promoted weight loss in diabetes: results from four weeks of the lead-in period of the SCOUT trial

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Weeke, Peter; Brendorp, Bente

    2009-01-01

    ABSTRACT: BACKGROUND AND AIMS: Elevated levels of serum uric acid are associated with an increased risk of cardiovascular morbidity and mortality. The response of uric acid to weight loss therapy (lifestyle plus sibutramine) in an overweight and obese cardiovascular high risk population was studied....... METHODS AND RESULTS: Data from a four week single-blind lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT) study were analyzed. 2584 patients (24%) had diabetes mellitus (DM) only, 1748 (16%) had cardiovascular disease (CVD) only and 6397 (60%) had both DM + CVD. Uric acid concentrations...... significantly more in patients without DM (p sibutramine induced lower uric acid levels...

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

    Science.gov (United States)

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

    2013-07-31

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

  4. Outbreak of HIV infection in a Scottish prison.

    OpenAIRE

    Taylor, A.; Goldberg, D.; Emslie, J.; Wrench, J.; Gruer, L.; Cameron, S.; Black, J.; Davis, B.; McGregor, J.; Follett, E.

    1995-01-01

    OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME ME...

  5. Do saproxylic beetles respond numerically to rapid changes in dead wood availability following moth outbreaks?

    OpenAIRE

    Schultze, Sabrina

    2012-01-01

    Outbreaks of defoliating insects periodically cause mass mortality of trees, thereby generating pulses of dead wood resources for saproxylic (i.e. dead-wood dependent) organisms. This study investigated the responses of saproxylic beetles to a dead wood resource pulse caused by recent (2001-2009) outbreaks of geometrid moths in the subarctic mountain birch forest of the Varanger region in northern Norway. A large scale (20 km) transect design, implementing window (flight interception) traps a...

  6. results

    Directory of Open Access Journals (Sweden)

    Salabura Piotr

    2017-01-01

    Full Text Available HADES experiment at GSI is the only high precision experiment probing nuclear matter in the beam energy range of a few AGeV. Pion, proton and ion beams are used to study rare dielectron and strangeness probes to diagnose properties of strongly interacting matter in this energy regime. Selected results from p + A and A + A collisions are presented and discussed.

  7. Impact of ethylene oxide gas sterilization of duodenoscopes after a carbapenem-resistant Enterobacteriaceae outbreak.

    Science.gov (United States)

    Naryzhny, Igor; Silas, Dean; Chi, Kenneth

    2016-08-01

    Carbapenem-resistant Enterobacteriaceae (CRE) outbreaks have been implicated at several medical institutions involving gastroenterology laboratories and, specifically, duodenoscopes. Currently, there are no specific guidelines to eradicate or prevent the outbreak of this bacteria. We describe ethylene oxide (ETO) gas sterilizations of duodenoscopes to address this issue. A complete investigation of the gastroenterology laboratory and an evaluation by the Centers for Disease Control and Prevention concluded that no lapses were found in the reprocessing of the equipment. With no deficiencies to address, we began a novel cleaning process using surgical ETO gas sterilizers in addition to standard endoscope reprocessing recommendations and guidelines, all while trying to eradicate the CRE contamination and prevent future recurrences. We also instituted a surveillance system for recurrence of CRE contamination via monthly cultures of the duodenoscopes. Between October 2013 and April 2014, 589 ERCPs were performed with 645 ETO gas sterilizations of 6 duodenoscopes. Given the extra 16 hours needed to sterilize the duodenoscopes, our institution incurred costs resulting from purchasing additional equipment and surveillance cultures. Four duodenoscopes sustained damage during this period; however, this could not be directly attributed to the sterilization process. Furthermore, after an 18-month success period we encountered a positive CRE culture after sterilization, albeit of a different strain than originally detected during the outbreak. The duodenoscope underwent additional ETO gas sterilization, with a negative repeated culture; all potentially exposed individuals screened negative for CRE. Proper use of high-level disinfection alone may not eliminate multidrug-resistant organisms from duodenoscopes. In this single-center study, the addition of ETO sterilization and frequent monitoring with cultures reduced duodenoscope contamination and eliminated clinical infections

  8. The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: results from 36 national telephone surveys in the UK.

    Science.gov (United States)

    Rubin, G J; Potts, H W W; Michie, S

    2010-07-01

    To assess the association between levels of worry about the possibility of catching swine flu and the volume of media reporting about it; the role of psychological factors in predicting likely uptake of the swine flu vaccine; and the role of media coverage and advertising in predicting other swine flu-related behaviours. Data from a series of random-digit-dial telephone surveys were analysed. A time series analysis tested the association between levels of worry and the volume of media reporting on the start day of each survey. Cross-sectional regression analyses assessed the relationships between likely vaccine uptake or behaviour and predictor variables. Thirty-six surveys were run at, on average, weekly intervals across the UK between 1 May 2009 and 10 January 2010. Five surveys (run between 14 August and 13 September) were used to assess likely vaccine uptake. Five surveys (1-17 May) provided data relating to other behaviours. Between 1047 and 1173 people aged 16 years or over took part in each survey: 5175 participants provided data about their likely uptake of the swine flu vaccine; 5419 participants provided data relating to other behaviours. All participants were asked to state how worried they were about the possibility of personally catching swine flu. Subsets were asked how likely they were to take up a swine flu vaccination if offered it and whether they had recently carried tissues with them, bought sanitising hand gel, avoided using public transport or had been to see a general practitioner, visited a hospital or called NHS Direct for a flu-related reason. The percentage of 'very' or 'fairly' worried participants fluctuated between 9.6% and 32.9%. This figure was associated with the volume of media reporting, even after adjusting for the changing severity of the outbreak [chi2(1) = 6.6, p = 0.010, coefficient for log-transformed data = 2.6]. However, this effect only occurred during the UK's first summer wave of swine flu. In total, 56.1% of

  9. Large-scale assessment of myxomatosis prevalence in European wild rabbits (Oryctolagus cuniculus) 60years after first outbreak in Spain.

    Science.gov (United States)

    Villafuerte, Rafael; Castro, Francisca; Ramírez, Esther; Cotilla, Irene; Parra, Francisco; Delibes-Mateos, Miguel; Recuerda, Pilar; Rouco, Carlos

    2017-10-01

    Myxomatosis is a viral disease that affects European rabbits (Oryctolagus cuniculus) worldwide. In Spain, populations of wild rabbits drastically decreased in the 1950s after the first outbreak of myxomatosis. Since that first appearance, it seems to be an annual epizootic in Spain with periodic outbreaks, predominantly in summer and autumn. Taking into account rabbit population structure, abundance, and genetic lineage, this paper attempts to make a large-scale characterization of myxomatosis seroprevalence based on the immune status of 29 rabbit populations distributed throughout Spain, where O. cuniculus cuniculus and O. c. algirus, the two known rabbit subspecies, naturally inhabit. A total of 654 samples were collected between 2003 and 2009, and seroprevalence of antibodies against Myxoma virus (MYXV) was determined. Overall, our results revealed that 53% of the rabbit samples were positive to antibodies against MYXV. Newborn and juvenile rabbits were the most susceptible animals to the virus, with 19% and 16% seropositivity for newborn and juveniles, respectively, while adult rabbits were the most protected, with 65% of seropositive samples. This suggests that prevalence is negatively related to the proportion of newborn and juvenile rabbits in a population. Our results also showed that seroprevalence against MYXV tended to be higher in high-abundance populations. In contrast, no differences were detected in seroprevalence between rabbit subspecies. This study confirms that >60years since first outbreak, myxomatosis is an endemic disease in Spain. Based on the results, the establishment of a myxomatosis surveillance protocol is proposed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Mumps outbreak in Incheon, Korea, 2009

    Directory of Open Access Journals (Sweden)

    Seon Young Cho

    2010-01-01

    Full Text Available Purpose : Recently, we have noticed an increase in the number of patients with mumps in Incheon, Korea. The aim of this study is to estimate the regional trend in mumps incidence and to evaluate the factors related to the recent increase. Methods : We reviewed the medical records of 66 patients with mumps who had been admitted to Incheon St. Mary’s Hospital from July 1999 to June 2009. We compared the differences in records between “outbreak, 2009” and “nonoutbreak, 2000&#8211;2008.” Results : Of the 66 patients, 35 (53% were admitted in 2009, and 31 (47% were admitted between 2000 and 2008. Most of the patients admitted during the outbreak were over 15 years of age (80.0%, were born before 1993 (77.1%, and had received a single dose of mumps vaccine (62.9%. There were no significant differences in contact history, present address, clinical manifestations, and complications, except for orchitis, between the two groups. Conclusion : There was a sharp increase in the number of inpatients with mumps who were born before 1993 and who were over 15 years of age. We recommend that a booster vaccination be considered for adolescents and young adults born before 1993 who are susceptible to mumps infection due to their reduced opportunities for receiving two doses of mumps vaccine.

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

    Directory of Open Access Journals (Sweden)

    Philomena Raftery

    2018-01-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2018-01-01

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

  14. Outbreak of ocular toxoplasmosis in Coimbatore, India

    Directory of Open Access Journals (Sweden)

    Palanisamy Manikandan

    2006-01-01

    Full Text Available Toxoplasma gondii is a protozoan parasite that infects up to a third of the world′s population. Infection is mainly acquired by ingestion of food that is contaminated with oocysts. We report an outbreak of ocular toxoplasmosis, which is an acute acquired type rather than reactivation of congenital toxoplasmosis. Our preliminary investigation points to municipal water contamination. This outbreak only proves the need of an effective public health system and health education in curtailing any outbreak.

  15. Outbreak of epidemic keratoconjunctivitis caused by adenovirus in medical residents.

    Science.gov (United States)

    Melendez, Carlos Pantoja; Florentino, Margarita Matias; Martinez, Irma Lopez; Lopez, Herlinda Mejia

    2009-01-01

    The present work documents an outbreak of epidemic keratoconjunctivitis among ophthalmology residents, its influence in the presentation of the community cases, the use of molecular techniques for its diagnosis, and the implementation of successful control measures for its containment. Isolation of the etiologic agent was achieved using cultured African green monkey kidney epithelial cells (VERO). Through molecular tests, such as polymerase chain reaction (PCR) and DNA sequencing, the genotype of the isolated virus was identified. The sequences obtained were aligned with data reported in the NCBI GenBank. A scheme of outbreak control measures was designed to enforce correct sanitary measures in the clinic. The statistical program, Epi info 2002, and openepi were used to determine the attack rate. The Excel Microsoft program was used to elaborate the endemic channel. Nine of the ten samples studied were isolated from the culture and identified by Adenovirus-specifc PCR. Sequencing allowed identification of Ad8 as the agent responsible for the outbreak. The attack rate was 24.39 cases per 100. The epidemic curve allowed identification of a disseminated source in the Institute of Ophthalmology "Conde de Valenciana." It was not possible to calculate the incubation periods among the cases. The endemic channel showed the presence of an epidemic keratoconjunctivitis among the patients that had been cared for at the out-patient services of the institute. One outbreak of a disseminated source caused by Ad8 was detected in the institute among its medical residents, probably associated with relaxation of the habitual sanitary measures during an epidemic of hemorrhagic conjunctivitis among the patients cared for at the institute. The proposed scheme to control the outbreak allowed for its containment and controlled the epidemic of associated cases.

  16. Shigellosis outbreak at Addis Ababa University: March-April 2010.

    Science.gov (United States)

    Aragaw, Mer'awi; Tafese, Tilahun; Beyene, Zayeda; Hailemariam, Zegeye; Azaze, Aklilu; Luce, Richard; Addissie, Adamu

    2011-10-01

    Between 2006 and 2008, there have been various reports of diarrhea with blood in Ethiopia and also reports of Shigelloses outbreaks in some parts of the country. In March 2010, Addis Ababa University (AAU) Technology Campus reported occurrence of an outbreak of diarrheal illness among students. The study was conducted to identify the causative agent and the possible source of the diarrhea outbreak that occurred at Technology Campus. Active case finding and review of medical records were undertaken to characterize the outbreak. The investigation consisted of a case-control study with laboratory testing and environmental assessment. A structured questionnaire was used to collect data. Data were analyzed using Epi-info (v3.3.2). A total of 104 suspected cases were identified, based on the case definition, with an attack rate of 6.8%. Stool culture confirmed Shigella flexneri species in 5/11 (45%) of specimens tested. Risk factors associated with illness included eating specific foods at specific meal times. Food items served on Friday March 26, at lunch time (OR: 3.59, CI: 1.0- 12.7, p = 0.04) and on Saturday March 27, during dinner (OR: 2.89 CI: 1.0- 8.2, p = 0.04) were significantly associated with increased odds of illness. Water stored in a tank in the cafeteria had evidence of fecal contamination (fecal coliform count > 161 Mpn /100ml) and the hygiene and sanitary conditions in the cafeteria, kitchen, living area were unsatisfactory. Food-borne transmission and water contamination were suspected as the sources of infection. Regular supervision and inspection of the campus' food handling facilities and practices were recommended to improve food hygiene and sanitation. Improved water storage, correcting periodic water shortages in the latrine facility and promotion of hand washing could reduce potential future outbreaks.

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

    Science.gov (United States)

    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.

  18. Recent Weather Extremes and Impacts on Agricultural Production and Vector-Borne Disease Outbreak Patterns

    Science.gov (United States)

    Anyamba, Assaf; Small, Jennifer L.; Britch, Seth C.; Tucker, Compton J.; Pak, Edwin W.; Reynolds, Curt A.; Crutchfield, James; Linthicum, Kenneth J.

    2014-01-01

    We document significant worldwide weather anomalies that affected agriculture and vector-borne disease outbreaks during the 2010-2012 period. We utilized 2000-2012 vegetation index and land surface temperature data from NASA's satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) to map the magnitude and extent of these anomalies for diverse regions including the continental United States, Russia, East Africa, Southern Africa, and Australia. We demonstrate that shifts in temperature and/or precipitation have significant impacts on vegetation patterns with attendant consequences for agriculture and public health. Weather extremes resulted in excessive rainfall and flooding as well as severe drought, which caused,10 to 80% variation in major agricultural commodity production (including wheat, corn, cotton, sorghum) and created exceptional conditions for extensive mosquito-borne disease outbreaks of dengue, Rift Valley fever, Murray Valley encephalitis, and West Nile virus disease. Analysis of MODIS data provided a standardized method for quantifying the extreme weather anomalies observed during this period. Assessments of land surface conditions from satellite-based systems such as MODIS can be a valuable tool in national, regional, and global weather impact determinations.

  19. [Venezuelan equine encephalitis. 1995 outbreak: clinical profile of the case with neurologic involvement].

    Science.gov (United States)

    Molina, O M; Morales, M C; Soto, I D; Peña, J A; Haack, R S; Cardozo, D P; Cardozo, J J

    Venezuelan equine encephalitis virus has caused periodic epidemics and epizootics in the American continent since the 1920s. Such events have been profusely documented from the epidemiologic point of view, however, reports concerning the clinical features of this disease are rather scarce. To analyze the clinical characteristics evidenced by Venezuelan equine encephalitis patients from Zulia state (western Venezuela) studied during the outbreak that occurred in Colombia and Venezuela in 1995. These cases, classified as complicated, were hospitalized at the Hospital Universitario de Maracaibo, state of Zulia, Venezuela. The clinical charts of 313 Venezuelan equine encephalitis patients hospitalized during the period January 1st 1995-March 31st 1996 were reviewed. These cases accounted for 2.82% of 11,072 patients that were medically assisted during the outbreak. The following variables were analyzed: age, gender, signs and symptoms, contact history, complications and evolution. Intracranial hypertension signs became eloquent in 55.9% of these patients. Neurologic complications were represented by two cases of cerebellitis, two cases of meningoencephalitis and one case of encephalomyelitis. The mortality rate was 1.7%. Our results corroborate the benign evolutionary profile that is typical of this entity.

  20. Recent weather extremes and impacts on agricultural production and vector-borne disease outbreak patterns.

    Directory of Open Access Journals (Sweden)

    Assaf Anyamba

    Full Text Available We document significant worldwide weather anomalies that affected agriculture and vector-borne disease outbreaks during the 2010-2012 period. We utilized 2000-2012 vegetation index and land surface temperature data from NASA's satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS to map the magnitude and extent of these anomalies for diverse regions including the continental United States, Russia, East Africa, Southern Africa, and Australia. We demonstrate that shifts in temperature and/or precipitation have significant impacts on vegetation patterns with attendant consequences for agriculture and public health. Weather extremes resulted in excessive rainfall and flooding as well as severe drought, which caused ∼10 to 80% variation in major agricultural commodity production (including wheat, corn, cotton, sorghum and created exceptional conditions for extensive mosquito-borne disease outbreaks of dengue, Rift Valley fever, Murray Valley encephalitis, and West Nile virus disease. Analysis of MODIS data provided a standardized method for quantifying the extreme weather anomalies observed during this period. Assessments of land surface conditions from satellite-based systems such as MODIS can be a valuable tool in national, regional, and global weather impact determinations.

  1. The effects of kinds of lumus and the storage period on the quality of patin wadi based on the results of nutrient tests

    Science.gov (United States)

    Dewi, Indah Sari; Hastuti, Utami Sri; Lestari, Umi; Suwono, Hadi

    2017-05-01

    Wadi is the processed product of fish, due to local knowledge of the Dayak community, made of fresh fish with salt and lumus. The efforts to increase the quality of wadi as a kind of food were based on local knowledge, and are still ongoing. It is one of the ways to conserve wadi existence in the middle of the modern culture. It is important to add a variety of spices in suitable amounts as the innovation in producing wadi. People process wadi by using lumus made of rice and corn. Lumus gives a special taste and aroma t o wadi, furthermore, the effects of kinds of lumus and their concentrates, and the storage period on the nutrients of wadi are not known yet. This research used patin fish (Pangasius sp), white rice (Oryza sativa), white sticky rice (Oryza sativa var.glutinous), and corn (Zea mays) as the kinds of lumus. Each kind of lumus is mixed with fresh patin fish in different concentrations: 15%, 25% and 35%. The results of nutrient tests include measures of protein, carbohydrate, and fat, and show that patin which has been processed into wadi has more nutrients than fresh patin. The storage period and the varying concentrates of lumus effect the level of nutrients in patin wadi.

  2. Scrub Typhus Outbreak in a Remote Primary School, Bhutan, 2014.

    Science.gov (United States)

    Tshokey, Tshokey; Graves, Stephen; Tshering, Dorji; Phuntsho, Kelzang; Tshering, Karchung; Stenos, John

    2017-08-01

    Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August-October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Scrub typhus warrants urgent public health interventions in Bhutan.

  3. Scrub Typhus Outbreak in a Remote Primary School, Bhutan, 2014

    OpenAIRE

    Tshokey, Tshokey; Graves, Stephen; Tshering, Dorji; Phuntsho, Kelzang; Tshering, Karchung; Stenos, John

    2017-01-01

    Scrub typhus in Bhutan was first reported in 2009. We investigated an outbreak of scrub typhus in a remote primary school during August?October 2014. Delay in recognition and treatment resulted in 2 deaths from meningoencephalitis. Scrub typhus warrants urgent public health interventions in Bhutan.

  4. Dynamics of Bacterial and Fungal Communities during the Outbreak and Decline of an Algal Bloom in a Drinking Water Reservoir.

    Science.gov (United States)

    Zhang, Haihan; Jia, Jingyu; Chen, Shengnan; Huang, Tinglin; Wang, Yue; Zhao, Zhenfang; Feng, Ji; Hao, Huiyan; Li, Sulin; Ma, Xinxin

    2018-02-18

    The microbial communities associated with algal blooms play a pivotal role in organic carbon, nitrogen and phosphorus cycling in freshwater ecosystems. However, there have been few studies focused on unveiling the dynamics of bacterial and fungal communities during the outbreak and decline of algal blooms in drinking water reservoirs. To address this issue, the compositions of bacterial and fungal communities were assessed in the Zhoucun drinking water reservoir using 16S rRNA and internal transcribed spacer (ITS) gene Illumina MiSeq sequencing techniques. The results showed the algal bloom was dominated by Synechococcus, Microcystis, and Prochlorothrix. The bloom was characterized by a steady decrease of total phosphorus (TP) from the outbreak to the decline period (p Limnobacter sp., Synechococcus sp., and Roseomonas sp. The relative size of the fungal community also changed with algal bloom and its composition mainly contained Ascomycota, Basidiomycota and Chytridiomycota. Heat map profiling indicated that algal bloom had a more consistent effect upon fungal communities at genus level. Redundancy analysis (RDA) also demonstrated that the structure of water bacterial communities was significantly correlated to conductivity and ammonia nitrogen. Meanwhile, water temperature, Fe and ammonia nitrogen drive the dynamics of water fungal communities. The results from this work suggested that water bacterial and fungal communities changed significantly during the outbreak and decline of algal bloom in Zhoucun drinking water reservoir. Our study highlights the potential role of microbial diversity as a driving force for the algal bloom and biogeochemical cycling of reservoir ecology.

  5. Estimation of basic reproduction number of the Middle East respiratory syndrome coronavirus (MERS-CoV) during the outbreak in South Korea, 2015.

    Science.gov (United States)

    Chang, Hyuk-Jun

    2017-06-13

    In South Korea, an outbreak of Middle East respiratory syndrome (MERS) occurred in 2015. It was the second largest MERS outbreak. As a result of the outbreak in South Korea, 186 infections were reported, and 36 patients died. At least 16,693 people were isolated with suspicious symptoms. This paper estimates the basic reproduction number of the MERS coronavirus (CoV), using data on the spread of MERS in South Korea. The basic reproduction number of an epidemic is defined as the average number of secondary cases that an infected subject produces over its infectious period in a susceptible and uninfected population. To estimate the basic reproduction number of the MERS-CoV, we employ data from the 2015 South Korea MERS outbreak and the susceptible-infected-removed (SIR) model, a mathematical model that uses a set of ordinary differential equations (ODEs). We fit the model to the epidemic data of the South Korea outbreak minimizing the sum of the squared errors to identify model parameters. Also we derive the basic reproductive number as the terms of the parameters of the SIR model. Then we determine the basic reproduction number of the MERS-CoV in South Korea in 2015 as 8.0977. It is worth comparing with the basic reproductive number of the 2014 Ebola outbreak in West Africa including Guinea, Sierra Leone, and Liberia, which had values of 1.5-2.5. There was no intervention to control the infection in the early phase of the outbreak, thus the data used here provide the best conditions to evaluate the epidemic characteristics of MERS, such as the basic reproduction number. An evaluation of basic reproduction number using epidemic data could be problematic if there are stochastic fluctuations in the early phase of the outbreak, or if the report is not accurate and there is bias in the data. Such problems are not relevant to this study because the data used here were precisely reported and verified by Korea Hospital Association.

  6. Risk factor profile for atherosclerosis among young adults in Israel--results of a large-scale survey from the young adult periodic examinations in Israel (YAPEIS) database.

    Science.gov (United States)

    Sharabi, Y; Grotto, I; Huerta, M; Eldad, A; Green, M S

    2001-01-01

    Assessing the prevalence of relevant risk factors among young adults is a critical step in the process of preventing atherosclerotic cardiovascular diseases (ASCVD) later in life. The Israel Defense Force Periodic Health Examination Center performs a routine check-up for subjects aged 25-45 years. Medical history, physical examination notes, laboratory results and ECG tracings are recorded, computerized and processed to form the Young Adults Periodic Examinations in Israel (YAPEIS) database. Data representing 31,640 subjects (27,769 males and 3871 females) examined between the years 1991-1999 were analyzed. The prevalence of documented risk factors for ASCVD were evaluated. The results of all parameters were graded categorically as low, moderate or high and the Framingham risk score was calculated. Fifty-one percent of the study participants were found to be overweight (body mass index > or = 25 kg/m2), 8.5% had high systolic blood pressure and 14.6% had high diastolic blood pressure. The prevalence of hypercholesterolemia and hyperglycemia was found to be 44.7 and 9.7%, respectively. Thirty-two percent of the subjects smoked cigarettes, and 76.7% reported not performing any routine physical activity. Furthermore, 31.8% had a Framingham score indicating a greater than 5% risk for developing a coronary event within the next 10 years. As expected, the prevalence of these risk factors increased with age and were found to be less frequent among females. Thus we conclude that many young Israeli adults hold significant risk factors for future ASCVD. Many of these risk factors are modifiable, and risk behavior is often amenable to alteration. Awareness to the high prevalence of risk factors among young adults should spark vigorous health-promotion programs as well as screening, education, and interventional measures aimed at altering the expected outcome of future ASCVD.

  7. Epidemiological analysis of a cluster within the outbreak of Shiga toxin-producing Escherichia coli serotype O104:H4 in Northern Germany, 2011.

    Science.gov (United States)

    Scharlach, Martina; Diercke, Michaela; Dreesman, Johannes; Jahn, Nicola; Krieck, Manuela; Beyrer, Konrad; Claußen, Katja; Pulz, Matthias; Floride, Regina

    2013-06-01

    In May 2011 one of the worldwide largest outbreaks of haemolytic uraemic syndrome (HUS) and bloody diarrhoea caused by Shiga toxin-producing Escherichia coli (STEC) serotype O104:H4 occurred in Germany. One of the most affected federal states was Lower Saxony. We present the investigation of a cluster of STEC and HUS cases within this outbreak by means of a retrospective cohort study. After a 70th birthday celebration which took place on 7th of May 2011 among 72 attendants seven confirmed cases and four probable cases were identified, two of them developed HUS. Median incubation period was 10 days. Only 35 persons (48.6%) definitely answered the question whether they had eaten the sprouts that were used for garnishing the salad. Univariable analysis revealed different food items, depending on the case definition, with Odds Ratio (OR)>1 indicating an association with STEC infection, but multivariable logistic regression showed no increased risk for STEC infection for any food item and any case definition. Sprouts as the source for the infection had to be assumed based on the results of a tracing back of the delivery ways from the catering company to the sprouts producer who was finally identified as the source of the entire German outbreak. In this large outbreak several case-control studies failed to identify the source of infection. Copyright © 2012 Elsevier GmbH. All rights reserved.

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

    Science.gov (United States)

    2010-11-05

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

  9. Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015.

    Science.gov (United States)

    Thomas, Shari; Hiebert, Joanne; Gubbay, Jonathan B; Gournis, Effie; Sharron, Jennifer; Severini, Alberto; Jiaravuthisan, Manisa; Shane, Amanda; Jaeger, Valerie; Crowcroft, Natasha S; Fediurek, Jill; Sander, Beate; Mazzulli, Tony; Schulz, Helene; Deeks, Shelley L

    2017-07-01

    The province of Ontario continues to experience measles virus transmissions despite the elimination of measles in Canada. We describe an unusual outbreak of measles in Ontario, Canada, in early 2015 that involved cases with a unique strain of virus and no known association among primary case-patients. A total of 18 cases of measles were reported from 4 public health units during the outbreak period (January 25-March 23, 2015); none of these cases occurred in persons who had recently traveled. Despite enhancements to case-patient interview methods and epidemiologic analyses, a source patient was not identified. However, the molecular epidemiologic analysis, which included extended sequencing, strongly suggested that all cases derived from a single importation of measles virus genotype D4. The use of timely genotype sequencing, rigorous epidemiologic investigation, and a better understanding of the gaps in surveillance are needed to maintain Ontario's measles elimination status.

  10. Measles Elimination Efforts and 2008–2011 Outbreak, France

    Science.gov (United States)

    Lévy-Bruhl, Daniel; Baudon, Claire; Freymuth, François; Lamy, Mathieu; Maine, Catherine; Floret, Daniel; Parent du Chatelet, Isabelle

    2013-01-01

    Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of >20,000 cases occurred during 2008–2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 year of age, reaching 135 cases/100,000 infants during the last epidemic wave. Almost 5,000 patients were hospitalized, including 1,023 for severe pneumonia and 27 for encephalitis/myelitis; 10 patients died. More than 80% of the cases during this period occurred in unvaccinated persons, reflecting heterogeneous vaccination coverage, where pockets of susceptible persons still remain. Although vaccine coverage among children improved, convincing susceptible young adults to get vaccinated remains a critical issue if the target to eliminate the disease by 2015 is to be met. PMID:23618523

  11. Restricted Outbreak of American Tegumentary Leishmaniasis with High Microfocal Transmission

    Science.gov (United States)

    Krolewiecki, Alejandro J.; Gil, José F.; Quipildor, Marcelo; Cajal, Silvana P.; Pravia, Carlos; Juarez, Marisa; Villalpando, Carlos; Locatelli, Fabricio M.; Chanampa, Mariana; Castillo, Gabriela; Oreste, María F.; Hoyos, Carlos L.; Negri, Vanesa; Nasser, Julio R.

    2013-01-01

    Cutaneous leishmaniasis is endemic in Salta, the northwestern province of Argentina. We describe an outbreak involving five recreational hunters whose exposure was limited to several hours in a residual patch of primary forest. All patients presented with typical cutaneous lesions after a mean incubation period of 59 days (range 15–78), and one developed simultaneous mucosal involvement. Polymerase chain reaction analysis of lesions confirmed Leishmania (V.) braziliensis as the etiologic agent in three cases. All patients were cured with anti-Leishmania treatment. Entomologic surveys in the transmission area revealed a predominance of Lutzomyia neivai. This outbreak report confirms a microfocal transmission pattern of tegumentary leishmaniasis in the Americas and based on a well-determined exposure, allows the determination of incubation times for leishmaniasis caused by Leishmania braziliensis. PMID:23339200

  12. Trends in drinking habits among adolescents in the Baltic countries over the period of transition: HBSC survey results, 1993–2002

    Directory of Open Access Journals (Sweden)

    Maser Mai

    2006-03-01

    Full Text Available Abstract Background The Baltic countries – Estonia, Latvia, and Lithuania – are considered to be an example of regional homogeneity over the period of transition. The World Health Organization cross-national study on Health Behavior in School-aged Children (HBSC allows a comparison and time trends analysis of behavioral patterns among adolescents in this region. The aim of this study was to estimate the prevalence and trends of alcohol consumption and drunkenness among adolescents of Estonia, Latvia, and Lithuania in 1993/94, 1997/98, and 2001/02. Methods Representative samples of 5286 boys and 6485 girls aged 15 from Estonia, Latvia, and Lithuania were surveyed in 1993/94, 1997/98, and 2001/02 school-year within the framework of HBSC study. The standardized survey methods were applied. The research focused on the following outcome variables: i frequency of drinking beer, wine, and spirits; and ii frequency of drunkenness. The same wording of questions on the consumption of alcohol was retained in each survey. Results Beer was the most frequently used alcoholic beverage across the Baltic countries among adolescents. The rate of weekly drinking of any alcoholic beverage increased considerably during the eight years of observation, especially among Estonian and Lithuanian students. In 2001/02, 25% of boys and 12.5% of girls have reported drinking alcohol at least weekly. The rate of regular alcohol drinking was two times higher in boys, while irregular drinking was more prevalent in girls. Two or more episodes of drunkenness in the lifespan were reported by 30% of boys and 15% of girls in 1993/94 and by 52% of boys and 36% of girls in 2001/02. The use of alcoholic beverages was related to the perceived family wealth: the students from the families perceived by them as wealthy were more likely to drink weekly as compared to the students from the families perceived by them as not wealthy. Conclusion Over the period between 1993 and 2002 the

  13. Measles Outbreak among Unvaccinated Children in Bajura

    Directory of Open Access Journals (Sweden)

    S Sitaula

    2010-12-01

    CFR of this outbreak is higher than the national CFR. Vaccine efficacy of 50% points towards the need for investigation of vaccine logistics and cold chain system. Moreover, this laboratory test confirmed an outbreak showing that the measles virus could be imported from an endemic region and rapidly spread through a susceptible population who were previously not immunized.

  14. Molecular Diagnostic Analysis of Outbreak Scenarios

    Science.gov (United States)

    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…

  15. MRSA outbreak at a transplantation unit

    Directory of Open Access Journals (Sweden)

    RMC Romanelli

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA infections frequently complicate the post-operative course of transplant recipients, and despite nasal carriage and endemic colonization, MRSA outbreaks are not commonly described. This study reports a case of MRSA outbreak and discusses infection control measures and recommendations for this situation.

  16. Mass media effect on vaccines uptake during silent polio outbreak.

    Science.gov (United States)

    Sagy, Iftach; Novack, Victor; Gdalevich, Michael; Greenberg, Dan

    2018-03-14

    During 2013, isolation of a wild type 1 poliovirus from routine sewage sample in Israel, led to a national OPV campaign. During this period, there was a constant cover of the outbreak by the mass media. To investigate the association of media exposure and OPV and non-OPV vaccines uptake during the 2013 silent polio outbreak in Israel. We received data on daily immunization rates during the outbreak period from the Ministry of Health (MoH). We conducted a multivariable time trend analysis to assess the association between daily media exposure and vaccines uptake. Analysis was stratified by ethnicity and socio-economic status (SES). During the MoH supplemental immunization activity, 138,799 OPV vaccines were given. There was a significant association between media exposure and OPV uptake, most prominent in a lag of 3-5 days from the exposure among Jews (R.R 1.79C.I 95% 1.32-2.41) and high SES subgroups (R.R 1.71C.I 95% 1.27-2.30). These subgroups also showed increased non-OPV uptake in a lag of 3-5 days from the media exposure, in all vaccines except for MMR. Lower SES and non-Jewish subgroups did not demonstrate the same association. Our findings expand the understanding of public behaviour during outbreaks. The public response shows high variability within specific subgroups. These findings highlight the importance of tailored communication strategies for each subgroup. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Fire severity unaffected by spruce beetle outbreak in spruce-fir forests in southwestern Colorado.

    Science.gov (United States)

    Andrus, Robert A; Veblen, Thomas T; Harvey, Brian J; Hart, Sarah J

    2016-04-01

    wildfires have increased autonomously due to recent climate variability, but this study does not support the expectation that post-beetle outbreak forests will alter fire severity, a result that has important implications for management and policy decisions.

  18. Pseudomonas aeruginosa outbreak in a pediatric oncology care unit caused by an errant water jet into contaminated siphons.

    Science.gov (United States)

    Schneider, Henriette; Geginat, Gernot; Hogardt, Michael; Kramer, Alexandra; Dürken, Matthias; Schroten, Horst; Tenenbaum, Tobias

    2012-06-01

    We analyzed an outbreak of invasive infections with an exotoxin U positive Pseudomonas aeruginosa strain within a pediatric oncology care unit. Environmental sampling and molecular characterization of the Pseudomonas aeruginosa strains led to identification of the outbreak source. An errant water jet into the sink within patient rooms was observed. Optimized outbreak management resulted in an abundance of further Pseudomonas aeruginosa infections within the pediatric oncology care unit.

  19. Lessons from Ebola: Sources of Outbreak Information and the Associated Impact on UC Irvine and Ohio University College Students

    OpenAIRE

    Koralek, Thrissia; Runnerstrom, Miryha G.; Brown, Brandon J.; Uchegbu, Chukwuemeka; Basta, Tania B.

    2016-01-01

    Objectives. We examined the role of outbreak information sources through four domains: knowledge, attitudes, beliefs, and stigma related to the 2014 Ebola virus disease (EVD) outbreak. Methods. We conducted an online survey of 797 undergraduates at the University of California, Irvine (UCI) and Ohio University (OU) during the peak of the outbreak. We calculated individual scores for domains and analyzed associations to demographic variables and news sources. Results. Knowledge of EVD was low ...

  20. Salmonella outbreak among railway and airline passengers.

    Science.gov (United States)

    Hatakka, M

    1992-01-01

    A widespread outbreak by Salmonella infantis, infecting a total of 226 people, occurred in Finland at the beginning of August 1986. Of those infected, 107 were railway passengers, 91 were airline passengers and 28 were employed in a food processing establishment. The outbreak among the railway passengers was caused by egg sandwiches, the airline passengers were infected by a meal served on board and the catering employees by the breakfast served in the establishment. The outbreak was caused by food prepared in the establishment's kitchen. The employees' breakfasts had probably been contaminated by an employee who was a symptom-free Salmonella infantis carrier, and a number of the employees subsequently became infected, leading to widespread contamination of the food prepared in the establishment. The spread of the outbreak was further influenced by a heatwave at the time and by shortcomings in the cold storage facilities. The kitchen's hygiene supervision and the quality control of its output were reorganized after the outbreak.

  1. Repeated, Intermittent Social Defeat across the Entire Juvenile Period Resulted in Behavioral, Physiological, Hormonal, Immunological, and Neurochemical Alterations in Young Adult Male Golden Hamsters

    Science.gov (United States)

    Yu, Wei-Chun; Liu, Ching-Yi; Lai, Wen-Sung

    2016-01-01

    The developing brain is vulnerable to social defeat during the juvenile period. As complements of human studies, animal models of social defeat provide a straightforward approach to investigating the functional and neurobiological consequences of social defeats. Taking advantage of agonist behavior and social defeat in male golden hamster, a set of 6 experiments was conducted to investigate the consequences at multiple levels in young adulthood resulting from repeated, intermittent social defeats or “social threats” across the entire juvenile period. Male hamsters at postnatal day 28 (P28) were randomly assigned to either the social defeat, “social threat”, or arena control group, and they correspondingly received a series of nine social interaction trials (i.e., either social defeat, “social threat”, or arena control conditions) from P33 to P66. At the behavioral level (Experiment 1), we found that repeated social defeats (but not “social threats”) significantly impacted locomotor activity in the familiar context and social interaction in the familiar/unfamiliar social contexts. At the physiological and hormonal levels (Experiments 2 and 3), repeated social defeat significantly enhanced the cortisol and norepinephrine concentrations in blood. Enlargement of the spleen was also found in the social defeat and “social threat” groups. At the immunological level (Experiment 4), the social defeat group showed lower levels of pro-inflammatory cytokines in the hypothalamus and hippocampus but higher concentration of IL-6 in the striatum compared to the other two groups. At the neurochemical level (Experiment 5), the socially defeated hamsters mainly displayed reductions of dopamine, dopamine metabolites, and 5-HT levels in the striatum and decreased level of 5-HT in the hippocampus. In Experiment 6, an increase in the spine density of hippocampal CA1 pyramidal neurons was specifically observed in the “social threat” group. Collectively, our

  2. Measurement of the solar neutrino capture rate with gallium metal. III. Results for the 2002-2007 data-taking period

    International Nuclear Information System (INIS)

    Abdurashitov, J. N.; Gavrin, V. N.; Gorbachev, V. V.; Gurkina, P. P.; Ibragimova, T. V.; Kalikhov, A. V.; Khairnasov, N. G.; Knodel, T. V.; Mirmov, I. N.; Shikhin, A. A.; Veretenkin, E. P.; Yants, V. E.; Zatsepin, G. T.; Bowles, T. J.; Elliott, S. R.; Teasdale, W. A.; Nico, J. S.; Cleveland, B. T.; Wilkerson, J. F.

    2009-01-01

    The Russian-American experiment SAGE began to measure the solar neutrino capture rate with a target of gallium metal in December 1989. Measurements have continued with only a few brief interruptions since that time. In this article we present the experimental improvements in SAGE since its last published data summary in December 2001. Assuming the solar neutrino production rate was constant during the period of data collection, combined analysis of 168 extractions through December 2007 gives a capture rate of solar neutrinos with energy more than 233 keV of 65.4 -3.0 +3.1 (stat) -2.8 +2.6 (syst) SNU. The weighted average of the results of all three Ga solar neutrino experiments, SAGE, Gallex, and GNO, is now 66.1±3.1 SNU, where statistical and systematic uncertainties have been combined in quadrature. During the recent period of data collection a new test of SAGE was made with a reactor-produced 37 Ar neutrino source. The ratio of observed to calculated rates in this experiment, combined with the measured rates in the three prior 51 Cr neutrino-source experiments with Ga, is 0.87±0.05. A probable explanation for this low result is that the cross section for neutrino capture by the two lowest-lying excited states in 71 Ge has been overestimated. If we assume these cross sections are zero, then the standard solar model including neutrino oscillations predicts a total capture rate in Ga in the range of 63 SNU to 66 SNU with an uncertainty of about 4%, in good agreement with experiment. We derive the current value of the neutrino flux produced in the Sun by the proton-proton fusion reaction to be φ pp · =(6.0±0.8)x10 10 /(cm 2 s), which agrees well with the pp flux predicted by the standard solar model. Finally, we make several tests and show that the data are consistent with the assumption that the solar neutrino production rate is constant in time.

  3. First Kepler results on compact pulsators – VIII. Mode identifications via period spacings in g-mode pulsating subdwarf B stars

    DEFF Research Database (Denmark)

    Reed, M.D.; Baran, A.; Quint, A.C.

    2011-01-01

    We investigate the possibility of nearly equally spaced periods in 13 hot subdwarf B (sdB) stars observed with the Kepler spacecraft and one observed with CoRoT. Asymptotic limits for gravity (g-)mode pulsations provide relationships between equal-period spacings of modes with differing degrees ℓ...

  4. Ebola Outbreak Containment: Real-Time Task and Resource Coordination With SORMAS

    Directory of Open Access Journals (Sweden)

    Cindy Perscheid

    2018-04-01

    Full Text Available Background: Since the beginning of the Ebola outbreak in West Africa in 2014, more than 11,000 people died. For outbreaks of infectious diseases like this, the rapid implementation of control measures is a crucial factor for containment. In West African countries, outbreak surveillance is a paper-based process with significant delays in forwarding outbreak information, which affects the ability to react adequately to situational changes. Our objective therefore was to develop a tool that improves data collection, situation assessment, and coordination of response measures in outbreak surveillance processes for a better containment.Methods: We have developed the Surveillance and Outbreak Response Management System (SORMAS based on findings from Nigeria's 2014 Ebola outbreak. We conducted a thorough requirements engineering and defined personas and processes. We also defined a data schema with specific variables to measure in outbreak situations. We designed our system to be a cloud application that consists of interfaces for both mobile devices and desktop computers to support all stakeholders in the process. In the field, health workers collect data on the outbreak situation via mobile applications and directly transmit it to control centers. At the control centers, health workers access SORMAS via desktop computers, receive instant updates on critical situations, react immediately on emergencies, and coordinate the implementation of control measures with SORMAS.Results: We have tested SORMAS in multiple workshops and a field study in July 2015. Results from workshops confirmed derived requirements and implemented features, but also led to further iterations on the systems regarding usability. Results from the field study are currently under assessment. General feedback showed high enthusiasm about the system and stressed its benefits for an effective outbreak containment of infectious diseases.Conclusions: SORMAS is a software tool to support

  5. Population control methods in stochastic extinction and outbreak scenarios.

    Directory of Open Access Journals (Sweden)

    Juan Segura

    Full Text Available 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.

  6. Population control methods in stochastic extinction and outbreak scenarios.

    Science.gov (United States)

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

    2017-01-01

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

  7. Legionnaires’ Disease: Clinicoradiological Comparison of Sporadic Versus Outbreak Cases

    Directory of Open Access Journals (Sweden)

    Hafiz Rizwan Talib Hashmi

    2017-06-01

    Full Text Available Background: In 2015, New York City experienced the worst outbreak of Legionnaires’ disease in the history of the city. We compare patients seen during the 2015 outbreak with sporadic cases of Legionella during the past 5 years. Methods: We conducted a retrospective chart review of 90 patients with Legionnaires’ disease, including sporadic cases of Legionella infection admitted from 2010 to 2015 (n = 55 and cases admitted during the 2015 outbreak (n = 35. Results: We saw no significant differences between the 2 groups regarding demographics, smoking habits, alcohol intake, underlying medical disease, or residence type. Univariate and multivariate analyses showed that patients with sporadic case of Legionella had a longer stay in the hospital and intensive care unit as well as an increased stay in mechanical ventilation. Short-term mortality, discharge disposition, and most clinical parameters did not differ significantly between the 2 groups. Conclusions: We found no specific clinicoradiological characteristics that could differentiate sporadic from epidemic cases of Legionella . Early recognition and high suspicion for Legionnaires’ disease are critical to provide appropriate treatment. Cluster of cases should increase suspicion for an outbreak.

  8. Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review.

    LENUS (Irish Health Repository)

    Neylon, Orla

    2012-01-31

    Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.

  9. Analysis and Modeling of Influenza Outbreaks as Driven by Weather

    Science.gov (United States)

    Thrastarson, H. T.; Teixeira, J.; Serman, E. A.; Parekh, A.; Yeo, E.

    2017-12-01

    Seasonal influenza outbreaks are a major source of illness, mortality and economic burden worldwide. Attributing what drives the seasonality of the outbreaks is still an unsettled problem. But in temperate regions absolute humidity conditions are a strong candidate (Shaman et al., 2010) and some studies have associated temperature conditions with influenza outbreaks. We use humidity and temperature data from NASA's AIRS (Atmospheric Infra-Red Sounder) instrument as well as data for influenza incidence in the US and South Africa to explore the connection between weather and influenza seasonality at different spatial scales. We also incorporate influenza surveillance data, satellite data and humidity forecasts into a numerical epidemiological prediction system. Our results give support for the role of local weather conditions as drivers of the seasonality of influenza in temperate regions. This can have implications for public health efforts where forecasting of the timing and intensity of influenza outbreaks has a great potential role (e.g., aiding management and organization of vaccines, drugs and other resources).

  10. Measles outbreak in the Republic of the Marshall Islands, 2003.

    Science.gov (United States)

    Hyde, Terri B; Dayan, Gustavo H; Langidrik, Justina R; Nandy, Robin; Edwards, Russell; Briand, Kennar; Konelios, Mailynn; Marin, Mona; Nguyen, Huong Q; Khalifah, Anthony P; O'leary, Michael J; Williams, Nobia J; Bellini, William J; Bi, Daoling; Brown, Cedric J; Seward, Jane F; Papania, Mark J

    2006-04-01

    Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.

  11. Antimicrobial resistance and PCR-ribotyping of Shigella responsible for foodborne outbreaks occurred in southern Brazil

    Directory of Open Access Journals (Sweden)

    Cheila Minéia Daniel de Paula

    2010-12-01

    Full Text Available Little information about Shigella responsible for foodborne shigellosis is available in Brazil. The present study aimed to investigate the antimicrobial resistance and PCR-ribotyping patterns of Shigella isolates responsible for foodborne outbreaks occurred in Rio Grande do Sul State (RS, Southern Brazil in the period between 2003 and 2007. Shigella strains (n=152 were isolated from foods and fecal samples of victims of shigellosis outbreaks investigated by the Surveillance Service. Identification of the strains at specie level indicated that 71.1% of them were S. flexneri, 21.5% S. sonnei, and 0.7% S. dysenteriae. Ten strains (6.7% were identified only as Shigella spp. An increasing occurrence of S. sonnei was observed after 2004. Most of the strains were resistant to streptomycin (88.6%, followed by ampicillin (84.6%, and sulfamethoxazole/trimethoprim (80.5 %. Resistant strains belonged to 73 patterns, and pattern A (resistance to ampicillin, sulfamethoxazole/trimethoprim, tetracycline, streptomycin, chloramphenicol, and intermediate resistance to kanamycin grouped the largest number of isolates (n=36. PCR-ribotyping identified three banding patterns (SH1, SH2, and SH3. SH1 grouped all S. flexneri and SH2 grouped all S. sonnei. The S. dysenteriae strain belonged to group SH3. According to the results, several Shigella isolates shared the same PCR-rybotyping banding pattern and the same resistance profile, suggesting that closely related strains were responsible for the outbreaks. However, other molecular typing methods need to be applied to confirm the clonal relationship of these isolates.

  12. Outbreak of Imipenemase-1-Producing Carbapenem-Resistant in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Jin Young Lee

    2017-02-01

    Full Text Available Background Carbapenem-resistant Enterobacteriaceae (CRE with acquired metallo β-lactamase (MBL resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP-1 MBL in a medical intensive care unit (MICU in Korea is reported. Methods Since isolating carbapenem-resistant K. pneumoniae (CRKP at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE. In addition, a surveillance study of environmental cultures and health-care workers (HCWs was conducted in the MICU during the same time frame. Results During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. Conclusions This study shows that rapid and systemic detection of CRE and strict infection controls are important

  13. Foodborne outbreak of Salmonella subspecies IV infections associated with contamination from bearded dragons.

    Science.gov (United States)

    Lowther, S A; Medus, C; Scheftel, J; Leano, F; Jawahir, S; Smith, K

    2011-12-01

    Approximately 1.4 million Salmonella infections and 400 deaths occur annually in the United States. Approximately 6% of human Salmonella cases are thought to be associated with reptiles; Salmonella enterica subspecies IV is primarily reptile-associated. During 1-4 December, 2009, three isolates of Salmonella IV 6,7:z4,z24:- with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns were identified through Minnesota Department of Health laboratory-based surveillance. None of the three patients associated with the isolates reported reptile contact; however, all had attended the same potluck dinner. Dinner attendees were asked questions regarding illness history, foods they prepared for and consumed at the event, and pet ownership. Cases were defined as illness in a person who had eaten potluck food and subsequently experienced fever and diarrhoea (three or more loose stools in 24 h) or laboratory-confirmed infection with Salmonella IV matching the outbreak PFGE subtype. Nineteen days after the event, environmental samples were collected from a food preparer's house where two pet bearded dragons were kept. Sixty-six of 73 potluck food consumers were interviewed; 19 cases were identified; 18 persons reported illness but did not meet the case definition. Median incubation period was 19 h (range: 3-26 h). Median duration of illness was 5 days (range: 1-11 days). Consumption of gravy, prepared by the bearded dragons' asymptomatic owner, was associated with illness (16/32 exposed versus 1/12 unexposed; risk ratio: 6.0; exact P = 0.02). Salmonella Labadi was recovered from 10 samples, including from one bearded dragon, the bathroom door knob and sink drain, and the kitchen sink drain. The outbreak PFGE subtype of Salmonella subspecies IV was isolated from vacuum-cleaner bag contents. This foodborne outbreak probably resulted from environmental contamination from bearded dragons. Reptiles pose a community threat when food for public consumption is prepared in

  14. Real-time projections of cholera outbreaks through data assimilation and rainfall forecasting

    Science.gov (United States)

    Pasetto, Damiano; Finger, Flavio; Rinaldo, Andrea; Bertuzzo, Enrico

    2017-10-01

    Although treatment for cholera is well-known and cheap, outbreaks in epidemic regions still exact high death tolls mostly due to the unpreparedness of health care infrastructures to face unforeseen emergencies. In this context, mathematical models for the prediction of the evolution of an ongoing outbreak are of paramount importance. Here, we test a real-time forecasting framework that readily integrates new information as soon as available and periodically issues an updated forecast. The spread of cholera is modeled by a spatially-explicit scheme that accounts for the dynamics of susceptible, infected and recovered individuals hosted in different local communities connected through hydrologic and human mobility networks. The framework presents two major innovations for cholera modeling: the use of a data assimilation technique, specifically an ensemble Kalman filter, to update both state variables and parameters based on the observations, and the use of rainfall forecasts to force the model. The exercise of simulating the state of the system and the predictive capabilities of the novel tools, set at the initial phase of the 2010 Haitian cholera outbreak using only information that was available at that time, serves as a benchmark. Our results suggest that the assimilation procedure with the sequential update of the parameters outperforms calibration schemes based on Markov chain Monte Carlo. Moreover, in a forecasting mode the model usefully predicts the spatial incidence of cholera at least one month ahead. The performance decreases for longer time horizons yet allowing sufficient time to plan for deployment of medical supplies and staff, and to evaluate alternative strategies of emergency management.

  15. The recent outbreaks and reemergence of poliovirus in war and conflict-affected areas.

    Science.gov (United States)

    Akil, Luma; Ahmad, H Anwar

    2016-08-01

    Poliomyelitis is a highly infectious disease caused by poliovirus, which becomes difficult to manage/eradicate in politically unstable areas. The objectives of this study were to determine the movement and management of such polio outbreaks in endemic countries and countries with reoccurring cases of polio and to determine the effect of political instability on polio eradication. In this study, the extent of polio outbreaks was examined and modeled using statistical methodologies and mapped with GIS software. Data on polio cases and immunization were collected for countries with polio cases for the period 2011 to 2014. Weekly data from the Global Polio Eradication Initiative were collected for selected countries. The recent virus origin and current movement was mapped using GIS. Correlations between immunization rates, the Global Peace Index (GPI), and other indicators of a country's political stability with polio outbreaks were determined. Data were analyzed using SAS 9.4 and ArcGIS 10. For several reasons, Pakistan remains highly vulnerable to new incidences of polio (306 cases in 2014). Overall immunization rates showed a steady decline over time in selected countries. Countries with polio cases were shown to have high rates of infant mortality, and their GPI ranked between 2.0 and 3.3; displaced populations, level of violent crime rating, and political instability also were ranked high for several countries. Polio was shown to be high in areas with increased conflict and instability. Displaced populations living in hard-to-reach areas may lack access to proper vaccination and health care. Wars and conflict have also resulted in the reemergence of polio in otherwise polio-free countries. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Source investigation of two outbreaks of skin and soft tissue infection by Mycobacterium abscessus subsp. abscessus in Venezuela.

    Science.gov (United States)

    Torres-Coy, J A; Rodríguez-Castillo, B A; Pérez-Alfonzo, R; DE Waard, J H

    2016-04-01

    Outbreaks of soft tissue or skin infection due to non-tuberculous mycobacteria are reported frequently in scientific journals but in general the infection source in these outbreaks remains unknown. In Venezuela, in two distinct outbreaks, one after breast augmentation surgery and another after hydrolipoclasy therapy, 16 patients contracted a soft tissue infection due to Mycobacterium abscessus subsp. abscessus. Searching for the possible environmental infection sources in these outbreaks, initially the tap water (in the hydrolipoclasy therapy outbreak) and a surgical skin marker (in the breast implant surgery outbreak), were identified as the infection sources. Molecular typing of the strains with a variable number tandem repeat typing assay confirmed the tap water as the infection source but the molecular typing technique excluded the skin marker. We discuss the results and make a call for the implementation of stringent hygiene and disinfection guidelines for cosmetic procedures in Venezuela.

  17. The layout of urban construction in Bolghar in the late Golden Horde period (preliminary results of studies on materials of excavations Southwest of the Cathedral Mosque

    Directory of Open Access Journals (Sweden)

    Badeev Denis Yu.

    2014-06-01

    Full Text Available The results of the archaeological studies on a monumental building, identified in the central part of the Bolghar fortified settlement site, 150 meters southwest of the Cathedral Mosque, during the 1989-1993, 2000 and 2011-2013 works are presented. Adobe brick masonry and remains of wooden flooring have been recorded. Findings in the form of numerous a large number of commercial stock-in-trade items and coins allow interpreting this building as the city market. The authors of the excavations of the building date it back to the 50-70s of the 14th century. The structural elements of the construction and its internal layout suggest the existence of the city market at the intersection of two streets. The presence of street system in this part of the city is also indicated by the remains of two brickworks of mud bricks, which had served as a street fence (duval and referred to layers of the 30-40s of the 14th century. In the mid-14th century, the building of the city market had been being erected in place of the street fence and the adjoining estates. Thus, the development dynamics of Bolghar urban planning in the Late Golden Horde period on the site southwest of the Cathedral Mosque could be traced.

  18. Differential changes in serum uric acid concentrations in sibutramine promoted weight loss in diabetes: results from four weeks of the lead-in period of the SCOUT trial

    Directory of Open Access Journals (Sweden)

    Caterson Ian D

    2009-10-01

    Full Text Available Abstract Background and aims Elevated levels of serum uric acid are associated with an increased risk of cardiovascular morbidity and mortality. The response of uric acid to weight loss therapy (lifestyle plus sibutramine in an overweight and obese cardiovascular high risk population was studied. Methods and results Data from a four week single-blind lead-in period of the Sibutramine Cardiovascular OUTcomes (SCOUT study were analyzed. 2584 patients (24% had diabetes mellitus (DM only, 1748 (16% had cardiovascular disease (CVD only and 6397 (60% had both DM + CVD. Uric acid concentrations (mean ± standard deviation at screening were significantly higher among patients with CVD compared to patients without CVD (p Conclusion A four week daily intake of sibutramine and life style changes was associated with significant reductions in mean uric acid levels. Changes in renal glucose load in diabetes seem to counteract a potential uricosuric effect of sibutramine. Trial Registration The trial is registered at ClinicalTrial.gov number: NCT00234832.

  19. Multi-Province Listeriosis Outbreak Linked to Contaminated Deli Meat Consumed Primarily in Institutional Settings, Canada, 2008.

    Science.gov (United States)

    Currie, Andrea; Farber, Jeffrey M; Nadon, Céline; Sharma, Davendra; Whitfield, Yvonne; Gaulin, Colette; Galanis, Eleni; Bekal, Sadjia; Flint, James; Tschetter, Lorelee; Pagotto, Franco; Lee, Brenda; Jamieson, Fred; Badiani, Tina; MacDonald, Diane; Ellis, Andrea; May-Hadford, Jennifer; McCormick, Rachel; Savelli, Carmen; Middleton, Dean; Allen, Vanessa; Tremblay, Francois-William; MacDougall, Laura; Hoang, Linda; Shyng, Sion; Everett, Doug; Chui, Linda; Louie, Marie; Bangura, Helen; Levett, Paul N; Wilkinson, Krista; Wylie, John; Reid, Janet; Major, Brian; Engel, Dave; Douey, Donna; Huszczynski, George; Di Lecci, Joe; Strazds, Judy; Rousseau, Josée; Ma, Kenneth; Isaac, Leah; Sierpinska, Urszula

    2015-08-01

    A multi-province outbreak of listeriosis occurred in Canada from June to November 2008. Fifty-seven persons were infected with 1 of 3 similar outbreak strains defined by pulsed-field gel electrophoresis, and 24 (42%) individuals died. Forty-one (72%) of 57 individuals were residents of long-term care facilities or hospital inpatients during their exposure period. Descriptive epidemiology, product traceback, and detection of the outbreak strains of Listeria monocytogenes in food samples and the plant environment confirmed delicatessen meat manufactured by one establishment and purchased primarily by institutions was the source of the outbreak. The food safety investigation identified a plant environment conducive to the introduction and proliferation of L. monocytogenes and persistently contaminated with Listeria spp. This outbreak demonstrated the need for improved listeriosis surveillance, strict control of L. monocytogenes in establishments producing ready-to-eat foods, and advice to vulnerable populations and institutions serving these populations regarding which high-risk foods to avoid.

  20. From tailor-made to ready-to-wear meningococcal B vaccines: longitudinal study of a clonal meningococcal B outbreak.

    Science.gov (United States)

    Caron, François; du Châtelet, Isabelle Parent; Leroy, Jean-Philippe; Ruckly, Corinne; Blanchard, Myriam; Bohic, Nicole; Massy, Nathalie; Morer, Isabelle; Floret, Daniel; Delbos, Valérie; Hong, Eva; Révillion, Martin; Berthelot, Gilles; Lemée, Ludovic; Deghmane, Ala-Eddine; Bénichou, Jacques; Lévy-Bruhl, Daniel; Taha, Muhamed-Kheir

    2011-06-01

    Outer-membrane-vesicle vaccines for meningococcal B outbreaks are complex and time consuming to develop. We studied the use of already available vaccine to control an outbreak caused by a genetically close strain. From 2006 to 2009, all individuals younger than 20 years living in the region of Normandy, France, in which an outbreak caused by a B:14:P1.7,16 strain occurred, were eligible to receive MenBvac, a Norwegian vaccine designed 20 years earlier against a strain sharing the same serosubtype (B:15:P1.7,16). The immunogenicity (in a randomly selected cohort of 400 children aged 1-5 years), safety, and epidemiological effect of the vaccination were assessed. 26,014 individuals were eligible to receive the vaccine. Shortage of vaccine production prompted start of the campaign in the highest incidence groups (1-5 years). 16,709 (64%) received a complete vaccination schedule of whom 13,589 (81%) received a 2+1 dose schedule (week 0, week 6, and month 8). At 6 weeks after the third dose, of 235 vaccinees for whom samples were available, 206 (88%) had a seroresponse, and 108 (56 %) of 193 had a seroresponse at 15 months. These results were similar to those described for tailor-made vaccines and their homologous strain. Only previously described adverse effects occurred. The incidence of B:14:P1.7,16 cases decreased significantly in the vaccine targeted population after the primary vaccination period (from 31·6 per 100,000 to 5·9 per 100,000; p=0·001). The ready-to-wear approach is reliable if epidemic and vaccine strains are genetically close. Other meningococcal B clonal outbreaks might benefit from this strategy; and previously described outer-membrane-vesicle vaccines can be effective against various strains. French Ministry of Health. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. MALDI-TOF MS typing of a nosocomial methicillin-resistant Staphylococcus aureus outbreak in a neonatal intensive care unit.

    Science.gov (United States)

    Steensels, Deborah; Deplano, Ariane; Denis, Olivier; Simon, Anne; Verroken, Alexia

    2017-08-01

    The early detection of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak is decisive to control its spread and rapidly initiate adequate infection control measures. Therefore, prompt determination of epidemiologic relatedness of clinical MRSA isolates is essential. Genetic typing methods have a high discriminatory power but their availability remains restricted. In this study, we aimed to challenge matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) as a typing tool of a nosocomial MRSA outbreak in a neonatal intensive care unit. Over a 2-year period, 15 MRSA isolates were recovered from patients (n = 14) and health care workers (n = 1) at the neonatal intensive care unit. Five reference strains were included for comparison. Identification was performed by MALDI-TOF MS and susceptibility profiles determined by automated broth microdilution. Typing analysis by MALDI-TOF MS included mean spectrum profiles and subsequent dendrogram creation using BioNumerics software. Results were compared with spa typing and pulsed-field gel electrophoresis (PFGE). Our study showed good concordance (93%) between PFGE, spa typing, and MALDI-TOF MS for the outbreak-related MRSA strains. MALDI-TOF MS typing showed excellent typeability and discriminatory power but showed poor reproducibility. This study is one of the first to document the potential usefulness of MALDI-TOF MS with standardized data analysis as a typing tool for investigating a nosocomial MRSA outbreak. A concordance of 93% compared to reference typing techniques was observed. However, because of poor reproducibility, long-term follow-up of prospective isolated strains is not practical for routine use. Further studies are needed to confirm our observations.

  2. Outbreak of Fusarium oxysporum infections in children with cancer: an experience with 7 episodes of catheter-related fungemia

    Directory of Open Access Journals (Sweden)

    Fabianne Carlesse

    2017-09-01

    Full Text Available Abstract Background Fusarium species are widely spread in nature as plant pathogens but are also able to cause opportunistic fungal infections in humans. We report a cluster of Fusarium oxysporum bloodstream infections in a single pediatric cancer center. Methods All clinical and epidemiological data related to an outbreak involving seven cases of fungemia by Fusarium oxysporum during October 2013 and February 2014 were analysed. All cultured isolates (n = 14 were identified to species level by sequencing of the TEF1 and RPB2 genes. Genotyping of the outbreak isolates was performed by amplified fragment length polymorphism fingerprinting. Results In a 5-month period 7 febrile pediatric cancer patients were diagnosed with catheter-related Fusarium oxysporum bloodstream infections. In a time span of 11 years, only 6 other infections due to Fusarium were documented and all were caused by a different species, Fusarium solani. None of the pediatric cancer patients had neutropenia at the time of diagnosis and all became febrile within two days after catheter manipulation in a specially designed room. Extensive environmental sampling in this room and the hospital did not gave a clue to the source. The outbreak was terminated after implementation of a multidisciplinary central line insertion care bundle. All Fusarium strains from blood and catheter tips were genetically related by amplified fragment length polymorphism fingerprinting. All patients survived the infection after prompt catheter removal and antifungal therapy. Conclusion A cluster with, genotypical identical, Fusarium oxysporum strains infecting 7 children with cancer, was most probably catheter-related. The environmental source was not discovered but strict infection control measures and catheter care terminated the outbreak.

  3. LIVER FUNCTION CHANGES IN PATIENTS WITH SPONDYLOARTHRITIS TAKING NONSTEROIDAL ANTI-INFLAMMATORY DRUGS OVER A LONG PERIOD: RESULTS OF A 10-YEAR PROGRESS PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    A. P. Rebrov

    2016-01-01

    Full Text Available Objective: to assess liver function changes in patients with spondyloarthritis (SpA taking NSAIDs regularly over a long period.Patients and methods. The data obtained during a 10-year PROGRESS prospective single-center cohort study of functional status, activity, and comorbidity (including gastrointestinal tract diseases in patients with SpA were analyzed. The data of 363 SpA patients receiving NSAIDs regularly over a long period and followed up for 10 years were also explored. The changes that had occurred over a decade in the liver enzyme levels, the number of discontinued NSAID treatments because of a persistent increase in liver enzyme levels, and the number of prescriptions of hepatoprotective agents were analyzed.Results. For 10 years, 18 patients with SpA discontinued their NSAID intake due to elevated liver enzyme levels (≥3 times greater than the reference value; during that time, the same increase in enzyme levels was observed in 2 healthy individuals (χ2 =1.39; p=0.2. In the patients with SpA as compared to the healthy individuals, the relative risk of abnormal liver function was 1.19 (95% CI, 1.009–1.405; odds ratio was 2.9 (95% CI, 0.65–12.95. There was no increased risk for discontinuation of some NSAIDs, including nimesulide (χ2 =0.03, p=0.85, the frequency of using hepatoprotective drugs was proved to be highest for diclofenac sodium, ibuprofen, nimesulide, and ketoprofen.Conclusion. The regular long-term (as long as 10 years use of NSAIDs to treat SpA is associated with treatment discontinuation because of elevated enzyme levels in every 10 patients. The maximum rate of discontinuation of NSAIDs due to a persistent increase in liver enzyme levels is observed 6–8 years after their regular use, so long-term NSAID therapy requires continuous monitoring of hepatic safety. The longterm intake of nimesulide, as compared with other NSAIDs, is shown to be unassociated with the higher rate of its discontinuation because of

  4. Investigations of subterranean microorganisms and their importance for performance assessment of radioactive waste disposal. Results and conclusions achieved during the period 1995 to 1997

    International Nuclear Information System (INIS)

    Pedersen, K.

    1997-11-01

    In 1987, microbiology became a part of the Swedish scientific program for the safe disposal of high level nuclear waste (HLW). The goal of the microbiology sub-program is to understand how subterranean microorganisms will interact with the performance of a future HLW repository. The Swedish research program on subterranean microbiology has mainly been performed at two sites in granitic rock aquifers at depths ranging from 70 m down to 1240 m; the Stripa research mine in the middle of Sweden and the Aespoe hard rock laboratory (HRL) situated on the south eastern coast of Sweden. Some work has also been performed in co-operation with other national or international research groups in Sweden, Canada and at the natural analogue sites in Oklo in Gabon and Maqarin in Jordan. The most recent report in the SKB technical report series on microbiology and performance assessment, SKB-TR--95-10, gave the state of the art regarding microorganisms and their importance for performance assessment. That report is recommended as a source of knowledge about basic microbiology, microbial ecology of subterranean environments and the nuclear waste disposal concept in a microbiological perspective. The present report summarises results and conclusions achieved during the period 1995 to 1997 and is a continuation of SKB TR 95-10. The report is structured as summary which explains and analyses the obtained results and conclusions in a performance assessment perspective. The scientific basis for the summary is an enclosed series of eleven papers of which eight have gone through an international peer review process for publication in international scientific journals and reports and papers published earlier

  5. Investigations of subterranean microorganisms and their importance for performance assessment of radioactive waste disposal. Results and conclusions achieved during the period 1995 to 1997

    Energy Technology Data Exchange (ETDEWEB)

    Pedersen, K [Goeteborg Univ. (Sweden). Dept. of General and Marine Microbiology

    1997-11-01

    In 1987, microbiology became a part of the Swedish scientific program for the safe disposal of high level nuclear waste (HLW). The goal of the microbiology sub-program is to understand how subterranean microorganisms will interact with the performance of a future HLW repository. The Swedish research program on subterranean microbiology has mainly been performed at two sites in granitic rock aquifers at depths ranging from 70 m down to 1240 m; the Stripa research mine in the middle of Sweden and the Aespoe hard rock laboratory (HRL) situated on the south eastern coast of Sweden. Some work has also been performed in co-operation with other national or international research groups in Sweden, Canada and at the natural analogue sites in Oklo in Gabon and Maqarin in Jordan. The most recent report in the SKB technical report series on microbiology and performance assessment, SKB-TR--95-10, gave the state of the art regarding microorganisms and their importance for performance assessment. That report is recommended as a source of knowledge about basic microbiology, microbial ecology of subterranean environments and the nuclear waste disposal concept in a microbiological perspective. The present report summarises results and conclusions achieved during the period 1995 to 1997 and is a continuation of SKB TR 95-10. The report is structured as summary which explains and analyses the obtained results and conclusions in a performance assessment perspective. The scientific basis for the summary is an enclosed series of eleven papers of which eight have gone through an international peer review process for publication in international scientific journals and reports and papers published earlier. 413 refs, 56 figs, 39 tabs.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Thomas Grönthal

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

  8. [Waterborne outbreak of gastroenteritis transmitted through the public water supply].

    Science.gov (United States)

    Godoy, P; Borrull, C; Palà, M; Caubet, I; Bach, P; Nuín, C; Espinet, L; Torres, J; Mirada, G

    2003-01-01

    The chlorination of public water supplies has led researchers to largely discard drinking water as a potential source of gastroenteritis outbreaks. The aim of this study was to investigate an outbreak of waterborne disease associated with drinking water from public supplies. A historical cohort study was carried out following notification of a gastroenteritis outbreak in Baqueira (Valle de Arán, Spain). We used systematic sampling to select 87 individuals staying at hotels and 67 staying in apartments in the target area. Information was gathered on four factors (consumption of water from the public water supply, sandwiches, water and food in the ski resorts) as well as on symptoms. We assessed residual chlorine in drinking water, analyzed samples of drinking water, and studied stool cultures from 4 patients. The risk associated with each water source and food type was assessed by means of relative risk (RR) and 95% confidence intervals (CI). The overall attack rate was 51.0% (76/149). The main symptoms were diarrhea 87.5%, abdominal pain 80.0%, nausea 50.7%, vomiting 30.3%, and fever 27.0%. The only factor associated with a statistically significant risk of disease was consumption of drinking water (RR = 11.0; 95% CI, 1.6-74.7). No residual chlorine was detected in the drinking water, which was judged acceptable. A problem associated with the location of the chlorinator was observed and corrected. We also recommended an increase in chlorine levels, which was followed by a reduction in the number of cases. The results of stool cultures of the four patients were negative for enterobacteria. This study highlights the potential importance of waterborne outbreaks of gastroenteritis transmitted through drinking water considered acceptable and suggests the need to improve microbiological research into these outbreaks (viruses and protozoa detection).

  9. Diarrhoeal disease outbreak in a rural area of Karnataka

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    Bhavana R Hiremath

    2015-12-01

    Full Text Available Background: Acute diarrhoea is the passage of 3 or more loose or watery stools in the past 24 hours with or without dehydration. Owing to WASH strategy (Water, Sanitation and Hygiene the burden of diarrheal diseases has seen a tremendous decline over the past 2 decades. Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio Cholerae. Objectives: 1. To document the factors responsible for the outbreak. 2. To provide recommendations for prevention and control of such outbreaks in future. Methods: After receiving verbal information from district office regarding outbreak of diarrhoeal disease (cholera in a town of Bijapur district, we independently conducted a cross sectional study in the affected area and collected information regarding no. of people affected since the outbreak, their age and sex distribution. A total of 3802 people were interviewed using a predesigned questionnaire on 28th and 29th July, 2012. We also conducted environmental investigation regarding the source of contamination and collected 2 water samples from drinking water source. Results: All the cases were clustered in the five streets, which were consuming water from contaminated two water tanks. A total of 121 cases of diarrhoea were identified affecting 3.18% of the population. Attack rate of cholera was highest (4.5% in 25-34 years age group followed by 4.22% in 15-24 years age group. Attack rates was higher among females (3.4% compared to males (2.9%. Laboratory report stated that water samples were unfit for drinking purpose. V. Cholera (Ogawa serotype was isolated from water sample. Conclusion: Consumption of contaminated water from a newly dug bore-well had led to the diarrhea outbreak. Lack of sanitation and hygiene had worsened the situation.

  10. Twin outbreak of cholera in rural North Karnataka, India

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    Shuchismita Dey

    2014-01-01

    Full Text Available Background & objectives: Successive outbreaks of acute watery diarrhoea occurred in Talikoti and Harnal, located in Bijapur District of the southern Indian s0 tate of Karnataka, in July and August 2012, respectively. These outbreaks were investigated to identify the aetiology and epidemiology. Methods: Information was collected from the local population and health centres. Stool and water samples were collected from the admitted patients and their drinking water sources. Standard microbiological and PCR techniques were employed for isolation and characterization of the pathogen. Results: While 101 people (0.38% were affected in Talikoti, 200 (20.94% were affected in Harnal which is a small remote village. All age groups were affected but no death occurred. While the outbreak was smaller, longer and apparently spread by person to person contact in Talikoti, it occurred as a single source flash outbreak at Harnal. A single clone of toxigenic Vibrio cholerae O1 Ogawa biotype El Tor was isolated from the two stool samples obtained from Talikoti and subsequently from three of five stool samples obtained from Harnal indicating village to village spread of the aetiological agent. Striking similarity in antibiotic resistance profiles of these isolates with a particular strain isolated from the city of Belgaum, 250 km away, in 2010, prompted tracking the lineage of the V. cholerae isolates by DNA fingerprinting. Random amplified polymorphic DNA (RAPD fingerprinting assay helped confirm the origin of the incriminating strain to Belgaum. Interpretation & conclusions: Our study reported the first twin outbreak of cholera in two remote areas of Bijapur district, Karnataka, south India. It also indicated the need for immediate preparedness to deal with such emergencies.

  11. Diarrhoeal disease outbreak in a rural area of Karnataka

    Directory of Open Access Journals (Sweden)

    Bhavana R Hiremath

    2015-12-01

    Full Text Available Background: Acute diarrhoea is the passage of 3 or more loose or watery stools in the past 24 hours with or without dehydration. Owing to WASH strategy (Water, Sanitation and Hygiene the burden of diarrheal diseases has seen a tremendous decline over the past 2 decades. Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio Cholerae. Objectives: 1. To document the factors responsible for the outbreak. 2. To provide recommendations for prevention and control of such outbreaks in future. Methods: After receiving verbal information from district office regarding outbreak of diarrhoeal disease (cholera in a town of Bijapur district, we independently conducted a cross sectional study in the affected area and collected information regarding no. of people affected since the outbreak, their age and sex distribution. A total of 3802 people were interviewed using a predesigned questionnaire on 28th and 29th July, 2012. We also conducted environmental investigation regarding the source of contamination and collected 2 water samples from drinking water source. Results: All the cases were clustered in the five streets, which were consuming water from contaminated two water tanks. A total of 121 cases of diarrhoea were identified affecting 3.18% of the population. Attack rate of cholera was highest (4.5% in 25-34 years age group followed by 4.22% in 15-24 years age group. Attack rates was higher among females (3.4% compared to males (2.9%. Laboratory report stated that water samples were unfit for drinking purpose. V. Cholera (Ogawa serotype was isolated from water sample. Conclusion: Consumption of contaminated water from a newly dug bore-well had led to the diarrhea outbreak. Lack of sanitation and hygiene had worsened the situation.

  12. Sources of Calicivirus contamination in foodborne outbreaks in Denmark, 2005-2011--the role of the asymptomatic food handler.

    Science.gov (United States)

    Franck, Kristina T; Lisby, Morten; Fonager, Jannik; Schultz, Anna C; Böttiger, Blenda; Villif, Annette; Absalonsen, Helle; Ethelberg, Steen

    2015-02-15

    Norovirus (NoV) is the predominant cause of foodborne disease outbreaks. Virus contamination may occur during all steps of food processing, from production to preparation and serving. The relative importance of these different routes of contamination is unknown. The purpose of this study was to estimate the proportions of outbreaks caused by asymptomatic and symptomatic food handlers (FHs). Reports of foodborne NoV and sapovirus outbreaks (n=191) that occurred over a 7-year period were extracted, reviewed, and categorized according to the available evidence for source of contamination. In 64 (34%) of the outbreaks, contamination from FHs took place during preparation or serving of food. In the majority of these outbreaks (n=41; 64%), the FHs were asymptomatic during food handling. Some had been in contact with ill household members before handling the food and remained asymptomatic; others developed symptoms shortly after or were post-symptomatic. In 51 (27%) of the outbreaks, contamination occurred during production of the food, and in 55 (29%) of the outbreaks, contamination had supposedly occurred after serving a guest at a self-serve buffet. Guidelines regarding exclusion of FHs where household members suffer from gastroenteritis could limit the number of outbreaks. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  13. 2014 outbreak of enterovirus D68 in North America.

    Science.gov (United States)

    Messacar, Kevin; Abzug, Mark J; Dominguez, Samuel R

    2016-05-01

    Enterovirus D68 (EV-D68) is an emerging picornavirus which causes severe respiratory disease, predominantly in children. In 2014, the largest and most widespread outbreak of EV-D68 described to date was reported in North America. Hospitals throughout the United States and Canada reported surges in patient volumes and resource utilization from August to October, 2014. In the US a total of 1,153 infections were confirmed in 49 states, although this is an underestimate of the likely millions of cases that occurred but were not tested. EV-D68 was detected in 14 patients who died; the role of the virus in these deaths is unknown. A possible association between EV-D68 and cases of acute flaccid paralysis with spinal cord gray matter lesions, known as acute flaccid myelitis, was observed during the outbreak and is under investigation. The 2014 outbreak of EV-D68 in North America demonstrates the public health importance of this emerging pathogen. © 2015 Wiley Periodicals, Inc.

  14. The biennial cycle of respiratory syncytial virus outbreaks in Croatia

    Directory of Open Access Journals (Sweden)

    Drazenovic Vladimir

    2008-01-01

    Full Text Available Abstract The paper analyses the epidemic pattern of respiratory syncytial virus (RSV outbreaks in children in Croatia. Over a period of 11 consecutive winter seasons (1994–2005 3,435 inpatients from Zagreb County aged from infancy to 10 years who were hospitalised with acute respiratory tract infections were tested for RSV-infection. RSV was identified in nasopharyngeal secretions of patients by virus isolation in cell culture and by detection of viral antigen with monoclonal antibodies. In the Zagreb area, RSV outbreaks were proven to vary in a two-year cycle, which was repeated every 23–25 months. This biennial cycle comprised one larger and one smaller season. Climate factors correlated significantly with the number of RSV cases identified only in the large seasons, which suggests that the biennial cycle is likely to continue regardless of meteorological conditions. Knowledge of this biennial pattern should be useful in predicting the onset of RSV outbreaks in Croatia, and would facilitate planning for the prevention and control of RSV infections in the region.

  15. Stress levels in parents of children with and without attention deficit hyperactivity disorder during the back-to-school period: results of an international survey in Italy.

    Science.gov (United States)

    Loprieno, Urania; Gagliano, Antonella

    2016-10-01

    The back-to-school stress survey was an international, non-clinical opinion survey, which aimed to compare stress levels in parents of children with/without attention deficit hyperactivity disorder (ADHD) during the back-to-school period. Here, we present results relating to the Italian sample, comparing them with European data. The questionnaire was built using a modified Holmes and Rahe stress scale. Parents of children with/without ADHD evaluated potentially stress-causing situations on a scale from 1 (low stress) to 10 (high stress). In Italy, 107 parents of children with ADHD (mean age ± SD 40.3±7.3 years) and 105 parents of children without ADHD (mean age 42.2±6.6 years) participated in the survey. The mean age of children with ADHD was 10.3±3.1 years; 77.6% were male, 72.9% had been diagnosed with at least one comorbid condition - in particular conduct disorder (24.3%), learning disorders/dyslexia (23.4%) and language/communication disorder (19.6%) - and 32.7% were receiving ADHD medication. Parents of children with ADHD showed significantly higher stress levels (p≤0.005) compared with the non-ADHD group in all areas analyzed that were related to the return to school. Significant differences between groups (Pchildren with ADHD suffer significantly higher stress levels compared with parents of children without ADHD. Considering parental stress is important for the management of children with ADHD, as stress can affect the control of behavioral symptoms of children.

  16. Tornado outbreak variability follows Taylor's power law of fluctuation scaling and increases dramatically with severity

    Science.gov (United States)

    Tippett, Michael K.; Cohen, Joel E.

    2016-01-01

    Tornadoes cause loss of life and damage to property each year in the United States and around the world. The largest impacts come from ‘outbreaks' consisting of multiple tornadoes closely spaced in time. Here we find an upward trend in the annual mean number of tornadoes per US tornado outbreak for the period 1954–2014. Moreover, the variance of this quantity is increasing more than four times as fast as the mean. The mean and variance of the number of tornadoes per outbreak vary according to Taylor's power law of fluctuation scaling (TL), with parameters that are consistent with multiplicative growth. Tornado-related atmospheric proxies show similar power-law scaling and multiplicative growth. Path-length-integrated tornado outbreak intensity also follows TL, but with parameters consistent with sampling variability. The observed TL power-law scaling of outbreak severity means that extreme outbreaks are more frequent than would be expected if mean and variance were independent or linearly related. PMID:26923210

  17. 19th-century and early 20th-century jaundice outbreaks, the USA.

    Science.gov (United States)

    Teo, C G

    2018-01-01

    Historical enquiry into diseases with morbidity or mortality predilections for particular demographic groups can permit clarification of their emergence, endemicity, and epidemicity. During community-wide outbreaks of hepatitis A in the pre-vaccine era, clinical attack rates were higher among juveniles rather than adults. In community-wide hepatitis E outbreaks, past and present, mortality rates have been most pronounced among pregnant women. Examination for these characteristic predilections in reports of jaundice outbreaks in the USA traces the emergence of hepatitis A and also of hepatitis E to the closing three decades of the 19th century. Thereafter, outbreaks of hepatitis A burgeoned, whereas those of hepatitis E abated. There were, in addition, community-wide outbreaks that bore features of neither hepatitis A nor E; they occurred before the 1870s. The American Civil War antedated that period. If hepatitis A had yet to establish endemicity, then it would not underlie the jaundice epidemic that was widespread during the war. Such an assessment may be revised, however, with the discovery of more extant outbreak reports.

  18. [Foodborne disease outbreaks around the urban Chilean areas from 2005 to 2010].

    Science.gov (United States)

    Alerte, Viller; Cortés A, Sandra; Díaz T, Janepsy; Vollaire Z, Jeannette; Espinoza M, M Eugenia; Solari G, Verónica; Cerda L, Jaime; Torres H, Marisa

    2012-02-01

    Foodborne disease outbreaks are one of the main health problems all over the world, which have an extensive impact on human health. [corrected] To analyze the foodborne disease outbreaks occurred in Chilean urban area from 2005 to 2010. We made a descriptive epidemiologic study. First, criteria were defined and classified according to previous epidemiologic investigations, clinical and environment samples, then. Variables of space, time, place and person were also analyzed. Among 2,806 reported outbreaks, 2434 (86.7%) fulfilled the inclusion criteria. Incidence rate of the period (2005-2010) were 32 cases per 100 inhabitants. A total of 12,196 people were affected, with an average of 5 patients per outbreak. The households (36.2%), restaurants (16.3%), supermarkets (6.3%) free fair (4.4%) have been the most important outbreak areas. The foods involved were seafood (15.4%), fish (15.1%), and fast food (13.5%). The etiologic agents were Salmonella spp, Shigella spp, Vibrio parahaemolyticus. Outbreaks foodborne diseases are frequents in the Chilean urban area, which make vulnerable a lot of people. The largest numbers happened in the households and were due to bad handling and/or inappropriate storage of the foods.

  19. Climate and the Timing of Imported Cases as Determinants of the Dengue Outbreak in Guangzhou, 2014: Evidence from a Mathematical Model.

    Directory of Open Access Journals (Sweden)

    Qu Cheng

    2016-02-01

    Full Text Available As the world's fastest spreading vector-borne disease, dengue was estimated to infect more than 390 million people in 2010, a 30-fold increase in the past half century. Although considered to be a non-endemic country, mainland China had 55,114 reported dengue cases from 2005 to 2014, of which 47,056 occurred in 2014. Furthermore, 94% of the indigenous cases in this time period were reported in Guangdong Province, 83% of which were in Guangzhou City. In order to determine the possible determinants of the unprecedented outbreak in 2014, a population-based deterministic model was developed to describe dengue transmission dynamics in Guangzhou. Regional sensitivity analysis (RSA was adopted to calibrate the model and entomological surveillance data was used to validate the mosquito submodel. Different scenarios were created to investigate the roles of the timing of an imported case, climate, vertical transmission from mosquitoes to their offspring, and intervention. The results suggested that an early imported case was the most important factor in determining the 2014 outbreak characteristics. Precipitation and temperature can also change the transmission dynamics. Extraordinary high precipitation in May and August, 2014 appears to have increased vector abundance. Considering the relatively small number of cases in 2013, the effect of vertical transmission was less important. The earlier and more frequent intervention in 2014 also appeared to be effective. If the intervention in 2014 was the same as that in 2013, the outbreak size may have been over an order of magnitude higher than the observed number of new cases in 2014.The early date of the first imported and locally transmitted case was largely responsible for the outbreak in 2014, but it was influenced by intervention, climate and vertical transmission. Early detection and response to imported cases in the spring and early summer is crucial to avoid large outbreaks in the future.

  20. Impact of delay on disease outbreak in a spatial epidemic model

    Science.gov (United States)

    Zhao, Xia-Xia; Wang, Jian-Zhong

    2015-04-01

    One of the central issues in studying epidemic spreading is the mechanism on disease outbreak. In this paper, we investigate the effects of time delay on disease outbreak in spatial epidemics based on a reaction-diffusion model. By mathematical analysis and numerical simulations, we show that when time delay is more than a critical value, the disease outbreaks. The obtained results show that the time delay is an important factor in the spread of the disease, which may provide new insights on disease control.

  1. Molecular epidemiology and evolution in an outbreak of fulminant hepatitis B virus.

    Science.gov (United States)

    Bracho, Maria Alma; Gosalbes, María José; González, Francisco; Moya, Andrés; González-Candelas, Fernando

    2006-04-01

    In order to establish the transmission pathway for two outbreak patients affected by fulminant hepatitis B (FHB) following a shared period of hospitalization, we sequenced the complete genomes of the hepatitis B viruses (HBV) isolated from them as well as from the suspected common source and 11 additional controls. Phylogenetic and statistical analyses of these sequences revealed that the two FHB patients were indeed infected by a common source and that the fatal development of the disease did not appear to be associated with any mutation previously reported to be related to FHB. These data have also allowed us to estimate the extent and distribution of genetic variability along the genomes of HBV genotype D samples from the same source population. As a result of these analyses, we provide an improved statistical method to individualize the assignment of each suspected patient and the source of an outbreak and information on which genome region to analyze in the molecular epidemiological assessment of hepatitis B virus transmission cases.

  2. Salmonella Litchfield outbreak associated with a hotel restaurant--Atlantic City, New Jersey, 2007.

    Science.gov (United States)

    2008-07-18

    On July 10, 2007, the Pennsylvania Department of Health notified the New Jersey Department of Health and Senior Services (NJDHSS) of three culture-confirmed cases of Salmonella Litchfield infection with matching pulsed-field gel electrophoresis (PFGE) patterns. Data from PulseNet, the national molecular subtyping network for foodborne disease surveillance, confirmed 11 cases (including the three from Pennsylvania) of this rarely identified Salmonella serotype in five states during a 5-week period; seven of the 11 patients had reported recent travel history to Atlantic City, New Jersey. This report describes the subsequent investigation led by NJDHSS and the Atlantic City Health Department (ACHD), which associated the outbreak with a hotel restaurant in Atlantic City. In all, 30 confirmed or probable cases of illness with S. Litchfield infection were identified among persons from eight states who had eaten at the hotel restaurant, including 10 restaurant food handlers. Investigators concluded that the outbreak most likely was associated with fruit salad, particularly the honeydew melon component, and that contamination likely resulted from an ill food handler. This investigation illustrates the potential for recurring food contamination by ill and asymptomatic food handlers and underscores the utility of PulseNet to link illnesses that might appear unrelated.

  3. Low-altitude outbreaks of human fascioliasis related with summer rainfall in Gilan province, Iran

    Directory of Open Access Journals (Sweden)

    Abdoreza Salahi-Moghaddam

    2011-11-01

    Full Text Available Following human fascioliasis outbreaks in 1988 and 1999 in Gilan province, northern Iran, efforts are now made to shed light on the seasonal pattern of fascioliasis transmission in this endemic area, taking into account snail host populations, climatic conditions and human cases. Populations of the intermediate host snail (Lymnaea spp. peak in May and November, while there is a fourfold increase in the rate of human fascioliasis in February compared to that of September. Transmission is likely to occur mainly in late autumn and sporadically in late spring. Rainfall, seasonally analysed in periods of 3 years, indicates that accumulated summer rainfall may be related with the 1988 and 1999 human fascioliasis outbreaks. Although a more detailed picture, based on the analysis of further abiotic and biotic factors influencing fascioliasis transmission in this area, is required to substantiate this hypothesis, our results serve as the first step of a geographical information system project concerning the epidemiological study of fascioliasis in Iran. This local-scale study concerning the effects of climate change and natural disasters on the spread of fascioliasis aims to facilitate the understanding of what goes on at the regional scale in this respect.

  4. Low-altitude outbreaks of human fascioliasis related with summer rainfall in Gilan province, Iran.

    Science.gov (United States)

    Salahi-Moghaddam, Abdoreza; Habibi-Nokhandam, Majid; Fuentes, Màrius V

    2011-11-01

    Following human fascioliasis outbreaks in 1988 and 1999 in Gilan province, northern Iran, efforts are now made to shed light on the seasonal pattern of fascioliasis transmission in this endemic area, taking into account snail host populations, climatic conditions and human cases. Populations of the intermediate host snail (Lymnaea spp.) peak in May and November, while there is a fourfold increase in the rate of human fascioliasis in February compared to that of September. Transmission is likely to occur mainly in late autumn and sporadically in late spring. Rainfall, seasonally analysed in periods of 3 years, indicates that accumulated summer rainfall may be related with the 1988 and 1999 human fascioliasis outbreaks. Although a more detailed picture, based on the analysis of further abiotic and biotic factors influencing fascioliasis transmission in this area, is required to substantiate this hypothesis, our results serve as the first step of a geographical information system project concerning the epidemiological study of fascioliasis in Iran. This local-scale study concerning the effects of climate change and natural disasters on the spread of fascioliasis aims to facilitate the understanding of what goes on at the regional scale in this respect.

  5. An outbreak of acute bovine mastitis caused by Klebsiella pneumoniae in a dairy herd

    Directory of Open Access Journals (Sweden)

    Silva N.

    2001-01-01

    Full Text Available An outbreak of coliform mastitis is described in a dairy herd from the State of Rio de Janeiro, Brazil. During a four-month period 14 fatal cases of Klebsiella pneumoniae-related mastitis were observed in a herd of 104 lactating cows. The symptoms included peracute enterotoxemia in which the cows died 6 to 12 h after the detection of mastitis by CMT. Staphylococcus aureus and Streptococcus agalactiae Streptococcus agalactiae were also isolated although could not be associated with cases of acute fatal mastitis. Milking practices were also evaluated. The milking machine was being used correctly and adequate precautions for hygiene and pre-milking and post-milking teat dipping were used. The organism was sensitive to gentamicin. Therapy for acute toxic mastitis required early action for the treatment of infections, involving corticosteroids and fluid therapy. The use of a Klebsiella vaccine produced from the microorganisms isolated from the herd, associated with hygiene measures, resulted in the control of the outbreak.

  6. Protecting healthcare workers in an acute care environment during epidemics: lessons learned from the SARS outbreak

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    John Casken

    2011-01-01

    Full Text Available During the 2002-2003 the SARS outbreak resulted in 8,450 illnesses and 812 deaths. Out of these documented cases 1706 were among healthcare workers (HCWsThe purpose of this paper is to focus on and examine the details of infection control (IC measures and which of these measures appear to be the most effective in stopping disease spread. Historically, HCWs have had poor compliance with the use of IC measures prior to the SARS outbreak. A number of lessons were learned from the SARS epidemic that should be incorporated into healthcare institutions policies and procedures. They include the following: an emphasis on the correct and immediate use of IC measures; an increased focus on HCWs recognizing early perceived threats; healthcare institutions should mandate routine in-house education with periodic updates on IC measures; administrators need to acknowledge and encourage role models among staff; engineeringcontrols should be put in place to protect staff from pathogens; and finally, there should be clear and constant communication between administration and staff.

  7. A report on the outbreak of Zika virus on Easter Island, South Pacific, 2014.

    Science.gov (United States)

    Tognarelli, J; Ulloa, S; Villagra, E; Lagos, J; Aguayo, C; Fasce, R; Parra, B; Mora, J; Becerra, N; Lagos, N; Vera, L; Olivares, B; Vilches, M; Fernández, J

    2016-03-01

    Zika virus (ZIKV) is an emerging mosquito-borne flavivirus circulating in Asia and Africa. In 2013, a large outbreak was reported on the archipelago of French Polynesia. In this study, we report the detection and molecular characterization of Zika virus for the first time in Chile from an outbreak among the inhabitants of Easter Island. A total of 89 samples from patients suspected of having ZIKV infection were collected between the period from January to May, 2014. Molecular diagnosis of the virus was performed by RT-PCR followed by the sequencing of the region containing the NS5 gene. A comparison of the viral nucleic acid sequence with those of other strains of ZIKA virus was performed using the MEGA software. Fifty-one samples were found positive for ZIKV by RT-PCR analysis. Further analysis of the NS5 gene revealed that the ZIKV strains identified in Easter Island were most closely related to those found in French Polynesia (99.8 to 99.9% nt and 100% aa sequence identity). These results strongly suggest that the transmission pathway leading to the introduction of Zika virus on Easter Island has its origin in French Polynesia.

  8. Linking healthcare associated norovirus outbreaks: a molecular epidemiologic method for investigating transmission

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    Andrews Nick

    2006-07-01

    Full Text Available Abstract Background Noroviruses are highly infectious pathogens that cause gastroenteritis in the community and in semi-closed institutions such as hospitals. During outbreaks, multiple units within a hospital are often affected, and a major question for control programs is: are the affected units part of the same outbreak or are they unrelated transmission events? In practice, investigators often assume a transmission link based on epidemiological observations, rather than a systematic approach to tracing transmission. Here, we present a combined molecular and statistical method for assessing: 1 whether observed clusters provide evidence of local transmission and 2 the probability that anecdotally|linked outbreaks truly shared a transmission event. Methods 76 healthcare associated outbreaks were observed in an active and prospective surveillance scheme of 15 hospitals in the county of Avon, England from April 2002 to March 2003. Viral RNA from 64 out of 76 specimens from distinct outbreaks was amplified by reverse transcription-PCR and was sequenced in the polymerase (ORF 1 and capsid (ORF 2 regions. The genetic diversity, at the nucleotide level, was analysed in relation to the epidemiological patterns. Results Two out of four genetic and epidemiological clusters of outbreaks were unlikely to have occurred by chance alone, thus suggesting local transmission. There was anecdotal epidemiological evidence of a transmission link among 5 outbreaks pairs. By combining this epidemiological observation with viral sequence data, the evidence of a link remained convincing in 3 of these pairs. These results are sensitive to prior beliefs of the strength of epidemiological evidence especially when the outbreak strains are common in the background population. Conclusion The evidence suggests that transmission between hospitals units does occur. Using the proposed criteria, certain hypothesized transmission links between outbreaks were supported while

  9. Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program

    Science.gov (United States)

    Martínez, Ana; Broner, Sonia; Sala, M Rosa; Manzanares-Laya, Sandra; Godoy, Pere; Planas, Caritat; Minguell, Sofia; Torner, Nuria; Jané, Mireia; Domínguez, Angela; for the Study of the Immune Status in Health Care, the Working Group; Hepatitis A in Catalonia, for the Study of

    2014-01-01

    A hepatitis A+B vaccine vaccination program of 12-year-olds was introduced in Catalonia in 1998. The aim of this study was to investigate the evolution of hepatitis A outbreaks in Catalonia and estimate the preventable fraction of cases associated with outbreaks as a measure of the impact of the vaccination program. Hepatitis A outbreaks reported to the Health Department between 1991 and 2012 were analyzed. The incidence rates of outbreaks, outbreak-associated cases and hospitalizations were calculated. The preventable fraction (PF) and 95% confidence intervals (CI) were estimated for the whole study period (pre-vaccination and post-vaccination) and the post-vaccination period. One-hundred-eight (108) outbreaks (rate of 2.21 per 106 persons-year) were reported in the pre-vaccination period and 258 outbreaks (rate of 2.82 per 106 persons-year) in the post-vaccination period. The rate of cases associated with outbreaks was 1.52 per 105 persons-year in the pre-vaccination period and 1.28 per 105 persons-year in the post-vaccination period. Hospitalization rates were 0.08 and 0.75 per 106 persons-year, respectively. The number of person-to-person outbreaks whose index case was a school contact decreased in the post-vaccination period (aOR 2.72; 95%CI 1.35–5.48), but outbreaks whose index case was a man who has sex with men (MSM) or an immigrant increased. The PF of all outbreak-associated cases was 6.46% (95%CI 3.11–9.82) and the highest PF was in the 15–24 years age group (42.53%; 95%CI 29.30–55.75). In the 0–4 years age group, the PF was 18.35% (95%CI 9.59–27.11), suggesting a protective herd effect in unvaccinated subjects. Vaccination of immigrants traveling to endemic countries and MSM should be reinforced. PMID:25483535

  10. Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010

    DEFF Research Database (Denmark)

    Rieckmann, Andreas; Tamason, Charlotte C.; Gurley, Emily S.

    2018-01-01

    An increased risk for cholera was witnessed during both droughts and floods in sub-Saharan Africa; these findings call for increased preparedness and surveillance during droughts in addition to floods. Cholera outbreaks in Africa have been attributed to both droughts and floods, but whether...... the risk of a cholera outbreak is elevated during droughts is unknown. We estimated the risk of cholera outbreaks during droughts and floods compared with drought- and flood-free periods in 40 sub-Saharan African countries during 1990–2010 based on data from EM-DAT: the OFDA/CRED International Disaster...... Database (www.emdat.be). A cholera outbreak was registered in one of every three droughts and one of every 15 floods. We observed an increased incidence rate of cholera outbreaks during drought periods (IRR = 4.3, 95% confidence interval [CI] = 2.9–7.2) and during flood periods (IRR = 144, 95% CI = 101...

  11. Dynamics of a Tularemia Outbreak in a Closely Monitored Free-Roaming Population of Wild House Mice.

    Science.gov (United States)

    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.

  12. Dynamics of a Tularemia Outbreak in a Closely Monitored Free-Roaming Population of Wild House Mice.

    Directory of Open Access Journals (Sweden)

    Akos Dobay

    Full Text Available 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.

  13. Get the news out loudly and quickly: the influence of the media on limiting emerging infectious disease outbreaks.

    Science.gov (United States)

    Mummert, Anna; Weiss, Howard

    2013-01-01

    During outbreaks of infectious diseases with high morbidity and mortality, individuals closely follow media reports of the outbreak. Many will attempt to minimize contacts with other individuals in order to protect themselves from infection and possibly death. This process is called social distancing. Social distancing strategies include restricting socializing and travel, and using barrier protections. We use modeling to show that for short-term outbreaks, social distancing can have a large influence on reducing outbreak morbidity and mortality. In particular, public health agencies working together with the media can significantly reduce the severity of an outbreak by providing timely accounts of new infections and deaths. Our models show that the most effective strategy to reduce infections is to provide this information as early as possible, though providing it well into the course of the outbreak can still have a significant effect. However, our models for long-term outbreaks indicate that reporting historic infection data can result in more infections than with no reporting at all. We examine three types of media influence and we illustrate the media influence with a simulated outbreak of a generic emerging infectious disease in a small city. Social distancing can never be complete; however, for a spectrum of outbreaks, we show that leaving isolation (stopping applying social distancing measures) for up to 4 hours each day has modest effect on the overall morbidity and mortality.

  14. Get the news out loudly and quickly: the influence of the media on limiting emerging infectious disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Anna Mummert

    Full Text Available During outbreaks of infectious diseases with high morbidity and mortality, individuals closely follow media reports of the outbreak. Many will attempt to minimize contacts with other individuals in order to protect themselves from infection and possibly death. This process is called social distancing. Social distancing strategies include restricting socializing and travel, and using barrier protections. We use modeling to show that for short-term outbreaks, social distancing can have a large influence on reducing outbreak morbidity and mortality. In particular, public health agencies working together with the media can significantly reduce the severity of an outbreak by providing timely accounts of new infections and deaths. Our models show that the most effective strategy to reduce infections is to provide this information as early as possible, though providing it well into the course of the outbreak can still have a significant effect. However, our models for long-term outbreaks indicate that reporting historic infection data can result in more infections than with no reporting at all. We examine three types of media influence and we illustrate the media influence with a simulated outbreak of a generic emerging infectious disease in a small city. Social distancing can never be complete; however, for a spectrum of outbreaks, we show that leaving isolation (stopping applying social distancing measures for up to 4 hours each day has modest effect on the overall morbidity and mortality.

  15. Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission--United States, 2009-2013.

    Science.gov (United States)

    Wikswo, Mary E; Kambhampati, Anita; Shioda, Kayoko; Walsh, Kelly A; Bowen, Anna; Hall, Aron J

    2015-12-11

    Acute gastroenteritis (AGE) is a major cause of illness in the United States, with an estimated 179 million episodes annually. AGE outbreaks propagated through direct person-to-person contact, contaminated environmental surfaces, and unknown modes of transmission were not systematically captured at the national level before 2009 and thus were not well characterized. 2009-2013. The National Outbreak Reporting System (NORS) is a voluntary national reporting system that supports reporting of all waterborne and foodborne disease outbreaks and all AGE outbreaks resulting from transmission by contact with contaminated environmental sources, infected persons or animals, or unknown modes. Local, state, and territorial public health agencies within the 50 U.S. states, the District of Columbia (DC), five U.S. territories, and three Freely Associated States report outbreaks to CDC via NORS using a standard online data entry system. A total of 10,756 AGE outbreaks occurred during 2009-2013, for which the primary mode of transmission occurred through person-to-person contact, environmental contamination, and unknown modes of transmission. NORS received reports from public health agencies in 50 U.S. states, DC, and Puerto Rico. These outbreaks resulted in 356,532 reported illnesses, 5,394 hospitalizations, and 459 deaths. The median outbreak reporting rate for all sites in a given year increased from 2.7 outbreaks per million population in 2009 to 11.8 outbreaks in 2013. The etiology was unknown in 31% (N = 3,326) of outbreaks. Of the 7,430 outbreaks with a suspected or confirmed etiology reported, norovirus was the most common, reported in 6,223 (84%) of these outbreaks. Other reported suspected or confirmed etiologies included Shigella (n = 332) and Salmonella (n = 320). Outbreaks were more frequent during the winter, with 5,716 (53%) outbreaks occurring during December-February, and 70% of the 7,001 outbreaks with a reported setting of exposure occurred in long

  16. Direct radiative effects during intense Mediterranean desert dust outbreaks

    Directory of Open Access Journals (Sweden)

    A. Gkikas

    2018-06-01

    Full Text Available The direct radiative effect (DRE during 20 intense and widespread dust outbreaks, which affected the broader Mediterranean basin over the period March 2000–February 2013, has been calculated with the NMMB-MONARCH model at regional (Sahara and European continent and short-term temporal (84 h scales. According to model simulations, the maximum dust aerosol optical depths (AODs range from  ∼  2.5 to  ∼  5.5 among the identified cases. At midday, dust outbreaks locally induce a NET (shortwave plus longwave strong atmospheric warming (DREATM values up to 285 W m−2; Niger–Chad; dust AODs up to  ∼  5.5 and a strong surface cooling (DRENETSURF values down to −337 W m−2, whereas they strongly reduce the downward radiation at the ground level (DRESURF values down to −589 W m−2 over the Eastern Mediterranean, for extremely high dust AODs, 4.5–5. During night-time, reverse effects of smaller magnitude are found. At the top of the atmosphere (TOA, positive (planetary warming DREs up to 85 W m−2 are found over highly reflective surfaces (Niger–Chad; dust AODs up to  ∼  5.5 while negative (planetary cooling DREs down to −184 W m−2 (Eastern Mediterranean; dust AODs 4.5–5 are computed over dark surfaces at noon. Dust outbreaks significantly affect the mean regional radiation budget, with NET DREs ranging from −8.5 to 0.5 W m−2, from −31.6 to 2.1 W m−2, from −22.2 to 2.2 W m−2 and from −1.7 to 20.4 W m−2 for TOA, SURF, NETSURF and ATM, respectively. Although the shortwave DREs are larger than the longwave ones, the latter are comparable or even larger at TOA, particularly over the Sahara at midday. As a response to the strong surface day-time cooling, dust outbreaks cause a reduction in the regional sensible and latent heat fluxes by up to 45 and 4 W m−2, respectively, averaged over land areas of the simulation domain. Dust outbreaks reduce the

  17. The WHO application of ICD-10 to deaths during the perinatal period (ICD-PM) : results from pilot database testing in South Africa and United Kingdom

    NARCIS (Netherlands)

    Allanson, E. R.; Tuncalp, Oe; Gardosi, J.; Pattinson, R. C.; Francis, A.; Vogel, J. P.; Erwich, J. J. H. M.; Flenady, V. J.; Froen, J. F.; Neilson, J.; Quach, A.; Chou, D.; Mathai, M.; Say, L.; Guelmezoglu, A. M.

    2016-01-01

    Objective To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICD-Perinatal Mortality (ICD-PM) to existing perinatal death databases. Design Retrospective application of ICD-PM.

  18. Infection control during filoviral hemorrhagic fever outbreaks

    Directory of Open Access Journals (Sweden)

    N Raabe Vanessa

    2012-01-01

    Full Text Available 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.

  19. Carcass Management During Avian Influenza Outbreaks

    Science.gov (United States)

    This page on Avian Influenza (AI) describes carcass management during Avian Flu outbreaks, including who oversees carcass management, how they're managed, environmental concerns from carcass management, and disinfection. The page also describes what AI is.

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Spatial and temporal structure of typhoid outbreaks in Washington, D.C., 1906–1909: evaluating local clustering with the Gi* statistic

    Directory of Open Access Journals (Sweden)

    Curtis Andrew

    2006-03-01

    Full Text Available Abstract Background To better understand the distribution of typhoid outbreaks in Washington, D.C., the U.S. Public Health Service (PHS conducted four investigations of typhoid fever. These studies included maps of cases reported between 1 May – 31 October 1906 – 1909. These data were entered into a GIS database and analyzed using Ripley's K-function followed by the Gi* statistic in yearly intervals to evaluate spatial clustering, the scale of clustering, and the temporal stability of these clusters. Results The Ripley's K-function indicated no global spatial autocorrelation. The Gi* statistic indicated clustering of typhoid at multiple scales across the four year time period, refuting the conclusions drawn in all four PHS reports concerning the distribution of cases. While the PHS reports suggested an even distribution of the disease, this study quantified both areas of localized disease clustering, as well as mobile larger regions of clustering. Thus, indicating both highly localized and periodic generalized sources of infection within the city. Conclusion The methodology applied in this study was useful for evaluating the spatial distribution and annual-level temporal patterns of typhoid outbreaks in Washington, D.C. from 1906 to 1909. While advanced spatial analyses of historical data sets must be interpreted with caution, this study does suggest that there is utility in these types of analyses and that they provide new insights into the urban patterns of typhoid outbreaks during the early part of the twentieth century.

  2. Giardiasis in Bergen. Outbreak and clinical consequences.

    OpenAIRE

    Wensaas, Knut-Arne

    2011-01-01

    Background Giardia lamblia is a common cause of waterborne disease. It is endemic in many parts of the world, especially where sanitation is poor, but in Europe and North America it is most often encountered in outbreaks following contamination of drinking water. The first registered outbreak of giardiasis affecting a large community in Norway happened in Bergen in the autumn of 2004. The reservoir “Svartediket” was the source, and the water probably held Giardia cysts for s...

  3. Association of Heavy Rainfall on Genotypic Diversity in V. cholerae Isolates from an Outbreak in India

    Directory of Open Access Journals (Sweden)

    A. K. Goel

    2011-01-01

    Full Text Available The outbreak of waterborne disease cholera has been associated with rainfall and flooding events by contamination of potable water with environmental Vibrio cholerae. The continuation of the epidemic in a region, however, is often due to secondary transmission of the initial outbreak strain through human waste. This paper reports, on the contrary, a rapid shift of genotype from one V. cholerae strain to another one in an epidemic region. V. cholerae isolated from patients during 2005 cholera epidemic in Chennai, India were characterized using PCR identification of toxin genes, antibiogram, and genomic fingerprinting analysis. The results showed that in spite of the similarity of toxin genes and antibiogram, the Vibrio isolates grouped into two different clusters based on the ERIC-PCR fingerprinting. Each cluster corresponded to a distinct peak of cholera outbreak, which occurred after separate heavy rainfall. The results suggest that the rainfall event can bring various genotypes of V. cholerae strains causing multiple outbreaks.

  4. Problem Periods

    Science.gov (United States)

    ... ovary syndrome. Read our information on PCOS for teens , and see your doctor if you think you may have PCOS. Major weight loss. Girls who have anorexia will often stop having periods. When to see ...

  5. Results from studies of precipitation by-products in Berlin-Dahlem in the period of September 1961 to December 1990

    International Nuclear Information System (INIS)

    Pelz, J.

    1991-01-01

    Special precipitation measurements performed since September 1961 by the aerosol-laboratory of the (Berlin Free University) Meteorological Institut have been listed and are now present in tabular form. Artifical beta-radioactivity and solid residue have been registered since the beginning of these observations, measurements of the pH-value and of electrical conductivity have been carried out continuously since September 1983 and November 1988, respectively. Some statistical investigations, as trendchecks, are presented; it proved, however, that the registration periods of both, pH-values and conductivity-measurements were not sufficient (too short) for this purpose. The individual paragraphs are supposed to give a general view, special investigations will follow. Within the observation period from September 1961 to December 1990 a total of 17036 l precipitation has been collectet on 4824 days, containing about 776 g solid substances and 98385 Becquerel radioactiv deposits per square meter. (orig.) [de

  6. Observation of gravity waves during the extreme tornado outbreak of 3 April 1974

    Science.gov (United States)

    Hung, R. J.; Phan, T.; Smith, R. E.

    1978-01-01

    A continuous wave-spectrum high-frequency radiowave Doppler sounder array was used to observe upper-atmospheric disturbances during an extreme tornado outbreak. The observations indicated that gravity waves with two harmonic wave periods were detected at the F-region ionospheric height. Using a group ray path computational technique, the observed gravity waves were traced in order to locate potential sources. The signals were apparently excited 1-3 hours before tornado touchdown. Reverse ray tracing indicated that the wave source was located at the aurora zone with a Kp index of 6 at the time of wave excitation. The summation of the 24-hour Kp index for the day was 36. The results agree with existing theories (Testud, 1970; Titheridge, 1971; Kato, 1976) for the excitation of large-scale traveling ionospheric disturbances associated with geomagnetic activity in the aurora zone.

  7. The Lack of Effect of Food on the Pharmacokinetics of ZX008 (Fenfluramine Oral Solution): Results of a Single-dose, Two-period Crossover Study.

    Science.gov (United States)

    Gammaitoni, Arnold; Smith, Steven; Boyd, Brooks

    2018-06-22

    Fenfluramine is being developed as a low-dose adjunctive treatment for seizures in patients with Dravet syndrome and other epileptic encephalopathies, including Lennox-Gastaut syndrome. Most patients with Dravet syndrome receive multiple antiepileptic drugs, making it challenging for caregivers to track correct administration times. The present Phase I study was conducted to determine the effect of food on the pharmacokinetic properties of fenfluramine. Healthy nonsmoking subjects aged 18 to 50years were enrolled in an open-label, crossover, Phase I pharmacokinetic and safety profile study and received 2 single 0.8-mg/kg doses of ZX008 (fenfluramine hydrochloride oral solution), 1 after a 10-hour overnight fast and the other 30 minutes after the start of consumption of a high-fat breakfast, in a randomly assigned order. A washout period of at least 9days separated the 2 treatment periods. Venous blood samples were taken before each dose and periodically for 72hours after each dose for determination of concentrations of fenfluramine and its active metabolite norfenfluramine. Plasma pharmacokinetic parameters were estimated for each subject by noncompartmental analysis. In the 13 subjects completing both treatment periods, food had no effect on the rate or extent of absorption and bioavailability of fenfluramine as assessed by fed vs fasted adjusted geometric mean observed plasma C max (59.1vs 56.7 ng/mL; NS) and AUC 0-∞ (1640vs 1600 ng · h/mL; NS). Additionally, there was no impact of food on systemic exposure of norfenfluramine. Seven subjects reported at least 1 treatment-emergent adverse event; all treatment-emergent adverse events were mild in severity. The bioequivalence and tolerability of single 0.8-mg/kg oral doses of ZX008 in the fed and fasted states support ZX008 administration without regard to meals. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

  8. Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

    Directory of Open Access Journals (Sweden)

    Gerald Amandu Matua

    2015-05-01

    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.

  9. Evolution of periodicity in periodical cicadas.

    Science.gov (United States)

    Ito, Hiromu; Kakishima, Satoshi; Uehara, Takashi; Morita, Satoru; Koyama, Takuya; Sota, Teiji; Cooley, John R; Yoshimura, Jin

    2015-09-14

    Periodical cicadas (Magicicada spp.) in the USA are famous for their unique prime-numbered life cycles of 13 and 17 years and their nearly perfectly synchronized mass emergences. Because almost all known species of cicada are non-periodical, periodicity is assumed to be a derived state. A leading hypothesis for the evolution of periodicity in Magicicada implicates the decline in average temperature during glacial periods. During the evolution of periodicity, the determinant of maturation in ancestral cicadas is hypothesized to have switched from size dependence to time (period) dependence. The selection for the prime-numbered cycles should have taken place only after the fixation of periodicity. Here, we build an individual-based model of cicadas under conditions of climatic cooling to explore the fixation of periodicity. In our model, under cold environments, extremely long juvenile stages lead to extremely low adult densities, limiting mating opportunities and favouring the evolution of synchronized emergence. Our results indicate that these changes, which were triggered by glacial cooling, could have led to the fixation of periodicity in the non-periodical ancestors.

  10. Organic micro-pollutants in a karst system during low and high flow periods, results of a two-year study

    Science.gov (United States)

    Reh, Roland; Licha, Tobias; Geyer, Tobias; Nödler, Karsten; Sauter, Martin

    2013-04-01

    and desethylatrazine, indicates limited aquifer connections and demonstrates a residence time of several years for vertical transport into the deep aquifer. Phenazone originates also from a disused waste disposal and is showing a persistency for more than three decades under the observed redox conditions. References Nödler K, Licha T, Bester K, Sauter M. Development of a multi-residue analytical method, based on liquid chromatography-tandem mass spectrometry, for the simultaneous determination of 46 micro-contaminants in aqueous samples. Journal of Chromatography A 2010;1217(42), 6511-6521. Reh R, Licha T, Geyer T, Nödler, K.,Sauter M. Occurrence and spatial distribution of organic micro-pollutants in a complex hydrogeological karst system during low flow and high flow periods, results of a two-year study. Science of The Total Environment 2013, 443,438-445, 10.1016/j.scitotenv.2012.11.005.

  11. Periodical safety review of the Goesgen-Daeniken nuclear power plant. Summary, results and evaluation; Periodische Sicherheitsueberpruefung fuer das Kernkraftwerk Goesgen-Daeniken. Zusammenfassung, Ergebnisse und Bewertung

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-11-15

    The Goesgen nuclear power plant (KKG) received its operational licence on September 9, 1978. The operational start-up of the plant went on into the year 1979, but there was a short interruption because of the accident in the Three Mile Island reactor on March 28, 1979. In May 1985 KKG submitted a request for raising the thermal reactor power from the then 2808 MW to 3002 MW. Based on the examination by the Federal Agency for the Safety of Nuclear Installations (HSK), the Swiss Federal Council granted the licence in two steps: in December 1985 for raising the thermal power to 2900 MW, and, in April 1992, to 3002 MW. The licence for the second step was given under the condition that some more experience was to be gained concerning the fuel rod cladding under higher loading. As part of the yearly re-licensing on restart after fuel assembly reloading, HSK confirmed that the plant status conformed to the legal requirements. In November 1986, HSK asked all Swiss nuclear power plant managers to state their opinions on proposed measures concerning severe accidents. Some of the measures were already in discussion; the Chernobyl accident on April 26, 1986, accelerated their implementation and was also a reason for the introduction of the measures against severe accidents. In this context, KKG carried out a risk study which led to the installation of a filtered pressure release system for the containment. Another consequence of the Chernobyl accident was the introduction of technical Periodical Safety Reviews (PSR) for all operating nuclear power plants. Central points of the PSR are: a) comparison with the continuously improving state-of-the-art of science and technology concerning safety precautions; b) a systematic evaluation of operating experience and plant status; c) the taking into account of probabilistic safety analyses in the overall evaluation of the plant. Within the framework of the examination of the overall plant, HSK also checks how its requirements concerning

  12. Primary and secondary cases in Escherichia coli O157 outbreaks: a statistical analysis.

    LENUS (Irish Health Repository)

    Snedeker, Kate G

    2009-01-01

    BACKGROUND: Within outbreaks of Escherichia coli O157 (E. coli O157), at least 10-15% of cases are thought to have been acquired by secondary transmission. However, there has been little systematic quantification or characterisation of secondary outbreak cases worldwide. The aim of this study was to characterise secondary outbreak cases, estimate the overall proportion of outbreak cases that were the result of secondary transmission and to analyse the relationships between primary and secondary outbreak cases by mode of transmission, country and median age. METHODS: Published data was obtained from 90 confirmed Escherichia coli O157 outbreaks in Great Britain, Ireland, Scandinavia, Canada, the United States and Japan, and the outbreaks were described in terms of modes of primary and secondary transmission, country, case numbers and median case age. Outbreaks were tested for statistically significant differences in the number of ill, confirmed, primary and secondary cases (analysis of variance and Kruskal-Wallis) and in the rate of secondary cases between these variables (Generalised Linear Models). RESULTS: The outbreaks had a median of 13.5 confirmed cases, and mean proportion of 0.195 secondary cases. There were statistically significant differences in the numbers of ill, confirmed, primary and secondary cases between modes of primary transmission (p < 0.021), and in primary and secondary cases between median age categories (p < 0.039) and modes of secondary transmission (p < 0.001).Secondary case rates differed statistically significantly between modes of secondary and primary transmission and median age categories (all p < 0.001), but not between countries (p = 0.23). Statistically significantly higher rates of secondary transmission were found in outbreaks with a median age <6 years and those with secondary transmission via person to person spread in nurseries. No statistically significant interactions were found between country, mode of transmission and age

  13. Can tail damage outbreaks in the pig be predicted by behavioural change?

    Science.gov (United States)

    Larsen, Mona Lilian Vestbjerg; Andersen, Heidi Mai-Lis; Pedersen, Lene Juul

    2016-03-01

    Tail biting, resulting in outbreaks of tail damage in pigs, is a multifactorial welfare and economic problem which is usually partly prevented through tail docking. According to European Union legislation, tail docking is not allowed on a routine basis; thus there is a need for alternative preventive methods. One strategy is the surveillance of the pigs' behaviour for known preceding indicators of tail damage, which makes it possible to predict a tail damage outbreak and prevent it in proper time. This review discusses the existing literature on behavioural changes observed prior to a tail damage outbreak. Behaviours found to change prior to an outbreak include increased activity level, increased performance of enrichment object manipulation, and a changed proportion of tail posture with more tails between the legs. Monitoring these types of behaviours is also discussed for the purpose of developing an automatic warning system for tail damage outbreaks, with activity level showing promising results for being monitored automatically. Encouraging results have been found so far for the development of an automatic warning system; however, there is a need for further investigation and development, starting with the description of the temporal development of the predictive behaviour in relation to tail damage outbreaks. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. A generalized-growth model to characterize the early ascending phase of infectious disease outbreaks

    DEFF Research Database (Denmark)

    Viboud, Cecile; Simonsen, Lone; Chowell, Gerardo

    2016-01-01

    the importance of sub-exponential growth for forecasting purposes.Results: We applied the generalized-growth model to 20 infectious disease outbreaks representing a range of transmission routes. We uncovered epidemic profiles ranging from very slow growth (p = 0.14 for the Ebola outbreak in Bomi, Liberia (2014...... African Ebola epidemic provided a unique opportunity to explore how growth profiles vary by geography; analysis of the largest district-level outbreaks revealed substantial growth variations (mean p = 0.59, range: 0.14–0.97). The districts of Margibi in Liberia and Bombali and Bo in Sierra Leone had near......-exponential growth, while the districts of Bomi in Liberia and Kenema in Sierra Leone displayed near constant incidences.Conclusions: Our findings reveal significant variation in epidemic growth patterns across different infectious disease outbreaks and highlights that sub-exponential growth is a common phenomenon...

  15. Tactics and Strategies for Managing Ebola Outbreaks and the Salience of Immunization

    Directory of Open Access Journals (Sweden)

    Wayne M. Getz

    2015-01-01

    Full Text Available We present a stochastic transmission chain simulation model for Ebola viral disease (EVD in West Africa, with the salutary result that the virus may be more controllable than previously suspected. The ongoing tactics to detect cases as rapidly as possible and isolate individuals as safely as practicable is essential to saving lives in the current outbreaks in Guinea, Liberia, and Sierra Leone. Equally important are educational campaigns that reduce contact rates between susceptible and infectious individuals in the community once an outbreak occurs. However, due to the relatively low R0 of Ebola (around 1.5 to 2.5 next generation cases are produced per current generation case in naïve populations, rapid isolation of infectious individuals proves to be highly efficacious in containing outbreaks in new areas, while vaccination programs, even with low efficacy vaccines, can be decisive in curbing future outbreaks in areas where the Ebola virus is maintained in reservoir populations.

  16. Tactics and strategies for managing Ebola outbreaks and the salience of immunization.

    Science.gov (United States)

    Getz, Wayne M; Gonzalez, Jean-Paul; Salter, Richard; Bangura, James; Carlson, Colin; Coomber, Moinya; Dougherty, Eric; Kargbo, David; Wolfe, Nathan D; Wauquier, Nadia

    2015-01-01

    We present a stochastic transmission chain simulation model for Ebola viral disease (EVD) in West Africa, with the salutary result that the virus may be more controllable than previously suspected. The ongoing tactics to detect cases as rapidly as possible and isolate individuals as safely as practicable is essential to saving lives in the current outbreaks in Guinea, Liberia, and Sierra Leone. Equally important are educational campaigns that reduce contact rates between susceptible and infectious individuals in the community once an outbreak occurs. However, due to the relatively low R 0 of Ebola (around 1.5 to 2.5 next generation cases are produced per current generation case in naïve populations), rapid isolation of infectious individuals proves to be highly efficacious in containing outbreaks in new areas, while vaccination programs, even with low efficacy vaccines, can be decisive in curbing future outbreaks in areas where the Ebola virus is maintained in reservoir populations.

  17. Using Outbreak Data for Source Attribution of Human Salmonellosis and Campylobacteriosis in Europe

    DEFF Research Database (Denmark)

    Pires, Sara Monteiro; Vigre, Håkan; Makela, Pia

    2010-01-01

    % of campylobacteriosis cases were attributed to chicken. Results also revealed regional differences in the relative importance of specific sources. We assessed the method to be of limited value to attribute human campylobacteriosis due to the limited number of outbreaks. Nevertheless, the presented source attribution...... are observed at the public health endpoint and can therefore be a direct measure of attribution at the point of exposure. An analysis or summary of outbreak investigations is useful for attributing illnesses to foods, but often the implicated foods in reported outbreaks are complex foods, containing several...... food items, many of which could be the specific source of the infection. We describe a method that is able to attribute human cases to specific food items contained in complex foods. The model is based on data from investigations of Salmonella and Campylobacter outbreaks in the European Union in 2005...

  18. Yellow Fever Outbreaks in Unvaccinated Populations, Brazil, 2008–2009

    Science.gov (United States)

    Romano, Alessandro Pecego Martins; Costa, Zouraide Guerra Antunes; Ramos, Daniel Garkauskas; Andrade, Maria Auxiliadora; Jayme, Valéria de Sá; de Almeida, Marco Antônio Barreto; Vettorello, Kátia Campomar; Mascheretti, Melissa; Flannery, Brendan

    2014-01-01

    Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever. PMID:24625634

  19. An outbreak of Newcastle disease in free-living pheasants (Phasianus colchicus)

    DEFF Research Database (Denmark)

    Jørgensen, Poul Henrik; Handberg, Kurt; Ahrens, Peter

    1999-01-01

    The epidemiology of an outbreak of Newcastle disease in a population of approximately 12 000 free-living pheasants (Phasianus colchicus) on the island of Faeno in Denmark in 1996 is described. The mortality epizootic demonstrated over an observation period of 3 weeks. A total of 70 avian paramyxo...... to the pheasants by feral birds....

  20. Oropharyngeal Tularemia Outbreak Associated with Drinking Contaminated Tap Water, Turkey, July-September 2013.

    Science.gov (United States)

    Aktas, Dilber; Celebi, Bekir; Isik, Mehmet Emirhan; Tutus, Celal; Ozturk, Huseyin; Temel, Fehminaz; Kizilaslan, Mecit; Zhu, Bao-Ping

    2015-12-01

    In 2013, an oropharyngeal tularemia outbreak in Turkey affected 55 persons. Drinking tap water during the likely exposure period was significantly associated with illness (attack rate 27% vs. 11% among non-tap water drinkers). Findings showed the tap water source had been contaminated by surface water, and the chlorination device malfunctioned.

  1. Effects of a western spruce budworm outbreak on private lands in eastern Oregon, 1980-1994.

    Science.gov (United States)

    David L. Azuma; David L. Overhulser

    2008-01-01

    Forest Inventory and Analysis data from three inventory periods were used to examine the effects of a western spruce budworm outbreak on private lands in eastern Oregon. Growth was negatively related to defoliation with differences between crown ratio and species. The mortality and salvage harvesting caused changes in stand structure on private lands. Although many...

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

    Directory of Open Access Journals (Sweden)

    Boer Rob

    2006-05-01

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

  3. Direct radiative effects induced by intense desert dust outbreaks over the broader Mediterranean basin

    Science.gov (United States)

    Gkikas, Antonis; Obiso, Vincenzo; Vendrell, Lluis; Basart, Sara; Jorba, Oriol; Pérez Garcia-Pando, Carlos; Hatzianastassiou, Nikos; Gassó, Santiago; Baldasano, Jose Maria

    2016-04-01

    Throughout the year, under favorable conditions, massive loads of mineral particles originating in the northern African and Middle East deserts are transported over the Mediterranean basin. Due to their composition and size, dust aerosols perturb the Earth-Atmosphere system's energy budget interacting directly with the shortwave (SW) and longwave (LW) radiation. The present study aims to compute the Mediterranean dust outbreaks' direct radiative effects (DREs) as well as to assess the effect of including dust DREs in numerical simulations of a regional model. To this aim, 20 intense dust outbreaks have been selected based on their spatial coverage and intensity. Their identification, over the period 2000-2013, has been achieved through an objective and dynamic algorithm which utilizes as inputs daily satellite retrievals derived by the MODIS-Terra, EP-TOMS and OMI-Aura sensors. For each outbreak, two simulations of the NMMB/BSC-Dust model were made for a forecast period of 84 hours, with the model initialized at 00 UTC of the day when the dust outbreak was ignited, activating (RADON) and deactivating (RADOFF) dust-radiation interactions. The simulation domain covers the northern Africa, the Middle East and Europe at 0.25° x 0.25° horizontal resolution, for 40 hybrid sigma pressure levels up to 50 hPa. The instantaneous and regional DREs have been calculated at the top of the atmosphere (TOA), into the atmosphere (ATMAB), and at surface, for the downwelling (SURF) and the absorbed (NETSURF) radiation, for the SW, LW and NET (SW+LW) radiation. The interaction between dust aerosols and NET radiation, locally leads to an atmospheric warming (DREATMAB) by up to 150 Wm-2, a surface cooling (DRENETSURF) by up to 250 Wm-2 and a reduction of the downwelling radiation at the surface (DRESURF) by up to 300 Wm-2. At TOA, DREs are mainly negative (down to -150 Wm-2) indicating a cooling of the Earth-Atmosphere system, although positive values (up to 50 Wm-2) are encountered

  4. Rapid MALDI-TOF Mass Spectrometry Strain Typing during a Large Outbreak of Shiga-Toxigenic Escherichia coli

    Science.gov (United States)

    Christner, Martin; Trusch, Maria; Rohde, Holger; Kwiatkowski, Marcel; Schlüter, Hartmut; Wolters, Manuel; Aepfelbacher, Martin; Hentschke, Moritz

    2014-01-01

    Background In 2011 northern Germany experienced a large outbreak of Shiga-Toxigenic Escherichia coli O104:H4. The large amount of samples sent to microbiology laboratories for epidemiological assessment highlighted the importance of fast and inexpensive typing procedures. We have therefore evaluated the applicability of a MALDI-TOF mass spectrometry based strategy for outbreak strain identification. Methods Specific peaks in the outbreak strain’s spectrum were identified by comparative analysis of archived pre-outbreak spectra that had been acquired for routine species-level identification. Proteins underlying these discriminatory peaks were identified by liquid chromatography tandem mass spectrometry and validated against publicly available databases. The resulting typing scheme was evaluated against PCR genotyping with 294 E. coli isolates from clinical samples collected during the outbreak. Results Comparative spectrum analysis revealed two characteristic peaks at m/z 6711 and m/z 10883. The underlying proteins were found to be of low prevalence among genome sequenced E. coli strains. Marker peak detection correctly classified 292 of 293 study isolates, including all 104 outbreak isolates. Conclusions MALDI-TOF mass spectrometry allowed for reliable outbreak strain identification during a large outbreak of Shiga-Toxigenic E. coli. The applied typing strategy could probably be adapted to other typing tasks and might facilitate epidemiological surveys as part of the routine pathogen identification workflow. PMID:25003758

  5. Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control.

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    Matua, Gerald Amandu; Van der Wal, Dirk Mostert; Locsin, Rozzano C

    2015-01-01

    Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks. Copyright

  6. A Forest Tent Caterpillar Outbreak Increased Resource Levels and Seedling Growth in a Northern Hardwood Forest.

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    Danaë M A Rozendaal

    Full Text Available In closed-canopy forests, gap formation and closure are thought to be major drivers of forest dynamics. Crown defoliation by insects, however, may also influence understory resource levels and thus forest dynamics. We evaluate the effect of a forest tent caterpillar outbreak on understory light availability, soil nutrient levels and tree seedling height growth in six sites with contrasting levels of canopy defoliation in a hardwood forest in northern lower Michigan. We compared resource levels and seedling growth of six hardwood species before, during and in the three years after the outbreak (2008-2012. Canopy openness increased strongly during the forest tent caterpillar outbreak in the four moderately and severely defoliated sites, but not in lightly defoliated sites. Total inorganic soil nitrogen concentrations increased in response to the outbreak in moderately and severely defoliated sites. The increase in total inorganic soil nitrogen was driven by a strong increase in soil nitrate, and tended to become stronger with increasing site defoliation. Seedling height growth increased for all species in the moderately and severely defoliated sites, but not in lightly defoliated sites, either during the outbreak year or in the year after the outbreak. Growth increases did not become stronger with increasing site defoliation, but were strongest in a moderately defoliated site with high soil nutrient levels. Growth increases tended to be strongest for the shade intolerant species Fraxinus americana and Prunus serotina, and the shade tolerant species Ostrya virginiana. The strong growth response of F. americana and P. serotina suggests that recurring forest tent caterpillar outbreaks may facilitate the persistence of shade intolerant species in the understory in the absence of canopy gaps. Overall, our results suggest that recurrent canopy defoliation resulting from cyclical forest insect outbreaks may be an additional driver of dynamics in

  7. A Forest Tent Caterpillar Outbreak Increased Resource Levels and Seedling Growth in a Northern Hardwood Forest.

    Science.gov (United States)

    Rozendaal, Danaë M A; Kobe, Richard K

    2016-01-01

    In closed-canopy forests, gap formation and closure are thought to be major drivers of forest dynamics. Crown defoliation by insects, however, may also influence understory resource levels and thus forest dynamics. We evaluate the effect of a forest tent caterpillar outbreak on understory light availability, soil nutrient levels and tree seedling height growth in six sites with contrasting levels of canopy defoliation in a hardwood forest in northern lower Michigan. We compared resource levels and seedling growth of six hardwood species before, during and in the three years after the outbreak (2008-2012). Canopy openness increased strongly during the forest tent caterpillar outbreak in the four moderately and severely defoliated sites, but not in lightly defoliated sites. Total inorganic soil nitrogen concentrations increased in response to the outbreak in moderately and severely defoliated sites. The increase in total inorganic soil nitrogen was driven by a strong increase in soil nitrate, and tended to become stronger with increasing site defoliation. Seedling height growth increased for all species in the moderately and severely defoliated sites, but not in lightly defoliated sites, either during the outbreak year or in the year after the outbreak. Growth increases did not become stronger with increasing site defoliation, but were strongest in a moderately defoliated site with high soil nutrient levels. Growth increases tended to be strongest for the shade intolerant species Fraxinus americana and Prunus serotina, and the shade tolerant species Ostrya virginiana. The strong growth response of F. americana and P. serotina suggests that recurring forest tent caterpillar outbreaks may facilitate the persistence of shade intolerant species in the understory in the absence of canopy gaps. Overall, our results suggest that recurrent canopy defoliation resulting from cyclical forest insect outbreaks may be an additional driver of dynamics in temperate closed

  8. Lungworm outbreaks in adult dairy cows: estimating economic losses and lessons to be learned.

    Science.gov (United States)

    Holzhauer, M; van Schaik, G; Saatkamp, H W; Ploeger, H W

    2011-11-05

    Two lungworm outbreaks in dairy herds were investigated in order to estimate the resulting economic costs. On the two farms, with 110 and 95 cows, total costs were estimated at €159 and €167 per cow, respectively. Overall, milk production reduced by 15 to 20 per cent during the outbreaks. Five cows died on one farm, while on the other farm seven cows died as a result of the lungworm outbreak. On one farm, 51.7 per cent of the total costs was due to reduced milk production and 33.1 per cent was due to disposal of dead animals. On the other farm, it was 36.3 and 50.9 per cent, respectively. The remaining 13 to 15 per cent of the total costs were due to extra inseminations, laboratory diagnosis and treatments. The history and development of the outbreaks are described. One lesson from these outbreaks is that recognising that potentially lungworm-naïve animals are to be introduced into the adult herd allows for timely measures (for example, vaccination) to prevent a lungworm outbreak.

  9. Influenza outbreak during Sydney World Youth Day 2008: the utility of laboratory testing and case definitions on mass gathering outbreak containment.

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    Sebastiaan J van Hal

    Full Text Available BACKGROUND: Influenza causes annual epidemics and often results in extensive outbreaks in closed communities. To minimize transmission, a range of interventions have been suggested. For these to be effective, an accurate and timely diagnosis of influenza is required. This is confirmed by a positive laboratory test result in an individual whose symptoms are consistent with a predefined clinical case definition. However, the utility of these clinical case definitions and laboratory testing in mass gathering outbreaks remains unknown. METHODS AND RESULTS: An influenza outbreak was identified during World Youth Day 2008 in Sydney. From the data collected on pilgrims presenting to a single clinic, a Markov model was developed and validated against the actual epidemic curve. Simulations were performed to examine the utility of different clinical case definitions and laboratory testing strategies for containment of influenza outbreaks. Clinical case definitions were found to have the greatest impact on averting further cases with no added benefit when combined with any laboratory test. Although nucleic acid testing (NAT demonstrated higher utility than indirect immunofluorescence antigen or on-site point-of-care testing, this effect was lost when laboratory NAT turnaround times was included. The main benefit of laboratory confirmation was limited to identification of true influenza cases amenable to interventions such as antiviral therapy. CONCLUSIONS: Continuous re-evaluation of case definitions and laboratory testing strategies are essential for effective management of influenza outbreaks during mass gatherings.

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

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    Peng Hong-Juan

    2012-01-01

    Full Text Available Abstract Background Dengue, a mosquito-borne febrile viral disease, is found in tropical and sub-tropical regions around the world. Since the first occurrence of dengue was confirmed in Guangdong, China in 1978, dengue outbreaks have been reported sequentially in different provinces in South China transmitted by.peridomestic Ae. albopictus mosquitoes, diplaying Ae. aegypti, a fully domestic vector that transmits dengue worldwide. Rapid and uncontrolled urbanization is a characteristic change in developing countries, which impacts greatly on vector habitat, human lifestyle and transmission dynamics on dengue epidemics. In September 2010, an outbreak of dengue was detected in Dongguan, a city in Guangdong province characterized by its fast urbanization. An investigation was initiated to identify the cause, to describe the epidemical characteristics of the outbreak, and to implement control measures to stop the outbreak. This is the first report of dengue outbreak in Dongguan, even though dengue cases were documented before in this city. Methods Epidemiological data were obtained from local Center of Disease Control and prevention (CDC. Laboratory tests such as real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR, the virus cDNA sequencing, and Enzyme-Linked immunosorbent assay (ELISA were employed to identify the virus infection and molecular phylogenetic analysis was performed with MEGA5. The febrile cases were reported every day by the fever surveillance system. Vector control measures including insecticidal fogging and elimination of habitats of Ae. albopictus were used to control the dengue outbreak. Results The epidemiological studies results showed that this dengue outbreak was initiated by an imported case from Southeast Asia. The outbreak was characterized by 31 cases reported with an attack rate of 50.63 out of a population of 100,000. Ae. albopictus was the only vector species responsible for the outbreak. The virus c

  11. [Orion (Outbreak Reports and Intervention studies of Nosocomial Infection) used for evaluating interventions and investigations of nosocomial infection outbreaks].

    Science.gov (United States)

    Pires-Cronenberger, S; Nicolle, M-C; Voirin, N; Giard, M; Luxemburger, C; Vanhems, P

    2009-04-01

    British colleagues have developed the Outbreak Reports and Intervention studies of Nosocomial Infection (Orion) guidelines with the aim to promote transparency of publications in the field of health-care associated infections and particularly for reports of outbreak investigation or intervention studies. The aim of this study was to translate the Orion criteria and to promote their use in France. The Orion guidelines include a checklist of 22 commented items related to the title, abstract, introduction, methods, results, and discussion sections of a scientific article. Specific points for each item are developed to enhance its relevance. The use of Orion guidelines by authors and editors should be encouraged and should improve the quality of standards in research, intervention studies, and publications on nosocomial infections and health-care associated infections.

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

    Science.gov (United States)

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

    2015-05-01

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

  13. Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study

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    E. Franceschini

    2016-01-01

    Full Text Available Background. Visceral leishmaniasis (VL caused by Leishmania infantum is endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy between 2012 and 2015. Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital. Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50% and all the isolates were identified as L. infantum by ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6–131 days. All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%. Conclusions. VL due to L. infantum could determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.

  14. Foodborne outbreak of hepatitis A, November 2007-January 2008, Austria.

    Science.gov (United States)

    Schmid, D; Fretz, R; Buchner, G; König, C; Perner, H; Sollak, R; Tratter, A; Hell, M; Maass, M; Strasser, M; Allerberger, F

    2009-04-01

    An outbreak of hepatitis A affecting 21 residents of an Austrian city occurred from the end of November 2007 until mid-January 2008. A case series investigation suggested the consumption of food purchased from supermarket X as the common link. A food handler employed in the delicatessen department of that supermarket had been serologically diagnosed with hepatitis A on 28th November 2007. During the infectious period of approximately 3 weeks, he worked on 11 days. Interviews with the other cluster cases revealed that the hepatitis A virus (HAV)-infected food handler did not practice appropriate hand hygiene. The investigation revealed no other possible source of infection. We hypothesize that the food of the delicatessen department contaminated by the HAV-infected food handler during his infectious period was the source of the outbreak. The district public health authority recommended the reinforcement of hygiene precautions, i.e., access to viricidal hand disinfectant and the use of disposable gloves and single-use paper towels, in the involved supermarket. The federal ministry of health recommended HAV vaccination for all food handlers in food production and gastronomy companies; this recommendation was included in the Austrian national vaccination plan 2008, even though the vaccination of food handlers is costly and its cost-effectiveness is not proven. Appropriate and regular hand hygiene, particularly after toilet visits, is the most effective measure for preventing HAV transmission.

  15. Evolutionary history and phylogeography of rabies viruses associated with outbreaks in Trinidad.

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    Janine F R Seetahal

    Full Text Available Bat rabies is an emerging disease of public health significance in the Americas. The Caribbean island of Trinidad experiences periodic outbreaks within the livestock population. We performed molecular characterisation of Trinidad rabies virus (RABV and used a Bayesian phylogeographic approach to investigate the extent to which outbreaks are a result of in situ evolution versus importation of virus from the nearby South American mainland. Trinidadian RABV sequences were confirmed as bat variant and clustered with Desmodus rotundus (vampire bat related sequences. They fell into two largely temporally defined lineages designated Trinidad I and II. The Trinidad I lineage which included sequences from 1997-2000 (all but two of which were from the northeast of the island was most closely related to RABV from Ecuador (2005, 2007, French Guiana (1990 and Venezuela (1993, 1994. Trinidad II comprised sequences from the southwest of the island, which clustered into two groups: Trinidad IIa, which included one sequence each from 2000 and 2007, and Trinidad IIb including all 2010 sequences. The Trinidad II sequences were most closely related to sequences from Brazil (1999, 2004 and Uruguay (2007, 2008. Phylogeographic analyses support three separate RABV introductions from the mainland from which each of the three Trinidadian lineages arose. The estimated dates for the introductions and subsequent lineage expansions suggest periods of in situ evolution within Trinidad following each introduction. These data also indicate co-circulation of Trinidad lineage I and IIa during 2000. In light of these findings and the likely vampire bat origin of Trinidadian RABV, further studies should be conducted to investigate the relationship between RABV spatiotemporal dynamics and vampire bat population ecology, in particular any movement between the mainland and Trinidad.

  16. Evolutionary History and Phylogeography of Rabies Viruses Associated with Outbreaks in Trinidad

    Science.gov (United States)

    Seetahal, Janine F. R.; Velasco-Villa, Andres; Allicock, Orchid M.; Adesiyun, Abiodun A.; Bissessar, Joseph; Amour, Kirk; Phillip-Hosein, Annmarie; Marston, Denise A.; McElhinney, Lorraine M.; Shi, Mang; Wharwood, Cheryl-Ann; Fooks, Anthony R.; Carrington, Christine V. F.

    2013-01-01

    Bat rabies is an emerging disease of public health significance in the Americas. The Caribbean island of Trinidad experiences periodic outbreaks within the livestock population. We performed molecular characterisation of Trinidad rabies virus (RABV) and used a Bayesian phylogeographic approach to investigate the extent to which outbreaks are a result of in situ evolution versus importation of virus from the nearby South American mainland. Trinidadian RABV sequences were confirmed as bat variant and clustered with Desmodus rotundus (vampire bat) related sequences. They fell into two largely temporally defined lineages designated Trinidad I and II. The Trinidad I lineage which included sequences from 1997–2000 (all but two of which were from the northeast of the island) was most closely related to RABV from Ecuador (2005, 2007), French Guiana (1990) and Venezuela (1993, 1994). Trinidad II comprised sequences from the southwest of the island, which clustered into two groups: Trinidad IIa, which included one sequence each from 2000 and 2007, and Trinidad IIb including all 2010 sequences. The Trinidad II sequences were most closely related to sequences from Brazil (1999, 2004) and Uruguay (2007, 2008). Phylogeographic analyses support three separate RABV introductions from the mainland from which each of the three Trinidadian lineages arose. The estimated dates for the introductions and subsequent lineage expansions suggest periods of in situ evolution within Trinidad following each introduction. These data also indicate co-circulation of Trinidad lineage I and IIa during 2000. In light of these findings and the likely vampire bat origin of Trinidadian RABV, further studies should be conducted to investigate the relationship between RABV spatiotemporal dynamics and vampire bat population ecology, in particular any movement between the mainland and Trinidad. PMID:23991230

  17. [Hospital hygiene - outbreak management of nosocomial infections].

    Science.gov (United States)

    Kerwat, Klaus; Wulf, Hinnerk

    2012-04-01

    According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. On the other hand, the occurrence of an outbreak can also be recognized through the vigilance of all involved personnel and a general sensibilization towards this subject. The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute. © Georg Thieme Verlag Stuttgart · New York.

  18. Measles outbreak in adults: A changing epidemiological pattern

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    Swati Bajaj

    2017-01-01

    Full Text Available Background: Thirty-one cases of fever with rash were reported among students of a college in Pune, India, from March to May 2014. The clinical profile was similar to that of measles and 7 of them tested positive for measles-specific immunoglobulin M (IgM. An outbreak of measles was declared, and epidemiological investigation was carried out to assess the situation and suggest preventive measures. Methods: An epidemiological case sheet filled for each case to identify the source and likely contacts. Medical and administrative authorities were sensitized about the increase in incidence and clustering of cases. A surveillance system was set up for detection of new cases and follow-up of contacts. Throat swabs and blood samples from 12 cases were tested by ELISA method for commonly occurring viral exanthematous fevers to confirm the diagnosis and 7 were positive for measles-specific IgM antibody. Preventive measures were advised to control the outbreak. Results: A total of 31 cases of fever with rashes were reported among students of a college in Pune, India, during the months of March–May 2014. Most of the students were in the age group of 18–24 years. Samples from 12 cases were sent for testing and 7 tested positive for measles-specific IgM antibodies. Seven cases were epidemiologically linked to a lab-confirmed case. All cases had fever, maculopapular rash, and sore throat and gave a history of vaccination for measles in childhood. Conclusion: An epidemiological investigation was carried out for outbreak of measles in a young adult population of college students from Pune. It is reported that, with increase in overall coverage of vaccination, there is a rise in incidence of measles in vaccinated individuals. The age profile also shifts to higher age groups. Investigation of such outbreaks provides an opportunity to identify high-risk groups, changes in measles epidemiology and weaknesses in the routine immunization programs.

  19. Molecular epidemiology of human oral Chagas disease outbreaks in Colombia.

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    Juan David Ramírez

    Full Text Available BACKGROUND: Trypanosoma cruzi, the causative agent of Chagas disease, displays significant genetic variability revealed by six Discrete Typing Units (TcI-TcVI. In this pathology, oral transmission represents an emerging epidemiological scenario where different outbreaks associated to food/beverages consumption have been reported in Argentina, Bolivia, Brazil, Ecuador and Venezuela. In Colombia, six human oral outbreaks have been reported corroborating the importance of this transmission route. Molecular epidemiology of oral outbreaks is barely known observing the incrimination of TcI, TcII, TcIV and TcV genotypes. METHODOLOGY AND PRINCIPAL FINDINGS: High-throughput molecular characterization was conducted performing MLMT (Multilocus Microsatellite Typing and mtMLST (mitochondrial Multilocus Sequence Typing strategies on 50 clones from ten isolates. Results allowed observing the occurrence of TcI, TcIV and mixed infection of distinct TcI genotypes. Thus, a majority of specific mitochondrial haplotypes and allelic multilocus genotypes associated to the sylvatic cycle of transmission were detected in the dataset with the foreseen presence of mitochondrial haplotypes and allelic multilocus genotypes associated to the domestic cycle of transmission. CONCLUSIONS: These findings suggest the incrimination of sylvatic genotypes in the oral outbreaks occurred in Colombia. We observed patterns of super-infection and/or co-infection with a tailored association with the severe forms of myocarditis in the acute phase of the disease. The transmission dynamics of this infection route based on molecular epidemiology evidence was unraveled and the clinical and biological implications are discussed.

  20. Surveillance for waterborne disease and outbreaks associated with recreational water--United States, 2003-2004.

    Science.gov (United States)

    Dziuban, Eric J; Liang, Jennifer L; Craun, Gunther F; Hill, Vincent; Yu, Patricia A; Painter, John; Moore, Matthew R; Calderon, Rebecca L; Roy, Sharon L; Beach, Michael J

    2006-12-22

    Since 1971, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaboratively maintained the Waterborne Disease and Outbreak Surveillance System for collecting and reporting waterborne disease and outbreak (WBDO)-related data. In 1978, WBDOs associated with recreational water (natural and treated water) were added. This system is the primary source of data regarding the scope and effects of WBDOs in the United States. Data presented summarize WBDOs associated with recreational water that occurred during January 2003-December 2004 and one previously unreported outbreak from 2002. Public health departments in the states, territories, localities, and the Freely Associated States (i.e., the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau, formerly parts of the U.S.-administered Trust Territory of the Pacific Islands) have primary responsibility for detecting, investigating, and voluntarily reporting WBDOs to CDC. Although the surveillance system includes data for WBDOs associated with drinking water, recreational water, and water not intended for drinking, only cases and outbreaks associated with recreational water are summarized in this report. During 2003-2004, a total 62 WBDOs associated with recreational water were reported by 26 states and Guam. Illness occurred in 2,698 persons, resulting in 58 hospitalizations and one death. The median outbreak size was 14 persons (range: 1-617 persons). Of the 62 WBDOs, 30 (48.4%) were outbreaks of gastroenteritis that resulted from infectious agents, chemicals, or toxins; 13 (21.0%) were outbreaks of dermatitis; and seven (11.3%) were outbreaks of acute respiratory illness (ARI). The remaining 12 WBDOs resulted in primary amebic meningoencephalitis (n = one), meningitis (n = one), leptospirosis (n = one), otitis externa (n = one), and mixed illnesses (n = eight). WBDOs associated with gastroenteritis resulted in 1,945 (72

  1. Massive salp outbreaks in the inner sea of Chiloé Island (Southern Chile: possible causes and ecological consequences

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    Ricardo Giesecke

    2014-07-01

    Full Text Available During 2010 several massive salp outbreaks of the Subantarctic species Ihlea magalhanica were recorded in the inner sea of Chiloé Island (ISCh, Southern Chile, affecting both phytoplankton abundance and salmon farmers by causing high fish mortality. First outbreaks were recorded during February 2010 when Ihlea magalhanica reached up to 654,000 ind m-3 close to the net pens in Maillen Island and consecutive outbreaks could be followed during March and from October to November 2010. One month prior to the first recorded salp outbreak, the adjacent oceanic region and ISCh showed a sharp decline of ca. 1.0°C in sea surface temperature and an atypical pattern of oceanic sea surface currents, changing from a predominantly meridional (northward to a zonal (eastward direction, probably causing a massive Subantarctic Water parcel to enter the ISCh. During the outbreaks, surface chlorophyll concentration decreased from an historical mean of 13.8 to less than 4 mg Chl-a m-3, and did not return to normal conditions throughout the entire year, and similar results were also observed in phytoplankton abundance. The abundance of salp aggregations were highest close to the salmon net pens, which acted as physical barriers, and may have favored the successful reproduction and persistence of the outbreaks during 2010. The possible impact of these outbreaks on phytoplankton quality and quantity, as well as potential scenarios for the development of further outbreaks is discussed.

  2. Characterizing the transmission potential of zoonotic infections from minor outbreaks.

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    Adam J Kucharski

    2015-04-01

    Full Text Available The transmission potential of a novel infection depends on both the inherent transmissibility of a pathogen, and the level of susceptibility in the host population. However, distinguishing between these pathogen- and population-specific properties typically requires detailed serological studies, which are rarely available in the early stages of an outbreak. Using a simple transmission model that incorporates age-stratified social mixing patterns, we present a novel method for characterizing the transmission potential of subcritical infections, which have effective reproduction number R<1, from readily available data on the size of outbreaks. We show that the model can identify the extent to which outbreaks are driven by inherent pathogen transmissibility and pre-existing population immunity, and can generate unbiased estimates of the effective reproduction number. Applying the method to real-life infections, we obtained accurate estimates for the degree of age-specific immunity against monkeypox, influenza A(H5N1 and A(H7N9, and refined existing estimates of the reproduction number. Our results also suggest minimal pre-existing immunity to MERS-CoV in humans. The approach we describe can therefore provide crucial information about novel infections before serological surveys and other detailed analyses are available. The methods would also be applicable to data stratified by factors such as profession or location, which would make it possible to measure the transmission potential of emerging infections in a wide range of settings.

  3. Outbreak of chickenpox in a refugee camp of northern Thailand

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    Camélique Olivier

    2010-02-01

    Full Text Available Abstract Although chickenpox is a generally mild, self-limited illness of children, it can cause fatal disease in adults. Accumulating reports from tropical countries showed a high prevalence of seronegativity among the adults, implying that varicella diseases could become a heavy burden in tropical countries. However, in the situation of humanitarian emergencies in tropical areas, chickenpox has largely been ignored as a serious communicable disease, due to lack of data regarding varicella mortality and hospital admissions in such a context. This is the first report describing an outbreak of chickenpox in a refugee camp of tropical region. In 2008, we experienced a varicella outbreak in ethnic Lao Hmong refugee camp in Phetchabun Province, northern Thailand. The attack rate was 4.0% (309/7,815 and this caused 3 hospitalizations including one who developed severe varicella pneumonia with respiratory failure. All hospitalizations were exclusively seen in adults, and the proportion of patients ≥15 years old was 13.6% (42/309. Because less exposure to varicella-zoster virus due to low population density has previously been suggested to be one of the reasons behind higher prevalence of susceptible adults in tropics, the influx of displaced people from rural areas to a densely populated asylum might result in many severe adult cases once a varicella outbreak occurs. Control interventions such as vaccination should be considered even in refugee camp, if the confluence of the risk factors present in this situation.

  4. An outbreak of trichinellosis in a military unit

    Directory of Open Access Journals (Sweden)

    Radosavljević Vladan

    2008-01-01

    Full Text Available Background/Aim. In December 2001, an outbreak of trichinellosis spreaded in a military unit. The aim of this paper was to show possibilities and consequences of trichinellosis infestations in military units during peace time, as well as to improve knowledge and awareness of medical corps personnel, commanders and soldiers about this disease. Methods. A descriptive and analytical epidemiological models were used to find out a source of outbreak and to identify the ways of its transmission. Results. This outbreak was caused by the contaminated raw smoked sausage which had not undergone health inspection and brought from civilians to a military unit. Thirty-eight persons were exposed, twenty-one affected and hospitalized. The most frequent symptoms reported were fever (76.2%, myalgia (76.2%, palpebral edema (42.8%, face edema (19.0% and diarrhea (14.3%. Test for indirect immunofluorescence was positive in 14.3% and ELISA test was positive in 28.6% of the patients. Eosinophilia was present in 85.7% of the affected. IgE values were increased in 28.6% and CPK values were increased in 61.9% of the diseased. All of the 17 exposed undiseased had negative laboratory analyses for trichinellosis. Conclusion. We propose intensifying health education and continuing the implementation of duly supervised and evaluated self-check programs. A well-tuned, fast-reacting epidemiological monitoring system has to be obligatory.

  5. Avian Schistosomes and Outbreaks of Cercarial Dermatitis

    Science.gov (United States)

    Mikeš, Libor; Lichtenbergová, Lucie; Skála, Vladimír; Soldánová, Miroslava; Brant, Sara Vanessa

    2015-01-01

    SUMMARY Cercarial dermatitis (swimmer's itch) is a condition caused by infective larvae (cercariae) of a species-rich group of mammalian and avian schistosomes. Over the last decade, it has been reported in areas that previously had few or no cases of dermatitis and is thus considered an emerging disease. It is obvious that avian schistosomes are responsible for the majority of reported dermatitis outbreaks around the world, and thus they are the primary focus of this review. Although they infect humans, they do not mature and usually die in the skin. Experimental infections of avian schistosomes in mice show that in previously exposed hosts, there is a strong skin immune reaction that kills the schistosome. However, penetration of larvae into naive mice can result in temporary migration from the skin. This is of particular interest because the worms are able to migrate to different organs, for example, the lungs in the case of visceral schistosomes and the central nervous system in the case of nasal schistosomes. The risk of such migration and accompanying disorders needs to be clarified for humans and animals of interest (e.g., dogs). Herein we compiled the most comprehensive review of the diversity, immunology, and epidemiology of avian schistosomes causing cercarial dermatitis. PMID:25567226

  6. Comparative Analysis of Dengue and Zika Outbreaks Reveals Differences by Setting and Virus.

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    Sebastian Funk

    2016-12-01

    Full Text Available The pacific islands of Micronesia have experienced several outbreaks of mosquito-borne diseases over the past decade. In outbreaks on small islands, the susceptible population is usually well defined, and there is no co-circulation of pathogens. Because of this, analysing such outbreaks can be useful for understanding the transmission dynamics of the pathogens involved, and particularly so for yet understudied pathogens such as Zika virus. Here, we compared three outbreaks of dengue and Zika virus in two different island settings in Micronesia, the Yap Main Islands and Fais, using a mathematical model of transmission dynamics and making full use of commonalities in disease and setting between the outbreaks. We found that the estimated reproduction numbers for Zika and dengue were similar when considered in the same setting, but that, conversely, reproduction number for the same disease can vary considerably by setting. On the Yap Main Islands, we estimated a reproduction number of 8.0-16 (95% Credible Interval (CI for the dengue outbreak and 4.8-14 (95% CI for the Zika outbreak, whereas for the dengue outbreak on Fais our estimate was 28-102 (95% CI. We further found that the proportion of cases of Zika reported was smaller (95% CI 1.4%-1.9% than that of dengue (95% CI: 47%-61%. We confirmed these results in extensive sensitivity analysis. They suggest that models for dengue transmission can be useful for estimating the predicted dynamics of Zika transmission, but care must be taken when extrapolating findings from one setting to another.

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

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    Ghobad Moradi

    2016-05-01

    Full Text Available 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.

  8. Field assessment of a model tuberculosis outbreak response plan for low-incidence areas

    Directory of Open Access Journals (Sweden)

    Pascopella Lisa

    2007-10-01

    Full Text Available Abstract Background For a regional project in four low-incidence states, we designed a customizable tuberculosis outbreak response plan. Prior to dissemination of the plan, a tuberculosis outbreak occurred, presenting an opportunity to perform a field assessment of the plan. The purpose of the assessment was to ensure that the plan included essential elements to help public health professionals recognize and respond to outbreaks. Methods We designed a semi-structured questionnaire and interviewed all key stakeholders involved in the response. We used common themes to assess validity of and identify gaps in the plan. A subset of participants provided structured feedback on the plan. Results We interviewed 11 public health and six community stakeholders. The assessment demonstrated that (1 almost all of the main response activities were reflected in the plan; (2 the plan added value by providing a definition of a tuberculosis outbreak and guidelines for communication and evaluation. These were areas that lacked written protocols during the actual outbreak response; and (3 basic education about tuberculosis and the interpretation and use of genotyping data were important needs. Stakeholders also suggested adding to the plan questions for evaluation and a section for specific steps to take when an outbreak is suspected. Conclusion An interactive field assessment of a programmatic tool revealed the value of a systematic outbreak response plan with a standard definition of a tuberculosis outbreak, guidelines for communication and evaluation, and response steps. The assessment highlighted the importance of education and training for tuberculosis in low-incidence areas.

  9. Sources of calicivirus contamination in foodborne outbreaks, Denmark, 2005-2011 - the role of the asymptomatic food handler

    DEFF Research Database (Denmark)

    Franck, Kristina T.; Lisby, Morten; Fonager, Jannik

    2015-01-01

    Background. Norovirus is the predominant cause of foodborne disease outbreaks. Virus contamination may occur during all steps of food processing from production to preparation and serving. The relative importance of these different routes of contamination is unknown. Methods. The purpose...... of contamination. Results. In 64 (34%) of the outbreaks, contamination from food handlers took place during preparation or serving of food. In the majority of these outbreaks (n=41; 64%), the food handlers were asymptomatic during food handling. Some had been in contact with ill household members before handling...... the food and remained asymptomatic; others developed symptoms shortly after or were post-symptomatic. In 51 (27%) of the outbreaks, contamination occurred during production of the food and in 55 (29%) of the outbreaks, contamination had supposedly occurred after serving via a guest at a self-serving buffet...

  10. Reduced-Sodium Lunches Are Well-Accepted by Uninformed Consumers Over a 3-Week Period and Result in Decreased Daily Dietary Sodium Intakes: A Randomized Controlled Trial.

    Science.gov (United States)

    Janssen, Anke M; Kremer, Stefanie; van Stipriaan, Willeke L; Noort, Martijn W J; de Vries, Jeanne H M; Temme, Elisabeth H M

    2015-10-01

    Processed foods are major contributors to excessive sodium intake in Western populations. We investigated the effect of food reformulation on daily dietary sodium intake. To determine whether uninformed consumers accept reduced-sodium lunches and to determine the effect of consuming reduced-sodium lunches on 24-hour urinary sodium excretion. A single-blind randomized controlled pretest-posttest design with two parallel treatment groups was used. Participants chose foods in an experimental real-life canteen setting at the Restaurant of the Future in Wageningen, the Netherlands, from May 16 until July 1, 2011. After a run-in period with regular foods for both groups, the intervention group (n=36) consumed foods with 29% to 61% sodium reduction (some were partially flavor compensated). The control group (n=38) continued consuming regular foods. Outcomes for assessment of acceptance were the amount of foods consumed, energy and sodium intake, remembered food liking, and intensity of sensory aspects. Influence on daily dietary sodium intake was assessed by 24-hour urinary sodium excretion. Between and within-subject comparisons were assessed by analysis of covariance. Energy intake and amount consumed of each food category per lunch remained similar for both groups. Compared with the control group, the intervention group's sodium intake per lunch was significantly reduced by -1,093 mg (adjusted difference) (95% CI -1,285 to -901), equivalent to 43 mmol sodium. Remembered food liking, taste intensity, and saltiness were scored similarly for almost all of the reduced-sodium foods compared with the regular foods. After consuming reduced-sodium lunches, compared with the control group, intervention participants' 24-hour urinary sodium excretion was significantly lower by -40 mEq (adjusted difference) (95% CI -63 to -16) than after consuming regular lunches, and this reflects a decreased daily sodium intake of 1 g. Comparing the two treatment groups, consumption of reduced

  11. Ecologic Features of Plague Outbreak Areas, Democratic Republic of the Congo, 2004–2014

    Science.gov (United States)

    Shako, Jean-Christophe; Gaudart, Jean; Sudre, Bertrand; Ilunga, Benoit Kebela; Shamamba, Stomy Karhemere Bi; Diatta, Georges; Davoust, Bernard; Tamfum, Jean-Jacques Muyembe; Piarroux, Renaud; Piarroux, Martine

    2018-01-01

    During 2004–2014, the Democratic Republic of the Congo (DRC) declared 54% of plague cases worldwide. Using national data, we characterized the epidemiology of human plague in DRC for this period. All 4,630 suspected human plague cases and 349 deaths recorded in DRC came from Orientale Province. Pneumonic plague cases (8.8% of total) occurred during 2 major outbreaks in mining camps in the equatorial forest, and some limited outbreaks occurred in the Ituri highlands. Epidemics originated in 5 health zones clustered in Ituri, where sporadic bubonic cases were recorded throughout every year. Classification and regression tree characterized this cluster by the dominance of ecosystem 40 (mountain tropical climate). In conclusion, a small, stable, endemic focus of plague in the highlands of the Ituri tropical region persisted, acting as a source of outbreaks in DRC. PMID:29350136

  12. Onychomadesis outbreak in Valencia, Spain associated with hand, foot, and mouth disease caused by enteroviruses.

    Science.gov (United States)

    Davia, Javier López; Bel, Pablo Hernández; Ninet, Violeta Zaragoza; Bracho, María Alma; González-Candelas, Fernando; Salazar, Antonio; Gobernado, Miguel; Bosch, Isabel Febrer

    2011-01-01

    This report evaluates the June 2008 onychomadesis outbreak in Valencia, Spain. The study sample consisted of 221 onychomadesis cases and 77 nonaffected individuals who lived close to those affected. We collected data on dietary variables, hygiene products, and individual pathological histories. Feces and blood specimens were collected from 44 cases and 24 controls to evaluate exposure to infectious agents. Pathological background data revealed a high frequency (61%) of hand, foot, and mouth disease among the onychomadesis cases. Coxsackievirus A10 was the most commonly detected enterovirus in both case and control groups (49%). Other enteroviruses such as coxsackieviruses A5, A6, A16, B1, and B3; echoviruses 3, 4, and 9; and enterovirus 71 were present in low frequencies in the case and control groups (3-9%). The 2008 onychomadesis outbreak in the metropolitan area of Valencia was associated with an outbreak of hand, foot, and mouth disease primarily caused by coxsackievirus A10. © 2010 Wiley Periodicals, Inc.

  13. Ebola viral hemorrhagic disease outbreak in West Africa- lessons from Uganda.

    Science.gov (United States)

    Mbonye, Anthony K; Wamala, Joseph F; Nanyunja, Miriam; Opio, Alex; Makumbi, Issa; Aceng, Jane Ruth

    2014-09-01

    There has been a rapid spread of Ebola Viral Hemorrhagic disease in Guinea, Liberia and Sierra Leone since March 2014. Since this is the first time of a major Ebola outbreak in West Africa; it is possible there is lack of understanding of the epidemic in the communities, lack of experience among the health workers to manage the cases and limited capacities for rapid response. The main objective of this article is to share Uganda's experience in controlling similar Ebola outbreaks and to suggest some lessons that could inform the control of the Ebola outbreak in West Africa. The article is based on published papers, reports of previous Ebola outbreaks, response plans and experiences of individuals who have participated in the control of Ebola epidemics in Uganda. Lessons learnt: The success in the control of Ebola epidemics in Uganda has been due to high political support, effective coordination through national and district task forces. In addition there has been active surveillance, strong community mobilization using village health teams and other community resources persons, an efficient laboratory system that has capacity to provide timely results. These have coupled with effective case management and infection control and the involvement of development partners who commit resources with shared responsibility. Several factors have contributed to the successful quick containment of Ebola outbreaks in Uganda. West African countries experiencing Ebola outbreaks could draw some lessons from the Uganda experience and adapt them to contain the Ebola epidemic.

  14. Comparison of norovirus RNA levels in outbreak-related oysters with background environmental levels.

    Science.gov (United States)

    Lowther, James A; Gustar, Nicole E; Hartnell, Rachel E; Lees, David N

    2012-02-01

    Norovirus is the principal agent of bivalve shellfish-associated gastroenteric illness worldwide. Numerous studies using PCR have demonstrated norovirus contamination in a significant proportion of both oyster and other bivalve shellfish production areas and ready-to-eat products. By comparison, the number of epidemiologically confirmed shellfish-associated outbreaks is relatively low. This suggests that factors other than the simple presence or absence of virus RNA are important contributors to the amount of illness reported. This study compares norovirus RNA levels in oyster samples strongly linked to norovirus or norovirus-type illness with the levels typically found in commercial production areas (non-outbreak-related samples). A statistically significant difference between norovirus levels in the two sets of samples was observed. The geometric mean of the levels in outbreak samples (1,048 copies per g) was almost one order of magnitude higher than for positive non-outbreak-related samples (121 copies per g). Further, while none of the outbreak-related samples contained fewer than 152 copies per g, the majority of positive results for non-outbreak-related samples was below this level. These observations support the concept of a dose-response for norovirus RNA levels in shellfish and could help inform the establishment of threshold criteria for risk management.

  15. Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009-2011.

    Science.gov (United States)

    Horwood, Paul F; Karl, Stephan; Mueller, Ivo; Jonduo, Marinjho H; Pavlin, Boris I; Dagina, Rosheila; Ropa, Berry; Bieb, Sibauk; Rosewell, Alexander; Umezaki, Masahiro; Siba, Peter M; Greenhill, Andrew R

    2014-08-20

    Cholera continues to be a devastating disease in many developing countries where inadequate safe water supply and poor sanitation facilitate spread. From July 2009 until late 2011 Papua New Guinea experienced the first outbreak of cholera recorded in the country, resulting in >15,500 cases and >500 deaths. Using the national cholera database, we analysed the spatio-temporal distribution and clustering of the Papua New Guinea cholera outbreak. The Kulldorff space-time permutation scan statistic, contained in the software package SatScan v9.2 was used to describe the first 8 weeks of the outbreak in Morobe Province before cholera cases spread throughout other regions of the country. Data were aggregated at the provincial level to describe the spread of the disease to other affected provinces. Spatio-temporal and cluster analyses revealed that the outbreak was characterized by three distinct phases punctuated by explosive propagation of cases when the outbreak spread to a new region. The lack of road networks across most of Papua New Guinea is likely to have had a major influence on the slow spread of the disease during this outbreak. Identification of high risk areas and the likely mode of spread can guide government health authorities to formulate public health strategies to mitigate the spread of the disease through education campaigns, vaccination, increased surveillance in targeted areas and interventions to improve water, sanitation and hygiene.

  16. Spatial diffusion of influenza outbreak-related climate factors in Chiang Mai Province, Thailand.

    Science.gov (United States)

    Nakapan, Supachai; Tripathi, Nitin Kumar; Tipdecho, Taravudh; Souris, Marc

    2012-10-24

    Influenza is one of the most important leading causes of respiratory illness in the countries located in the tropical areas of South East Asia and Thailand. In this study the climate factors associated with influenza incidence in Chiang Mai Province, Northern Thailand, were investigated. Identification of factors responsible for influenza outbreaks and the mapping of potential risk areas in Chiang Mai are long overdue. This work examines the association between yearly climate patterns between 2001 and 2008 and influenza outbreaks in the Chiang Mai Province. The climatic factors included the amount of rainfall, percent of rainy days, relative humidity, maximum, minimum temperatures and temperature difference. The study develops a statistical analysis to quantitatively assess the relationship between climate and influenza outbreaks and then evaluate its suitability for predicting influenza outbreaks. A multiple linear regression technique was used to fit the statistical model. The Inverse Distance Weighted (IDW) interpolation and Geographic Information System (GIS) techniques were used in mapping the spatial diffusion of influenza risk zones. The results show that there is a significance correlation between influenza outbreaks and climate factors for the majority of the studied area. A statistical analysis was conducted to assess the validity of the model comparing model outputs and actual outbreaks.

  17. Spatial Diffusion of Influenza Outbreak-Related Climate Factors in Chiang Mai Province, Thailand

    Directory of Open Access Journals (Sweden)

    Marc Souris

    2012-10-01

    Full Text Available Influenza is one of the most important leading causes of respiratory illness in the countries located in the tropical areas of South East Asia and Thailand. In this study the climate factors associated with influenza incidence in Chiang Mai Province, Northern Thailand, were investigated. Identification of factors responsible for influenza outbreaks and the mapping of potential risk areas in Chiang Mai are long overdue. This work examines the association between yearly climate patterns between 2001 and 2008 and influenza outbreaks in the Chiang Mai Province. The climatic factors included the amount of rainfall, percent of rainy days, relative humidity, maximum, minimum temperatures and temperature difference. The study develops a statistical analysis to quantitatively assess the relationship between climate and influenza outbreaks and then evaluate its suitability for predicting influenza outbreaks. A multiple linear regression technique was used to fit the statistical model. The Inverse Distance Weighted (IDW interpolation and Geographic Information System (GIS techniques were used in mapping the spatial diffusion of influenza risk zones. The results show that there is a significance correlation between influenza outbreaks and climate factors for the majority of the studied area. A statistical analysis was conducted to assess the validity of the model comparing model outputs and actual outbreaks.

  18. Ponderosa pine mortality resulting from a mountain pine beetle outbreak

    Science.gov (United States)

    William F. McCambridge; Frank G. Hawksworth; Carleton B. Edminster; John G. Laut

    1982-01-01

    From 1965 to 1978, mountain pine beetles killed 25% of the pines taller than 4.5 feet in a study area in north-central Colorado. Average basal area was reduced from 92 to 58 square feet per acre. Mortality increased with tree diameter up to about 9 inches d.b.h. Larger trees appeared to be killed at random. Mortality was directly related to number of trees per acre and...

  19. Lethal canine distemper virus outbreak in cynomolgus monkeys in Japan in 2008.

    Science.gov (United States)

    Sakai, Kouji; Nagata, Noriyo; Ami, Yasushi; Seki, Fumio; Suzaki, Yuriko; Iwata-Yoshikawa, Naoko; Suzuki, Tadaki; Fukushi, Shuetsu; Mizutani, Tetsuya; Yoshikawa, Tomoki; Otsuki, Noriyuki; Kurane, Ichiro; Komase, Katsuhiro; Yamaguchi, Ryoji; Hasegawa, Hideki; Saijo, Masayuki; Takeda, Makoto; Morikawa, Shigeru

    2013-01-01

    Canine distemper virus (CDV) has recently expanded its host range to nonhuman primates. A large CDV outbreak occurred in rhesus monkeys at a breeding farm in Guangxi Province, China, in 2006, followed by another outbreak in rhesus monkeys at an animal center in Beijing in 2008. In 2008 in Japan, a CDV outbreak also occurred in cynomolgus monkeys imported from China. In that outbreak, 46 monkeys died from severe pneumonia during a quarantine period. A CDV strain (CYN07-dV) was isolated in Vero cells expressing dog signaling lymphocyte activation molecule (SLAM). Phylogenic analysis showed that CYN07-dV was closely related to the recent CDV outbreaks in China, suggesting continuing chains of CDV infection in monkeys. In vitro, CYN07-dV uses macaca SLAM and macaca nectin4 as receptors as efficiently as dog SLAM and dog nectin4, respectively. CYN07-dV showed high virulence in experimentally infected cynomolgus monkeys and excreted progeny viruses in oral fluid and feces. These data revealed that some of the CDV strains, like CYN07-dV, have the potential to cause acute systemic infection in monkeys.

  20. An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital.

    Science.gov (United States)

    Mali, Swapna; Dash, Lona; Gautam, Vikas; Shastri, Jayanthi; Kumar, Sunil

    2017-01-01

    Burkholderia cepacia complex (Bcc) has emerged as a serious nosocomial pathogen worldwide especially in patients with indwelling catheters and cystic fibrosis. Bcc is a common contaminant of pharmaceutical products. We describe an outbreak of Bcc bacteraemia amongst children admitted in Paediatric Intensive Care Unit (PICU) and paediatric ward at a tertiary care hospital, Mumbai, in Western India. Blood culture samples from paediatric patients yielded growth of non-fermenting, oxidase positive, motile, Gram negative bacilli (NFGNB) (76/909) over a period of 8 months. Based on conventional biochemical tests and antimicrobial susceptibility testing, these isolates were provisionally identified as Bcc. The increased, repeated and continued isolation of Bcc alerted the possibility of an outbreak confined to PICU and paediatric ward. Active surveillance was undertaken to trace the source and contain the outbreak. Isolates were subjected to recA polymerase chain reaction (PCR) and Expanded multilocus sequence typing (EMLST). Surveillance revealed the presence of Bcc on the upper surface of rubber stopper of sealed multidose amikacin vials. Isolates from blood culture and rubber stoppers were confirmed as Bcc by recA PCR. EMLST revealed that these isolates shared an identical novel sequence type 824 proving clonality. Timely interventions instituted led to control of the outbreak. This study highlights the importance of identification and molecular characterization of Bcc to establish its role in infection and outbreak.

  1. Management of rodent viral disease outbreaks: one institutions (r)evolution.

    Science.gov (United States)

    Smith, Abigail L

    2010-01-01

    At first blush, an outbreak of mouse hepatitis virus or epizootic diarrhea of infant mice virus in a research colony of laboratory mice may not seem like a disaster. However, irrespective of magnitude, such an outbreak at an academic institution is disruptive for researchers at all levels. It can be a disaster for the graduate student who may have just a few experiments to finish before writing the thesis or for the postdoctoral fellow who is in the lab for only 1 or 2 years. Infectious disease outbreaks also limit the ability of principal investigators to share their animals with collaborators at their home institution as well as with those at extramural sites, thereby thwarting the expectation that research materials supported by federal funds will be made readily available to colleagues. This article traces the evolution of a change in culture at a large, well-funded academic institution with over 1,800 active IACUC protocols, more than 1,000 of which include mice. During a period of less than 5 years, the institution evolved from virtual paralysis in the face of such outbreaks to the implementation of policies and practices that enable effective outbreak management and the timely resumption of research functionality. This evolution required not only support from the highest levels of leadership in the university and its school of medicine but also a huge outlay of financial resources.

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

    Science.gov (United States)

    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.

  3. Landscape Epidemiology of Tularemia Outbreaks in Sweden

    Science.gov (United States)

    Svensson, Kerstin; Bäck, Erik; Eliasson, Henrik; Berglund, Lennart; Granberg, Malin; Karlsson, Linda; Larsson, Pär; Forsman, Mats

    2009-01-01

    Summer outbreaks of tularemia that occurred from 1995 through 2005 in 2 locations in Sweden affected 441 persons. We performed an epidemiologic investigation of these outbreaks using a novel strategy, involving high-resolution genotyping of Francisella tularensis isolates obtained from 136 patients (using 18 genetic markers developed from 6 F. tularensis genome sequences) and interviews with the patients. Strong spatial associations were found between F. tularensis subpopulations and the places of disease transmission; infection by some subpopulations occurred within areas as small as 2 km2, indicating unidentified environmental point sources of tularemia. In both locations, disease clusters were associated with recreational areas beside water, and genetic subpopulations were present throughout the tularemia season and persisted over years. High-resolution genotyping in combination with patients’ statements about geographic places of disease transmission provided valuable indications of likely sources of infection and the causal genotypes during these tularemia outbreaks. PMID:19961673

  4. Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period.

    Science.gov (United States)

    Casella, Donato; Calabrese, Claudio; Orzalesi, Lorenzo; Gaggelli, Ilaria; Cecconi, Lorenzo; Santi, Caterina; Murgo, Roberto; Rinaldi, Stefano; Regolo, Lea; Amanti, Claudio; Roncella, Manuela; Serra, Margherita; Meneghini, Graziano; Bortolini, Massimiliano; Altomare, Vittorio; Cabula, Carlo; Catalano, Francesca; Cirilli, Alfredo; Caruso, Francesco; Lazzaretti, Maria Grazia; Meattini, Icro; Livi, Lorenzo; Cataliotti, Luigi; Bernini, Marco

    2017-05-01

    Reconstruction options following nipple-sparing mastectomy (NSM) are diverse and not yet investigated with level IA evidence. The analysis of surgical and oncological outcomes of NSM from the Italian National Registry shows its safety and wide acceptance both for prophylactic and therapeutic cases. A further in-depth analysis of the reconstructive approaches with their trend over time and their failures is the aim of this study. Data extraction from the National Database was performed restricting cases to the 2009-2014 period. Different reconstruction procedures were analyzed in terms of their distribution over time and with respect to specific indications. A 1-year minimum follow-up was conducted to assess reconstructive unsuccessful events. Univariate and multivariate analyses were performed to investigate the causes of both prosthetic and autologous failures. 913 patients, for a total of 1006 procedures, are included in the analysis. A prosthetic only reconstruction is accomplished in 92.2 % of cases, while pure autologous tissues are employed in 4.2 % and a hybrid (prosthetic plus autologous) in 3.6 %. Direct-to-implant (DTI) reaches 48.7 % of all reconstructions in the year 2014. Prophylactic NSMs have a DTI reconstruction in 35.6 % of cases and an autologous tissue flap in 12.9 % of cases. Failures are 2.7 % overall: 0 % in pure autologous flaps and 9.1 % in hybrid cases. Significant risk factors for failures are diabetes and the previous radiation therapy on the operated breast. Reconstruction following NSM is mostly prosthetic in Italy, with DTI gaining large acceptance over time. Failures are low and occurring in diabetic and irradiated patients at the multivariate analysis.

  5. The Influence of Large-Scale Circulation on Fire Outbreaks in the Amazon Region

    Science.gov (United States)

    Pires, L. B. M.; Romao, M.; Freitas, A. C. V.

    2017-12-01

    The combination of alterations in land use cover and severe droughts may dramatically increase fire outbreaks. Tropical convection in the Amazon Basin is regulated mainly by large-scale atmospheric systems such as the Walker circulation. Many of the documented drought episodes in the Amazon occurred during intense El Niño events such as those recorded in 1926, 1983, 1997-1998, and 2010. However, not all El Niño events are related to drought in the Amazon. Recent studies have also pointed out the importance of the tropical Atlantic Ocean in the modulation of the Amazonian climate, as observed during the drought episodes in 2005 and 2010. This work investigates the fire outbreak tendency in the Amazon region, and the influence of large-scale circulation on these events. Data from the Fire Program of the Center for Weather Forecasting and Climate Studies (CPTEC/INPE) show a substantial increase in the number of fire outbreaks in the last few years, especially during 2016. However, in the 2017 year a sharp drop in fire outbreaks reaching levels similar to the years prior to 2016 is being noted, already showing a reduction of 54% in relation to the preceding 2016 year. The 2015-2016 period was marked by one of the strongest El Niño in history. This was reflected in the increase of the number of fire outbreaks due to the increase of the drought and temperature elevation period. On the other hand, the 2017 year is being characterized by a condition of neutrality in relation to the El Niño-Southern Oscillation (ENSO) phenomena, and have overall presented positive sea surface temperature (SST) anomalies in the tropical Atlantic. Variations of these systems and their relation to fire outbreaks is demonstrated.

  6. Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

    Directory of Open Access Journals (Sweden)

    Julia Harrington

    2013-01-01

    Full Text Available Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans.

  7. An Enhanced Satellite-Based Algorithm for Detecting and Tracking Dust Outbreaks by Means of SEVIRI Data

    Directory of Open Access Journals (Sweden)

    Francesco Marchese

    2017-05-01

    Full Text Available Dust outbreaks are meteorological phenomena of great interest for scientists and authorities (because of their impact on the climate, environment, and human activities, which may be detected, monitored, and characterized from space using different methods and procedures. Among the recent dust detection algorithms, the RSTDUST multi-temporal technique has provided good results in different geographic areas (e.g., Mediterranean basin; Arabian Peninsula, exhibiting a better performance than traditional split window methods, in spite of some limitations. In this study, we present an optimized configuration of this technique, which better exploits data provided by Spinning Enhanced Visible and Infrared Imager (SEVIRI aboard Meteosat Second Generation (MSG satellites to address those issues (e.g., sensitivity reduction over arid and semi-arid regions; dependence on some meteorological clouds. Three massive dust events affecting Europe and the Mediterranean basin in May 2008/2010 are analysed in this work, using information provided by some independent and well-established aerosol products to assess the achieved results. The study shows that the proposed algorithm, christened eRSTDUST (i.e., enhanced RSTDUST, which provides qualitative information about dust outbreaks, is capable of increasing the trade-off between reliability and sensitivity. The results encourage further experimentations of this method in other periods of the year, also exploiting data provided by different satellite sensors, for better evaluating the advantages arising from the use of this dust detection technique in operational scenarios.

  8. Coronary heart disease among adult population evacuated from the 30-km zone of the Chernobyl NPP (Descriptive epidemiologic research results. Observation period 1988-2012

    Directory of Open Access Journals (Sweden)

    Olga A. Kapustynskaia

    2015-02-01

    determination and analyses of the dynamics of the evacuated adults sickness rate of the coronary heart disease also including its particular types including of age at the time of the accident sex and from the moment of the accident. The materials of the Ukrainian public register of people who suffered from the Chernobyl accident (UPR and the statistical data of the Ministry of Healthcare about the sickness of the Ukrainian population are used in the article. Subject of inquiry: adult population at the time of the accident avacuated from the 30-km Zone of the Chernobyl APP. Object of research - Coronary heart disease. The research was made on the coronary heart disease in whole and also due to nosological forms: angina pectoris; cardiac infarction; chronic coronary heart disease. Descriptive epidemiologic research was made for the period of 1988-2010 years. The cohort of adult avacuated population constituted 55022 people, 22056 men and 32966 women off them. For the comparison the statistic data about the sickness of adult population of Ukraine were used. In the article was also used the method of inner comparison, which allows to evaluate the credibility of the sickness rate figures difference for the periods of observation. The analisys is carried through following five periods (1988-1992 years, 1993-1997 years, 1998-2002 years, 2003-2008 years, 2009-2010 years. In accordance with the 24-years medical observation was determined that the coronary heart disease incidence of the adult evacuated population has significant differences due to age, sex and time. The increase in the coronary heart disease incidence regardless age at the moment of the accident is to be considered for the period of 12-22 years. The peak of the sickness for those, who were 40-60 at the time of the accident, was registered for the third period of observation, i. e. after 12-16 years from the moment of the accident at the Chernobyl NPP, for those, evacuated at the age of 18-39 – after 17-22 years and

  9. Use of the Ishikawa diagram in a case-control analysis to assess the causes of a diffuse lamellar keratitis outbreak

    Directory of Open Access Journals (Sweden)

    Luis Henrique Lira

    Full Text Available ABSTRACT Purpose: To identify the causes of a diffuse lamellar keratitis (DLK outbreak using a systematic search tool in a case-control analysis. Methods: An Ishikawa diagram was used to guide physicians to determine the potential risk factors involved in this outbreak. Coherence between the occurrences and each possible cause listed in the diagram was verified, and the total number of eyes at risk was used to calculate the proportion of affected eyes. Multivariate analysis was performed using logistic regression to determine the independent effect of the risk factors, after controlling for confounders and test interactions. Results: All DLK cases were reported in 2007 between June 13 and December 21; during this period, 3,698 procedures were performed. Of the 1,682 flap-related procedures, 204 eyes of 141 individuals presented with DLK. No direct relationship was observed between the occurrence of DLK and the presence of any specific factors; however, flap-lifting enhancements, procedures performed during the morning shift, and non-use of therapeutic contact lenses after the surgery were significantly related to higher occurrence percentages of this condition. Conclusions: The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.

  10. Altered environment and risk of malaria outbreak in South Andaman, Andaman & Nicobar Islands, India affected by tsunami disaster

    Directory of Open Access Journals (Sweden)

    Shriram AN

    2005-07-01

    Full Text Available Abstract Background Pools of salt water and puddles created by giant waves from the sea due to the tsunami that occurred on 26th December 2004 would facilitate increased breeding of brackish water malaria vector, Anopheles sundaicus. Land uplifts in North Andaman and subsidence in South Andaman have been reported and subsidence may lead to environmental disturbances and vector proliferation. This warrants a situation analysis and vector surveillance in the tsunami hit areas endemic for malaria transmitted by brackish water mosquito, An. sundaicus to predict the risk of outbreak. Methods An extensive survey was carried out in the tsunami-affected areas in Andaman district of the Andaman and Nicobar Islands, India to assess the extent of breeding of malaria vectors in the habitats created by seawater flooding. Types of habitats in relation to source of seawater inundation and frequency were identified. The salinity of the water samples and the mosquito species present in the larval samples collected from these habitats were recorded. The malaria situation in the area was also analysed. Results South Andaman, covering Port Blair and Ferrargunj sub districts, is still under the recurring phenomenon of seawater intrusion either directly from the sea or through a network of creeks. Both daily cycles of high tides and periodical spring tides continue to cause flooding. Low-lying paddy fields and fallow land, with a salinity ranging from 3,000 to 42,505 ppm, were found to support profuse breeding of An. sundaicus, the local malaria vector, and Anopheles subpictus, a vector implicated elsewhere. This area is endemic for both vivax and falciparum malaria. Malaria slide positivity rate has started increasing during post-tsunami period, which can be considered as an indication of risk of malaria outbreak. Conclusion Paddy fields and fallow land with freshwater, hitherto not considered as potential sites for An. sundaicus, are now major breeding sites due to

  11. Molecular typing and whole genome next generation sequencing of human adenovirus 8 strains recovered from four 2012 outbreaks of keratoconjunctivitis in New York State.

    Science.gov (United States)

    Lamson Bs, Daryl M; Kajon, Adriana E; Shudt, Matthew; Quinn, Monica; Newman, Alexandra; Whitehouse, Joan; Greenko, Jane; Adams, Eleanor; St George, Kirsten

    2018-05-11

    Ocular infections caused by human adenovirus (HAdV) are highly contagious. The most severe are usually caused by members of species HAdV-D (types HAdV8, 19, 37, 53, 54, and 56) and can manifest as epidemic keratoconjunctivitis (EKC), often resulting in prolonged impairment of vision. During the early months of 2012, EKC outbreaks occurred in neonatal intensive care units (NICUs) in 3 hospitals in New York State (New York and Suffolk Counties). A total of 32 neonates were affected. For 14 of them, HAdV8 was laboratory-confirmed as the causative agent. Nine healthcare workers were also affected with 3 laboratory-confirmed, HAdV-positive EKC. A fourth EKC outbreak was documented among patients attending a private ophthalmology practice in Ulster County involving a total of 35 cases. Epidemiological linkage between the neonatal intensive care unit outbreaks was demonstrated by molecular typing of virus isolates with restriction enzyme analysis and next generation whole genome sequencing. The strain isolated from the ophthalmology clinic was easily distinguishable from the others by restriction enzyme analysis. © 2018 Wiley Periodicals, Inc.

  12. Incomplete sanitation of a meat grinder and ingestion of raw ground beef: contributing factors to a large outbreak of Salmonella typhimurium infection.

    Science.gov (United States)

    Roels, T H; Frazak, P A; Kazmierczak, J J; Mackenzie, W R; Proctor, M E; Kurzynski, T A; Davis, J P

    1997-10-01

    Consumers in the United States continue to eat raw or undercooked foods of animal origin despite public health warnings following several well-publicized outbreaks. We investigated an outbreak of Salmonella serotype Typhimurium infection in 158 patients in Wisconsin during the 1994 Christmas holiday period. To determine the vehicle and source of the outbreak, we conducted cohort and case-control studies, and environmental investigations in butcher shop A. Eating raw ground beef purchased from butcher shop A was the only item significantly associated with illness [cohort study: relative risk = 5.8, 95% confidence interval (CI) = 1.5-21.8; case control study: odds ratio = 46.2, 95% CI = 3.8-2751]. Inadequate cleaning and sanitization of the meat grinder in butcher shop A likely resulted in sustained contamination of ground beef during an 8-day interval. Consumer education, coupled with hazard reduction efforts at multiple stages in the food processing chain, will continue to play an important role in the control of foodborne illness.

  13. The effect of school dismissal on rates of influenza-like illness in New York City schools during the spring 2009 novel H1N1 outbreak.

    Science.gov (United States)

    Egger, Joseph R; Konty, Kevin J; Wilson, Elisha; Karpati, Adam; Matte, Thomas; Weiss, Don; Barbot, Oxiris

    2012-03-01

    The effects of individual school dismissal on influenza transmission have not been well studied. During the spring 2009 novel H1N1 outbreak, New York City implemented an individual school dismissal policy intended to limit influenza transmission at schools with high rates of influenza-like illness (ILI). Active disease surveillance data collected by the New York City Health Department on rates of ILI in schools were used to evaluate the impact. Sixty-four schools that met the Health Department's criteria for considering dismissal were included in the analysis. Twenty-four schools that met criteria subsequently dismissed all classes for approximately 1 school week. A regression model was fit to these data, estimating the effect of school dismissal on rates of in-school ILI following reconvening, adjusting for potential confounders. The model estimated that, on average, school dismissal reduced the rate of ILI by 7.1% over the entire average outbreak period. However, a large proportion of in-school ILI occurred before dismissal criteria were met. A separate model estimated that school absenteeism rates were not significantly affected by dismissal. Results suggest that individual school dismissal could be considered in situations where schools have a disproportionate number of high-risk students or may be unable to implement recommended preventive or infection control measures. Future work should focus on developing more sensitive indicators of early outbreak detection in schools and evaluating the impact of school dismissal on community transmission. © 2012, American School Health Association.

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

    Science.gov (United States)

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

    2014-01-01

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

  15. Analysis of epidemiological data of foodborne outbreak reported in Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Soltan Dallal

    2015-02-01

    Conclusion: The knowledge of bacterial agent of foodborne diseases and determination of antimicrobial resistance pattern are helpful to reduce the rate of foodborne outbreaks, the cost of treatment. The prevention control of outbreaks is also very important.

  16. Key transmission parameters of an institutional outbreak during the 1918 influenza pandemic estimated by mathematical modelling

    Directory of Open Access Journals (Sweden)

    Nelson Peter

    2006-11-01

    Full Text Available Abstract Aim To estimate the key transmission parameters associated with an outbreak of pandemic influenza in an institutional setting (New Zealand 1918. Methods Historical morbidity and mortality data were obtained from the report of the medical officer for a large military camp. A susceptible-exposed-infectious-recovered epidemiological model was solved numerically to find a range of best-fit estimates for key epidemic parameters and an incidence curve. Mortality data were subsequently modelled by performing a convolution of incidence distribution with a best-fit incidence-mortality lag distribution. Results Basic reproduction number (R0 values for three possible scenarios ranged between 1.3, and 3.1, and corresponding average latent period and infectious period estimates ranged between 0.7 and 1.3 days, and 0.2 and 0.3 days respectively. The mean and median best-estimate incidence-mortality lag periods were 6.9 and 6.6 days respectively. This delay is consistent with secondary bacterial pneumonia being a relatively important cause of death in this predominantly young male population. Conclusion These R0 estimates are broadly consistent with others made for the 1918 influenza pandemic and are not particularly large relative to some other infectious diseases. This finding suggests that if a novel influenza strain of similar virulence emerged then it could potentially be controlled through the prompt use of major public health measures.

  17. Global reaction to the recent outbreaks of Zika virus: Insights from a Big Data analysis

    Science.gov (United States)

    Trucchi, Cecilia; Paganino, Chiara; Barberis, Ilaria; Martini, Mariano; Sticchi, Laura; Trinka, Eugen; Brigo, Francesco; Ansaldi, Filippo; Icardi, Giancarlo; Orsi, Andrea

    2017-01-01

    Objective The recent spreading of Zika virus represents an emerging global health threat. As such, it is attracting public interest worldwide, generating a great amount of related Internet searches and social media interactions. The aim of this research was to understand Zika-related digital behavior throughout the epidemic spreading and to assess its consistence with real-world epidemiological data, using a behavioral informatics and analytics approach. Methods In this study, the global web-interest and reaction to the recently occurred outbreaks of the Zika Virus were analyzed in terms of tweets and Google Trends (GT), Google News, YouTube, and Wikipedia search queries. These data streams were mined from 1st January 2004 to 31st October 2016, with a focus on the period November 2015—October 2016. This analysis was complemented with the use of epidemiological data. Spearman’s correlation was performed to correlate all Zika-related data. Moreover, a multivariate regression was performed using Zika-related search queries as a dependent variable, and epidemiological data, number of inhabitants in 2015 and Human Development Index as predictor variables. Results Overall 3,864,395 tweets, 284,903 accesses to Wikipedia pages dedicated to the Zika virus were analyzed during the study period. All web-data sources showed that the main spike of researches and interactions occurred in February 2016 with a second peak in August 2016. All novel data streams-related activities increased markedly during the epidemic period with respect to pre-epidemic period when no web activity was detected. Correlations between data from all these web platforms resulted very high and statistically significant. The countries in which web searches were particularly concentrated are mainly from Central and South Americas. The majority of queries concerned the symptoms of the Zika virus, its vector of transmission, and its possible effect to babies, including microcephaly. No statistically

  18. International employees' concerns during serious disease outbreaks and the potential impact on business continuity: Lessons identified from the 2014-15 West African Ebola outbreak.

    Science.gov (United States)

    Cole, Jennifer; Watkins, Chris

    This paper presents the findings of research carried out into the information-seeking behaviour, and information requirements of a small sample of international workers stationed in West Africa during the Zaire Ebola virus outbreak of 2014-15. The research study under which these results were obtained was part of exploratory research for a PhD focused on the use, and potential uses, of social media platforms during serious disease outbreaks that might be used to inform policy planning for public health and emergency response interventions. Thus, the findings from this study may provide valuable insights to business continuity managers and emergency planners in making future decisions about information exchange and crisis decision-making during future serious disease outbreaks.

  19. Treatment, therapy results and survival for non-small cell lung cancer in a period of new therapeutic modalities and cytotoxic substances

    International Nuclear Information System (INIS)

    Treff, J.

    2002-09-01

    During the last years considerable changes have been made in the treatment of non-small cell lung cancer. This retrospective study analyzed besides the common characteristics the treatment, response rates and overall survival of patients with non-small cell lung cancer in a central internistical and oncological outpatient department. 328 patients treated at the haematology-oncology outpatient department were included in this study. Requirements have been patients with histologically or cytologically verified non-small cell lung cancer, diagnosis between 1989 and 2001 and comprehensible courses of disease and treatment. Results: Most of the patients were men (72 %) and only 28 % were women. Median age at diagnosis was 61 years; 8.8 % of the patients were aged under 45 years. Adenocarcinoma (46 %) and squamous cell carcinoma (36 %) were the most frequent histologic types. At time of diagnosis 68 % of the patients have been in an already advanced stage IIIB or IV. Surprisingly the diagnosis resulted for 25 % of the patients by chance, 75 % of the patients were diagnosed due to symptoms. Only 8 % of the patients did not receive a specific therapy (surgery, radiation therapy, chemotherapy) due to their advanced disease. 21 patients were treated in a neoadjuvant setting and for 10 (48 %) surgery with curative intention could be performed. The most frequently given chemotherapy in the first-line palliative therapy were Cis-, Carboplatin/VP 16 (40 %) and Cis-, Carboplatin/Navelbine (27 %). The response rate was poor - six complete responses (2.5 %) and 34 (14.3 %) partial responses. 107 patients received a second-line chemotherapy. The overall median survival of all patients was 13.5 months. The stage at time of diagnosis was the most important prognostic factor. Interestingly enough also a survival benefit for women could be demonstrated (15.5 months vs. 13 months). The common characteristics of the analyzed patients correspond to the typical collective of patients in a

  20. Identification of suitable areas for the occurrence of Rift Valley fever outbreaks in Spain using a multiple criteria decision framework.

    Science.gov (United States)

    Sánchez-Vizcaíno, Fernando; Martínez-López, Beatriz; Sánchez-Vizcaíno, José Manuel

    2013-07-26

    Rift Valley fever (RVF) is a mosquito-borne viral disease that may produce a considerable impact on the economy in affected countries. In the last decades, the geographic distribution of RVF virus has increased including most of the countries in Africa, Arabia Saudi and Yemen. This situation has raised the concerns regarding its potential introduction in the European Union (EU) countries where the high number of susceptible species and competent vectors may contribute to the spread of the disease and challenge its rapid control. Thus, the identification of the areas and time periods with highest suitability for RVF outbreak occurrence would be useful for improving the early detection and rapid response of the disease into free countries. The objective of this study was to identify suitable areas for the occurrence of RVF outbreaks in Spain using a multiple criteria decision making model based on weighted linear combination of factors in geographical information systems (GIS). To the best of the author's knowledge this is the first comprehensive GIS-based framework that provides risk maps for RVF suitability in an EU country. Spanish zones with the highest suitability for RVF were concentrated in the regions of Extremadura, south-western Castile and Leon, eastern Galicia, Asturias, Cantabria, Basque Country, northern-central and southern region of Andalusia and in the Balearic Islands. October and May were the most suitable months for RVF outbreak occurrence. Methods and results presented here may be useful to target risk-based surveillance strategies and to more cost-effectively control potential RVFV incursions into Spain. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. Extrapolation of short term observations to time periods relevant to the isolation of long lived radioactive waste. Results of a co-ordinated research project 1995-2000

    International Nuclear Information System (INIS)

    2000-09-01

    This report addresses safety analysis of the whole repository life-cycle that may require long term performance assessment of its components and evaluation of potential impacts of the facility on the environment. Generic consideration of procedures for the development of predictive tools are completed by detailed characterization of selected principles and methods that were applied and presented within the co-ordinated research project (CRP). The project focused on different approaches to extrapolation, considering radionuclide migration/sorption, physical, geochemical and geotechnical characteristics of engineered barriers, irradiated rock and backfill performance, and on corrosion of metallic and vitreous materials. This document contains a comprehensive discussion of the overall problem and the practical results of the individual projects preformed within the CRP. Each of the papers on the individual projects has been indexed separately

  2. How do long-term development and periodical changes of river-floodplain systems affect the fate of contaminants? Results from European rivers

    International Nuclear Information System (INIS)

    Lair, G.J.; Zehetner, F.; Fiebig, M.; Gerzabek, M.H.; Gestel, C.A.M. van; Hein, T.; Hohensinner, S.; Hsu, P.; Jones, K.C.; Jordan, G.; Koelmans, A.A.

    2009-01-01

    In many densely populated areas, riverine floodplains have been strongly impacted and degraded by river channelization and flood protection dikes. Floodplains act as buffers for flood water and as filters for nutrients and pollutants carried with river water and sediment from upstream source areas. Based on results of the EU-funded 'AquaTerra' project (2004-2009), we analyze changes in the dynamics of European river-floodplain systems over different temporal scales and assess their effects on contaminant behaviour and ecosystem functioning. We find that human-induced changes in the hydrologic regime of rivers have direct and severe consequences on nutrient cycling and contaminant retention in adjacent floodplains. We point out the complex interactions of contaminants with nutrient availability and other physico-chemical characteristics (pH, organic matter) in determining ecotoxicity and habitat quality, and draw conclusions for improved floodplain management. - Human activities have changed the hydraulics and contaminant fate in river-floodplain ecosystems.

  3. Improvement of quality service in Uruguay - plans developed and its results in the period 93-95. Fault statistic as a parameter of measurement

    Energy Technology Data Exchange (ETDEWEB)

    Carrasco, J.; Rodriguez, R.; Rondoni, A.; Pardo, A. [U.T.E. (Uruguay)

    1997-12-31

    The present paper aims to describe the improvement process of the quality of the product and the technical service that has been undertaken in UTE since 1990 and to show the results obtained so far as well as the actions foreseen in the future. In addition the system for the quality control is developed. It is structured based on global and individual indexes supported by the corporate centralised and distributed informatic tools that the company possess. This control system has allowed us to carry out a pursuit of the relative evolution of the quality year to year and to establish absolute comparisons with companies from the region and from Europe. The current situation and the improvements for Montevideo, are described. (author)

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

    Science.gov (United States)

    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.

  5. Cholera outbreak in districts around Lake Chilwa, Malawi: Lessons ...

    African Journals Online (AJOL)

    Cholera is endemic in Malawi with seasonal outbreaks during the wet season. People living around Lake Chilwa rely on the lake for their water supply. From May 2009 to May 2010, a cholera outbreak occurred in fishing communities around Lake Chilwa. This paper describes the outbreak response and lessons learned for ...

  6. Grasshopper species composition shifts following a severe rangeland grasshopper outbreak

    Science.gov (United States)

    Little is known about how grasshopper species abundances shift during and following severe outbreaks, as sampling efforts usually end when outbreaks subside. Grasshopper densities, species composition and vegetation have infrequently been sampled during and after a severe outbreak in the western U.S...

  7. An outbreak of Mycobacterium fortuitum cutaneous infection associated with mesotherapy.

    Science.gov (United States)

    Quiñones, C; Ramalle-Gómara, E; Perucha, M; Lezaun, M-E; Fernández-Vilariño, E; García-Morrás, P; Simal, G

    2010-05-01

    We describe an outbreak of Mycobacterium fortuitum cutaneous infections associated with mesotherapy in La Rioja, Spain. Descriptive epidemiology. Private practice. Case subjects were customers of a single beauty salon who were treated with mesotherapy injections. Two skin biopsies were taken from each patient. Over the designated period, 138 women received mesotherapy. Of these women, 39, or 28.3%, developed lesions ultimately thought to be caused by Mycobacterium fortuitum infection. The number of lesions per patient varied from 3 to 20 in the most severe case. Most of the lesions were indurated, erythematous or violaceous papules, some progressing to become fluctuant boils with suppuration, fistulization and scarring. The individual lesions varied in diameter from 0.5 to 6 cm. Two patients (5.1%) developed inguinal or axillary adenopathy. Two others presented with fever. One reported muscular pain. In 12 of the 39 cases, M. fortuitum was isolated from the wound cultures. The patients were all successfully treated with clarithromycin and levofloxacin. We identified a large outbreak of rapidly growing mycobacterial lesions among women who received mesotherapy injections in a single beauty salon.

  8. Sporothrix brasiliensis outbreaks and the rapid emergence of feline sporotrichosis.

    Science.gov (United States)

    Sanchotene, Karine Ortiz; Madrid, Isabel Martins; Klafke, Gabriel Baracy; Bergamashi, Mariana; Della Terra, Paula Portella; Rodrigues, Anderson Messias; de Camargo, Zoilo Pires; Xavier, Melissa Orzechowski

    2015-11-01

    Sporotrichosis is the main subcutaneous mycosis in Brazil, and is caused by Sporothrix schenckii and allied species. Sporothrix propagules present on soil and plant debris may be traumatically inoculated into the cutaneous/ subcutaneous tissues of the warm-blooded host. An alternative route involves direct animal-animal and animal-human transmissions through deep scratches and bites of diseased cats. Sporotrichosis is much more common than previously appreciated with several cases emerging over the years especially in South and Southeast Brazil. We conducted an epidemiological surveillance in endemic areas of feline sporotrichosis in the southern region of Rio Grande do Sul state, Brazil. Over the last 5-year period the number of feline sporotrichosis in Rio Grande increased from 0.75 new cases per month in 2010 to 3.33 cases per month in 2014. The wide geographic distribution of diagnosed cases highlights the dynamics of Sporothrix transmission across urban areas with high population density. Molecular identification down to species level by PCR-RFLP of cat-transmitted Sporothrix revealed the emergence of the clonal offshoot S. brasiliensis during feline outbreaks; this scenario is similar to the epidemics taking place in the metropolitan areas of Rio de Janeiro and São Paulo. Controlling and preventing sporotrichosis outbreaks are essential steps to managing the disease among humans and animals. © 2015 Blackwell Verlag GmbH.

  9. Measles seroprevalence, outbreaks, and vaccine coverage in Rwanda.

    Science.gov (United States)

    Seruyange, Eric; Gahutu, Jean-Bosco; Mambo Muvunyi, Claude; Uwimana, Zena G; Gatera, Maurice; Twagirumugabe, Theogene; Katare, Swaibu; Karenzi, Ben; Bergström, Tomas

    2016-01-01

    Measles outbreaks are reported after insufficient vaccine coverage, especially in countries recovering from natural disaster or conflict. We compared seroprevalence to measles in blood donors in Rwanda and Sweden and explored distribution of active cases of measles and vaccine coverage in Rwanda. 516 Rwandan and 215 Swedish blood donors were assayed for measles-specific immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA). Data on vaccine coverage and acute cases in Rwanda from 1980 to 2014 were collected, and IgM on serum samples and polymerase chain reaction (PCR) on nasopharyngeal (NPH) swabs from suspected measles cases during 2010-2011 were analysed. The seroprevalence of measles IgG was significantly higher in Swedish blood donors (92.6%; 95% CI: 89.1-96.1%) compared to Rwandan subjects (71.5%; 95% CI: 67.6-75.4%) and more pronounced Rwanda, with the exception of an outbreak in 1995 following the 1994 genocide. 76/544 serum samples were IgM positive and 21/31 NPH swabs were PCR positive for measles, determined by sequencing to be of genotype B3. Measles seroprevalence was lower in Rwandan blood donors compared to Swedish subjects. Despite this, the number of reported measles cases in Rwanda rapidly decreased during the study period, concomitant with increased vaccine coverage. Taken together, the circulation of measles was limited in Rwanda and vaccine coverage was favourable, but seroprevalence and IgG levels were low especially in younger age groups.

  10. Fish and Shellfish Associated Disease Outbreaks.

    Science.gov (United States)

    Levin, M.

    1978-01-01

    Presents a literature review of disease outbreaks related to fish and shellfish, covering publications of 1976-77. This review covers the chemical, bacterial, and viral diseases that are transmitted by fish and shellfish. A list of 50 references is also presented. (HM)

  11. Canine distemper outbreak in rhesus monkeys, China.

    Science.gov (United States)

    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.

  12. E. Coli: Preventing Outbreaks at Camp.

    Science.gov (United States)

    McKinney, Mary D.

    1996-01-01

    One strain of E. coli is not usually found in foods, but has been related to consumption of undercooked ground beef. Symptoms are stomach cramps and diarrhea, and 2-7% of infections lead to hemolytic uremic syndrome, which is life threatening. Camps can prevent outbreaks by avoiding uncooked meat on overnight campouts and requiring appropriate…

  13. Pneumonia outbreaks in calves and finishers.

    Science.gov (United States)

    2016-03-19

    Pneumonia in calves and finishers. Ovarian tumour in a calf . Abortion associated with bovine herpesvirus 1 in a suckler herd. Parasitic gastroenteritis causing illthrift and death in sheep. Outbreaks of acute fasciolosis in sheep. These are among matters discussed in the disease surveillance report for December 2015 from SAC Consulting: Veterinary Services (SAC C VS). British Veterinary Association.

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

    Science.gov (United States)

    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.

  15. October 2012 Multistate Fungal Meningitis Outbreak

    Centers for Disease Control (CDC) Podcasts

    2012-10-17

    This podcast gives an overview of the October 2012 multistate fungal meningitis outbreak, including symptoms to watch for and a website for up-to-date information.  Created: 10/17/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 10/17/2012.

  16. Preparing for a Pandemic Flu Outbreak

    Science.gov (United States)

    Dittbenner, Richard

    2009-01-01

    This article discusses the things college leaders should know and do in case of a pandemic influenza outbreak. The author talks about four principles that will guide college leaders in developing a pandemic influenza plan and presents the 10 elements of an effective college pandemic planning process.

  17. Canine Distemper Outbreak in Rhesus Monkeys, China

    Science.gov (United States)

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

    2011-01-01

    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. PMID:21801646

  18. Quantifying reporting timeliness to improve outbreak control

    NARCIS (Netherlands)

    Bonačić Marinović, Axel; Swaan, Corien; van Steenbergen, Jim; Kretzschmar, MEE

    The extent to which reporting delays should be reduced to gain substantial improvement in outbreak control is unclear. We developed a model to quantitatively assess reporting timeliness. Using reporting speed data for 6 infectious diseases in the notification system in the Netherlands, we calculated

  19. Outbreak of Mysterious Illness Among Hospital Staff

    DEFF Research Database (Denmark)

    Jacobsen, Peter; Ebbehøj, Niels Erik

    2016-01-01

    BACKGROUND: Hospitals are rarely reported as settings for mass psychogenic illness (MPI). The present report scrutinizes an outbreak of probable MPI among hospital staff, with medical intervention reinforcing the course of the illness. CASE REPORT: Four of seven staff members in an emergency...

  20. Lessons in Outbreak a Consumer perspective

    NARCIS (Netherlands)

    Fischer, A.R.H.

    2008-01-01

    Lessons in Outbreak a Consumer perspective. Arnout Fischer Consumer risk perceptions is not necessarily the same as an economic weighing of risks and benefits. Consumers tend to be risk averse, tend to estimate catastrophic, unnatural or involuntary risks as larger, while personal lifestyle risks

  1. Use of the Ishikawa diagram in a case-control analysis to assess the causes of a diffuse lamellar keratitis outbreak.

    Science.gov (United States)

    Lira, Luis Henrique; Hirai, Flávio E; Oliveira, Marivaldo; Portellinha, Waldir; Nakano, Eliane Mayumi

    2017-01-01

    To identify the causes of a diffuse lamellar keratitis (DLK) outbreak using a systematic search tool in a case-control analysis. An Ishikawa diagram was used to guide physicians to determine the potential risk factors involved in this outbreak. Coherence between the occurrences and each possible cause listed in the diagram was verified, and the total number of eyes at risk was used to calculate the proportion of affected eyes. Multivariate analysis was performed using logistic regression to determine the independent effect of the risk factors, after controlling for confounders and test interactions. All DLK cases were reported in 2007 between June 13 and December 21; during this period, 3,698 procedures were performed. Of the 1,682 flap-related procedures, 204 eyes of 141 individuals presented with DLK. No direct relationship was observed between the occurrence of DLK and the presence of any specific factors; however, flap-lifting enhancements, procedures performed during the morning shift, and non-use of therapeutic contact lenses after the surgery were significantly related to higher occurrence percentages of this condition. The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.

  2. Estimating challenge load due to disease outbreaks and other challenges using reproduction records of sows.

    Science.gov (United States)

    Mathur, P K; Herrero-Medrano, J M; Alexandri, P; Knol, E F; ten Napel, J; Rashidi, H; Mulder, H A

    2014-12-01

    using data analysis were confirmed based on diagnostic information received from the farms. Among these, 30 outbreaks were due to PRRS while 11 were due to other diseases and challenging conditions. The results suggest that proposed method could be useful for estimation of challenge load and detection of challenge phases such as disease outbreaks.

  3. Changes in body mass index in Canadians over a five-year period: Results of a prospective, population-based study

    Directory of Open Access Journals (Sweden)

    Poliquin Suzette

    2007-07-01

    Full Text Available Abstract Background The initiation of the Canadian Multicentre Osteoporosis Study in 1996, and subsequent follow-up of the cohort 5 years later, provided longitudinal body mass index (BMI data for a random sample of Canadians. Methods Height and weight were measured at baseline and 5 years and used to calculate BMI and assign one of six weight categories. Multiple imputation was used to adjust for missing weight at year 5. Data were stratified by age and gender. The proportion of participants moving between categories was generated, and multivariable linear regression was used to identify factors associated with weight change. Results Baseline data were available for 8548 participants, year 5 data for 6721, and year 5 weight was imputed for 1827 (17.6%. Mean BMI for every age and gender group exceeded healthy weight guidelines. Most remained within their BMI classification over 5 years, but when change occurred, BMI category was more likely to increase than decrease. Several sociodemographic, lifestyle and clinical characteristics were associated with change. Conclusion Mean baseline BMI tended to be higher than recommended. Moreover, on average, men under age 45 and women under age 55 were gaining approximately 0.45 kilograms (one pound per year, which leveled off with increased age and reversed in the oldest age groups. These findings underscore the need for public health efforts aimed at combating obesity.

  4. [Lessons learnt from the German smallpox outbreaks after World War II].

    Science.gov (United States)

    Sasse, Julia; Gelderblom, Hans R

    2015-07-01

    Even though smallpox was declared eradicated by WHO in 1980, it cannot be ruled out that the etiological variola virus could be used as a biological weapon. Undestroyed viruses from biowarfare programmes, virus strains left undetected in a freezer or dangerous recombinant poxvirus constructs could cause dangerous outbreaks in a relatively unprotected population. Despite an abundance of studies performed during the eradication of smallpox, epidemiological data for preparedness planning and outbreak control in modern, industrialized countries are scarce. Full-text hand search for the period from 1945 to 1975 in the main German public health journals. After World War II 12 smallpox outbreaks occurred in Germany. They were studied with the focus on the period of contagiousness, the protective effect of vaccination, booster-effect of revaccination and the place of infection. A total of 95 individuals contracted smallpox, including 10 fatalities. Despite having been previously vaccinated, 81 vaccinated persons came down with smallpox, yet 91% of them developed only mild symptoms. These patients presented a high risk for spreading the infection to contact persons due to misinterpretation of symptoms and the continuing social contacts. Basically, the risk of transmission in the first 2 to 3 days after onset of symptoms was low, thus facilitating antiepidemic measures. The importance of hospital preparedness is emphasized by the fact that most infections occurred in hospitals. The data analyzed provide valuable information for today's outbreak response planning and counter bioterrorism preparedness.

  5. Measles outbreak linked to European B3 outbreaks, Wales, United Kingdom, 2017.

    Science.gov (United States)

    Currie, Jonny; Davies, Llion; McCarthy, Joanne; Perry, Malorie; Moore, Catherine; Cottrell, Simon; Bowley, Mererid; Williams, Chris; Shankar, Ananda Giri; Stiff, Rhianwen

    2017-10-01

    The United Kingdom achieved interrupted endemic measles transmission for 36 months in 2016. Despite this, ongoing challenges from sporadic measles cases typically imported from abroad remain. We summarise a B3 measles genotype outbreak in south-east Wales occurring between May and September 2017, linked with other European outbreaks, and lessons learnt. Seventeen confirmed cases and one probable case occurred principally in education and healthcare-settings. Six confirmed cases attended healthcare settings when infectious, without being isolated.

  6. Cholera Outbreaks in Urban Bangladesh In 2011.

    Science.gov (United States)

    Haque, Farhana; Hossain, M Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd; Rahman, Mahmudur; Luby, Stephen P

    In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae . The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate approaches for ensuring safe drinking

  7. Groundwater degassing and two-phase flow in fractured rock: Summary of results and conclusions achieved during the period 1994-2000

    International Nuclear Information System (INIS)

    Jarsjoe, J.; Destouni, G.

    2001-06-01

    drifts, by summarising and systematically interpreting all available laboratory and field investigations that have been conducted within the SKB degassing and two-phase flow programme. Data from various sites in Sweden show that the volumetric percent gas coming out of solution as the pressure of deep groundwater is lowered down to atmospheric pressure is generally less than 5%. Laboratory experiments and an analytical expression showed that conditions often are favourable for trapping and accumulation of gas bubbles in the fracture pore space (once bubbles are formed), implying that local fracture gas saturation degrees may become considerable, even though the evolved percent gas per unit volume flowing water is relatively low. For instance, a saturation degree of 40% was observed in a laboratory fracture for 7% evolved gas. However, degassing effects such as inflow reductions to boreholes and drifts will not be considerable unless the potential degassing zone (where the water pressure is lower than the gas bubble pressure) is sufficiently large in relation to the total length of the fracture. A series of borehole test conducted at Aespoe HRL between 300 and 450 meters depth indicated that degassing only causes considerable flow reductions for gas contents that are well above the normal ones in Swedish granitic bedrock. This field result was reproduced by a predictive degassing model, developed considering independent degassing observations in the laboratory. Since the model predictions were shown to be robust with regard to plausible variable ranges for rock fractures intersecting boreholes at depths between 20 and 600 metres, we conclude more generally that groundwater degassing will not cause considerable inflow reductions in fractures intersecting open boreholes under conditions normal for Swedish granitic bedrock. We also considered the relatively large drift inflow reductions observed in the Stripa simulated drift experiment. These reductions were hypothesised to

  8. The 2014 Ebola virus outbreak in West Africa highlights no evidence of rapid evolution or adaptation to humans.

    Science.gov (United States)

    Li, Xingguang; Zai, Junjie; Liu, Haizhou; Feng, Yi; Li, Fan; Wei, Jing; Zou, Sen; Yuan, Zhiming; Shao, Yiming

    2016-10-21

    Following its immergence in December 2013, the recent Zaire Ebola virus (EBOV) outbreak in West Africa has spread and persisted for more than two years, making it the largest EBOV epidemic in both scale and geographical region to date. In this study, a total of 726 glycoprotein (GP) gene sequences of the EBOV full-length genome obtained from West Africa from the 2014 outbreak, combined with 30 from earlier outbreaks between 1976 and 2008 were used to investigate the genetic divergence, evolutionary history, population dynamics, and selection pressure of EBOV among distinct epidemic waves. Results from our dataset showed that no non-synonymous substitutions occurred on the GP gene coding sequences of EBOV that were likely to have affected protein structure or function in any way. Furthermore, the significantly different dN/dS ratios observed between the 2014 West African outbreak and earlier outbreaks were more likely due to the confounding presence of segregating polymorphisms. Our results highlight no robust evidence that the 2014 EBOV outbreak is fast-evolving and adapting to humans. Therefore, the unprecedented nature of the 2014 EBOV outbreak might be more likely related to non-virological elements, such as environmental and sociological factors.

  9. Yellow Fever outbreak in Darfur, Sudan in October 2012; the initial outbreak investigation report.

    Science.gov (United States)

    Soghaier, Mohammed A; Hagar, Ahmed; Abbas, Mohammed A; Elmangory, Mutasim M; Eltahir, Khalid M; Sall, Amadou A

    2013-10-01

    Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. The field investigation confirmed the outbreak and identified its cause to be YF. National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  10. Outbreak of viral hemorrhagic fever caused by dengue virus type 3 in Al-Mukalla, Yemen

    Science.gov (United States)

    2013-01-01

    Background Investigations were conducted by the authors to explore an outbreak of viral hemorrhagic fever (VHF) reported in 2010 from Al-Mukalla city, the capital of Hadramout in Yemen. Methods From 15–17 June 2010, the outbreak investigation period, specimens were obtained within 7 days after onset of illness of 18 acutely ill patients hospitalized with VHF and 15 household asymptomatic contacts of 6 acute cases. Additionally, 189 stored sera taken from acutely ill patients with suspected VHF hospitalized in the preceding 12 months were obtained from the Ministry of Health of Yemen. Thus, a total of 222 human specimens were collected; 207 specimens from acute cases and 15 specimens from contacts. All samples were tested with RT-PCR for dengue (DENV), Alkhumra (ALKV), Rift Valley Fever (RVFV), Yellow Fever (YFV), and Chikungunya (CHIKV) viruses. Samples were also tested for DENV IgM, IgG, and NS1-antigen. Medical records of patients were reviewed and demographic, clinical, and laboratory data was collected. Results Of 207 patients tested, 181 (87.4%) patients were confirmed to have acute dengue with positive dengue NS1-antigen (97 patients, 46.9%) and/or IgM (163 patients, 78.7%). Of the 181 patients with confirmed dengue, 100 (55.2%) patients were IgG-positive. DENV RNA was detected in 2 (1%) patients with acute symptoms; both samples were molecularly typed as DENV type 3. No other VHF viruses were detected. For the 15 contacts tested, RT-PCR tests for the five viruses were negative, one contact was dengue IgM positive, and another one was dengue IgG positive. Of the 181 confirmed dengue patients, 120 (66.3%) patients were males and the median age was 24 years. The most common manifestations included fever (100%), headache (94.5%), backache (93.4%), malaise (88.4%), arthralgia (85.1%), myalgia (82.3%), bone pain (77.9%), and leukopenia (76.2%). Two (1.1%) patients died. Conclusions DENV-3 was confirmed to be the cause of an outbreak of VHF in Al

  11. Alkaline peptone water enrichment with a dipstick test to quickly detect and monitor cholera outbreaks

    Directory of Open Access Journals (Sweden)

    Godfrey Bwire

    2017-11-01

    Full Text Available Abstract Background Detection, confirmation and monitoring of cholera outbreaks in many developing countries including Uganda is a big challenge due to lack of the required resources and the time the test takes. Culture method which takes 24–48 h to get the feedback and requires highly skilled laboratory staff plus other complex resources is the standard test. This study evaluated the new cholera rapid detection method that relies on Crystal VC dipsticks after enrichment with alkaline peptone water (APW against the culture method for monitoring the progress of cholera outbreaks in rural setting. Methods We conducted the study between March and June 2015. Fresh stool samples and rectal swabs were incubated in 1% APW for 6 h at room temperature before testing with RDT following the manufacturer’s instruction. The same stool sample was cultured to isolate V. cholerae in the standard manner. We also reviewed patient registers to epidemiologically describe the cholera epidemic. Results We tested stool from 102 consenting suspected cholera patients reporting during daytime at Bwera Hospital (n = 69, Kilembe Mines Hospital (n = 4 and Kinyabwama Health Centre (n = 29. Ninety one (91 samples were positive and nine samples were negative according to both methods. One (1 sample was positive only by dipstick and one sample was positive only by culture (sensitivity of 99%, specificity of 90%, Positive Predictive Value of 99% and Negative Predictive Value of 90%. Overall, 146 suspected cholera cases and two deaths, (case fatality rate of 1.36% were recorded during the study period. Among the cases aged 1–9 years, 63% (50/79 were males while in those aged 20–49 years, 76% (34/45 were females. Conclusions Our findings showed that the modified dipstick test after enrichment with 1% APW had high level of accuracy in detection of V. cholerae and is quick, affordable alternative cholera outbreak monitoring tool in resource constrained

  12. Comparison of The Effects of A Positive Reappraisal Coping Intervention and Problem-Solving Skills Training on Depression during The Waiting Period of The Result of Intrauterine Insemination Treatment: A Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Marzieh Ghasemi gojani, , ,

    2018-01-01

    Full Text Available Background The outcomes of fertility treatments are unpredictable, and levels of depressive symptoms increase in patients during the waiting period of the result of intrauterine insemination (IUI treatment. The aim of this study was to compare the effects of a positive reappraisal coping intervention (PRCI and problem-solving skills training (PSS on depression during the waiting period of the result of IUI Treatment. Materials and Methods This randomized control clinical trial was done among 108 women undergoing IUI treat- ment. In the control group, the women received routine care. In the PRCI group, women attended two training sessions and were asked to complete coping thoughts cards and fill out daily monitoring forms during the waiting period. In the PSS group, PSS were taught over three sessions. The depression was measured by the beck depression inventory. Results On the 10th day of the IUI waiting period, there were significant differences between the control group (21.42 ± 11.42 and the PSS group (12.52 ± 8.05 and PRCI groups (13.14 ± 9.7 (P<0.001, but no significant difference between the PRCI group and the PSS group. Conclusion According to the results of this randomized control trial there is no difference between a PRCI and PSS on depression during the waiting period of the result of IUI treatment. This suggests that both interventions can be used to help infertile women combat depression during the waiting period of the result of fertility treatments (Registration number: IRCT2016020926490N1.

  13. Global reaction to the recent outbreaks of Zika virus: Insights from a Big Data analysis.

    Science.gov (United States)

    Bragazzi, Nicola Luigi; Alicino, Cristiano; Trucchi, Cecilia; Paganino, Chiara; Barberis, Ilaria; Martini, Mariano; Sticchi, Laura; Trinka, Eugen; Brigo, Francesco; Ansaldi, Filippo; Icardi, Giancarlo; Orsi, Andrea

    2017-01-01

    The recent spreading of Zika virus represents an emerging global health threat. As such, it is attracting public interest worldwide, generating a great amount of related Internet searches and social media interactions. The aim of this research was to understand Zika-related digital behavior throughout the epidemic spreading and to assess its consistence with real-world epidemiological data, using a behavioral informatics and analytics approach. In this study, the global web-interest and reaction to the recently occurred outbreaks of the Zika Virus were analyzed in terms of tweets and Google Trends (GT), Google News, YouTube, and Wikipedia search queries. These data streams were mined from 1st January 2004 to 31st October 2016, with a focus on the period November 2015-October 2016. This analysis was complemented with the use of epidemiological data. Spearman's correlation was performed to correlate all Zika-related data. Moreover, a multivariate regression was performed using Zika-related search queries as a dependent variable, and epidemiological data, number of inhabitants in 2015 and Human Development Index as predictor variables. Overall 3,864,395 tweets, 284,903 accesses to Wikipedia pages dedicated to the Zika virus were analyzed during the study period. All web-data sources showed that the main spike of researches and interactions occurred in February 2016 with a second peak in August 2016. All novel data streams-related activities increased markedly during the epidemic period with respect to pre-epidemic period when no web activity was detected. Correlations between data from all these web platforms resulted very high and statistically significant. The countries in which web searches were particularly concentrated are mainly from Central and South Americas. The majority of queries concerned the symptoms of the Zika virus, its vector of transmission, and its possible effect to babies, including microcephaly. No statistically significant correlation was found

  14. Global reaction to the recent outbreaks of Zika virus: Insights from a Big Data analysis.

    Directory of Open Access Journals (Sweden)

    Nicola Luigi Bragazzi

    Full Text Available The recent spreading of Zika virus represents an emerging global health threat. As such, it is attracting public interest worldwide, generating a great amount of related Internet searches and social media interactions. The aim of this research was to understand Zika-related digital behavior throughout the epidemic spreading and to assess its consistence with real-world epidemiological data, using a behavioral informatics and analytics approach.In this study, the global web-interest and reaction to the recently occurred outbreaks of the Zika Virus were analyzed in terms of tweets and Google Trends (GT, Google News, YouTube, and Wikipedia search queries. These data streams were mined from 1st January 2004 to 31st October 2016, with a focus on the period November 2015-October 2016. This analysis was complemented with the use of epidemiological data. Spearman's correlation was performed to correlate all Zika-related data. Moreover, a multivariate regression was performed using Zika-related search queries as a dependent variable, and epidemiological data, number of inhabitants in 2015 and Human Development Index as predictor variables.Overall 3,864,395 tweets, 284,903 accesses to Wikipedia pages dedicated to the Zika virus were analyzed during the study period. All web-data sources showed that the main spike of researches and interactions occurred in February 2016 with a second peak in August 2016. All novel data streams-related activities increased markedly during the epidemic period with respect to pre-epidemic period when no web activity was detected. Correlations between data from all these web platforms resulted very high and statistically significant. The countries in which web searches were particularly concentrated are mainly from Central and South Americas. The majority of queries concerned the symptoms of the Zika virus, its vector of transmission, and its possible effect to babies, including microcephaly. No statistically significant

  15. The Study of Campylobacter Frequency in Foodborne Disease Outbreaks in Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Soltan Dallal

    2017-07-01

    Full Text Available Introduction:Food-borne diseases are the widespread problems worldwide. Campylobacter species are the most important pathogens causing gastroenteritis which is generally transmitted through the food with animal origin. The aim of this study was to identify the Campylobacter spp. in diarrheal outbreaks in food-borne diseases at country level. Methods:This cross-sectional study carried out in spring and summer, 2015. In total, 305 swabs from diarrheal stool samples of 102 food-borne outbreaks were collected in various provinces of Iran. All samples were examined for the presence and growth of Campylobacter spp. The descriptive analysis, chi-square test and SPSS v.21 software were used for the analysis of results. Results:From the total of 102 foodborne outbreaks, Zanjan Province with 24 outbreaks (24.5% and Yazd Province with 70 samples of diarrhea (23% included the most reported cases. Out of 305 tested samples, 119 (39% were from food, 35 (11.5% from water and 151 (41.5% from unknown sources (p <0.001.  Two outbreaks in Yazd Province including three stool samples contained Campylobacter coli. Typical symptoms included diarrhea (30.9%, abdominal cramps (68.5%, fever (31.8%, headache (42.3%, diarrhea (5.2%, nausea (62.3% and vomiting (64.9%. Conclusion:Results from this study showed that C. coli was responsible for diarrhea rather than C. jejuni.

  16. Ascertaining the impact of catastrophic events on dengue outbreak: The 2014 gas explosions in Kaohsiung, Taiwan

    Science.gov (United States)

    2017-01-01

    Infectious disease outbreaks often occur in the aftermath of catastrophic events, either natural or man-made. While natural disasters such as typhoons/hurricanes, flooding and earthquakes have been known to increase the risk of infectious disease outbreak, the impact of anthropogenic disasters is less well-understood. Kaohsiung City is located in southern Taiwan, where most dengue outbreaks had occurred in the past two decades. It is also the center of petrochemical industry in Taiwan with pipelines running underneath city streets. Multiple underground gas explosions occurred in Kaohsiung in the evening of July 31, 2014 due to chemical leaks in the pipelines. The explosions caused 32 deaths, including five firefighters and two volunteer firefighters, and injured 321 persons. Historically, dengue outbreaks in southern Taiwan occurred mostly in small numbers of around 2000 cases or less, except in 2002 with over 5000 cases. However, in the months after the gas explosions, the city reported 14528 lab-confirmed dengue cases from August to December. To investigate the possible impact, if any, of the gas explosions on this record-breaking dengue outbreak, a simple mathematical model, the Richards model, is utilized to study the temporal patterns of the spread of dengue in the districts of Kaohsiung in the proximity of the explosion sites and to pinpoint the waves of infections that had occurred in each district in the aftermath of the gas explosions. The reproduction number of each wave in each district is also computed. In the aftermath of the gas explosions, early waves occurred 4–5 days (which coincides with the minimum of human intrinsic incubation period for dengue) later in districts with multiple waves. The gas explosions likely impacted the timing of the waves, but their impact on the magnitude of the 2014 outbreak remains unclear. The modeling suggests the need for public health surveillance and preparedness in the aftermath of future disasters. PMID:28520740

  17. Mumps-containing vaccine effectiveness during outbreaks in two schools in Guangdong, China, 2012

    Directory of Open Access Journals (Sweden)

    Su Qi-ru

    2012-12-01

    Full Text Available Introduction: Mumps-containing vaccine was licensed in the 1990s in China with a single dose administered routinely to children aged 18–24 months since 2008. However, an increase in reported mumps cases during the period 2009 to 2012 casts doubt on the effectiveness of a single-dose mumps vaccination. In March 2012, large numbers of mumps cases in a day-care centre and primary school in Guangdong Province were investigated to estimate the effectiveness of mumps-containing vaccine.Methods: A mumps case was defined as a case with acute onset of unilateral or bilateral swelling of the parotid gland or other salivary glands. Clinical data were collected among students and staff members in the two schools from 6 February to 3 June 2012. Vaccination history was obtained from immunization certificates. Vaccine effectiveness (VE was calculated among children in classes that had more than two mumps cases.Results: The cohort included 369 children from seven classes, four from the day-care centre and three from the primary school. Vaccination certificates available for 347 children showed immunization coverage of 82% (285/347. The overall attack rate was 14.6% (54/369; the VE for a single dose of mumps vaccine was 65% (95% confidence interval [CI]: 19%–85% when given within three years and 15% (95% CI: -2%–52% when given three to six years before the outbreak. For two doses of vaccine the VE was 53% (95% CI: -15–80%.Discussion: A single dose of mumps-containing vaccine was not effective to prevent these outbreaks among preschool and schoolchildren. A second dose of mumps-containing vaccine to four to five-year-old children should be considered in China.

  18. Syphilis Resurgence in Belgrade, Serbia, in the New Millennium: An Outbreak in 2014.

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    Bjekić, Milan; Šipetić-Grujičić, Sandra; Begović-Vuksanović, Biljana; Rafailović, Nevena; Vlajinac, Hristina

    2017-12-01

    A worldwide syphilis incidence increase was recorded at the beginning of the new millennium, occurring primarily among men who have sex with men (MSM). The aim of this study was to analyse the epidemiological situation of syphilis in the Belgrade population between 2005 and 2014 and to examine the characteristics of an early syphilis outbreak among MSM in Belgrade in 2014. Reporting of syphilis is compulsory in Serbia. Routinely reported data were analysed along with data collected from patients' charts. During the period observed, syphilis incidence increased from 1.07 per 100,000 in 2005 to 4.1 per 100,000 in 2014 (383.2%). From 2005 to 2009, syphilis rates in Belgrade were low, around 1 case per 100,000 people. The first outbreak was registered in 2010. The new incidence increase happened in 2012, and again in 2014 when it was the highest. These incidence changes were registered mainly in men, where the frequency of syphilis was much higher than in women. In 2014, primary syphilis was diagnosed in 20 cases, secondary syphilis in 42, and early latent syphilis in 9 patients. Fifty-seven were MSM, 10 were heterosexual men and 4 were women. Twenty-four cases, all MSM were co-infected with HIV. Majority of patients acquired infection in Belgrade, while in 42/71 cases oral sex was the only risk factor. In comparison with HIV negative, HIV positive syphilis patients were older, more frequently unemployed and MSM. They also more frequently had sex with unknown partners and were diagnosed in the secondary stage of infection. Study results underline the need for coordinated and expeditious surveillance, partner services, enhanced screening of population at risk, health education, as well as early diagnosis and treatment. Copyright© by the National Institute of Public Health, Prague 2017

  19. Investigation of key interventions for shigellosis outbreak control in China.

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    Tianmu Chen

    Full Text Available Shigellosis is a major public health concern in China, where waterborne disease outbreaks are common. Shigellosis-containing strategies, mostly single or multiple interventions, are implemented by primary-level health departments. Systematic assessment of the effectiveness of these measures is scarce. To estimate the efficacy of commonly used intervention strategies, we developed a Susceptible-Exposed-Infectious/Asymptomatic-Recovered-Water model. No intervention was predicted to result in a total attack rate (TAR of 90% of the affected population (95% confidence interval [CI]: 86.65-92.80 and duration of outbreak (DO of 89 days, and the use of single-intervention strategies can be futile or even counter-productive. Prophylactics and water disinfection did not improve TAR or DO. School closure for up to 3 weeks did not help but only increased DO. Isolation alone significantly increased DO. Only antibiotics treatment could shorten the DO to 35 days with TAR unaffected. We observed that these intervention effects were additive when in combined usage under most circumstances. Combined intervention "Isolation+antibiotics+prophylactics+water disinfection" was predicted to result in the lowest TAR (41.9%, 95%CI: 36.97-47.04% and shortest DO (28 days. Our actual Shigellosis control implementation that also included school closure for 1 week, attained comparable results and the modeling produced an epidemic curve of Shigellosis highly similar to our actual outbreak data. This lends a strong support to the reality of our model that provides a possible reference for public health professionals to evaluate their strategies towards Shigellosis control.

  20. Response to a large rotavirus outbreak on South Tarawa, Kiribati, 2013

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    Teanibuaka Tabunga

    2014-05-01

    Full Text Available Introduction: In July 2013, during annual independence celebrations in Kiribati, staff at Tungaru Central Hospital on South Tarawa reported an increase in children presenting with severe diarrhoea. This report describes the outbreak investigation, findings and response. Method: After notification of the outbreak, all health facilities on South Tarawa began reporting cases of acute diarrhoea and/or vomiting through the early warning syndromic surveillance system on a daily basis. Community awareness was raised and the public was encouraged to present to a health facility if ill with acute gastroenteritis. Specimens were collected and sent for laboratory testing. Results: Between 10 and 24 July 2013, 1118 cases of gastroenteritis were reported; 103 were hospitalized and six died. The median age of cases was one year (range: 0–68 years; 93.4% were aged less than five years. Rotavirus was identified in 81% of specimens tested. The outbreak response included enhanced surveillance, community education, clinical training and changes to in-hospital patient management for infection control. Discussion: This outbreak was the largest diarrhoea outbreak in Kiribati in five years. Factors that may have contributed to the magnitude and severity of the outbreak included high household density, inadequate sanitation infrastructure and a mass gathering – all increasing the chance of transmission – as well as limited clinical response capacity. The current outbreak highlights the importance of clinical management to minimize severe dehydration and death. Rotavirus vaccination should be considered as an adjunct to other comprehensive enteric disease control measures as recommended by the World Health Organization.

  1. Comparison of The Effects of A Positive Reappraisal Coping Intervention and Problem-Solving Skills Training on Depression during The Waiting Period of The Result of Intrauterine Insemination Treatment: A Randomized Control Trial.

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    Ghasemi Gojani, Marzieh; Kordi, Masoumeh; Asgharipour, Negar; Esmaeili, Habibollah

    2018-04-01

    The outcomes of fertility treatments are unpredictable, and levels of depressive symptoms increase in patients during the waiting period of the result of intrauterine insemination (IUI) treatment. The aim of this study was to compare the effects of a positive reappraisal coping intervention (PRCI) and problem-solving skills training (PSS) on depression during the waiting period of the result of IUI Treatment. This randomized control clinical trial was done among 108 women undergoing IUI treatment. In the control group, the women received routine care. In the PRCI group, women attended two training sessions and were asked to complete coping thoughts cards and fill out daily monitoring forms during the waiting period. In the PSS group, PSS were taught over three sessions. The depression was measured by the beck depression inventory. On the 10 th th day of the IUI waiting period, there were significant differences between the control group (21.42 ± 11.42) and the PSS group (12.52 ± 8.05) and PRCI groups (13.14 ± 9.7) (P<0.001), but no significant difference between the PRCI group and the PSS group. According to the results of this randomized control trial there is no difference between a PRCI and PSS on depression during the waiting period of the result of IUI treatment. This suggests that both interventions can be used to help infertile women combat depression during the waiting period of the result of fertility treatments (Registration number: IRCT2016020926490N1). Copyright© by Royan Institute. All rights reserved.

  2. Reported foodborne outbreaks due to fresh produce in the United States and European Union: trends and causes.

    Science.gov (United States)

    Callejón, Raquel M; Rodríguez-Naranjo, M Isabel; Ubeda, Cristina; Hornedo-Ortega, Ruth; Garcia-Parrilla, M Carmen; Troncoso, Ana M

    2015-01-01

    The consumption of fruit and vegetables continues to rise in the United States and European Union due to healthy lifestyle recommendations. Meanwhile, the rate of foodborne illness caused by the consumption of these products remains high in both regions, representing a significant public health and financial issue. This study addresses the occurrence of reported foodborne outbreaks associated with fresh fruits and vegetables consumption in the United States and European Union during the period 2004-2012, where data are available. Special attention is paid to those pathogens responsible for these outbreaks, the mechanisms of contamination, and the fresh produce vehicles involved. Norovirus is shown to be responsible for most of the produce-related outbreaks, followed by Salmonella. Norovirus is mainly linked with the consumption of salad in the United States and of berries in the European Union, as demonstrated by the Multiple Correspondence Analysis (MCA). Salmonella was the leading cause of multistate produce outbreaks in the United States and was the pathogen involved in the majority of sprouts-associated outbreaks. As is reflected in the MCA, the pattern of fresh produce outbreaks differed in the United States and European Union by the type of microorganism and the food vehicle involved.

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

    Science.gov (United States)

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

    2017-10-01

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

  4. Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients.

    Science.gov (United States)

    Jeong, Hyunho; Jeong, Sikyoung; Oh, Juseok; Woo, Seon Hee; So, Byung Hak; Wee, Jeong Hee; Kim, Ji Hoon; Im, Ji Yong; Choi, Seung Pill; Park, Kyoungnam; Cho, Byul Nim Hee; Hong, Sungyoup

    2017-06-01

    Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attend