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Sample records for successful outbreak control

  1. Nosocomial outbreak of carbapenem-resistant Acinetobacter baumannii in intensive care units and successful outbreak control program.

    Science.gov (United States)

    Choi, Won Suk; Kim, Su Hyun; Jeon, Eun Gyong; Son, Myeung Hee; Yoon, Young Kyung; Kim, Jung-Yeon; Kim, Mi Jeong; Sohn, Jang Wook; Kim, Min Ja; Park, Dae Won

    2010-07-01

    Acinetobacter baumannii has been increasingly reported as a significant causative organism of various nosocomial infections. Here we describe an outbreak of carbapenem-resistant A. baumannii (CRAB) in the ICUs of a Korean university hospital, along with a successful outbreak control program. From October 2007 through July 2008, CRAB was isolated from 57 ICU patients. Nineteen patients were diagnosed as being truly infected with CRAB, four of whom were presumed to have died due to CRAB infection, producing a case-fatality rate of 21.1%. In surveillance of the environment and the healthcare workers (HCWs), CRAB was isolated from 24 (17.9%) of 135 environmental samples and seven (10.9%) of 65 HCWs. The pulsed field gel electrophoresis patterns showed that the isolates from patients, HCWs, and the environment were genetically related. Control of the outbreak was achieved by enforcing contact precautions, reducing environmental contamination through massive cleaning, and use of a closed-suctioning system. By August 2008 there were no new cases of CRAB in the ICUs. This study shows that the extensive spread of CRAB can happen through HCWs and the environmental contamination, and that proper strategies including strict contact precautions, massive environmental decontamination, and a closed-suctioning system can be effective for controlling CRAB outbreaks.

  2. Vancomycin-resistant enterococcus outbreak in a pediatric intensive care unit: report of successful interventions for control and prevention

    Directory of Open Access Journals (Sweden)

    F. Carmona

    2012-02-01

    Full Text Available The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE outbreak in a tertiary-care pediatric intensive care unit (PICU of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction, and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

  3. Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region

    OpenAIRE

    Cheng, VCC; Chan, JFW; Tai, JWM; Ho, YY; Li, IWS; To, KKW; Ho, PL; Yuen, KY

    2011-01-01

    Vancomycin-resistant enterococci (VRE) have emerged in many parts of the world, but have only been reported sporadically in Hong Kong. We report an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in a neurosurgical unit at a tertiary teaching hospital between 3 March and 3 April 2009 in Hong Kong. During the outbreak investigation, clinical samples from 193 (91.5%) of 211 patients who had stayed in the neurosurgical unit and 506 environmental samples were screened for VREfm. Bes...

  4. Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region

    OpenAIRE

    Cheng, V C C; Chan, J. F. W.; Tai, J. W. M.; Ho, Y Y; Li, I W S; To, K. K. W.; Ho, P. L.; Yuen, K Y

    2010-01-01

    Vancomycin-resistant enterococci (VRE) have emerged in many parts of the world, but have only been reported sporadically in Hong Kong. We report an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in a neurosurgical unit at a tertiary teaching hospital between 3 March and 3 April 2009 in Hong Kong. During the outbreak investigation, clinical samples from 193 (91.5%) of 211 patients who had stayed in the neurosurgical unit and 506 environmental samples were screened...

  5. Successful control of a large outbreak of HIV infection associated with injection of cathinone derivatives in Tel Aviv, Israel.

    Science.gov (United States)

    Katchman, E; Ben-Ami, R; Savyon, M; Chemtob, D; Avidor, B; Wasserman, A; Zeldis, I; Girshengorn, S; Amitai, Z; Sheffer, R; Turner, D

    2017-05-01

    Outbreaks of HIV infection have been linked to injectable drug abuse, but specific triggers often remain obscure. We report on an outbreak of primary HIV infection among people who inject drugs (PWID) in Tel Aviv, associated with a local shift in drug-use practices. A cluster of primary HIV infection cases in PWID was detected in May 2012. Retrospective and prospective multi-hospital case finding was initiated. PWID were interviewed and risk factors for primary HIV infection were identified. Starting in December 2012, a multifaceted intervention was implemented, including educational activities, increasing syringe exchange supplies, active screening, early initiation of antiretroviral therapy, and referral to drug withdrawal programmes. Forty-two PWID with primary HIV infection were detected between May 2012 and April 2013. Compared with the corresponding pre-outbreak period, the annual incidence of primary HIV infection in PWID increased from 0 to 20 cases/1000 population (p infections and sepsis. Phylogenetic analysis of HIV isolates from case patients showed tight clustering suggesting a single common source of infection. The outbreak was temporally related to a widespread shift from heroin to injectable cathinone-derivatives and buprenorphine, which entailed high-risk injection practices. Targeted intervention resulted in a dramatic and sustained reduction in HIV infection in the PWID population. Injectable amphetamines are gaining momentum among PWID worldwide. Tracing of this outbreak to cathinone use and implementing a targeted intervention programme effectively terminated the outbreak. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  6. Successful Multi-partner Response to a Cholera Outbreak

    African Journals Online (AJOL)

    46987.2

    earthquakes, tsunami, volcanic eruptions, landslides and floods also contribute to outbreaks by disrupting the. 2 normal balance of nature. Cholera epidemics continue to cause major morbidity and mortality globally, and recent large outbreaks in Haiti, Zimbabwe, and Sierra Leone show the urgent need for improved control ...

  7. Infection control during filoviral hemorrhagic fever outbreaks

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    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.

  8. Successful multi-partner response to a cholera outbreak in Lusaka ...

    African Journals Online (AJOL)

    Successful multi-partner response to a cholera outbreak in Lusaka, Zambia 2016: a case control study. B Matapo, E Chizema, B.M. Hangombe, K Chishimba, A.M. Mwiinde, I Mwanamwalye, G Zulu, K Malama, J Mufunda, C.M. Muzongwe, F.M. Kabinga, O Chewe, B Vwalika ...

  9. Molecular characteristics and successful management of a respiratory syncytial virus outbreak among pediatric patients with hemato-oncological disease.

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    Baier, Claas; Haid, Sibylle; Beilken, Andreas; Behnert, Astrid; Wetzke, Martin; Brown, Richard J P; Schmitt, Corinna; Ebadi, Ella; Hansen, Gesine; Schulz, Thomas F; Pietschmann, Thomas; Bange, Franz-Christoph

    2018-01-01

    Respiratory syncytial virus (RSV) is responsible for upper and lower respiratory tract infection in adults and children. Especially immunocompromised patients are at high risk for a severe course of infection, and mortality is increased. Moreover RSV can spread in healthcare settings and can cause outbreaks. Herein we demonstrate the successful control and characteristics of a RSV outbreak that included 8 patients in our Department of Pediatric Hematology and Oncology. We performed an epidemiologic investigation and a molecular analysis of the outbreak strains. Moreover we present the outbreak control bundle and our concept for RSV screening in the winter season. RSV A and B strains caused the outbreak. RSV B strains affected 3 patients, 2 of whom were co-infected with RSV A. Exactly this RSV A strain was detected in another 5 patients. Our multimodal infection control bundle including prophylactic RSV screening was able to rapidly stop the outbreak. An infection control bundle in RSV outbreaks should address all potential transmission pathways. In pediatric settings the restriction of social activities might have a temporal negative impact on quality of life but helps to limit transmission opportunities. Molecular analysis allows better understanding of RSV outbreaks and, if done in a timely manner, might be helpful for guidance of infection control measures.

  10. Antivirals and the control of influenza outbreaks.

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    Hota, Susy; McGeer, Allison

    2007-11-15

    During annual influenza epidemics, outbreaks of influenza in closed institutions are common. Among healthy children or young adults, such outbreaks are uncommonly associated with serious morbidity or mortality; however, in hospitals and nursing homes, attack rates as high as 60% and case-fatality rates as high as 50% have been reported. Annual influenza vaccination of both patients or residents and hospital and nursing home staff has had a substantial impact on mortality and has reduced the number of outbreaks. Nonpharmacologic interventions (e.g., handwashing and contact isolation of case patients) may reduce the spread of influenza, although evidence for their efficacy is lacking. Nonetheless, long-term care facilities for the elderly population with high vaccination rates and better-than-average infection-control programs have a 25%-50% chance of experiencing an influenza outbreak each year, with an expected resident attack rate of 35%-40%. Thus, antiviral drugs have been increasingly used to mitigate the impact of influenza outbreaks. There are 2 classes of antiviral drugs that are active against influenza: adamantanes and neuraminidase inhibitors. Drugs of the 2 classes appear to be equally effective for the treatment and prophylaxis of susceptible influenza A virus strains. However, adamantanes are not active against influenza B virus, and an increasing proportion of influenza A isolates are resistant to adamantanes. Adamantanes are associated with higher rates of adverse events than are neuraminidase inhibitors. There is substantial evidence that antiviral prophylaxis is effective in terminating outbreaks of seasonal influenza in closed institutions. If stockpiles are adequate, antiviral drugs are likely to be even more important in mitigating the impact of influenza transmission in health care institutions during the next influenza pandemic.

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

    Science.gov (United States)

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

    2015-03-26

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

  12. Successful Multi-partner Response to a Cholera Outbreak

    African Journals Online (AJOL)

    46987.2

    ABSTRACT. Background:A Cholera outbreak was reported in Lusaka. District between February and May 2016, with 1,079 cases and 20 deaths recorded in the per-urban areas. Bauleni catchment area alone reported 441 (40.9%) case patients with case fatality rate of 4 (0.9%). Bauleni clinic was one of the three ...

  13. 75 FR 34146 - Draft Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in...

    Science.gov (United States)

    2010-06-16

    ... of Norovirus Gastroenteritis Outbreaks in Healthcare Settings AGENCY: Centers for Disease Control and... for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings...-based recommendations for prevention and control of norovirus outbreaks in healthcare settings. DATES...

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

    Science.gov (United States)

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

    2012-12-01

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

  15. Economic Value of Norovirus Outbreak Control Measures in Healthcare Settings

    OpenAIRE

    Lee, Bruce Y.; Wettstein, Zachary S.; McGlone, Sarah M.; Bailey, Rachel R.; Umscheid, Craig A.; Smith, Kenneth J.; Muder, Robert R.

    2010-01-01

    Although norovirus is a significant cause of nosocomial viral gastroenteritis, the economic value of hospital outbreak containment measures following identification of a norovirus case is currently unknown. We developed computer simulation models to determine the potential cost-savings from the hospital perspective of implementing the following norovirus outbreak control interventions: (1) increased hand hygiene measures, (2) enhanced disinfection practices, (3) patient isolation, (4) use of ...

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

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    Daniel H. de Vries

    2016-02-01

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

  17. Outbreaks of virulent diarrheagenic Escherichia coli--are we in control?

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    Werber, Dirk; Krause, Gérard; Frank, Christina; Fruth, Angelika; Flieger, Antje; Mielke, Martin; Schaade, Lars; Stark, Klaus

    2012-02-02

    Shiga toxin-producing Escherichia coli (STEC) are the most virulent diarrheagenic E. coli known to date. They can be spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that was centered in northern Germany and affected several countries. Effective control of such outbreaks is an important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle and immediate removal of the suspected food from the market, flanked by consumer advice and measures to prevent secondary spread.In our view, opportunities to improve control of STEC outbreaks lie in early clinical suspicion for STEC infection, timely diagnosis of all STEC at the serotype-level and integrating molecular subtyping information into surveillance systems. Furthermore, conducting analytical studies that supplement patients' imperfect food history recall and performing, as an investigative element, product tracebacks, are pivotal but underutilized tools for successful epidemiologic identification of the suspected vehicle in foodborne outbreaks. As a corollary, these tools are amenable to tailor microbiological testing of suspected food. Please see related article: http://www.biomedcentral.com/1741-7015/10/12.

  18. Strategy for effective collaboration in the control of pertussis outbreaks that involve schools.

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    Haselow, Dirk

    2013-11-01

    Outbreaks of pertussis are increasing in size and frequency in the US. Experts believe that this is due in part to differing protective characteristics of pertussis vaccines currently in use as compared to pertussis vaccines used previously. Pertussis outbreak control requires use of antibiotics to prevent or treat infection among persons exposed or ill regardless of immunization history. It also may be necessary to provide vaccines to the exposed groups--often outside of the typical immunization schedule. Primary care providers (PCPs) are crucial in the diagnosis of cases and early identification of an outbreak. Prompt notification of public health authorities allows rapid initiation of outbreak investigation and response activities. Partners in outbreak investigation and response will include school nurses, PCPs, local public health authorities, and parents. Larger outbreaks may also involve state public health authorities, school administrators, county health officers, local elected officials, emergency management officials, other community leaders, and/or various mass media outlets. Strong relationships of local public health nurses with school nurses and PCPs can greatly aid the timeliness and effectiveness of a response. Clear consistent messages are critical to prevent confusion or panic as well as misuse of limited resources. State and local public health communications experts are willing and available to assist school administrators or local leaders with effective messaging. In summation, controlling a pertussis outbreak involving a school is complicated. It requires strong collaborative efforts and excellent communication between school nurses and administrators, PCPs, and public health authorities. When all involved partners understand each others' roles and responsibilities, opportunity for rapid and successful control of the outbreak is maximized.

  19. Respiratory syncytial virus outbreak in neonatal intensive care unit: Impact of infection control measures plus palivizumab use

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    Silva Camila de A

    2012-05-01

    Full Text Available Abstract Background The occurrence of a respiratory syncytial virus (RSV outbreak in a Neonatal Intensive Care Unit (NICU is related to unfavorable outcomes, as this infection can lead to respiratory distress and death in premature in infants. Report the successful control of an outbreak that occurred in April 2010 in a NICU. Methods After the index case, of 18 premature infants placed in the same room 10 infants were infected. Of those 10, 6 developed mild to moderate respiratory symptoms, 4 persisted asymptomatic and no death occurred. Contact and respiratory precautions were rapidly initiated, the infants were cohorted in 3 different rooms and palivizumab was administered to all contacts. Results The outbreak was controlled and no new cases were subsequently indentified. Conclusion Standard infection control measures plus palivizumab prophylaxis were efficient in rapid control of the outbreak.

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

    Science.gov (United States)

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

    2016-12-30

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

  1. OUTBREAK INVESTIGATION AND CONTROL OF BRUCELLOSIS

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    Biserka I. Vasileva

    2016-08-01

    Full Text Available Background: Brucellosisis an infectious and contagious disease caused by bacterial species of the genus Brucella. It is a major zoonosis with an important social and economic impact. Objective: The objective of this study was to investigate and analyze the measures application for control and eradication of brucellosis occurred in the region of Pleven. Methods: We conducted a retrospective epidemiological study. Respective documents were reviewed. We analyzed Case report form and Questionnaire for persons suspected of having brucellosis. Conclusions were made of the possible source of the disease and the risk factors leading to infection of humans. Results: A focus of Brucellosis among the animals to private goat farm in August was detected. The connection to other existing in the country focuses has been proved. Two of the persons, having had contacts with the animals developed clinical symptoms of the disease; referenced persons have consumed fresh goat cheese and milk. A joint epidemiological investigation with representatives of responsible authorities was carried out and measures undertook to restrict and liquidate the focus. Conclusion: Brucellosis in man can only be prevented effectively by elimination of the animal reservoir. This necessitates a close interaction between the medical authorities concerned with public health authorities on the one hand and the veterinary authorities on the other.

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

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

    2015-06-01

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

  3. Quick control of bubonic plague outbreak in Uttar Kashi, India.

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    Mittal, Veena; Rana, U V S; Jain, S K; Kumar, Kaushal; Pal, I S; Arya, R C; Ichhpujani, R L; Lal, Shiv; Agarwal, S P

    2004-12-01

    A localized outbreak of bubonic plague occurred in village Dangud (population 332), district Uttar Kashi, Uttaranchal, India in the second week of October 2004. 8 cases were considered outbreak associated based on their clinical and epidemiological characteristics; 3 (27.3%) of them died within 48 hours of developing illness. All the 3 fatal cases and five surviving cases had enlargement of inguinal lymph nodes. None of them had pneumonia. The age of the cases ranged from 23-70 years and both sexes were affected. No such illness was reported from adjoining villages. The outbreak was fully contained within two weeks of its onset by supervised comprehensive chemoprophylaxis using tetracycline. A total of approximately 1250 persons were given chemoprophylaxis in three villages. There was no clear history of rat fall in the village. No flea was found on rodents or animals. 16 animal serum samples were found to be negative for antibodies against F-1 antigen of Y. pestis. However, Y. pestis was isolated from two rodents (Rattus rattus and Mus musculus) trapped in the village. One case and three animal sera showed borderline sero-positivity against rickettsial infection. The diagnosis of plague was confirmed by detection of four fold rise of antibody titre against F-1 antigen of Yersinia pestis in paired sera of three cases (one of the WHO approved criteria of diagnosis of confirmed plague). This outbreak and the occurrence of earlier outbreaks of plague in Surat (Gujarat) and Beed (Maharashtra) in 1994 and in district Shimla (Himachal Pradesh) in 2002 confirm that plague infection continue to exist in sylvatic foci in many parts of India which is transmitted to humans occasionally. Thus, there is a strong need for the States to monitor the plague activity in known sylvatic foci regularly and have a system of surveillance to facilitate prompt diagnosis and treatment of cases to control the disease. This investigation highlights that with high index of suspicion the

  4. Ebola virus disease outbreak in Nigeria: Transmission dynamics and rapid control.

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    Althaus, C L; Low, N; Musa, E O; Shuaib, F; Gsteiger, S

    2015-06-01

    International air travel has already spread Ebola virus disease (EVD) to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and calculated the risk that a single undetected case will cause a new outbreak. We fitted an EVD transmission model to data from the outbreak in Nigeria and estimated the reproduction number of the index case at 9.0 (95% confidence interval [CI]: 5.2-15.6). We also found that the net reproduction number fell below unity 15 days (95% CI: 11-21 days) after the arrival of the index case. Hence, our study illustrates the time window for successful containment of EVD outbreaks caused by infected air travelers. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Ebola virus disease outbreak in Nigeria: Transmission dynamics and rapid control

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    C.L. Althaus

    2015-06-01

    Full Text Available International air travel has already spread Ebola virus disease (EVD to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and calculated the risk that a single undetected case will cause a new outbreak. We fitted an EVD transmission model to data from the outbreak in Nigeria and estimated the reproduction number of the index case at 9.0 (95% confidence interval [CI]: 5.2–15.6. We also found that the net reproduction number fell below unity 15 days (95% CI: 11–21 days after the arrival of the index case. Hence, our study illustrates the time window for successful containment of EVD outbreaks caused by infected air travelers.

  6. [First Results of the German consulting center for infection control outbreak registry].

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    Schulz-Stübner, S; Reska, M; Hauer, T; Schaumann, R

    2016-03-01

    Outbreaks of infectious diseases and / or colonization pose an increasing burden on hospitals and the health system in general and can be a threat to patient safety. At the end of 2013 we implemented a quality assurance registry of outbreak investigations performed by the Deutsches Beratungszentrum für Hygiene (German Consulting Center for Infection Control and prevention) in Freiburg. Now we analyzed the registered outbreaks until January 2015. Norovirus was the leading causative organism and gram negative bacteria dominated the group of bacterial outbreaks. Outbreaks lasted between 6 and 185 days. 24 % of outbreaks were related to colonization only. Within 29 outbreaks we had 187 infected patients, 50 colonized patients und 92 infected health care workers (64 x norovirus, 20 x influenza, 8 x scabies). No deaths were recorded. Several risk factors and improvement potentials for future outbreaks could be identified. Lack of staff compliance with vaccination or prophylactic therapy, misuse of personal protective equipment and lapses in absence from work for the required time can play an important role for prolonged outbreak situations esp. with viral outbreaks and scabies. A structured and goal directed outbreak management especially in the initial phase of an outbreak seems to be important for an efficient and fast termination of an outbreak. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Investigation of key interventions for shigellosis outbreak control in China.

    Directory of Open Access Journals (Sweden)

    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.

  8. Norovirus outbreaks in a hospital setting: the role of infection control.

    Science.gov (United States)

    Lynn, Sarah; Toop, Julianne; Hanger, Carl; Millar, Nigel

    2004-02-20

    Noroviruses (NV) (until recently known as Norwalk-like viruses) are a common cause of outbreaks of viral gastroenteritis and can result in significant hospital disruption. We report our experience of two outbreaks that occurred in a geriatric rehabilitation hospital and the role of infection control in limiting their spread. The outbreaks occurred in two separate rehabilitation wards for older people. A case definition was developed and a register kept to record patient and staff sickness. The NV was identified from faecal specimens by reverse transcriptase polymerase chain reaction. There were 41 cases in the first outbreak, with an attack rate of 57.1% for patients and 41% for staff. The outbreak lasted 14 days and closed the ward for 11 days. During this outbreak one patient died, with gastroenteritis the precipitating event of his final illness. There were 24 cases in the second outbreak, with an attack rate of 56.5% for patients and 18% for staff. The outbreak lasted 16 days with the ward closed for six days. The mean duration of staff sickness was 3.5 days in the second outbreak compared with only 1.2 days in the first outbreak. In both outbreaks infection was contained within a single ward. NV infections can significantly disrupt hospitals through their rapid spread to patients and staff as well as the associated high attack rate. Early recognition of an outbreak and prompt implementation of infection control measures, staffing restrictions and ward closure can limit the spread of infection.

  9. Tularemia outbreak investigation in Kosovo: case control and environmental studies.

    Science.gov (United States)

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

    2002-01-01

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

  10. Contact switching as a control strategy for epidemic outbreaks.

    Science.gov (United States)

    Risau-Gusman, Sebastián; Zanette, Damián H

    2009-03-07

    We study the effects of switching social contacts as a strategy to control epidemic outbreaks. Connections between susceptible and infective individuals can be broken by either individual, and then reconnected to a randomly chosen member of the population. It is assumed that the reconnecting individual has no previous information on the epidemiological condition of the new contact. We show that reconnection can completely suppress the disease, both by continuous and discontinuous transitions between the endemic and the infection-free states. For diseases with an asymptomatic phase, we analyze the conditions for the suppression of the disease, and show that-even when these conditions are not met-the increase of the endemic infection level is usually rather small. We conclude that, within some simple epidemiological models, contact switching is a quite robust and effective control strategy. This suggests that it may also be an efficient method in more complex situations.

  11. 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

  12. 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

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

  13. Bluetongue outbreaks: Looking for effective control strategies against Culicoides vectors.

    Science.gov (United States)

    Benelli, Giovanni; Buttazzoni, Luca; Canale, Angelo; D'Andrea, Armando; Del Serrone, Paola; Delrio, Gavino; Foxi, Cipriano; Mariani, Susanna; Savini, Giovanni; Vadivalagan, Chithravel; Murugan, Kadarkarai; Toniolo, Chiara; Nicoletti, Marcello; Serafini, Mauro

    2017-12-01

    Several arthropod-borne diseases are now rising with increasing impact and risks for public health, due to environmental changes and resistance to pesticides currently marketed. In addition to community surveillance programs and a careful management of herds, a next-generation of effective products is urgently needed to control the spread of these diseases, with special reference to arboviral ones. Natural product research can afford alternative solutions. Recently, a re-emerging of bluetongue disease is ongoing in Italy. Bluetongue is a viral disease that affects ruminants and is spread through the bite of bloodsucking insects, especially Culicoides species. In this review, we focused on the importance of vector control programs for prevention or bluetongue outbreaks, outlining the lack of effective tools in the fight against Culicoides vectors. Then, we analyzed a field case study in Sardinia (Italy) concerning the utilization of the neem cake (Azadirachta indica), to control young instar populations of Culicoides biting midges, the vectors of bluetongue virus. Neem cake is a cheap and eco-friendly by-product obtained from the extraction of neem oil. Overall, we propose that the employ of neem extraction by-products as aqueous formulations in muddy sites close to livestock grazing areas may represent an effective tool in the fight against the spread of bluetongue virus in the Mediterranean areas. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2016-04-01

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

  15. [A model for evaluation of key measures for control of chikungunya fever outbreak in China].

    Science.gov (United States)

    Zhao, Jin; Liu, Ruchun; Chen, Shuilian; Chen, Tianmu

    2015-11-01

    To analyze the transmission pattern of Chikungunya (CHIK) fever in community and evaluate the effectiveness of mosquito control, case isolation and other key control measures by using ordinary differential equation (ODE) model. According to natural history of CHIK, an ODE model for the epidemiological analysis of CHIK outbreak was established. The key parameters of the model were obtained by fitting the model with reported outbreak data of the first CHIK outbreak in China. Then the outbreak characteristics without intervention, the effectiveness of mosquito control and case isolation were simulated. Without intervention, an imported case would cause an outbreak in a community with population of 11 000, and cumulative case number would exceed 941 when the total attack rate was 8.55%. The results of our simulation revealed that the effectiveness of case isolation was not perfect enough when it was implemented alone. Although the number of cases could be decreased by case isolation, the duration of outbreak would not be shortened. Differently, the effectiveness of mosquito control was remarkable. In addition, the earlier the measure was implemented, the better the effectiveness would be. The effectiveness of mosquito control plus case isolation was same with mosquito control. To control a CHIK outbreak, mosquito control is the most recommended measures. However, case isolation is also necessary as the supplementation of mosquito control.

  16. Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

    Science.gov (United States)

    Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John

    2017-10-01

    Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Detection and control of influenza outbreaks in well-vaccinated nursing home populations.

    Science.gov (United States)

    Monto, Arnold S; Rotthoff, Judy; Teich, Esther; Herlocher, M Louise; Truscon, Rachel; Yen, Hui-Ling; Elias, Stephanie; Ohmit, Suzanne E

    2004-08-15

    Influenza outbreaks continue to occur in nursing homes despite high vaccination coverage among residents. Recommendations for outbreak control in institutions such as nursing homes advises use of antiviral drugs to reduce influenza transmission. Influenza surveillance was performed among elderly residents of nursing homes in Michigan during 2 influenza seasons. The antiviral drug oseltamivir was used for outbreak control at the discretion of nursing home staff once influenza transmission was confirmed by virus isolation or rapid antigen detection. During 2000-2001, influenza was not confirmed in any of the 28 participating homes, despite transmission of types A (H1N1) and B in the community. During 2001-2002, influenza type A (H3N2) transmission was confirmed in 8 (26%) of 31 participating homes; influenza vaccine coverage among residents was 57%- 98% in outbreak-associated homes. Oseltamivir was used in all homes with influenza transmission; outbreak control varied according to the rapidity of outbreak recognition and the extent of antiviral use. Reported adverse events were primarily gastrointestinal reactions and rashes. Analysis of the usefulness of rapid antigen detection tests for outbreak recognition indicated a sensitivity of only 77% (specificity, 92%). Oseltamivir was reasonably well tolerated, and its use, along with continued promotion of vaccination coverage among nursing home residents and staff, should be a valuable addition to institutional outbreak-control strategies.

  18. Modelling Aedes aegypti mosquito control via transgenic and sterile insect techniques: Endemics and emerging outbreaks

    KAUST Repository

    Seirin Lee, S.

    2013-08-01

    The invasion of pest insects often changes or destroys a native ecosystem, and can result in food shortages and disease endemics. Issues such as the environmental effects of chemical control methods, the economic burden of maintaining control strategies and the risk of pest resistance still remain, and mosquito-borne diseases such as malaria and dengue fever prevail in many countries, infecting over 100 million worldwide in 2010. One environmentally friendly method for mosquito control is the Sterile Insect Technique (SIT). This species-specific method of insect control relies on the mass rearing, sterilization and release of large numbers of sterile insects. An alternative transgenic method is the Release of Insects carrying a Dominant Lethal (RIDL). Our objective is to consider contrasting control strategies for two invasive scenarios via SIT and RIDL: an endemic case and an emerging outbreak. We investigate how the release rate and size of release region influence both the potential for control success and the resources needed to achieve it, under a range of conditions and control strategies, and we discuss advantageous strategies with respect to reducing the release resources and strategy costs (in terms of control mosquito numbers) required to achieve complete eradication of wild-type mosquitoes. © 2013 Elsevier Ltd.

  19. Epidemiologic features of four successive annual outbreaks of bubonic plague in Mahajanga, Madagascar.

    Science.gov (United States)

    Boisier, Pascal; Rahalison, Lila; Rasolomaharo, Monique; Ratsitorahina, Maherisoa; Mahafaly, Mahafaly; Razafimahefa, Maminirana; Duplantier, Jean-Marc; Ratsifasoamanana, Lala; Chanteau, Suzanne

    2002-03-01

    From 1995 to 1998, outbreaks of bubonic plague occurred annually in the coastal city of Mahajanga, Madagascar. A total of 1,702 clinically suspected cases of bubonic plague were reported, including 515 laboratory confirmed by Yersinia pestis isolation (297), enzyme-linked immunosorbent assay, or both. Incidence was higher in males and young persons. Most buboes were inguinal, but children had a higher frequency of cervical or axillary buboes. Among laboratory-confirmed hospitalized patients, the case-fatality rate was 7.9%, although all Y. pestis isolates were sensitive to streptomycin, the recommended antibiotic. In this tropical city, plague outbreaks occur during the dry and cool season. Most cases are concentrated in the same crowded and unsanitary districts, a result of close contact among humans, rats, and shrews. Plague remains an important public health problem in Madagascar, and the potential is substantial for spread to other coastal cities and abroad.

  20. Epidemiologic Features of Four Successive Annual Outbreaks of Bubonic Plague in Mahajanga, Madagascar

    Science.gov (United States)

    Rahalison, Lila; Rasolomaharo, Monique; Ratsitorahina, Maherisoa; Mahafaly, Mahafaly; Razafimahefa, Maminirana; Duplantier, Jean-Marc; Ratsifasoamanana, Lala; Chanteau, Suzanne

    2002-01-01

    From 1995 to 1998, outbreaks of bubonic plague occurred annually in the coastal city of Mahajanga, Madagascar. A total of 1,702 clinically suspected cases of bubonic plague were reported, including 515 laboratory confirmed by Yersinia pestis isolation (297), enzyme-linked immunosorbent assay, or both. Incidence was higher in males and young persons. Most buboes were inguinal, but children had a higher frequency of cervical or axillary buboes. Among laboratory-confirmed hospitalized patients, the case-fatality rate was 7.9%, although all Y. pestis isolates were sensitive to streptomycin, the recommended antibiotic. In this tropical city, plague outbreaks occur during the dry and cool season. Most cases are concentrated in the same crowded and insanitary districts, a result of close contact among humans, rats, and shrews. Plague remains an important public health problem in Madagascar, and the potential is substantial for spread to other coastal cities and abroad. PMID:11927030

  1. Epidemiologic Features of Four Successive Annual Outbreaks of Bubonic Plague in Mahajanga, Madagascar

    OpenAIRE

    Boisier, Pascal; Rahalison, Lila; Rasolomaharo, Monique; Ratsitorahina, Maherisoa; Mahafaly, Mahafaly; Razafimahefa, Maminirana; Duplantier, Jean-Marc; Ratsifasoamanana, Lala; Chanteau, Suzanne

    2002-01-01

    From 1995 to 1998, outbreaks of bubonic plague occurred annually in the coastal city of Mahajanga, Madagascar. A total of 1,702 clinically suspected cases of bubonic plague were reported, including 515 laboratory confirmed by Yersinia pestis isolation (297), enzyme-linked immunosorbent assay, or both. Incidence was higher in males and young persons. Most buboes were inguinal, but children had a higher frequency of cervical or axillary buboes. Among laboratory-confirmed hospitalized patients, ...

  2. Burden of norovirus in healthcare facilities and strategies for outbreak control

    Science.gov (United States)

    Kambhampati, A.; Koopmans, M.; Lopman, B.A.

    2015-01-01

    SUMMARY Norovirus is the most frequently occurring cause of community-acquired acute gastroenteritis in people of all ages. It is also one of the most frequent causes of outbreaks in healthcare settings, affecting both long-term care facilities and acute care hospitals. Whereas norovirus gastroenteritis is typically mild and resolves without medical attention, healthcare-associated infections often affect vulnerable populations, resulting in severe infections and disruption of healthcare services. Globally, most norovirus outbreaks in hospitals and residential care institutions are associated with genogroup II type 4 (GII.4) strains. Recent data demonstrate that excess mortality occurs during outbreak periods in healthcare facilities. Nosocomial outbreaks can result in large economic and societal costs. Current control measures for norovirus are largely based on general infection control principles, and treatment is mainly supportive and non-specific. While neither vaccines nor antiviral agents are currently available, both are being developed with encouraging results. PMID:25726433

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

    Science.gov (United States)

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

    2007-03-01

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

  4. 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

    2013-02-01

    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.

  5. Influenza outbreak detection and control measures in nursing homes in the United States.

    Science.gov (United States)

    Zadeh, M M; Buxton Bridges, C; Thompson, W W; Arden, N H; Fukuda, K

    2000-10-01

    To evaluate the use of influenza vaccine, rapid influenza testing, and influenza antiviral medication in nursing homes in the US to prevent and control outbreaks. Survey questionnaires were sent to 1017 randomly selected nursing homes in nine states. Information was collected on influenza prevention, detection and control practices, and on outbreaks during three influenza seasons (1995-1998). The survey response rate was 78%. Influenza vaccine was offered to residents and staff by 99% and 86%, respectively, of nursing homes. Among nursing homes offering the influenza vaccine, the average vaccination rate was 83% for residents and 46% for staff. Sixty-seven percent of the nursing homes reported having access to laboratories with rapid antigen testing capabilities, and 19% reported having a written policy for the use of influenza antiviral medications for outbreak control. Nursing homes from New York, where organized education programs on influenza detection and control have been conducted for many years, were more likely to have reported a suspected or laboratory-confirmed influenza outbreak (51% vs 10%, P = .01), to have access to rapid antigen testing for influenza (92% vs 63%, P = .01), and to use antivirals for prophylaxis and treatment of influenza A for their nursing home residents (94% vs 55%, P = .01) compared with nursing homes from the other eight states. Influenza outbreaks among nursing home residents can lead to substantial morbidity and mortality when prevention measures are not rapidly instituted. However, many nursing homes in this survey were neither prepared to detect nor to control influenza A outbreaks. Targeted, sustained educational efforts can improve the detection and control of outbreaks in nursing homes.

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

    Science.gov (United States)

    Chorba, Terence, L.; And Others

    1987-01-01

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

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

    DEFF Research Database (Denmark)

    Dórea, Fernanda C.; Nöremark, Maria; Widgren, Stefan

    2017-01-01

    To minimize the potential consequences of an introduction of foot-and-mouth disease (FMD) in Europe, European Union (EU) member states are required to present a contingency plan. This study used a simulation model to study potential outbreak scenarios in Sweden and evaluate the best control...... of enforcement of interventions, was assessed. With the estimated currently available resources, an FMD outbreak in Sweden is expected to be controlled (i.e., last infected herd detected) within 3 weeks of detection in any evaluated scenario. The density of farms in the area where the epidemic started would have...... efficacy of the basic control measures evaluated, under the conditions of the Swedish livestock industry, and considering the assumed control resources available. The results indicate that the duration and extent of FMD outbreaks could be kept limited in Sweden using the EU standard control strategy...

  8. A review of gastrointestinal outbreaks in schools: effective infection control interventions.

    Science.gov (United States)

    Lee, Marilyn B; Greig, Judy D

    2010-12-01

    The purpose of this study was to review documented outbreaks of gastrointestinal illness in schools, published in the last 10 years, to identify etiology, mode of transmission, the number of children affected, morbidity and mortality patterns, and interventions for control and prevention. Searches of electronic databases, public health publications, and federal, state, and provincial public health Web sites were completed. Of the 121 outbreaks that met the inclusion criteria, 51% were bacterial, 40% viral, 7% were from Cryptosporidium, and 2% from multiple organisms. Transmission routes recorded in 101 reports included foodborne (45%), person-to-person (16%), waterborne (12%), and animal contact (11%). Actions to control outbreaks included alerting medical and public health authorities or the community to the outbreak (13%), treating cases (12%), enhancing hand washing (11%), and increased vigilance during food preparation (8%). Recommendations to prevent future outbreaks were compared with previously published studies that demonstrated effectiveness. The risk of foodborne illness was reduced when food handlers practiced effective hand washing technique and received food safety training and certification. Student training programs on hand hygiene, enhanced cleaning and disinfection of the school, and hepatitis A vaccination were found effective. Children should be supervised on farm visits, hand washing strictly enforced, and food eaten in an area separated from the animals. Staff and students should have a positive, continuous communication with public health authorities including educational sessions and immediate reporting of possible outbreaks. © 2010, American School Health Association.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Gerald Amandu Matua

    Full Text Available Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridaefamily, 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, Bundibugyoand RestonEbola 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

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

    Science.gov (United States)

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

    2016-01-01

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

  12. Essential information: Uncertainty and optimal control of Ebola outbreaks

    Science.gov (United States)

    Li, Shou-Li; Bjornstad, Ottar; Ferrari, Matthew J.; Mummah, Riley; Runge, Michael C.; Fonnesbeck, Christopher J.; Tildesley, Michael J.; Probert, William J. M.; Shea, Katriona

    2017-01-01

    Early resolution of uncertainty during an epidemic outbreak can lead to rapid and efficient decision making, provided that the uncertainty affects prioritization of actions. The wide range in caseload projections for the 2014 Ebola outbreak caused great concern and debate about the utility of models. By coding and running 37 published Ebola models with five candidate interventions, we found that, despite this large variation in caseload projection, the ranking of management options was relatively consistent. Reducing funeral transmission and reducing community transmission were generally ranked as the two best options. Value of information (VoI) analyses show that caseloads could be reduced by 11% by resolving all model-specific uncertainties, with information about model structure accounting for 82% of this reduction and uncertainty about caseload only accounting for 12%. Our study shows that the uncertainty that is of most interest epidemiologically may not be the same as the uncertainty that is most relevant for management. If the goal is to improve management outcomes, then the focus of study should be to identify and resolve those uncertainties that most hinder the choice of an optimal intervention. Our study further shows that simplifying multiple alternative models into a smaller number of relevant groups (here, with shared structure) could streamline the decision-making process and may allow for a better integration of epidemiological modeling and decision making for policy.

  13. 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.

  14. Infectious Diseases Associated With Organized Sports and Outbreak Control.

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2013-09-01

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

  16. Use of oral cholera vaccines in an outbreak in Vietnam: a case control study.

    Directory of Open Access Journals (Sweden)

    Dang Duc Anh

    Full Text Available BACKGROUND: Killed oral cholera vaccines (OCVs are available but not used routinely for cholera control except in Vietnam, which produces its own vaccine. In 2007-2008, unprecedented cholera outbreaks occurred in the capital, Hanoi, prompting immunization in two districts. In an outbreak investigation, we assessed the effectiveness of killed OCV use after a cholera outbreak began. METHODOLOGY/PRINCIPAL FINDINGS: From 16 to 28 January 2008, vaccination campaigns with the Vietnamese killed OCV were held in two districts of Hanoi. No cholera cases were detected from 5 February to 4 March 2008, after which cases were again identified. Beginning 8 April 2008, residents of four districts of Hanoi admitted to one of five hospitals for acute diarrhea with onset after 5 March 2008 were recruited for a matched, hospital-based, case-control outbreak investigation. Cases were matched by hospital, admission date, district, gender, and age to controls admitted for non-diarrheal conditions. Subjects from the two vaccinated districts were evaluated to determine vaccine effectiveness. 54 case-control pairs from the vaccinated districts were included in the analysis. There were 8 (15% and 16 (30% vaccine recipients among cases and controls, respectively. The vaccine was 76% protective against cholera in this setting (95% CI 5% to 94%, P = 0.042 after adjusting for intake of dog meat or raw vegetables and not drinking boiled or bottled water most of the time. CONCLUSIONS/SIGNIFICANCE: This is the first study to explore the effectiveness of the reactive use of killed OCVs during a cholera outbreak. Our findings suggest that killed OCVs may have a role in controlling cholera outbreaks.

  17. Control of a Multi-Drug-Resistant Acinetobacter baumannii Outbreak after Orthopedics Department Relocation

    Science.gov (United States)

    Gogou, Vasiliki; Meletis, Georgios; Tsitouras, Dimosthenis

    2013-01-01

    Acinetobacter baumannii clinical isolates have the ability to survive in the hospital niche for prolonged time periods and to develop resistance against multiple antimicrobial agents. Therefore, A. baumannii has emerged as an important cause of nosocomial outbreaks worldwide, especially in critical-care environments such as intensive care units. In the present communication, we report a multi-drug-resistant A. baumannii outbreak that occurred in an orthopedics department in Greece after the admission of a patient previously hospitalized in the intensive care unit of a Greek tertiary care hospital. Despite the implementation of infection control measures, 29 patients were infected, significantly raising their hospitalization periods and treatment costs. Interestingly, the outbreak was put under control after the department’s previously programmed relocation. PMID:27694769

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2014-01-01

    We describe the identification and control of an outbreak of gentamicin resistant, meticillin susceptible Staphylococcus aureus (GR-MSSA) on a 36-bed neonatal unit (NNU) in London. Control measures included admission and weekly screening for GR-MSSA, cohorting affected babies, environmental and staff screening, hydrogen peroxide vapour (HPV) for terminal disinfection of cohort rooms, and reinforcement of hand hygiene. Seventeen babies were affected by the outbreak strain over ten months; seven were infected and ten were asymptomatic carriers. The outbreak strain was gentamicin resistant and all isolates were indistinguishable by pulsed-field gel electrophoresis. The outbreak strains spread rapidly and were associated with a high rate of bacteraemia (35% of 17 affected patients had bacteraemia vs. 10% of 284 patients with MSSA prior to the outbreak, p=0.007). None of 113 staff members tested were colonised with GR-MSSA. GR-MSSA was recovered from 11.5% of 87 environmental surfaces in cohort rooms, 7.1% of 28 communal surfaces and 4.1% of 74 surfaces after conventional terminal disinfection. None of 64 surfaces sampled after HPV decontamination yielded GR-MSSA. Recovery of GR-MSSA from two high level sites suggested that the organism could have been transmitted via air. Occasional breakdown in hand hygiene compliance and contaminated environmental surfaces probably contributed to transmission. PMID:28989367

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

    Science.gov (United States)

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

    2016-10-01

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

  1. Norovirus outbreaks in nursing homes: the evaluation of infection control measures.

    NARCIS (Netherlands)

    Friesema, I.H.; Vennema, H.; Heijne, J.C.; Jager, C.M. de; Morroy, G.; Kerkhof, J.H. van den; Coster, E.J. de; Wolters, B.A.; Waarbeek, H.L. ter; Fanoy, E.B.; Teunis, P.F.; Linde, R. van der; Duynhoven, Y.T.H.P. van

    2009-01-01

    Effective infection control measures during norovirus outbreaks are urgently needed in places where vulnerable individuals gather. In the present study, the effect of a number of measures was investigated in daily practice. Forty-nine Dutch nursing homes were monitored prospectively for norovirus

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

    Science.gov (United States)

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

    2014-01-01

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

  3. Control of an Acinetobacter [corrected] baumannii outbreak in a neonatal ICU without suspension of service: a devastating outbreak in Diyarbakir, Turkey.

    Science.gov (United States)

    Hosoglu, S; Hascuhadar, M; Yasar, E; Uslu, S; Aldudak, B

    2012-02-01

    A nosocomial outbreak of Acinetobacter baumannii bloodstream infections (Ab-BSI) was identified in Diyarbakir Children's Hospital's (Diyarbakir, Turkey) 60-bed Neonatal Intensive Care Unit (NICU) in 2006 and 2007. The investigation and control of the outbreak were based on case-control and epidemiological studies as well as multifaceted interventions. Sixty-four neonates (case patients) with Ab-BSI and 128 neonates (control patients) free of Ab-BSI, who had been hospitalized at the unit during the outbreak period, were included in the study. Case and control patients were compared for possible predisposing factors (e.g., gender, length of NICU stay, antibiotic use, intubation, etc.). An intervention program (cohorting, education, reinforcing hand hygiene, antibiotic restriction, improving processes of patient care, environmental cleaning, and barrier isolation) was implemented to control the outbreak. Surveillance cultures were collected from all possible sources, and the epidemiological investigation was supplemented by a pulsed field gel electrophoresis (PFGE) study. Fifty-three neonates (82.8%) died in the case group and 51 (39.8%) in the control group (P cases and environmental samples, had an identical PFGE fingerprint pattern. The control of Ab-BSI requires a multifaceted intervention program and complex efforts and implementations, especially if the ICU does not implement any suspension of care provision.

  4. Phylogenetic analysis in a recent controlled outbreak of Crimean-Congo haemorrhagic fever in the south of Iran, December 2008

    DEFF Research Database (Denmark)

    Chinikar, S; Ghiasi, Seyed Mojtaba; Mojtaba Ghiasi, S

    2010-01-01

    Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus is transmitted to humans through the bite of Ixodid ticks or contact with blood or tissues of CCHF patients or infected livestock. In December 2008, a re-emerging outbreak...... of this transmission. This outbreak should be considered as a warning for the national CCHF surveillance system to avoid further outbreaks through robust prevention and control programmes....

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

    Science.gov (United States)

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

    2012-01-01

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

  6. Efficacies of prevention and control measures applied during an outbreak in Southwest Madrid, Spain.

    Directory of Open Access Journals (Sweden)

    Anaiá da Paixão Sevá

    in this and in other similar outbreaks. The present mathematical model was able to reproduce the leishmaniasis dynamics in the Madrid outbreak, providing theoretical support based on successful experiences, such as the reduction of human cases in Southwest Madrid, Spain.

  7. Efficacies of prevention and control measures applied during an outbreak in Southwest Madrid, Spain.

    Science.gov (United States)

    Sevá, Anaiá da Paixão; Martcheva, Maia; Tuncer, Necibe; Fontana, Isabella; Carrillo, Eugenia; Moreno, Javier; Keesling, James

    2017-01-01

    other similar outbreaks. The present mathematical model was able to reproduce the leishmaniasis dynamics in the Madrid outbreak, providing theoretical support based on successful experiences, such as the reduction of human cases in Southwest Madrid, Spain.

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

    Science.gov (United States)

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

    2017-02-01

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

  9. Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica.

    Science.gov (United States)

    Wong-McClure, Roy A; Ramírez-Salas, Elenita; Mora-Brenes, Nury; Aguero-Sandí, Lorena; Morera-Sigler, Maritza; Badilla-Vargas, Xiomara; Hernández-de Merzerville, Marcela; O'Shea, Michele; Bryce, Elizabeth

    2013-12-15

    The C. difficile BI/NAP 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. The present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a C. difficile BI/NAP 1 hyper virulent strain outbreak in Costa Rica. A descriptive analysis of the C. difficile outbreak was completed for the period of January 2007 to December 2010 in one affected hospital. An unmatched case-control study was subsequently performed to evaluate the association of exposure factors with C. difficile infection. The pattern of the outbreak was characterized by a sharp increase in the incidence rate during the initial weeks of the outbreak, which was followed by a reduction in the incidence curve as several infection control measures were implemented. The C. difficile BI/NAP1 infection was associated with the prescription of antibiotics, in particular levofloxacin (OR: 9.3; 95%CI: 2.1-40.2), meropenem (OR: 4.9, 95%CI: 1.0-22.9), cefotaxime (OR: 4.3, 95%CI: 2.4-7.7), as well as a medical history of diabetes mellitus (OR: 2.9, 95%CI: 1.5-5.8). The infection control strategies implemented proved to be effective in achieving outbreak control and in maintaining the baseline C. difficile incidence rate following it. The reported C. difficile outbreak was associated with the prescription of broad-spectrum antibiotics and a medical history of diabetes.

  10. Detection and control of a nosocomial outbreak caused by Salmonella newport at a large animal hospital.

    Science.gov (United States)

    Steneroden, K K; Van Metre, D C; Jackson, C; Morley, P S

    2010-01-01

    Nosocomial salmonellosis is often assumed to occur because infection control and surveillance practices are inadequate, but published evidence is lacking to support the related contention that rigorous application of these practices can impact the severity of outbreaks. Describe active surveillance, early recognition, and intensive mitigation efforts used in an effort to control an outbreak of nosocomial Salmonella enterica serotype Newport infections without hospital closure. Large animals hospitalized at a referral hospital. This prospective outbreak investigation was initiated when Salmonella Newport infections were detected among hospitalized animals by active surveillance. Data were analyzed to identify temporal and spatial patterns for epidemic spread of Salmonella in the hospital. Mitigation efforts were aggressively adjusted in response to surveillance data. Genetic relatedness of isolates was investigated by pulsed-field gel electrophoresis. Of 145 large animals sampled, 8 (5.6%) were infected with the Salmonella strain associated with this outbreak, and all but 1 shed Salmonella in the absence of or before the onset of disease. This strain was recovered from 14.2% (42/295) of environmental samples (ENV samples), indicating that widespread environmental contamination had occurred. Isolates of Salmonella Newport obtained from infected animals and the environment were genetically indistinguishable, confirming clonal dissemination. Active surveillance allowed early detection of nosocomial Salmonella transmission and hospital contamination. Use of aggressive interventions was followed by cessation of transmission. Active surveillance can allow earlier recognition and mitigation compared with programs by only sampling of clinically affected animals.

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

    Directory of Open Access Journals (Sweden)

    Dominik Kulakowski

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

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

    Directory of Open Access Journals (Sweden)

    Fernanda C. Dórea

    2017-07-01

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

  13. Prolonged outbreak of Serratia marcescens in Tartu University Hospital: a case-control study.

    Science.gov (United States)

    Adamson, Vivika; Mitt, Piret; Pisarev, Heti; Metsvaht, Tuuli; Telling, Kaidi; Naaber, Paul; Maimets, Matti

    2012-10-31

    The aim of our study was to investigate and control an outbreak and identify risk factors for colonization and infection with Serratia marcescens in two departments in Tartu University Hospital. The retrospective case-control study was conducted from July 2005 to December 2006. Molecular typing by pulsed field gel electrophoresis was used to confirm the relatedness of Serratia marcescens strains. Samples from the environment and from the hands of personnel were cultured. The outbreak involved 210 patients, 61 (29%) developed an infection, among them 16 were invasive infections. Multivariate analysis identified gestational age, arterial catheter use and antibiotic treatment as independent risk factors for colonization and infection with Serratia marcescens. Molecular typing was performed on 83 Serratia marcescens strains, 81 of them were identical and 2 strains were different. Given the occasionally severe consequences of Serratia marcescens in infants, early implementation of aggressive infection control measures involving patients and mothers as well as the personnel is of utmost importance.

  14. Outbreaks: Sources of Epidemiological Knowledge in Communicable Disease Control

    NARCIS (Netherlands)

    P.L.J.M. Mertens (Paulus Leonardus Johannes Marie)

    2008-01-01

    textabstractPublic health has been defined as the science and art of disease prevention, prolonging life, and promoting health and well-being through organized community effort for the sanitation of the environment, the control of communicable infections, the organization of medical and nursing

  15. Dengue fever outbreaks in Eritrea, 2005-2015: A case for strengthening surveillance, control and reporting.

    Science.gov (United States)

    Usman, Abdulmumini; Ball, Jacob D; Rojas, Diana Patricia; Berhane, Araia; Ghebrat, Yohannes; Mebrahtu, Goitom; Gebresellasie, Azmera; Zehaie, Assefash; Mufunda, Jacob; Liseth, Olivia; Haque, Ubydul; Chanda, Emmanuel

    2016-01-01

    The geographic distribution and burden of dengue is increasing globally. This study aims to evaluate dengue outbreaks and to substantiate the need for strengthened surveillance, reporting and control in Eritrea. Data from two cross-sectional dengue epidemic investigations in 2005 and 2010 were analyzed. Samples were tested for dengue virus-specific IgM and IgG antibodies using capture enzyme-linked immunosorbent assays. Dengue vectors' breeding attributes were characterized and epidemic risk indices determined. National routine surveillance weekly reports from 2005 to the second quarter of 2015 were analyzed for spatiotemporal trends. Dengue outbreaks increased in Eritrea from 2005 to 2015 with clinical presentation varying markedly among patients. The house and container indices for Aedes aegypti were 40 and 39.6 % respectively, with containers having A. aeqypti varying significantly (P Eritrea and necessitates strengthening of surveillance and health worker and laboratory capacity, as well as targeted vector control interventions.

  16. Rubella outbreak investigation, Gokwe North District, Midlands province, Zimbabwe, 2014 - a case control study.

    Science.gov (United States)

    Makoni, Annamercy Chenaimoyo; Chemhuru, Milton; Bangure, Donewell; Gombe, Notion Tafara; Tshimanga, Mufuta

    2015-01-01

    Rubella is a contagious disease, caused by rubella virus and transmitted via the respiratory route. Rubella in pregnancy may cause Congenital Rubella Syndrome (CRS), characterized by multiple defects to the brain, heart, eyes and ears. Gokwe North experienced an increase in rubella cases from 6 cases (24 June 2014) to 374 cases (12 August 2014). The study was conducted to determine risk factors associated with contracting rubella. A 1:1 unmatched case control study was conducted. A case was a child 3 children in a household (AOR 2.59; 95%CI (1.23-5.42)). Only 10.2% and 6.8% of the caregivers' cases and controls respectively, knew rubella is spread through contact with an infected person (p = 0.57). Majority of caregivers (97.8%) reported to the health facility within two days of onset of rash. Outbreak was driven by contact at school and was spread into the community through school children. Screening and isolation of the sick controlled the outbreak. Routine rubella vaccination could be considered to prevent similar outbreaks.

  17. SECURE INTERNET OF THINGS-BASED CLOUD FRAMEWORK TO CONTROL ZIKA VIRUS OUTBREAK.

    Science.gov (United States)

    Sareen, Sanjay; Sood, Sandeep K; Gupta, Sunil Kumar

    2017-01-01

    Zika virus (ZikaV) is currently one of the most important emerging viruses in the world which has caused outbreaks and epidemics and has also been associated with severe clinical manifestations and congenital malformations. Traditional approaches to combat the ZikaV outbreak are not effective for detection and control. The aim of this study is to propose a cloud-based system to prevent and control the spread of Zika virus disease using integration of mobile phones and Internet of Things (IoT). A Naive Bayesian Network (NBN) is used to diagnose the possibly infected users, and Google Maps Web service is used to provide the geographic positioning system (GPS)-based risk assessment to prevent the outbreak. It is used to represent each ZikaV infected user, mosquito-dense sites, and breeding sites on the Google map that helps the government healthcare authorities to control such risk-prone areas effectively and efficiently. The performance and accuracy of the proposed system are evaluated using dataset for 2 million users. Our system provides high accuracy for initial diagnosis of different users according to their symptoms and appropriate GPS-based risk assessment. The cloud-based proposed system contributed to the accurate NBN-based classification of infected users and accurate identification of risk-prone areas using Google Maps.

  18. A Serratia marcescens outbreak in a neonatal intensive care unit was successfully managed by rapid hospital hygiene interventions and screening.

    Science.gov (United States)

    Åttman, Emilia; Korhonen, Päivi; Tammela, Outi; Vuento, Risto; Aittoniemi, Janne; Syrjänen, Jaana; Mattila, Erja; Österblad, Monica; Huttunen, Reetta

    2017-10-25

    Serratia marcescens is a rare, but important, pathogen in hospital-acquired infections, especially in neonatal units. Outbreaks may cause significant mortality among neonates. This paper describes how an outbreak of Serratia marcescens was handled in a neonatal intensive care unit in Finland in June 2015. Tampere University Hospital is the only hospital that offers intensive care for preterm neonates in the Pirkanmaa health district area in Finland. Between 9 June to 29 June 2015 seven neonates were screened positive for Serratia marcescens in the hospital. We examined the management and outcomes, including environmental sampling. Two of the seven neonates developed a blood stream infection and one with Serratia marcescens sepsis died after six days of antibiotic treatment. The outbreak was rapidly managed with active hospital hygiene interventions, including strict hand hygiene, cleaning, patient screening, contact precautions and education. Environmental sampling was limited to one water tap and a ventilator and the results were negative. The outbreak was contained within three weeks and no further cases appeared. The screening of healthcare workers was not necessary. A Serratia marcescens outbreak caused significant morbidity in neonates and one death. Rapid hospital hygiene interventions and patient screening effectively contained the outbreak. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  19. Control of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a day-care institution

    DEFF Research Database (Denmark)

    Jensen, Jens Ulrik; Jensen, ET; Larsen, AR

    2006-01-01

    This article describes an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in two institutions for multi-handicapped children in Copenhagen. The aim of the study was to determine whether it was possible to eradicate MRSA in a setting with multi-handicapped children and staff where...... there was a high degree of physical interaction. This was a prospective interventional uncontrolled cohort study that took place from January 2003 to March 2005. All individuals in close contact with the two institutions and/or in close contact with an MRSA-colonized subject from the outbreak were included...... in the study: 38 children, 60 staff members and 12 close relatives of colonized subjects. Infection control measures included screening all individuals. When MRSA infection or colonization was found, an attempt was made to eradicate MRSA, staff education was undertaken and attempts were made to determine...

  20. Estimating influenza vaccine effectiveness in an outbreak when anti-viral medications were used as a control measure.

    Science.gov (United States)

    Guy, Rebecca; Lambert, Stephen; Kelly, Heath

    2005-12-01

    To estimate influenza vaccine effectiveness (VE) from an outbreak of influenza A in an aged care facility in which neuraminidase inhibitors were used as part of outbreak control measures. The outbreak occurred between 25 December 2001 and 21 January 2002. Neuraminidase inhibitors were used to control the outbreak. Residents and staff with respiratory symptoms were tested for influenza using RT-PCR and/or serology. Vaccine effectiveness (VE) was estimated for the prevention of laboratory-confirmed influenza. Nineteen of 42 (45%) residents and four of 29 (14%) staff were laboratory-confirmed as cases. The outbreak was caused by an influenza A (H3N2) strain, antigenically matched to that season's vaccine. The VE for preventing laboratory-confirmed influenza infection was 61% (95% CI 41-73) among residents and 100% (95% CI 63-100) among staff. The VE estimates calculated from this outbreak were consistent with other published results. Outbreaks of influenza in institutions provide a good opportunity to review influenza VE, but use of antiviral medications as control measures may affect interpretation of findings.

  1. 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

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

    Science.gov (United States)

    Castilla, J; Barricarte, A; Aldaz, J; García Cenoz, M; Ferrer, T; Pelaz, C; Pineda, S; Baladrón, B; Martín, I; Goñi, B; Aratajo, P; Chamorro, J; Lameiro, F; Torroba, L; Dorronsoro, I; Martínez-Artola, V; Esparza, M J; Gastaminza, M A; Fraile, P; Aldaz, P

    2008-06-01

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

  3. Outbreaks of influenza A in nursing homes in Sheffield during the 1997-1998 season: implications for diagnosis and control.

    Science.gov (United States)

    Read, C A; Mohsen, A; Nguyen-Van-Tam, J S; McKendrick, M; Kudesia, G

    2000-03-01

    Three recent outbreaks of influenza A in nursing and residential homes in Sheffield were characterized by high attack rates among both residents and staff, and a high mortality rate among residents. The epidemiology of the outbreaks was unusual in that all three occurred towards the end of a quiet influenza season, against a generally low level of community activity, and involved strains of influenza that were not included in the current season's vaccine. The outbreak investigation was aided by the use of a novel rapid diagnostic technique. In future the combination of vaccination, surveillance, rapid diagnosis and new antineuraminidase drugs should improve prospects for control of influenza within closed communities.

  4. Potential Challenges of Controlling Leishmaniasis in Sri Lanka at a Disease Outbreak

    Directory of Open Access Journals (Sweden)

    Tharaka Wijerathna

    2017-01-01

    Full Text Available The present works reviewed the existing information on leishmaniasis in Sri Lanka and in other countries, focusing on challenges of controlling leishmaniasis in the country, in an outbreak. Evidence from recent studies suggests that there is a possibility of a leishmaniasis outbreak in Sri Lanka in the near future. Difficulty of early diagnosis due to lack of awareness and unavailability or inadequacy of sensitive tests are two of the main challenges for effective case management. Furthermore, the absence of a proper drug for treatment and lack of knowledge about vector biology, distribution, taxonomy and bionomics, and reservoir hosts make the problem serious. The evident potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka may also complicate the issue. Lack of knowledge among local communities also reduces the effectiveness of vector and reservoir host control programs. Immediate actions need to be taken in order to increase scientific knowledge about the disease and a higher effectiveness of the patient management and control programs must be achieved through increased awareness about the disease among general public and active participation of local community in control activities.

  5. Ebola virus disease outbreak in Nigeria: transmission dynamics and rapid control

    OpenAIRE

    Althaus, Christian L.; Gsteiger, Sandro; Musa, Emmanuel O.; Shuaib, Faisal; Low, Nicola

    2014-01-01

    International air travel has already spread Ebola virus disease (EVD) to major cities as part of the unprecedented epidemic that started in Guinea in December 2013. An infected airline passenger arrived in Nigeria on July 20, 2014 and caused an outbreak in Lagos and then Port Harcourt. After a total of 20 reported cases, including 8 deaths, Nigeria was declared EVD free on October 20, 2014. We quantified the impact of early control measures in preventing further spread of EVD in Nigeria and c...

  6. Previous Creatinine Levels Safely Predict Amantadine Dose for Influenza a Outbreak Control

    Directory of Open Access Journals (Sweden)

    Jane A Buxton

    2001-01-01

    Full Text Available BACKGROUND: Amantadine, an antiviral agent, is the only drug currently approved in Canada for prophylaxis of influenza A virus infection. To minimize side effects, the amantadine dose is adjusted for age and estimated creatinine clearance (CrCl based on plasma creatinine (Cr levels. As amantadine is used more frequently for influenza A outbreak control in care facilities for elderly people, physicians are increasingly called on to prescribe it for residents and to consider the necessity of requesting plasma Cr levels.

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

    Directory of Open Access Journals (Sweden)

    Laura Prieto

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

  8. The recent outbreaks of Zika virus: Mosquito control faces a further challenge

    Directory of Open Access Journals (Sweden)

    Giovanni Benelli

    2016-04-01

    Full Text Available The recent outbreaks of Zika virus infection occurring in South America, Central America and the Caribbean, represent the most recent of four key arrivals of arboviruses in the Western Hemisphere over the last 20 years. Zika virus is mainly vectored by Aedes mosquitoes. The development of effective and eco-friendly mosquito control methods is required in order to minimize the negative effects of currently marketed synthetic pesticides, including multidrug resistance. In this scenario, natural product research can afford solutions as part of integrated pest management strategies. In this review, we focused on neem (Azadirachta indica products as sources of cheap control tools of Aedes vectors. Current knowledge on the larvicidal, pupicidal, adulticidal and oviposition deterrent potential of neem-borne products against the arbovirus vectors Aedes aegypti and Aedes albopictus is reviewed. Furthermore, we considered the rising importance of neem extraction by-products as sources of bio-reducing agents for the synthesis of nanoformulated mosquitocides. The last section examined biosafety and nontarget effects on neem-borne mosquitocides in the aquatic environment. Overall, we support the employ of neem-borne molecules as an advantageous alternative to build newer and safer Aedes control tools, in the framework of Zika virus outbreak prevention.

  9. Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

    Directory of Open Access Journals (Sweden)

    Jorge Alberto Cortes

    Full Text Available Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.

  10. Outbreak of acute renal failure in Panama in 2006: a case-control study.

    Science.gov (United States)

    Rentz, E Danielle; Lewis, Lauren; Mujica, Oscar J; Barr, Dana B; Schier, Joshua G; Weerasekera, Gayanga; Kuklenyik, Peter; McGeehin, Michael; Osterloh, John; Wamsley, Jacob; Lum, Washington; Alleyne, Camilo; Sosa, Nestor; Motta, Jorge; Rubin, Carol

    2008-10-01

    In September 2006, a Panamanian physician reported an unusual number of patients with unexplained acute renal failure frequently accompanied by severe neurological dysfunction. Twelve (57%) of 21 patients had died of the illness. This paper describes the investigation into the cause of the illness and the source of the outbreak. Case-control and laboratory investigations were implemented. Case patients (with acute renal failure of unknown etiology and serum creatinine > 2 mg/dl) were individually matched to hospitalized controls for age (+/- 5 years), sex and admission date (< 2 days before the case patient). Questionnaire and biological data were collected. The main outcome measure was the odds of ingesting prescription cough syrup in cases and controls. Forty-two case patients and 140 control patients participated. The median age of cases was 68 years (range: 25-91 years); 64% were male. After controlling for pre-existing hypertension and renal disease and the use of angiotensin-converting enzyme inhibitors, a significant association was found between ingestion of prescription cough syrup and illness onset (adjusted odds ratio: 31.0, 95% confidence interval: 6.93-138). Laboratory analyses confirmed the presence of diethylene glycol (DEG) in biological samples from case patients, 8% DEG contamination in cough syrup samples and 22% contamination in the glycerin used to prepare the cough syrup. The source of the outbreak was DEG-contaminated cough syrup. This investigation led to the recall of approximately 60 000 bottles of contaminated cough syrup, widespread screening of potentially exposed consumers and treatment of over 100 affected patients.

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

    Science.gov (United States)

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

    2017-04-01

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

  12. Successfully controlling malaria in South Africa

    African Journals Online (AJOL)

    Goal 6 of the MDGs was set to combat HIV/. AIDS ... [5]. Later that year, the Southern. African Development Community (SADC) similarly pledged to eliminate malaria from southern Africa. The SADC Malaria Strategic ... Political commitment and long-term funding for the malaria control programme have been a critical.

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

    Science.gov (United States)

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

    2010-05-06

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

  14. [How an outbreak of MRSA in Gothenburg was eliminated: by strict hygienic routines and massive control-culture program].

    Science.gov (United States)

    Seeberg, Staffan; Larsson, Leif; Welinder-Olsson, Christina; Sandberg, Torsten; Skyman, Eva; Bresky, Bo; Lindqvist, Anna; van Raalte, Margaretha

    2002-08-08

    The largest single-strain outbreak of methicillin resistant Staphylococcus aureus (MRSA) in Scandinavia so far occurred at Sahlgrenska University Hospital in Western Sweden 1997-2000. The strain identified was identical to the UK EMRSA-16 strain. 147 patients at 36 different wards became colonised or infected. Established routines for infection control had to be revised. The endemic situation necessitated an MRSA screening programme in October 1999 for all former hospital patients on re-admission. Since May 2000 no patient has been found with the outbreak strain at Sahlgrenska University Hospital.

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

    OpenAIRE

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

    2007-01-01

    Abstract Background From June to November 2005, 18 cases of community-acquired Legionnaires' disease (LD) were reported in Rapid City South Dakota. We conducted epidemiologic and environmental investigations to identify the source of the outbreak. Methods We conducted a case-control study that included the first 13 cases and 52 controls randomly selected from emergency department records and matched on underlying illness. We collected information about activities of case-patients and controls...

  16. Ensuring safety of home-produced eggs to control salmonellosis in Poland: lessons from an outbreak in September 2011.

    Science.gov (United States)

    Zielicka-Hardy, A; Zarowna, D; Szych, J; Madajczak, G; Sadkowska-Todys, M

    2012-11-22

    Implementation of control measures in line with European Commission regulations has led to a decrease in salmonellosis in the European Union since 2004. However, control programmes do not address laying hens whose eggs are produced for personal consumption or local sale. This article reports an investigatxion of a salmonellosis outbreak linked to home-produced eggs following a family event held in a farm in September 2011 near Warsaw, Poland. In the outbreak, 34 people developed gastroenteritis symptoms. Results from a cohort study indicated a cake, prepared from raw home-produced eggs, as the vehicle of the outbreak. Laboratory analysis identified Salmonella enterica serotype Enteritidis (S. Enteritidis) in stool samples or rectal swabs from 18 of 24 people and in two egg samples. As no food items remained, we used phage typing to link the source of the outbreak with the isolated strains. Seven S. Enteritidis strains analysed (five from attendees and two from eggs) were phage type 21c. Our findings resulted in culling of the infected laying hens and symptomatic pigeons housed next to the hens. Salmonella poses as a public health problem in Poland: control measures should not forget home-produced eggs, as there is a risk of infection from their consumption.

  17. Modeling the impact of vaccination control strategies on a foot and mouth disease outbreak in the Central United States.

    Science.gov (United States)

    McReynolds, Sara W; Sanderson, Michael W; Reeves, Aaron; Hill, Ashley E

    2014-12-01

    The central United States (U.S.) has a large livestock population including cattle, swine, sheep and goats. Simulation models were developed to assess the impact of livestock herd types and vaccination on foot and mouth disease (FMD) outbreaks using the North American Animal Disease Spread Model. In this study, potential FMD virus outbreaks in the central region of the U.S. were simulated to compare different vaccination strategies to a depopulation only scenario. Based on data from the U.S. Department of Agriculture National Agricultural Statistics Service, a simulated population of 151,620 livestock operations characterized by latitude and longitude, production type, and herd size was generated. For the simulations, a single 17,000 head feedlot was selected as the initial latently infected herd in an otherwise susceptible population. Direct and indirect contact rates between herds were based on survey data of livestock producers in Kansas and Colorado. Control methods included ring vaccination around infected herds. Feedlots ≥3000 head were either the only production type that was vaccinated or were assigned the highest vaccination priority. Simulated vaccination scenarios included low and high vaccine capacity, vaccination zones of 10 km or 50 km around detected infected premises, and vaccination trigger of 10 or 100 detected infected herds. Probability of transmission following indirect contact, movement controls and contact rate parameters were considered uncertain and so were the subjects of sensitivity analysis. All vaccination scenarios decreased number of herds depopulated but not all decreased outbreak duration. Increased size of the vaccination zone during an outbreak decreased the length of the outbreak and number of herds destroyed. Increased size of the vaccination zone primarily resulted in vaccinating feedlots ≥3000 head across a larger area. Increasing the vaccination capacity had a smaller impact on the outbreak and may not be feasible if

  18. The use of typing methods and infection prevention measures to control a bullous impetigo outbreak on a neonatal ward

    Directory of Open Access Journals (Sweden)

    Koningstein Maike

    2012-11-01

    Full Text Available Abstract Background We describe an outbreak of Bullous Impetigo (BI, caused by a (methicillin susceptible, fusidic acid resistant Staphylococcus aureus (SA strain, spa-type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011. Methods We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of SA isolates. Spa typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates. Results Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW with SA t408 was detected. These strains were MecA-, PVL-, Exfoliative Toxin (ETA-, ETB+, ETAD-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak. Conclusions We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.

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

    Directory of Open Access Journals (Sweden)

    Krishna Regmi

    2015-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Shannon M Fast

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Roberta Maia de Castro Romanelli

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

  3. 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.

  4. Importance of controlling pH-depended dissolved inorganic carbon to prevent algal bloom outbreaks.

    Science.gov (United States)

    Liu, Na; Yang, Yixuan; Li, Feng; Ge, Fei; Kuang, Yangduo

    2016-11-01

    This study investigated effects of pH-depended inorganic carbon (IC) species and pH on algal growth in the sewage simulation system, and fruitfully discussed the relationships among IC, pH and algal growth by the Monod kinetics. Results showed HCO3(-) significantly increased algal growth by 3.17-6.52 times than that of CO3(2-) and/or glucose when the value of pH was in the range of 8.0-9.5, and also the preferentially utilized indicated by the affinity coefficient (Kp) of HCO3(-), CO3(2-) and glucose (0.17, 15.14 and 31.22, respectively). Meanwhile, the same pH range facilitated HCO3(-) to become a dominated species (e.g., 48.80-93.19% of total IC). More importantly, good linear correlations pairwise existed among pH, IC species and algae growth. These results suggested pH plays a critical role in regulation of IC species and algae growth, which would be an efficient method to control the IC discharge from sewage effluents and weaken bloom outbreak. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. [Clinical epidemiology of an outbreak of nosocomial infection caused by Staphylococcus aureus resistant to methicillin and aminoglycosides: efficacy of control measures. Comité de Control de Infecciones].

    Science.gov (United States)

    Trilla, A; Marco, F; Moreno, A; Prat, A; Soriano, E; Jiménez de Anta, M T

    1993-02-13

    The appearance of outbreaks of nosocomial infections due to methicillin resistant Staphylococcus aureus (MRSA) is a current problem in Spain. The clinical and molecular epidemiology of these outbreaks as well as the efficacy of their control measures are a matter of controversy. An outbreak of MRSA nosocomial infections in the Hospital Clínic i Provincial of Barcelona, a 953-bed University Hospital, with a total of 347 cases from September 1989 to October 1991 is described. The control measures used include prospective and continued surveillance of all MRSA isolations, identification of the reservoir, use of different types of isolation and control of nasal carriers among health care workers. The MRSA strains isolated were studied by standard microbiological procedures, phage-typing and extrachromosomal (plasmid) DNA analysis by means of restriction endonuclease analysis (REAP). From the Intensive Care Units, the outbreak extended to the medical and surgical wards. Seventy-one percent of the cases corresponded to infected patients and 29% to asymptomatic carrier patients. The MRSA strain responsible of the outbreak had a notable antibiotic multiple-resistance pattern. The studies performed showed that most of the strains belonged to phage group III and were lysed by phage 77. Plasmid DNA analysis showed that 95% of the strains isolated had a unique homogeneous profile. Despite the different control measures used, the MRSA infection has acquired a medium level endemic rate in the Hospital Clínic i Provincial. The introduction and spread of methicillin-resistant MRSA in a teaching hospital with more than 500-bed may be rapid and affecting large number of patients. Effective control measures carries multiple problems, which must be addressed with the collaboration of all hospital employees. The molecular typing techniques used (REAP) further identified that the outbreak is due to one single MRSA strain, with an epidemiologic behavior identical to the one showed by

  6. Multidrug-resistant NDM-1 Klebsiella outbreak and infection control in endoscopic urology.

    Science.gov (United States)

    Koo, Vincent S W; O'Neill, Patricia; Elves, Andrew

    2012-12-01

    What's known on the subject? and What does the study add? Since the first case of multidrug-resistant New Delhi metallo-β-lactamase (NDM-1) Klebsiella and Escherichia coli UTI in January 2008, there have been more reports of cases worldwide. Urology is a specialty uniquely vulnerable to these organisms because the NDM-1 carriers tend to be the common UTI-causing organisms. Further, the nature of the procedures involved in endoscopy in the urinary tract confers the potential for direct exposure and transmission of the organisms that commonly cause UTI. Although decontamination by sterilization of urological endoscopes and surgical instruments is well established in the operating theatre suite, there were no national standardized guidelines for infection control measures with respect to the video camera head in endoscopic urology in the UK. This paper reports the first UK outbreak of NDM-1 Klebsiella UTI, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where single-use sterile disposable plastic camera sheaths were not routinely used and the camera head was regularly cleaned with detergent wipes. We found that infection control practices vary across UK urology units. In the context of infection control, we highlight a need for standardized practice in the use of camera sheaths and in the decontamination process for endoscopic video camera heads. Either sterilization or use of single-use sterile disposable plastic camera sheaths with regular cleaning of the camera head using approved disinfectant for all endoscopy work is recommended. • To report the first UK outbreak of NDM-1 Klebsiella, for which the common source of infection was rapidly traced to the endoscopic camera head in the urology theatre, where camera sheathing was not routinely used and the camera head was regularly cleaned with detergent wipes. • To survey the use of camera sheath and infection control practices in endoscopy in

  7. Control of carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit of a teaching hospital in Southern Italy.

    Science.gov (United States)

    Bianco, Aida; Quirino, Angela; Giordano, Mariavalentina; Marano, Vito; Rizzo, Claudia; Liberto, Maria Carla; Focà, Alfredo; Pavia, Maria

    2016-12-12

    Acinetobacter baumannii is an opportunistic pathogen that has become a major cause of concern, since it is a frequent cause of healthcare-associated infections (HAIs). The aim of the study was to describe the occurrence, the management and the control of an outbreak that occurred in an intensive care unit (ICU) of a teaching hospital in Southern Italy caused by multiple strains of extensively drug-resistant A. baumannii (XDRAB). Case-patient was defined as a patient with an healthcare-associated infection caused by an XDRAB isolate identified in a clinically significant culture. Environmental samples were collected from different surfaces. The isolates were identified by typical Gram stain morphology, using the Vitek 2 system (bioMérieux, France) and by MALDI-TOF MS mass spectrometry (bioMèrieux, France). Genotyping was performed through rep-PCR analysis. A patient presented an XDRAB ventilator-associated pneumonia at admission and was managed with strict isolation precautions until discharge. Five patients had a ventilator-associated pneumonia and two had a central line-associated bloodstream infection. Of the environmental samples, 1 sample obtained from the side of the bed of an infected patient yielded growth of XDRAB. Infection control measures were adopted. Rep-PCR analysis identified four patterns. The integration of epidemiological and microbiological data and the application of infection control measures were crucial to bring such an outbreak to a rapid halt. The distinctive characteristic of this study was the complex molecular pattern of the outbreak, which subsided in a short period of time due to adherence to infection-control measures, confirming the fundamental role of molecular typing in the comprehension of outbreaks dynamics and of integrated control interventions for the interruption of epidemic events.

  8. Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study.

    OpenAIRE

    Cao-Lormeau, Van-Mai; Blake, Alexandre; Mons, Sandrine; Lastère, Stéphane; Roche, Claudine; Vanhomwegen, Jessica; Dub, Timothée; Baudouin, Laure; Teissier, Anita; Larre, Philippe; Vial, Anne-Laure; Decam, Christophe; Choumet, Valérie; Halstead, Susan K.; Willison, Hugh J

    2016-01-01

    International audience; Between October, 2013, and April, 2014, French Polynesia experienced the largest Zika virus outbreak ever described at that time. During the same period, an increase in Guillain-Barré syndrome was reported, suggesting a possible association between Zika virus and Guillain-Barré syndrome. We aimed to assess the role of Zika virus and dengue virus infection in developing Guillain-Barré syndrome.; In this case-control study, cases were patients with Guillain-Barré syndrom...

  9. Success Stories in Control: Nonlinear Dynamic Inversion Control

    Science.gov (United States)

    Bosworth, John T.

    2010-01-01

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

  10. Success-slope effects on the illusion of control and on remembered success-frequency

    Directory of Open Access Journals (Sweden)

    Anastasia Ejova

    2013-07-01

    Full Text Available The illusion of control refers to the inference of action-outcome contingency in situations where outcomes are in fact random. The strength of this illusion has been found to be affected by whether the frequency of successes increases or decreases over repeated trials, in what can be termed a ``success-slope'' effect. Previous studies have generated inconsistent findings regarding the nature of this effect. In this paper we present an experiment (N = 334 that overcomes several methodological limitations within this literature, employing a wider range of dependent measures (measures of two different types of illusory control, primary (by self and secondary (by luck, as well as measures of remembered success-frequency. Results indicate that different dependent measures lead to different effects. On measures of (primary, but not secondary control over the task, scores were highest when the rate of success increased over time. Meanwhile, estimates of success-frequency in the task did not vary across conditions and showed trends consistent with the broader literature on human memory.

  11. Control of zoonoses in emergency situations: lessons learned during recent outbreaks (gaps and weaknesses of current zoonoses control programmes

    Directory of Open Access Journals (Sweden)

    Darem Tabbaa

    2008-12-01

    Full Text Available In emergency situations, domestic animals and wildlife are, like people, exposed to infectious diseases and environmental contaminants in the air, soil, water and food. They can suffer from acute and/or chronic diseases from such exposure. Often animals serve as disease reservoirs or early warning systems for the community in regard to the spread of zoonotic diseases. Over 100 years of experience have shown that animal and human health are closely related. During the past few years, emergent disease episodes have increased; nearly all have involved zoonotic agents. As there is no way to predict when or where the next important new zoonotic pathogen will emerge or what its ultimate importance might be, investigation at the first sign of emergence of a new zoonotic disease is particularly important. Today, in many emerging situations, different activities involving zoonotic disease control are at risk because of failed investigative infrastructures or financial constraints. Considering that zoonotic diseases have their own characteristics, their prevention and control require unique strategies, based more on fundamental and applied research than on traditional approaches. Such strategies require cooperation and coordination between animal and public health sectors and the involvement of other disciplines and experts such as epidemiologists, entomologists, environmentalists and climatologists. Lessons learned from the avian influenza pandemic threat, the Crimean-Congo haemorrhagic fever and rabies outbreaks are presented and the gaps and weakness of current control programmes are discussed.

  12. National outbreak of Salmonella Enteritidis phage type 14b in England, September to December 2009: case-control study.

    Science.gov (United States)

    Janmohamed, K; Zenner, D; Little, C; Lane, C; Wain, J; Charlett, A; Adak, B; Morgan, D

    2011-04-14

    We conducted an unmatched retrospective case–control study to investigate an upsurge of non-travel-related sporadic cases of infection with Salmonella enterica subsp. enterica serotype Enteritidis phage type 14b with antimicrobial resistance to nalidixic acid and partial resistance to ciprofloxacin (S. Enteritidis PT 14b NxCp(L)) that was reported in England from 1 September to 31 December 2009. We analysed data from 63 cases and 108 controls to determine whether cases had the same sources of infection as those found through investigation of 16 concurrent local foodborne outbreaks in England and Wales. Multivariable logistic regression analysis adjusting for age and sex identified food consumption at restaurants serving Chinese or Thai cuisine (odds ratio (OR): 4.4; 95% CI: 1.3–14.8; p=0.02), egg consumed away from home (OR: 5.1; 95% CI: 1.3–21.2; p=0.02) and eating vegetarian foods away from home (OR: 14.6; 95% CI: 2.1–99; p=0.006) as significant risk factors for infection with S. Enteritidis PT 14b NxCp(L). These findings concurred with those from the investigation of the16 outbreaks, which identified the same Salmonella strain in eggs from a specified source outside the United Kingdom. The findings led to a prohibition of imports from this source, in order to control the outbreak.

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

    Science.gov (United States)

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

    2016-12-15

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

  14. The outbreak and control of Ebola viral haemorrhagic fever in a Ugandan medical school.

    Science.gov (United States)

    Bitekyerezo, Medard; Kyobutungi, Catherine; Kizza, Ruth; Mugeni, James; Munyarugero, Emmanuel; Tirwomwe, Francis; Twongyeirwe, Eunice; Muhindo, George; Nakibuuka, Victoria; Nakate, Maimuna; John, Laurence; Ruiz, Ana; Frame, Karen; Priotto, Gerardo; Pepper, Larry; Kabakyenga, Jerome; Baingana, Sheila; Ledo, Dennis

    2002-01-01

    Uganda has just experienced the largest outbreak of Ebola haemorrhagic fever (EHF) ever recorded. Mbarara University Teaching Hospital (MUTH) is responsible for training approximately one-third of Uganda's doctors. Mbarara is located in SouthWest Uganda, 614 km from Gulu, the main epicentre of the outbreak. On 23 October a patient was admitted to the medical ward of MUTH with an acute fever. He soon exhibited haemorrhagic symptoms and died. He was later confirmed to have suffered Ebola. Three more patients subsequently contracted the disease. All died. There were no further cases in Mbarara. No members of staff or medical student was infected. We give details of the clinical features of those patients who contracted the disease, the setting up of an Ebola isolation unit, the case surveillance and the search for the source of the outbreak. The implications for similar institutions in East Africa are discussed.

  15. Identifying Meteorological Controls on Open and Closed Mesoscale Cellular Convection Associated with Marine Cold Air Outbreaks

    Science.gov (United States)

    McCoy, Isabel L.; Wood, Robert; Fletcher, Jennifer K.

    2017-11-01

    Mesoscale cellular convective (MCC) clouds occur in large-scale patterns over the ocean and have important radiative effects on the climate system. An examination of time-varying meteorological conditions associated with satellite-observed open and closed MCC clouds is conducted to illustrate the influence of large-scale meteorological conditions. Marine cold air outbreaks (MCAO) influence the development of open MCC clouds and the transition from closed to open MCC clouds. MCC neural network classifications on Moderate Resolution Imaging Spectroradiometer (MODIS) data for 2008 are collocated with Clouds and the Earth's Radiant Energy System (CERES) data and ERA-Interim reanalysis to determine the radiative effects of MCC clouds and their thermodynamic environments. Closed MCC clouds are found to have much higher albedo on average than open MCC clouds for the same cloud fraction. Three meteorological control metrics are tested: sea-air temperature difference (ΔT), estimated inversion strength (EIS), and a MCAO index (M). These predictive metrics illustrate the importance of atmospheric surface forcing and static stability for open and closed MCC cloud formation. Predictive sigmoidal relations are found between M and MCC cloud frequency globally and regionally: negative for closed MCC cloud and positive for open MCC cloud. The open MCC cloud seasonal cycle is well correlated with M, while the seasonality of closed MCC clouds is well correlated with M in the midlatitudes and EIS in the tropics and subtropics. M is found to best distinguish open and closed MCC clouds on average over shorter time scales. The possibility of a MCC cloud feedback is discussed.

  16. Outbreak investigation of pertussis in an elementary school: a case-control study among vaccinated students.

    Science.gov (United States)

    Ryu, Sukhyun; Kim, Joon Jai; Chen, Meng-Yu; Jin, Hyunju; Lee, Hyun Kyung; Chun, Byung Chul

    2018-01-01

    A pertussis patient from an elementary school, in Gyeonggi Province, Korea, was notified to public health authority on July 25, 2017. Epidemiologic investigation was conducted to identify the magnitude, possible source of infection and risk factors for this outbreak on August 17, 2017. A case was defined as the school student experiencing cough for more than two weeks with or without paroxysmal, whoop, or post-tussive vomiting. Control was defined as the student polymerase chain reaction-negative at the school. School based surveillance was implemented to identify additional cases. From June 29 to August 27, 2017, nine patients of pertussis were identified from an elementary school. Among nine cases, eight were confirmed by polymerase chain reaction positive. All cases had cough, one (11%) had post-tussive vomiting, and one (11%) had fever. Eight cases had macrolide for 7 days in outpatient clinic, and one case admitted in a hospital. There was no significant difference of demographic factors including gender (p=0.49), age group (p=0.97), number of series of vaccination of pertussis (p=0.52), the number of participation of after school activity (p=0.28), and the time elapsed since last vaccination (p=0.42). However, we found the history of contact within the classroom or after-school activity was only the independent risk factor among all the demographic factors collected (odds ratio, 63.61; 95% confidence interval, 4.35 to 930.79). The contributing factor for transmission is associated with the case-contact. Immediate identification of pertussis with use of appropriate diagnostic test may help to avoid a large number of cases.

  17. Outbreak of Ampicillin/Piperacillin-Resistant Klebsiella Pneumoniae in a Neonatal Intensive Care Unit (NICU): Investigation and Control Measures

    Science.gov (United States)

    Fabbri, Giuliana; Panico, Manuela; Dallolio, Laura; Suzzi, Roberta; Ciccia, Matilde; Sandri, Fabrizio; Farruggia, Patrizia

    2013-01-01

    Klebsiella pneumoniae is a frequent cause of infectious outbreaks in Neonatal Intensive Care Units (NICUs). The aim of this paper is to describe an outbreak occurred in a 13-bed NICU and the control measures adopted in order to interrupt the chain of transmission. We described the microbiological investigations, the NICU staff compliance to the infection control measures by means of a specifically designed check-list and the control measures adopted. Six cases of primary bloodstream infections sustained by ampicillin/piperacillin-resistant Klebsiella pneumoniae were observed over a two-month period. One culture obtained from a 12% saccarose multiple-dose solution allowed the growth of Klebsiella pneumoniae. During the inspections performed by the Hospital Infection Control Team, using the check-list for the evaluation of the NICU staff compliance to the infection control measures, several breaches in the infection control policy were identified and control measures were adopted. In our case the definition of a specific check-list led to the adoption of the correct control measures. Further studies would be helpful in order to develop a standard check-list able to identify critical flows in the adhesion to the guidelines. It could be used in different NICUs and allow to obtain reproducible levels of infection control. PMID:23442560

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

    National Research Council Canada - National Science Library

    Bergström, Karin; Nyman, Görel; Widgren, Stefan; Johnston, Christopher; Grönlund-Andersson, Ulrika; Ransjö, Ulrika

    2012-01-01

    The first outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in horses in Sweden occurred in 2008 at the University Animal Hospital and highlighted the need for improved infection prevention and control...

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

    Science.gov (United States)

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

    2014-09-01

    Little is known about the occurrence of chikungunya fever in the Eastern Mediterranean Region of the World Health Organization (WHO). In January 2011, the Ministry of Public Health and Population (MoPH&P) of Yemen reported to WHO an increasing number of "dengue-like" acute febrile illnesses of unknown origin from one of its coastal governorates. An epidemiological investigation was conducted in Al-Hudaydah governorate between 23 and 26 January 2011 by a joint team of WHO, the MoPH&P of Yemen and the U.S. Naval Medical Research Unit (NAMRU-3) in Cairo, Egypt. The investigation led to the detection of an outbreak of chikungunya in Yemen which was the first time ever from any of the 22 countries in the Eastern Mediterranean Region of WHO. Appropriate public health control measures were strengthened following the investigation, and the outbreak was contained. This paper provides a short description of the outbreak and its epidemiological characteristics and highlights the important lessons that were learned for early detection and control of chikungunya in countries where competent vectors for transmission of the virus exist. Copyright © 2014 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Riikka Linnakoski

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2014-09-01

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

  4. Investigation and Control of Anthrax Outbreak at the Human–Animal Interface, Bhutan, 2010

    Science.gov (United States)

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

    2014-01-01

    In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan. PMID:25147965

  5. Burden of norovirus in healthcare facilities and strategies for outbreak control

    NARCIS (Netherlands)

    A. Kambhampati; M.P.G. Koopmans D.V.M. (Marion); B.A. Lopman (Benjamin A.)

    2015-01-01

    textabstractNorovirus is the most frequently occurring cause of community-acquired acute gastroenteritis in people of all ages. It is also one of the most frequent causes of outbreaks in healthcare settings, affecting both long-term care facilities and acute care hospitals. Whereas norovirus

  6. Control of an amoebiasis outbreak in the Philippi area near Cape ...

    African Journals Online (AJOL)

    endemicity of pathogenic strains of Entamoeba histolytica. We therefore proposed that antibody profiles could be used to detect epidemic situations. An outbreak of amoebiasis in the normally non-endemic Philippi area near. Cape Town provided an. opportunity for testing this hypothesis. Seven of 9 patients presenting at a ...

  7. Outbreak of hepatitis C virus infections at an outpatient hemodialysis facility: the importance of infection control competencies.

    Science.gov (United States)

    Rao, Agam K; Luckman, Emily; Wise, Matthew E; MacCannell, Taranisia; Blythe, David; Lin, Yulin; Xia, Guoliang; Drobeniuc, Jan; Noble-Wang, Judith; Arduino, Matthew J; Thompson, Nicola D; Patel, Priti R; Wilson, Lucy E

    2013-01-01

    In the United States, the prevalence of hepatitis C virus infection among patients treated in hemodialysis facilities is five times higher than among the general population. This study investigated eight new hepatitis C virus infections among patients treated at an outpatient hemodialysis facility. Epidemiologic investigation and viral sequencing demonstrated that transmission likely occurred between patients typically treated during the same or consecutive shifts at the same or a nearby station. Several infection control breaches were observed including lapses involving the preparation, handling, and administration of parenteral medications. Improved infection control education and training for all hemodialysis facility staff is an important component of assuring adherence to appropriate procedures and preventing future outbreaks.

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Benson Robert F

    2007-08-01

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

  10. [Vaccination as a supporting measure to control animal disease outbreaks in Europe: Findings for Switzerland].

    Science.gov (United States)

    Di Labio, E; Perler, L

    2010-09-01

    Switzerland and the European Union have a non-vaccination policy for many animal diseases relevant for trade. Because of the relatively low animal density, disease control measures in Switzerland focus on the immediate culling of infected animals. However, the use of vaccines as a supporting measure can represent an effective option to promptly contain an epidemic and to reduce the number of animals to be killed. A prerequisite for the success of vaccination is its early, rapid and purposeful implementation. Vaccinations can be cost-intensive and can entail restrictions in international trade. For the choice of the appropriate control measure it is therefore important to thoroughly assess the epidemiology, the economic consequences of the control measures and the acceptance of these measures by the environment. Because of their special epidemiology, vaccination has clear advantages as a preventive measure for vector-borne diseases.

  11. Successful plague control in Namibia | Shangula | South African ...

    African Journals Online (AJOL)

    Objective. To demonstrate that plague can be successfully controlled. Design. A descriptive study outlining patterns of plague occurrence in relation to variables such as age group, gender, place and time. Setting. Two northern districts, namely Engela in Ohangwena region and Onandjokwe in Oshikoto region, an area of 2 ...

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

    Science.gov (United States)

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

    2014-10-01

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

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

    Science.gov (United States)

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

    2014-06-11

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

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

    Directory of Open Access Journals (Sweden)

    Kelly L Edmunds

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

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

    Science.gov (United States)

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

    2013-01-01

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

  16. A nosocomial outbreak of multidrug-resistant Mycobacterium bovis among HIV-infected patients. A case-control study.

    Science.gov (United States)

    Bouvet, E; Casalino, E; Mendoza-Sassi, G; Lariven, S; Vallée, E; Pernet, M; Gottot, S; Vachon, F

    1993-11-01

    To identify risk factors in a nosocomial outbreak of multidrug-resistant Mycobacterium bovis (MDRMB) tuberculosis (TB) among HIV-infected patients. We evaluated the study period (from the first to the last MDRMB smear-positive patients hospitalized in the unit) using a case-control study with three control groups. Since MDRMB is extremely rare, we assumed that a single strain was responsible for all six cases. A 19-bed infectious diseases unit in Paris, France. The index case was an AIDS patient who was hospitalized in September 1989 because of MDRMB TB. The cases were five HIV-infected patients who developed MDRMB TB between January 1990 and October 1991. Controls were randomly selected from HIV-infected patients in our unit during the study period (case-control study 1, 15 patients), during the contact period (at least one MDRMB smear-positive patient hospitalized in the unit; case-control study 2,20 patients), and patients matched according to the length of contact (case-control study 3, 24 patients). After detecting the nosocomial outbreak, we took respiratory isolation precautions for all patients suspected of having active TB. Risk factors for MDRMB nosocomial transmission, and the occurrence of new cases of MDRMB infection in HIV-infected patients and health-care workers after the introduction of isolation precautions. The most important predictor of nosocomial transmission of MDRMB to HIV-infected patients was the (mean +/- s.d.) length of contact in days [cases, 22 +/- 15.8; study 1 controls, 11.2 +/- 18.9 (P = 0.07); study 2 controls, 14.6 +/- 8.5 (P = 0.043)]. Only one case of MDRMB TB resulted from exposure to MDRMB-smear-positive patient after the introduction of respiratory isolation measures. The incubation period in the single health-care worker who developed MDRMB TB was longer than in the cases. In a nosocomial outbreak of MDRMB TB, the contact time was the main risk factor of transmission to HIV-infected patients. Respiratory isolation measures

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

    Science.gov (United States)

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

    2015-10-01

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

  18. A review on the Ebola virus, outbreak history and the current research tools to control the disease

    Directory of Open Access Journals (Sweden)

    Cesar Marcial Escobedo-Bonilla

    2015-01-01

    Full Text Available The Ebola virus is a zoonotic pathogen causing hemorrhagic fever disease with a high mortality rate. The distribution of this pathogen has been limited to woodlands from Central and West Africa and the forest-savannah ecotone in East Africa. The likely reservoir species are frugivorous bats living in these areas. This pathogen is becoming an increasing threat to human populations since its distribution range is expanding faster than expected. The current Ebola outbreaks in Western Africa and in the Democratic Republic of Congo have rapidly spread infecting high numbers of individuals in five African countries. The disease has reached the United States and Spain. This expansion is due partly to increasing global connectivity. This situation represents a new challenge to control the spread of the disease. Experimental drugs have been used to treat a few infected people with promising results. This gives hope for an effective treatment against Ebola hemorrhagic fever in the near future, though thousands of people remain at risk of infection. The present review aims to give an update of the knowledge on the disease, including features of the Ebola virus, the history of disease outbreaks in Africa and the tools that are being developed in order to control this re-emergent disease.

  19. A model for a chikungunya outbreak in a rural Cambodian setting: implications for disease control in uninfected areas.

    Directory of Open Access Journals (Sweden)

    Marguerite Robinson

    2014-09-01

    Full Text Available Following almost 30 years of relative silence, chikungunya fever reemerged in Kenya in 2004. It subsequently spread to the islands of the Indian Ocean, reaching Southeast Asia in 2006. The virus was first detected in Cambodia in 2011 and a large outbreak occurred in the village of Trapeang Roka Kampong Speu Province in March 2012, in which 44% of the villagers had a recent infection biologically confirmed. The epidemic curve was constructed from the number of biologically-confirmed CHIKV cases per day determined from the date of fever onset, which was self-reported during a data collection campaign conducted in the village after the outbreak. All individuals participating in the campaign had infections confirmed by laboratory analysis, allowing for the identification of asymptomatic cases and those with an unreported date of fever onset. We develop a stochastic model explicitly including such cases, all of whom do not appear on the epidemic curve. We estimate the basic reproduction number of the outbreak to be 6.46 (95% C.I. [6.24, 6.78]. We show that this estimate is particularly sensitive to changes in the biting rate and mosquito longevity. Our model also indicates that the infection was more widespread within the population on the reported epidemic start date. We show that the exclusion of asymptomatic cases and cases with undocumented onset dates can lead to an underestimation of the reproduction number which, in turn, could negatively impact control strategies implemented by public health authorities. We highlight the need for properly documenting newly emerging pathogens in immunologically naive populations and the importance of identifying the route of disease introduction.

  20. A Model for a Chikungunya Outbreak in a Rural Cambodian Setting: Implications for Disease Control in Uninfected Areas

    Science.gov (United States)

    Duong, Veasna; Ly, Sowath; Ngan, Chantha; Buchy, Philippe; Tarantola, Arnaud; Rodó, Xavier

    2014-01-01

    Following almost 30 years of relative silence, chikungunya fever reemerged in Kenya in 2004. It subsequently spread to the islands of the Indian Ocean, reaching Southeast Asia in 2006. The virus was first detected in Cambodia in 2011 and a large outbreak occurred in the village of Trapeang Roka Kampong Speu Province in March 2012, in which 44% of the villagers had a recent infection biologically confirmed. The epidemic curve was constructed from the number of biologically-confirmed CHIKV cases per day determined from the date of fever onset, which was self-reported during a data collection campaign conducted in the village after the outbreak. All individuals participating in the campaign had infections confirmed by laboratory analysis, allowing for the identification of asymptomatic cases and those with an unreported date of fever onset. We develop a stochastic model explicitly including such cases, all of whom do not appear on the epidemic curve. We estimate the basic reproduction number of the outbreak to be 6.46 (95% C.I. [6.24, 6.78]). We show that this estimate is particularly sensitive to changes in the biting rate and mosquito longevity. Our model also indicates that the infection was more widespread within the population on the reported epidemic start date. We show that the exclusion of asymptomatic cases and cases with undocumented onset dates can lead to an underestimation of the reproduction number which, in turn, could negatively impact control strategies implemented by public health authorities. We highlight the need for properly documenting newly emerging pathogens in immunologically naive populations and the importance of identifying the route of disease introduction. PMID:25210729

  1. Detection and control of a nosocomial respiratory syncytial virus outbreak in a stem cell transplantation unit: the role of palivizumab.

    Science.gov (United States)

    Kassis, Christelle; Champlin, Richard E; Hachem, Ray Y; Hosing, Chitra; Tarrand, Jeffrey J; Perego, Cheryl A; Neumann, Joyce L; Raad, Issam I; Chemaly, Roy F

    2010-09-01

    Respiratory syncytial virus (RSV) is a common community-acquired virus that causes upper and lower respiratory tract infections in children, hematologic malignancy patients, and hematopoietic stem cell transplant (HSCT) recipients. Nosocomial transmission of RSV in immunocompromised patients can significantly affect morbidity, mortality, and duration of hospitalization. Stringent infection control measurements are needed to control further hospital transmission. Prophylactic palivizumab was found to result in a significant reduction in hospitalization rates in high-risk children. In this article, we report a nosocomial outbreak of RSV in an adult HSCT unit (4 pods) from January 16 to February 4, 2004, including the infection control interventions used and the prophylactic administration of palivizumab in high-risk patients. Active surveillance identified 5 cases, a substantial increase from previous seasons (2 or 3 cases per season). All infected patients were isolated to 1 nursing pod and placed on contact isolation. All patients on the HSCT unit underwent rapid RSV antigen screening using nasal washes; this was repeated 1 week later, and 1 additional RSV case was identified. Patients identified to be at increased risk for RSV infection received prophylactic palivizumab. Routine screenings of the staff and visitors were undertaken. All patient and visitor areas were thoroughly cleaned with bleach. We educated health care workers about RSV transmission, highlighting proper hand hygiene and contact precautions. Four of 6 patients with RSV infection developed RSV pneumonia, and 2 of these patients died. Staff and visitors with upper respiratory symptoms were screened, and all were negative for RSV. Prophylactic palivizumab was administered in 16 patients who tested negative for RSV, but were considered to be at increased risk for RSV infection. None of these patients developed RSV infections. An RSV outbreak was controlled using prompt preventive measures, including

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lêda Regis

    2008-02-01

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

  4. Outbreak Control and Clinical, Pathological, and Epidemiological Aspects and Molecular Characterization of a Bovine Herpesvirus Type 5 on a Feedlot Farm in São Paulo State

    Directory of Open Access Journals (Sweden)

    Jane Megid

    2015-01-01

    Full Text Available This paper describes the control, epidemiological, pathological, and molecular aspects of an outbreak of meningoencephalitis in calves due to bovine herpesvirus 5 at a feedlot with 540 animals in São Paulo State, Brazil. The introduction of new animals and contact between the resident animals and the introduced ones were most likely responsible for virus transmission. Bovine herpesvirus 1 vaccine was used, resulting in the efficacy of the outbreak control, although two bovine herpesvirus 1 positive animals, vaccinated and revaccinated, presented meningoencephalitis, thereby characterizing vaccinal failure.

  5. The success of headwater rehabilitation towards gully erosion control

    Science.gov (United States)

    Frankl, Amaury; Poesen, Jean; Nyssen, Jan

    2017-04-01

    The ill-management of headwaters has frequently shown to have adverse effects on both humans and the environment. Historical examples often refer to altered hydrological conditions and stream incision resulting from deforestation. Agricultural expansion and intensification - often accompanied with land reforms in the 20th century - also showed to severely impact the fluvial environment, with stream incision and gully erosion hazards increasingly affecting many headwater areas around the world. To counter this, many regions have adopted improved management schemes aiming at restoring the physical, biological and hydrological integrity of the soil- and landscape. In terms of hydrogeomorpology, the objective was to minimize dynamics to a lower level so that runoff, sediment and pollutant transfers do not cause danger to human life, environmental/natural resources deterioration or economic stress. Therefore, much attention was given to the rehabilitation and re-naturalization of headwater streams and gullies, which are the conduits of these transfers. This is done in both indirect and direct ways, i.e. reducing the delivery of runoff and sediment to the gullies and interventions in the incised channels. Although much has been published on gully erosion development and control, few studies assess the success of gully rehabilitation on the mid- to long term or confront results against the gully life-cycle. The latter refers to the rate law in fluvial geomorphology, whereby gully morphological changes (increases in length, area, volume) are initially rapid, followed by a much slower development towards a new equilibrium state. Here, we present a review of headwater rehabilitation measures and their success towards gully erosion control. By confronting this to the life-cycle of a gully, we also want to shed light on our understanding of when and where gully erosion control needs to be applied; making land management more efficient and effective. Keywords: land

  6. Investigation and control of a Plasmodium falciparum malaria outbreak in Shan Special Region II of Myanmar along the China-Myanmar Border from June to December 2014.

    Science.gov (United States)

    Liu, Hui; Xu, Jian-Wei; Yang, Heng-Lin; Li, Mei; Sun, Cheng-De; Yin, Yi-Jie; Zheng, Zhi-Liang; Zhang, Guang-Yun; Yu, Ai-Shui; Yang, Yong-Hui; Li, Chun-Hui; Ai, Shui

    2016-04-25

    From 2007 to 2013, intensive control measures reduced malaria burden by 90 % along the China-Myanmar border. However, despite these measures a P. falciparum malaria outbreak was reported in the Shan Special Region II of Myanmar in June of 2014. Epidemiological, parasitological and entomological investigations were performed. Dihydroartemisinin piperaquine (DAPQ) was immediately administered to treat parasite positive individuals. Long lasting insecticidal nets (LLIN), indoor residual spraying (IRS) with insecticides and behavior change communication (BCC) were also provided for outbreak control. An embedded efficacy study was conducted evaluating DP. Molecular genotyping via polymerase chain reaction (PCR) was performed on the Kelch gene on chromosome 13. All infections were identified as Plasmodium falciparum by RDT and microscopy. Two fatalities resulted from the outbreak. The attack rate was 72.8 % (67/92) and the incidence density rate was 14.2 per 100 person-weeks. The positive rate of rapid diagnostic test (RDT) was 72.2 % (65/90) and microscopically-determine parasite rate 42.2 % (38/90). Adjusted odds ratio (OR) of multivariate logistic regression analysis for aged malaria attacks, parasites and antigen were reduced to zero between July 1 and December 1, 2014. The cure rate of P. falciparum patients at day 42 was 94.3 % (95 % CI, 80.8-99.3 %). The PCR did not detect K13-propeller mutations. Imported P. falciparum caused the outbreak. Age, seeking inappropriate treatment and lack of bed nets were risk factors for infection during the outbreak. P. falciparum was sensitive to treatment with DAPQ. The integrated measures controlled the outbreak and prevented the spread of P. falciparum effectively. The results of this study indicate that malaria control on the China-Myanmar border, especially among special populations, needs further collaboration between China, Myanmar and international societies.

  7. Barriers to successful dietary control among pregnant women with phenylketonuria.

    Science.gov (United States)

    Brown, Amanda Savage; Fernhoff, Paul M; Waisbren, Susan E; Frazier, Dianne M; Singh, Rani; Rohr, Fran; Morris, Jill M; Kenneson, Aileen; MacDonald, Pia; Gwinn, Marta; Honein, Margaret; Rasmussen, Sonja A

    2002-01-01

    The teratogenic effects of maternal PKU are preventable, yet affected babies continue to be born. This study's purpose was to identify barriers to successful dietary control among pregnant women with PKU. An interview-based study was conducted of women with PKU who were known to metabolic disease clinics in three states and pregnant during 1998 to 2000. Medical records were used to document timing of metabolic control. Of 24 women in the study, only 8 (33%) initiated the diet before pregnancy. Of 22 medical records received, only 12 (55%) indicated control of blood phenylalanine levels before 10 weeks' gestation. Risk factors for late dietary control included young age and belief that treatment costs complicated the diet. Although all of the women expressed confidence in the metabolic clinic staff, few perceived their obstetricians were knowledgeable about the maternal PKU diet. Of 13 women enrolled in state-based assistance programs, 9 (69%) reported proof of pregnancy was required for eligibility. Many women using private insurance reported their insurers were unwilling to pay for medical foods. When the data were stratified according to state of residence, differences were observed in the rate of live-born infants, prepregnancy medical food use, average travel time to the metabolic clinic, and gestational week when metabolic control was achieved. Our study's findings may be used to target educational messages to women with PKU and to direct future research directions. For example, obstetric knowledge of maternal PKU needs further evaluation. Discrepancies should be resolved between maternal PKU medical recommendations and the policies of third party-payers. The disparities in financial assistance and services available to pregnant women with PKU residing in different states should be examined further.

  8. Importance of Internet surveillance in public health emergency control and prevention: evidence from a digital epidemiologic study during avian influenza A H7N9 outbreaks.

    Science.gov (United States)

    Gu, Hua; Chen, Bin; Zhu, Honghong; Jiang, Tao; Wang, Xinyi; Chen, Lei; Jiang, Zhenggang; Zheng, Dawei; Jiang, Jianmin

    2014-01-17

    Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media. This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks. Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword "H7N9" from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine. Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (Psocial media. The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to

  9. Experience with the use of palivizumab together with infection control measures to prevent respiratory syncytial virus outbreaks in neonatal intensive care units.

    Science.gov (United States)

    Kurz, H; Herbich, K; Janata, O; Sterniste, W; Bauer, K

    2008-11-01

    Respiratory syncytial virus (RSV) frequently causes nosocomial outbreaks in general paediatric wards and occasionally in neonatal intensive care units (NICUs). Conventional infection control measures often fail to prevent the spread of RSV, and it can cause significant morbidity especially in preterm and young infants. We report our experience in preventing an outbreak on a NICU after RSV had been detected in a premature infant. The index case was a 34-day-old premature infant who presented with clinical infection and RSV was detected in a clinical specimen. There were 11 patients in the ward at the time including the index case. The RSV-positive patient was isolated, the ward closed to admissions and infection control measures were implemented. Two patients were transferred to another hospital. Palivizumab 15 mg/kg i.m. was given to all patients and no further cases occurred. All subsequent RSV tests on nasal secretions were negative. Palivizumab combined with conventional infection control measures appeared to prevent the spread of RSV in this NICU. Strategies for the prevention of RSV outbreaks on NICUs all recommend the reinforcement of routine infection control measures. Recommendations concerning the use of palivizumab range from monthly prophylaxis to all infants at risk, to prophylaxis of selected cases only. Currently there are no guidelines for the use of palivizumab in NICUs or for the control of RSV outbreaks.

  10. Characterization of outbreak response strategies and potential vaccine stockpile needs for the polio endgame.

    Science.gov (United States)

    Duintjer Tebbens, Radboud J; Pallansch, Mark A; Wassilak, Steven G F; Cochi, Stephen L; Thompson, Kimberly M

    2016-03-24

    expect over 25% probability of a shortage of stockpiled filled mOPV vaccine, which could jeopardize the achievement of global polio eradication. For the long term, responding to any poliovirus reintroductions may require a global IPV stockpile. Despite the risks, our model suggests that good risk management and response strategies can successfully control most potential outbreaks after OPV cessation. Health leaders should carefully consider the numerous outbreak response choices that affect the probability of successfully managing poliovirus risks after OPV cessation.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  13. Disease Outbreak News

    Science.gov (United States)

    ... Diseases Biorisk reduction Disease outbreak news Disease Outbreak News (DONs) Latest DONs Rift Valley fever – Gambia ... Disease outbreaks by country RSS feeds Disease outbreak news Related links Ebola virus disease - website Avian influenza ...

  14. Molecular characterization of SAT 2 foot-and-mouth disease virus from post-outbreak slaughtered animals: implications for disease control in Uganda

    DEFF Research Database (Denmark)

    Balinda, Sheila N; Belsham, Graham; Masembe, Charles

    2010-01-01

    In Uganda, limiting the extent of foot-and-mouth disease (FMD) spread during outbreaks involves short term measures such as ring vaccination and restrictions to the movement of livestock and their products to and from the affected areas. In this study, the presence of FMD virus RNA was investigated...... in cattle samples, three months after FMD quarantine measures had been lifted in the area in 2004 following an outbreak. Oropharyngeal tissue samples were obtained from 12 cattle slaughtered in a small town abattoir of Kiboga. FMD virus RNA was detected by diagnostic RT- PCR in 9 of the 12 tissue samples....... Part of the coding region for the capsid protein VP1 was amplified and sequenced. All samples were identified as belonging to the SAT 2 serotype. The implications for FMD control of both virus introductions into Uganda and the presence of carrier animals following outbreaks are discussed....

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

    Science.gov (United States)

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

    2011-01-01

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

  16. Risk factors for the acquisition of OXA-48-producing Enterobacteriaceae in a hospital outbreak setting : a matched case-control study

    NARCIS (Netherlands)

    Dautzenberg, M J D; Ossewaarde, J M; de Greeff, S C; Troelstra, A; Bonten, M J M

    2016-01-01

    OBJECTIVES: In the context of a large outbreak of OXA-48-producing Enterobacteriaceae (OXA-E) in a Dutch hospital we determined risk factors for acquisition of OXA-E. PATIENTS AND METHODS: A matched case-control study was performed in which cases (culture positive for OXA-E) were matched 1:3 to

  17. Surveillance for Pasteurella multocida in Ring-Necked Pheasants (Phasianus colchicus) After an Outbreak of Avian Cholera and Apparently Successful Antibiotic Treatment.

    Science.gov (United States)

    Brown, Justin D; Dunn, Patricia; Wallner-Pendleton, Eva; Kariyawasam, Subhashinie; Schriner, Timothy; Hofacre, Charles; Johnson, Joshua; Boyd, Robert

    2016-03-01

    Avian cholera is a significant disease of domestic and wild birds caused by the bacterium Pasteurella multocida (PM). In poultry, a major source of PM infection is chronic carriers, domestic birds that have become infected and recovered or had subclinical infections. Although outbreaks of avian cholera in ring-necked pheasants (Phasianus colchicus) have been reported, the potential for chronic carriers is unknown. To address this, we conducted surveillance for PM in a flock of captive ring-necked pheasants after an outbreak of avian cholera that responded positively to antibiotic treatment based on resolution of morbidity and mortality. At approximately 1 mo after antibiotic treatment, oropharyngeal swabs were collected from 300 pheasants (out of a total population of ~2300) in a single winter holding pen. All samples were tested for PM through routine aerobic bacterial culture, but none of the samples were positive. In addition, there were no additional outbreaks within this infected pen over the subsequent months. These data provide preliminary evidence to suggest that pheasants that respond to antibiotic therapy may be less likely to become chronic carriers of PM than other poultry species, such as chickens (Gallus domesticus). However, due to marked phenotypic and biologic differences between PM strains, additional studies are needed to further support or refute these findings and better understand avian cholera in this species.

  18. Malaria in Turkey: successful control and strategies for achieving elimination.

    Science.gov (United States)

    Özbilgina, Ahmet; Topluoglu, Seher; Es, Saffet; Islek, Elif; Mollahaliloglu, Salih; Erkoc, Yasin

    2011-01-01

    Turkey is located in the middle of Asia, Africa and Europe, close to Caucasia, Balkans and Middle East in subtropical climate zone. Malaria has been known since the early ages of human history and it was one of the leading diseases in Anatolian history, as well. Today, chloroquine-sensitive Plasmodium vivax is the only agent of autochthonous malaria cases in Turkey. The other Plasmodium species identified are isolated from imported cases of malaria. The most common vector of malaria in Turkey is Anopheles sacharovi followed by An. superpictus, An. maculipennis and An. subalpinus. In 2009, pre-elimination stage of Malaria Program was started due to dramatic decline in the number of malaria cases in Turkey (Total, 84; 38 autochthonous cases only in 26 foci in south-eastern Anatolia, and 46 imported cases; incidence: 0.1/100,000). As there were no detected cases of new autochthonous malaria in the first 8 months of 2010, elimination stage was started. The role of the persistent policies and successful applications of the Ministry of Health, such as the strict control of the patients using anti-malarial drugs especially chloroquine, avoidance of resistant insecticides, facilitation of access to patients via Health Transformation Program (HTP), establishment of close contact with the patients' families, and improvement of reporting and surveillance system, was essential. In addition, improvement maintained in the motivations and professional rights of malaria workers, as well in the coordination of field studies and maintenance of a decline or termination in vector-to-person transmission were all achieved with the insistent policies of the Ministry of Health. Other factors that probably contributed to elimination studies include lessening of military operations in south-eastern Anatolia and the lowering of malaria cases in neighbouring countries in recent years. Free access to health services concerning malaria is still successfully conducted throughout the country

  19. 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.

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

    OpenAIRE

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

    2015-01-01

    Little research has been undertaken on how infection prevention and control (IPC) teams operate and how their effectiveness is assessed. This review aimed to explore how IPC teams embed IPC throughout hospitals, balance outbreak management with strategic aspects of IPC work (e.g. education), and how IPC team performance is measured. A scoping exercise was performed combining literature searches, evidence synthesis, and intelligence from expert advisers. Eleven publications were identified. On...

  1. Physiological and psychological characteristics of successful combat controller trainees.

    Science.gov (United States)

    Walker, Thomas B; Lennemann, Lynette M; McGregor, Julia N; Mauzy, Camilla; Zupan, Michael F

    2011-01-01

    The United States Air Force (USAF) Combat Controller (CCT) training pipeline is extremely arduous and historically has an attrition rate of 70-80%. The primary objective of this study was to identify the physiological, psychological, or demographical characteristics associated with successful progression through the CCT pipeline program. A battery of physiological measurements, biographical information, and psychological tests were used to determine the profile of a successful CCT trainee. These measures were chosen on the basis of being standard physical fitness parameters, CCT-specific physical attribute indicators or validated psychological surveys. A multiple of physical tests served as measurements for cardiovascular endurance (VO2max and running economy), ?anaerobic? capacity (Wingate power and loaded anaerobic endurance treadmill tests), body composition skinfolds measurements, power (Wingate and vertical jump), and reaction time (Makoto eye-hand test.) Each test was conducted using a standardized protocol. Psychological characteristics were explored through use of the International Personality Item Pool (IPIP-NEO) and the Mental Toughness Questionnaire 48 (MTQ 48). Our findings revealed the following mean characteristics of 109 CCTs who completed Phase I of the pipeline and achieved their 3-level rating: 23 years old, 1.8m tall, 81 kg, 12% body fat, VO2max of 59 ml/kg/min, vertical jump of 62 cm, able to generate 11.4 W/kg peak power and 9.3 W/Kg mean power during Wingate tests, overall mental toughness rating of 8 (out of 10) with high levels of extraversion and conscientiousness and low levels of neuroticism. The most popular competitive sport played in high school was football, followed by track, wrestling, and baseball. The results of the investigation confirm that CCT trainees who have achieved a 3-level rating possess much higher than average levels of aerobic and anaerobic fitness, power, mental toughness, extraversion and conscientiousness. They

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

    Science.gov (United States)

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

  3. Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit.

    Science.gov (United States)

    Cantey, Joseph B; Sreeramoju, Pranavi; Jaleel, Mambarambath; Treviño, Sylvia; Gander, Rita; Hynan, Linda S; Hill, Jennifer; Brown, Cari; Chung, Wendy; Siegel, Jane D; Sánchez, Pablo J

    2013-09-01

    To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting. A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted. Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002). This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices. Copyright © 2013 Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2003-06-01

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

  5. Rabies outbreak in Greece during 2012-2014: use of Geographical Information System for analysis, risk assessment and control.

    Science.gov (United States)

    Giannakopoulos, A; Valiakos, G; Papaspyropoulos, K; Dougas, G; Korou, L M; Tasioudi, K E; Fthenakis, G C; Hutchings, M R; Kaimaras, D; Tsokana, C N; Iliadou, P; Spyrou, V; Tzani, M; Birtsas, P; Kostoglou, P; Sokos, C; Doudounakis, S; Yon, L; Hannant, D; Artois, M; Tsiodras, S; Hadjichristodoulou, C; Billinis, C

    2016-10-01

    The objectives of this work were (i) geographical analysis of the 2012-2014 outbreak of rabies in Greece using GIS and (ii) comparative analysis of animal cases with data of potential human exposure to rabies together with environmental data, in order to provide information for risk assessment, effective monitoring and control. Most animal cases (40/48) involved red foxes, while domestic animals were also diagnosed with rabies. Overall, 80% of the cases were diagnosed in central northern Greece; 75% of the cases were diagnosed in low altitudes (rabies (889/1060) presented with dog bite injuries. Maximum entropy analysis revealed that distance from farms contributed the highest percentage in defining environmental niche profiles for rabid foxes. Oral vaccination programmes were implemented in 24 administrative units of the country during 2013 and 2014, covering a total surface area of ~60 000 km2. Rabies re-occurrence in Greece emphasizes the need for ongoing surveillance in cross-border areas and in areas with intense human activity.

  6. 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.

  7. Outbreak characteristics associated with identification of contributing factors to foodborne illness outbreaks.

    Science.gov (United States)

    Brown, L G; Hoover, E R; Selman, C A; Coleman, E W; Schurz Rogers, H

    2017-08-01

    Information on the factors that cause or amplify foodborne illness outbreaks (contributing factors), such as ill workers or cross-contamination of food by workers, is critical to outbreak prevention. However, only about half of foodborne illness outbreaks reported to the United States' Centers for Disease Control and Prevention (CDC) have an identified contributing factor, and data on outbreak characteristics that promote contributing factor identification are limited. To address these gaps, we analyzed data from 297 single-setting outbreaks reported to CDC's new outbreak surveillance system, which collects data from the environmental health component of outbreak investigations (often called environmental assessments), to identify outbreak characteristics associated with contributing factor identification. These analyses showed that outbreak contributing factors were more often identified when an outbreak etiologic agent had been identified, when the outbreak establishment prepared all meals on location and served more than 150 meals a day, when investigators contacted the establishment to schedule the environmental assessment within a day of the establishment being linked with an outbreak, and when multiple establishment visits were made to complete the environmental assessment. These findings suggest that contributing factor identification is influenced by multiple outbreak characteristics, and that timely and comprehensive environmental assessments are important to contributing factor identification. They also highlight the need for strong environmental health and food safety programs that have the capacity to complete such environmental assessments during outbreak investigations.

  8. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in Singapore: a 20-month study of clinical characteristics and control.

    Science.gov (United States)

    Tan, K W; Tay, L; Lim, S H

    1994-06-01

    Methicillin resistant Staphylococcus aureus (MRSA) is a major infection control problem in many countries. There have been many reports of outbreaks in neonatal nurseries including, in our part of the world, Australia, Hong Kong and Malaysia. A recent outbreak of MRSA in the neonatal intensive care unit in the Kandang Kerbau Hospital, Singapore, presented us with the opportunity to study the clinical characteristics of the outbreak and the effects of infection control measures. Neonates admitted to the neonatal intensive care unit were studied over a 20-month period. They were all screened for nasal colonisation on admission and weekly thereafter. Infections were documented. Over this period there were altogether 2,576 admissions of which 85 infants had nasal colonisation with MRSA (3.3%) and 28 developed infections (1%). Although the majority of infants colonised by MRSA suffered no ill effects, 3 had septicaemia and 2 had septicaemia with osteomyelitis. There were no deaths. Standard infection control measures with barrier nursing and the use of mupirocin nasal ointment were ineffective, and control was achieved only after strict cohorting together with the use of mupirocin was instituted. This was done without additional costs to the department and without additional nurses or doctors.

  9. Control of plankton seasonal succession by adaptive grazing

    DEFF Research Database (Denmark)

    Mariani, Patrizio; Andersen, Ken Haste; Visser, Andre

    2013-01-01

    The ecological succession of phytoplankton communities in temperate seas is characterized by the dominance of nonmotile diatoms during spring and motile flagellates during summer, a pattern often linked to the seasonal variation in the physical environment and nutrient availability. We focus...... on the effects of adaptive zooplankton grazing behavior on the seasonal succession of temperate plankton communities in an idealized community model consisting of a zooplankton grazer and two phytoplankton species, one motile and the other nonmotile. The grazer can switch between ambush feeding on motile cells...... behavior that optimizes its fitness. The adaptive grazing model predicts essential features of the seasonal plankton succession reported from temperate seas, including the vertical distribution and seasonal variation in the relative abundance of motile and nonmotile phytoplankton and the seasonal variation...

  10. [Water-borne disease outbreaks in Norway].

    Science.gov (United States)

    Nygård, Karin; Gondrosen, Bjørn; Lund, Vidar

    2003-12-04

    The drinking water in Norway has traditionally been considered being of good quality. However, outbreaks related to drinking water are reported every year. We review waterborne outbreaks in Norway over the last 15 years, and describe the aetiology of and contributory factors in these outbreaks. We compiled data on waterborne outbreaks reported to the Norwegian Institute of Public Health and Norwegian Food Control Authority during 1988-2002. We included all events in which two or more people fell ill and water was the suspected source of infection. Over the 15-year period. 72 outbreaks were reported, affecting a total of 10 616 persons. Campylobacter was the cause in 26% (19/72) of the outbreaks, norovirus in 18% (13/72). The causative organism was unknown in 46% (33/72). The water came from public waterworks in 32 of the 54 outbreaks for which this information was available (59%); from a private supply in the remaining 22. For 62% (16/26) of the outbreaks related to waterworks, the water was not disinfected before distribution. None of the private water supplies were disinfected. Over the last five years, there were more outbreaks related to private supplies. The most important contributory factor to waterborne outbreaks in Norway is contamination of the raw water combined with missing or faulty disinfecting procedures. To prevent future outbreaks, a continuous upgrading of small and private water supplies is needed. Reporting of outbreaks is important for the implementation of targeted and effective preventive measures.

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-05-01

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

  13. Rate Control Efficacy in Permanent Atrial Fibrillation : Successful and Failed Strict Rate Control Against a Background of Lenient Rate Control

    NARCIS (Netherlands)

    Groenveld, Hessel F.; Tijssen, Jan G. P.; Crijns, Harry J. G. M.; Van den Berg, Maarten P.; Hillege, Hans L.; Alings, Marco; Van Veldhuisen, Dirk J.; Van Gelder, Isabelle C.

    2013-01-01

    Objectives This study sought to investigate differences in outcome between patients treated with successful strict, failed strict, and lenient rate control. Background The RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation) study showed no difference in outcome between lenient and

  14. 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.

  15. Outbreak of Salmonella enterica serovar Typhimurium in Switzerland, May-June 2008, implications for production and control of meat preparations.

    Science.gov (United States)

    Schmid, H; Hachler, H; Stephan, R; Baumgartner, A; Boubaker, K

    2008-10-30

    An increased number of Salmonella Typhimurium cases were reported in Switzerland between May and June 2008. Investigations involved 72 cases. Results of PFGE typing identified several outbreak strains, the dominating one present in 43 of the 72 isolates. Strains affecting one third of the cases were also found in animal samples, in particular pork. However, no specific food source could be identified. Outbreaks described in this paper highlight the importance of food safety regulations such as those on minced meat and meat preparations issued by the European Commission and adopted by Switzerland into the national law.

  16. Malaria control in South Africa — challenges and successes

    African Journals Online (AJOL)

    The major strategies for malaria control are vector control through indoor residual spraying, case management, disease surveillance, epidemic preparedness and response, and public awareness. There has been a significant and sustained decrease in malaria case notifications since 2000, as a result of intensive indoor.

  17. Malaria control in South Africa - challenges and successes

    African Journals Online (AJOL)

    Africa; relatively small areas experience seasonal transmission. (hence malaria is unstable and epidemic-prone);3 a well- organised national malaria control programme exists; and the country has a relatively well-developed scientific, economic and health infrastructure. History of malaria control in South Africa. Malaria was ...

  18. 76 FR 45600 - Order of Succession for the Office of Healthy Homes and Lead Hazard Control

    Science.gov (United States)

    2011-07-29

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

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

    Science.gov (United States)

    Bergström, Karin; Nyman, Görel; Widgren, Stefan; Johnston, Christopher; Grönlund-Andersson, Ulrika; Ransjö, Ulrika

    2012-03-08

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

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

    Directory of Open Access Journals (Sweden)

    Bergström Karin

    2012-03-01

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

  1. Use of palivizumab and infection control measures to control an outbreak of respiratory syncytial virus in a neonatal intensive care unit confirmed by real-time polymerase chain reaction.

    LENUS (Irish Health Repository)

    O'Connell, K

    2011-04-01

    Respiratory syncytial virus (RSV) is a potentially life-threatening infection in premature infants. We report an outbreak involving four infants in the neonatal intensive care unit (NICU) of our hospital that occurred in February 2010. RSV A infection was confirmed by real-time polymerase chain reaction. Palivizumab was administered to all infants in the NICU. There were no additional symptomatic cases and repeat RSV surveillance confirmed that there was no further cross-transmission within the unit. The outbreak highlighted the infection control challenge of very high bed occupancy in the unit and the usefulness of molecular methods in facilitating detection and management.

  2. [Tobacco control politics in Germany. Evidence, success, and barriers].

    Science.gov (United States)

    Mons, U; Pötschke-Langer, M

    2010-02-01

    Structural measures of tobacco prevention are effective and cost-efficient measures to reduce tobacco consumption and the related health and economic consequences. However, Germany has been very reluctant in implementing tobacco control laws for several decades. Only recently has Germany increased its efforts in tobacco control, which has resulted in a decrease of tobacco consumption and in a decrease of smoking rates, especially in youths. This paper summarizes the evidence-based measures of tobacco prevention as well as the progress of recent German tobacco control policies. Finally, the barriers of further effective tobacco control policies are discussed and illustrated with examples. For decades, politics gave in to pressure and influence of lobbyists of the strong tobacco industry, which deceived the public and politics for their economic interests and in order to establish a high social acceptance of smoking. In addition, there is the phenomenon of "denialism", which means the convinced denial of scientific findings regarding smoking and smoking prevention in opponents of tobacco control, who are not directly affiliated with the tobacco industry.

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

    Science.gov (United States)

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

    2017-04-01

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

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

    Science.gov (United States)

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

    2017-09-01

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

  5. Successful renal transplant in patient with controlled pulmonary non ...

    African Journals Online (AJOL)

    infections in solid organ transplant recipients: a case-control study. Transpl Infect Dis. 2014; 16: 76Б83. 2. Haas S, Scully B, Cohen D, Radhakrishnan J. Mycobacterium avium complex infection in kidney transplant patients. Transpl. Infect Dis. 2005; 7: 75Б9. 3. Piersimoni C. Nontuberculous mycobacteria infection in solid.

  6. Malaria prevention and control in Bhutan: successes and challenges.

    Science.gov (United States)

    Tobgay, Tashi; Torres, Cristina E; Na-Bangchang, Kesara

    2011-03-01

    This paper highlights on the current malaria situations in Bhutan and its challenges for future prevention and control strategies. In Bhutan, malaria affects more than half of the entire population, mostly residing in the southern districts bordering with Indian states of Assam and West Bengal. Over the past ten years, due to concerted efforts, the morbidity and mortality due to malaria has significantly declined. These preventive and control measures focused on the mass distribution of long lasting insecticidal treated nets, focal indoor residual spray and use of artemisinin-based combination therapies. However, considerable challenge lies ahead and research is needed to generate local evidence for sustainable elimination of malaria from Bhutan. The article should be of value and interest to planners, malaria programs and for future researchers on malaria in Bhutan. Copyright © 2010 Elsevier B.V. All rights reserved.

  7. An epidemiological investigation of the early phase of the porcine epidemic diarrhea (PED) outbreak in Canadian swine herds in 2014: A case-control study.

    Science.gov (United States)

    Perri, Amanda M; Poljak, Zvonimir; Dewey, Cate; Harding, John C S; O'Sullivan, Terri L

    2018-02-01

    The first case of porcine epidemic diarrhea (PED) in Canada was diagnosed in January 2014 in Ontario, approximately 9 months after PED emerged in the United States. An early investigation of the Canadian outbreak suspected that the probable source of the virus was contaminated feed. The objective of this study was to evaluate the role of feed and other possible factors in the early phase of the PED outbreak in Canadian swine herds. The study period of interest for this case-control study was January 22nd to March 1st, 2014. A case herd was defined as a swine herd with a confirmed positive laboratory diagnostic test (RT-PCR) results for PED virus, along with pigs exhibiting typical clinical signs at the herd level during the study period. A questionnaire was administered to participating producers from the 22 Canadian swine herds enrolled (n = 9 case and n = 13 control herds). Case herd producers were asked to provide information from the initial day of onset of clinical signs and 30 days prior to that day. Control herds were matched to a case herd on the basis of province, herd type and approximate size. The period of interest for a control herd was matched to the initial day of clinical signs of PED for the case herd, along with the 30 days prior to this day. The questionnaire questions focused on herd demographics, biosecurity protocols, live animal movements onto and off sites, deadstock movements, feed and people movements for both the case and control herds. The questionnaire for control herds were based on their matched case's period of interest, and together with case herds formed a matched stratum. Multivariable exact conditional logistic regression and mixed multivariable logistic regression models, with the matched stratum as a random effect, were used to assess the association between various risk factors and the odds of PED introduction into a herd. After adjusting for biosecurity practices, the odds of a PED occurrence was 38.1 (95% CI: 2

  8. Case-control study of an outbreak of acute toxoplasmosis in an industrial plant in the state of São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Claudio Cesar Jaguaribe Ekman

    2012-10-01

    Full Text Available Foodborne diseases represent operational risks in industrial restaurants. We described an outbreak of nine clustered cases of acute illness resembling acute toxoplasmosis in an industrial plant with 2300 employees. These patients and another 36 similar asymptomatic employees were diagnosed with anti-T. gondii IgG titer and avidity by ELISA. We excluded 14 patients based on high IgG avidity and chronic toxoplasmosis: 13 from controls and one from acute disease other than T. gondii infection. We also identified another three asymptomatic employees with T.gondii acute infection and also anti-T. gondii IgM positive as remaining acute cases. Case control study was conducted by interview in 11 acute infections and 20 negative controls. The ingestion of green vegetables, but not meat or water, was observed to be associated with the incidence of acute disease. These data reinforce the importance of sanitation control in industrial restaurants and also demonstrate the need for improvement in quality control regarding vegetables at risk for T. gondii oocyst contamination. We emphasized the accurate diagnosis of indexed cases and the detection of asymptomatic infections to determine the extent of the toxoplasmosis outbreak.

  9. Citric Acid Injections: An Accessible and Efficient Method for Controlling Outbreaks of the Crown-of-Thorns Starfish Acanthaster cf. solaris

    Directory of Open Access Journals (Sweden)

    Alexander C. E. Buck

    2016-12-01

    Full Text Available Outbreaks of the crown-of-thorns starfish (Acanthaster cf. solaris, COTS are one of the primary causes of coral decline in the Indo-Pacific region. Effective methods to control COTS outbreaks may therefore be one of the most direct and immediate ways to reduce coral loss. However, the cost and logistical challenges associated with current control methods have undermined the effectiveness of many control efforts. In this study, we tested the feasibility of using powdered citric acid, which is widely available and low-cost, as an injection chemical for COTS control. We tested what combination of concentration, number of injections, volume, and water type were most efficient at killing COTS. All COTS injected in two or four sites died, irrespectively of the concentration of citric acid used, while single injections failed at reaching 100% mortality. The fastest combination was the injection of 150 g·L−1 citric acid solution in four injection sites (5 mL per site, which killed the starfish in 26.4 ± 4 h. These results suggest that injections of powdered citric acid are an effective, economical, and widely available alternative to current COTS control methods.

  10. An outbreak of Kingella kingae infections associated with hand, foot and mouth disease/herpangina virus outbreak in Marseille, France, 2013.

    Science.gov (United States)

    El Houmami, Nawal; Minodier, Philippe; Dubourg, Grégory; Martin-Laval, Alain; Lafont, Elisabeth; Jouve, Jean-Luc; Charrel, Rémi; Raoult, Didier; Fournier, Pierre-Edouard

    2015-03-01

    Outbreaks of invasive Kingella kingae infections recently emerged as a new public health concern in daycare centers in Europe, USA and Israel. Despite this, no trigger factor has been yet identified, preventing the setting up of rational measures of control and prevention. We report an outbreak of K. kingae infections associated with hand, foot and mouth disease/herpangina outbreak, and we define the research and policy priorities. From April 22 to May 07, 2013, 5 toddlers presented successive osteo-articular infections in a daycare center in Marseille, France. Real-time polymerase chain reaction targeting the cpn60 gene of K. kingae was used to investigate suspected cases and the prevalence of oropharyngeal K. kingae carriage of their close contacts. The attack rate of the K. kingae infections outbreak was 23.7% (5/21) with no fatality. Positive real-time polymerase chain reaction targeting the cpn60 gene of K. kingae confirmed the diagnosis in 3 cases and revealed a rate of K. kingae oropharynx carriage in the index classroom of 94.4% (17/18) among daycare attendees not given antibiotic during the previous month, and of 76.9% (10/13) among staff in close contact. The eradication rate of K. kingae was 21.4% (3/14) among classmates after oral administration of rifampicin, and eradication occurred spontaneously in 83.3% (5/6) of the staff. Clinical and epidemiological features of the herpangina outbreak were consistent with that of an emerging European Coxsackievirus-A6 outbreak. Hand, foot and mouth disease/herpangina virus outbreak enables triggering a K. kingae infections outbreak. Our findings offer support for new guidelines of K. kingae infections outbreaks management and emphasize the need for further research.

  11. Ecological Complexity and the Success of Fungal Biological Control Agents

    Directory of Open Access Journals (Sweden)

    Guy R. Knudsen

    2014-01-01

    Full Text Available Fungal biological control agents against plant pathogens, especially those in soil, operate within physically, biologically, and spatially complex systems by means of a variety of trophic and nontrophic interspecific interactions. However, the biocontrol agents themselves are also subject to the same types of interactions, which may reduce or in some cases enhance their efficacy against target plant pathogens. Characterization of these ecologically complex systems is challenging, but a number of tools are available to help unravel this complexity. Several of these tools are described here, including the use of molecular biology to generate biocontrol agents with useful marker genes and then to quantify these agents in natural systems, epifluorescence and confocal laser scanning microscopy to observe their presence and activity in situ, and spatial statistics and computer simulation modeling to evaluate and predict these activities in heterogeneous soil habitats.

  12. 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.

  13. 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.

  14. 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.

  15. African horse sickness: The potential for an outbreak in disease-free regions and current disease control and elimination techniques.

    Science.gov (United States)

    Robin, M; Page, P; Archer, D; Baylis, M

    2016-09-01

    African horse sickness (AHS) is an arboviral disease of equids transmitted by Culicoides biting midges. The virus is endemic in parts of sub-Saharan Africa and official AHS disease-free status can be obtained from the World Organization for Animal Health on fulfilment of a number of criteria. AHS is associated with case fatality rates of up to 95%, making an outbreak among naïve horses both a welfare and economic disaster. The worldwide distributions of similar vector-borne diseases (particularly bluetongue disease of ruminants) are changing rapidly, probably due to a combination of globalisation and climate change. There is extensive evidence that the requisite conditions for an AHS epizootic currently exist in disease-free countries. In particular, although the stringent regulations enforced upon competition horses make them extremely unlikely to redistribute the virus, there are great concerns over the effects of illegal equid movement. An outbreak of AHS in a disease free region would have catastrophic effects on equine welfare and industry, particularly for international events such as the Olympic Games. While many regions have contingency plans in place to manage an outbreak of AHS, further research is urgently required if the equine industry is to avoid or effectively contain an AHS epizootic in disease-free regions. This review describes the key aspects of AHS as a global issue and discusses the evidence supporting concerns that an epizootic may occur in AHS free countries, the planned government responses, and the roles and responsibilities of equine veterinarians. © 2016 EVJ Ltd.

  16. Knowledge, attitude and practice of hygiene and sanitation in a Burundian refugee camp: implications for control of a Salmonella typhi outbreak.

    Science.gov (United States)

    Nahimana, Marie-Rosette; Ngoc, Candide Tran; Olu, Olushayo; Nyamusore, Jose; Isiaka, Ayodeji; Ndahindwa, Vedaste; Dassanayake, Lakruwan; Rusanganwa, André

    2017-01-01

    A Salmonella typhi outbreak was reported in a Burundian refugee camp in Rwanda in October 2015. Transmission persisted despite increased hygiene promotion activities and hand-washing facilities instituted to prevent and control the outbreak. A knowledge, attitude and practice (KAP) study was carried out to assess the effectiveness of ongoing typhoid fever preventive interventions. A cross-sectional survey was conducted in Mahama Refugee Camp of Kirehe District, Rwanda from January to February 2016. Data were obtained through administration of a structured KAP questionnaire. Descriptive, bivariate and multivariate analysis was performed using STATA software. A total of 671 respondents comprising 264 (39.3%) males and 407 (60.7%) females were enrolled in the study. A comparison of hand washing practices before and after institution of prevention and control measures showed a 37% increase in the proportion of respondents who washed their hands before eating and after using the toilet (p practices. The findings of this study underline the need for bolstering up health education and hygiene promotion activities in Mahama and other refugee camp settings.

  17. 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.

  18. An investigation of an outbreak of gastroenteritis in the Tavsanli District of Kutahya Province, July 2014, a Case-Control Study

    Directory of Open Access Journals (Sweden)

    Gülşen Barlas

    2016-08-01

    Full Text Available Objective: On 18.06.2014 health authorities of the Tavsanli district reported 684 gastroenteritis patients; of whom 28 were hospitalized. We investigated this outbreak to identify the cause, mode of transmission and to implement control measures. Method: In this case-control investigation, we evaluated 154 probable cases defined as onset of vomiting or diarrhea (≥3/day, which were randomly selected from the 5 neighborhoods with highest attack rates. These were diagnosed as A09, R11, K52 ICD-10 codes between the 7th and the-30th June; and their age-groups were matched 1:1 with neighborhood-controls. Clinical and tap water samples were collected. Results: The attack rate was 3.3% and cases were widespread in the district. Main symptoms were nausea (88.9%, diarrhea (88.2%, abdominal pain (82.8%, and vomiting (71.8%. The symptoms started to increase 6 days after a flood, and the epidemic curve revealed a high peak. 66.9% of cases (103/154 had drunk from a neighborhood water fountain, compared with 37% (57/154 of the controls (ORMH=4.3, 95% CI=2.2-8.6; 18% (28/156 of cases compared with 27% (43/95 of the controls used bottled water (ORMH=0.5, 95% CI=0.3-0.9. Norovirus was detected in five stool specimens. Environmental investigation showed that there were 35 untreated neighborhood fountains and that the water tanks that providing water to neighborhood fountains was full of flood water. Norovirus was not identified in the water samples. Conclusion: The findings of the study reveal that this norovirus outbreak was likely due to drinking contaminated water from neighborhood fountains after the flood due to an unprotected neighborhood storage tank next to a canal, supplying the fountains.Keywords: Norovirus, matched case-control study, water, diarrhea

  19. Modeling cholera outbreaks

    Science.gov (United States)

    Longini, Ira M.; Morris, J. Glenn

    2014-01-01

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

  20. Psychological factors of professional success of nuclear power plant main control room operators

    OpenAIRE

    Kosenkov A.A.

    2014-01-01

    Aim: to conduct a comparative analysis of the psychological characteristics of the most and least successful main control room operators. Material and Methods. Two NPP staff groups: the most and least successful main control room operators, who worked in routine operating conditions, were surveyed. Expert evaluation method has been applied to identify the groups. The subjects were administered the Minnesota Multiphasic Personality Inventory (MMPI), Cattell's Sixteen Personality Factor Questio...

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

    Science.gov (United States)

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

    2002-08-01

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

  2. Chikungunya Outbreak, South India, 2006

    Science.gov (United States)

    Kaur, Prabhdeep; Ponniah, Manickam; Murhekar, Manoj V.; Ramachandran, Vidya; Ramachandran, Ramakrishnan; Raju, Hari Kishan; Perumal, Vanamail; Mishra, Akhilesh C.

    2008-01-01

    We investigated chikungunya outbreaks in South India and observed a high attack rate, particularly among adults and women. Transmission was facilitated by Aedes aegypti mosquitoes in peridomestic water containers, as indicated by a high Breteau index. We recommended vector control measures and health education to promote safe water storage practices. PMID:18826830

  3. Resisting Temptation: Tracking How Self-Control Conflicts Are Successfully Resolved in Real Time.

    Science.gov (United States)

    Stillman, Paul E; Medvedev, Danila; Ferguson, Melissa J

    2017-09-01

    Across four studies, we used mouse tracking to identify the dynamic, on-line cognitive processes that underlie successful self-control decisions. First, we showed that individuals display real-time conflict when choosing options consistent with their long-term goal over short-term temptations. Second, we found that individuals who are more successful at self-control-whether measured or manipulated-show significantly less real-time conflict in only self-control-relevant choices. Third, we demonstrated that successful individuals who choose a long-term goal over a short-term temptation display movements that are smooth rather than abrupt, which suggests dynamic rather than stage-based resolution of self-control conflicts. These findings have important implications for contemporary theories of self-control.

  4. [Medical controlling as medical economical service center. Successful concept for orthopedics and trauma surgery centers?].

    Science.gov (United States)

    Auhuber, T C; Hoffmann, R

    2015-01-01

    The management of patients from administrative admission through the orthopedic-surgical treatment to completion of the billing is complex. Additional challenges originate from the necessity to treat patients in both outpatient and inpatient departments and in more than one medical sector. A superior coordination is essential for a successful cooperation of the various procedures of controlling. The model of a medical controlling department as a service center with effective competence in the management of service and cost, functions as a successful solution to the problem. Central elements of a successful medical economical case management are a well-defined assignment of tasks and definitions of intersections, the integration of health professionals and administrative employees, the utilization of software for process control and the implementation of inlier controlling.

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

    Science.gov (United States)

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

    2015-05-07

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Redente, E.F.; McLendon, T.

    1992-09-25

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

  7. Habitual exercise is associated with cognitive control and cognitive reappraisal success.

    Science.gov (United States)

    Giles, Grace E; Cantelon, Julie A; Eddy, Marianna D; Brunyé, Tad T; Urry, Heather L; Mahoney, Caroline R; Kanarek, Robin B

    2017-12-01

    Habitual exercise is associated with enhanced domain-general cognitive control, such as inhibitory control, selective attention, and working memory, all of which rely on the frontal cortex. However, whether regular exercise is associated with more specific aspects of cognitive control, such as the cognitive control of emotion, remains relatively unexplored. The present study employed a correlational design to determine whether level of habitual exercise was related to performance on the Stroop test measuring selective attention and response inhibition, the cognitive reappraisal task measuring cognitive reappraisal success, and associated changes in prefrontal cortex (PFC) oxygenation using functional near-infrared spectroscopy. 74 individuals (24 men, 50 women, age 18-32 years) participated. Higher habitual physical activity was associated with lower Stroop interference (indicating greater inhibitory control) and enhanced cognitive reappraisal success. Higher habitual exercise was also associated with lower oxygenated hemoglobin (O2Hb) in the PFC in response to emotional information. However, NIRS data indicated that exercise was not associated with cognitive control-associated O2Hb in the PFC. Behaviorally, the findings support and extend the previous findings that habitual exercise relates to more successful cognitive control of neutral information and cognitive reappraisal of emotional information. Future research should explore whether habitual exercise exerts causal benefits to cognitive control and PFC oxygenation, as well as isolate specific cognitive control processes sensitive to change through habitual exercise.

  8. Opportunity for collaboration: a conceptual model of success in tobacco control and cancer prevention.

    Science.gov (United States)

    Stillman, Frances A; Schmitt, Carol L; Rosas, Scott R

    2012-01-01

    Collaborations between cancer prevention and tobacco control programs can leverage scarce resources to address noncommunicable diseases globally, but barriers to cooperation and actual collaboration are substantial. To foster collaboration between cancer prevention and tobacco control programs, the Global Health Partnership conducted research to identify similarities and differences in how the 2 programs viewed program success. Using concept mapping, cancer prevention and tobacco control experts generated statements describing the components of a successful cancer prevention or tobacco control program and 33 participants sorted and rated the final 99 statements. Multidimensional scaling analysis with a 2-dimensional solution was used to identify an 8-cluster conceptual map of program success. We calculated Pearson correlation coefficients for all 99 statements to compare the item-level ratings of both groups and used t tests to compare the mean importance of ratings assigned to each cluster. Eight major clusters of success were identified: 1) advocacy and persuasion, 2) building sustainability, 3) partnerships, 4) readiness and support, 5) program management fundamentals, 6) monitoring and evaluation, 7) utilization of evidence, and 8) implementation. We found no significant difference between the maps created by the 2 groups and only 1 mean difference for the importance ratings for 1 of the clusters: cancer prevention experts rated partnerships as more important to program success than did tobacco control experts. Our findings are consistent with those of research documenting the necessary components of successful programs and the similarities between cancer prevention and tobacco control. Both programs value the same strategies to address a common risk factor: tobacco use. Identifying common ground between these 2 research and practice communities can benefit future collaborations at the local, state, tribal, national, and international levels, and inform the

  9. First nosocomial outbreak of vanA-type vancomycin-resistant Enterococcus raffinosus in France.

    Science.gov (United States)

    Jolivet, S; Fines-Guyon, M; Nebbad, B; Merle, J C; Le Pluart, D; Brun-Buisson, C; Decousser, J-W; Cattoir, V

    2016-12-01

    Vancomycin-resistant Enterococcus raffinosus has rarely been associated with nosocomial infection and outbreaks. To report the successful control of a nosocomial outbreak of vanA-type vancomycin-resistant E. raffinosus in a surgical intensive care unit. The investigation of the outbreak is reported with control measures taken. Molecular typing of vancomycin-resistant E. raffinosus isolates was performed by repetitive sequence-based polymerase chain reaction (PCR). Between September and October 2014, vancomycin-resistant E. raffinosus isolates were isolated from four patients. The index patient had been hospitalized previously in Portugal, and was not found to be colonized by vancomycin-resistant enterococci on screening cultures obtained at admission. However, vancomycin-resistant E. raffinosus was isolated from a bile sample 19 days after hospital admission. All four isolates were resistant to both vancomycin and teicoplanin due to the presence of the vanA gene, while remaining susceptible to daptomycin and linezolid. Repetitive sequence-based PCR confirmed the spread of a single vanA-positive E. raffinosus clone. Infection control measures including direct PCR screening on rectal specimens, contact precautions, and cohorting of patients and personnel led to successful control of the outbreak. This is the first reported outbreak of vanA-type vancomycin-resistant E. raffinosus in France in both clinical and screening specimens among hospitalized patients. The inability of routine selective screening media to detect the vancomycin-resistant E. raffinosus in the index case likely contributed to the outbreak. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. The First Outbreak Caused by Acinetobacter baumannii ST208 and ST195 in China

    Directory of Open Access Journals (Sweden)

    Junyan Qu

    2016-01-01

    Full Text Available This study aimed to analyze the clinical characteristics of patients and molecular mechanisms of the first outbreak mainly caused by sequence types (STs 208 multidrug resistant (MDR Acinetobacter baumannii in China. A total of 10 clinical samples were collected from 5 patients who were involved in the outbreak. Bacterial identification and antibiotic sensitivity tests were performed by the VITEK-2 COMPACT automated system. MICs of tigecycline for clinical isolates were determined using broth microdilution. The clonal relatedness of A. baumannii clinical isolates in our local settings was determinated by pulsed-field gel electrophoresis (PFGE and multilocus sequence typing (MLST. A total of 7 A. baumannii strains were isolated and all were MDR strains; two of them were carbapenem-nonsusceptible strains. blaOXA-23 was the only acquired carbapenemase gene in the isolates. The isolates belonged to a single clonal pulsotype determined by PFGE and two sequences types (STs determined by MLST. The isolates belonged to the globally disseminated clonal complex 92, among which ST195 and ST208 were the most common sequence types (71.43% and 28.57%. The outbreak was successfully controlled by stringent infection control measures, especially improving the hand hygiene compliance and enhancing antimicrobial stewardship. In conclusion, this is the first description of an outbreak caused mainly by A. baumannii of ST208 in China. Infection control measures should be strengthened when infection outbreaks in hospital.

  11. European Food Safety Authority, European Centre for Disease Prevention and Control; The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2009

    DEFF Research Database (Denmark)

    Korsgaard, Helle; Borck Høg, Birgitte; Helwigh, Birgitte

    The European Food Safety Authority and the European Centre for Disease Prevention and Control have analysed the information on the occurrence of zoonoses and food-borne outbreaks in 2009 submitted by 27 European Union Member States. In 2009, 108,614 salmonellosis cases in humans were reported and...

  12. Impact and cost of infection control measures to reduce nosocomial transmission of extended-spectrum beta-lactamase-producing organisms in a non-outbreak setting.

    Science.gov (United States)

    Conterno, L O; Shymanski, J; Ramotar, K; Toye, B; Zvonar, R; Roth, V

    2007-04-01

    We evaluated the impact of infection control interventions to reduce nosocomial extended-spectrum beta-lactamase (ESBL) transmission in a non-outbreak setting. This study was conducted at a tertiary 1200-bed hospital in Canada. The incidence of ESBLs was based on recovery of clinical isolates and assessed prospectively from 1999 to 2005. The incidence increased significantly from 0.28 to 0.67 per 1000 admissions during this period (Pnosocomial ESBL rates increased only marginally, suggesting that infection control measures had an impact on nosocomial transmission. Infection control measures consisted of isolating all ESBL patients, as well as implementing the use of contact precautions for those with a high risk for transmission. The cost of these measures was CN$138 046.00 per year and CN$3191.83 per case admitted. A combination of control measures including active surveillance cultures, contact precautions for all colonized or infected patients and antimicrobial stewardship is required to significantly reduce the incidence of ESBLs.

  13. Extensively drug-resistant Acinetobacter baumannii outbreak cross-transmitted in an intensive care unit and respiratory intensive care unit.

    Science.gov (United States)

    Lei, Jin'e; Han, Shaoshan; Wu, Wenjing; Wang, Xue; Xu, Jiru; Han, Lei

    2016-11-01

    Extensively drug-resistant Acinetobacter baumannii (XDRAB) is a great threat in intensive care units (ICUs). The aim of this study was to describe an XDRAB outbreak which was cross-transmitted in the ICU and respiratory intensive care unit (RICU) in a tertiary care hospital from January-March 2013. Patient and environmental surveillances were performed. Isolates were tested for antimicrobial susceptibility. Genotypes were analyzed by multilocus sequence typing (MLST). A series of enhanced strategies were implemented to control the outbreak. A total of 11 patients were infected by XDRAB strains during this outbreak. Three patients in the ICU were found positive for XDRAB at the onset of the outbreak. Thereafter, infections were detected in 6 patients in the RICU, followed by reappearance of this strain in the ICU in 2 patients. All A baumannii strains isolated from patients and the environment were extensively drug resistant. MLST revealed them as ST368. After 3 rounds of environmental screening and cleaning, the laminar flow system connecting the ICU and RICU was found as the source of transmission. Successful control of this outbreak was achieved through multifaceted intervention measures. This study suggested the importance of thorough surveillance and disinfection of the environment, including concealed devices, in preventing the transmission of an outbreak. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2015-02-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  16. Cholera outbreaks in Africa.

    Science.gov (United States)

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

    2014-01-01

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

  17. An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study.

    Directory of Open Access Journals (Sweden)

    Yvette H van Beurden

    Full Text Available An outbreak of Clostridium difficile ribotype 027 infection (CDI occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study.Cases (n = 79, diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316. Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10 was genotyped by Whole Genome Sequencing (WGS.WGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates. Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU (OR: 2.4, 95% CI 1.0-5.6, longer length of stay (LOS, and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1-0.6. Analysis of patients who stayed at the ICU (35 cases; 51 controls, indicated that the use of selective decontamination of the digestive tract (SDD and a longer LOS in the ICU were associated with CDI risk.In this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.

  18. Electrolysis-Driven and Pressure-Controlled Diffusive Growth of Successive Bubbles on Microstructured Surfaces

    NARCIS (Netherlands)

    Van Der Linde, Peter; Moreno Soto, Álvaro; Peñas-López, Pablo; Rodríguez-Rodríguez, Javier; Lohse, Detlef; Gardeniers, J.G.E.; Van Der Meer, Devaraj; Fernández Rivas, David

    2017-01-01

    Control over the bubble growth rates forming on the electrodes of water-splitting cells or chemical reactors is critical with respect to the attainment of higher energy efficiencies within these devices. This study focuses on the diffusion-driven growth dynamics of a succession of H2 bubbles

  19. SUCCESSFUL LONG-TERM CONTROL OF IDIOPATHIC HYPEREOSINOPHILIC SYNDROME WITH ETOPOSIDE

    NARCIS (Netherlands)

    SMIT, AJ; VANESSEN, LH; DEVRIES, EGE

    1991-01-01

    A 38-year-old man with idiopathic hypereosinophilic syndrome had an inadequate response to steroids and severe side effects from hydroxyurea treatment, which necessitated withdrawal of the treatment. Successful control of clinical symptoms and eosinophil counts was obtained with etoposide (VP16-213)

  20. Great Basin insect outbreaks

    Science.gov (United States)

    Barbara Bentz; Diane Alston; Ted Evans

    2008-01-01

    Outbreaks of native and exotic insects are important drivers of ecosystem dynamics in the Great Basin. The following provides an overview of range, forest, ornamental, and agricultural insect outbreaks occurring in the Great Basin and the associated management issues and research needs.

  1. Almond oil implicated in a Staphylococcus capitis outbreak in a neonatal intensive care unit.

    Science.gov (United States)

    Gras-Le Guen, C; Fournier, S; Andre-Richet, B; Caillon, J; Chamoux, C; Espaze, E; Richet, H; Roze, J C; Lepelletier, D

    2007-11-01

    To develop an effective outbreak-control strategy by identifying the source and modes of transmission of Staphylococcus capitis in a 60-bed neonatal intensive care unit (NICU). We conducted a study among neonates hospitalized during the outbreak (June 2000 through November 2003). All cases of S. capitis colonization or infection detected by clinical samples during the outbreak were included. The molecular analysis of the isolated was assessed by pulsed-field electrophoresis. We reported the description of the outbreak and the measures taken during this investigation. Thirty-three patients were colonized or infected by S. capitis. Mean gestational age was 28.5+/-4.4 weeks of gestation, mean birth weight was 1068+/-637.3 g and the mean length of hospital stay was 77.9+/-35.9 days. We observed that positive S. capitis cultures were over-represented in six beds of the NICU. Because S. capitis is known to thrive in lipid media, we cultured samples from the almond oil bottles assigned to these beds. S. capitis strain recovered from one of the almond oil sample was genetically identical to the strain recovered from the cases. Almond oil is an unusual reservoir infection. Control policy allowed prompt institution of measures that were successful in ending the outbreak.

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

    Science.gov (United States)

    Winter, David G

    2010-12-01

    Several decades of research have established that implicit achievement motivation (n Achievement) is associated with success in business, particularly in entrepreneurial or sales roles. However, several political psychology studies have shown that achievement motivation is not associated with success in politics; rather, implicit power motivation often predicts political success. Having versus lacking control may be a key difference between business and politics. Case studies suggest that achievement-motivated U.S. presidents and other world leaders often become frustrated and thereby fail because of lack of control, whereas power-motivated presidents develop ways to work with this inherent feature of politics. A reevaluation of previous research suggests that, in fact, relationships between achievement motivation and business success only occur when control is high. The theme of control is also prominent in the development of achievement motivation. Cross-national data are also consistent with this analysis: In democratic industrialized countries, national levels of achievement motivation are associated with strong executive control. In countries with low opportunity for education (thus fewer opportunities to develop a sense of personal control), achievement motivation is associated with internal violence. Many of these manifestations of frustrated achievement motivation in politics resemble authoritarianism. This conclusion is tested by data from a longitudinal study of 113 male college students, showing that high initial achievement motivation combined with frustrated desires for control is related to increases in authoritarianism (F-scale scores) during the college years. Implications for the psychology of leadership and practical politics are discussed. © 2010 The Author. Journal of Personality © 2010, Wiley Periodicals, Inc.

  3. Successfully controlling intrusive memories is harder when control must be sustained

    NARCIS (Netherlands)

    K. van Schie (Kevin); M.C. Anderson (Michael)

    2017-01-01

    textabstractAfter unpleasant events, people often experience intrusive memories that undermine their peace of mind. In response, they often suppress these unwanted memories from awareness. Such efforts may fail, however, when inhibitory control demands are high due to the need to sustain control, or

  4. Successfully Controlling Intrusive Memories is Harder When Control Must be Sustained

    NARCIS (Netherlands)

    van Schie, K.; Anderson, Michael

    2017-01-01

    After unpleasant events, people often experience intrusive memories that undermine their peace of mind. In response, they often suppress these unwanted memories from awareness. Such efforts may fail, however, when inhibitory control demands are high due to the need to sustain control, or when

  5. Waterborne outbreaks of cryptosporidiosis

    Directory of Open Access Journals (Sweden)

    Rachel M. Chalmers

    2012-12-01

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

  6. Characteristics Associated With Successful Fitting of a Vaginal Bowel Control System for Fecal Incontinence.

    Science.gov (United States)

    Matthews, Catherine A; Varma, Madhulika G; Takase-Sanchez, Michelle M; Hale, Douglas S; Van Drie, Douglas; Muir, Tristi; Wells, Ellen; Jannelli, Mary; Richter, Holly E

    2016-01-01

    We previously showed that management with a novel vaginal bowel control system was efficacious in women with moderate to severe fecal incontinence. The objective of this secondary analysis was to evaluate the clinical characteristics associated with device-fitting success. This is a secondary analysis of an institutional review board-approved, multicenter, prospective, open-label clinical study of women aged 19 to 75 years with 4 or more episodes of fecal incontinence recorded on a 2-week baseline bowel diary. Those successfully fitted with the vaginal bowel control device entered a 1-month treatment period, and efficacy was assessed with a repeat bowel diary. Demographic data, medical and surgical history, and pelvic examination findings were compared across women with successful and unsuccessful completion of the fitting period. Multivariate logistic regression analysis was performed. Six clinical sites in the United States recruited from August 2012 through October 2013. Overall, 110 women underwent attempted fitting, of which 61 (55.5%) of 110 were successful and entered the treatment portion of the study. Multivariate logistic regression analysis revealed that previous prolapse surgery (P = 0.007) and shorter vaginal length (P = 0.041) were independently associated with unsuccessful fitting. Women who have not undergone previous prolapse surgery had 4.7 times the odds (95% confidence interval [CI], 1.53-14.53) of a successful fit. In addition, for every additional centimeter of vaginal length, women had 1.49 times the odds (95% CI, 1.02-2.17) of a successful fit. Shorter vaginal length and previous prolapse surgery were associated with an increased risk of fitting failure. These findings may be used to inform patients regarding their expectation of successful fitting.

  7. Successful dieters have increased neural activity in cortical areas involved in the control of behavior.

    Science.gov (United States)

    DelParigi, A; Chen, K; Salbe, A D; Hill, J O; Wing, R R; Reiman, E M; Tataranni, P A

    2007-03-01

    To investigate whether dietary restraint, a landmark of successful dieting, is associated with specific patterns of brain responses to the sensory experience of food and meal consumption. Cross-sectional study of the brain's response to the sensory experience of food and meal consumption in nine successful dieters (age: 38+/-7 years, body fat (%): 28+/-3) and 20 non-dieters (age: 31+/-9 years, body fat (%): 33+/-9), all women. Changes in brain activity in response to the sensory experience of food and meal consumption were assessed by using positron emission tomography and (15)O water as a radiotracer. Body fatness was assessed by dual X-ray absorptiometry. Subjective ratings of hunger and fullness were measured by visual analogue scale. Dietary restraint, disinhibition and hunger were assessed by the Three Factor Eating Questionnaire. Successful dieters had a significantly higher level of dietary restraint compared to non-dieters. In response to meal consumption, successful dieters had a greater activation in the dorsal prefrontal cortex (DPFC), dorsal striatum and anterior cerebellar lobe as compared to non-dieters. In response to the same stimulation, the orbitofrontal cortex (OFC) was significantly more activated in non-dieters as compared to successful dieters. Dietary restraint was positively correlated with the response in the DPFC and negatively with the response in the OFC. The responses in the DPFC and OFC were negatively intercorrelated. Cortical areas involved in controlling inappropriate behavioral responses, such as the DPFC, are particularly activated in successful dieters in response to meal consumption. The association between the degree of dietary restraint and the coordinated neural changes in the DPFC and OFC raises the possibility that cognitive control of food intake is achieved by modulating neural circuits controlling food reward.

  8. Cholera returns to southern Vietnam in an outbreak associated with consuming unsafe water through iced tea: A matched case-control study.

    Science.gov (United States)

    Nguyen, Thuong V; Pham, Quang D; Do, Quoc K; Diep, Tai T; Phan, Hung C; Ho, Thang V; Do, Hong T; Phan, Lan T; Tran, Huu N

    2017-04-01

    After more than a decade of steadily declining notifications, the number of reported cholera cases has recently increased in Vietnam. We conducted a matched case-control study to investigate transmission of cholera during an outbreak in Ben Tre, southern Vietnam, and to explore the associated risk factors. Sixty of 71 diarrheal patients confirmed to be infected with cholera by culture and diagnosed between May 9 and August 3, 2010 in Ben Tre were consecutively recruited as case-patients. Case-patients were matched 1:4 to controls by commune, sex, and 5-year age group. Risk factors for cholera were examined by multivariable conditional logistic regression. In addition, environmental samples from villages containing case-patients were taken to identify contamination of food and water sources. The regression indicated that drinking iced tea (adjusted odds ratio (aOR) = 8.40, 95% confidence interval (CI): 1.84-39.25), not always boiling drinking water (aOR = 2.62, 95% CI: 1.03-6.67), having the main source of water for use being close to a toilet (aOR = 4.36, 95% CI: 1.37-13.88), living with people who had acute diarrhea (aOR = 13.72, 95% CI: 2.77-67.97), and little or no education (aOR = 4.89, 95% CI: 1.18-20.19) were significantly associated with increased risk of cholera. In contrast, drinking stored rainwater (aOR = 0.17, 95% CI: 0.04-0.63), eating cooked seafood (aOR = 0.27, 95% CI: 0.10-0.73), and eating steamed vegetables (aOR = 0.22, 95% CI: 0.07-0.70) were protective against cholera. Vibrio cholerae O1 Ogawa carrying ctxA was found in two of twenty-five river water samples and one of six wastewater samples. The magnitude of the cholera outbreak in Ben Tre was lower than in other similar settings. This investigation identified several risk factors and underscored the importance of continued responses targeting cholera prevention in southern Vietnam. The association between drinking iced tea and cholera and the spread of V. cholerae O1, altered El Tor strains

  9. Psychological factors of professional success of nuclear power plant main control room operators

    Directory of Open Access Journals (Sweden)

    Kosenkov A.A.

    2014-12-01

    Full Text Available Aim: to conduct a comparative analysis of the psychological characteristics of the most and least successful main control room operators. Material and Methods. Two NPP staff groups: the most and least successful main control room operators, who worked in routine operating conditions, were surveyed. Expert evaluation method has been applied to identify the groups. The subjects were administered the Minnesota Multiphasic Personality Inventory (MMPI, Cattell's Sixteen Personality Factor Questionnaire (16PF form A and Raven's Progressive Matrices test. Results. Numerous significant psychological differences between the groups of most and least successful control room operators were obtained: the best operators were significantly more introverted and correctly solved more logical tasks with smaller percentage of mistakes under time pressure than worst ones. Conclusions: 1. The psychodiagnostic methods used in the study were adequate to meet research objective 2. Tendency to introversion, as well as developed the ability to solve logic problems undertime pressure, apparently, are important professional qualities for control room operators. These indicators should be considered in the process of psychological selection and professional guidance of nuclear power plant operators.

  10. Transferring brain-computer interfaces beyond the laboratory: successful application control for motor-disabled users.

    Science.gov (United States)

    Leeb, Robert; Perdikis, Serafeim; Tonin, Luca; Biasiucci, Andrea; Tavella, Michele; Creatura, Marco; Molina, Alberto; Al-Khodairy, Abdul; Carlson, Tom; Millán, José D R

    2013-10-01

    Brain-computer interfaces (BCIs) are no longer only used by healthy participants under controlled conditions in laboratory environments, but also by patients and end-users, controlling applications in their homes or clinics, without the BCI experts around. But are the technology and the field mature enough for this? Especially the successful operation of applications - like text entry systems or assistive mobility devices such as tele-presence robots - requires a good level of BCI control. How much training is needed to achieve such a level? Is it possible to train naïve end-users in 10 days to successfully control such applications? In this work, we report our experiences of training 24 motor-disabled participants at rehabilitation clinics or at the end-users' homes, without BCI experts present. We also share the lessons that we have learned through transferring BCI technologies from the lab to the user's home or clinics. The most important outcome is that 50% of the participants achieved good BCI performance and could successfully control the applications (tele-presence robot and text-entry system). In the case of the tele-presence robot the participants achieved an average performance ratio of 0.87 (max. 0.97) and for the text entry application a mean of 0.93 (max. 1.0). The lessons learned and the gathered user feedback range from pure BCI problems (technical and handling), to common communication issues among the different people involved, and issues encountered while controlling the applications. The points raised in this paper are very widely applicable and we anticipate that they might be faced similarly by other groups, if they move on to bringing the BCI technology to the end-user, to home environments and towards application prototype control. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Effect of awareness programs and travel-blocking operations in the control of HIV/AIDS outbreaks: a multi-domains SIR model

    National Research Council Canada - National Science Library

    Zakary, Omar; Larrache, Abdelilah; Rachik, Mostafa; Elmouki, Ilias

    2016-01-01

    The main goal of this article is to exhibit the importance of awareness programs and travel-blocking operations, in the prevention of HIV/AIDS outbreaks, based on a multi-domains SIR epidemic model...

  12. Nosocomial Outbreak of New Delhi Metallo-β-Lactamase-1-Producing Gram-Negative Bacteria in South Africa: A Case-Control Study.

    Science.gov (United States)

    de Jager, Pieter; Chirwa, Tobias; Naidoo, Shan; Perovic, Olga; Thomas, Juno

    2015-01-01

    New Delhi metallo-β-lactamase (NDM)-producing Gram-negative bacteria have spread globally and pose a significant public health threat. There is a need to better define risk factors and outcomes of NDM-1 clinical infection. We assessed risk factors for nosocomial infection with NDM-1-producers and associated in-hospital mortality. A matched case-control study was conducted during a nosocomial outbreak of NDM-1-producers in an adult intensive care unit (ICU) in South Africa. All patients from whom NDM-1-producers were identified were considered (n=105). Cases included patients admitted during the study period in whom NDM-1 producing Gram-negative bacteria were isolated from clinical specimens collected ≥48 hours after admission, and where surveillance definitions for healthcare-associated infections were met. Controls were matched for age, sex, date of hospital admission and intensive-care admission. Conditional logistic regression was used to identify risk factors for NDM-1 clinical infection and associated in-hospital mortality. 38 cases and 68 controls were included. Klebsiella pneumoniae was the most common NDM-1-producer (28/38, 74%). Cases had longer mean hospital stays (44.0 vs. 13.3 days; P cases was significantly higher than controls (55.3% vs. 14.7%; AOR, 11.29; P Cases had a significantly higher likelihood of in-hospital mortality when the NDM-1-producer was Klebsiella pneumoniae (AOR, 16.57; P = 0.007), or when they had a bloodstream infection (AOR, 8.84; P = 0.041). NDM-1 infection is associated with significant in-hospital mortality. Risk factors for hospital-associated infection include the presence of co-morbid disease, mechanical ventilation and piperacillin/tazobactam exposure.

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

    Science.gov (United States)

    Zhu, Dingyun; Gedeon, Tom; Taylor, Ken

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

  14. Influenza outbreak in a correctional facility.

    Science.gov (United States)

    Awofeso, N; Fennell, M; Waliuzzaman, Z; O'Connor, C; Pittam, D; Boonwaat, L; de Kantzow, S; Rawlinson, W D

    2001-10-01

    The outbreak of influenza in a corrections facility occurred during August 2000. The outbreak progressed following introduction of the disease by a member of the public to the facility. Rapid diagnosis and typing of the influenza isolates was available, although two prisoners required hospital admission due to the severity of complications at the time of diagnosis. The group demonstrated rapid transmission of the virus by the respiratory route and probably by fomites. The identified infecting virus was A/Moscow-like, an H3N2 subtype typically associated with large outbreaks. Prevention of such outbreaks will involve either achieving high rates of vaccination within the risk groups, or rapid (possibly point of care) diagnosis with the institution of antiviral therapy within 48 hours of symptoms. Influenza control within institutions is feasible using such strategies, although it requires considerable planning to have such approaches in place during winter--a time when institutional staff absenteeism is typically high.

  15. Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Affendi Isa

    Full Text Available Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour.We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2 = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963. Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours.To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.

  16. Mediational Effects of Self-Efficacy Dimensions in the Relationship between Knowledge of Dengue and Dengue Preventive Behaviour with Respect to Control of Dengue Outbreaks: A Structural Equation Model of a Cross-Sectional Survey

    Science.gov (United States)

    Isa, Affendi; Loke, Yoon K.; Smith, Jane R.; Papageorgiou, Alexia; Hunter, Paul R.

    2013-01-01

    Background Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. Methods and Findings We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ2 = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. Conclusions To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy. PMID:24086777

  17. Mediational effects of self-efficacy dimensions in the relationship between knowledge of dengue and dengue preventive behaviour with respect to control of dengue outbreaks: a structural equation model of a cross-sectional survey.

    Science.gov (United States)

    Isa, Affendi; Loke, Yoon K; Smith, Jane R; Papageorgiou, Alexia; Hunter, Paul R

    2013-01-01

    Dengue fever is endemic in Malaysia, with frequent major outbreaks in urban areas. The major control strategy relies on health promotional campaigns aimed at encouraging people to reduce mosquito breeding sites close to people's homes. However, such campaigns have not always been 100% effective. The concept of self-efficacy is an area of increasing research interest in understanding how health promotion can be most effective. This paper reports on a study of the impact of self-efficacy on dengue knowledge and dengue preventive behaviour. We recruited 280 adults from 27 post-outbreak villages in the state of Terengganu, east coast of Malaysia. Measures of health promotion and educational intervention activities and types of communication during outbreak, level of dengue knowledge, level and strength of self-efficacy and dengue preventive behaviour were obtained via face-to-face interviews and questionnaires. A structural equation model was tested and fitted the data well (χ(2) = 71.659, df = 40, p = 0.002, RMSEA = 0.053, CFI = 0.973, TLI = 0.963). Mass media, local contact and direct information-giving sessions significantly predicted level of knowledge of dengue. Level and strength of self-efficacy fully mediated the relationship between knowledge of dengue and dengue preventive behaviours. Strength of self-efficacy acted as partial mediator in the relationship between knowledge of dengue and dengue preventive behaviours. To control and prevent dengue outbreaks by behavioural measures, health promotion and educational interventions during outbreaks should now focus on those approaches that are most likely to increase the level and strength of self-efficacy.

  18. 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.

  19. 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...

  20. The interrelationship between cognitive control and academic success of first-year students: An interdisciplinary study

    Directory of Open Access Journals (Sweden)

    Kostromina S.N.

    2017-12-01

    Full Text Available Background. Though many Russian and foreign studies have been devoted to the study of self-control in educational activity, most of the research has been limited to the use of questionnaires or psychodiagnostic methods. The neurophysiological mechanisms underlying the process of cognitive control in the context of learning have still not been sufficiently understood, despite the obvious significance of controlling action for academic success. Objective. The purpose of this study is to identify the psychological and neurophysiological features of cognitive control in the process of learning activity, for students with different levels of academic success. Design. This study investigates the control function in first-year students who have varying degrees of academic success. The research design is interdisciplinary and integrates three different approaches: the neurophysiological, psychological, and pedagogical. In the empirical part, 31 first-year students at Saint Petersburg State University (SPbSU participated in the research. We measured the personal characteristics of the subjects (using the five-factor personality questionnaire as modified by A.B. Khromov, their self-management ability (Peysakhov’s SMA test, characteristics of the event-related potentials of the brain in response to presentation of stimuli in the solving of problems that require searching for an error in a word (electroencephalographic method, response time, and number of errors and corrections. Four types of stimuli were used: the correct spelling of a word, the replacement of a letter with one that is written similarly or sounds similar, or by one that is not similar. The indicators used to measure academic success were the results of the Unified State Examination (USE and the first (winter term of the 2016–17 academic year. The data were analyzed by correlation analysis and analysis of variance. Results. Comparison of groups of students with lower and higher levels

  1. Fractional diffusion emulates a human mobility network during a simulated disease outbreak

    OpenAIRE

    Gustafson, Kyle B; Bayati, Basil S.; Eckhoff, Philip A.

    2016-01-01

    Mobility networks facilitate the growth of populations, the success of invasive species, and the spread of communicable diseases among social animals, including humans. Disease control and elimination efforts, especially during an outbreak, can be optimized by numerical modeling of disease dynamics on transport networks. This is especially true when incidence data from an emerging epidemic is sparse and unreliable. However, mobility networks can be complex, challenging to characterize, and ex...

  2. School Systems' Practices of Controlling Socialization during Principal Succession: Looking through the Lens of an Organizational Socialization Theory

    Science.gov (United States)

    Bengtson, Ed; Zepeda, Sally J.; Parylo, Oksana

    2013-01-01

    The importance of effective school leadership is well known. The inevitable changing of school leaders raises concerns over the successfulness of the succession process. Directly linked to leader succession is socialization; therefore, the purpose of this study was to examine the processes and practices of school systems that control the…

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

    Science.gov (United States)

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

    2012-03-29

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

  4. Evaluation of the Control Strategy for the 2010 Foot-and-Mouth Disease Outbreak in Japan Using Disease Simulation.

    Science.gov (United States)

    Wada, M; Stevenson, M; Cogger, N; Carpenter, T

    2017-06-01

    In 2010, Japan experienced a foot-and-mouth disease (FMD) epidemic where 292 premises were infected over a period of 75 days. The epidemic was controlled by stamping-out and vaccination, applied 5 weeks after the first confirmation of disease within a 10 km radius of identified infected places. This study aimed at identifying the role of emergency vaccination to epidemic control while adjusting for the dynamic pattern of local spread, and assessing alternative vaccination strategies, using a disease simulation model. Our results indicate that the overall hazard of local spread remained high throughout the silent spread phase and the first two weeks post-detection, with significant reduction occurring from week 3 onwards. The estimated effectiveness of emergency vaccination quantified as reduction in the hazard of infection was at most 81% and 44% for cattle and pig farms, respectively. The vaccination strategy reduced the simulated median number of IPs by 22%, epidemic duration by 64% and culling duration by 52%, but increased the total number of infected or vaccinated premises subject to culling by 144% compared with no vaccination. The simulation indicated that vaccination starting 2 weeks earlier (3 weeks post-first detection) with a smaller vaccination radius (3 km) was more effective for eradication of the epidemic compared with the actually implemented strategy. © 2016 Blackwell Verlag GmbH.

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

    Science.gov (United States)

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

    2015-12-01

    The arrival of chikungunya fever (CHIKF) in Latin American countries has been expected to trigger epidemics and challenge health systems. Historically considered as dengue-endemic countries, abundant Aedes aegypti populations make this region highly vulnerable to chikungunya virus (CHIKV) circulation. This review describes the current dengue and CHIKF epidemiological situations, as well as the role of uncontrolled Ae. aegypti and Aedes albopictus vectors in spreading the emerging CHIKV. Comments are included relating to the vector competence of both species and failures of surveillance and vector control measures. Dengue endemicity is a reflection of these abundant and persistent Aedes populations that are now spreading CHIKV in the Americas. This article forms part of a symposium in Antiviral Research on "Chikungunya discovers the New World." Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2015-08-01

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

  7. [Case control trial on putative factors antagonising the successful project course of MD thesis projects].

    Science.gov (United States)

    Scharfenberg, J; Schaper, K; Krummenauer, F

    2015-05-01

    Award of the degree MD has special relevance in Germany since the underlying research project can be started during the qualification for admission to doctoral training. This leads to a large number of thesis projects with a not always sufficiently pronounced enthusiasm and thus poor chances of success. Accordingly a case control study was undertaken in the Department of Human Medicine, Witten/Herdecke University to investigate reported drop-outs of thesis projects. In autumn 2012 all students in the clinical phases of human medicine education were surveyed using a self-conceived questionnaire on previously initiated or terminated thesis projects, "terminated" is defined as the unsuccessful ending of a project after working for at least 3 months. Individually reported thesis terminations were evaluated using defined items in a 4-stage Likert scale regarding thesis plan and project, subsequently, graduate students who successfully completed a project received the same questionnaire. The items possibly corresponding to process determinants were averaged to a total of 7 dimensions prior to the analysis; the resulting scores were normalised in value ranges 0.0 to 1.0 (1.0 = optimal project situation) whereby individual items could be included in several scores. By means of 5 items a primary endpoint from the faculty's perspective on "compliance with formal procedures" was aggregated; by means of a two-sided Wilcoxon test at the 5 % level students with unsuccessful and successful courses were compared along the corresponding scores. 181 of 276 students from 7 study semesters participated in the screening; details of 17 terminations and 23 currently successful courses could be evaluated in the case control study. For significant differences (p thesis projects to the responsible committees. A weakness is the low number of evaluable self-reported drop-outs as well as the overall moderate response rate. Georg Thieme Verlag KG Stuttgart · New York.

  8. Optimal feedback control successfully explains changes in neural modulations during experiments with brain-machine interfaces

    Directory of Open Access Journals (Sweden)

    Miriam eZacksenhouse

    2015-05-01

    Full Text Available Recent experiments with brain-machine-interfaces (BMIs indicate that the extent of neural modulations increased abruptly upon starting to operate the interface, and especially after the monkey stopped moving its hand. In contrast, neural modulations that are correlated with the kinematics of the movement remained relatively unchanged. Here we demonstrate that similar changes are produced by simulated neurons that encode the relevant signals generated by an optimal feedback controller during simulated BMI experiments. The optimal feedback controller relies on state estimation that integrates both visual and proprioceptive feedback with prior estimations from an internal model. The processing required for optimal state estimation and control were conducted in the state-space, and neural recording was simulated by modeling two populations of neurons that encode either only the estimated state or also the control signal. Spike counts were generated as realizations of doubly stochastic Poisson processes with linear tuning curves. The model successfully reconstructs the main features of the kinematics and neural activity during regular reaching movements. Most importantly, the activity of the simulated neurons successfully reproduces the observed changes in neural modulations upon switching to brain control. Further theoretical analysis and simulations indicate that increasing the process noise during normal reaching movement results in similar changes in neural modulations. Thus we conclude that the observed changes in neural modulations during BMI experiments can be attributed to increasing process noise associated with the imperfect BMI filter, and, more directly, to the resulting increase in the variance of the encoded signals associated with state estimation and the required control signal.

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-05-22

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

  11. Considering behaviour to ensure the success of a disease control strategy.

    Science.gov (United States)

    McQuaid, Christopher Finn; Gilligan, Christopher Aidan; van den Bosch, Frank

    2017-12-01

    The success or failure of a disease control strategy can be significantly affected by the behaviour of individual agents involved, influencing the effectiveness of disease control, its cost and sustainability. This behaviour has rarely been considered in agricultural systems, where there is significant opportunity for impact. Efforts to increase the adoption of control while decreasing oscillations in adoption and yield, particularly through the administration of subsidies, could increase the effectiveness of interventions. We study individual behaviour for the deployment of clean seed systems to control cassava brown streak disease in East Africa, noting that high disease pressure is important to stimulate grower demand of the control strategy. We show that it is not necessary to invest heavily in formal promotional or educational campaigns, as word-of-mouth is often sufficient to endorse the system. At the same time, for improved planting material to have an impact on increasing yields, it needs to be of a sufficient standard to restrict epidemic spread significantly. Finally, even a simple subsidy of clean planting material may be effective in disease control, as well as reducing oscillations in adoption, as long as it reaches a range of different users every season.

  12. Successful pregnancy outcome in paroxysmal nocturnal hemoglobinuria (PNH following escalated eculizumab dosing to control breakthrough hemolysis

    Directory of Open Access Journals (Sweden)

    Ruby Sharma

    2015-01-01

    Full Text Available Pregnancy in women with paroxysmal nocturnal hemoglobinuria (PNH is associated with increased maternal and fetal morbidity and mortality. There is limited published experience regarding therapy of PNH during pregnancy. We describe a case of a 30 year old female with hypoplastic myelodysplastic syndrome and PNH. After two years of treatment with eculizumab, she became pregnant. She developed breakthrough hemolysis at 20 weeks gestation. Pharmacokinetic and pharmacodynamic studies demonstrated a subtherapeutic eculizumab level with absence of complement blockade. Escalation of her eculizumab dose successfully controlled hemolysis and restored therapeutic eculizumab level and activity. She delivered a healthy baby at 36 weeks.

  13. Nosocomial Outbreak of New Delhi Metallo-β-Lactamase-1-Producing Gram-Negative Bacteria in South Africa: A Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Pieter de Jager

    Full Text Available New Delhi metallo-β-lactamase (NDM-producing Gram-negative bacteria have spread globally and pose a significant public health threat. There is a need to better define risk factors and outcomes of NDM-1 clinical infection. We assessed risk factors for nosocomial infection with NDM-1-producers and associated in-hospital mortality.A matched case-control study was conducted during a nosocomial outbreak of NDM-1-producers in an adult intensive care unit (ICU in South Africa. All patients from whom NDM-1-producers were identified were considered (n=105. Cases included patients admitted during the study period in whom NDM-1 producing Gram-negative bacteria were isolated from clinical specimens collected ≥48 hours after admission, and where surveillance definitions for healthcare-associated infections were met. Controls were matched for age, sex, date of hospital admission and intensive-care admission. Conditional logistic regression was used to identify risk factors for NDM-1 clinical infection and associated in-hospital mortality.38 cases and 68 controls were included. Klebsiella pneumoniae was the most common NDM-1-producer (28/38, 74%. Cases had longer mean hospital stays (44.0 vs. 13.3 days; P < 0.001 and ICU stays (32.5 vs. 8.3 days; P < 0.001. Adjusting for co-morbid disease, the in-hospital mortality of cases was significantly higher than controls (55.3% vs. 14.7%; AOR, 11.29; P < 0.001. Higher Charlson co-morbidity index score (5.2 vs. 4.1; AOR, 1.59; P = 0.005, mechanical ventilation days (7.47 vs. 0.94 days; AOR, 1.32; P = 0.003 and piperacillin/tazobactam exposure (11.03 vs. 1.05 doses; AOR, 1.08; P = 0.013 were identified as risk factors on multivariate analysis. Cases had a significantly higher likelihood of in-hospital mortality when the NDM-1-producer was Klebsiella pneumoniae (AOR, 16.57; P = 0.007, or when they had a bloodstream infection (AOR, 8.84; P = 0.041.NDM-1 infection is associated with significant in-hospital mortality

  14. Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

    Science.gov (United States)

    Martinez, Ana; Dominguez, Angela; Torner, Nuria; Ruiz, Laura; Camps, Neus; Barrabeig, Irene; Arias, Cesar; Alvarez, Josep; Godoy, Pere; Balaña, Pilar Jorgina; Pumares, Analia; Bartolome, Rosa; Ferrer, Dolors; Perez, Unai; Pinto, Rosa; Buesa, Javier

    2008-01-01

    Background Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV); the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03) the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03) in bacterial outbreaks (8.6%) than in NoV outbreaks (0.15%). Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p < 0.001) Conclusion Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions. PMID:18410687

  15. Epidemiology of foodborne Norovirus outbreaks in Catalonia, Spain

    Directory of Open Access Journals (Sweden)

    Godoy Pere

    2008-04-01

    Full Text Available Abstract Background Noroviruses are one of the principal biological agents associated with the consumption of contaminated food. The objective of this study was to analyse the size and epidemiological characteristics of foodborne outbreaks of gastroenteritis in Catalonia, a region in the northeast of Spain. Methods In all reported outbreaks of gastroenteritis associated with food consumption, faecal samples of persons affected were analysed for bacteria and viruses and selectively for parasites. Study variables included the setting, the number of people exposed, age, sex, clinical signs and hospital admissions. The study was carried out from October 2004 to October 2005. Results Of the 181 outbreaks reported during the study period, 72 were caused by Salmonella and 30 by norovirus (NoV; the incidence rates were 14.5 and 9.9 per 100,000 person-years, respectively. In 50% of the NoV outbreaks and 27% of the bacterial outbreaks (p = 0.03 the number of persons affected was ≥10; 66.7% of NoV outbreaks occurred in restaurants; no differences in the attack rates were observed according to the etiology. Hospitalizations were more common (p = 0.03 in bacterial outbreaks (8.6% than in NoV outbreaks (0.15%. Secondary cases accounted for 4% of cases in NoV outbreaks compared with 0.3% of cases in bacterial outbreaks (p Conclusion Norovirus outbreaks were larger but less frequent than bacterial outbreaks, suggesting that underreporting is greater for NoV outbreaks. Food handlers should receive training on the transmission of infections in diverse situations. Very strict control measures on handwashing and environmental disinfection should be adopted in closed or partially-closed institutions.

  16. Is it possible and necessary to control European spruce bark beetle Ips typographus (L. outbreak in the Białowieża Forest?

    Directory of Open Access Journals (Sweden)

    Hilszczański Jacek

    2017-03-01

    Full Text Available In response to the information published in ‘Forest Research Papers’ (vol. 77(4, 2016, regarding the problem of the European spruce bark beetle Ips typographus (L. in the Białowieża Forest, we present our viewpoint on this issue. The role of the European spruce bark beetle in the Białowieża Forest is discussed based on the experience gained in Europe’s forests. We present the effects of I. typographus outbreaks on forest biodiversity as well as outbreak mitigation in the context of the processes taking place in semi-natural forests.

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

    Science.gov (United States)

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

    2015-01-01

    This study represents a complete comparative analysis of the most widely used African swine fever (ASF) diagnostic techniques in the European Union (EU) using field and experimental samples from animals infected with genotype II ASF virus (ASFV) isolates circulating in Europe. To detect ASFV, three different PCRs were evaluated in parallel using 785 field and experimental samples. The results showed almost perfect agreement between the Universal ProbeLibrary (UPL-PCR) and the real-time (κ = 0.94 [95% confidence interval {CI}, 0.91 to 0.97]) and conventional (κ = 0.88 [95% CI, 0.83 to 0.92]) World Organisation for Animal Health (OIE)-prescribed PCRs. The UPL-PCR had greater diagnostic sensitivity for detecting survivors and allows earlier detection of the disease. Compared to the commercial antigen enzyme-linked immunosorbent assay (ELISA), good-to-moderate agreement (κ = 0.67 [95% CI, 0.58 to 0.76]) was obtained, with a sensitivity of 77.2% in the commercial test. For ASF antibody detection, five serological methods were tested, including three commercial ELISAs, the OIE-ELISA, and the confirmatory immunoperoxidase test (IPT). Greater sensitivity was obtained with the IPT than with the ELISAs, since the IPT was able to detect ASF antibodies at an earlier point in the serological response, when few antibodies are present. The analysis of the exudate tissues from dead wild boars showed that IPT might be a useful serological tool for determining whether or not animals had been exposed to virus infection, regardless of whether antibodies were present. In conclusion, the UPL-PCR in combination with the IPT was the most trustworthy method for detecting ASF during the epidemic outbreaks affecting EU countries in 2014. The use of the most appropriate diagnostic tools is critical when implementing effective control programs. PMID:26041901

  18. A joint Nordic interdisciplinary education programme in infection control: a successful, but short-lived initiative.

    Science.gov (United States)

    Holt, Jette; Sorknes, Nina K; Povlsen, Lene

    2014-11-01

    Prevention of healthcare-associated infections and a restrictive antibiotics policy in the Nordic countries have contributed to a low prevalence of multi-drug resistant microorganisms, compared to many other countries. This requires professional competences acquired through education in infection control, both in hospitals and in primary health care. This paper describes a joint Nordic Interdisciplinary Education Programme in infection control, established at the Nordic School of Public Health NHV (NHV) in 2007. The education programme was considered highly relevant and successful by students and their employers. The paper describes the background and contents of the programme, which may serve as inspiration in the development of future educational initiatives in other countries. © 2014 the Nordic Societies of Public Health.

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

    Science.gov (United States)

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

    2012-12-01

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

  20. Outbreaks Attributed to Cheese: Differences Between Outbreaks Caused by Unpasteurized and Pasteurized Dairy Products, United States, 1998–2011

    Science.gov (United States)

    Gould, L. Hannah; Mungai, Elisabeth; Behravesh, Casey Barton

    2015-01-01

    Introduction The interstate commerce of unpasteurized fluid milk, also known as raw milk, is illegal in the United States, and intrastate sales are regulated independently by each state. However, U.S. Food and Drug Administration regulations allow the interstate sale of certain types of cheeses made from unpasteurized milk if specific aging requirements are met. We describe characteristics of these outbreaks, including differences between outbreaks linked to cheese made from pasteurized or unpasteurized milk. Methods We reviewed reports of outbreaks submitted to the Foodborne Disease Outbreak Surveillance System during 1998–2011 in which cheese was implicated as the vehicle. We describe characteristics of these outbreaks, including differences between outbreaks linked to cheese made from pasteurized versus unpasteurized milk. Results During 1998–2011, 90 outbreaks attributed to cheese were reported; 38 (42%) were due to cheese made with unpasteurized milk, 44 (49%) to cheese made with pasteurized milk, and the pasteurization status was not reported for the other eight (9%). The most common cheese–pathogen pairs were unpasteurized queso fresco or other Mexican-style cheese and Salmonella (10 outbreaks), and pasteurized queso fresco or other Mexican-style cheese and Listeria (6 outbreaks). The cheese was imported from Mexico in 38% of outbreaks caused by cheese made with unpasteurized milk. In at least five outbreaks, all due to cheese made from unpasteurized milk, the outbreak report noted that the cheese was produced or sold illegally. Outbreaks caused by cheese made from pasteurized milk occurred most commonly (64%) in restaurant, delis, or banquet settings where cross-contamination was the most common contributing factor. Conclusions In addition to using pasteurized milk to make cheese, interventions to improve the safety of cheese include limiting illegal importation of cheese, strict sanitation and microbiologic monitoring in cheese-making facilities, and

  1. How outbreaks can contribute to prevention of nosocomial infection: analysis of 1,022 outbreaks.

    Science.gov (United States)

    Gastmeier, Petra; Stamm-Balderjahn, Sabine; Hansen, Sonja; Nitzschke-Tiemann, Frauke; Zuschneid, Irina; Groneberg, Katrin; Rüden, Henning

    2005-04-01

    To describe the epidemiology of nosocomial outbreaks published in the scientific literature. Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002. Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database. A structured questionnaire was devised to extract information in a systematic manner on nosocomial outbreaks published in the literature. The following items were used: the reference, type of study (case reports or studies applying epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel involved, type of infection, source of infection, mode of transmission, risk factors identified, and preventive measures applied. Bloodstream infection was the most frequently identified type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In 37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%), and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks. Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%. The percentage of outbreaks investigated by case-control studies or cohort studies over the years was small (21% and 9%, respectively, for the whole time period). Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.

  2. Legionnaires’ Disease Outbreak in Murcia, Spain

    Science.gov (United States)

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

    2003-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

    groups. To successfully prevent and control these outbreaks, guidelines and strategies should be reviewed to assign clear roles and responsibilities to cholera actors on collaboration, prevention, detection, monitoring and control of these epidemics.

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

    Directory of Open Access Journals (Sweden)

    Godfrey Bwire

    affected age groups. To successfully prevent and control these outbreaks, guidelines and strategies should be reviewed to assign clear roles and responsibilities to cholera actors on collaboration, prevention, detection, monitoring and control of these epidemics.

  5. Large outbreaks of Salmonella Typhimurium infection in Denmark in 2008

    DEFF Research Database (Denmark)

    Ethelberg, S.; Wingstrand, Anne; Jensen, T.

    2008-01-01

    An outbreak of Salmonella Typhimurium phage type U292 has been ongoing in Denmark since 1 April, with 1,054 cases registered until 23 October 2008. Extensive investigations including hypothesis-generating interviews, matched case-control studies, cohort studies in embedded outbreaks, shopping list...

  6. An outbreak of food poisoning among children attending an ...

    African Journals Online (AJOL)

    Objectives. To describe an outbreak of food poisoning at a major international sports event in Johannesburg and to determine the likely cause and source of the outbreak. Design. A descriptive, case-control study. Setting. An international sports event in Johannesburg. Methods. A questionnaire survey of involved children ...

  7. Teachers' Risk Perception and Needs in Addressing Infectious Disease Outbreak

    Science.gov (United States)

    Wong, Emmy M. Y.; Cheng, May M. H.; Lo, S.K.

    2010-01-01

    The outbreak of the Influenza A (H1N1) virus has led to numerous precautionary school closures in several countries. No research is available on the school teachers' perceptions as a health protective resource in controlling communicable disease outbreaks. The purposes of this study were to examine the risk perception, the perceived understanding…

  8. A case-control study developing a model for predicting risk factors for high SeM-specific antibody titers after natural outbreaks of Streptococcus equi subsp equi infection in horses.

    Science.gov (United States)

    Boyle, Ashley G; Smith, Meagan A; Boston, Raymond C; Stefanovski, Darko

    2017-06-15

    OBJECTIVE To develop a risk prediction model for factors associated with an SeM-specific antibody titer ≥ 3,200 in horses after naturally occurring outbreaks of Streptococcus equi subsp equi infection and to validate this model. DESIGN Case-control study. ANIMALS 245 horses: 57 horses involved in strangles outbreaks (case horses) and 188 healthy horses (control horses). PROCEDURES Serum samples were obtained from the 57 cases over a 27.5-month period after the start of outbreaks; serum samples were obtained once from the 188 controls. A Bayesian mixed-effects logistic regression model was used to assess potential risk factors associated with an antibody titer ≥ 3,200 in the case horses. A cutoff probability for an SeM-specific titer ≥ 3,200 was determined, and the model was externally validated in the control horses. Only variables with a 95% credibility interval that did not overlap with a value of 1 were considered significant. RESULTS 9 of 57 (6%) case horses had at least 1 titer ≥ 3,200, and 7 of 188 (3.7%) of control horses had a titer ≥ 3,200. The following variables were found to be significantly associated with a titer ≥ 3,200 in cases: farm size > 20 horses (OR, 0.11), history of clinically evident disease (OR, 7.92), and male sex (OR, 0.11). The model had 100% sensitivity but only 24% specificity when applied to the 188 control horses (area under the receiver operating characteristic curve = 0.62.) CONCLUSIONS AND CLINICAL RELEVANCE Although the Bayesian mixed-effects logistic regression model developed in this study did not perform well, it may prove useful as an initial screening tool prior to vaccination. We suggest that SeM-specific antibody titer be measured prior to vaccination when our model predicts a titer ≥ 3,200.

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

    Science.gov (United States)

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

    2015-08-01

    This report describes an outbreak of hepatitis A virus linked to a nursery which affected a total of 10 individuals. Active case finding, using oral fluid testing, helped identify asymptomatic cases. Nucleotide sequencing showed that all cases were caused by the same virus, which was most similar to HAV strains circulating Zimbabwe. Interestingly, an asymptomatic child had recently returned from visiting family in that country. Standard infection control procedures and vaccination of contacts successfully contained the outbreak. Only one patient developed hepatitis A despite having been vaccinated a week before symptoms began. This hepatitis A outbreak scenario may become more common as the numbers of international travellers and immigrants increase in the UK. It highlights the importance of recommending HAV vaccination to foreign nationals and their families who are travelling to countries endemic for hepatitis A. Copyright © 2015. Published by Elsevier B.V.

  10. Attributing human foodborne illness to food sources and water in Latin America and the Caribbean using data from outbreak investigations

    DEFF Research Database (Denmark)

    Pires, Sara Monteiro; Vieira, Antonio; Perez, Enrique

    2012-01-01

    &C). Foods implicated in outbreaks were classified by their ingredients as simple foods (i.e. belonging to one single food category), or complex foods (i.e. belonging to multiple food categories). For each agent, the data from simple-food outbreaks were summarized, and the proportion of outbreaks caused...... be a consequence of changes in the control of zoonotic disease over the years, of changes in food consumption habits, or of changes in public health focus and availability of data of different pathogens. This study identified data gaps in the region and highlighted the importance of effective surveillance systems...... to identify sources of disease. Still, the application of this method for source attribution in the LA&C region was successful, and we concluded that this approach can be used to attribute disease to food sources and water in other regions, including developing regions with limited data on the public health...

  11. Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial.

    Science.gov (United States)

    Scales, D C; Cheskes, S; Verbeek, P R; Pinto, R; Austin, D; Brooks, S C; Dainty, K N; Goncharenko, K; Mamdani, M; Thorpe, K E; Morrison, L J

    2017-10-05

    Targeted temperature management (TTM) improves survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA), but is delivered inconsistently and often with delay. To determine if prehospital cooling by paramedics leads to higher rates of 'successful TTM', defined as achieving a target temperature of 32-34°C within 6h of hospital arrival. Pragmatic RCT comparing prehospital cooling (surface ice packs, cold saline infusion, wristband reminders) initiated 5min after return of spontaneous circulation (ROSC) versus usual resuscitation and transport. The primary outcome was rate of 'successful TTM'; secondary outcomes were rates of applying TTM in hospital, survival with good neurological outcome, pulmonary edema in emergency department, and re-arrest during transport. 585 patients were randomized to receive prehospital cooling (n=279) or control (n=306). Prehospital cooling did not increase rates of 'successful TTM' (30% vs 25%; RR, 1.17; 95% confidence interval [CI] 0.91-1.52; p=0.22), but increased rates of applying TTM in hospital (68% vs 56%; RR, 1.21; 95%CI 1.07-1.37; p=0.003). Survival with good neurological outcome (29% vs 26%; RR, 1.13, 95%CI 0.87-1.47; p=0.37) was similar. Prehospital cooling was not associated with re-arrest during transport (7.5% vs 8.2%; RR, 0.94; 95%CI 0.54-1.63; p=0.83) but was associated with decreased incidence of pulmonary edema in emergency department (12% vs 18%; RR, 0.66; 95%CI 0.44-0.99; p=0.04). Prehospital cooling initiated 5min after ROSC did not increase rates of achieving a target temperature of 32-34°C within 6h of hospital arrival but was safe and increased application of TTM in hospital. Copyright © 2017. Published by Elsevier B.V.

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

    Science.gov (United States)

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

    2013-01-01

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

  13. The use of clinical profiles in the investigation of foodborne outbreaks in restaurants: United States, 1982-1997.

    Science.gov (United States)

    Hedberg, C W; Palazzi-Churas, K L; Radke, V J; Selman, C A; Tauxe, R V

    2008-01-01

    Improving the efficiency of outbreak investigation in restaurants is critical to reducing outbreak-associated illness and improving prevention strategies. Because clinical characteristics of outbreaks are usually available before results of laboratory testing, we examined their use for determining contributing factors in outbreaks caused by restaurants. All confirmed foodborne outbreaks reported to the Centers for Disease Control and Prevention (CDC) from 1982 to 1997 were reviewed. Clinical profiles were developed based on outbreak characteristics. We compared the percentage of contributing factors by known agent and clinical profile to their occurrence in outbreaks of unclassified aetiology. In total, 2246 foodborne outbreaks were included: 697 (31%) with known aetiology and 1549 (69%) with aetiology undetermined. Salmonella accounted for 65% of outbreaks with a known aetiology. Norovirus-like clinical profiles were noted in 54% of outbreaks with undetermined aetiology. Improper holding times and temperatures were associated with outbreaks caused by Clostridium perfringens, Bacillus cereus, Staphylococcus aureus, and Salmonella, and also with outbreaks of undetermined aetiology that fitted diarrhoea-toxin and vomiting-toxin clinical profiles. Poor personal hygiene was associated with norovirus, Shigella, and Salmonella, and also with outbreaks that fitted norovirus-like and vomiting-toxin clinical profiles. Contributing factors were similar for outbreaks with known aetiology and for those where aetiology was assigned by corresponding clinical profile. Rapidly categorizing outbreaks by clinical profile, before results of laboratory testing are available, can help identification of factors which contributed to the occurrence of the outbreak and will promote timely and efficient outbreak investigations.

  14. Identifying outbreaks of sexually transmitted infection: who cares?

    Directory of Open Access Journals (Sweden)

    Evans Meirion R

    2006-10-01

    Full Text Available Abstract Background Current routine surveillance schemes for sexually transmitted infections (STIs in the United Kingdom (UK are not designed for outbreak identification. Recognising STI outbreaks, therefore, depends almost entirely on the alertness of health professionals. The objective of this study was to explore health professionals' knowledge of, and attitudes towards, identification and investigation of STI outbreaks in Wales. Methods We conducted a cross-sectional survey in Wales in June 2005, and sent a questionnaire to consultants of genitourinary medicine (GUM, n = 11, a consultant microbiologist from each laboratory (n = 14, all consultants in communicable disease control (n = 5, and to epidemiologists of the National Public Health Service (n = 4. Results 26 (76% of 34 survey recipients responded. Of these, 17 (65% ranked the investigation of STI outbreaks as important or very important, and 19 (73% perceived participation in the investigation of an STI outbreak as part of their responsibility. Only six (25% respondents had actively searched their computer system or patient records for a possible STI outbreak in the previous twelve months, and 15 (63% had never looked for an outbreak. Of seven GUM physicians who said they had identified at least one STI outbreak, three had never informed public health authorities. Conclusion Prompt identification and coordinated investigation of outbreaks, usually through a multidisciplinary outbreak control team, is central to the control of many infectious diseases. This does not appear to be the case for STIs, which we believe represents a lost opportunity to reduce transmission. Besides improved surveillance methods, a change in culture towards STI outbreaks is needed among health professionals in Wales.

  15. 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.

  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. 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.

  18. Successes and Challenges in Implementation of Radon Control Activities in Iowa, 2010-2015.

    Science.gov (United States)

    Bain, Allison A; Abbott, Anne L; Miller, Laura L

    2016-04-14

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

  19. 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 natalen...

  20. Characteristics of success in mentoring and research productivity - a case-control study of academic centers.

    Science.gov (United States)

    Cohen, Joshua G; Sherman, Alexander E; Kiet, Tuyen K; Kapp, Daniel S; Osann, Kathryn; Chen, Lee-may; O'Sullivan, Patricia S; Chan, John K

    2012-04-01

    While mentoring has been associated with research productivity, the specific characteristics of successful mentoring have not been well studied. Thus, we performed a case-control study to identify characteristics of successful mentoring programs. Institutions were divided based on number of plenary research presentations at an annual society meeting over 6years. Case institutions (Group A) had more presentations vs. controls (Group B). A survey of professors and research fellows assessed characteristics of their mentoring program. Chi-square and logistic regression analyses were performed. Of 159 surveyed, response rates were 46% for professors and 51% for fellows. Compared to Group B, Group A was more likely to have: an additional year of protected fellowship research training (62% vs. 24%; p=0.003), an established program to connect a mentor and mentee with similar research interests (52% vs. 27%; p=0.049), methods to provide feedback to mentors (62% vs. 29%; p=0.01), require mentee research progress reports (45% vs. 21%; p=0.047), and report ease of identifying a mentor (90% vs. 69%; p=0.046). On multivariate analyses, the additional year of research training (OR=7.53, 95% CI: 2.10-27.09; p=0.002) and ease at identifying a research mentor (OR=7.45, 95% CI: 1.44-38.6; p=0.017) remained as independent factors associated with higher research productivity. Our data suggest that programs can enhance research productivity with the incorporation of accountability features including formalized reports of progress and mentorship feedback in fellowship training. Facilitating the identification of a mentor and providing an additional year of research may be independent factors associated with research productivity. Copyright © 2012. Published by Elsevier Inc.

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

    Science.gov (United States)

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

    2011-01-01

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

  2. Detection and Quantification of Norovirus in Raspberries Implicated in Disease Outbreaks

    DEFF Research Database (Denmark)

    Schultz, Anna Charlotte; Vinje, Jan; Böttiger, Blenda

    2012-01-01

    In recent years, raspberries have emerged as high risk foods for norovirus (NoV) outbreaks. However, the lack of robust and standardized methods has limited our understanding of the level of NoV contamination of raspberries correlated to public health risk. We present an optimized and quality...... controlled protocol for the viral RNA extraction using NucliSens and Plant RNA Isolation Aid and detection by RT-qPCR including bovine serum albumin of NoV in 25 g of raspberries. The protocol was applied on raspberries that had been linked epidemiologically to nine NoV outbreaks which had occurred...... in Denmark from 2009-2011. To minimize false negative results, mengovirus and murine norovirus were evaluated as sample process control viruses (SPCVs). Using the median RT-qPCR recovery for either SPCV±2 SD as quality criteria for successful extraction, 98% of samples were approved. The 50% limit...

  3. 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.

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

    Science.gov (United States)

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

    2013-11-01

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

  5. Interventions to Control Virus Transmission During an Outbreak of Ebola Hemorrhagic Fever: Experience from Kikwit, Democratic Republic of the Congo, 1995.

    OpenAIRE

    Kerstiëns, B; Matthys, F.

    1999-01-01

    On 6 May 1995, the Médecins sans Frontières (MSF) coordinator in Kinshasa, Democratic Republic of the Congo (DRC), received a request for assistance for what was believed to be a concurrent outbreak of bacillary dysentery and viral hemorrhagic fever (suspected Ebola hemorrhagic fever [EHF]) in the town of Kikwit, DRC. On 11 May, the MSF intervention team assessed Kikwit General Hospital. This initial assessment revealed a nonfunctional isolation ward for suspected EHF cases; a lack of water a...

  6. Success/failure condition influences attribution of control, negative affect, and shame among patients with depression in Singapore.

    Science.gov (United States)

    Yeo, Si-Ning; Zainal, Hani; Tang, Catherine S; Tong, Eddie M; Ho, Cyrus S; Ho, Roger C

    2017-08-02

    There remains a paucity of research on control attribution and depression within Asian populations. This study examines: (1) Success/Failure condition as a moderator between depression and negative affect or shame, and (2) differences in control attribution between patients with depression and healthy controls in Singapore. Seventy one patients with depression and 71 healthy controls went through a digit-span memory task where they were randomized into either the Success or Failure condition. Participants in the Success condition had to memorize and recall 5-digit strings, while participants in the Failure condition did the same for 12-digit strings. They then completed self-report measures of negative affect, shame, and attribution of control. One-way ANCOVA was performed to examine task condition as a moderator of association between mental health status and post-task negative affect or shame. Test of simple effects was carried out on significant interactions. Sign test and Mann-Whitney U test were employed to investigate differences in attribution of control. Mental health status and Success/Failure condition had significant effects on reported negative affect and shame. Healthy controls reported less post-task negative affect and shame in the Success than in the Failure condition while patients with depression reported similar levels of post-task negative affect and shame in both conditions. However, these differences were not significant in the test of simple effects. In addition, healthy controls felt a stronger sense of personal control in success than in failure and were more likely to blame external factors in failure than in success. Conversely, patients with depression were more inclined to credit external factors in success than in failure and ascribed greater personal control in failure than in success. The results suggest that successful conditions may not necessitate the reduction of negative affect in Asians with depression, indicating possible

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

    Science.gov (United States)

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

    1973-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jean Frantz Lemoine

    2016-10-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

  10. An outbreak of Clostridium perfringens and the enforcement of food safety standards.

    Science.gov (United States)

    Young, Megan K; Smith, Peta; Holloway, Jack; Davison, Rod P

    2008-12-01

    Investigation and management of a possible foodborne outbreak notified to the Brisbane Northside Population Health Unit aimed to determine the likely source of the outbreak and prevent the same scenario from recurring. Environmental health officers inspected the implicated premises and collected legal samples prior to the 1st outbreak control team meeting. Interview evidence was carefully documented. Inspection revealed large quantities of meat dishes being allowed to cool at room temperature overnight. Microbiological results implicated the meat dishes as a source of Clostridium perfringens, consistent with the cause of illness in notified cases. When educational measures failed to alter food handling practices, the restaurant owner was successfully prosecuted under the Food Act 2006. Education and voluntary compliance with food safety standards must form the foundation of sustainable behaviour change among food handlers. When these fail, prosecution is justified to mitigate the risk to public health. Immediate inspection, sampling left over food, and attention to formal interview technique and evidence collection can assist the investigation of outbreaks of foodborne illness and help to ensure any necessary court proceedings are a cost effective use of resources.

  11. Avian influenza outbreak in Turkey through health personnel's views: a qualitative study

    Directory of Open Access Journals (Sweden)

    Erbaydar Tugrul

    2007-11-01

    communication between the government and the public played an important part in overcoming difficulties. Conclusion Although there were problems during the avian influenza outbreak in Turkey, the rapid responses of the central and regional health authorities and the performance of the health workers were the key points in controlling the epidemic. The lessons from this outbreak should provide an opportunity for integrating the preparation plans of the health and agricultural organizations, and for revising the surveillance system and enhancing the role of the primary health care services in controlling epidemic disease. Developing successful strategies based on knowledge and experience may play a valuable role in delaying an avian influenza pandemic.

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Science.gov (United States)

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

    2013-11-06

    Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save--through early response activities--resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems.The country case studies--conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the different cost components (vector control

  14. The global health network on alcohol control: successes and limits of evidence-based advocacy.

    Science.gov (United States)

    Schmitz, Hans Peter

    2016-04-01

    Global efforts to address alcohol harm have significantly increased since the mid-1990 s. By 2010, the World Health Organization (WHO) had adopted the non-binding Global Strategy to Reduce the Harmful Use of Alcohol. This study investigates the role of a global health network, anchored by the Global Alcohol Policy Alliance (GAPA), which has used scientific evidence on harm and effective interventions to advocate for greater global public health efforts to reduce alcohol harm. The study uses process-tracing methodology and expert interviews to evaluate the accomplishments and limitations of this network. The study documents how network members have not only contributed to greater global awareness about alcohol harm, but also advanced a public health approach to addressing this issue at the global level. Although the current network represents an expanding global coalition of like-minded individuals, it faces considerable challenges in advancing its cause towards successful implementation of effective alcohol control policies across many low- and middle-income countries (LMICs). The analysis reveals a need to transform the network into a formal coalition of regional and national organizations that represent a broader variety of constituents, including the medical community, consumer groups and development-focused non-governmental organizations. Considering the growing harm of alcohol abuse in LMICs and the availability of proven and cost-effective public health interventions, alcohol control represents an excellent 'buy' for donors interested in addressing non-communicable diseases. Alcohol control has broad beneficial effects for human development, including promoting road safety and reducing domestic violence and health care costs across a wide variety of illnesses caused by alcohol consumption. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

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

  16. Striving for control: lessons learned from a successful international Type 1 Diabetes Youth Challenge.

    Science.gov (United States)

    Kordonouri, Olga; Vazeou, Andriani; Scharf, Mauro; Würsig, Martina; Battelino, Tadej

    2017-04-01

    To demonstrate whether young people with T1D using modern insulin treatment and CGM could successfully participate in extreme sport activity while maintaining good glycemic control. The challenge took place in Crete/Greece over 4 days combining a long-distance trek of different levels of severity with final destination the summit of the White Mountains at 2080 m. Eleven participants (5/6 female/male, age 18.2 ± 1.3 years, T1D duration 7.9 ± 3.5 years, HbA1c 7.3 ± .7% (56 ± 16 mmol/mol); mean ± SD) from 11 SWEET centers in Belgium, Brazil, Canada, Germany, Greece, France, India, Italy, Portugal, Slovenia and Sweden participated to the challenge. Five participants were on CSII, six on MDI; all were wearing a continuous glucose monitoring system. The glycemic targets during trekking were defined as 80-180 mg/dl (4.4-10 mmol/l). All participants completed the challenge. In total, the group walked 54.5 km under varying climate conditions (temperature 14-35 °C). During the challenge, insulin requirements decreased significantly compared to baseline: total daily insulin by 31.1 ± 16.7% (p < .001), basal by 30.8 ± 14.9% (p < .001), and prandial by 32.5 ± 28.0% (p = .023), with no differences between participants with CSII or MDI. No episode of severe hypoglycemia or DKA occurred. Mean glucose levels were 170.7 ± 60.1 mg/dl with 61.5 ± 18.7% of CGM values in the target range, 5.4 ± 5.4% under 80 mg/dl and 32.8 ± 16.6% above 180 mg/dl. The results of this SWEET Initiative activity demonstrated that well-educated adolescents and young adults with T1D using modern insulin treatments are able to perform successfully even extraordinary physical challenges while maintaining good glycemic control without diabetes-related acute complications.

  17. 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.

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

    Science.gov (United States)

    Wang, Jiao; Deng, Zhiqiang

    2016-05-01

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

  19. Quantitative assessment of social and economic impact of African swine fever outbreaks in northern Uganda.

    Science.gov (United States)

    Chenais, Erika; Boqvist, Sofia; Emanuelson, Ulf; von Brömssen, Claudia; Ouma, Emily; Aliro, Tonny; Masembe, Charles; Ståhl, Karl; Sternberg-Lewerin, Susanna

    2017-09-01

    African swine fever (ASF) is one of the most important pig diseases, causing high case fatality rate and trade restrictions upon reported outbreaks. In Uganda, a low-income country with the largest pig population in East Africa, ASF is endemic. Animal disease impact is multidimensional and include social and economic impact along the value chain. In low-income settings, this impact keep people poor and push those that have managed to escape poverty back again. If the diseases can be controlled, their negative consequences can be mitigated. However, to successfully argue for investment in disease control, its cost-benefits need to be demonstrated. One part in the cost-benefit equations is disease impact quantification. The objective of this study was therefore to investigate the socio-economic impact of ASF outbreaks at household level in northern Uganda. In a longitudinal study, structured interviews with two hundred, randomly selected, pig-keeping households were undertaken three times with a six month interval. Questions related to family and pig herd demographics, pig trade and pig business. Associations between ASF outbreaks and economic and social impact variables were evaluated using linear regression models. The study showed that pigs were kept in extreme low-input-low-output farming systems involving only small monetary investments. Yearly incidence of ASF on household level was 19%. Increasing herd size was positively associated with higher economic output. The interaction between ASF outbreaks and the herd size showed that ASF outbreaks were negatively associated with economic output at the second interview occasion and with one out of two economic impact variables at the third interview occasion. No significant associations between the social impact variables included in the study and ASF outbreaks could be established. Trade and consumption of sick and dead pigs were coping strategies used to minimize losses of capital and animal protein. The results

  20. [Success in maintaining weight loss in Portugal: the Portuguese Weight Control Registry].

    Science.gov (United States)

    Vieira, Paulo Nuno; Teixeira, Pedro; Sardinha, Luís Bettencourt; Santos, Teresa; Coutinho, Sílvia; Mata, Jutta; Silva, Marlene Nunes

    2014-01-01

    The scope of this article is to describe the Portuguese Weight Control Registry (PWCR) methodology and the participants currently enrolled specifically with respect to their individual and family weight history, previous weight loss attempts, and psychosocial characteristics. One hundred and ninety-eight adults (age: 39.7±11.1 years; BMI: 26.0±3.9 kg/m2), 59% women, filled out a questionnaire about demographics, health-related behaviors and motivation, and methods and strategies used to lose and/or maintain weight loss. Participants reported an average weight loss of 17.4 kg for an average of 29 months. Concerning the number of weight loss attempts, 73% of participants reported a maximum of three attempts of going on a diet, and 34% indicated only one attempt to lose weight in the past. The PWCR now features a considerable number of successful long-term weight loss maintainers in Portugal. Participants will be followed over the next years to learn about their characteristics and weight loss strategies in further detail, as well as to identify predictors of continued weight loss maintenance.

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

    Science.gov (United States)

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

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

  2. A quality control mechanism linking meiotic success to release of ascospores.

    Directory of Open Access Journals (Sweden)

    Haiyan Guo

    Full Text Available Eukaryotic organisms employ a variety of mechanisms during meiosis to assess and ensure the quality of their gametes. Defects or delays in successful meiotic recombination activate conserved mechanisms to delay the meiotic divisions, but many multicellular eukaryotes also induce cell death programs to eliminate gametes deemed to have failed during meiosis. It is generally thought that yeasts lack such mechanisms. Here, we show that in the fission yeast Schizosaccharomyces pombe, defects in meiotic recombination lead to the activation of a checkpoint that is linked to ascus wall endolysis--the process by which spores are released in response to nutritional cues for subsequent germination. Defects in meiotic recombination are sensed as unrepaired DNA damage through the canonical ATM and ATR DNA damage response kinases, and this information is communicated to the machinery that stimulates ascus wall breakdown. Viability of spores that undergo endolysis spontaneously is significantly higher than that seen upon chemical endolysis, demonstrating that this checkpoint contributes to a selective mechanism for the germination of high quality progeny. These results provide the first evidence for the existence of a checkpoint linking germination to meiosis and suggest that analysis solely based on artificial, enzymatic endolysis bypasses an important quality control mechanism in this organism and potentially other ascomycota, which are models widely used to study meiosis.

  3. A study of the 2006 Chikungunya epidemic outbreak in Mauritius

    Directory of Open Access Journals (Sweden)

    Mr. V. Pydiah

    2008-01-01

    Full Text Available Chikungunya epidemic outbreaks have affected more than 1 million people in 2005-2006 in many Indian Ocean islands and in India. Mauritius experienced a major outbreak in February/March 2006 following a minor outbreak in April/May 2005. No cases have been registered on the island since August 2006. The objectives of this study were to understand the timing and development of the 2006-outbreak in Mauritius, to investigate the possibility of a future outbreak, and to propose measures to prevent the recurrence of an epidemic in Mauritius. Mauritius rainfall, temperature and humidity data were analyzed. A door-to-door household census-type survey was carried out in a study locality on the island. A compartmental human-mosquito interaction model was integrated to understand outbreak evolutions in the surveyed locality and in a theoretical locality. It was observed that the onset of the 2006-outbreak in February followed an abnormally high rainfall in the third week of January 2006. 51% of the surveyed population was found to be suspected Chikungunya cases. Computer simulations indicated that a small number of infected humans and mosquitoes existed in the surveyed locality at the outbreak onset. From simulations in the theoretical locality, it was deduced that the level of infectivity in some localities may be below a herd immunity threshold and that the additional percentage of infected inhabitants in a follow-up epidemic would be significantly reduced with the case-reactive control of infected adult mosquitoes.

  4. Securing Stability and Inclusiveness: G20 Summit Success in Controlling Financial Crises

    Directory of Open Access Journals (Sweden)

    John Kirton

    2017-08-01

    Full Text Available The G20 summit system has successfully controlled financial crises, restoring global financial stability after the shock from the US in 2008 and preventing the third shock from Europe in 2010 from resulting in a global contagion. After the G20 finance ministers effectively responded to the Asian-turned-global financial crisis in 1999, they failed to prevent the greater American-turned-global financial crisis in 2008, yet their leaders together responded effectively to it, then prevented the escalating euro crisis from going global, and finally reduced the likelihood of another global financial crisis emanating from a systemically significant country. Since 2013, the G20 has also enhanced economic equality between rich and poor countries, but has not fully made up for the loss in economic growth experienced in 2008 to 2013 or eliminated the socioeconomic scarring created during that period. This increasing success was driven by the changing conditions of the forces identified in the systemic hub model of G20 governance. The first was steadily escalating shocks in finance and economics, and related fields, from 1997 to 2012. The sources of these shifted from emerging Asia to a newly-vulnerable United States, Europe and then China in a much reduced form. With such shocks exposing and equalizing the vulnerability of the major powers, the formal multilateral organizations created by the United States and its Atlantic allies in the 1940s and their subsequent informal supplements such as the G7 could not cope. Among its many international institutional competitors, the G20 alone contained, as full, equal members, the countries that increasingly possessed the collectively predominant and internally equalizing capabilities required to respond effectively. They increasingly, if unevenly, became more internationally and domestically open and interconnected financial systems, economies and societies, albeit with some setbacks after 2013. The often high

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

    Science.gov (United States)

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

    2005-02-01

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

  6. The second great wall of China: evolution of a successful policy of population control.

    Science.gov (United States)

    Stycos, J M

    1989-10-01

    In 1949, Mao Tse-tung professed that overpopulation could not occur under communism and more people and socialist organization leads only to more wealth and power. Yet 3 decades later communist China has adopted Malthusian population policies claiming them as socialist with a Chinese approach. This shift is ideology came about due to rapid population growth, concomitant food shortages, and insufficient economic growth. Since 1982 China has added 13 million persons/year to its population of 1 billion. In 1963, urban fertility began to decline from 6 children/woman to 3 at the end of the decade. The early 1970s marked the beginning of the politicization of birth control. Unlike Western nations and other developing countries that emphasize the health of mothers and children in their family planning campaigns, China emphasizes political goals. For example, the Chinese purports that family planning can speed world revolution by reducing family size. The Chinese prefer to persuade others to use contraceptives rather than coercing them to do so. Actually Chinese prefer very small families (2 in urban areas and 2 in rural areas). This persuasion and the introduction of oral contraceptives (OCs) and a simpler technique for female sterilization (minilaparotomy) contributed to the high contraceptive usage of 70% for couples of childbearing age and a high abortion rate of 318/1000 live birth by the end of the 1970s. The Chinese constitution states that family planning is the duty of each couple rather than a right. Further, the government has a 1 child/couple population policy. Even though China has had many successes, it has not reached a below replacement level (1989 total fertility rate=2.4), however.

  7. Delivering risk information in a dynamic information environment: Framing and authoritative voice in Centers for Disease Control (CDC) and primetime broadcast news media communications during the 2014 Ebola outbreak.

    Science.gov (United States)

    Kott, Anne; Limaye, Rupali J

    2016-11-01

    During a disease outbreak, media serve as primary transmitters of information from public health agencies to the public, and have been shown to influence both behavior and perception of risk. Differences in news frequency, framing and information source can impact the public's interpretation of risk messages and subsequent attitudes and behaviors about a particular threat. The media's framing of an outbreak is important, as it may affect both perception of risk and the ability to process important health information. To understand how risk communication by the Centers for Disease Control and Prevention (CDC) during the 2014 Ebola outbreak was framed and delivered and to what extent primetime broadcast news media mirrored CDC's framing and authoritative voice, 209 CDC communications and primetime broadcast transcripts issued between July 24 and December 29, 2014 were analyzed and coded by thematic frame and authoritative voice. Dominant frame and voice were determined for each month and for overall period of analysis. Medical frame was dominant in CDC (60%), Anderson Cooper 360 (49%), The Rachel Maddow Show (47%) and All In with Chris Hayes (47%). The human interest frame was dominant in The Kelly File (45%), while The O'Reilly Factor coverage was equally split between sociopolitical and medical frames (28%, respectively). Primetime news media also changed dominant frames over time. Dominant authoritative voice in CDC communications was that of CDC officials, while primetime news dominantly featured local and federal (non-CDC) government officials and academic/medical experts. Differences in framing and delivery could have led the public to interpret risk in a different way than intended by CDC. Overall, public health agencies should consider adapting risk communication strategies to account for a dynamic news environment and the media's agenda. Options include adapting communications to short-form styles and embracing the concept of storytelling. Copyright © 2016

  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. The History of Dengue Outbreaks in the Americas

    Science.gov (United States)

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

    2012-01-01

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

  10. Environmental triggers of Past Ebola Outbreaks in Africa, 1981 - 2014

    Science.gov (United States)

    Dartevelle, S.; NguyRobertson, A. L.

    2016-12-01

    Ebola virus, especially its most common and lethal form, Zaire Ebolavirus, has eluded scientists nearly 50 years. What is its primary host? Why does it go dormant to suddenly to reappear full force years later? What are the driving forces behind its intriguing dynamic? It has been surmised that local environmental factors (such as droughts, seasons) might be at play behind the on-and-off Ebola outbreak outbursts. However, so far, no clear lead has been demonstrated making Ebola a constant hidden lethal menace lurking in the environment for many African communities. We have analyzed long-term time-series of three environmental variables that influence the controlling factor behind the cycle of Ebola virus outbreaks: (i) vegetation health, as determined from the Normalized Difference Vegetation Index (NDVI) collected by AVHRR and MODIS satellite sensors, and the weather variables (ii) temperature and (iii) precipitation from the Climate Forecast System ver. 2. Time series data were averaged monthly and spatially over a 100 km grid around past known outbreak locations. Seasonal effects were removed from these time series before applying statistical analyses identifying causal linkages between NDVI, temperature, precipitation and Ebola outbreaks. Likewise, possible tipping-points prior to outbreaks (i.e., early warning signals of an upcoming outbreak) were identified. Our results indicate that there is a causal dynamic link between outbreaks and the three environmental variables examined months prior to an outbreak. This was likely due to an abnormal change in the local precipitation pattern which influence NDVI values and to a lesser extent temperature. Furthermore, our results provide evidence that these factors demonstrate early warning signals of a dynamical system at a tipping-point, prior to a future outbreak. These tipping-point or early warning models may open new ways to furthermore develop forecast models of future Ebola outbreaks. [US Government — Approved

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

    Science.gov (United States)

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

    2017-10-01

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

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

    LENUS (Irish Health Repository)

    McDonnell, R J

    1995-09-15

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

  13. A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

    Science.gov (United States)

    Margolis, Karen L; Asche, Stephen E; Bergdall, Anna R; Dehmer, Steven P; Maciosek, Michael V; Nyboer, Rachel A; O'Connor, Patrick J; Pawloski, Pamala A; Sperl-Hillen, JoAnn M; Trower, Nicole K; Tucker, Ann D; Green, Beverly B

    2015-11-01

    It is important to understand which components of successful multifaceted interventions are responsible for study outcomes, since some components may be more important contributors to the intervention effect than others. We conducted a mediation analysis to determine which of seven factors had the greatest effect on change in systolic blood pressure (BP) after 6 months in a trial to improve hypertension control. The study was a preplanned secondary analysis of a cluster-randomized clinical trial. Eight clinics in an integrated health system were randomized to provide usual care to their patients (n = 222), and eight were randomized to provide a telemonitoring intervention (n = 228). Four hundred three of 450 trial participants completing the 6-month follow-up visit were included. Intervention group participants received home BP telemonitors and transmitted measurements to pharmacists, who adjusted medications and provided advice to improve adherence to medications and lifestyle modification via telephone visits. Path analytic models estimated indirect effects of the seven potential mediators of intervention effect (defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months). The potential mediators were change in home BP monitor use, number of BP medication classes, adherence to BP medications, physical activity, salt intake, alcohol use, and weight. The difference in change in systolic BP was 11.3 mmHg. The multivariable mediation model explained 47 % (5.3 mmHg) of the intervention effect. Nearly all of this was mediated by two factors: an increase in medication treatment intensity (24 %) and increased home BP monitor use (19 %). The other five factors were not significant mediators, although medication adherence and salt intake improved more in the intervention group than in the usual care group. Most of the explained intervention effect was attributable to the combination of self

  14. Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control.

    Science.gov (United States)

    Salomão, Cristolde; Nacima, Amílcar; Cuamba, Lutero; Gujral, Lorna; Amiel, Olga; Baltazar, Cynthia; Cliff, Julie; Gudo, Eduardo Samo

    2017-07-01

    In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities. We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures.

  15. Bluetongue in small ruminants: An opinionated review, with a brief appraisal of the 2014 outbreak of the disease in Greece and the south-east Europe.

    Science.gov (United States)

    Kyriakis, C S; Billinis, C; Papadopoulos, E; Vasileiou, N G C; Athanasiou, L V; Fthenakis, G C

    2015-12-14

    Bluetongue is an arthropod-borne viral disease of ruminants, especially of sheep, caused by Bluetongue virus, which belongs to the genus Orbivirus of the family Reoviridae and is classified into 26 antigenically distinct serotypes. Once thought to be restricted in Africa and parts of the Middle East, bluetongue has now become a concern in sheep-rearing countries around the world. In the past 10 years, severe outbreaks have occurred in Europe with important economic consequences; of these, the 2006-20008 outbreak in Europe was caused by a serotype 8 strain and the 2014 outbreak in Greece and the other countries of south-east Europe was caused by a serotype 4 strain, suggested to be a reassortant strain with genome segments from lineages of serotype 1, 2 and 4. Immunisation campaigns can be implemented for successful control and limiting of the disease. Nevertheless, in both of the above outbreaks, late application of vaccinations led to a wide spread of the disease, which subsequently resulted in significant losses in livestock in the affected regions. In view of that, standardisation of control measures in the future will be beneficial for efficiently limiting outbreaks of the disease. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. First Wave of the 2016-17 Cholera Outbreak in Hodeidah City, Yemen - ACF Experience and Lessons Learned.

    Science.gov (United States)

    Altmann, Mathias; Suarez-Bustamante, Miguel; Soulier, Celine; Lesavre, Celine; Antoine, Caroline

    2017-10-13

    Although cases were reported only in 2010 and 2011, cholera is probably endemic in Yemen. In the context of a civil war, a cholera outbreak was declared in different parts of the country October 6th, 2016. This paper describes the ACF outbreak response in Hodeidah city from October 28th, 2016 to February 28th, 2017 in order to add knowledge to this large outbreak. The ACF outbreak response in Hodeidah city included a case management component and prevention measures in the community. In partnership with the Ministry of Public Health and Population of Yemen (MoPHP), the case management component included a Cholera Treatment Center (CTC) implemented in the Al Thoraw hospital, 11 Oral Rehydration Therapy Corners (ORTCs) and an active case finding system. In partnership with other stakeholders, prevention measures in the community, including access to safe water and hygiene promotion, were implemented in the most affected communities of the city. From October 28th, 2016 until February 28th, 2017, ACF provided care to 8,270 Acute Watery Diarrhea (AWD) cases, of which 5,210 (63%) were suspected cholera cases, in the CTC and the 11 ORTCs implemented in Hodeidah city. The attack rate was higher among people living in Al Hali district, with a peak in November 2016. At the CTC, 8% of children under 5 years-old also presented with Severe Acute Malnutrition (SAM). The Case-Fatality Rate (CFR) was low (0.07%) but 15% of admitted cases defaulted for cultural and security reasons. Environmental management lacked the information to appropriately target affected areas. Financial resources did not allow complete coverage of the city. Response to the first wave of a large cholera outbreak in Hodeidah city was successful in maintaining a CFR Yemen and its water infrastructure, much more efforts are needed to control the current outbreak resurgence.

  17. Electrolysis-driven and pressure-controlled diffusive growth of successive bubbles on micro-structured surfaces

    NARCIS (Netherlands)

    van der Linde, Peter; Moreno-Soto, Álvaro; Peñas-López, Pablo; Rodríguez-Rodríguez, Javier; Lohse, Detlef; Gardeniers, Han; van der Meer, Devaraj; Fernandez Rivas, David

    2017-01-01

    Control over the bubble growth rates forming on the electrodes of water-splitting cells or chemical reactors is critical towards the attainment of higher energy efficiencies within these devices. This study focuses on the diffusion-driven growth dynamics of a succession of H2 bubbles generated at a

  18. Multiclonal outbreak of methicillin-resistant Staphylococcus aureus infections on a collegiate football team.

    Science.gov (United States)

    Hall, A J; Bixler, D; Haddy, L E

    2009-01-01

    An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) occurred in a college football team in August 2006. Of 109 players on the team roster, 88 (81%) were interviewed during a cohort investigation. Twenty-five cases were identified, six of which were culture-confirmed. Available culture isolates were typed by pulsed-field gel electrophoresis (PFGE), which identified two different MRSA strains associated with the outbreak. Playing positions with the most physical contact (offensive linemen, defensive linemen, and tight ends) had the greatest risk of infection [risk ratio (RR) 5.1, 95% confidence interval (CI) 2.3-11.5. Other risk factors included recent skin trauma (RR 1.9, 95% CI 0.95-3.7), use of therapeutic hydrocollator packs (RR 2.5, 95% CI 1.1-5.7), and miscellaneous training equipment use (RR 2.1, 95% CI 1.1-4.1). The outbreak was successfully controlled through team education and implementation of improved infection-control practices and hygiene policies.

  19. A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition

    Directory of Open Access Journals (Sweden)

    Sora Mercedes

    2011-10-01

    Full Text Available Abstract Background Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR Pseudomonas aeruginosa (PA and evaluate the effectiveness of the surveillance procedures and control measures applied. Methods Patients with MRPA isolates were prospectively identified (January 2006-May 2008. A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs] and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs was designed and implemented. Results Three hundred and ninety patients were identified. ICU patients were the most numerous group (22% followed by urology patients (18%. Environmental surveillance found that 3/19 (16% non-ICU environmental samples and 4/63 (6% ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures: -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003 and intervention 2 (extensive decontamination: -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p Conclusions In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem.

  20. Leadership, Control, Communication and Comprehension: Key Factors in Successful Implementation of SBDM.

    Science.gov (United States)

    Etheridge, Carol Plata; And Others

    This study examines the effects of principal leadership styles on the development of the working styles of seven local school councils in Memphis (Tennessee) during their first 15 months of operation. The successful implementation of a school-based decision making (SBDM) management model depends upon the ability of the local school council to…

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

    NARCIS (Netherlands)

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

    2012-01-01

    Suriname has cleared malaria from its capital city and coastal areas mainly through the successful use of chloroquine and DDT (dichloro-diphenyl-trichloroethane) during the Global Malaria Eradication programme that started in 1955. Nonetheless, malaria transmission rates remained high in the

  2. Analysis of norovirus outbreaks reveals the need for timely and extended microbiological testing.

    Science.gov (United States)

    Mattner, F; Guyot, A; Henke-Gendo, C

    2015-12-01

    Norovirus outbreaks in hospitals remain a substantial threat despite many recommendations for prevention published recently. To analyse the factors contributing to onset of a norovirus outbreak in hospitals in order to identify new prevention options. Data from 71 norovirus outbreaks occurring in five German hospitals between 2002 and 2012 were analysed focusing on the start conditions: the weekday of outbreak, the time span between the first symptomatic cases and the outbreak onset date, the timing of a positive norovirus test result in an outbreak, and presence of concomitant Clostridium difficile infections. In 68 (96%) outbreaks index cases were identifiable. In 30 of 44 (68%) outbreaks the index case patient acquired norovirus infection in hospital. In 20% of all outbreaks, the index case was a staff member. Nine outbreaks were caused by not isolating contact patients during the incubation time after their exposure to a symptomatic case. Case numbers in norovirus outbreaks were lower when the norovirus test results were available before the outbreak onset (P = 0.028). In 30 of 46 (64%) norovirus outbreaks, C. difficile toxin tests were positive in up to ten patients. Co-infection or subsequent infection with norovirus and C. difficile in single patients occurred in nine (20%) outbreaks. Future prevention strategies should focus not only on patients but also on staff. Constant surveillance for new cases of diarrhoea and vomiting and timely adherence to contact precautions for all exposed persons is crucial in outbreak control, as is the need for extended microbiological testing. Copyright © 2015. Published by Elsevier Ltd.

  3. The Cost of Responding to an Acinetobacter Outbreak in Critically Ill Surgical Patients.

    Science.gov (United States)

    Jiang, Yushan; Resch, Stephen; Liu, Xiaoxia; Rogers, Selwyn O; Askari, Reza; Klompas, Michael; Jayaraman, Sudha P

    2016-02-01

    Our institution had an outbreak of multi-drug-resistant Acinetobacter (MDRA) in 2011. We analyzed the costs of responding to this outbreak from the hospital's perspective. We estimated retrospectively the excess costs associated with an MDRA outbreak response at a major academic medical center, including the costs of staffing, supplies, administrative time, deep cleaning, and environmental testing. Differences in mean costs before and during the 2011 MDRA outbreak were analyzed using the Student t-test. The overall excess cost incurred during the outbreak response was $371,079 in 2011 U.S. dollars. The largest contributors were the extra resources needed to staff and clean the two intensive care units (ICUs) (78%). In the general surgery ICU, the mean weekly cost of nursing during the outbreak was $13,276 more for regular hours (+15%; p reputation. Strategies to prevent and control such outbreaks better have substantial value.

  4. Investigation of A Cholera Outbreak in Kanpur Village of Panchmahal, Gujarat

    OpenAIRE

    Shroff Bhavesh D, Mazumdar Vihang S

    2011-01-01

    Introduction: Diarrhoeal disease outbreaks are causes of major public health emergencies in India. We investigated such outbreak in Kanpur village of Panchmahal district, Gujarat to identify the etiological agent, source of transmission and propose control measures. We also conducted case-control study to identify risk factors. Results: The outbreak was caused by V. cholera 01. Cases were not localized to any specific area but scattered in village depending on location of children who had eat...

  5. NASA flight controllers - Meeting cultural and leadership challenges on the critical path to mission success

    Science.gov (United States)

    Clement, James L., Jr.; Ritsher, Jennifer Boyd

    2006-01-01

    As part of its preparation for missions to the Moon and Mars, NASA has identified high priority critical path roadmap (CPR) questions, two of which focus on the performance of mission control personnel. NASA flight controllers have always worked in an incredibly demanding setting, but the International Space Station poses even more challenges than prior missions. We surveyed 14 senior ISS flight controllers and a contrasting sample of 12 more junior controllers about the management and cultural challenges they face and the most effective strategies for addressing them. There was substantial consensus among participants on some issues, such as the importance of building a personal relationship with Russian colleagues. Responses from junior and senior controllers differed in some areas, such as training. We frame the results in terms of two CPR questions. We aim to use our results to improve flight controller training.

  6. Methylisothiazolinone outbreak in the European Union.

    Science.gov (United States)

    Latheef, Faheem; Wilkinson, Stephen Mark

    2015-10-01

    The aim of this review was to examine the current outbreak of cases of contact allergy to methylisothiazolinone in Europe, a phenomenon that has also been observed worldwide, despite initial legislative control of the introduction of methylisothiazolinone into the market. Reported allergic contact reactions are primarily eczematous, most commonly in women over 40 from cosmetic use, but there are reports of noneczematous eruptions such as lichen planus-like or lymphomatoid reactions. Methylisothiazolinone in cosmetic, personal care, for example, wet wipe, and household products are the most common exposure. Occupational exposure is represented by workplace use of hygiene (healthcare) and beauty products (hairdressers, beauticians) together with water-based paints and other aqueous solutions such as cutting fluid.Methylisothiazolinone should be patch tested at a concentration of 2000 ppm (0.2% aqueous) to maximize sensitivity of the test.Notwithstanding the recommendation to discontinue the use of methylisothiazolinone in leave-on cosmetics, studies suggest safer use of concentrations should also be determined for rinse-off products. Legislation to improve labelling of industrial materials is also required.Going forward there is a need for collaboration between the cosmetic industry and interested physicians to break the recurrent cycle of sensitization to preservatives as one is replaced with another to maintain the risk of sensitization at an acceptably low level. Methylisothiazolinone is particularly relevant at present as strategies to control the outbreak are yet to be enforced and there is no current evidence of the outbreak abating.

  7. The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study

    Directory of Open Access Journals (Sweden)

    Ifeanyi-Stanley Muoghalu

    2017-07-01

    Full Text Available IntroductionSierra Leone experienced an unprecedented Ebola virus disease (EVD outbreak in all its districts. Koinadugu District was the last to report an EVD case. Several outbreak response strategies were implemented. As part of lessons learnt, we conducted an observational study to describe the transmission chain in the district and the impact of the control measures implemented to contain the outbreak.MethodsWe reconstructed the transmission chain, positioning both confirmed and probable cases, described the distribution of the EVD confirmed cases in the context of the routes of transmission (Community, Funeral or Health facility setting and assessed the impact of control measures using the surveillance data collected during the outbreak.ResultsAll 142 confirmed and probable EVD cases registered were fully resolved in the transmission chain. 72.5% of all the EVD cases in the district were exposed in the community, 26.1% exposed during funerals, and 1.4% exposed in the health facility setting. Health-care workers contributed little to the EVD outbreak. 71.1% of EVD transmission occurred among family members. Female EVD cases generated more secondary cases than their male counterparts (P = 0.03. With removal of EVD cases from the community and admission to the community care center (CCC, the EVD transmission in the community decreased to substantially lower rates. In addition, transmission due to exposure in health facilities was further reduced with the implementation of full infection and prevention controls.ConclusionThis study details the transmission chain of EVD in a rural district setting and the public health interventions implemented to successfully limit the outbreak to just one of 11 chiefdoms. Heightened community-based surveillance for early case detection, swift isolation of suspect cases, efficient contact tracing and monitoring, and good infection prevention and control measures in health facilities were highly effective in

  8. Electronic outbreak surveillance in Germany: a first evaluation for nosocomial norovirus outbreaks.

    Directory of Open Access Journals (Sweden)

    Anja M Hauri

    Full Text Available BACKGROUND: In Germany, surveillance for infectious disease outbreaks is integrated into an electronic surveillance system. For 2007, the national surveillance database contains case-based information on 201,224 norovirus cases, three-quarters of which are linked to outbreaks. We evaluated the data quality of the national database in reflecting nosocomial norovirus outbreak (NNO data available in 19 Hessian local public health authorities (LPHAs and the influence of differences between LPHA's follow-up procedures for laboratory notifications of Norovirus positive stool samples on outbreak underascertainment. METHODS: Data on NNO beginning in 2007 and notified to the 19 LPHAs were extracted from the national database, investigated regarding internal validity and compared to data collected from LPHAs for a study on NNO control. LPHAs were questioned whether they routinely contacted all persons for whom a laboratory diagnosis of norovirus infection was notified. The number of outbreaks per 1,000 hospital beds and the number of cases within NNOs for acute care and rehabilitation hospitals were compared between counties with and without complete follow-up. RESULTS: The national database contained information on 155 NNOs, including 3,115 cases. Cases were missed in the national database in 58 (37% of the outbreaks. Information on hospitalisation was incorrect for an estimated 47% of NNO cases. Information on county of infection was incorrect for 24% (199/820 of cases being forwarded between LPHAs for data entry. Reported NNO incidence and number of NNO cases in acute care hospitals was higher in counties with complete follow-up (incidence-rate ratio (IRR 2.7, 95% CI 1.4-5.7, p-value 0.002 and IRR 2.1, 95% CI 1.9-2.4, p-value 0.001, respectively. CONCLUSIONS: Many NNOs are not notified by hospitals and differences in LPHA procedures have an impact on the number of outbreaks captured in the surveillance system. Forwarding of case-by-case data on

  9. Experiência bem-sucedida no controle do Aedes aegypti sem uso de venenos no sertão cearense | Successful experience in the control of Aedes aegypti without the use of poisons in Ceará backcountry

    Directory of Open Access Journals (Sweden)

    Fernando Ferreira Carneiro

    2016-05-01

    , presenting absence of local transmission of dengue for more than ten years, and reaching in 2016, 0.09% infestation index by Aedes aegypti in six months. This is the result of 15 years of work that has been maintained by successive municipal administrations, which includes: monthly visits by the endemics controlling agents; ovitraps; environmental monitoring; sealing shells; biological control; outbreaks delimitation; health education; integration of the Family Health Strategy with the endemic diseases controlling agents and the Education Office; and municipal administration support as a whole. The experience of Pedra Branca points out to more effective and sustainable ways that could be implemented in other local health systems, and which may guide actions against this triple epidemic.

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

    Science.gov (United States)

    Pavlock, Kate M.

    2011-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  13. Potential for large outbreaks of Ebola virus disease

    Directory of Open Access Journals (Sweden)

    A. Camacho

    2014-12-01

    Full Text Available Outbreaks of Ebola virus can cause substantial morbidity and mortality in affected regions. The largest outbreak of Ebola to date is currently underway in West Africa, with 3944 cases reported as of 5th September 2014. To develop a better understanding of Ebola transmission dynamics, we revisited data from the first known Ebola outbreak, which occurred in 1976 in Zaire (now Democratic Republic of Congo. By fitting a mathematical model to time series stratified by disease onset, outcome and source of infection, we were able to estimate several epidemiological quantities that have previously proved challenging to measure, including the contribution of hospital and community infection to transmission. We found evidence that transmission decreased considerably before the closure of the hospital, suggesting that the decline of the outbreak was most likely the result of changes in host behaviour. Our analysis suggests that the person-to-person reproduction number was 1.34 (95% CI: 0.92–2.11 in the early part of the outbreak. Using stochastic simulations we demonstrate that the same epidemiological conditions that were present in 1976 could have generated a large outbreak purely by chance. At the same time, the relatively high person-to-person basic reproduction number suggests that Ebola would have been difficult to control through hospital-based infection control measures alone.

  14. Fractional Diffusion Emulates a Human Mobility Network during a Simulated Disease Outbreak

    Directory of Open Access Journals (Sweden)

    Kyle B. Gustafson

    2017-04-01

    Full Text Available Mobility networks facilitate the growth of populations, the success of invasive species, and the spread of communicable diseases among social animals, including humans. Disease control and elimination efforts, especially during an outbreak, can be optimized by numerical modeling of disease dynamics on transport networks. This is especially true when incidence data from an emerging epidemic is sparse and unreliable. However, mobility networks can be complex, challenging to characterize, and expensive to simulate with agent-based models. We therefore studied a parsimonious model for spatiotemporal disease dynamics based on a fractional diffusion equation. We implemented new stochastic simulations of a prototypical influenza-like infection spreading through the United States' highly-connected air travel network. We found that the national-averaged infected fraction during an outbreak is accurately reproduced by a space-fractional diffusion equation consistent with the connectivity of airports. Fractional diffusion therefore seems to be a better model of network outbreak dynamics than a diffusive model. Our fractional reaction-diffusion method and the result could be extended to other mobility networks in a variety of applications for population dynamics.

  15. Surveillance for foodborne disease outbreaks - United States, 2006.

    Science.gov (United States)

    2009-06-12

    Foodborne illnesses are a major health burden in the United States. Most of these illnesses are preventable, and analysis of outbreaks helps identify control measures. Although most cases are sporadic, investigation of the portion that occur as part of recognized outbreaks can provide insights into the pathogens, food vehicles, and food-handling practices associated with foodborne infections. CDC collects data on foodborne disease outbreaks (FBDOs) from all states and territories through the Foodborne Disease Outbreak Surveillance System (FBDSS). This report summarizes epidemiologic data on FBDOs reported during 2006 (the most recent year for which data have been analyzed). A total of 1,270 FBDOs were reported, resulting in 27,634 cases and 11 deaths. Among the 624 FBDOs with a confirmed etiology, norovirus was the most common cause, accounting for 54% of outbreaks and 11,879 cases, followed by Salmonella (18% of outbreaks and 3,252 cases). Among the 11 reported deaths, 10 were attributed to bacterial etiologies (six Escherichia coli O157:H7, two Listeria monocytogenes, one Salmonella serotype Enteritidis, and one Clostridium botulinum), and one was attributed to a chemical (mushroom toxin). Among outbreaks caused by a single food vehicle, the most common food commodities to which outbreak-related cases were attributed were poultry (21%), leafy vegetables (17%), and fruits/nuts (16%). Public health professionals can use this information to 1) target control strategies for specific pathogens in particular foods along the farm-to-table continuum and 2) support good food-handling practices among restaurant workers and the public.

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

    OpenAIRE

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

    2017-01-01

    The present study addressed concerns over the high risk of university students' academic failure. It examined how perceived academic control and academic emotions predict undergraduate students' academic success, conceptualized as both low dropout intention and high achievement (indicated by GPA). A cross-sectional survey was administered to 883 undergraduate students across all disciplines of a German STEM orientated university. The study additionally compared freshman students (N = 597) vs....

  17. The Role of Self-control and Grit in Domains of School Success in Students of Primary and Secondary School

    Directory of Open Access Journals (Sweden)

    Xavier Oriol

    2017-10-01

    Full Text Available Objective: Self-control and grit have become two of the most important variables that explain success in different aspects of people's daily life (Duckworth and Gross, 2014. Self-control promotes delayed gratification and directly influences thoughts, emotions, and impulses. On the other hand, grit enhances the achievement of goals through perseverance even before extreme external circumstances. Since both constructs are related, examining them together is compelling, as long as the different nuances that characterize each are taken into account. Two structural equation models (SEM were conducted to observe the effect of self-control and grit on a more specific indicator of academic success (academic self-efficacy and a more general indicator of school experience (satisfaction with school.Methods: The first model comprises 5,681 primary students (M = 9.05; SD = 0.79, and the second 10,017 secondary students (M = 14.20; SD = 1.04 from Lima, Peru. In both models, the influence of grit and self-control on school satisfaction was observed when taking self-efficacy as a mediator variable.Results: The results show that grit and self-control have strong associations in both primary and secondary students. When estimating the covariance of both constructs, grit is related with academic-self efficacy at both educational stages, but only to satisfaction with school in secondary students. On the contrary, self-control shows a significant relationship with school satisfaction only in primary education. In turn, self-efficacy shows a mediating effect between grit and school satisfaction. After calculating the invariance of the models, differences are observed by gender in the relationships between variables.Conclusion: The results indicate that both constructs are strongly interrelated. Regarding the associations with the indicators of academic success, a need for timely interventions specific to each educational stage is observed.

  18. The Role of Self-control and Grit in Domains of School Success in Students of Primary and Secondary School.

    Science.gov (United States)

    Oriol, Xavier; Miranda, Rafael; Oyanedel, Juan C; Torres, Javier

    2017-01-01

    Objective: Self-control and grit have become two of the most important variables that explain success in different aspects of people's daily life (Duckworth and Gross, 2014). Self-control promotes delayed gratification and directly influences thoughts, emotions, and impulses. On the other hand, grit enhances the achievement of goals through perseverance even before extreme external circumstances. Since both constructs are related, examining them together is compelling, as long as the different nuances that characterize each are taken into account. Two structural equation models (SEM) were conducted to observe the effect of self-control and grit on a more specific indicator of academic success (academic self-efficacy) and a more general indicator of school experience (satisfaction with school). Methods: The first model comprises 5,681 primary students (M = 9.05; SD = 0.79), and the second 10,017 secondary students (M = 14.20; SD = 1.04) from Lima, Peru. In both models, the influence of grit and self-control on school satisfaction was observed when taking self-efficacy as a mediator variable. Results: The results show that grit and self-control have strong associations in both primary and secondary students. When estimating the covariance of both constructs, grit is related with academic-self efficacy at both educational stages, but only to satisfaction with school in secondary students. On the contrary, self-control shows a significant relationship with school satisfaction only in primary education. In turn, self-efficacy shows a mediating effect between grit and school satisfaction. After calculating the invariance of the models, differences are observed by gender in the relationships between variables. Conclusion: The results indicate that both constructs are strongly interrelated. Regarding the associations with the indicators of academic success, a need for timely interventions specific to each educational stage is observed.

  19. VARICELLA OUTBREAK IN A DAYCARE

    Science.gov (United States)

    Daskalaki, Irini; Thermitus, Rodrerica; Perella, Dana; Viner, Kendra; Spells, Niya; Mohanty, Salini; Lopez, Adriana; Johnson, Caroline

    2017-01-01

    As a result of single-dose varicella vaccination, daycare outbreaks have become rare. We investigated a daycare outbreak resulting from a misdiagnosed varicella case in an unvaccinated attendee. Of 25 attendees aged 12–32 months without evidence of immunity, 7 (28%) were unvaccinated due to religious/philosophical opposition or recent 1st birthday. Single-dose vaccination reduced disease by 92% compared with no vaccination. PMID:24136372

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

    Directory of Open Access Journals (Sweden)

    Daniel Tom-Aba

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

  1. Vandetanib successfully controls medullary thyroid cancer-related Cushing syndrome in an adolescent patient.

    Science.gov (United States)

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

    2014-09-01

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

  2. European experiences in the development of approaches for the successful control of workplace health risks.

    Science.gov (United States)

    Money, C D

    2003-10-01

    In recent years, several approaches have been proposed for the application of control banding concepts to the assessment and management of various workplace health and safety risks. Whilst many of the earlier approaches have originated in the UK, several of the most recent examples have been developed in Europe. The European schemes have attempted to build upon the lessons learned from the earlier control banding schemes and to apply them to new areas of health and safety. This paper analyses the evolution of the earlier approaches and reviews the more recent European developments in the context of continuing regulatory and societal demands for the improved assessment and regulation of workplace chemical risks.

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

    Directory of Open Access Journals (Sweden)

    Fen-juan Wang

    2014-09-01

    Conclusions: Hospital exposure 1–2 weeks before infection with measles was the main cause of the measles outbreak. We must be fully aware of the possibility of nosocomial infection in an outbreak of measles; controlling nosocomial infections is a vital step in the prevention and control of the propagation of measles.

  4. 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.

  5. Learning to Learn Online: Using Locus of Control to Help Students Become Successful Online Learners

    Science.gov (United States)

    Lowes, Susan; Lin, Peiyi

    2015-01-01

    In this study, approximately 600 online high school students were asked to take Rotter's locus of control questionnaire and then reflect on the results, with the goal of helping them think about their ability to regulate their learning in this new environment. In addition, it was hoped that the results could provide a diagnostic for teachers who…

  6. Biological control of pests in protected cultivation: implementation in Latin America and successes in Europe

    NARCIS (Netherlands)

    Bueno, V.H.P.; Lenteren, van J.C.

    2010-01-01

    The area with greenhouse crops is estimated to be around 40,000 hectares in Latin America, of which approximately 60% is occupied with ornamentals. Several pests are responsible for losses in yield or quality of greenhouse crops production and pest control is still mainly by chemicals. However,

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

    Energy Technology Data Exchange (ETDEWEB)

    Violari, Elena G., E-mail: eviolari@live.com; Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States); Reidy, Diane L. [Memorial Sloan-Kettering Cancer Center, Department of Medicine, Gastrointestinal Oncology Service (United States); Jarnagin, William R. [Memorial Sloan-Kettering Cancer Center, Department of Surgery, Hepatopancreatobiliary Service (United States); Brown, Karen T. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, Interventional Radiology Service (United States)

    2015-04-15

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

  8. Economic evaluation of the successful biological control of Azolla filiculoides in South Africa

    CSIR Research Space (South Africa)

    McConnachie, AJ

    2003-09-01

    Full Text Available -user) was 2.17 ha, with an expansion rate of 1.33 ha per year. The frond-feeding weevil Stenopelmus rufinasus was released as a biological control agent at the end of 1997. Within 3 years, the weevil had reduced the weed population to the point...

  9. Arms Control and Missile Defense: Explaining Success and Failure in U.S.-Russian Cooperation

    Science.gov (United States)

    2013-09-01

    Tsypkin Thesis Co-Advisor: Michael Glosny THIS PAGE INTENTIONALLY LEFT BLANK i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public...the socialization received during their time as KGB or FSB officers. 14. SUBJECT TERMS Russia, United States, BMD, Arms Control...as KGB or FSB officers. vi THIS PAGE INTENTIONALLY LEFT BLANK vii TABLE OF CONTENTS I. INTRODUCTION

  10. The First Running Period of the CMS Detector Controls System - A Success Story

    CERN Document Server

    Glege, F; Chaze, O; Cittolin, S; Coarasa, J A; Deldicque, C; Dobson, M; Gigi, D; Gomez-Reino, R; Hartl, C; Masetti, L; Meijers, F; Meschi, E; Morovic, S; Nunez-Barranco-Fernandez, C; Orsini, L; Ozga, W; Bauer, G; Behrens, U; Branson, J; Holzner, A; Erhan, S; Mommsen, R K; O'Dell, V

    2014-01-01

    The Detector Control System (DCS) of the Compact Muon Solenoid (CMS) experiment at the Large Hadron Collider (LHC) at CERN has been running since the ?rst detector test in summer 2006. It has proven to be robust, ef?cient and easy to maintain.

  11. [Food borne infectious outbreaks, Austria 2005].

    Science.gov (United States)

    Much, Peter; Pichler, Juliane; Allerberger, Franz

    2007-01-01

    In Austria, a total of 606 food borne outbreaks, affecting 1,910 people altogether (including 368 hospitalized patients and 1 fatal outcome) were documented in 2005. Salmonella spp. and Campylobacter spp. accounted for 99% of all reported outbreaks. Fortysix (8%) of the 606 outbreaks were acquired abroad. Bacteria caused all but one of the 560 domestically acquired food borne outbreaks: 427 (76%) were due to Salmonella spp., 128 (23%) due to Campylobacter spp. and two outbreaks each due to enterohaemorrhagic Escherichia coli and Yersinia enterocolitica. Norovirus caused an outbreak affecting 22 persons. The respective hospitalization rate for domestically acquired Salmonella spp. and Campylobacter spp. infections was 20% and 16%. Of those outbreaks where information as to the source was provided, eggs were implicated in 57%, meat products (especially poultry) in 30% and milk or dairy products (especially raw milk) in 4%. The ratio between family outbreaks and general outbreaks was 89% to 11%. For general outbreaks the following locations of exposure were given: commercial food suppliers (incl. restaurants, cafeterias) 34 x, family celebrations 14 x, nursery schools 4 x, festivities (e.g. fairs) 3 x, nursing homes twice and once a mixed outbreak involving commercial food suppliers plus homes (Austria-wide S. Enteritidis PT19 outbreak). In our opinion, the relatively high number of family outbreaks merely reflects the still insufficient quality of epidemiological outbreak investigation in Austria, i.e. lack of consolidating individual clusters into larger food borne outbreaks which exceed district or provincial borders.

  12. How to Successfully Renovate a Controls System? - Lessons Learned from the Renovation of the CERN Injectors’ Controls Software

    CERN Document Server

    Kruk, G; Kulikova, O; Lezhebokov, V; Pace, M; Pera Mira, P; Roux, E; Wozniak, J Pawel

    2014-01-01

    Renovation of the control system of the CERN LHC injectors was initiated in 2007 in the scope of the Injector Controls Architecture (InCA) project. One of its main objectives was to homogenize the controls software across CERN accelerators and reuse as much as possible the existing modern sub-systems, such as the settings management used for the LHC. The project team created a platform that would permit coexistence and intercommunication between old and new components via a dedicated gateway, allowing a progressive replacement of the former. Dealing with a heterogeneous environment, with many diverse and interconnected modules, implemented using different technologies and programming languages, the team had to introduce all the modifications in the smoothest possible way, without causing machine downtime. After a brief description of the system architecture, the paper discusses the technical and non-technical sides of the renovation process such as validation and deployment methodology, operational applicatio...

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2011-12-01

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

  15. 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.

  16. 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.

  17. Functional brain response to food images in successful adolescent weight losers compared with normal-weight and overweight controls.

    Science.gov (United States)

    Jensen, Chad D; Kirwan, C Brock

    2015-03-01

    Research conducted with adults suggests that successful weight losers demonstrate greater activation in brain regions associated with executive control in response to viewing high-energy foods. No previous studies have examined these associations in adolescents. Functional neuroimaging was used to assess brain response to food images among groups of overweight (OW), normal-weight (NW), and successful weight-losing (SWL) adolescents. Eleven SWL, 12 NW, and 11 OW participants underwent functional magnetic resonance imaging while viewing images of high- and low-energy foods. When viewing high-energy food images, SWLs demonstrated greater activation in the dorsolateral prefrontal cortex (DLPFC) compared with OW and NW controls. Compared with NW and SWL groups, OW individuals demonstrated greater activation in the ventral striatum and anterior cingulate in response to food images. Adolescent SWLs demonstrated greater neural activation in the DLPFC compared with OW/NW controls when viewing high-energy food stimuli, which may indicate enhanced executive control. OW individuals' brain responses to food stimuli may indicate greater reward incentive processes than either SWL or NW groups. © 2015 The Obesity Society.

  18. Discrimination of tornadic and non-tornadic severe weather outbreaks

    Science.gov (United States)

    Mercer, Andrew Edward

    best discriminating statistical technique (SVM) at 24-hours lead time. Results degrade only slightly by 72-hours lead time (maximum POD of 0.833 and minimum FAR of 0.276). Synoptic composites of the outbreak types are the second analysis considered. Composites are used to reveal synoptic features of outbreak types, which can be utilized to diagnose the differences between classes (in this case, TOs and NTOs). The composites are created using PCA. Five raw variables, height, temperature, relative humidity, and u and v wind components, are extracted from the NCEP/NCAR reanalysis data for North America. Converging longitude lines with increasing latitude on the reanalysis grid introduce bias into correlation calculations in higher latitudes; hence, the data are mapped onto both a latitudinal density grid and a Fibonacci grid. The resulting PCA produces two significant principal components (PCs), and a cluster analysis on these PCs for each outbreak type results in two types of TOs and NTOs. TO composites are characterized by a trough of low pressure over the central United States and major quasigeostrophic forcing features such as an upper level jet streak, cyclonic vorticity advection increasing with height, and warm air advection. These dynamics result in a strong surface cyclone in most tornado outbreaks. These features are considerably less pronounced in NTOs. The statistical analyses presented herein were successful in classifying outbreak types at various lead times, using synoptic scale data as input.

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

    Science.gov (United States)

    Pavlock, Kate M.

    2011-01-01

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

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

    OpenAIRE

    Esteves, Sandro C; Bento, Fabiola C.

    2015-01-01

    A recently published article described how a fertility center in the United States implemented air quality control to newly designed in vitro fertilization (IVF) laboratory.1 A highly-efficient air filtration was achieved by installing a centered system supplying filtered air to the IVF laboratory and related critical areas, combining air particulate and volatile organic compound (VOC) filtration. As a consequence, live birth rates were increased by improvements in air quality. This article h...

  1. 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

  2. Collaboration between infection control and occupational health in three continents: a success story with international impact

    Directory of Open Access Journals (Sweden)

    Ndelu Lindiwe

    2011-11-01

    Full Text Available Abstract Globalization has been accompanied by the rapid spread of infectious diseases, and further strain on working conditions for health workers globally. Post-SARS, Canadian occupational health and infection control researchers got together to study how to better protect health workers, and found that training was indeed perceived as key to a positive safety culture. This led to developing information and communication technology (ICT tools. The research conducted also showed the need for better workplace inspections, so a workplace audit tool was also developed to supplement worker questionnaires and the ICT. When invited to join Ecuadorean colleagues to promote occupational health and infection control, these tools were collectively adapted and improved, including face-to-face as well as on-line problem-based learning scenarios. The South African government then invited the team to work with local colleagues to improve occupational health and infection control, resulting in an improved web-based health information system to track incidents, exposures, and occupational injury and diseases. As the H1N1 pandemic struck, the online infection control course was adapted and translated into Spanish, as was a novel skill-building learning tool that permits health workers to practice selecting personal protective equipment. This tool was originally developed in collaboration with the countries from the Caribbean region and the Pan American Health Organization (PAHO. Research from these experiences led to strengthened focus on building capacity of health and safety committees, and new modules are thus being created, informed by that work. The products developed have been widely heralded as innovative and interactive, leading to their inclusion into “toolkits” used internationally. The tools used in Canada were substantially improved from the collaborative adaptation process for South and Central America and South Africa. This international

  3. Are multilateral malaria research and control programs the most successful? Lessons from the past 100 years in Africa.

    Science.gov (United States)

    Alilio, Martin S; Bygbjerg, Ib C; Breman, Joel G

    2004-08-01

    Multilateral malaria research and control programs in Africa have regained prominence recently as bilateral assistance has diminished. The transnational nature of the threat and the need for inspired leadership, good coordination, and new discoveries to decrease the impact of the disease has led to the founding of the Multilateral Initiative on Malaria, the Roll Back Malaria Project, Global Fund for HIV, Tuberculosis and Malaria (Global Fund), the Medicines for Malaria Venture, and the Malaria Vaccine Initiative, among other groups. Historically, the most striking feature of malaria control and elimination activities was the connectedness and balance between malaria research and control especially, from 1892 to 1949. A combination of scientific originality, perseverance in research, integrated approaches, and social concern were the keys for success. The elimination of Anopheles gambiae from Upper Egypt in 1942 using integrated vector control methods is a prime example of malaria control during the first half of the 20th century where those factors were brought together. After 1949, there were three decades of great optimism. Four notable landmarks characterized this period: the Kampala Conference in 1950; the Global Malaria Eradication Program beginning in 1955; the primary health care strategies adopted by most African States after attaining their political independence in the 1960s, and accelerating in the 1980s; and creation of the Special Program in Training and Research in Tropical Diseases at the World Health Organization in 1975. The initial highly encouraging operational results, largely obtained in temperate or subtropical areas where transmission was unstable, engendered undue expectations for the success of identical antimalarial measures elsewhere. Many were convinced that the eradication was in sight, such that support for malaria research virtually ceased. Young, bright scientists were discouraged from seeking a career in a discipline that appeared

  4. Public health approach to detection of non-O157 Shiga toxin-producing Escherichia coli: summary of two outbreaks and laboratory procedures.

    Science.gov (United States)

    Schaffzin, J K; Coronado, F; Dumas, N B; Root, T P; Halse, T A; Schoonmaker-Bopp, D J; Lurie, M M; Nicholas, D; Gerzonich, B; Johnson, G S; Wallace, B J; Musser, K A

    2012-02-01

    Routine laboratory testing may not detect non-O157 Shiga toxin-producing Escherichia coli (STEC) reliably. Active clinical, epidemiological, environmental health, and laboratory collaboration probably influence successful detection and study of non-O157 STEC infection. We summarized two outbreak investigations in which such coordinated efforts identified non-O157 STEC disease and led to effective control measures. Outbreak 1 involved illness associated with consuming unpasteurized apple cider from a local orchard. Public health personnel were notified by a local hospital; stool specimens from ill persons contained O111 STEC. Outbreak 2 involved bloody diarrhoea at a correctional facility. Public health personnel were notified by the facility infection control officer; O45 STEC was the implicated agent. These reports highlight the ability of non-O157 STEC to cause outbreaks and demonstrate that a coordinated effort by clinicians, infection-control practitioners, clinical diagnostic laboratorians, and public health personnel can lead to effective identification, investigation, and prevention of non-O157 STEC disease.

  5. Management of a nosocomial outbreak of Mycobacterium tuberculosis Beijing/W genotype in Taiwan: an emphasis on case tracing with high-resolution computed tomography.

    Science.gov (United States)

    Chen, Tun-Chieh; Lu, Po-Liang; Yang, Chih-Jen; Lin, Wei-Ru; Lin, Chun-Yu; Jou, Ruwen; Feng, Ming-Chu; Wang, Tung-Heng; Ho, Chi-Kung; Hwang, Jhi-Jhu; Chen, Yen-Hsu; Chiang, Horn-Che; Huang, Ming-Shyan; Chen, Tyen-Po

    2010-05-01

    A nosocomial outbreak of Mycobacterium tuberculosis Beijing/W genotype infected 15 healthcare workers (HCWs) in a medical center in Taiwan, where there is a high prevalence of tuberculosis and a high rate of positive tuberculin skin tests. An index patient with laryngeal cancer and a lung abscess was identified by epidemiological investigation and it was found that an M. tuberculosis isolate from his lung tissue sample had an identical IS6110 restriction fragment length polymorphism pattern to the isolates from 3 HCWs. Confirmation of the identity of this strain as Beijing/W genotype was made using spoligotyping. Seven hundred and eighty-five HCWs potentially exposed to the probable index patient received contact investigation and chest X-ray screening. We used chest high-resolution computed tomography (HRCT) to clarify trivial lesions in chest X-rays. Nine HCWs with smear-negative pulmonary tuberculosis were diagnosed by HRCT. Fifteen of the 35 (42.9%) HCWs with documented exposure to the index patient developed pulmonary tuberculosis within 11 months after exposure. The outbreak was successfully controlled by active case finding and enforcement of infection control strategies. Intervention to detect the potential tuberculosis source is helpful in the prevention and control of a nosocomial tuberculosis outbreak. HRCT can be a useful tool for tuberculosis diagnosis of contacts in an outbreak situation.

  6. 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.

  7. Scabies: Prevention and Control

    Science.gov (United States)

    ... Diseases Laboratory Diagnostic Assistance [DPDx] Parasites Home Prevention & Control Recommend on Facebook Tweet Share Compartir When a ... avoid outbreaks. Institutional outbreaks can be difficult to control and require a rapid, aggressive, and sustained response. ...

  8. Are multilateral malaria research and control programs the most successful? Lessons from the past 100 years in Africa

    DEFF Research Database (Denmark)

    Alilio, Martin S; Bygbjerg, Ib C; Breman, Joel G

    2004-01-01

    to the founding of the Multilateral Initiative on Malaria, the Roll Back Malaria Project, Global Fund for HIV, Tuberculosis and Malaria (Global Fund), the Medicines for Malaria Venture, and the Malaria Vaccine Initiative, among other groups. Historically, the most striking feature of malaria control......Multilateral malaria research and control programs in Africa have regained prominence recently as bilateral assistance has diminished. The transnational nature of the threat and the need for inspired leadership, good coordination, and new discoveries to decrease the impact of the disease has led...... and elimination activities was the connectedness and balance between malaria research and control especially, from 1892 to 1949. A combination of scientific originality, perseverance in research, integrated approaches, and social concern were the keys for success. The elimination of Anopheles gambiae from Upper...

  9. Successful Control of Disseminated Intravascular Coagulation by Recombinant Thrombomodulin during Arsenic Trioxide Treatment in Relapsed Patient with Acute Promyelocytic Leukemia

    Directory of Open Access Journals (Sweden)

    Motohiro Shindo

    2012-01-01

    Full Text Available Disseminated intravascular coagulation (DIC frequently occurs in patients with acute promyelocytic leukemia (APL. With the induction of therapy in APL using all-trans retinoic acid (ATRA, DIC can be controlled in most cases as ATRA usually shows immediate improvement of the APL. However, arsenic trioxide (ATO which has been used for the treatment of relapse in APL patients has shown to take time to suppress APL cells, therefore the control of DIC in APL with ATO treatment is a major problem. Recently, the recombinant soluble thrombomodulin fragment has received a lot of attention as the novel drug for the treatment of DIC with high efficacy. Here, we present a relapsed patient with APL in whom DIC was successfully and safely controlled by rTM during treatment with ATO.

  10. The link between the West African Ebola outbreak and health systems in Guinea, Liberia and Sierra Leone: a systematic review.

    Science.gov (United States)

    Shoman, Haitham; Karafillakis, Emilie; Rawaf, Salman

    2017-01-04

    governance had least findings but an overarching consensus that they would have helped prompt response, adequate coordination and management of resources. Ensuring an adequate and efficient health workforce is of the utmost importance to ensure a strong health system and a quick response to new outbreaks. Adequate service delivery results from a collective success of the other blocks. Health financing and its management is crucial to ensure availability of medical products, fund payments to staff and purchase necessary equipment. However, leadership and governance needs to be rigorously explored on their main defects to control the outbreak.

  11. Impact analysis of critical success factors on the benefits from statistical process control implementation

    Directory of Open Access Journals (Sweden)

    Fabiano Rodrigues Soriano

    Full Text Available Abstract The Statistical Process Control - SPC is a set of statistical techniques focused on process control, monitoring and analyzing variation causes in the quality characteristics and/or in the parameters used to control and process improvements. Implementing SPC in organizations is a complex task. The reasons for its failure are related to organizational or social factors such as lack of top management commitment and little understanding about its potential benefits. Other aspects concern technical factors such as lack of training on and understanding about the statistical techniques. The main aim of the present article is to understand the interrelations between conditioning factors associated with top management commitment (Support, SPC Training and Application, as well as to understand the relationships between these factors and the benefits associated with the implementation of the program. The Partial Least Squares Structural Equation Modeling (PLS-SEM was used in the analysis since the main goal is to establish the causal relations. A cross-section survey was used as research method to collect information of samples from Brazilian auto-parts companies, which were selected according to guides from the auto-parts industry associations. A total of 170 companies were contacted by e-mail and by phone in order to be invited to participate in the survey. However, just 93 industries agreed on participating, and only 43 answered the questionnaire. The results showed that the senior management support considerably affects the way companies develop their training programs. In turn, these trainings affect the way companies apply the techniques. Thus, it will reflect on the benefits gotten from implementing the program. It was observed that the managerial and technical aspects are closely connected to each other and that they are represented by the ratio between top management and training support. The technical aspects observed through SPC

  12. Post biopsy Liver Hemorrhage Successfully Controlled by Ultrasound-guided Percutaneous Microwave Ablation

    Directory of Open Access Journals (Sweden)

    Ophelia Ka Heng Wai

    2016-01-01

    Full Text Available Percutaneous microwave coagulation therapy has been one of the major new developments in tumor ablation. Microwave ablation has also been used intraoperatively to achieve hemostasis at surgical margins in laparotomy. However, the use of microwave ablation for coagulation and hemostasis through percutaneous approach has not been described in the literature. Here, we report a case of hepatic amyloidosis with massive post biopsy liver hemorrhage, which could not be by transarterial embolization, and subsequently controlled by ultrasound-guided percutaneous microwave ablation. To the best of our knowledge, this is the first reported case of this technology application in human.

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

    Science.gov (United States)

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

    2013-03-01

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

  14. Recruiting and retaining low-income, multi-ethnic women into randomized controlled trials: successful strategies and staffing.

    Science.gov (United States)

    Barnett, Josephine; Aguilar, Stephanie; Brittner, Mindy; Bonuck, Karen

    2012-09-01

    Developing effective recruitment and retention strategies in populations with traditionally high attrition rates is critical to the success of Randomized Controlled Trials (RCTs). Data on successful participation of women from low-income, minority populations in RCTs of behavioral interventions are limited. This is problematic given the multiplicity of Healthy People 2020 goals that target health disparities in these populations. This paper reports successful recruitment and retention methods from two separately funded NIH clinical trials of primary care-based prenatal interventions to increase breastfeeding among ethnically diverse, low-income women in urban medical centers in the Bronx, NY. It also presents the required staff effort necessary to conduct such a successful RCT, in terms of full-time equivalents (FTEs). Results include timely recruitment of 941 participants over 29 months, with 98.1% completing >¯¯1 follow-up interview. A recruitment and retention plan that maximized study staff access and availability to the participant, as well as strong study staff rapport with participants, addressed previously reported barriers in this population, optimizing follow-up rates. A qualitative assessment of the participants' study experience suggesting that high retention was due to strong rapport with participants, short interviews requiring little time commitment, and participants' perception of the study as informative, provides further evidence of our approach's effectiveness. Logistical protocol procedures and staff management strategies relating to successful recruitment/retention are provided to propose a practical, cost-effective and translational recruitment-retention plan for other researchers to adopt. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea.

    Science.gov (United States)

    Remmers, John; Charkhandeh, Shouresh; Grosse, Joshua; Topor, Zbigniew; Brant, Rollin; Santosham, Peter; Bruehlmann, Sabina

    2013-10-01

    The present study addresses the need for a validated tool that prospectively identifies favorable candidates for oral appliance therapy in treatment of obstructive sleep apnea. The objective of the study was to evaluate the ability of a mandibular titration study, performed with a remotely controlled mandibular positioner (RCMP), to predict treatment outcome with a mandibular repositioning appliance (MRA) and to predict an effective target protrusive position (ETPP). A prospective, blinded, outcome study. Standard clinical care with tests performed in the polysomnographic laboratory. Consecutive patients (n = 67) recruited from a sleep center or a dental practice using broad inclusion criteria (age 21-80 years; AHI > 10/h; BMI < 40 kg/m(2)). Therapeutic outcome with a mandibular protruding oral appliance was predicted following a mandibular protrusive titration study in the polysomnographic laboratory using a remotely controlled positioner and prospectively established predictive rules. An ETPP was also prospectively determined for participants predicted to be therapeutically successful with MRA therapy. All participants were blindly treated with a MRA, at either the predicted ETPP or a sham position, and therapeutic outcome was compared against prediction. At the final protrusive position, standard predictive parameters (sensitivity, specificity, positive and negative predictive values) showed statistically significant predictive accuracy (P < 0.05) in the range of 83% to 94%. The predicted ETPP provided an efficacious protrusive position in 87% of participants predicted to be therapeutically successful with MRA therapy (P < 0.05). Using prospectively established rules for interpreting the polysomnographic data, the mandibular titration study predicted mandibular repositioning appliance therapeutic outcome with significant accuracy, particularly with regard to accurately predicting therapeutic success. As well, among the participants predicted to be

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

    Science.gov (United States)

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

    2015-08-05

    Despite the success of vaccination against myxoma virus, myxomatosis remains a problem on rabbit farms throughout Spain and Europe. In this study we set out to evaluate possible causes of myxoma virus (MYXV) vaccine failures addressing key issues with regard to pathogen, vaccine and vaccination strategies. This was done by genetically characterising MYXV field isolates from farm outbreaks, selecting a representative strain for which to assay its virulence and measuring the protective capability of a commercial vaccine against this strain. Finally, we compare methods (route) of vaccine administration under farm conditions and evaluate immune response in vaccinated rabbits. The data presented here show that the vaccine tested is capable of eliciting protection in rabbits that show high levels of seroconversion. However, the number of animals failing to seroconvert following subcutaneous vaccination may leave a large number of rabbits unprotected following vaccine administration. Successful vaccination requires the strict implication of workable, planned, on farm programs. Following this, analysis to confirm seroconversion rates may be advisable. Factors such as the wild rabbit reservoir, control of biting insects and good hygienic practices must be taken into consideration to prevent vaccine failures from occurring. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Conflict processing in juvenile patients with neurofibromatosis type 1 (NF1 and healthy controls – Two pathways to success

    Directory of Open Access Journals (Sweden)

    Annet Bluschke

    2017-01-01

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

  18. Successful prevention of respiratory syncytial virus nosocomial transmission following an enhanced seasonal infection control program.

    Science.gov (United States)

    Lavergne, V; Ghannoum, M; Weiss, K; Roy, J; Béliveau, C

    2011-01-01

    Respiratory syncytial virus (RSV) infections can be serious in severely immunocompromised patients. Use of a targeted infection control program (TICP) has been shown to reduce RSV nosocomial transmission. We evaluated the impact of an enhanced seasonal infection control program (ESICP) vs standard TICP in a hematology-oncology ward. TICP was applied from 1999 to 2001 and ESICP applied from 2001 to 2003. ESICP consisted of strict isolation for all patients admitted on the ward during the RSV season. We prospectively evaluated the incidence, related morbidity and mortality of nosocomial RSV in both field interventions. A total of 40 hospitalized RSV infections were documented. The cumulative incidence of nosocomial RSV during TICP and ESICP was respectively of 42.8 and 3.9 cases/1000 admissions (relative risk = 0.09). ESICP needed to be implemented on 26 admitted patients on our ward to prevent one RSV nosocomial case. Furthermore, implementation of ESICP prevented four pneumonias and two deaths per RSV season. We conclude that ESICP is significantly more efficient than TICP to reduce the occurrence of nosocomial RSV infections and its related morbidity and mortality in patients with hematological malignancy and recipients of hematopoietic SCT.

  19. “Save Antibiotics, Save lives”: an Indian success story of infection control through persuasive diplomacy

    Directory of Open Access Journals (Sweden)

    Ghafur A

    2012-08-01

    Full Text Available Abstract Background Carbapenem resistant Enterobacteriaceae is a worldwide threat, with increasing prevalence in many countries. Restricted usage of higher end antibiotics, especially carbapenem is of great importance in tackling these super bugs. Purpose of this retrospective study was to analyse the impact of antibiotic stewardship activities on the prevalence of carbapenem resistant Enterobacteriaceae in our hospital. Findings In the first Quarter of 2009, average usage of carbapenem group of antibiotics was 955 vials a month while in 2010, the usage dropped to 745 vials per month. Carbapenem resistant E.coli rate dropped from 3.7% in 2009 to 1.6% in 2010 and Klebsiella rate reduced from 6% in 2009 to 3.6% in 2010. Conclusions Strict antibiotic stewardship strategies in conjunction with good infection control practices are useful in restricting higher end antibiotic usage and reducing the prevalence of carbapenem resistant Enterobacteriaceae.

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

    Science.gov (United States)

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

    2015-07-15

    The purpose of this work was to study the challenges and prospects of regional-dependent absorption in a controlled-release scenario, through the oral biopharmaceutics of the sulfonylurea antidiabetic drug glipizide. The BCS solubility class of glipizide was determined, and its physicochemical properties and intestinal permeability were thoroughly investigated, both in-vitro (PAMPA and Caco-2) and in-vivo in rats. Metoprolol was used as the low/high permeability class boundary marker. Glipizide was found to be a low-solubility compound. All intestinal permeability experimental methods revealed similar trend; a mirror image small intestinal permeability with opposite regional/pH-dependency was obtained, a downward trend for glipizide, and an upward trend for metoprolol. Yet the lowest permeability of glipizide (terminal Ileum) was comparable to the lowest permeability of metoprolol (proximal jejunum). At the colon, similar permeability was evident for glipizide and metoprolol, that was higher than metoprolol's jejunal permeability. We present an analysis that identifies metoprolol's jejunal permeability as the low/high permeability class benchmark anywhere throughout the intestinal tract; we show that the permeability of both glipizide and metoprolol matches/exceeds this threshold throughout the entire intestinal tract, accounting for their success as controlled-release dosage form. This represents a key biopharmaceutical characteristic for a successful controlled-release dosage form. Copyright © 2015 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2012-01-01

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

  2. Seafood-associated disease outbreaks in New York, 1980-1994.

    Science.gov (United States)

    Wallace, B J; Guzewich, J J; Cambridge, M; Altekruse, S; Morse, D L

    1999-07-01

    Seafood-associated disease outbreaks in New York were examined to describe their epidemiology and to identify areas for prevention and control efforts. We reviewed reports submitted to the New York State Department of Health (NYSDOH) of seafood-associated outbreaks occurring from January 1, 1980, through December 31, 1994. During 1980-1994, 339 seafood-associated outbreaks were reported, resulting in 3959 illnesses, 76 hospitalizations, and 4 deaths. During this period, seafood-associated outbreaks accounted for 19% of all reported foodborne outbreaks and 10% of foodborne illnesses. Shellfish, the most frequently implicated seafood item, accounted for 64% of seafood outbreaks, followed by finfish (31% of outbreaks). Of the 148 seafood-associated outbreaks with a confirmed etiologic agent, Norwalk virus and scombrotoxin were the most frequently identified agents: Norwalk virus accounted for 42% of outbreaks and 42% of illnesses, and scombrotoxin accounted for 44% of outbreaks and 19% of illnesses. Three of the 4 seafood-associated deaths were caused by Clostridium botulinum; the remaining death was caused by Vibrio vulnificus. Reducing the number of seafood outbreaks will require continued and coordinated efforts by many different agencies, including those involved with water quality; disease surveillance; consumer education; and seafood harvesting, processing, and marketing. New York's foodborne disease surveillance data highlight potential areas on which to focus prevention efforts, including: (1) commodities and associated pathogens causing the largest number of seafood-associated outbreaks and illnesses, namely shellfish-associated viral gastroenteritis and finfish-associated scombroid fish poisoning, and (2) venues at which seafood were most frequently consumed in reported outbreaks, such as commercial food establishments and catered events.

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

    Science.gov (United States)

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

    2016-11-01

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

  4. Genetic diversity among food-borne and waterborne norovirus strains causing outbreaks in Sweden.

    Science.gov (United States)

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

    2009-08-01

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

  5. Integration of advances in social media and mHealth technology are pivotal to successful cancer prevention and control.

    Science.gov (United States)

    O'Leary, D Peter; Zaheer, Amir; Redmond, H Paul; Corrigan, Mark A

    2016-01-01

    The successful prevention and treatment of cancer is dependent upon efficient and reliable communication between healthcare workers and patients. Advances in social media and mHealth platforms have provided new ways in which to enhance the sharing of cancer related information. Other benefits of embracing this technology include utilising its analytic capabilities which can process the vast quantity of information generated from genome exploration in a highly efficient manner. The aim of this review is to provide an overview of the rapidly evolving areas through which digital engagement is proving useful in the prevention and control of cancer.

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

    Science.gov (United States)

    Gneiting, Uwe

    2016-04-01

    Global policy attention to tobacco control has increased significantly since the 1990 s and culminated in the first international treaty negotiated under the auspices of the World Health Organization--the Framework Convention on Tobacco Control (FCTC). Although the political process that led to the creation of the FCTC has been extensively researched, the FCTC's progression from an aspirational treaty towards a global health governance framework with tangible policy effects within FCTC member countries has not been well-understood to date. This article analyses the role of the global health network of tobacco control advocates and scientists, which formed during the FCTC negotiations during the late 1990 s, in translating countries' commitment to the FCTC into domestic policy change. By comparing the network's influence around two central tobacco control interventions (smoke-free environments and taxation), the study identifies several scope conditions, which have shaped the network's effectiveness around the FCTC's implementation: the complexity of the policy issue and the relative importance of non-health expertise, the required scope of domestic political buy-in, the role of the general public as network allies, and the strength of policy opposition. These political factors had a greater influence on the network's success than the evidence base for the effectiveness of tobacco control interventions. The network's variable success points to a trade-off faced by global health networks between their need to maintain internal cohesion and their ability to form alliances with actors in their social environment. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

  7. Biogeochemical interactions control a temporal succession in the elemental composition of marine communities

    KAUST Repository

    Martiny, Adam C.

    2015-11-23

    Recent studies have revealed clear regional differences in the particulate organic matter composition and stoichiometry of plankton communities. In contrast, less is known about potential mechanisms and patterns of temporal changes in the elemental composition of marine systems. Here, we monitored weekly changes in environmental conditions, phytoplankton abundances, and particulate organic carbon, nitrogen, and phosphorus concentrations over a 3-yr period. We found that variation in the particulate organic matter (POM) concentrations and ratios were related to seasonal oscillations of environmental conditions and phytoplankton abundances. Periods with low temperature, high nutrient concentrations and a dominance of large phytoplankton corresponded to low C : N : P and vice-versa for warmer periods during the summer and fall. In addition to seasonal changes, we observed a multiyear increase in POM C : P and N : P that might be associated with the Pacific Decadal Oscillation. Finally, there was substantial short-term variability in all factors but similar linkages between environmental variability and elemental composition as observed on seasonal and interannual time-scales. Using a feed-forward neural network, we could explain a large part of the variation in POM concentrations and ratios based on changes in environmental conditions and phytoplankton abundances. The apparent links across all time-scales between changes in physics, chemistry, phytoplankton, and POM concentrations and ratios suggest we have identified key controls of the elemental composition of marine communities in this region.

  8. Molecular Characterization of Salmonella Typhimurium Highly Successful Outbreak Strains

    DEFF Research Database (Denmark)

    Petersen, Randi Føns; Litrup, Eva; Larsson, Jonas T.

    2011-01-01

    Three large clusters of Salmonella Typhimurium infections in Denmark in 2008 and 2009 were defined by multilocus variable number of tandem repeat analysis (MLVA). One of these proved to be the hereto largest Danish cluster of salmonellosis with 1446 cases. Two smaller clusters with a total of 197...

  9. Consecutive Outbreaks of Enterotoxigenic Escherichia coli O6 in Schools in South Korea Caused by Contamination of Fermented Vegetable Kimchi.

    Science.gov (United States)

    Shin, Jaeseung; Yoon, Ki-Bok; Jeon, Doo-Young; Oh, Sung-Suk; Oh, Kyung-Hwan; Chung, Gyung Tae; Kim, Seung Woo; Cho, Seung-Hak

    2016-10-01

    Two outbreaks of gastroenteritis occurred in South Korea, affecting a middle school in the Jeollanam-do province in 2013 (Outbreak 1) and 10 schools in the Incheon province in 2014 (Outbreak 2). We investigated the outbreaks to identify the pathogen and mode of transmission. A retrospective cohort study was conducted in the Outbreak 1; and case-control studies were performed for the Outbreak 2. Samples from students, environments, and preserved food items were collected and pulsed-field gel electrophoresis (PFGE) was conducted to identify strains of pathogen. We identified 167 and 1022 students who met the case definition (≥3 loose stools in any 24-h period) in the Outbreaks 1 and 2, respectively. The consumption of cabbage kimchi and young radish kimchi were significantly associated with the illness. Adjusted odds ratios of kimchi were 2.62-11.74. In the Outbreak 1, cabbage kimchi was made and consumed in the school restaurant and in the Outbreak 2, young radish kimchi was supplied by food company X and distributed to all the 10 schools in the Incheon province. Enterotoxigenic Escherichia coli (ETEC) O6 was isolated from fecal samples in 375 cases (33.9%) and from kimchi samples. PFGE patterns of the outbreak strains isolated from cases and food were indistinguishable in each outbreak. The suspected food vehicle in these two consecutive outbreaks was kimchi contaminated with ETEC O6. We recommend continued monitoring and stricter sanitation requirements for the food supply process in Korea, especially in relation to kimchi.

  10. Surveillance and endemic vancomycin-resistant enterococci: some success in control is possible.

    LENUS (Irish Health Repository)

    Morris-Downes, M

    2010-07-01

    Vancomycin-resistant enterococci (VRE) are prevalent in many Irish hospitals. We analysed surveillance data from 2001 to 2008 in a centre where VRE is endemic. All clinically significant enterococci were tested for susceptibility to vancomycin. All intensive care unit admissions were screened on admission and weekly thereafter. Interventions included isolating\\/cohorting VRE patients, monthly prevalence surveys of VRE patients, the introduction of an electronic alert system, programmes to improve hand and environmental hygiene, and the appointment of an antibiotic pharmacist. There was a significant increase in the number of positive VRE screening samples from 2001 (1.96 patients with positive VRE screens per 10 000 bed-days) to 2006 (4.98 per 10 000 bed-days) (P < or = 0.001) with a decrease in 2007 (3.18 per 10 000 bed-days) (P < or = 0.01). The number of VRE bloodstream infections (BSI) increased from 0.09 BSI per 10 000 bed-days in 2001 to 0.78 per 10 000 bed-days in 2005 (P < or = 0.001) but decreased subsequently. Linear regression analysis indicated a significant association between new cases of VRE and non-isolated VRE patients, especially between May 2005 and December 2006 [P=0.009; 95% confidence interval (CI): 0.08-0.46] and between May 2005 and December 2008 (P = 0.008; 95% CI: 0.06-0.46). Routine surveillance for VRE together with other measures can control VRE BSI and colonisation, even where VRE is endemic, and where facilities are constrained.

  11. Damage control : minimizing damage using newer technologies contributes to northeast BC gas play success

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, L.

    2007-03-15

    A recent study of drilling practices in British Columbia's Jean Marie gas formation has indicated that horizontal wells are typically 2 to 4 times more productive than vertical wells. The study also suggested that the reservoir is characterized by higher-permeability gas flow paths through vuggy porosity and fractures in addition to low-permeability gas storage in leached limestone and dolomites. Underbalanced drilling has proven to be effective in the region because it has helped to overcome problems attributed to the formation's compartmentalization, dual-permeability system, underpressured gas, and low water saturation. Coiled tubing drilling has also proved to be economical in several applications, and has allowed slimmer wells to be drilled in areas where smaller rig footprints are required. Coiled tubing methods also allow operators to gain better control of bottomhole pressure as well as to ensure that the reservoir rock is protected from water. The use of coiled tubing has also allowed operators in the formation to work more quickly and in a safer working environment. A total of 148 billion cubic feet of gas was produced using horizontal drilling methods in the Jean Marie formation during the first 11 months of 2006. Vertical drilling accounted for 12.3 bcf of gas output in the first 11 months of 2006. EnCana and Canadian Natural Resources Limited are currently the top operators in the region. Both companies prefer the use of horizontal underbalanced drilling methods using jointed drill pipes. It was concluded that underbalanced drilling techniques have increased activity in the Greater Sierra region for the past several years. 4 figs.

  12. Successful Treatment of Acute Radiation Proctitis with Aloe Vera: A Preliminary Randomized Controlled Clinical Trial.

    Science.gov (United States)

    Sahebnasagh, Adeleh; Ghasemi, Arash; Akbari, Jafar; Alipour, Abbas; Lashkardoost, Hossein; Ala, Shahram; Salehifar, Ebrahim

    2017-11-01

    Acute radiation proctitis (ARP) is a common side-effect that affects up to 50% of patients receiving radiotherapy. The aim of this study was to evaluate the role of a topical preparation of Aloe vera in the treatment of ARP induced by radiotherapy of pelvic area. In this double-blind placebo-controlled trial, 20 consecutive patients with ARP after external-beam radiation therapy (46-72 Gy) of pelvic malignancies were randomized to receive either Aloe vera 3% or placebo ointment, 1 g twice daily for 4 weeks. These patients presented with at least two of the following symptoms: rectal bleeding, abdominal/rectal pain, diarrhea, or fecal urgency. These symptoms were rated by the patients in terms of their severity (grade 0-4) for each of the symptoms mentioned earlier at baseline and then weekly for 4 weeks. A symptom index was calculated by the addition of the scores (16 most symptomatic). Radiation Therapy Oncology Group (RTOG) acute toxicity criteria and psychosocial status of the patients were also recorded weekly. The lifestyle impact of the symptoms was assessed by questionnaire grading from 0 (no effect on daily activity) to 4 (afraid to leave home). There was a significant (p Aloe vera) for diarrhea (median score: 0.67 vs. 0.11), fecal urgency (median score: 0.89 vs. 0.11), clinical presentation total (median score: 4.33 vs. 1.22), RTOG total (median score: 2.89 vs. 0.89), and lifestyle (median score: 1.1 vs. 0.33). Hemorrhage and abdominal/rectal pain did not improve significantly. The odds ratios for advantage of Aloe vera over placebo for "clinical presentation total" and "RTOG total" were 3.97 (1.3-11.9) and 5.9 (1.6-21.6), respectively. A substantial number of patients with radiation proctitis seem to benefit from therapy with Aloe vera 3% ointment.

  13. A Campylobacter coli foodborne outbreak in Belgium.

    Science.gov (United States)

    Ronveaux, O; Quoilin, S; Van Loock, F; Lheureux, P; Struelens, M; Butzler, J P

    2000-01-01

    In May 1995, the Scientific Institute of Public Health was informed of an outbreak of gastrointestinal illness in a congregational school in the Brussels area. The field investigation identified 24 cases with mild to severe gastrointestinal and general symptoms of acute bacterial enterocolitis. Campylobacter coli was detected in the stools of 5 patients. A retrospective cohort study suggested that a mixed salad (containing ham and feta cheese) was the probable source of infection, but the route of contamination remained unknown. The rapid investigation of such episodes of collective foodborne infections is essential for the implementation of adequate control measures.

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

    Science.gov (United States)

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

    2017-07-10

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

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

    Directory of Open Access Journals (Sweden)

    Akaninyene Otu

    2017-07-01

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

  16. Measles outbreak in young adults in Victoria, 1999.

    Science.gov (United States)

    Lambert, S B; Morgan, M L; Riddell, M A; Andrews, R M; Kelly, H A; Leydon, J A; Catton, M C; Lynch, P A; Gercovich, D K; Lester, R A; Carnie, J A; Rouch, G J

    2000-11-06

    To describe an outbreak of measles in Victoria. Case series with cases identified through enhanced passive surveillance and outbreak-related active surveillance. State of Victoria, 1999. Number of cases; epidemiological links and patterns of transmission; patient demographic features and vaccination status; complications. 75 cases were identified (74 laboratory-confirmed; and one epidemiologically linked to a laboratory-confirmed case), with onset between 11 February and 2 May 1999. The first case was in a 21-year-old woman who had recently holidayed in Bali and worked at a large cinema complex in Melbourne. Sixteen cases occurred in people who had contact with the index case at the cinema on one evening. The outbreak spread to regional Victoria and South Australia. Median age of patients was 22 years; 64 (85%) were born between 1968 and 1981, with only one patient in the age group targeted by the primary school component of the 1998 Australian Measles Control Campaign; this child had not been vaccinated. More than a third of patients (28) were hospitalised (total, 97 inpatient days), and five were healthcare workers. This outbreak was caused by international importation of measles virus. It highlights the change in epidemiology of measles in Australia, from a disease of childhood to one predominantly affecting young adults. A strong two-dose childhood vaccination program, vigilant surveillance, and rapid response to outbreaks will continue to be the basis of measles control, but better protection for young adults should be considered.

  17. Role of plant-fungal nutrient trading and host control in determining the competitive success of ectomycorrhizal fungi.

    Science.gov (United States)

    Hortal, Sara; Plett, Krista Lynn; Plett, Jonathan Michael; Cresswell, Tom; Johansen, Mathew; Pendall, Elise; Anderson, Ian Charles

    2017-07-21

    Multiple ectomycorrhizal fungi (EMF) compete to colonise the roots of a host plant, but it is not known whether their success is under plant or fungal control, or a combination of both. We assessed whether plants control EMF colonisation by preferentially allocating more carbon to more beneficial partners in terms of nitrogen supply or if other factors drive competitive success. We combined stable isotope labelling and RNA-sequencing approaches to characterise nutrient exchange between the plant host Eucalyptus grandis and three Pisolithus isolates when growing alone and when competing either indirectly (with a physical barrier) or directly. Overall, we found that nitrogen provision to the plant does not explain the amount of carbon that an isolate receives nor the number of roots that it colonises. Differences in nutrient exchange among isolates were related to differences in expression of key fungal and plant nitrogen and carbon transporter genes. When given a choice of partners, the plant was able to limit colonisation by the least cooperative isolate. This was not explained by a reduction in allocated carbon. Instead, our results suggest that partner choice in EMF could operate through the upregulation of defence-related genes against those fungi providing fewer nutrients.The ISME Journal advance online publication, 21 July 2017; doi:10.1038/ismej.2017.116.

  18. Leadership, management and technical lessons learnt from a successful public-private partnership for TB control in Nepal.

    Science.gov (United States)

    Newell, J N; Pande, S B; Baral, S C; Bam, D S; Malla, P

    2005-09-01

    There is considerable interest in involving private practitioners (PPs) in tuberculosis (TB) control, but little experience. To describe and discuss leadership, management and technical lessons learnt from the successful implementation of a public-private partnership (PPP) for TB control in Nepal. Description and discussion of implementation of the PPP is based on feedback from the working group charged with developing the PPP, PPs involved in diagnosis and referral, NGOs providing direct observation of treatment and tracing of late patients, and members of the Nepal National TB Programme. The process of building the partnership was slow and demoralising, yet with perseverance partners gradually increased their involvement and commitment to the PPP. Leadership was needed to foster communication and openness between partners. It was not necessary to involve all PPs: many patients bypassed PPs and went directly to the free DOTS centres. An understanding of issues that arose during development of the Lalitpur PPP may assist assessment of the feasibility of PPPs in other settings, and increase the likelihood of successful implementation. The wider literature on partnerships may be useful to further inform the development of PPPs for health in developing countries.

  19. Gastro-enteritis outbreak among Nordic patients with psoriasis in a health centre in Gran Canaria, Spain: a cohort study

    Directory of Open Access Journals (Sweden)

    Rose Angela MC

    2004-10-01

    Full Text Available Abstract Background Between November 2 and 10, 2002 several patients with psoriasis and personnel staying in the health centre in Gran Canaria, Spain fell ill with diarrhoea, vomiting or both. Patient original came from Norway, Sweden and Finland. The patient group was scheduled to stay until 8 November. A new group of patients were due to arrive from 7 November. Methods A retrospective cohort study was conducted to assess the extent of the outbreak, to identify the source and mode of transmission and to prevent similar problems in the following group. Results Altogether 41% (48/116 of persons staying at the centre fell ill. Norovirus infection was suspected based on clinical presentations and the fact that no bacteria were identified. Kaplan criteria were met. Five persons in this outbreak were hospitalised and the mean duration of diarrhoea was 3 days. The consequences of the illness were more severe compared to many other norovirus outbreaks, possibly because many of the cases suffered from chronic diseases and were treated with drugs reported to affect the immunity (methotrexate or steroids. During the two first days of the outbreak, the attack rate was higher in residents who had consumed dried fruit (adjusted RR = 3.1; 95% CI: 1.4–7.1 and strawberry jam (adjusted RR = 1.9; 95% CI: 0.9–4.1 than those who did not. In the following days, no association was found. The investigation suggests two modes of transmission: a common source for those who fell ill during the two first days of the outbreak and thereafter mainly person to person transmission. This is supported by a lower risk associated with the two food items at the end of the outbreak. Conclusions We believe that the food items were contaminated by foodhandlers who reported sick before the outbreak started. Control measures were successfully implemented; food buffets were banned, strict hygiene measures were implemented and sick personnel stayed at home >48 hours after last

  20. Are bark beetle outbreaks less synchronous than forest Lepidoptera outbreaks?

    Science.gov (United States)

    Bjorn Okland; Andrew M. Liebhold; Ottar N. Bjornstad; Nadir Erbilgin; Paal Krokene; Paal Krokene

    2005-01-01

    Comparisons of intraspecific spatial synchrony across multiple epidemic insect species can be useful for generating hypotheses about major determinants of population patterns at larger scales. The present study compares patterns of spatial synchrony in outbreaks of six epidemic bark beetle species in North America and Europe. Spatial synchrony among populations of the...

  1. Mass Gatherings and Respiratory Disease Outbreaks in the United States - Should We Be Worried? Results from a Systematic Literature Review and Analysis of the National Outbreak Reporting System.

    Directory of Open Access Journals (Sweden)

    Jeanette J Rainey

    Full Text Available Because mass gatherings create environments conducive for infectious disease transmission, public health officials may recommend postponing or canceling large gatherings during a moderate or severe pandemic. Despite these recommendations, limited empirical information exists on the frequency and characteristics of mass gathering-related respiratory disease outbreaks occurring in the United States.We conducted a systematic literature review to identify articles about mass gathering-related respiratory disease outbreaks occurring in the United States from 2005 to 2014. A standard form was used to abstract information from relevant articles identified from six medical, behavioral and social science literature databases. We also analyzed data from the National Outbreaks Reporting System (NORS, maintained by the Centers for Disease Control and Prevention since 2009, to estimate the frequency of mass gathering-related respiratory disease outbreaks reported to the system.We identified 21 published articles describing 72 mass gathering-related respiratory disease outbreaks. Of these 72, 40 (56% were associated with agriculture fairs and Influenza A H3N2v following probable swine exposure, and 25 (35% with youth summer camps and pandemic Influenza A H1N1. Outbreaks of measles (n = 1 and mumps (n = 2 were linked to the international importation of disease. Between 2009 and 2013, 1,114 outbreaks were reported to NORS, including 96 respiratory disease outbreaks due to Legionella. None of these legionellosis outbreaks was linked to a mass gathering according to available data.Mass gathering-related respiratory disease outbreaks may be uncommon in the United States, but have been reported from fairs (zoonotic transmission as well as at camps where participants have close social contact in communal housing. International importation can also be a contributing factor. NORS collects information on certain respiratory diseases and could serve as a platform to

  2. Mass Gatherings and Respiratory Disease Outbreaks in the United States - Should We Be Worried? Results from a Systematic Literature Review and Analysis of the National Outbreak Reporting System.

    Science.gov (United States)

    Rainey, Jeanette J; Phelps, Tiffani; Shi, Jianrong

    2016-01-01

    Because mass gatherings create environments conducive for infectious disease transmission, public health officials may recommend postponing or canceling large gatherings during a moderate or severe pandemic. Despite these recommendations, limited empirical information exists on the frequency and characteristics of mass gathering-related respiratory disease outbreaks occurring in the United States. We conducted a systematic literature review to identify articles about mass gathering-related respiratory disease outbreaks occurring in the United States from 2005 to 2014. A standard form was used to abstract information from relevant articles identified from six medical, behavioral and social science literature databases. We also analyzed data from the National Outbreaks Reporting System (NORS), maintained by the Centers for Disease Control and Prevention since 2009, to estimate the frequency of mass gathering-related respiratory disease outbreaks reported to the system. We identified 21 published articles describing 72 mass gathering-related respiratory disease outbreaks. Of these 72, 40 (56%) were associated with agriculture fairs and Influenza A H3N2v following probable swine exposure, and 25 (35%) with youth summer camps and pandemic Influenza A H1N1. Outbreaks of measles (n = 1) and mumps (n = 2) were linked to the international importation of disease. Between 2009 and 2013, 1,114 outbreaks were reported to NORS, including 96 respiratory disease outbreaks due to Legionella. None of these legionellosis outbreaks was linked to a mass gathering according to available data. Mass gathering-related respiratory disease outbreaks may be uncommon in the United States, but have been reported from fairs (zoonotic transmission) as well as at camps where participants have close social contact in communal housing. International importation can also be a contributing factor. NORS collects information on certain respiratory diseases and could serve as a platform to monitor mass

  3. Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic.

    Science.gov (United States)

    Muller, Matthew P; Siddiqui, Naureen; Ivancic, Rose; Wong, David

    2018-01-02

    Adenovirus-associated epidemic keratoconjunctivitis (A-EKC) is a cause of large and prolonged outbreaks in ophthalmology clinics and can result in substantial morbidity. A-EKC outbreaks are often the result of contaminated ophthalmologic equipment, surfaces, or hands. Contaminated multidose eye drops are also a likely culprit, but few prior studies provide clear epidemiologic evidence that adenovirus transmission resulted from contamination of eye drops. We describe an A-EKC outbreak at a large, hospital-affiliated eye clinic that affected 44 patients. The unique epidemiology of the outbreak provides strong evidence that contaminated multidose dilating eye drops resulted in adenovirus transmission. Removal of multidose eye medication from the clinic, combined with case finding, enhanced infection control and enhanced environmental cleaning, led to rapid control of the outbreak. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. CDC Vital Signs: Preventing Norovirus Outbreaks

    Science.gov (United States)

    ... Press Kit Read the MMWR Science Clips Preventing Norovirus Outbreaks Food service has a key role. Language: ... and on-call staffing, to support compliance. Problem Norovirus outbreaks from contaminated food are common in food ...

  6. Reporting and Surveillance for Norovirus Outbreaks

    Science.gov (United States)

    ... Health NoroCORE Food Virology Reporting and Surveillance for Norovirus Recommend on Facebook Tweet Share Compartir On this ... identify newly emerging norovirus strains. Definition of a Norovirus Outbreak An outbreak of norovirus is defined as ...

  7. Norovirus: U.S. Trends and Outbreaks

    Science.gov (United States)

    ... a new strain of the virus going around. Norovirus-associated Deaths See also: Norovirus-associated Hospitalizations Norovirus- ... to the Foodborne Outbreak Online Database (FOOD) . Common Norovirus Outbreak Settings Norovirus in Healthcare Facilities Health care ...

  8. Outbreak of caliciviruses in the Singapore military, 2015

    Directory of Open Access Journals (Sweden)

    Freddy Jun Xian Neo

    2017-11-01

    Full Text Available Abstract Background From 31 August to 9 September 2015, a total of 150 military personnel at a military institution in Singapore were infected with acute gastroenteritis (AGE with an attack rate of approximately 3%. This study aimed to determine the epidemiology of the outbreak, investigate its origins, and discuss measures to prevent future occurrences. Methods After the AGE outbreak was declared on 31 August 2015, symptom surveys, hygiene inspections, and the testing of water, food, and stool samples were initiated. We collected 86 stool samples from AGE cases and 58 samples from food-handlers during the course of the outbreak and these stool samples were tested for 8 bacterial pathogens and 2 viral pathogens (i.e., norovirus and sapovirus. Results We detected Sapovirus (SaV, group I Norovirus (NoV GI and group II Norovirus (NoV GII from the stool samples of AGE cases. Further sequence analyses showed that the AGE outbreak in August was caused mainly by three rarely reported calicivirus novel genotypes: NoV GI.7, NoV GII.17 and SaV GII.3. Control measures implemented focused on the escalation of personal and environmental hygiene, which included the separation of affected and unaffected soldiers, enforcement of rigorous hand-washing and hygiene, raising awareness of food and water safety, and disinfection of communal areas with bleach. Conclusions This study identified both NoV and SaV as the causative agents for an AGE outbreak at a Singapore military camp in August 2015. This study is also the first to report SaV as one of the main causative agents, highlighting the importance of caliciviruses as causative agents of AGE outbreaks in the Singapore military. As there are no commercially available vaccines against caliciviruses, strict personal hygiene and proper disinfection of environmental surfaces remain crucial to prevent calicivirus outbreak and transmission.

  9. Outbreaks and Investigations

    Science.gov (United States)

    ... patients at a medical center in Jamaica. Infect Control Hosp Epidemiol 2013; 34:638-641. Mucormycosis associated with hospital linens Number of cases : 5 Pathogen : Rhizopus delemar Type of infection : Cutaneous Setting : Pediatric hospital ...

  10. Chikungunya fever outbreak, Bhutan, 2012.

    Science.gov (United States)

    Wangchuk, Sonam; Chinnawirotpisan, Piyawan; Dorji, Tshering; Tobgay, Tashi; Dorji, Tandin; Yoon, In-Kyu; Fernandez, Stefan

    2013-10-01

    In 2012, chikungunya virus (CHIKV) was reported for the first time in Bhutan. IgM ELISA results were positive for 36/210 patient samples; PCR was positive for 32/81. Phylogenetic analyses confirmed that Bhutan CHIKV belongs to the East/Central/South African genotype. Appropriate responses to future outbreaks require a system of surveillance and improved laboratory capacity.

  11. Measles (Rubeola) Cases and Outbreaks

    Science.gov (United States)

    ... the Field: Measles Outbreak at a United States Immigration and Customs Enforcement Facility — Arizona, May–June 2016 MMWR. May 26, ... May 25, 2016, a detainee at a U.S. Immigration and Customs Enforcement (ICE) detention center in Arizona who had been ...

  12. Emergency vaccination use in a modelled foot and mouth disease outbreak in Minnesota.

    Science.gov (United States)

    Miller, G; Gale, S B; Eshelman, C E; Wells, S J

    2015-12-01

    Epidemiological modelling is an important approach used by the Veterinary Services of the United States Department of Agriculture Animal and Plant Health Inspection Service to evaluate the potential effectiveness of different strategies for handling foot and mouth disease (FMD). Identifying the potential spread of FMD by modelling an outbreak, and then considering the impacts of FMD vaccination, is important in helping to inform decision-makers about the potential outcomes of vaccination programmes. The objective of this study was to evaluate emergency vaccination control strategies used in a simulated FMD outbreak in Minnesota. The North American Animal Disease Spread Model (NAADSM, Version 3.2.18) was used to simulate the outbreak. Large-scale (1,500 herds per day) emergency vaccination reduced the size of the modelled outbreak in both swine and dairy production types, but the effect was larger when the outbreak began in a dairy herd. Large-scale vaccination also overcame limitations caused by delays in vaccine delivery. Thus, even if vaccination did not begin until 21 days into the outbreak, large-scale vaccination still reduced the size and duration of the outbreak. The quantity of vaccine used was markedly larger when large-scale vaccination was used, compared with small-scale (50 herds per day) vaccine administration. In addition, the number of animals and herds vaccinated in an outbreak originating in a herd of swine was substantially lower than in an outbreak beginning in a herd of dairy cattle.

  13. [Protracted nosocomial outbreak of Salmonella Enteritidis LT 8/7].

    Science.gov (United States)

    Jansen, A; Hiller, P; Desai, S; Feier, B; Habermann, F; Baumann, A; Dreesman, J; Beyrer, K; Pulz, M; von Benten, K; Malorny, B; Rabsch, W; Stark, K

    2008-11-01

    In spring 2007a cluster of nosocomial salmonellosis cases, culture confirmed for SALMONELLA Enteritidis lysotype (LT) 8/7, occurred in a Wolfsburg hospital. An outbreak investigation was initiated to determine the epidemiology of the outbreak and to identify and control the possible sources. A multidisciplinary outbreak team was formed including members from hospital hygiene and local, state and national health and veterinarian authorities. Active surveillance was set up in the hospital to find new cases. A retrospective case control study was conducted to identify possible risk factors for disease. Hospital workers and food samples were tested for the pathogen and positive isolates were typed. Between calendar weeks 4 and 24 of the year 2007, a total of 28 patients with a median age 66 years had nosocomial salmonellosis culture confirmed for SALMONELLA Enteritidis LT 8/7. In food samples from February, the same Salmonella lysotype was isolated in 4 different food samples. SALMONELLA Enteritidis LT 8/7 was also identified in stool samples from 5 kitchen personnel. The case control study indicated antacida therapy (odds ratio: 5.5, 95 % CI 1.2 - 26.0) as a risk factor for nosocomial salmonellosis among patients. No particular diet was associated with an increased risk of disease. This nosocomial salmonellosis outbreak was characterised by prolonged duration and a low infection rate among patients. The epidemiological investigation suggests that the origin of the outbreak was food that was probably associated with a contamination in the hospital kitchen. Furthermore, kitchen staff could, as carriers, have contributed to a low-level contamination of various foods for a long period. The intermittent occurrence of the cases is best explained by a low level of contaminated food which primarily led to clinical symptoms among especially vulnerable persons (older patients with antacida therapy). Considering the unusual progression of this outbreak, hospitals should initiate

  14. Infection control assessment after an influenza outbreak in a residential care facility for children and young adults with neurologic and neurodevelopmental conditions.

    Science.gov (United States)

    Azofeifa, Alejandro; Yeung, Lorraine F; Peacock, Georgina; Moore, Cynthia A; Rodgers, Loren; DiOrio, Mary; Page, Shannon L; Fowler, Brian; Stone, Nimalie D; Finelli, Lyn; Jhung, Michael A

    2013-07-01

    To assess the knowledge, attitudes, and practices of infection control among staff in a residential care facility for children and young adults with neurologic and neurodevelopmental conditions. Self-administered survey. Residential care facility (facility A). Facility A staff ([Formula: see text]). We distributed a survey to staff at facility A. We classified staff with direct care responsibilities as clinical (ie, physicians, nurses, and therapists) or nonclinical (ie, habilitation assistants, volunteers, and teachers) and used χ(2) tests to measure differences between staff agreement to questions. Of 248 surveys distributed, 200 (81%) were completed; median respondent age was 36 years; 85% were female; and 151 were direct care staff (50 clinical, 101 nonclinical). Among direct care staff respondents, 86% agreed they could identify residents with respiratory symptoms, 70% stayed home from work when ill with respiratory infection, 64% agreed that facility administration encouraged them to stay home when ill with respiratory infection, and 72% reported that ill residents with respiratory infections were separated from well residents. Clinical and nonclinical staff differed in agreement about using waterless hand gel as a substitute for handwashing (96% vs 78%; [Formula: see text]) and whether handwashing was done after touching residents (92% vs 75%; [Formula: see text]). Respondents' knowledge, attitudes, and practices regarding infection control could be improved, especially among nonclinical staff. Facilities caring for children and young adults with neurologic and neurodevelopmental conditions should encourage adherence to infection control best practices among all staff having direct contact with residents.

  15. Analysis of Factors Affecting Successful Clinical Trial Enrollment in the Context of Three Prospective, Randomized, Controlled Trials

    Energy Technology Data Exchange (ETDEWEB)

    Logan, Jennifer K.; Tang, Chad; Liao, Zhongxing [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Lee, J. Jack [Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Heymach, John V. [Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Swisher, Stephen G. [Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Welsh, James W. [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Zhang, Jianjun [Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H. [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)

    2017-03-15

    Purpose: Challenges can arise when attempting to maximize patient enrollment in clinical trials. There have been limited studies focusing on the barriers to enrollment and the efficacy of alternative study design to improve accrual. We analyzed barriers to clinical trial enrollment, particularly the influence of timing, in context of three prospective, randomized oncology trials where one arm was considered more aggressive than the other. Methods and Materials: From June 2011 to March 2015, patients who were enrolled on 3 prospective institutional protocols (an oligometastatic non-small cell lung cancer [NSCLC] trial and 2 proton vs intensity modulated radiation therapy trials in NSCLC and esophageal cancer) were screened for protocol eligibility. Eligible candidates were approached about trial participation, and patient characteristics (age, sex, T/N categorization) were recorded along with details surrounding trial presentation (appointment number). Fisher's exact test, Student's t tests, and multivariate analysis were performed to assess differences between enrolled and refusal patients. Results: A total of 309 eligible patients were approached about trial enrollment. The enrollment success rate during this time span was 52% (n=160 patients). Enrolled patients were more likely to be presented trial information at an earlier appointment (oligometastatic protocol: 5 vs 3 appointments [P<.001]; NSCLC protocol: 4 vs 3 appointments [P=.0018]; esophageal protocol: 3 vs 2 appointments [P=.0086]). No other factors or patient characteristics significantly affected enrollment success rate. Conclusion: Improvement in enrollment rates for randomized control trials is possible, even in difficult accrual settings. Earlier presentation of trial information to patients is the most influential factor for success and may help overcome accrual barriers without compromising trial design.

  16. What can we learn about the Ebola outbreak from tweets?

    Science.gov (United States)

    Odlum, Michelle; Yoon, Sunmoo

    2015-06-01

    Twitter can address the challenges of the current Ebola outbreak surveillance. The aims of this study are to demonstrate the use of Twitter as a real-time method of Ebola outbreak surveillance to monitor information spread, capture early epidemic detection, and examine content of public knowledge and attitudes. We collected tweets mentioning Ebola in English during the early stage of the current Ebola outbreak from July 24-August 1, 2014. Our analysis for this observational study includes time series analysis with geologic visualization to observe information dissemination and content analysis using natural language processing to examine public knowledge and attitudes. A total of 42,236 tweets (16,499 unique and 25,737 retweets) mentioning Ebola were posted and disseminated to 9,362,267,048 people, 63 times higher than the initial number. Tweets started to rise in Nigeria 3-7 days prior to the official announcement of the first probable Ebola case. The topics discussed in tweets include risk factors, prevention education, disease trends, and compassion. Because of the analysis of a unique Twitter dataset captured in the early stage of the current Ebola outbreak, our results provide insight into the intersection of social media and public health outbreak surveillance. Findings demonstrate the usefulness of Twitter mining to inform public health education. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Application of Humidity Data for Predictions of Influenza Outbreaks.

    Science.gov (United States)

    Teixeira, J.; Thrastarson, H. T.; Yeo, E.

    2016-12-01

    Seasonal influenza outbreaks infect millions of people, cause hundreds of thousands of deaths worldwide, and leave an immense economic footprint. Potential forecasting of the timing and intensity of these outbreaks can help mitigation and response efforts (e.g., the management and organization of vaccines, drugs and other resources). Absolute (or specific) humidity has been identified as an important driver of the seasonal behavior of influenza outbreaks in temperate regions. Building upon this result, we incorporate humidity data from both NASA's AIRS (Atmospheric Infra-Red Sounder) instrument and ERA-Interim re-analysis into a SIRS (Susceptible-Infectious-Recovered-Susceptible) type numerical epidemiological model, comprising a prediction system for influenza outbreaks. Data for influenza activity is obtained from sources such as Google Flu Trends and the CDC (Center for Disease Control) and used for comparison and assimilation. The accuracy and limitations of the prediction system are tested with hindcasts of outbreaks in the United States for the years 2005-2015. Our results give support to the hypothesis that local weather conditions drive the seasonality of influenza in temperate regions. The implementation of influenza forecasts that make use of NCEP humidity forecasts is also discussed.

  18. 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.

  19. Food-borne tonsillopharyngitis outbreak in a hospital cafeteria.

    Science.gov (United States)

    Ertugrul, B M; Erol, N; Emek, M; Ozturk, B; Saylak, O M; Cetin, K; Sakarya, S

    2012-02-01

    A food-borne tonsillopharyngitis outbreak was reported between 9th and 13th of February, 2008, in Söke State Hospital, Aydın, Turkey. This descriptive cohort study was carried out immediately after the outbreak. In order to determine the probable origin, a questionnaire involving demographical features, clinical features, and possible risk factors was distributed to 403 persons. The participants of the questionnaire (n = 403) were divided into two groups: the study group (n = 252); those with any two of the following three complaints; sore throat, fever, and dizziness, and the control group (n = 151); those without these complaints. This investigation revealed that 252 people were affected by this outbreak. Group A β-hemolytic streptococci were isolated from the throat cultures of 63 affected individuals (25%) and an employee working in the patisserie that made desserts served for lunch. Since the number of people who ate the milky dessert was statistically higher compared to the non-eaters, the milky dessert was thought to be the origin of the outbreak. We suggest that throat infections among employees working in food production may cause outbreaks of upper respiratory tract infections.

  20. Norovirus outbreak management: how much cohorting is necessary?

    Science.gov (United States)

    Korte, S; Pettke, A; Kossow, A; Mellmann, A; Willems, S; Kipp, F

    2016-03-01

    For the control of norovirus outbreaks, it is widely recommended that exposed but asymptomatic patients should be cohorted separately from unexposed patients and from symptomatic patients. The frequency of subsequent symptomatic norovirus infection in contact patients has not been investigated systematically. We retrospectively investigated the development of typical norovirus symptoms in contact patients during seven norovirus outbreaks affecting 57 patients between November 2014 and May 2015. Only one of 14 contact patients developed typical norovirus symptoms, calling into question current recommendations to isolate contact patients. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  1. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Martinez

    2011-01-01

    Full Text Available Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  2. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Science.gov (United States)

    Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

  3. Yellow fever live attenuated vaccine: A very successful live attenuated vaccine but still we have problems controlling the disease.

    Science.gov (United States)

    Barrett, Alan D T

    2017-10-20

    Yellow fever (YF) is regarded as the original hemorrhagic fever and has been a major public health problem for at least 250years. A very effective live attenuated vaccine, strain 17D, was developed in the 1930s and this has proved critical in the control of the disease. There is little doubt that without the vaccine, YF virus would be considered a biosafety level 4 pathogen. Significantly, YF is currently the only disease where an international vaccination certificate is required under the International Health Regulations. Despite having a very successful vaccine, there are occasional issues of supply and demand, such as that which occurred in Angola and Democratic Republic of Congo in 2016 when there was insufficient vaccine available. For the first time fractional dosing of the vaccine was approved on an emergency basis. Thus, continued vigilance and improvements in supply and demand are needed in the future. Copyright © 2017. Published by Elsevier Ltd.

  4. 3D Volumetric Measurements of GH Secreting Adenomas Correlate with Baseline Pituitary Function, Initial Surgery Success Rate, and Disease Control.

    Science.gov (United States)

    Tirosh, Amit; Papadakis, Georgios Z; Chittiboina, Prashant; Lyssikatos, Charalampos; Belyavskaya, Elena; Keil, Meg; Lodish, Maya B; Stratakis, Constantine A

    2017-06-01

    There is scarce data on the clinical utility of volume measurement for growth hormone (GH)-secreting pituitary adenomas. The current study objective was to assess the association between pituitary adenoma volumes and baseline endocrine evaluation, initial surgical success rate, and disease control among patients with acromegaly. A retrospective cohort study was conducted at a clinical research center including patients with acromegaly due to GH-secreting pituitary adenomas. Baseline hormonal evaluation and adenoma characteristics according to MRI were collected. Volumetric measurements of pituitary adenomas were performed using a semi-automated lesion segmentation and tumor-volume assessment tools. Rates of post-operative medical treatment, radiation therapy, and re-operation were gathered from the patients' medical records. Twenty seven patients (11 females) were included, median age 21.0 years (interquartile range 29 years, range 3-61 years). Patients harboring adenomas with a volume <2 000 mm 3 had higher chance to achieve disease remission [94.1% (n=16) vs. 50.0% (n=4), p<0.05]. Adenoma volumes positively correlated with baseline plasma GH levels before and after oral glucose administration, and with plasma IGF-I and PRL levels. Adenoma volume had negative correlation with morning plasma cortisol levels. Finally, patients harboring larger adenomas required 2nd surgery and/or medical treatment more often compared with subjects with smaller adenomas. Accurate 3D volume measurement of GH-secreting pituitary adenomas may be used for the prediction of initial surgery success and for disease control rates among patients with a GH-secreting pituitary adenomas and performs better than standard size assessments. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Multiple outbreaks of Salmonella braenderup associated with consumption of iceberg lettuce.

    Science.gov (United States)

    Gajraj, Roger; Pooransingh, Shalini; Hawker, Jeremy I; Olowokure, Babatunde

    2012-01-01

    The aim of this study was to describe the findings from an outbreak investigation following several apparently unrelated community outbreaks of gastroenteritis. Epidemiological, environmental, laboratory and traceback investigations were used to identify the source of the outbreak. We enrolled 23 (of 29) laboratory confirmed cases and 24 neighbourhood case-nominated controls in a case-control study which revealed that illness was associated with consumption of iceberg lettuce (matched odds ratio 8.0 (95% CI 1.1-355) contaminated with Salmonella braenderup. Several eating establishments were affected and the lettuce was traced back to a single producer in Spain. This is the first UK report implicating S. braenderup in an outbreak due to lettuce. The results highlight the need to increase attention to the various stages in the farm-to-fork process to reduce produce-associated outbreaks related to the global food trade.

  6. NOROVIRUS OUTBREAK AT A DAYCARE CENTER IN BANGKOK, 2014.

    Science.gov (United States)

    Phumpholsup, Tikumporn; Theamboonlers, Apiradee; Wanlapakorn, Nasamon; Felber, Joshua A; Suvaporn Anugulruengkit; Puthanakit, Thanyawee; Chomto, Sirinuch; Payungporn, Sunchai; Poovorawan, Yong

    2015-07-01

    Norovirus is a leading cause of acute non-bacterial gastroenteritis worldwide, affecting developing and developed countries, both children and adults. This study describes an outbreak of acute gastroenteritis at a daycare center of a tertiary level hospital in Bangkok, Thailand during October 2014. Although none of the staff became symptomatic, 8 of 11 children attending the center and 4 of their household contacts developed acute gastroenteritis. No pathogenic bacteria or rotavirus were detected in their evaluation; however, 3 out of 7 stool samples from the cases were positive for norovirus GII.17. Reverse transcriptase polymerase chain reaction analysis with sequence and phylogenetic analysis revealed the viral strain was the same strain reported from Taiwan in 2013. Because norovirus is a frequent cause of outbreaks in crowded conditions, early detection and preventive measures are important to control outbreaks.

  7. [Serratia marcescens outbreak in Neonatal Intensive Care Unit: Guayaquil, Ecuador].

    Science.gov (United States)

    Soria, Claudia; Nieto, Nelson; Villacís, José E; Lainez, Sara; Cartelle, Mónica

    2016-12-01

    We report a Serratia marcescens outbreak occurred in the NICU of a pediatric hospital in Guayaquil, Ecuador. Nine cases of infection were detected, from which septicemia was developed in 55.5%. The index case was a newborn derived from another institution with septic arthritis caused by the outbreak strain. The infection rate was 17.6% and mortality rate was 33.3%. All isolates were resistant to aminoglycosides and susceptible to third generation cephalosporins and carbapenems. Clonality analysis by pulsed-field gel electrophoresis (PFGE) revealed the presence of two closely related clones confirming the horizontal spread. Measures were taken by the committee such as: strengthening the hand hygiene, patient hygiene and cohort studies of gastrointestinal colonization, which allowed the control of the outbreak.

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

    Science.gov (United States)

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

    2015-10-01

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

  9. Gumboro Disease Outbreaks Cause High Mortality Rates in ...

    African Journals Online (AJOL)

    Bulletin of Animal Health and Production in Africa ... Thirty nine outbreak farms (5 keeping broilers, 19 keeping layers and 15 keeping indigenous flock) were visited; vaccination history collected, clinical signs observed, flock size ... Keywords: Infectious bursal disease, vaccination failure, disease control, chicken production ...

  10. Measles outbreak reveals measles susceptibility among adults in ...

    African Journals Online (AJOL)

    5 Namibia Country Office, Center for Global Health, US Centers for Disease Control and Prevention, Windhoek, Namibia. 6 World Health Organization Field ... The wide age distribution of cases indicated measles-susceptible individuals accumulated over several decades prior to the start of the outbreak. S Afr Med J 2016 ...

  11. Sharing Data for Global Infectious Disease Surveillance and Outbreak Detection

    DEFF Research Database (Denmark)

    Aarestrup, Frank Møller; Koopmans, Marion G.

    2016-01-01

    Rapid global sharing and comparison of epidemiological and genomic data on infectious diseases would enable more rapid and efficient global outbreak control and tracking of diseases. Several barriers for global sharing exist but, in our opinion, the presumed magnitude of the problems appears larg...

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

    NARCIS (Netherlands)

    Heijne, J.C.; Teunis, P.; Morroy, G.; Wijkmans, C.J.; Oostveen, S.; Duizer, E.; Kretzschmar, M.; Wallinga, J.

    2009-01-01

    Control of norovirus outbreaks relies on enhanced hygiene measures, such as handwashing, surface cleaning, using disposable paper towels, and using separate toilets for sick and well persons. However, little is known about their effectiveness in limiting further spread of norovirus infections. We

  13. Guidance for Schools on the Recent Flu Outbreak

    Science.gov (United States)

    US Department of Education, 2009

    2009-01-01

    The document provides a transcript of a conference call moderated by Bill Modzeleski, Director of the Office of Safe and Drug-Free Schools. The focus of the call was the recent outbreak of swine flu in Mexico and the United States. Centers for Disease Control (CDC) actions and recommendations to the education community were discussed. A comparison…

  14. Outbreak of a New Strain of Flu at a Fair

    Centers for Disease Control (CDC) Podcasts

    2013-02-28

    Dr. Karen Wong, an EIS officer with the Centers for Disease Control and Prevention, discusses her study about flu outbreaks at agricultural fairs.  Created: 2/28/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 3/4/2013.

  15. Wetland environmental conditions associated with the risk of avian cholera outbreaks and the abundance of Pasteurella multocida

    Science.gov (United States)

    Blanchong, Julie A.; Samuel, Michael D.; Goldberg, Diana R.; Shadduck, Daniel J.; Creekmore, L.H.

    2006-01-01

    Avian cholera is a significant infectious disease affecting waterfowl across North America and occurs worldwide among various avian species. Despite the importance of this disease, little is known about the factors that cause avian cholera outbreaks and what management strategies might be used to reduce disease mortality. Previous studies indicated that wetland water conditions may affect survival and transmission of Pasteurella multocida, the agent that causes avian cholera. These studies hypothesized that water conditions affect the likelihood that avian cholera outbreaks will occur in specific wetlands. To test these predictions, we collected data from avian cholera outbreak and non-outbreak (control) wetlands throughout North America (wintera??spring 1995a??1996 to 1998a??1999) to evaluate whether water conditions were associated with outbreaks. Conditional logistic regression analysis on paired outbreak and non-outbreak wetlands indicated no significant association between water conditions and the risk of avian cholera outbreaks. For wetlands where avian cholera outbreaks occurred, linear regression showed that increased eutrophic nutrient concentrations (Potassium [K], nitrate [NO3], phosphorus [P], and phosphate [PO3]) were positively related to the abundance of P. multocida recovered from water and sediment samples. Wetland protein concentration and an El Ni??o event were also associated with P. multocida abundance. Our results indicate that wetland water conditions are not strongly associated with the risk of avian cholera outbreaks; however, some variables may play a role in the abundance of P. multocida bacteria and might be important in reducing the severity of avian cholera outbreaks.

  16. Successful Vaccination Induces Multifunctional Memory T-Cell Precursors Associated with Early Control of Hepatitis C Virus

    Science.gov (United States)

    Park, Su-Hyung; Shin, Eui-Cheol; Capone, Stefania; Caggiari, Laura; De Re, Valli; Nicosia, Alfredo; Folgori, Antonella; Rehermann, Barbara

    2012-01-01

    Background & Aims T cells are an important component for development of a vaccine against hepatitis C virus (HCV), but little is known about the features of successful vaccine-induced T cells. Methods We compared the phenotype, function, and kinetics of vaccine-induced and infection-induced T cells in chimpanzees with HCV infection using multicolor flow cytometry and real-time PCR. Results In chimpanzees successfully vaccinated with recombinant adenovirus and DNA against HCV NS3-NS5, HCV-specific T cells appeared earlier, maintained better functionality, and persisted at higher frequencies, for a longer time after HCV-challenge, than those of mock-vaccinated chimpanzees. Vaccine-induced T cells displayed higher levels of CD127, a marker of memory precursors, and lower levels of programmed death (PD)-1 than infection-induced T cells. Vaccine-induced, but not infection-induced T cells, were multifunctional; their ability to secrete interferon-γ and tumor necrosis factor-α correlated with early expression of CD127 but not PD-1. Based on a comparison of vaccine-induced and infection-induced T cells from the same chimpanzee, the CD127+ memory precursor phenotype was induced by the vaccine itself, rather than by low viremia. In contrast, PD-1 induction correlated with viremia, and levels of intrahepatic PD-1, PD-L1, and 2,5-OAS-1 mRNAs correlated with peak titers of HCV. Conclusions Compared with infection, vaccination induced HCV-specific CD127+ T cells with high functionality that persisted at higher levels for a longer time. Control of viremia prevented upregulation of PD-1 on T cells, and induction of PD-1, PD-L1, and 2,5-OAS-1 in the liver. Early development of a memory T-cell phenotype and, via control of viremia, attenuation of the inhibitory PD1–PD-L1 pathway might be necessary components of successful vaccine-induced protection against HCV. PMID:22705008

  17. [Outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in the Rijnmond region: the largest outbreak in the Netherlands].

    Science.gov (United States)

    Melles, D C; Hendriks, W D; Ott, A; Verbrugh, H A

    2004-05-22

    EPIDEMIC: The annual number of new MRSA isolates in the Netherlands tripled in 2002 compared with previous years. This increase was in part due to a MRSA outbreak in the Rijnmond region. The outbreak occurred in two merged hospitals and is the largest ever to occur in the Netherlands. From November 2001 till June 2003 MRSA was isolated from 381 patients and 113 hospital employees. The worst affected departments were Surgery and Internal Medicine. One MRSA strain (pulsed-field gel electroforesis (PFGE) type 16) remained initially unrecognised and was therefore able to spread unnoticed. Soon two additional epidemic MRSA strains (types 37 and 38) were discovered. Multiple factors played a role in the extent and duration of the outbreak. Because of the delayed detection and rapid spread of MRSA type 16, the outbreak grew too large once recognised to be resolved within the available infrastructure. Investments were needed at various fields, including the infection-control service and the microbiology laboratory. Employees had to be informed and motivated, and a separate MRSA ward and OPD were provided. New MRSA outbreaks occurred, despite extensive MRSA (contact) screening among patients and employees. The numbers of isolates began falling as from the beginning of 2003.

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

    Science.gov (United States)

    Robertson, Robert E.

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

  19. Group A Streptococcal Endometritis: Report of an Outbreak and Review of the Literature

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    Ziad A Memish

    1994-01-01

    Full Text Available Two cases of group A streptococcus (gas postpartum endometritis were diagnosed within 24 h following uncomplicated vaginal delivery. Investigation by the infection control service identified all 10 obstetric personnel who performed any invasive procedure on both cases. These personnel were questioned about a recent history of sore throat, skin lesions, vaginal or rectal symptoms. Throat and rectal cultures were obtained for gas from all 10 personnel. A carrier was identified among the personnel screened. This nurse was removed from direct patient care and treated with a two-week course of oral clindamycin and rifampin with documentation of carrier eradication of gas at the end of therapy, 30 days, 60 days and six months post-treatment. All three isolated strains were identical by restriction endonuclease analysis and by M and T typing. Rapid implementation of infection control measures were successful in arresting this outbreak, with no further cases of gas occurring in the subsequent year.

  20. Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

    Science.gov (United States)

    Watkins, Louise K. Francois; Demirjian, Alicia; Lin, Xia; Robinson, Christine C.; Pretty, Kristin; Benitez, Alvaro J.; Winchell, Jonas M.; Diaz, Maureen H.; Miller, Lisa A.; Foo, Teresa A.; Mason, Melanie D.; Lauper, Ursula L.; Kupfer, Oren; Kennedy, Jeffrey; Glodé, Mary P.; Kutty, Preeta K.; Dominguez, Samuel R.

    2015-01-01

    BACKGROUND: Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children’s Hospital Colorado. METHODS: Outbreak cases were children aged 5–21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection. RESULTS: During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8–16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR–positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 10.0, confidence interval [CI] 1.3–5.1), preceding respiratory symptoms (OR 30.0, CI 1.6–72.6), an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1–244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2–17.4) than non–Mp-associated SJS episodes (n = 23). CONCLUSIONS: We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection. PMID:26216320

  1. Successful control of methicillin-resistant Staphylococcus aureus in endemic neonatal intensive care units--a 7-year campaign.

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    Yhu-Chering Huang

    Full Text Available BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA is among the most important nosocomial pathogens in the intensive care unit (ICU worldwide, including Taiwan. Since 1997, our neonatal ICUs (NICUs had become endemic for MRSA. METHODOLOGY/PRINCIPAL FINDINGS: To control MRSA spread in our NICUs, we implemented a series of infection control measures stepwise, including reinforcement of hand hygiene since January 2000, augmentation of aseptic care over the insertion site of central venous catheter since July 2001, introduction of alcohol-based handrubs since April 2003, surveillance culture for MRSA and cohort care for the colonized patients between March 2003 and February 2004, and surveillance culture with subsequent decolonization of MRSA between August 2005 and July 2006. After implementation of these measures, MRSA healthcare-associated infection (HAI density reduced by 92%, from 5.47 episodes per 1000 patient-days in 1999 to 0.45 episodes per 1000 patient-days in 2006; MRSA bloodstream infection reduced from 40 cases in 1999 to only one case in 2006. Compared to those obtained during the period of surveillance culture without decolonization, both rates of MRSA colonization (8.6% vs. 41%, p<0.001 and infection (1.1% vs. 12%, p<0.001 decreased significantly during the period of surveillance and decolonization. Molecular analysis of the clinical isolates during the study period showed that the endemic clone, which dominated between 1998 and 2005, almost disappeared in 2006, while the community clones increased significantly in 2006-2007. CONCLUSION/SIGNIFICANCE: Through infection control measures, MRSA HAIs can be successfully controlled, even in areas with high levels of endemic MRSA infections such as our NICUs.

  2. Temporal relationship between successful pancreas transplantation and control of ocular complications in alloxan-induced diabetic rats.

    Science.gov (United States)

    Spadella, C T; Machado, J L M; Lerco, M M; Ortolan, E V P; Schellini, S A; Gregório, E A

    2008-03-01

    The impact of pancreas transplantation (PT) on the progression of eye disease is still controversial. This study evaluated the course of retinopathy in transplanted rats in two different diabetic stages. Sixty inbred male Lewis rats were assigned to four experimental groups: NC-15 nondiabetic control rats; DC-15 untreated diabetic control rats; PT1-15 diabetic rats that received syngeneic pancreas transplants 2 weeks after alloxan diabetes induction; PT2-15 diabetic rats that received pancreas transplants 12 weeks after diabetes onset. Clinical and laboratory parameters and lens opacity were examined in all rats prior to treatment and at 1-, 6-, and 12-months follow-up. Nucleated eyes from five rats in each group processed for ultrastructural study of the retinal at 6 and 12 months after PT or at follow-up. Cataracts were observed in 20%, 60%, and 100% of DC rats at 1-, 6-, and 12-months follow-up, respectively. Early PT (2 weeks) significantly reduced the prevalence of this complication but not late (12 weeks) PT. PT1 rats also showed improved ultrastructure of the superficial and deep capillary plexuses of the retina, and of Müller cells, compared with DC and PT2. In the last group, retinopathy continued to evolve despite successful PT. Our results suggested that prevention of diabetic ocular lesions by PT was closely dependent on earlier performance of the procedure.

  3. Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital

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    Matt, Benedikt

    2014-09-01

    Full Text Available [english] Background: The aim of this study was to characterise the epidemiology of isolated from cystic fibrosis (CF patients at the Vienna General Hospital (VGH by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols.Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for during the study period. Fifty isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab method.Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each.Nine patients presented with two or more phenotypically diverse isolates. In five of these cases the retrieved isolates belonged to the same genotype.Conclusion: The broad genetic heterogeneity of in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population.

  4. A large outbreak of salmonellosis associated with sandwiches contaminated with multiple bacterial pathogens purchased via an online shopping service.

    Science.gov (United States)

    Wei, Sung-Hsi; Huang, Angela S; Liao, Ying-Shu; Liu, Yu-Lun; Chiou, Chien-Shun

    2014-03-01

    Food sold over the internet is an emerging business that also presents a concern with regard to food safety. A nationwide foodborne disease outbreak associated with sandwiches purchased from an online shop in July 2010 is reported. Consumers were telephone interviewed with a structured questionnaire and specimens were collected for etiological examination. A total of 886 consumers were successfully contacted and completed the questionnaires; 36.6% had become ill, with a median incubation period of 18 h (range, 6-66 h). The major symptoms included diarrhea (89.2%), abdominal pain (69.8%), fever (47.5%), headache (32.7%), and vomiting (17.3%). Microbiological laboratories isolated Salmonella enterica serovar Enteritidis, Salmonella Virchow, Staphylococcus aureus, Bacillus cereus, and enterotoxigenic Escherichia coli from the contaminated sandwiches, Salmonella Enteritidis and Salmonella Virchow from the patients, and Salmonella Enteritidis and Staphylococcus aureus from food handlers. Pulsed-field gel electrophoresis genotyping suggested a common origin of Salmonella bacteria recovered from the patients, food, and a food handler. Among the pathogens detected, the symptoms and incubation period indicated that Salmonella, likely of egg origin, was the probable causative agent of the outbreak. This outbreak illustrates the importance of meticulous hygiene practices during food preparation and temperature control during food shipment and the food safety challenges posed by online food-shopping services.

  5. Swine flu - A pandemic outbreak

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    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

  6. Rubella outbreak in the union territory of Chandigarh, North India.

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    Singh, Mini P; Kumar, Archit; Gautam, Neha; Khurana, Jasmine; Gupta, Madhu; Ratho, Radha Kanta

    2015-02-01

    Rubella virus outbreaks usually occur when a large numbers of susceptible individuals accumulate. The disease presents clinically with fever and maculopapular rash. The present study reports the investigation of rubella outbreak in a modern and well-planned village near Chandigarh, North India. The blood samples were collected from 39 cases with febrile rash and from 15 age and sex matched healthy controls residing in the same locality and subjected for the detection of Rubella IgM and IgG antibodies by Enzyme linked immunosorbent assay. The throat swabs, urine and blood samples from acute cases were also collected and subjected to RT-PCR using the primers targeting the E1 region. The genetic characterization of the rubella virus was carried out to identify the circulating genotypes. In the present outbreak, 13 laboratory confirmed cases were reported. Rubella IgM antibodies were detected in 12/39 (30.7%) patients. Rubella RNA could be detected in 83.3% (5/6) of urine, 22.2% (2/9) of throat swabs, and 8.3% (1/12) of blood samples. The rubella genotype responsible for the present outbreak was identified as genotype 1a. This outbreak highlights the need for the introduction of rubella vaccine in the National Immunization Programme of India to prevent outbreaks and to aim towards the eradication of this disease. This study reports the presence of genotype 1a in North India for the first time and stresses the need for further molecular work to identify the circulating strains of the virus. © 2014 Wiley Periodicals, Inc.

  7. A gastroenteritis outbreak investigation, NIGDE city center, March 2014

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    Ebru Tozan

    2016-05-01

    Full Text Available Objective: In Nigde city center, during 18–30 March 2014, 1288 acute gastroenteritis cases were admitted to hospitals and family health centers. We investigated to identify the cause, mode of transmission, implement control measures, prevent future outbreaks. Methods: In case-control study to test the hypothesis “The source of this outbreak is contaminated tap water”, we reviewed health records for ICD-10 codes (A09, R11, K52 during 18–30 March. We defined probable case as onset of vomiting or diarrhea among 0-14 age-group resident of 15 neighborhoods with highest attack rates.. We compared 88 case-patients and randomly selected age-group-matched neighborhood controls. We tested clinical specimens, water samples. Results: Main symptoms of probable cases were diarrhea (80.7%, abdominal pain (84.1%, nausea (89.8%, vomiting (84.1%, fever (55.7%. When drinking only bottled water was taken as reference, drinking only tap water was 6.5 times higher in case patients (ORadj=6.5, 95%Cl=2.1–19.1. Of the 6 stool specimens, 4 tested positive for rotavirus. Water samples were positive for Escherichia coli, coliform bacteria. Free chlorine level was zero ppm in 5 of 7 samples. Conclusions: Contaminated tap water caused this rotavirus outbreak. The point of contamination couldn’t be identified. We recommended, drinking tap water chlorination, monitoring should be done regularly to prevent waterborne outbreaks.Key words: Water, Diarrhea, Case-Control Studies, Rotavirus, Outbreaks.

  8. INfluence of Successful Periodontal Intervention in REnal Disease (INSPIRED): study protocol for a randomised controlled pilot clinical trial.

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    Sharma, Praveen; Cockwell, Paul; Dietrich, Thomas; Ferro, Charles; Ives, Natalie; Chapple, Iain L C

    2017-11-13

    Patients with chronic kidney disease (CKD) exhibit increased morbidity and mortality which is associated with an increased systemic inflammatory burden. Identifying and managing comorbid diseases that contribute to this load may inform novel care pathways that could have a beneficial impact on the morbidity/mortality associated with CKD. Periodontitis, a highly prevalent, chronic inflammatory disease affecting the supporting structures of teeth, is associated with an increased systemic inflammatory and oxidative stress burden and the successful treatment of periodontitis has been shown to reduce both. This pilot study aims to gather data to inform a definitive study into the impact of successful periodontal treatment on the cardio-renal health of patients with CKD. This pilot study will employ a randomised, controlled, parallel-group design. Sixty adult patients, with CKD with a high risk of progression and with periodontitis, from the Queen Elizabeth Hospital, Birmingham, will be randomised to receive either immediate, intensive periodontal treatment (n = 30) or treatment at a delay of 12 months (n = 30). Patients will be excluded if they have reached end-stage renal disease or have received specialist periodontal treatment in the previous year. Periodontal treatment will be delivered under local anaesthetic, on an outpatient basis, over several visits by a qualified dental hygienist at the Birmingham Dental Hospital, UK. Patients in the delayed-treatment arm will continue to receive the standard community level of periodontal care for a period of 12 months followed by the intensive periodontal treatment. Randomization will occur using a centralised telephone randomisation service, following baseline assessments. The assessor of periodontal health will be blinded to the patients' treatment allocation. Patients in either arm will be followed up at 3-monthly intervals for 18 months. Aside from the pilot outcomes to inform the practicalities of a larger

  9. A point source outbreak of acute gastroenteritis among school students in Kerala, India.

    Science.gov (United States)

    Rakesh, P S; Thiagesan, Rajeswaran; Ramachandran, Rakesh

    2017-01-01

    An outbreak investigation was initiated following an outbreak of acute gastroenteritis among schoolchildren in Kottarakara. Steps included active search for cases at schools, describing the outbreak in terms of person, place, and time, generating hypothesis based on the findings from descriptive study, environmental observations, and testing the hypothesis using a case-control design. The final line list consisted of 871 children from different schools who attended a Republic Day parade. Having consumed the lemon juice near railway station (odds ratio [OR] 29.14; 95% confidence interval CI 9.06-93.67) during Republic day parade was associated with the outbreak. The time frame of the disease occurrence, laboratory results, and the results of the analytical study indicated the point source of acute gastroenteritis outbreak as the contaminated water used for lemon juice distributed during the parade. The findings warrant effective food and water safety surveillance, especially during mass gatherings.

  10. Contagious comments: what was the online buzz about the 2011 Quebec measles outbreak?

    Science.gov (United States)

    Pereira, Jennifer A; Quach, Susan; Dao, Huy Hao; Kwong, Jeffrey C; Deeks, Shelley L; Crowcroft, Natasha S; Quan, Sherman D; Guay, Maryse

    2013-01-01

    Although interruption of endemic measles was achieved in the Americas in 2002, Quebec experienced an outbreak in 2011 of 776 reported cases; 80% of these individuals had not been fully vaccinated. We analyzed readers' online responses to Canadian news articles regarding the outbreak to better understand public perceptions of measles and vaccination. We searched Canadian online English and French news sites for articles posted between April 2011 and March 2012 containing the words "measles" and "Quebec". We included articles that i) concerned the outbreak or related vaccination strategies; and ii) generated at least ten comments. Two English and two bilingual researchers coded the unedited comments, categorizing codes to allow themes to emerge. We analyzed 448 comments from 188 individuals, in response to three French articles and six English articles; 112 individuals expressed positive perceptions of measles vaccination (2.2 comments/person), 38 were negative (4.2 comments/person), 11 had mixed feelings (1.5 comments/person), and 27 expressed no opinion (1.1 comments/person). Vaccine-supportive themes involved the success of vaccination in preventing disease spread, societal responsibility to vaccinate for herd immunity, and refutation of the autism link. Those against measles vaccination felt it was a personal rather than societal choice, and conveyed a distrust of vaccine manufacturers, believing that measles infection is not only safe but safer than vaccination. Commenters with mixed feelings expressed uncertainty of the infection's severity, and varied in support of all vaccines based on perceived risk/benefit ratios. The anti-vaccine minority's volume of comments translates to a disproportionately high representation on online boards. Public health messages should address concerns by emphasizing that immunization is always a personal choice in Canada, and that the pharmaceutical industry is strictly controlled. Illustrating the dangers of measles through

  11. 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

  12. Contagious comments: what was the online buzz about the 2011 Quebec measles outbreak?

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    Jennifer A Pereira

    Full Text Available BACKGROUND: Although interruption of endemic measles was achieved in the Americas in 2002, Quebec experienced an outbreak in 2011 of 776 reported cases; 80% of these individuals had not been fully vaccinated. We analyzed readers' online responses to Canadian news articles regarding the outbreak to better understand public perceptions of measles and vaccination. METHODS: We searched Canadian online English and French news sites for articles posted between April 2011 and March 2012 containing the words "measles" and "Quebec". We included articles that i concerned the outbreak or related vaccination strategies; and ii generated at least ten comments. Two English and two bilingual researchers coded the unedited comments, categorizing codes to allow themes to emerge. RESULTS: We analyzed 448 comments from 188 individuals, in response to three French articles and six English articles; 112 individuals expressed positive perceptions of measles vaccination (2.2 comments/person, 38 were negative (4.2 comments/person, 11 had mixed feelings (1.5 comments/person, and 27 expressed no opinion (1.1 comments/person. Vaccine-supportive themes involved the success of vaccination in preventing disease spread, societal responsibility to vaccinate for herd immunity, and refutation of the autism link. Those against measles vaccination felt it was a personal rather than societal choice, and conveyed a distrust of vaccine manufacturers, believing that measles infection is not only safe but safer than vaccination. Commenters with mixed feelings expressed uncertainty of the infection's severity, and varied in support of all vaccines based on perceived risk/benefit ratios. CONCLUSION: The anti-vaccine minority's volume of comments translates to a disproportionately high representation on online boards. Public health messages should address concerns by emphasizing that immunization is always a personal choice in Canada, and that the pharmaceutical industry is strictly

  13. Determinants of the Final Size and Case Rate of Nosocomial Outbreaks.

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    Amy Hurford

    Full Text Available Different nosocomial pathogen species have varying infectivity and durations of infectiousness, while the transmission route determines the contact rate between pathogens and susceptible patients. To determine if the pathogen species and transmission route affects the size and spread of outbreaks, we perform a meta-analysis that examines data from 933 outbreaks of hospital-acquired infection representing 14 pathogen species and 8 transmission routes. We find that the mean number of cases in an outbreak is best predicted by the pathogen species and the mean number of cases per day is best predicted by the species-transmission route combination. Our fitted model predicts the largest mean number of cases for Salmonella outbreaks (22.3 and the smallest mean number of cases for Streptococci outbreaks (8.5. The largest mean number of cases per day occurs during Salmonella outbreaks spread via the environment (0.33 and the smallest occurs for Legionella outbreaks spread by multiple transmission routes (0.005. When combined with information on the frequency of outbreaks these findings could inform the design of infection control policies in hospitals.

  14. Comparing "insider" and "outsider" news coverage of the 2014 Ebola outbreak.

    Science.gov (United States)

    Humphries, Brittany; Radice, Martha; Lauzier, Sophie

    2017-11-09

    Information provided by news media during an infectious disease outbreak can affect the actions taken to safeguard public health. There has been little evaluation of how the content of news published during an outbreak varies by location of the news outlet. This study analyzes coverage of the 2014 Ebola outbreak by one news outlet operating within a country affected by the outbreak and one country not directly affected. A qualitative content analysis was conducted of articles published in two national news outlets, The Globe and Mail (Canada) and the Vanguard (Nigeria), between January 1 and December 31, 2014. Articles available through LexisNexis Academic were sorted by date and sampled using a stratified sampling method (The Globe and Mail n = 100; Vanguard n = 105). A coding scheme was developed and modified to incorporate emerging themes until saturation was achieved. There were substantial differences in outbreak coverage in terms of the topic and content of the articles, as well as the sources consulted. The Globe and Mail framed the outbreak in terms of national security and national interests, as well as presenting it as an international humanitarian crisis. In contrast, the Vanguard framed the outbreak almost exclusively in terms of public health. Our findings highlight how different geographic contexts can shape reporting on the same event. Further research is required to investigate how the political, social or economic situations of a country shape its news media, potentially influencing actions taken to control disease outbreaks.

  15. The need of a weight management control program in judo: a proposal based on the successful case of wrestling

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    Sterkowicz Stanislaw

    2010-05-01

    Full Text Available Abstract Judo competitions are divided into weight classes. However, most athletes reduce their body weight in a few days before competition in order to obtain a competitive advantage over lighter opponents. To achieve fast weight reduction, athletes use a number of aggressive nutritional strategies so many of them place themselves at a high health-injury risk. In collegiate wrestling, a similar problem has been observed and three wrestlers died in 1997 due to rapid weight loss regimes. After these deaths, the National Collegiate Athletic Association had implemented a successful weight management program which was proven to improve weight management behavior. No similar program has ever been discussed by judo federations even though judo competitors present a comparable inappropriate pattern of weight control. In view of this, the basis for a weight control program is provided in this manuscript, as follows: competition should begin within 1 hour after weigh-in, at the latest; each athlete is allowed to be weighed-in only once; rapid weight loss as well as artificial rehydration (i.e., saline infusion methods are prohibited during the entire competition day; athletes should pass the hydration test to get their weigh-in validated; an individual minimum competitive weight (male athletes competing at no less than 7% and females at no less than 12% of body fat should be determined at the beginning of each season; athletes are not allowed to compete in any weight class that requires weight reductions greater than 1.5% of body weight per week. In parallel, educational programs should aim at increasing the athletes', coaches' and parents' awareness about the risks of aggressive nutritional strategies as well as healthier ways to properly manage body weight.

  16. The need of a weight management control program in judo: a proposal based on the successful case of wrestling

    Science.gov (United States)

    2010-01-01

    Judo competitions are divided into weight classes. However, most athletes reduce their body weight in a few days before competition in order to obtain a competitive advantage over lighter opponents. To achieve fast weight reduction, athletes use a number of aggressive nutritional strategies so many of them place themselves at a high health-injury risk. In collegiate wrestling, a similar problem has been observed and three wrestlers died in 1997 due to rapid weight loss regimes. After these deaths, the National Collegiate Athletic Association had implemented a successful weight management program which was proven to improve weight management behavior. No similar program has ever been discussed by judo federations even though judo competitors present a comparable inappropriate pattern of weight control. In view of this, the basis for a weight control program is provided in this manuscript, as follows: competition should begin within 1 hour after weigh-in, at the latest; each athlete is allowed to be weighed-in only once; rapid weight loss as well as artificial rehydration (i.e., saline infusion) methods are prohibited during the entire competition day; athletes should pass the hydration test to get their weigh-in validated; an individual minimum competitive weight (male athletes competing at no less than 7% and females at no less than 12% of body fat) should be determined at the beginning of each season; athletes are not allowed to compete in any weight class that requires weight reductions greater than 1.5% of body weight per week. In parallel, educational programs should aim at increasing the athletes', coaches' and parents' awareness about the risks of aggressive nutritional strategies as well as healthier ways to properly manage body weight. PMID:20441594

  17. 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.

  18. Not merely a question of self-control: The longitudinal effects of overeating behaviors, diet quality and physical activity on dieters' perceived diet success.

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    Keller, Carmen; Hartmann, Christina

    2016-12-01

    This longitudinal study was conducted between 2010 (T1) and 2014 (T2) on a random sample from the general Swiss population (N = 2781, 46% male). Results showed that dieters (restrained eaters) who reported lack of success in T2 were overweight in T1, had higher levels of emotional and external eating, overeating, and ambivalence toward eating palatable food in T1, and a significantly increased body mass index (BMI) in the period between T1 and T2. Dieters who reported success in T2 had maintained a normal BMI between T1 and T2, had a higher diet quality in T1 and had maintained regular physical activity for at least one year before T2. The logistic regression revealed that high levels of dispositional self-control provided the most important predictor of being a successful dieter. When controlling for dispositional self-control, high levels of emotional eating, overeating, and ambivalence in T1, together with increases in these levels between T1 and T2, were associated with a decreased likelihood of being a successful dieter in T2. High levels of diet quality in T1 and the maintenance of regular physical activity were associated with an increased likelihood of being a successful dieter in T2. Results suggest that diet success and failure is a long-term phenomenon, partly but not fully explained by dispositional self-control. Independent of self-control persistent patterns of overeating due to emotional eating and ambivalent feelings toward eating palatable food, also explain long-term diet failure. A high diet quality and maintenance of regular physical activity accounted for dieters' long-term success. This is the first study that examined the long-term psychological and behavioral characteristics of successful and unsuccessful restrained eaters. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. A 17-year review of foodborne outbreaks: describing the continuing decline in England and Wales (1992-2008).

    Science.gov (United States)

    Gormley, F J; Little, C L; Rawal, N; Gillespie, I A; Lebaigue, S; Adak, G K

    2011-05-01

    Systematic national surveillance of foodborne disease outbreaks effectively serves the development of public health policy on food safety. The Health Protection Agency has maintained a collaborative surveillance system for foodborne outbreaks in England and Wales since 1992. Up to 2008, 2429 foodborne outbreaks were identified, described and analysed for changes over time. Salmonella spp. accounted for half of the outbreaks, although the proportion of these decreased over the surveillance period. Similarly, the proportion of outbreaks caused by Clostridium perfringens decreased, while those attributed to Campylobacter spp. and Vero cytotoxin-producing Escherichia coli O157 increased. Although poultry meat was the most frequently implicated food vehicle in outbreaks followed by miscellaneous foods and red meats, the proportion of outbreaks attributed to meats in fact decreased over time but those linked to miscellaneous foods did not. Over the surveillance period, the proportion of outbreaks linked to eggs and S. Enteritidis non-phage-type 4, particularly in food service establishments, increased, highlighting the importance of this organism/setting/vehicle association. Contributory factors in most outbreaks were cross-contamination, inadequate heat treatment, and inappropriate food storage. This study describes the overall decline in foodborne outbreaks, providing evidence that the introduction and adherence to effective control measures provide the best means of minimizing the risk of foodborne infection.

  20. GEO-VISUAL APPROACH FOR SPATIAL SCAN STATISTICS: AN ANALYSIS OF DENGUE FEVER OUTBREAKS IN DELHI

    OpenAIRE

    Shuchi Mala; Raja Sengupta

    2013-01-01

    There are very few surveillance systems being used to detect disease outbreaks at present. In disease surveillance system, data related to cases and various risk factors are collected and then the collected data is transformed into meaningful information for effective disease control using statistical analysis tools. Disease outbreaks can be detected but for effective disease control, a visualization approach is required. Without appropriate visualization, it is very difficult to interpret th...

  1. Cryptosporidiosis Outbreak Associated With a Single Hotel.

    Science.gov (United States)

    Fill, Mary-Margaret A; Lloyd, Jennifer; Chakraverty, Tamal; Sweat, David; Manners, Judy; Garman, Katie; Hlavsa, Michele C; Roellig, Dawn M; Dunn, John R; Schaffner, William; Jones, Timothy F

    2017-05-01

    We investigated a gastrointestinal illness cluster among persons who attended a baseball tournament (>200 teams) during July 2015. We interviewed representatives of 19 teams; illness was reported among only the 9 (47%) teams that stayed at Hotel A (p Hotel A was significantly associated with illness (odds ratio: 7.3; 95% confidence interval: 3.6, 15.2). Eight out of nine (89%) stool specimens tested were positive for Cryptosporidium, with C. hominis IfA12G1 subtype identified in two specimens. The environmental health assessment detected a low free available chlorine level, and pool water tested positive for E. coli and total coliforms. A possible diarrheal contamination event, substantial hotel pool use, and use of cyanuric acid might have contributed to this outbreak and magnitude. Aquatic facilities practicing proper operation and maintenance (e.g., following the Centers for Disease Control and Prevention’s Model Aquatic Health Code) can protect the public’s health.

  2. Diphtheria outbreak in Lao People's Democratic Republic, 2012-2013.

    Science.gov (United States)

    Sein, Carolyn; Tiwari, Tejpratap; Macneil, Adam; Wannemuehler, Kathleen; Soulaphy, Chanthavy; Souliphone, Phouthone; Reyburn, Rita; Ramirez Gonzalez, Alejandro; Watkins, Margaret; Goodson, James L

    2016-08-05

    Diphtheria is a vaccine-preventable disease. When vaccination coverage and population immunity are low, outbreaks can occur. We investigated a diphtheria outbreak in Lao People's Democratic Republic that occurred during 2012-2013 and highlighted challenges in immunization services delivery to children in the country. We reviewed diphtheria surveillance data from April 1, 2012-May 31, 2013. A diphtheria case was defined as a respiratory illness consisting of pharyngitis, tonsillitis, or laryngitis, and an adherent tonsillar or nasopharyngeal pseudomembrane. To identify potential risk factors for diphtheria, we conducted a retrospective case-control study with two aged-matched neighborhood controls per case-patient in Houaphan Province, using bivariate analysis to calculate matched odds ratio (mOR) with 95% confidence intervals (CI). Reasons for non-vaccination among unvaccinated persons were assessed. Sixty-two clinical cases of diphtheria and 12 diphtheria-related deaths were reported in seven of 17 provinces. Among case-patients, 43 (69%) were diphtheria case-patients from Houaphan province and 79 matched-controls were enrolled. Five (12%) case-patients and 20 (25%) controls had received DTP3 (mOR=0.4, CI=0.1-1.7). No diphtheria toxoid-containing vaccine was received by 20 (48%) case-patients and 38 (46%) controls. Among case-patients and controls with no DTP dose, 43% of case-patients and 40% of controls lacked access to routine immunization services. Suboptimal DTP3 coverage likely caused the outbreak. To prevent continued outbreaks, access to routine immunization services should be strengthened, outreach visits need to be increased, and missed opportunities need to be minimized. In the short term, to rapidly increase population immunity, three rounds of DTP immunization campaign should be completed, targeting children aged 0-14years in affected provinces. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Ebola virus disease: history, epidemiology and outbreaks.

    Science.gov (United States)

    Weyer, Jacqueline; Grobbelaar, Antoinette; Blumberg, Lucille

    2015-05-01

    Over the past 40 years, sporadic Ebola virus disease (EVD) outbreaks have occurred mostly in the central African region. In March 2014, an outbreak of EVD was recognized in Guinea which would become the most significant outbreak of haemorrhagic fever in Africa to date. The outbreak started in Guinea and rapidly spread to Liberia and Sierra Leone, claiming thousands of lives. Many questions still remain regarding the ecology of Ebola viruses, but it is believed that contact with infected bushmeat is an important risk factor for initial spill over of the virus into the human population. At present, there is still no registered prophylaxis or curative biologicals against EVD.

  4. International epidemiological and microbiological study of outbreak of Salmonella agona infection from a ready to eat savoury snack--I: England and Wales and the United States.

    Science.gov (United States)

    Killalea, D; Ward, L R; Roberts, D; de Louvois, J; Sufi, F; Stuart, J M; Wall, P G; Susman, M; Schwieger, M; Sanderson, P J; Fisher, I S; Mead, P S; Gill, O N; Bartlett, C L; Rowe, B

    1996-11-02

    To identify the source of an international outbreak of food poisoning due to Salmonella agona phage type 15 and to measure how long the underlying cause persisted. Case-control study of 16 primary household cases and 32 controls of similar age and dietary habit. Packets of the implicated foodstuff manufactured on a range of days were examined for salmonella. All isolates of the epidemic phage type were further characterised by pulsed field gel electrophoresis. 27 cases were identified, of which 26 were in children. The case-control study showed a strong association between infection with S agona phage type 15 and consumption of a peanut flavoured ready to eat kosher savoury snack imported from Israel. S agona phage type 15 was isolated from samples of this snack. The combined food sampling results from the United Kingdom, Canada, the United States, and Israel showed that contaminated snacks were manufactured on at least seven separate dates during a four month period between October 1994 and February 1995. Voluntary recalls of the product successfully interrupted transmission. Rapid international exchanges of information led to the identification of the source of a major outbreak of S agona in Israel and of associated cases in North America. The outbreak showed the value of the Salm-Net surveillance system and its links outside Europe, both for increasing case ascertainment and for improving the information on the duration of the fault at the manufacturing plant.

  5. ABILITY TO SELF-CONTROL IN BIOFEEDBACK GAMES AND SUCCESS OF PUPILS OF 11–13 YEARS

    Directory of Open Access Journals (Sweden)

    O. B. Gileva

    2013-01-01

    Full Text Available The relation of indicators of biofeedback and the school success was studied. The relation of pulse interval, wave structure of heart rate, Sacred George's index (StGe and progress of children is found out. Results are discussed with relations of use of computer biofeedback games for studying of psychophysiological features and predictors of school success.

  6. An epidemic outbreak of cryptosporidiosis

    DEFF Research Database (Denmark)

    Mølbak, Kåre; Højlyng, Niels; Ingholt, Liselotte

    1990-01-01

    In the first year of a prospective community study of childhood diarrhea conducted in a semiurban area in the capital of Guinea Bissau, Cryptosporidium sp. was found in 73 (6.0%) of 1216 episodes of diarrhea. The parasite was the second most prevalent intestinal parasite, and the only one...... significantly associated with diarrhea (OR = 2.79, P = 0.0006). The seasonal distribution was striking, with a peak prevalence in the beginning of the rainy season (May 17.6%) when an epidemic outbreak of diarrhea started. The prevalence was highest in children younger than 18 months, an age at which...

  7. Simulating coupled carbon and nitrogen dynamics following mountain pine beetle outbreaks in the western United States

    Energy Technology Data Exchange (ETDEWEB)

    Edburg, Steven L. [Univ. of Idaho, Moscow, ID (United States); Hicke, Jeffrey A. [Univ. of Idaho, Moscow, ID (United States); Lawrence, David M. [National Center for Atmospheric Research, Boulder, CO (United States); Thornton, Peter E. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2011-01-01

    Insect outbreaks are major ecosystem disturbances, affecting a similar area as forest fires annually across North America. Tree mortality caused by epidemics of bark beetles alters carbon cycling in the first several years following the disturbance by reducing stand-level primary production and increasing decomposition rates. The few studies of biogeochemical cycling following outbreaks have shown a range of impacts from small responses of net carbon fluxes in the first several years after a severe outbreak to large forest areas that are sources of carbon to the atmosphere for decades. To gain more understanding about causes of this range of responses, we used an ecosystem model to assess impacts of different bark beetle outbreak conditions on coupled carbon and nitrogen cycling. We modified the Community Land Model with prognostic carbon and nitrogen to include prescribed bark beetle outbreaks. We then compared control simulations (without a bark beetle outbreak) to simulations with various mortality severity, durations of outbreak, and snagfall dynamics to quantify the range of carbon flux responses and recovery rates of net ecosystem exchange to a range of realistic outbreak conditions. Prescribed mortality by beetles reduced leaf area and thus productivity. Gross primary productivity decreased by as much as 80% for a severe outbreak (95% mortality) and by 10% for less severe outbreaks (25% mortality). Soil mineral nitrogen dynamics (immobilization and plant uptake) were important in governing post-outbreak productivity, and were strongly modulated by carbon inputs to the soil from killed trees. Initial increases in heterotrophic respiration caused by a pulse of labile carbon from roots were followed by a slight reduction (from pre-snagfall reduced inputs), then a secondary increase (from inputs due to snagfall). Secondary increases in heterotrophic respiration were largest for simulated windthrow of snags after a prescribed snagfall delay period. Net ecosystem

  8. Nitrogen availability as a control mechanism of secondary succession within a semiarid shrubland ecosystem. Final report, October 1, 1990--June 27, 1992

    Energy Technology Data Exchange (ETDEWEB)

    Redente, E.F.; McLendon, T.

    1992-09-25

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

  9. Outbreak

    DEFF Research Database (Denmark)

    Dahl, Kristian Aagaard; Agger Nielsen, Jeppe

    Forestillingen om at ledelse er situationsafhængig og varierer alt efter hvilket lederniveau der fokuseres på trækker spor tilbage til en række tidlige ledelsesteoretikere. I de senere år har tilgangen på ny tiltrukket sig opmærksomhed såvel i praksisfeltet som blandt forskere, nok tydeligst illu...

  10. Weak Compliance Undermines the Success of No-Take Zones in a Large Government-Controlled Marine Protected Area

    KAUST Repository

    Campbell, Stuart J.

    2012-11-30

    The effectiveness of marine protected areas depends largely on whether people comply with the rules. We quantified temporal changes in benthic composition, reef fish biomass, and fishing effort among marine park zones (including no-take areas) to assess levels of compliance following the 2005 rezoning of the government-controlled Karimunjawa National Park (KNP), Indonesia. Four years after the rezoning awareness of fishing regulations was high amongst local fishers, ranging from 79.5±7.9 (SE) % for spatial restrictions to 97.7±1.2% for bans on the use of poisons. Despite this high awareness and strong compliance with gear restrictions, compliance with spatial restrictions was weak. In the four years following the rezoning reef fish biomass declined across all zones within KNP, with >50% reduction within the no-take Core and Protection Zones. These declines were primarily driven by decreases in the biomass of groups targeted by local fishers; planktivores, herbivores, piscivores, and invertivores. These declines in fish biomass were not driven by changes in habitat quality; coral cover increased in all zones, possibly as a result of a shift in fishing gears from those which can damage reefs (i.e., nets) to those which cause little direct damage (i.e., handlines and spears). Direct observations of fishing activities in 2009 revealed there was limited variation in fishing effort between zones in which fishing was allowed or prohibited. The apparent willingness of the KNP communities to comply with gear restrictions, but not spatial restrictions is difficult to explain and highlights the complexities of the social and economic dynamics that influence the ecological success of marine protected areas. Clearly the increased and high awareness of fishery restrictions following the rezoning is a positive step. The challenge now is to understand and foster the conditions that may facilitate compliance with spatial restrictions within KNP and marine parks worldwide. © 2012

  11. Repetitive dengue outbreaks in East Africa: A proposed phased mitigation approach may reduce its impact.

    Science.gov (United States)

    Baba, Marycelin; Villinger, Jandouwe; Masiga, Daniel K

    2016-05-01

    Dengue outbreaks have persistently occurred in eastern African countries for several decades. We assessed each outbreak to identify risk factors and propose a framework for prevention and impact mitigation. Seven out of ten countries in eastern Africa and three islands in the Indian Ocean have experienced dengue outbreaks between 1823 and 2014. Major risk factors associated with past dengue outbreaks include climate, virus and vector genetics and human practices. Appropriate use of dengue diagnostic tools and their interpretation are necessary for both outbreak investigations and sero-epidemiological studies. Serosurvey findings during inter-epidemic periods have not been adequately utilised to prevent re-occurrence of dengue outbreaks. Local weather variables may be used to predict dengue outbreaks, while entomological surveillance can complement other disease-mitigation efforts during outbreaks and identify risk-prone areas during inter-epidemic periods. The limitations of past dengue outbreak responses and the enormous socio-economic impacts of the disease on human health are highlighted. Its repeated occurrence in East Africa refutes previous observations that susceptibility may depend on race. Alternate hypotheses on heterotypic protection among flaviviruses may not be applied to all ecologies. Prevention and mitigation of severe dengue outbreaks should necessarily consider the diverse factors associated with their occurrence. Implementation of phased dengue mitigation activities can enforce timely and judicious use of scarce resources, promote environmental sanitation, and drive behavioural change, hygienic practices and community-based vector control. Understanding dengue epidemiology and clinical symptoms, as determined by its evolution, are significant to preventing future dengue epidemics. Copyright © 2016 John Wiley & Sons, Ltd.

  12. Alarm Variables for Dengue Outbreaks: A Multi-Centre Study in Asia and Latin America.

    Directory of Open Access Journals (Sweden)

    Leigh R Bowman

    Full Text Available Worldwide, dengue is an unrelenting economic and health burden. Dengue outbreaks have become increasingly common, which place great strain on health infrastructure and services. Early warning models could allow health systems and vector control programmes to respond more cost-effectively and efficiently.The Shewhart method and Endemic Channel were used to identify alarm variables that may predict dengue outbreaks. Five country datasets were compiled by epidemiological week over the years 2007-2013. These data were split between the years 2007-2011 (historic period and 2012-2013 (evaluation period. Associations between alarm/ outbreak variables were analysed using logistic regression during the historic period while alarm and outbreak signals were captured during the evaluation period. These signals were combined to form alarm/ outbreak periods, where 2 signals were equal to 1 period. Alarm periods were quantified and used to predict subsequent outbreak periods. Across Mexico and Dominican Republic, an increase in probable cases predicted outbreaks of hospitalised cases with sensitivities and positive predictive values (PPV of 93%/ 83% and 97%/ 86% respectively, at a lag of 1-12 weeks. An increase in mean temperature ably predicted outbreaks of hospitalised cases in Mexico and Brazil, with sensitivities and PPVs of 79%/ 73% and 81%/ 46% respectively, also at a lag of 1-12 weeks. Mean age was predictive of hospitalised cases at sensitivities and PPVs of 72%/ 74% and 96%/ 45% in Mexico and Malaysia respectively, at a lag of 4-16 weeks.An increase in probable cases was predictive of outbreaks, while meteorological variables, particularly mean temperature, demonstrated predictive potential in some countries, but not all. While it is difficult to define uniform variables applicable in every country context, the use of probable cases and meteorological variables in tailored early warning systems could be used to highlight the occurrence of dengue

  13. A Chryseobacterium meningosepticum outbreak in a neonatal ward.

    Science.gov (United States)

    Güngör, Serdal; Ozen, Metehan; Akinci, Aysehan; Durmaz, Riza

    2003-08-01

    To report epidemiologic, bacteriologic, and clinical features of a Chryseobacterium meningosepticum outbreak. Outbreak investigation. A neonatal intensive care unit (NICU) of a referral teaching hospital. During 2 weeks in September 2001, four neonates in the NICU developed sepsis and underwent laboratory investigation. Multiple samples were obtained for cultures from endotracheal tubes, mechanical ventilators and humidifier boxes, infant incubators, parenteral and antiseptic solutions, feeding bottles, sinks, faucets, doors, and healthcare workers. C. meningosepticum was isolated from the blood cultures of four patients. The first isolate was identified 5 days after the death of the index case. Although all isolates were ciprofloxacin susceptible in vitro, the remaining three patients did not respond to ciprofloxacin therapy given for 6 or 7 days. Therapy was switched to vancomycin and rifainpin and all three patients survived, with one having a complication (hydrocephalus). Environmental surveillance revealed C. meningosepticum in the stock lipid solution as the source of the epidemic. The outbreak was controlled after discontinuation of intravenous lipid solution, restriction of further neonatal admissions, and thorough disinfection of the unit and its equipment. Early identification of an epidemic and its source is important in avoiding morbidity and mortality. A contaminated lipid stock bottle was the source of this outbreak associated with multiple cases and one death.

  14. Measles Outbreak among Previously Immunized Adult Healthcare Workers, China, 2015

    Directory of Open Access Journals (Sweden)

    Zhengyi Zhang

    2016-01-01

    Full Text Available Measles is caused by measles virus belonging to genus Morbillivirus of the family Paramyxoviridae. Vaccination has played a critical role in controlling measles infection worldwide. However, in the recent years, outbreaks of measles infection still occur in many developing countries. Here, we report an outbreak of measles among healthcare workers and among the 60 measles infected patients 50 were healthcare workers including doctors, nurses, staff, and medics. Fifty-one patients (85% tested positive for IgM antibodies against the measles virus and 50 patients (83.3% tested positive for measles virus RNA. Surprisingly, 73.3% of the infected individuals had been previously immunized against measles. Since there is no infection division in our hospital, the fever clinics are located in the Emergency Division. In addition, the fever and rash were not recognized as measles symptoms at the beginning of the outbreak. These factors result in delay in isolation and early confirmation of the suspected patients and eventually a measles outbreak in the hospital. Our report highlights the importance of following a two-dose measles vaccine program in people including the healthcare workers. In addition, vigilant attention should be paid to medical staff with clinical fever and rash symptoms to avoid a possible nosocomial transmission of measles infection.

  15. Key data for outbreak evaluation: building on the Ebola experience.

    Science.gov (United States)

    Cori, Anne; Donnelly, Christl A; Dorigatti, Ilaria; Ferguson, Neil M; Fraser, Christophe; Garske, Tini; Jombart, Thibaut; Nedjati-Gilani, Gemma; Nouvellet, Pierre; Riley, Steven; Van Kerkhove, Maria D; Mills, Harriet L; Blake, Isobel M

    2017-05-26

    Following the detection of an infectious disease outbreak, rapid epidemiological assessment is critical for guiding an effective public health response. To understand the transmission dynamics and potential impact of an outbreak, several types of data are necessary. Here we build on experience gained in the West African Ebola epidemic and prior emerging infectious disease outbreaks to set out a checklist of data needed to: (1) quantify severity and transmissibility; (2) characterize heterogeneities in transmission and their determinants; and (3) assess the effectiveness of different interventions. We differentiate data needs into individual-level data (e.g. a detailed list of reported cases), exposure data (e.g. identifying where/how cases may have been infected) and population-level data (e.g. size/demographics of the population(s) affected and when/where interventions were implemented). A remarkable amount of individual-level and exposure data was collected during the West African Ebola epidemic, which allowed the assessment of (1) and (2). However, gaps in population-level data (particularly around which interventions were applied when and where) posed challenges to the assessment of (3). Here we highlight recurrent data issues, give practical suggestions for addressing these issues and discuss priorities for improvements in data collection in future outbreaks.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'. © 2017 The Authors.

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

    Science.gov (United States)

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

    2008-08-01

    Catering businesses continue to be the most common setting for foodborne disease outbreaks. In a study of catering businesses in England and Wales, operational practices relating to the supply, preparation, and service