An eclogite-bearing continental tectonic slice in the Zermatt-Saas high-pressure ophiolites at Trockener Steg (Zermatt, Swiss Western Alps)

Science.gov (United States)

Weber, Sebastian; Bucher, Kurt

2015-09-01

The Theodul Glacier Unit (TGU) at "Trockener Steg" represents a continental slice, embedded within the ophiolitic Zermatt-Saas Zone. The Zermatt-Saas Zone is the remnant of the Piemonte-Liguria oceanic lithosphere, formed in the middle Jurassic and subducted up to eclogite facies conditions in the Early Tertiary. The close spatial association of the TGU to the Zermatt-Saas Zone permits a comparison of the metamorphic evolution of the units by detailed field mapping and a petrological investigation of eclogites. The eclogites from both tectono-metamorphic units can be clearly distinguished by their textures, mineral assemblages and by mineral and bulk-rock composition. Geothermobarometry and computed assemblage stability diagrams for the TGU eclogites indicate P-T conditions of 2.2 ± 0.1 GPa and 580 ± 50 °C. These derived P-T conditions must be considered as minimum peak metamorphic conditions the rocks achieved during subduction. The P-T data are different from those derived for eclogites of Zermatt-Saas Zone adjacent to the Theodul Glacier Unit, that reached maximal burial depths at 2.3-2.4 GPa and 500 ± 50 °C. While the estimates of the eclogites of Zermatt-Saas Zone are in good agreement with some of the previous studies, the contrasting P-T estimates for the TGU eclogites suggest that the Zermatt-Saas complex must be subdivided into several tectonic subunits. The non-uniform peak conditions over the "Trockener Steg" area and the maximum pressures conditions reported from ultra-high pressure localities within Zermatt-Saas Zone suggest, that individual tectonic slices have been assembled after detachment from the slab at the return-point, i.e. along the exhumation path. Detached packages of rocks may range from small tectonic slices up to several kilometer-sized fragments. The TGU is separated from the surrounding rocks of the ophiolite unit by two major tectonic contacts. In addition, the formation of biotite-rich crusts along the basal contact of the TGU

Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.

Science.gov (United States)

Shaikhani, Mohammad A R; Husein, Hiwa A B; Karbuli, Taha A; Mohamed, Mohamed Abdulrahman

2013-09-01

Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

Typhoid outbreak in Songkhla, Thailand 2009-2011: clinical outcomes, susceptibility patterns, and reliability of serology tests.

Directory of Open Access Journals (Sweden)

Wannee Limpitikul

Full Text Available OBJECTIVE: To determine the clinical manifestations and outcomes, the reliability of Salmonella enterica serotype Typhi (S ser. Typhi IgM and IgG rapid tests, and the susceptibility patterns and the response to treatment during the 2009-2011 typhoid outbreak in Songkhla province in Thailand. METHOD: The medical records of children aged <15 years with S ser. Typhi bacteremia were analysed. The efficacy of the typhoid IgM and IgG rapid tests and susceptibility of the S ser. Typhi to the current main antibiotics used for typhoid (amoxicillin, ampicillin, cefotaxime, ceftriaxone, co-trimoxazole, and ciprofloxacin, were evaluated. RESULTS: S ser. Typhi bacteremia was found in 368 patients, and all isolated strains were susceptible to all 6 antimicrobials tested. Most of the patients were treated with ciprofloxacin for 7-14 days. The median time (IQR of fever before treatment and duration of fever after treatment were 5 (4, 7 days and 4 (3, 5 days, respectively. Complications of ascites, lower respiratory symptoms, anemia (Hct <30%, and ileal perforation were found in 7, 7, 22, and 1 patients, respectively. None of the patients had recurrent infection or died. The sensitivities of the typhoid IgM and IgG tests were 58.3% and 25.6% respectively, and specificities were 74.1% and 50.5%, respectively. CONCLUSION: Most of the patients were diagnosed at an early stage and treated with a good outcome. All S ser. Typhi strains were susceptible to standard first line antibiotic typhoid treatment. The typhoid IgM and IgG rapid tests had low sensitivity and moderate specificity.

Typhoid outbreak investigation in Dzivaresekwa, suburb of Harare

African Journals Online (AJOL)

abp

2014-08-18

Aug 18, 2014 ... Abstract. Introduction: Typhoid fever is a systemic infection caused by a Gram negative bacterium, Salmonella typhi. Harare City reported 1078 cases of suspected typhoid fever cases from October 2011 to January 2012. We initiated an investigation to identify possible source of transmission so as to.

Vaccination for typhoid fever in sub-Saharan Africa.

Science.gov (United States)

Slayton, Rachel B; Date, Kashmira A; Mintz, Eric D

2013-04-01

Emerging data on the epidemiologic, clinical and microbiologic aspects of typhoid fever in sub-Saharan Africa call for new strategies and new resources to bring the regional epidemic under control. Areas with endemic disease at rates approaching those in south Asia have been identified; large, prolonged and severe outbreaks are occurring more frequently; and resistance to antimicrobial agents, including fluoroquinolones is increasing. Surveillance for typhoid fever is hampered by the lack of laboratory resources for rapid diagnosis, culture confirmation and antimicrobial susceptibility testing. Nonetheless, in 2010, typhoid fever was estimated to cause 725 incident cases and 7 deaths per 100,000 person years in sub-Saharan Africa. Efforts for prevention and outbreak control are challenged by limited access to safe drinking water and sanitation and by a lack of resources to initiate typhoid immunization. A comprehensive approach to typhoid fever prevention including laboratory and epidemiologic capacity building, investments in water, sanitation and hygiene and reconsideration of the role of currently available vaccines could significantly reduce the disease burden. Targeted vaccination using currently available typhoid vaccines should be considered as a short- to intermediate-term risk reduction strategy for high-risk groups across sub-Saharan Africa.

Typhoid fever: A report on a point-source outbreak of 69 cases in Cape Town.

Science.gov (United States)

Popkiss, M E

1980-03-01

In 1978, after a party in a Cape Town suburb attended by several hundred people, 69 persons were treated for typhoid fever. The precise source of the infection could not be traced, although it is reasonable to suppose that food eaten at the party had been contaminated by the main caterer. All 57 cultures of Salmonella typhi phage-typed were of phage type 46, including that obtained from the stool of the main caterer, who was asymptomatic. An epidemiological profile of the cases and an account of the management of the outbreak is given. There were no deaths and no patient became a carrier. Although the outbreak was contained, certain problems relating thereto are aired, including in particular the potential hazard of food-borne disease wherever housing and environmental standards are low.

A typhoid fever outbreak in a slum of South Dumdum municipality, West Bengal, India, 2007: Evidence for foodborne and waterborne transmission

Directory of Open Access Journals (Sweden)

Pal Nishith

2009-04-01

Full Text Available Abstract Background In April 2007, a slum of South Dumdum municipality, West Bengal reported an increase in fever cases. We investigated to identify the agent, the source and to propose recommendations. Methods We defined a suspected case of typhoid fever as occurrence of fever for ≥ one week among residents of ward 1 of South Dumdum during February – May 2007. We searched for suspected cases in health care facilities and collected blood specimens. We described the outbreak by time, place and person. We compared probable cases (Widal positive >= 1:80 with neighbourhood-matched controls. We assessed the environment and collected water specimens. Results We identified 103 suspected cases (Attack rate: 74/10,000, highest among 5–14 years old group, no deaths. Salmonella (enterica Typhi was isolated from one of four blood specimens and 65 of 103 sera were >= 1:80 Widal positive. The outbreak started on 13 February, peaked twice during the last week of March and second week of April and lasted till 27 April. Suspected cases clustered around three public taps. Among 65 probable cases and 65 controls, eating milk products from a sweet shop (Matched odds ratio [MOR]: 6.2, 95% confidence interval [CI]: 2.4–16, population attributable fraction [PAF]: 53% and drinking piped water (MOR: 7.3, 95% CI: 2.5–21, PAF-52% were associated with illness. The sweet shop food handler suffered from typhoid in January. The pipelines of intermittent non-chlorinated water supply ran next to an open drain connected with sewerage system and water specimens showed faecal contamination. Conclusion The investigation suggested that an initial foodborne outbreak of typhoid led to the contamination of the water supply resulting in a secondary, waterborne wave. We educated the food handler, repaired the pipelines and ensured chlorination of the water.

A typhoid fever outbreak in a slum of South Dumdum municipality, West Bengal, India, 2007: evidence for foodborne and waterborne transmission.

Science.gov (United States)

Bhunia, Rama; Hutin, Yvan; Ramakrishnan, Ramachandran; Pal, Nishith; Sen, Tapas; Murhekar, Manoj

2009-04-27

In April 2007, a slum of South Dumdum municipality, West Bengal reported an increase in fever cases. We investigated to identify the agent, the source and to propose recommendations. We defined a suspected case of typhoid fever as occurrence of fever for > or = one week among residents of ward 1 of South Dumdum during February - May 2007. We searched for suspected cases in health care facilities and collected blood specimens. We described the outbreak by time, place and person. We compared probable cases (Widal positive > or = 1:80) with neighbourhood-matched controls. We assessed the environment and collected water specimens. We identified 103 suspected cases (Attack rate: 74/10,000, highest among 5-14 years old group, no deaths). Salmonella (enterica) Typhi was isolated from one of four blood specimens and 65 of 103 sera were > or = 1:80 Widal positive. The outbreak started on 13 February, peaked twice during the last week of March and second week of April and lasted till 27 April. Suspected cases clustered around three public taps. Among 65 probable cases and 65 controls, eating milk products from a sweet shop (Matched odds ratio [MOR]: 6.2, 95% confidence interval [CI]: 2.4-16, population attributable fraction [PAF]: 53%) and drinking piped water (MOR: 7.3, 95% CI: 2.5-21, PAF-52%) were associated with illness. The sweet shop food handler suffered from typhoid in January. The pipelines of intermittent non-chlorinated water supply ran next to an open drain connected with sewerage system and water specimens showed faecal contamination. The investigation suggested that an initial foodborne outbreak of typhoid led to the contamination of the water supply resulting in a secondary, waterborne wave. We educated the food handler, repaired the pipelines and ensured chlorination of the water.

Photovoltaic plant `Sunnegga` in Zermatt: Powerful sun; Photovoltaikanlage ``Sunnegga`` in Zermatt: Sonne ``in Stroemen``

Energy Technology Data Exchange (ETDEWEB)

Arnold, L

1995-09-01

People of the Upper Wallis and German Swiss mean with the dialect term ``Egga`` or ``Egge`` not only a geometric corner but also a hill in the landscape. The whole canton of Wallis actually is the Sunnegga, the sunny corner of Switzerland. This title results from the ideal orientation of the Rhone valley in East-West direction - the direction in which ``the sun moves during the day``. Above all the south-oriented flanks of the mountains (right of the Rhone) are up to the bottom of the valley best suited to use solar energy for water heating and power generation. The municipality of Zermatt has therefore installed a photovoltaic pilot plant on the roof of the restaurant ``Sunnegga``. ``HAUS TECH`` presents the plant. (orig.) [Deutsch] Die Oberwalliser und Deutschschweizer verstehen unter dem Dialektausdruck ``Egga`` bzw. ``Egge`` nicht nur eine raeumliche Ecke, sondern auch einen Huegel in der Landschaft. Der gesamte Kanton Wallis ist die eigentliche Sunnegga, die ``Sonnenecke`` der Schweiz. Dieses Praedikat verleiht ihm die ideale Ausrichtung des Rhonetales in Ost/West-Richtung - in der ``Laufrichtung`` der Sonne. Vor allem aber sind die suedwaerts exponierten Bergflanken (rechts der Rhone) bis in die Talsohle hervorragend geeignet, die Sonnenenergie sowohl zur Wassererwaermung wie auch Stromerzeugung zu nutzen. Die Gemeinde Zermatt hat deshalb eine solare Photovoltaik-Pilotanlage auf den Daechern des Restaurantes ``Sunnegga`` realisiert. ``HAUS TECH`` stellt die Anlage vor. (orig.)

An Outbreak of Food-Borne Typhoid Fever Due to Salmonella enterica Serotype Typhi in Japan Reported for the First Time in 16 Years

Science.gov (United States)

Kobayashi, Tetsuro; Kutsuna, Satoshi; Hayakawa, Kayoko; Kato, Yasuyuki; Ohmagari, Norio; Uryu, Hideko; Yamada, Ritsuko; Kashiwa, Naoyuki; Nei, Takahito; Ehara, Akihito; Takei, Reiko; Mori, Nobuaki; Yamada, Yasuhiro; Hayasaka, Tomomi; Kagawa, Narito; Sugawara, Momoko; Suzaki, Ai; Takahashi, Yuno; Nishiyama, Hiroyuki; Morita, Masatomo; Izumiya, Hidemasa; Ohnishi, Makoto

2016-01-01

For the first time in 16 years, a food-borne outbreak of typhoid fever due to Salmonella enterica serotype Typhi was reported in Japan. Seven patients consumed food in an Indian buffet at a restaurant in the center of Tokyo, while one was a Nepali chef in the restaurant, an asymptomatic carrier and the implicated source of this outbreak. The multiple-locus variable-number tandem repeat analysis showed 100% consistency in the genomic sequence for five of the eight cases. PMID:26621565

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

Science.gov (United States)

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

2016-10-01

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

Typhoid outbreak investigation in Dzivaresekwa, suburb of Harare

African Journals Online (AJOL)

abp

2014-08-18

Aug 18, 2014 ... typhoid fever carry the bacteria in their bloodstream and intestinal tract [1,2]. ... preparedness and response of the Harare City Health Department. Records of .... Treated shallow well water had residual chlorine of 0.1 mg/litre.

Typhoid Fever in South Africa in an Endemic HIV Setting.

Science.gov (United States)

Keddy, Karen H; Sooka, Arvinda; Smith, Anthony M; Musekiwa, Alfred; Tau, Nomsa P; Klugman, Keith P; Angulo, Frederick J

2016-01-01

Typhoid fever remains an important disease in Africa, associated with outbreaks and the emerging multidrug resistant Salmonella enterica serotype Typhi (Salmonella Typhi) haplotype, H58. This study describes the incidence of, and factors associated with mortality due to, typhoid fever in South Africa, where HIV prevalence is high. Nationwide active laboratory-based surveillance for culture-confirmed typhoid fever was undertaken from 2003-2013. At selected institutions, additional clinical data from patients were collected including age, sex, HIV status, disease severity and outcome. HIV prevalence among typhoid fever patients was compared to national HIV seroprevalence estimates. The national reference laboratory tested Salmonella Typhi isolates for antimicrobial susceptibility and haplotype. Unadjusted and adjusted logistic regression analyses were conducted determining factors associated with typhoid fever mortality. We identified 855 typhoid fever cases: annual incidence ranged from 0.11 to 0.39 per 100,000 population. Additional clinical data were available for 369 (46.8%) cases presenting to the selected sites. Among typhoid fever patients with known HIV status, 19.3% (29/150) were HIV-infected. In adult females, HIV prevalence in typhoid fever patients was 43.2% (19/44) versus 15.7% national HIV seroprevalence (P Typhoid fever incidence in South Africa was largely unchanged from 2003-2013. Typhoid fever mortality was associated disease severity. HIV infection may be a contributing factor. Interventions mandate improved health care access, including to HIV management programmes as well as patient education. Further studies are necessary to clarify relationships between HIV infection and typhoid fever in adults.

Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border.

Science.gov (United States)

Lutterloh, Emily; Likaka, Andrew; Sejvar, James; Manda, Robert; Naiene, Jeremias; Monroe, Stephan S; Khaila, Tadala; Chilima, Benson; Mallewa, Macpherson; Kampondeni, Sam D; Lowther, Sara A; Capewell, Linda; Date, Kashmira; Townes, David; Redwood, Yanique; Schier, Joshua G; Nygren, Benjamin; Tippett Barr, Beth; Demby, Austin; Phiri, Abel; Lungu, Rudia; Kaphiyo, James; Humphrys, Michael; Talkington, Deborah; Joyce, Kevin; Stockman, Lauren J; Armstrong, Gregory L; Mintz, Eric

2012-04-01

Salmonella enterica serovar Typhi causes an estimated 22 million cases of typhoid fever and 216 000 deaths annually worldwide. We investigated an outbreak of unexplained febrile illnesses with neurologic findings, determined to be typhoid fever, along the Malawi-Mozambique border. The investigation included active surveillance, interviews, examinations of ill and convalescent persons, medical chart reviews, and laboratory testing. Classification as a suspected case required fever and ≥1 other finding (eg, headache or abdominal pain); a probable case required fever and a positive rapid immunoglobulin M antibody test for typhoid (TUBEX TF); a confirmed case required isolation of Salmonella Typhi from blood or stool. Isolates underwent antimicrobial susceptibility testing and subtyping by pulsed-field gel electrophoresis (PFGE). We identified 303 cases from 18 villages with onset during March-November 2009; 214 were suspected, 43 were probable, and 46 were confirmed cases. Forty patients presented with focal neurologic abnormalities, including a constellation of upper motor neuron signs (n = 19), ataxia (n = 22), and parkinsonism (n = 8). Eleven patients died. All 42 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 4 were also resistant to nalidixic acid. Thirty-five of 42 isolates were indistinguishable by PFGE. The unusual neurologic manifestations posed a diagnostic challenge that was resolved through rapid typhoid antibody testing in the field and subsequent blood culture confirmation in the Malawi national reference laboratory. Extending laboratory diagnostic capacity, including blood culture, to populations at risk for typhoid fever in Africa will improve outbreak detection, response, and clinical treatment.

Review of current typhoid fever vaccines, cross-protection against paratyphoid fever, and the European guidelines.

Science.gov (United States)

Zuckerman, Jane N; Hatz, Christoph; Kantele, Anu

2017-10-01

Typhoid and paratyphoid fever remain a global health problem, which - in non-endemic countries - are mainly seen in travelers, particularly in VFRs (visiting friends and relatives), with occasional local outbreaks occurring. A rise in anti-microbial resistance emphasizes the role of preventive measures, especially vaccinations against typhoid and paratyphoid fever for travelers visiting endemic countries. Areas covered: This state-of-the-art review recapitulates the epidemiology and mechanisms of disease of typhoid and paratyphoid fever, depicts the perspective of non-endemic countries and travelers (VFRs), and collectively presents current European recommendations for typhoid fever vaccination. We provide a brief overview of available (and developmental) vaccines in Europe, present current data on cross-protection to S. Paratyphi, and aim to provide a background for typhoid vaccine decision-making in travelers. Expert commentary: European recommendations are not harmonized. Experts must assess vaccination of travelers based on current country-specific recommendations. Travel health practitioners should be aware of the issues surrounding vaccination of travelers and be motivated to increase awareness of typhoid and paratyphoid fever risks.

The internal structure of eclogite-facies ophiolite complexes: Implications from the Austroalpine outliers within the Zermatt-Saas Zone, Western Alps

Science.gov (United States)

Weber, Sebastian; Martinez, Raul

2016-04-01

The Western Alpine Penninic domain is a classical accretionary prism that formed after the closure of the Penninic oceans in the Paleogene. Continental and oceanic nappes were telescoped into the Western Alpine stack associated with continent-continent collision. Within the Western Alpine geologic framework, the ophiolite nappes of the Zermatt-Saas Zone and the Tsate Unit are the remnants of the southern branch of the Piemonte-Liguria ocean basin. In addition, a series of continental basement slices reported as lower Austroalpine outliers have preserved an eclogitic high-pressure imprint, and are tectonically sandwiched between these oceanic nappes. Since the outliers occur at an unusual intra-ophiolitic setting and show a polymetamorphic character, this group of continental slices is of special importance for understanding the tectono-metamorphic evolution of Western Alps. Recently, more geochronological data from the Austroalpine outliers have become available that make it possible to establish a more complete picture of their complex geological history. The Lu-Hf garnet-whole rock ages for prograde growth of garnet fall into the time interval of 52 to 62 Ma (Weber et al., 2015, Fassmer et al. 2015), but are consistently higher than the Lu-Hf garnet-whole rock ages from several other locations throughout the Zermatt-Saas zone that range from 52 to 38 Ma (Skora et al., 2015). This discrepancy suggests that the Austroalpine outliers may have been subducted earlier than the ophiolites of the Zermatt-Saas Zone and therefore have been tectonically emplaced into their present intra-ophiolite position. This points to the possibility that the Zermatt-Saas Zone consists of tectonic subunits, which reached their respective pressure peaks over a prolonged time period, approximately 10-20 Ma. The pressure-temperature estimates from several members of the Austroalpine outliers indicate a complex distribution of metamorphic peak conditions, without ultrahigh

[Epidemiological characteristics of typhoid fever and antibiotic susceptibility testing of Salmonella Typhi isolates in Guangxi, 1994-2013].

Science.gov (United States)

Wang, Mingliu; Kan, Biao; Yang, Jin; Lin, Mei; Yan, Meiying; Zeng, Jun; Quan, Yi; Liao, Hezhuang; Zhou, Lingyun; Jiang, Zhenling; Huang, Dehui

2014-08-01

Through analyzing the typhoid epidemics and to determine and monitor regional resistance characteristics of the shift of drug resistant profile on Salmonella (S.) Typhi, to understand the related epidemiological characteristics of typhoid fever and to provide evidence for the development of strategies, in Guangxi. Data of typhoid fever from surveillance and reporting system between 1994 to 2013 was collected and statistically analyzed epidemiologically. The susceptibility of 475 S. Typhi isolates from patients on ten antibiotics was tested by broth micro-dilution method and minimum inhibition concentration was obtained and interpreted based on the CLSI standard. From 1994 to 2013, a total of 57 928 cases of typhoid fever were reported in Guangxi province with an annual incidence of 6.29/100 000 and mortality as 0.03%. The higher incidence was observed in the population under 20 years of age. There was no significant difference on incidence between male and female, but farmers and students were among the hardest hit groups. More cases were seen from the northern part of the province. Cases appeared all year round with the peak from May to October. A total of 13 major outbreaks during 2001 to 2013 were reported and the main transmission route was water-borne. All the strains were sensitive to third generation cephalosporins cefotaxime and fluoroquinolones norfloxacin. The susceptibility rates to tetracycline, chloramphenicol, ampicillin and gentamicin was around 98% but relative lower susceptible rate to ciprofloxacin was seen as 89.89% . The lowest susceptibility was found for streptomycin and sulfamethoxazole agents, with the rates as 67.73% and 65.89% , respectively. One strain was found to have been resistant to ciprofloxacin and another 47 isolates with reduced susceptibility to ciprofloxacin. Twenty eight isolates were found to be resistant to multiple antibiotics and one displayed ampicillin, chloramphenicol, streptomycin, sulfamethoxazole tetracycline and

Identifying the Risk Factors for Typhoid Fever among the Residents of Rural Islamabad

International Nuclear Information System (INIS)

Javed, N.; Bashir, F.; Abbasi, S.; Tahir, M.

2017-01-01

Background: During August 2015, unusually high typhoid fever cases were reported from rural Islamabad at Federal General Hospital (FGH), Islamabad. Objectives: To determine the risk factors for typhoid fever outbreak and recommend preventive measures. Study design, settings and duration: Outbreak investigation study conducted in Union Councils 19 and 22 of rural Islamabad in the catchment area for Federal General Hospital, from 7 th July-30 th August 2015. Subjects and Methods: A questionnaire was used to identify risk factors of typhoid fever. A case was defined as any resident of the rural Islamabad within the mauza Chatta Bakhtawar and Terlai Kalan presenting with high grade fever (>101 F) with one of the following signs/symptoms; headache, abdominal pain and vomiting with positive typhidot test from 7 th July-30 th August 2015. Two age and sex matched controls for each case was selected from the neighborhood. Epi Info 7 was used for analysis. Results: Total of 50 cases and 100 controls were enrolled. Among cases 30 (61 percent) were females and 20 (39 percent) males with M;F ratio of 1:1.5. Mean age was 23.0 years (9.9 +- SD). The most affected age group was 15-25 years (AR 0.19 percent, n=21). Only one case died (CFR 2percent). Use of untreated public water after rains (OR 3.7 CI 1.6-9.7 p< 0.0002), reconstruction areas and bursting/leaking of water pipes (OR 4.017 CI 1.6-9.7 p < 0.001) and presence of confirmed typhoid cases at home/close contacts (OR 5.7 CI 2.019-16.18 p < 0.0003) were the significant risk factors found associated with the disease. Whereas using well/private bore (OR 0.29 CI 0.329-0.653 p < 0.001) and hand washing practices (OR 0.7 CI 0.297-1.9 < 0.5) had a protective effect. Multivariate analysis showed that use of untreated public water (OR: 3.34, CI: 1.52-7.29, p < 0.002), bursting/leaking pipes (OR 2.86, CI 0.96-8.48, p < 0.05) were significantly associated with typhoid disease. Conclusion: Contamination of drinking water with sewage

Abdominal ultrasonographic findings in typhoid fever: a comparison between typhoid patients and those with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis.

Science.gov (United States)

Kobayashi, Akira; Adachi, Yasuo; Iwata, Yoshinori; Sakai, Yoshiyuki; Shigemitu, Kazuaki; Todoroki, Miwako; Ide, Mituru

2012-03-01

Typhoid fever is a major health problem in many developing countries and its clinical features are similar to other types of bacterial enterocolitis. Definitive diagnosis by blood culture requires several days and is often unfeasible to perform in developing countries. More efficient and rapid diagnostic methods for typhoid are needed. We compared the pathological changes in the bowel and adjacent tissues of patients having typhoid fever with those having bacterial enterocolitis using ultrasonography. A characteristic of patients with non-typhoidal Salmonella and Campylobacter jejuni enterocolitis was mural thickening of the terminal ileum; only mild mural swelling or no swelling was observed in patients with typhoid fever. Mesenteric lymph nodes in patients with typhoid fever were significantly more enlarged compared to patients with other types of bacterial enterocolitis. Our findings suggest typhoid fever is not fundamentally an enteric disease but rather resembles mesenteric lymphadenopathy and ultrasound is a promising modality for diagnosing typhoid fever in developing countries.

Modelling and Optimal Control of Typhoid Fever Disease with Cost-Effective Strategies.

Science.gov (United States)

Tilahun, Getachew Teshome; Makinde, Oluwole Daniel; Malonza, David

2017-01-01

We propose and analyze a compartmental nonlinear deterministic mathematical model for the typhoid fever outbreak and optimal control strategies in a community with varying population. The model is studied qualitatively using stability theory of differential equations and the basic reproductive number that represents the epidemic indicator is obtained from the largest eigenvalue of the next-generation matrix. Both local and global asymptotic stability conditions for disease-free and endemic equilibria are determined. The model exhibits a forward transcritical bifurcation and the sensitivity analysis is performed. The optimal control problem is designed by applying Pontryagin maximum principle with three control strategies, namely, the prevention strategy through sanitation, proper hygiene, and vaccination; the treatment strategy through application of appropriate medicine; and the screening of the carriers. The cost functional accounts for the cost involved in prevention, screening, and treatment together with the total number of the infected persons averted. Numerical results for the typhoid outbreak dynamics and its optimal control revealed that a combination of prevention and treatment is the best cost-effective strategy to eradicate the disease.

Typhoid Fever surveillance and vaccine use - South-East Asia and Western Pacific regions, 2009-2013.

Science.gov (United States)

Date, Kashmira A; Bentsi-Enchill, Adwoa D; Fox, Kimberley K; Abeysinghe, Nihal; Mintz, Eric D; Khan, M Imran; Sahastrabuddhe, Sushant; Hyde, Terri B

2014-10-03

Typhoid fever is a serious, systemic infection resulting in nearly 22 million cases and 216,500 deaths annually, primarily in Asia. Safe water, adequate sanitation, appropriate personal and food hygiene, and vaccination are the most effective strategies for prevention and control. In 2008, the World Health Organization (WHO) recommended use of available typhoid vaccines to control endemic disease and outbreaks and strengthening of typhoid surveillance to improve disease estimates and identify high-risk populations (e.g., persons without access to potable water and adequate sanitation). This report summarizes the status of typhoid surveillance and vaccination programs in the WHO South-East Asia (SEAR) and Western Pacific regions (WPR) during 2009-2013, after the revised WHO recommendations. Data were obtained from the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization, a supplemental survey of surveillance and immunization program managers, and published literature. During 2009-2013, 23 (48%) of 48 countries and areas of SEAR (11) and WPR (37) collected surveillance or notifiable disease data on typhoid cases, with most surveillance activities established before 2008. Nine (19%) countries reported implementation of typhoid vaccination programs or recommended vaccine use during 2009-2013. Despite the high incidence, typhoid surveillance is weak in these two regions, and vaccination efforts have been limited. Further progress toward typhoid fever prevention and control in SEAR and WPR will require country commitment and international support for enhanced surveillance, targeted use of existing vaccines and availability of newer vaccines integrated within routine immunization programs, and integration of vaccination with safe water, sanitation, and hygiene measures.

Typhoid fever

Science.gov (United States)

Typhoid fever is an infection that causes diarrhea and a rash . It is most commonly caused due to ... in their stools for years, spreading the disease. Typhoid fever is common in developing countries. Most cases in ...

A review of typhoid fever transmission dynamic models and economic evaluations of vaccination.

Science.gov (United States)

Watson, Conall H; Edmunds, W John

2015-06-19

Despite a recommendation by the World Health Organization (WHO) that typhoid vaccines be considered for the control of endemic disease and outbreaks, programmatic use remains limited. Transmission models and economic evaluation may be informative in decision making about vaccine programme introductions and their role alongside other control measures. A literature search found few typhoid transmission models or economic evaluations relative to analyses of other infectious diseases of similar or lower health burden. Modelling suggests vaccines alone are unlikely to eliminate endemic disease in the short to medium term without measures to reduce transmission from asymptomatic carriage. The single identified data-fitted transmission model of typhoid vaccination suggests vaccines can reduce disease burden substantially when introduced programmatically but that indirect protection depends on the relative contribution of carriage to transmission in a given setting. This is an important source of epidemiological uncertainty, alongside the extent and nature of natural immunity. Economic evaluations suggest that typhoid vaccination can be cost-saving to health services if incidence is extremely high and cost-effective in other high-incidence situations, when compared to WHO norms. Targeting vaccination to the highest incidence age-groups is likely to improve cost-effectiveness substantially. Economic perspective and vaccine costs substantially affect estimates, with disease incidence, case-fatality rates, and vaccine efficacy over time also important determinants of cost-effectiveness and sources of uncertainty. Static economic models may under-estimate benefits of typhoid vaccination by omitting indirect protection. Typhoid fever transmission models currently require per-setting epidemiological parameterisation to inform their use in economic evaluation, which may limit their generalisability. We found no economic evaluation based on transmission dynamic modelling, and no

Identification of carriers among individuals recruited in the typhoid registry in Malaysia using stool culture, polymerase chain reaction, and dot enzyme immunoassay as detection tools.

Science.gov (United States)

Chua, Ang Lim; Aziah, Ismail; Balaram, Prabha; Bhuvanendran, Saatheeyavaane; Anthony, Amy Amilda; Mohmad, Siti Norazura; Nasir, Norhafiza M; Hassan, Haslizai; Naim, Rochman; Meran, Lila P; Hussin, Hani M; Ismail, Asma

2015-03-01

Chronic carriers of Salmonella Typhi act as reservoirs for the organism and become the agents of typhoid outbreaks in a community. In this study, chronic carriers in Kelantan, Malaysia were first identified using the culture and polymerase chain reaction method. Then, a novel serological tool, designated Typhidot-C, was evaluated in retrospect using the detected individuals as control positives. Chronic carriage positive by the culture and polymerase chain reaction method was recorded at 3.6% (4 out of 110) among individuals who previously had acute typhoid fever and a 9.4% (10 out of 106) carriage rate was observed among food handlers screened during outbreaks. The Typhidot-C assay was able to detect all these positive carriers showing its potential as a viable carrier screening tool and can be used for efficient detection of typhoid carriers in an endemic area. These findings were used to establish the first carrier registry for S Typhi carriers in Malaysia. © 2012 APJPH.

Utilization and Accessibility of Healthcare on Pemba Island, Tanzania: Implications for Health Outcomes and Disease Surveillance for Typhoid Fever

Science.gov (United States)

Kaljee, Linda M.; Pach, Alfred; Thriemer, Kamala; Ley, Benedikt; Ali, Said M.; Jiddawi, Mohamed; Puri, Mahesh; von Seidlein, Lorenz; Deen, Jacqueline; Ochiai, Leon; Wierzba, Thomas; Clemens, John

2013-01-01

Salmonella enterica serotype Typhi (S. Typhi) was estimated to cause over 200,000 deaths and more than 21 million illnesses worldwide, including over 400,000 illnesses in Africa. The current study was conducted in four villages on Pemba Island, Zanzibar, in 2010. We present data on policy makers', health administrators', and village residents' and leaders' perceptions of typhoid fever, and hypothetical and actual health care use among village residents for typhoid fever. Qualitative data provided descriptions of home-based treatment practices and use of western pharmaceuticals, and actual healthcare use for culture-confirmed typhoid fever. Survey data indicate health facility use was associated with gender, education, residency, and perceptions of severity for symptoms associated with typhoid fever. Data have implications for education of policy makers and health administrators, design and implementation of surveillance studies, and community-based interventions to prevent disease outbreaks, decrease risks of complications, and provide information about disease recognition, diagnosis, and treatment. PMID:23208887

[Salmonellosis outbreaks and the size and role of the Chilean State].

Science.gov (United States)

Fica, Alberto; Acosta, Gerardo; Dabanch, Jeannette; Perret, Cecilia; Torres, Marisa; López, Javier; Jofré, Leonor; Weitzel, Thomas

2012-04-01

During year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence. Several government websites were searched looking for epidemiological data. Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation. The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.

Travelers' Health: Typhoid and Paratyphoid Fever

Science.gov (United States)

... days should raise suspicion of typhoid or paratyphoid fever. Typhoid fever is a nationally notifiable disease. TREATMENT Specific ... typhoid-fever Table 3-21. Vaccines to prevent typhoid fever VACCINA- TION AGE (y) DOSE, MODE OF ADMINISTRA- ...

Toll-like receptor 4 Asp299Gly and Thr399Ile polymorphisms and typhoid susceptibility in Asian Malay population in Malaysia.

Science.gov (United States)

Bhuvanendran, Saatheeyavaane; Hussin, Hani M; Meran, Lila P; Anthony, Amy A; Zhang, Leilei; Burch, Lauranell H; Phua, Kia K; Ismail, Asma; Balaram, Prabha

2011-09-01

Typhoid fever is a major health problem with frequent outbreaks in Kelantan, Malaysia. Prevalence of TLR4 gene polymorphisms varies with ethnic groups (0-20%) and predisposean individual to gram-negative infections. The prevalence rate of TLR4 Asp299Gly and Thr399lle polymorphisms in the Malay population or the influence of these on typhoid fever susceptibility is not yet reported. 250 normal and 304 susceptible Malay individuals were investigated for these polymorphisms using allele-specific PCR and analysed for its association with typhoid fever susceptibility. The total prevalence of polymorphisms in the normal population was 4.8% in comparison to 12.5% in the susceptible population (p = 0.002). An increased frequency of both polymorphisms was observed in the susceptible population (p population and suggests that these polymorphisms confer a higher risk for typhoid, infection. The higher incidence of typhoid fever in Kelantan could be attributed to the higher percentage of Malays (95%) in this state. In order to reduce the incidence of this disease, people with these polymorphisms, can be prioritised for prophylactic strategies. Copyright © 2011 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

Mathematical Modeling to Assess the Drivers of the Recent Emergence of Typhoid Fever in Blantyre, Malawi.

Science.gov (United States)

Pitzer, Virginia E; Feasey, Nicholas A; Msefula, Chisomo; Mallewa, Jane; Kennedy, Neil; Dube, Queen; Denis, Brigitte; Gordon, Melita A; Heyderman, Robert S

2015-11-01

Multiyear epidemics of Salmonella enterica serovar Typhi have been reported from countries across eastern and southern Africa in recent years. In Blantyre, Malawi, a dramatic increase in typhoid fever cases has recently occurred, and may be linked to the emergence of the H58 haplotype. Strains belonging to the H58 haplotype often exhibit multidrug resistance and may have a fitness advantage relative to other Salmonella Typhi strains. To explore hypotheses for the increased number of typhoid fever cases in Blantyre, we fit a mathematical model to culture-confirmed cases of Salmonella enterica infections at Queen Elizabeth Central Hospital, Blantyre. We explored 4 hypotheses: (1) an increase in the basic reproductive number (R0) in response to increasing population density; (2) a decrease in the incidence of cross-immunizing infection with Salmonella Enteritidis; (3) an increase in the duration of infectiousness due to failure to respond to first-line antibiotics; and (4) an increase in the transmission rate following the emergence of the H58 haplotype. Increasing population density or decreasing cross-immunity could not fully explain the observed pattern of typhoid emergence in Blantyre, whereas models allowing for an increase in the duration of infectiousness and/or the transmission rate of typhoid following the emergence of the H58 haplotype provided a good fit to the data. Our results suggest that an increase in the transmissibility of typhoid due to the emergence of drug resistance associated with the H58 haplotype may help to explain recent outbreaks of typhoid in Malawi and similar settings in Africa. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Typhoid toxin provides a window into typhoid fever and the biology of Salmonella Typhi.

Science.gov (United States)

Galán, Jorge E

2016-06-07

Salmonella Typhi is the cause of typhoid fever, a disease that has challenged humans throughout history and continues to be a major public health concern. Unlike infections with most other Salmonellae, which result in self-limiting gastroenteritis, typhoid fever is a life-threatening systemic disease. Furthermore, in contrast to most Salmonellae, which can infect a broad range of hosts, S. Typhi is a strict human pathogen. The unique features of S. Typhi pathogenesis and its stringent host specificity have been a long-standing puzzle. The discovery of typhoid toxin not only has provided major insight into these questions but also has offered unique opportunities to develop novel therapeutic and prevention strategies to combat typhoid fever.

Antimicrobial resistance problems in typhoid fever

Science.gov (United States)

Saragih, R. H.; Purba, G. C. F.

2018-03-01

Typhoid fever (enteric fever) remains a burden in developing countries and a major health problem in Southern and Southeastern Asia. Salmonella typhi (S. typhi), the causative agent of typhoid fever, is a gram-negative, motile, rod-shaped, facultative anaerobe and solely a human pathogen with no animal reservoir. Infection of S. typhi can cause fever, abdominal pain and many worsenonspecific symptoms, including gastrointestinal symptoms suchas nausea, vomiting, constipation, and diarrhea. Chloramphenicol, ampicillin,and cotrimoxazole were the first-recommended antibiotics in treating typhoid fever. In the last two decades though, these three traditional drugs started to show resistance and developed multidrug resistance (MDR) S. typhi strains. In many parts of the world, the changing modes ofpresentation and the development of MDR have made typhoid fever increasingly difficult to treat.The use of first-line antimicrobials had been recommended to be fluoroquinolone as a replacement. However, this wassoonfollowedbyreportsof isolates ofS. typhi showing resistancetofluoroquinolones as well. These antimicrobial resistance problems in typhoid fever have been an alarming situation ever since and need to be taken seriously or else typhoid fever will no longer be taken care completely by administering antibiotics.

A cross-sectional seroepidemiological survey of typhoid fever in Fiji.

Directory of Open Access Journals (Sweden)

Conall H Watson

2017-07-01

Full Text Available Fiji, an upper-middle income state in the Pacific Ocean, has experienced an increase in confirmed case notifications of enteric fever caused by Salmonella enterica serovar Typhi (S. Typhi. To characterize the epidemiology of typhoid exposure, we conducted a cross-sectional sero-epidemiological survey measuring IgG against the Vi antigen of S. Typhi to estimate the effect of age, ethnicity, and other variables on seroprevalence. Epidemiologically relevant cut-off titres were established using a mixed model analysis of data from recovering culture-confirmed typhoid cases. We enrolled and assayed plasma of 1787 participants for anti-Vi IgG; 1,531 of these were resident in mainland areas that had not been previously vaccinated against S. Typhi (seropositivity 32.3% (95%CI 28.2 to 36.3%, 256 were resident on Taveuni island, which had been previously vaccinated (seropositivity 71.5% (95%CI 62.1 to 80.9%. The seroprevalence on the Fijian mainland is one to two orders of magnitude higher than expected from confirmed case surveillance incidence, suggesting substantial subclinical or otherwise unreported typhoid. We found no significant differences in seropositivity prevalences by ethnicity, which is in contrast to disease surveillance data in which the indigenous iTaukei Fijian population are disproportionately affected. Using multivariable logistic regression, seropositivity was associated with increased age (odds ratio 1.3 (95% CI 1.2 to 1.4 per 10 years, the presence of a pit latrine (OR 1.6, 95%CI 1.1 to 2.3 as opposed to a septic tank or piped sewer, and residence in settlements rather than residential housing or villages (OR 1.6, 95% CI 1.0 to 2.7. Increasing seropositivity with age is suggestive of low-level endemic transmission in Fiji. Improved sanitation where pit latrines are used and addressing potential transmission routes in settlements may reduce exposure to S. Typhi. Widespread unreported infection suggests there may be a role for typhoid

A cross-sectional seroepidemiological survey of typhoid fever in Fiji.

Science.gov (United States)

Watson, Conall H; Baker, Stephen; Lau, Colleen L; Rawalai, Kitione; Taufa, Mere; Coriakula, Jerimaia; Thieu, Nga Tran Vu; Van, Tan Trinh; Ngoc, Dung Tran Thi; Hens, Niel; Lowry, John H; de Alwis, Ruklanthi; Cano, Jorge; Jenkins, Kylie; Mulholland, E Kim; Nilles, Eric J; Kama, Mike; Edmunds, W John

2017-07-01

Fiji, an upper-middle income state in the Pacific Ocean, has experienced an increase in confirmed case notifications of enteric fever caused by Salmonella enterica serovar Typhi (S. Typhi). To characterize the epidemiology of typhoid exposure, we conducted a cross-sectional sero-epidemiological survey measuring IgG against the Vi antigen of S. Typhi to estimate the effect of age, ethnicity, and other variables on seroprevalence. Epidemiologically relevant cut-off titres were established using a mixed model analysis of data from recovering culture-confirmed typhoid cases. We enrolled and assayed plasma of 1787 participants for anti-Vi IgG; 1,531 of these were resident in mainland areas that had not been previously vaccinated against S. Typhi (seropositivity 32.3% (95%CI 28.2 to 36.3%)), 256 were resident on Taveuni island, which had been previously vaccinated (seropositivity 71.5% (95%CI 62.1 to 80.9%)). The seroprevalence on the Fijian mainland is one to two orders of magnitude higher than expected from confirmed case surveillance incidence, suggesting substantial subclinical or otherwise unreported typhoid. We found no significant differences in seropositivity prevalences by ethnicity, which is in contrast to disease surveillance data in which the indigenous iTaukei Fijian population are disproportionately affected. Using multivariable logistic regression, seropositivity was associated with increased age (odds ratio 1.3 (95% CI 1.2 to 1.4) per 10 years), the presence of a pit latrine (OR 1.6, 95%CI 1.1 to 2.3) as opposed to a septic tank or piped sewer, and residence in settlements rather than residential housing or villages (OR 1.6, 95% CI 1.0 to 2.7). Increasing seropositivity with age is suggestive of low-level endemic transmission in Fiji. Improved sanitation where pit latrines are used and addressing potential transmission routes in settlements may reduce exposure to S. Typhi. Widespread unreported infection suggests there may be a role for typhoid

Burden of typhoid fever in Sulaimania, Iraqi Kurdistan.

Science.gov (United States)

Dworkin, Jonathan; Saeed, Rebeen; Mykhan, Hawar; Kanan, Shwan; Farhad, Dlawer; Ali, Kocher Omer; Abdulwahab, Runak Hama Kareem; Palardy, John; Neill, Marguerite A

2014-10-01

Typhoid fever imposes a high disease burden worldwide, but resource limitations mean that the burden of typhoid fever in many countries is poorly understood. The authors conducted a prospective surveillance study at the adult and pediatric teaching hospitals in Sulaimania, Iraqi Kurdistan. All patients presenting with an undifferentiated febrile illness consistent with typhoid were eligible for enrollment. Enrolled patients had blood cultures and Brucella serologies performed. Incidence was calculated with reference to census data. Both typhoid fever and brucellosis were common, and the incidence of typhoid fever was 21 cases/100 000 patient-years. Classic disease symptoms were uncommonly observed. Cost-effective surveillance projects to calculate disease burden of typhoid fever are practical and replicable. Typhoid has successfully adapted to the healthcare environment in Sulaimania. Additional work in the region should focus on antibiotic resistance and other enteric pathogens such as Brucella spp. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Evaluation on the effects of prevention and control programs regarding typhoid fever and paratyphoid fever in Guizhou province, from 2007 to 2012].

Science.gov (United States)

Yao, Guanghai; Zou, Zhiting; Wang, Dan; Huang, Yanping; Nie, Wei; Liu, Huihui; Tang, Guangpeng

2014-05-01

This study was to evaluate the effects of prevention and control regarding programs on typhoid fever and paratyphoid fever, in Guizhou province, from 2007 to 2012, to provide evidence for the improvement of related programs. Data on typhoid fever and paratyphoid including information on epidemics, individual, cases, measures for prevention and control programs taken and relative government documents were collected and analyzed in Guizhou province, from 2007 to 2012. Information related to the average annual incidence, nature of outbreaks, time span before confirmed diagnosis was made, unit which carried the case report, proportion of laboratory confirmed diagnosed cases and case-management were compared between 2007-2009 and 2010-2012 descriptively while chi-square test with Excel and EpiInfo software were used for data analysis. In the period of 2007-2009, a total of 5 978 typhoid fever and paratyphoid fever cases were reported in Guizhou province with the average yearly incidence as 5.29/100 000. In the period of 2010-2012, 2 765 cases were reported with the average yearly incidence as 2.57/100 000. When compared to the former, data from the latter period showed that the average yearly incidence had declined 51.31% in all the prefectures. There were still some outbreaks appeared but the total number of cases involved reduced 87.50%. The time span before the confirmation of diagnosis became shorter but the difference was not statistically significant (χ² = 0.08, P = 0.99). Number of cases reported by hospitals at county or above had 11.51% of increase while those cases reported at the township hospitals or below decreased for 61.47% . The proportion of laboratory diagnosed cases increased 23.63%. Rates of timeliness on cards being filled in, input and audited showed increase of 8.44%, 6.76% and 2.40% respectively. Successful measures for prevention and control on typhoid fever and paratyphoid fever had been remarkably taken in Guizhou province, but the potential

Fabrics produced mimetically during static metamorphism in retrogressed eclogites from the Zermatt-Saas zone, Western Italian Alps

Science.gov (United States)

McNamara, D. D.; Wheeler, J.; Pearce, M.; Prior, D. J.

2012-11-01

Lattice preferred orientations (LPOs) are commonly interpreted to form by dislocation creep. Consequently they are used to infer deformation at the metamorphic grade at which the minerals were stable, especially if those minerals show a shape fabric. Here we show that LPOs can occur through mimicry of a pre-existing LPO, so they formed statically, not during deformation. Omphacite and glaucophane LPOs occur in eclogite facies rocks from the Zermatt-Saas Unit of the Northwest Italian Alps. Barroisite grew during greenschist facies retrogression and has an LPO controlled significantly by the eclogite facies omphacite and glaucophane LPOs, rather than directly by deformation. Using spatially resolved lattice orientation data from the three key minerals, collected using electron backscatter diffraction, we deploy a new technique of interphase misorientation distribution analysis to prove this. Barroisite LPO develops by mimicry of omphacite (via a particular lattice orientation relationship) and by direct topotactic and epitactic replacement of glaucophane. LPO in turn influenced anisotropic grain growth, resulting in a barroisite grain shape fabric. Thus regional retrogression during exhumation of the Zermatt-Saas high-pressure rocks was, in large part, static, rather than dynamic as previously interpreted. In general the possibility of mimetic fabrics forming during metamorphic reactions must be borne in mind when interpreting direct structural observations and seismic anisotropy data in terms of deformation, in both crust and mantle.

Liver function assessment in malaria, typhoid and malaria-typhoid co-infection in Aba, Abia State, Nigeria.

Science.gov (United States)

Enemchukwu, B N; Ibe, C C; Udedi, S C; Iroha, A; Ubaoji, K I; Ogundapo, S S

2014-06-01

Malaria and typhoid fever are among the most endemic diseases in the tropics and are associated with poverty and underdevelopment with significant morbidity and mortality. Both diseases can lead to liver damage if not properly treated. The liver function assessment was therefore conducted on (90) volunteer patients; comprising (30) patients with malaria only, (30) with typhoid only and (30) with malaria-typhoid co-infection randomly selected from Abia State University Teaching Hospital, Aba, Abia State, Nigeria and (20) healthy individuals were used as control. Blood samples collected from these subjects were screened for malaria parasite and Staphylococcus typhi using standard methods. Mean serum levels of ALP (112.55±84.23), AST (31.33±12.80), ALT (23.10±11.84), TB (19.43±5.02), CB (5.91±3.03) and ALP (116.69±48.68), AST (28.33±11.72), ALT (22.8±5.94), TB (19.31±5.84),CB (5.60±2.50) were obtained for those subjects with malaria and typhoid respectively and subjects with malaria-typhoid co-infection recorded the following; ALP (134.33±56.62), AST (33.97±8.43), ALT (24.40±4.37),TB (21.27±2.96),CB (6.58±3.10) while the control subjects had mean serum levels ofALP (71.05±18.18), AST (16.65±7.45), ALT (13.85±6.09), TB (10.05±4.85) and CB (3.00±1.67). These mean values were subjected to a statistical test using students t-test which revealed a significant increase (p<0.05).The results suggest that malaria, typhoid and malaria-typhoid co-infection can elevate ALP, AST, ALT, TB and CB serum levels and can lead to liver damage if not properly treated.

Black workers, typhoid fever and the construction of the Berg River – Saldanha military water pipeline, 1942 – 1943

Directory of Open Access Journals (Sweden)

Lieutenant Colonel GE (Deon Visser

2008-04-01

Full Text Available War creates a huge need for labour to support the war efforts of the belligerent parties. In South Africa tens of thousands of ‘non-white’ workers were mobilised during the Second World War to satisfy the Union Defence Force’s (UDF’s labour needs at home and abroad. This article, firstly, outlines the role of ‘non-white people’, particularly black Africans, in the UDF with special reference to those employed within the Union of South Africa. Secondly, it briefly delineates typhoid fever as an historical thorn in the flesh of military forces up to the early 20th century. It then looks briefly into the incidence of and perceptions on typhoid fever as a killer disease in South Africa on the eve of the Second World War. Against that background, the article investigates the employment of black workers on the construction of the Berg River-Saldanha Bay military water pipeline and the UDF’s response to the threat and subsequent outbreak of typhoid fever amongst the workers at the Berg River intake site in 1943. The article concludes that the public health authorities and UDF were aware of the threat of typhoid fever with regard to the Berg River water scheme, but did not take sufficient precautionary measures, which could have had serious repercussions for the Allied war effort. This incident should serve as a warning to the South African National Defence Force when deploying on peace support operations on the African continent where typhoid fever remains a serious threat next to Hiv/Aids.

Epidemiologic analysis of sporadic Salmonella typhi isolates and those from outbreaks by pulsed-field gel electrophoresis.

Science.gov (United States)

Thong, K L; Cheong, Y M; Puthucheary, S; Koh, C L; Pang, T

1994-05-01

Pulsed-field gel electrophoresis (PFGE) was used to compare and analyze 158 isolates of Salmonella typhi from five well-defined outbreaks of typhoid fever in Malaysia and also isolates involved in sporadic cases of typhoid fever occurring during the same period. Digestion of chromosomal DNAs from these S. typhi isolates with the restriction endonucleases XbaI (5'-TCTAGA-3'), SpeI (5'-ACTAGT-3'), and AvrII (5'-CCTAGG-3') and then PFGE produced restriction endonuclease analysis (REA) patterns consisting of 11 to 24 DNA fragments ranging in size from 20 to 630 kbp. Analysis of the REA patterns generated by PFGE after digestion with XbaI and SpeI indicated that the S. typhi isolates obtained from sporadic cases of infection were much more heterogeneous (at least 13 different REA patterns were detected; Dice coefficient, between 0.73 and 1.0) than those obtained during outbreaks of typhoid fever. The clonal nature and the close genetic identities of isolates from outbreaks in Alor Setar, Penang, Kota Kinabalu, Johor Bahru, and Kota Bahru were suggested by the fact that only a limited number of REA patterns, which mostly differed by only a single band, were detected (one to four patterns; Dice coefficient, between 0.82 and 1.0), although a different pattern was associated with each of these outbreaks. Comparison of REA patterns with ribotyping for 18 S. typhi isolates involved in sporadic cases of infection showed a good correlation, in that 72% of the isolates were in the same group. There was no clear correlation of phage types with a specific REA pattern. We conclude that PFGE of s. typhi chromosomal DNA digested with infrequently cutting restriction endonucleases is a useful method for comparing and differentiating S. typhi isolates for epidemiological purposes.

Radiological observation in typhoid fever

Energy Technology Data Exchange (ETDEWEB)

Lim, K Y; Park, H Y; Kim, J D; Rhee, H S [Presbyterian Medical Center, Jeonju (Korea, Republic of)

1985-12-15

Radiographic findings in plain abdominal films, chest PA and liver scanning are considered to be ancillary diagnostic methods for uncomplicated typhoid fever and a valuable method for detection of complication such as intestinal perforation. 189 cases of clinically proven typhoid fever from Mar. 1973 to Feb. 1979 in this Hospital were reviewed and radiographic findings were analyzed carefully. The results are as follows: 1. Most (73.6%) cases were between 20 and 40 years of age. 2. Three of the most common radiographic findings were as follows: 1) Localized paralytic ileus in RLQ or diffuse paralytic ileus (96.3%). 2) Hepatomegaly (56.5%). 3) Splenomegaly (49.7%). 3. In cases of typhoid fever with intestinal perforation there were additional significant findings such as free air under diaphragm (85%), free fluid in peritoneal cavity (90%) and air fluid levels in RLQ (80%). 4. The most frequent chest x-ray finding was elevation of diaphragm (11.1%). 5. 8 cases of complicated typhoid fever which eventually came to operation were diagnosed only by radiographic method.

Radiological observation in typhoid fever

International Nuclear Information System (INIS)

Lim, K. Y.; Park, H. Y.; Kim, J. D.; Rhee, H. S.

1985-01-01

Radiographic findings in plain abdominal films, chest PA and liver scanning are considered to be ancillary diagnostic methods for uncomplicated typhoid fever and a valuable method for detection of complication such as intestinal perforation. 189 cases of clinically proven typhoid fever from Mar. 1973 to Feb. 1979 in this Hospital were reviewed and radiographic findings were analyzed carefully. The results are as follows: 1. Most (73.6%) cases were between 20 and 40 years of age. 2. Three of the most common radiographic findings were as follows: 1) Localized paralytic ileus in RLQ or diffuse paralytic ileus (96.3%). 2) Hepatomegaly (56.5%). 3) Splenomegaly (49.7%). 3. In cases of typhoid fever with intestinal perforation there were additional significant findings such as free air under diaphragm (85%), free fluid in peritoneal cavity (90%) and air fluid levels in RLQ (80%). 4. The most frequent chest x-ray finding was elevation of diaphragm (11.1%). 5. 8 cases of complicated typhoid fever which eventually came to operation were diagnosed only by radiographic method.

Typhoid fever in Fiji: a reversible plague?

Science.gov (United States)

Thompson, Corinne N; Kama, Mike; Acharya, Shrish; Bera, Una; Clemens, John; Crump, John A; Dawainavesi, Aggie; Dougan, Gordon; Edmunds, W John; Fox, Kimberley; Jenkins, Kylie; Khan, M Imran; Koroivueta, Josefa; Levine, Myron M; Martin, Laura B; Nilles, Eric; Pitzer, Virginia E; Singh, Shalini; Raiwalu, Ratu Vereniki; Baker, Stephen; Mulholland, Kim

2014-10-01

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations. © 2014 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

EpiReview: Typhoid fever, NSW, 2005-2011.

Science.gov (United States)

Gunaratnam, Praveena; Tobin, Sean; Seale, Holly; Musto, Jennie

2013-11-01

To examine trends in the incidence of typhoid fever in NSW to inform the development of prevention strategies. Typhoid fever case notification data for the period 2005-2011 were extracted from the NSW Notifiable Conditions Information Management System. Population incidence rates were calculated and analysed by demographic variables. There were 250 case notifications of typhoid fever in NSW from 2005 to 2011, of which 240 are likely to have been acquired overseas. Case notifications remained relatively stable over the review period with the highest rates in Western Sydney Local Health District (10.9 per 100,000 population). Two-thirds (66.4%) of all case notifications are likely to have been acquired in South Asia, and about half of overseas-acquired case notifications were most likely to have been associated with travel to visit friends and relatives. Hospitalisation was required for 79.6% of cases where hospitalisation status was known. Prior typhoid vaccination was reported in 7% of cases in 2010 and 2011 where vaccination status was known. While typhoid fever rates remain low in NSW, case notifications of this preventable infection continue to be reported, particularly in travellers visiting friends and relatives in South Asia. Further research to better understand barriers to the use of preventive measures may be useful in targeting typhoid fever prevention messages in high-risk groups, particularly South Asian communities in NSW.

25 years after Vi typhoid vaccine efficacy study, typhoid affects significant number of population in Nepal.

Directory of Open Access Journals (Sweden)

Deepak Bajracharya

Full Text Available Salmonella Typhi, first isolated in 1884, results in infection of the intestines and can end in death and disability. Due to serious adverse events post vaccination, whole cell killed vaccines have been replaced with new generation vaccines. The efficacy of Vi polysaccharide (ViPS vaccine, a new generation, single-dose intramuscular typhoid vaccine was assessed in Nepal in 1987. However, despite the availability of ViPS vaccine for more than 25 years, Nepal has one of the highest incidence of typhoid fever. Therefore we collected information from hospitals in the Kathmandu Valley from over the past five years. There were 9901 enteric fever cases between January 2008 and July 2012. 1,881 of these were confirmed typhoid cases from five hospitals in the Kathmandu district. Approximately 70% of the cases involved children under 15 years old. 1281 cases were confirmed as S. Paratyphi. Vaccines should be prioritized for control of typhoid in conjunction with improved water and sanitation conditions in Nepal and in endemic countries of Asia and Africa.

Microscopic haematuria: A rare presentation of typhoid fever.

Science.gov (United States)

Nisahan, Balasingam; Thirunavukarasu, Kumanan; Selvaratnam, Gowry

2015-04-01

Typhoid fever can cause a number of renal manifestations heretofore dubbed 'nephrotyphoid'. Haematuria in the absence of renal impairment is extremely rare among typhoid patients. We report a case of an adult who presented with a prolonged febrile illness and microscopic haematuria. Blood culture confirmed the diagnosis of typhoid and the patient was treated successfully with ceftriaxone. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Cluster analysis of typhoid cases in Kota Bharu, Kelantan, Malaysia

Directory of Open Access Journals (Sweden)

Nazarudin Safian

2008-09-01

Full Text Available Typhoid fever is still a major public health problem globally as well as in Malaysia. This study was done to identify the spatial epidemiology of typhoid fever in the Kota Bharu District of Malaysia as a first step to developing more advanced analysis of the whole country. The main characteristic of the epidemiological pattern that interested us was whether typhoid cases occurred in clusters or whether they were evenly distributed throughout the area. We also wanted to know at what spatial distances they were clustered. All confirmed typhoid cases that were reported to the Kota Bharu District Health Department from the year 2001 to June of 2005 were taken as the samples. From the home address of the cases, the location of the house was traced and a coordinate was taken using handheld GPS devices. Spatial statistical analysis was done to determine the distribution of typhoid cases, whether clustered, random or dispersed. The spatial statistical analysis was done using CrimeStat III software to determine whether typhoid cases occur in clusters, and later on to determine at what distances it clustered. From 736 cases involved in the study there was significant clustering for cases occurring in the years 2001, 2002, 2003 and 2005. There was no significant clustering in year 2004. Typhoid clustering also occurred strongly for distances up to 6 km. This study shows that typhoid cases occur in clusters, and this method could be applicable to describe spatial epidemiology for a specific area. (Med J Indones 2008; 17: 175-82Keywords: typhoid, clustering, spatial epidemiology, GIS

Vaccines for preventing typhoid fever.

Science.gov (United States)

Milligan, Rachael; Paul, Mical; Richardson, Marty; Neuberger, Ami

2018-05-31

Typhoid fever and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in south-central and southeast Asia. Two typhoid vaccines are widely available, Ty21a (oral) and Vi polysaccharide (parenteral). Newer typhoid conjugate vaccines are at varying stages of development and use. The World Health Organization has recently recommended a Vi tetanus toxoid (Vi-TT) conjugate vaccine, Typbar-TCV, as the preferred vaccine for all ages. To assess the effects of vaccines for preventing typhoid fever. In February 2018, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and mRCT. We also searched the reference lists of all included trials. Randomized and quasi-randomized controlled trials (RCTs) comparing typhoid fever vaccines with other typhoid fever vaccines or with an inactive agent (placebo or vaccine for a different disease) in adults and children. Human challenge studies were not eligible. Two review authors independently applied inclusion criteria and extracted data, and assessed the certainty of the evidence using the GRADE approach. We computed vaccine efficacy per year of follow-up and cumulative three-year efficacy, stratifying for vaccine type and dose. The outcome addressed was typhoid fever, defined as isolation of Salmonella enterica serovar Typhi in blood. We calculated risk ratios (RRs) and efficacy (1 - RR as a percentage) with 95% confidence intervals (CIs). In total, 18 RCTs contributed to the quantitative analysis in this review: 13 evaluated efficacy (Ty21a: 5 trials; Vi polysaccharide: 6 trials; Vi-rEPA: 1 trial; Vi-TT: 1 trial), and 9 reported on adverse events. All trials but one took place in typhoid-endemic countries. There was no information on vaccination in adults aged over 55 years of age, pregnant women, or travellers. Only one trial included data on children under two years of age.Ty21a vaccine (oral vaccine, three doses

Typhoid Fever in nineteenth-century Colombia: between medical geography and bacteriology.

Science.gov (United States)

García, Mónica

2014-01-01

This paper analyses how the Colombian medical elites made sense of typhoid fever before and during the inception of bacteriological ideas and practices in the second half of the nineteenth century. Assuming that the identity of typhoid fever has to be understood within the broader concerns of the medical community in question, I show how doctors first identified Bogotá's epidemics as typhoid fever during the 1850s, and how they also attached specificity to the fever amongst other continuous fevers, such as its European and North American counterparts. I also found that, in contrast with the discussions amongst their colleagues from other countries, debates about typhoid fever in 1860-70 among doctors in Colombia were framed within the medico-geographical scheme and strongly shaped by the fear of typhoid fever appearing alongside 'paludic' fevers in the highlands. By arguing in medico-geographical and clinical terms that typhoid fever had specificity in Colombia, and by denying the medico-geographical law of antagonism between typhoid and paludic fevers proposed by the Frenchman Charles Boudin, Colombian doctors managed to question European knowledge and claimed that typhoid fever had distinct features in Colombia. The focus on paludic and typhoid fevers in the highlands might explain why the bacteriological aetiology of typhoid fever was ignored and even contested during the 1880s. Anti-Pasteurian arguments were raised against its germ identity and some physicians even supported the idea of spontaneous origin of the disease. By the 1890s, Pasteurian knowledge had come to shape clinical and hygienic practices.

Same species, different diseases: how and why typhoidal and non-typhoidal Salmonella enterica serovars differ

Directory of Open Access Journals (Sweden)

Ohad eGal-Mor

2014-08-01

Full Text Available Human infections by the bacterial pathogen Salmonella enterica represent major disease burdens worldwide. This highly ubiquitous species consists of more than 2600 different serovars that can be divided into typhoidal and non-typhoidal Salmonella (NTS serovars. Despite their genetic similarity, these two groups elicit very different diseases and distinct immune responses in humans. Comparative analyses of the genomes of multiple Salmonella serovars have begun to explain the basis of the variation in disease manifestations. Recent advances in modeling both enteric fever and intestinal gastroenteritis in mice will facilitate investigation into both the bacterial- and host-mediated mechanisms involved in salmonelloses. Understanding the genetic and molecular mechanisms responsible for differences in disease outcome will augment our understanding of Salmonella pathogenesis, host immunity, and the molecular basis of host specificity. This review outlines the differences in epidemiology, clinical manifestations, and the human immune response to typhoidal and NTS infections and summarizes the current thinking on why these differences might exist.

Clinical Features Of Malaria And Typhoid Fever | Mba | Journal of ...

African Journals Online (AJOL)

Features to distinguish Malaria from Typhoid fever. These can be discerned from a good and detailed clinical history, in addition to a thorough physical examination. The following would help. The paroxysms of malaria fever as against the step ladder pattern fever of typhoid fever. The prominence of headaches in typhoid ...

Gallbladder perforation complicating typhoid fever: report of two cases.

Science.gov (United States)

Gali, B M; Ali, N; Agbese, G O; Duna, V D; Dawha, S D; Ismai, G I; Mohammed, M

2011-01-01

Gallbladder perforation (GBP) is rare and as a complication of typhoid fever is extremely rare. We present two consecutive patients with GBP diagnosed incidentally at laparotomy. Information on the management of two patients with gallbladder perforation seen at Federal Medical Centre Azare in June and October 2008 was extracted from their case records. The two patients were both males aged 13 years and 16 years. They both presented with high fever of more than 2 weeks duration; and abdominal pain and distension. Both patients had features of generalised peritonitis. Pre-operative diagnoses of typhoid enteric perforation were made based on a positive Widal test. Intra-operative findings however, were that of bile peritonitis and gallbladder perforation. Both had cholecystectomy. Culture of the bile aspirate yielded Salmonella typhi. Gallbladder perforation secondary to typhoid fever should be considered as a differential diagnosis in patients with suspected typhoid enteric perforation in typhoid fever endemic region.

A Case Report of Typhoidal Acute Acalculous Cholecystitis

Directory of Open Access Journals (Sweden)

Neeha Rajan

2014-01-01

Full Text Available Introduction. Acalculous cholecystitis in the setting of typhoid fever in adults is an infrequent clinical encounter, reported sparsely in the literature. In this case report we review the presentation and management of enteric fever involving the biliary system and consider the literature surrounding this topic. The aim of this case report is to alert clinicians to the potential diagnosis of extraintestinal complications in the setting of typhoid fever in the returned traveller, requiring surgical intervention. Presentation of Case. We report the case of a 23-year-old woman with acalculous cholecystitis secondary to Salmonella Typhi. Discussion. There is scarce evidence surrounding the optimal treatment and prognosis of typhoidal acalculous cholecystitis. In the current case, surgical invention was favoured due to failure of medical management. Conclusion. Clinical judgement dictated surgical intervention in this case of typhoidal acute acalculous cholecystitis, and cholecystectomy was safely performed.

Pulmonary affectation in a patient with typhoid fever

International Nuclear Information System (INIS)

Duenas C, Carmelo; Martinez, Adel; Maza, Augusto

1997-01-01

Typhoid fever is a rare disease in the USA with no more of 500 cases per year. In Latin America, it occurs four to five times more frequently. Pulmonary symptoms are found in less than 20% of the cases. The development of pneumonia is more common in immunocompromised patients. In last 10 years, the frequency of typhoid pneumonia has increased because of the HIV epidemic and the advance of other forms of immunosuppression. We presented the case of a young adult male with typhoid multilobar pneumonia who did not have VIH infection or any demonstrated immunosuppression

Reproducible diagnostic metabolites in plasma from typhoid fever patients in Asia and Africa.

Science.gov (United States)

Näsström, Elin; Parry, Christopher M; Vu Thieu, Nga Tran; Maude, Rapeephan R; de Jong, Hanna K; Fukushima, Masako; Rzhepishevska, Olena; Marks, Florian; Panzner, Ursula; Im, Justin; Jeon, Hyonjin; Park, Seeun; Chaudhury, Zabeen; Ghose, Aniruddha; Samad, Rasheda; Van, Tan Trinh; Johansson, Anders; Dondorp, Arjen M; Thwaites, Guy E; Faiz, Abul; Antti, Henrik; Baker, Stephen

2017-05-09

Salmonella Typhi is the causative agent of typhoid. Typhoid is diagnosed by blood culture, a method that lacks sensitivity, portability and speed. We have previously shown that specific metabolomic profiles can be detected in the blood of typhoid patients from Nepal (Näsström et al., 2014). Here, we performed mass spectrometry on plasma from Bangladeshi and Senegalese patients with culture confirmed typhoid fever, clinically suspected typhoid, and other febrile diseases including malaria. After applying supervised pattern recognition modelling, we could significantly distinguish metabolite profiles in plasma from the culture confirmed typhoid patients. After comparing the direction of change and degree of multivariate significance, we identified 24 metabolites that were consistently up- or down regulated in a further Bangladeshi/Senegalese validation cohort, and the Nepali cohort from our previous work. We have identified and validated a metabolite panel that can distinguish typhoid from other febrile diseases, providing a new approach for typhoid diagnostics.

Epidemiological analysis of typhoid fever in Kelantan from a retrieved registry

Directory of Open Access Journals (Sweden)

Ismail, A.

2013-01-01

Full Text Available Aim: Despite the endemicity of typhoid in Kelantan, epidemiological data showing typhoid association to age, sex,ethnicity and district of patients is limited. This retrospective study investigated the statistical association of thesevariables from a retrieved registry.Methodology and results: Cross-tabulation using SPSS was used to analyze 1394 cases of confirmed typhoid patientsadmitted to various hospitals in Kelantan state over a six-year period. Fourteen age groups with a five-year rangeinterval were generated. There was a significant association between typhoid infection and sex of subjects, wherebyfemales were generally more susceptible than males. Ethnicity and district of typhoid patients did not show significantassociation.Conclusion, significance and impact of study: The observation of an increased number of typhoid cases with a malepredominance in the age group 5-14 and female predominance in the 20-60 age group calls for improved hygiene,continued public health education, together with better laboratory diagnostics to identify carriers, are some measures tocontrol this disease.

Scan Manifestations and Blood Clearance Rates in Typhoid Liver

International Nuclear Information System (INIS)

Bahk, Yong Whee; Ahn, Jae Sung; Kim, Soon Hi

1970-01-01

Fourteen patients with typhoid fever studied by scanning and clearance-rate measurements of subcritical dose colloidal radiogold ( 198 Au). Mild to moderate enlargement of the liver and spleen was noted in 78.6 and 64.3 percent of patients, respectively; and splenic and spinal bone-marrow uptake was seen in 78.6 and 57.1 percent of cases, respectively. Typically, these scan changes occurred concomitantly (57.1%) and are considered to represent increased phagocytic activity of the RE cells which is characteristic of typhoid fever. The half clearance-time was significantly shortened during the first 10-day period of the illness indicating an increase in the hepatic blood in the early phase of typhoid infection. Hepatomegaly, splenomegaly and extrahepatic uptakes along with an accelerated (or less a normal) clearance time are characteristic of typhoid fever.

Environmental Transmission of Typhoid Fever in an Urban Slum.

Science.gov (United States)

Akullian, Adam; Ng'eno, Eric; Matheson, Alastair I; Cosmas, Leonard; Macharia, Daniel; Fields, Barry; Bigogo, Godfrey; Mugoh, Maina; John-Stewart, Grace; Walson, Judd L; Wakefield, Jonathan; Montgomery, Joel M

2015-12-01

Enteric fever due to Salmonella Typhi (typhoid fever) occurs in urban areas with poor sanitation. While direct fecal-oral transmission is thought to be the predominant mode of transmission, recent evidence suggests that indirect environmental transmission may also contribute to disease spread. Data from a population-based infectious disease surveillance system (28,000 individuals followed biweekly) were used to map the spatial pattern of typhoid fever in Kibera, an urban informal settlement in Nairobi Kenya, between 2010-2011. Spatial modeling was used to test whether variations in topography and accumulation of surface water explain the geographic patterns of risk. Among children less than ten years of age, risk of typhoid fever was geographically heterogeneous across the study area (p = 0.016) and was positively associated with lower elevation, OR = 1.87, 95% CI (1.36-2.57), p typhoid fever did not vary geographically or with elevation among individuals more than ten years of age [corrected]. Our results provide evidence of indirect, environmental transmission of typhoid fever among children, a group with high exposure to fecal pathogens in the environment. Spatially targeting sanitation interventions may decrease enteric fever transmission.

Biomagnetic Pair Therapy and Typhoid Fever: A Pilot Study.

Science.gov (United States)

Frank, Bryan L

2017-10-01

Objective: This pilot study examined the laboratory responses of patients with laboratory-documented typhoid fever who were treated with Biomagnetic Pair Therapy (BPT; medical biomagnetism), a specific application of pairs of magnets for various ailments that are infectious and otherwise. Materials and Methods: This study was an assessment of patients' response to treatment with only BPT for Salmonella typhi infections (typhoid fever) using standard conventional laboratory techniques. The research was conducted in an outpatient village clinic in Kenya. There were 52 participants who were evaluated for possible systemic illness, including typhoid fever, from an open-label study. Participants who felt sick and requested testing for possible typhoid fever were tested with a standard Widal test by a certified laboratory technician. Participants who tested positive (13 patients) were then treated with BPT (a "First Aid" approach) only. These participants then returned for follow-up laboratory and clinical evaluations after 2 days. Results: Most of the participants (10 of 13) retested as negative, and all patients reported symptomatic clinical improvement. Conclusions: As a significant majority of participants demonstrated clearing of their S. typhi after BPT, this technique should be studied further in larger trials for its efficacy in treating typhoid fever.

Environmental Transmission of Typhoid Fever in an Urban Slum.

Directory of Open Access Journals (Sweden)

Adam Akullian

2015-12-01

Full Text Available Enteric fever due to Salmonella Typhi (typhoid fever occurs in urban areas with poor sanitation. While direct fecal-oral transmission is thought to be the predominant mode of transmission, recent evidence suggests that indirect environmental transmission may also contribute to disease spread.Data from a population-based infectious disease surveillance system (28,000 individuals followed biweekly were used to map the spatial pattern of typhoid fever in Kibera, an urban informal settlement in Nairobi Kenya, between 2010-2011. Spatial modeling was used to test whether variations in topography and accumulation of surface water explain the geographic patterns of risk.Among children less than ten years of age, risk of typhoid fever was geographically heterogeneous across the study area (p = 0.016 and was positively associated with lower elevation, OR = 1.87, 95% CI (1.36-2.57, p <0.001. In contrast, the risk of typhoid fever did not vary geographically or with elevation among individuals more than ten years of age [corrected].Our results provide evidence of indirect, environmental transmission of typhoid fever among children, a group with high exposure to fecal pathogens in the environment. Spatially targeting sanitation interventions may decrease enteric fever transmission.

Scan Manifestations and Blood Clearance Rates in Typhoid Liver

Energy Technology Data Exchange (ETDEWEB)

Bahk, Yong Whee; Ahn, Jae Sung; Kim, Soon Hi [St. Mary' s Hospital, Catholic Medical College, Seoul (Korea, Republic of)

1970-09-15

Fourteen patients with typhoid fever studied by scanning and clearance-rate measurements of subcritical dose colloidal radiogold ({sup 198}Au). Mild to moderate enlargement of the liver and spleen was noted in 78.6 and 64.3 percent of patients, respectively; and splenic and spinal bone-marrow uptake was seen in 78.6 and 57.1 percent of cases, respectively. Typically, these scan changes occurred concomitantly (57.1%) and are considered to represent increased phagocytic activity of the RE cells which is characteristic of typhoid fever. The half clearance-time was significantly shortened during the first 10-day period of the illness indicating an increase in the hepatic blood in the early phase of typhoid infection. Hepatomegaly, splenomegaly and extrahepatic uptakes along with an accelerated (or less a normal) clearance time are characteristic of typhoid fever.

Unusual complication of toxic megacolon in typhoid colitis.

Science.gov (United States)

Arun Babu, Thirunavukkarasu; Ananthakrishnan, Shanthi; Jayakumar, P; Kullu, Poonam

2014-05-01

Colitis is a rare manifestation of enteric fever in children. Toxic megacolon complicating typhoid colitis is even rarer and requires early recognition and aggressive management due to the high mortality associated with this condition. The authors report a rare case of Toxic megacolon secondary to typhoid colitis in a seven-year-old girl.

Non-Typhoidal Salmonella Aortitis in a transplant patient

International Nuclear Information System (INIS)

Tarif, N.; Azam, M.N.; Mitwalli, Ahmad H.; Al-Wakeel, Jamal S.; El-Kheder, A. Al-Aboud

2002-01-01

Non-typhoidal salmonella bacteremia may result in extra gastrointestinallocalization of infection. Aortitis due to non-typhoidal salmonella wasreported to be the cause of 38-42% of all infected abdominal aortitis.Underlying atherosclerosis is a frequent site for salmonella aortitis. Wedescribe here a case of possible salmonella aortitis in a renal transplantpatient. (author)

A rabbit model of non-typhoidal Salmonella bacteremia.

Science.gov (United States)

Panda, Aruna; Tatarov, Ivan; Masek, Billie Jo; Hardick, Justin; Crusan, Annabelle; Wakefield, Teresa; Carroll, Karen; Yang, Samuel; Hsieh, Yu-Hsiang; Lipsky, Michael M; McLeod, Charles G; Levine, Myron M; Rothman, Richard E; Gaydos, Charlotte A; DeTolla, Louis J

2014-09-01

Bacteremia is an important cause of morbidity and mortality in humans. In this study, we focused on the development of an animal model of bacteremia induced by non-typhoidal Salmonella. New Zealand White rabbits were inoculated with a human isolate of non-typhoidal Salmonella strain CVD J73 via the intra-peritoneal route. Blood samples were collected at specific time points and at euthanasia from infected rabbits. Additionally, tissue samples from the heart, lungs, spleen, gastrointestinal tract, liver and kidneys were obtained at euthanasia. All experimentally infected rabbits displayed clinical signs of disease (fever, dehydration, weight loss and lethargy). Tissues collected at necropsy from the animals exhibited histopathological changes indicative of bacteremia. Non-typhoidal Salmonella bacteria were detected in the blood and tissue samples of infected rabbits by microbiological culture and real-time PCR assays. The development of this animal model of bacteremia could prove to be a useful tool for studying how non-typhoidal Salmonella infections disseminate and spread in humans. Copyright © 2014 Elsevier Ltd. All rights reserved.

Molecular and phylogenetic analyses of Salmonella Gallinarum trace the origin and diversification of recent outbreaks of fowl typhoid in poultry farms.

Science.gov (United States)

De Carli, Silvia; Gräf, Tiago; Kipper, Diéssy; Lehmann, Fernanda Kieling Moreira; Zanetti, Nathalie; Siqueira, Franciele Maboni; Cibulski, Samuel; Fonseca, André Salvador Kazantzi; Ikuta, Nilo; Lunge, Vagner Ricardo

2017-12-01

Fowl typhoid (FT) and pullorum disease (PD) are two important poultry infections caused by Salmonella enterica subsp. enterica serotype Gallinarum (S. Gallinarum). S. Gallinarum strains are adapted to birds and classified into biovars Gallinarum (bvGA) and Pullorum (bvPU) as they are the causative agent of FT and PD, respectively. In Brazil, FT/PD outbreaks have been reported along the last 50 years, but there was a recent increase of FT field reports with the suspicion it could be due to virulence reversion of the attenuated live vaccine SG9R. In this study, we applied molecular biology assays and phylogenetic methods to detect and investigate S. Gallinarum isolates from commercial poultry flocks in order to understand the evolutionary history and origin of the recent FT outbreaks in Brazil. S. Gallinarum isolates were obtained from thirteen different poultry flocks with clinical signs of FT/PD from 2013 to 2015. These isolates were serotyped, tested with three specific PCR (for the detection of bvGA, bvPU and live vaccine strain SG9R) and submitted to sequencing of a variable genome region (ISR analysis). The complete genome of one bvGA strain (BR_RS12) was also compared to other S. Gallinarum complete genomes (including other two Brazilian ones: bvGA 287/91 and bvPU FCVA198). PCR detected all thirteen isolates as S. Gallinarum (eight bvGA and five bvPU), none positive for SG9R strain. ISR analysis revealed that all eight bvGA isolates showed exactly the same nucleotide sequences with 100% similarity to reference strains, while two patterns were observed for bvPU. Genome phylogeny demonstrated distinct clades for bvGA and bvPU, with the bvGA clade showing a clear subdivision including three genomes: SG9R vaccine, the respective SG9 parent strain and one SG9R revertant field isolate (MB4523). The evolutionary rate of the total S. Gallinarum genome was calculated at 6.15×10 -7 substitutions/site/year, with 2.8 observed substitutions per year per genome (1 SNP per

Typhoid fever : aspects of environment, host and pathogen interaction

NARCIS (Netherlands)

Ali, Soegianto

2006-01-01

In a surveillance study in Jakarta, Indonesia, 88 typhoid and 26 paratyphoid fever patients were identified by blood culture. Risk factors for transmission of typhoid fever were mainly intra-household factors (poor hand-washing hygiene, recent household contacts), whereas paratyphoid was mainly

Typhoid fever: case report and literature review.

Science.gov (United States)

Sanhueza Palma, Natalia Carolina; Farías Molina, Solange; Calzadilla Riveras, Jeannette; Hermoso, Amalia

2016-06-21

Typhoid fever remains a major health problem worldwide, in contrast to Chile, where this disease is an isolated finding. Clinical presentation is varied, mainly presenting with fever, malaise, abdominal discomfort, and nonspecific symptoms often confused with other causes of febrile syndrome. We report a six-year-old, male patient presenting with fever of two weeks associated with gastrointestinal symptoms, malaise, hepatomegaly and elevated liver enzymes. Differential diagnoses were considered and a Widal reaction and two blood cultures were requested; both came back positive, confirming the diagnosis of typhoid fever caused by Salmonella typhi. Prior to diagnosis confirmation, empirical treatment was initiated with ceftriaxone and metronidazole, with partial response; then drug therapy was adjusted according to ciprofloxacin susceptibility testing with a favorable clinical response. We discuss diagnostic methods and treatment of enteric fever with special emphasis on typhoid fever.

Food panics in history: corned beef, typhoid and "risk society".

Science.gov (United States)

Smith, David F

2007-07-01

An outline of the "risk society" thesis of the German social theorist Ulrich Beck is given, and some points that he has taken from food safety examples are discussed. The potential for exploring the viability and utility of the thesis, via a comparative study of historical food safety episodes is illustrated through an account and discussion of the large corned beef-associated typhoid outbreak which occurred in 1964 in Aberdeen, Scotland. The outcome of the Aberdeen affair, in terms of public and political interest in food safety, and impact on the official food safety system, is compared with the outcome and impact of the series of food safety episodes of the 1980s and 1990s. The interactions between the latter episodes and the new food movement, the proactive responses of corporate interests, and the dramatic changes in the food safety regime represented by the formation of the Food Standards Agency in Britain, are contrasted with the relative lack of impact of the Aberdeen outbreak. Despite criticisms of Beck's thesis, this comparative study highlights, in particular, the value of his concept of "subpolitics", and his expectation that the transition to risk society will involve the emergence of new social institutions. Such insights may help orientate epidemiologists and community health specialists who are currently active in food safety and regulation.

Clinical and Haematological Manifestations of Typhoid Fever in Children in Eastern Turkey.

Science.gov (United States)

Akbayram, S; Parlak, M; Dogan, M; Karasin, G; Akbayram, H T; Karaman, K

2016-01-12

Typhoid fever can involve various organs, leading to a wide range of presentations: from uncomplicated to complicated typhoid fever. The haematological changes are common in typhoid fever and include anaemia, leucopaenia, thrombocytopaenia and bleeding diathesis. This study was undertaken in order to determine the clinical and haematological presentation of typhoid fever in children. In this study, records of children and adolescents with typhoid fever aged under or equal to 16 years, admitted to Yuzuncu Yil University Hospital between 2010 and 2014, were analysed retrospectively. The cases (56%) were admitted to our hospital in July and October. Major symptoms of patients were abdominal pain (24%), arthralgia (21%) and fever (11%). In our study, decreased mean platelet volume (31%), eosinopaenia 20%), abnormal platelet count (19%), anaemia (16%), leucocytosis (16%) and eosinophilia (12%) were the most common haematological findings in the children. Typhoid fever is predominant in children at school age with a slight male predominance. Decreased mean platelet volume and abdominal pain might be useful as early diagnostic clues.

Typhoid fever in a South African in-patient population

NARCIS (Netherlands)

Khan, Mohammad Enayet Hossain

2004-01-01

In conclusion, the data presented herein show that no single clinical or paraclinical parameter is reliable in arriving at a correct clinical diagnosis of typhoid fever and that bacteriologic confirmation is necessary for the diagnosis of typhoid fever. Patients ’ age and sex influence the clinical

Early detection of typhoid by polymerase chain reaction

International Nuclear Information System (INIS)

Haque, A.; Qureshi, Javed A.; Ahmed, J.

1999-01-01

Typhoid is a common problem in developing countries. Cultivation ofbacteria and serology (especially Widal test) gives unacceptable levels offalse-negative and false-positive results respectively. In this study, arecently introduced polymerase chain reaction based technique (which has 100%specificity for Salmonella typhi) was compared with blood culture and Widaltest during the first week of illness of 82 suspected cases of typhoid. Therespective figures of positivity for PCR, blood culture and Widal test were71.95%, 34.1% and 36.5%. A control group of 20 healthy persons gave figuresof 0%, 0% and 33.3%, respectively. We conclude that this PCR-based techniqueis not only absolutely specific, but also very sensitive and therefore muchsuperior to blood culture and, Widal test for the early diagnosis of typhoid.(author)

Risk Factors of Typhoid Infection in the Indonesian Archipelago.

Directory of Open Access Journals (Sweden)

Sandra Alba

Full Text Available Knowledge of risk factors and their relative importance in different settings is essential to develop effective health education material for the prevention of typhoid. In this study, we examine the effect of household level and individual behavioural risk factors on the risk of typhoid in three Indonesian islands (Sulawesi, Kalimantan and Papua in the Eastern Indonesian archipelago encompassing rural, peri-urban and urban areas.We enrolled 933 patients above 10 years of age in a health facility-based case-control study between June 2010 and June 2011. Individuals suspected of typhoid were tested using the typhoid IgM lateral flow assay for the serodiagnosis of typhoid fever followed by blood culture testing. Cases and controls were defined post-recruitment: cases were individuals with a culture or serology positive result (n = 449; controls were individuals negative to both serology and culture, with or without a diagnosis other than typhoid (n = 484. Logistic regression was used to examine the effect of household level and individual level behavioural risk factors and we calculated the population attributable fraction (PAF of removing each risk significant independent behavioural risk factor.Washing hands at critical moments of the day and washing hands with soap were strong independent protective factors for typhoid (OR = 0.38 95% CI 0.25 to 0.58 for each unit increase in hand washing frequency score with values between 0 = Never and 3 = Always; OR = 3.16 95% CI = 2.09 to 4.79 comparing washing hands with soap sometimes/never vs. often. These effects were independent of levels of access to water and sanitation. Up to two thirds of cases could be prevented by compliance to these practices (hand washing PAF = 66.8 95% CI 61.4 to 71.5; use of soap PAF = 61.9 95%CI 56.7 to 66.5. Eating food out in food stalls or restaurant was an important risk factor (OR = 6.9 95%CI 4.41 to 10.8 for every unit increase in frequency score.Major gains could

Food panics in history: corned beef, typhoid and “risk society”

Science.gov (United States)

Smith, David F

2007-01-01

An outline of the “risk society” thesis of the German social theorist Ulrich Beck is given, and some points that he has taken from food safety examples are discussed. The potential for exploring the viability and utility of the thesis, via a comparative study of historical food safety episodes is illustrated through an account and discussion of the large corned beef‐associated typhoid outbreak which occurred in 1964 in Aberdeen, Scotland. The outcome of the Aberdeen affair, in terms of public and political interest in food safety, and impact on the official food safety system, is compared with the outcome and impact of the series of food safety episodes of the 1980s and 1990s. The interactions between the latter episodes and the new food movement, the proactive responses of corporate interests, and the dramatic changes in the food safety regime represented by the formation of the Food Standards Agency in Britain, are contrasted with the relative lack of impact of the Aberdeen outbreak. Despite criticisms of Beck's thesis, this comparative study highlights, in particular, the value of his concept of “subpolitics”, and his expectation that the transition to risk society will involve the emergence of new social institutions. Such insights may help orientate epidemiologists and community health specialists who are currently active in food safety and regulation. PMID:17568045

A cost-effectiveness analysis of typhoid fever vaccines in US military personnel.

Science.gov (United States)

Warren, T A; Finder, S F; Brier, K L; Ries, A J; Weber, M P; Miller, M R; Potyk, R P; Reeves, C S; Moran, E L; Tornow, J J

1996-11-01

Typhoid fever has been a problem for military personnel throughout history. A cost-effectiveness analysis of typhoid fever vaccines from the perspective of the US military was performed. Currently 3 vaccine preparations are available in the US: an oral live Type 21A whole cell vaccine; a single-dose parenteral, cell subunit vaccine; and a 2-dose parenteral heat-phenol killed, whole cell vaccine. This analysis assumed all vaccinees were US military personnel. Two pharmacoeconomic models were developed, one for personnel who have not yet been deployed, and the other for personnel who are deployed to an area endemic for typhoid fever. Drug acquisition, administration, adverse effect and lost work costs, as well as the costs associated with typhoid fever, were included in this analysis. Unique military issues, typhoid fever attack rates, vaccine efficacy, and compliance with each vaccine's dosage regimen were included in this analysis. A sensitivity analysis was performed to test the robustness of the models. Typhoid fever immunisation is not cost-effective for US military personnel unless they are considered imminently deployable or are deployed. The most cost-effective vaccine for US military personnel is the single-dose, cell subunit parenteral vaccine.

Reproducible diagnostic metabolites in plasma from typhoid fever patients in Asia and Africa

NARCIS (Netherlands)

Näsström, Elin; Parry, Christopher M.; Vu Thieu, Nga Tran; Maude, Rapeephan R.; de Jong, Hanna K.; Fukushima, Masako; Rzhepishevska, Olena; Marks, Florian; Panzner, Ursula; Im, Justin; Jeon, Hyonjin; Park, Seeun; Chaudhury, Zabeen; Ghose, Aniruddha; Samad, Rasheda; van, Tan Trinh; Johansson, Anders; Dondorp, Arjen M.; Thwaites, Guy E.; Faiz, Abul; Antti, Henrik; Baker, Stephen

2017-01-01

Salmonella Typhi is the causative agent of typhoid. Typhoid is diagnosed by blood culture, a method that lacks sensitivity, portability and speed. We have previously shown that specific metabolomic profiles can be detected in the blood of typhoid patients from Nepal (Näsström et al., 2014). Here, we

Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia.

NARCIS (Netherlands)

Vollaard, A.M.; Ali, S.; Asten, H.A.G.H. van; Widjaja, S.; Visser, L.G.; Surjadi, C.; Dissel, J.T. van

2004-01-01

CONTEXT: The proportion of paratyphoid fever cases to typhoid fever cases may change due to urbanization and increased dependency on food purchased from street vendors. For containment of paratyphoid a different strategy may be needed than for typhoid, because risk factors for disease may not

Should close contacts of returning travellers with typhoid fever be protected by vaccination?

Science.gov (United States)

Kantele, A

2015-03-17

Increasing international travel to areas endemic for typhoid fever correlates with increased risk for travellers to contract the disease. At home, the acutely ill/convalescent patients may pose some risk to their close contacts. In Finland an unofficial guideline suggests vaccination for close contacts of patients with acute typhoid fever; in other developed countries, routine typhoid vaccinations are only recommended to contacts of chronic carriers. This paper discusses the possibilities and limitations of prophylactic/post-exposure typhoid vaccination for contacts of patients with acute disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

Typhoid Fever Presenting With Acute Renal Failure And Hepatitis Simultaneously - A Rare Presentation

Directory of Open Access Journals (Sweden)

Rajput R.

2016-05-01

Full Text Available Typhoid fever is an important health problem worldwide but its incidence is more in developing countries. Hepatic involvement is common, but both hepatic and renal involvement is rare in typhoid fever. We report a case of typhoid fever presenting with hepatitis and acute renal failure. A 17 year old male presenting with fever and pain abdomen was found to have raised blood urea, creatinine, liver enzymes and bilirubin. Widal and typhidot (IgM,IgG test were positive. His symptoms subsided and deranged parameters resolved with treatment of typhoid fever.

Limitations of typhoid fever diagnostics and the need for prevention

NARCIS (Netherlands)

Smits, Henk L.

2013-01-01

Evaluation of: Siba V, Horwood PF, Vanuga K et al. Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard. Clin. Vaccine Immunol. 19(11), 1833-1837 (2012). The study under review evaluated serological tests for typhoid fever against PCR

Typhoid ileal perforation: a 13-year experience

Directory of Open Access Journals (Sweden)

Poras Chaudhary

2015-07-01

Full Text Available Typhoid fever is endemic in many developing countries with a high rate of complications. Aim of this study is to analyse epidemiological features, clinical presentations, complications and therapeutic outcomes of enteric perforation peritonitis diagnosed and treated in our hospital. Records of total number of 646 patients, who presented with perforation peritonitis due to enteric fever in the surgical emergency unit of Dr Ram Manohar Lohia hospital, New Delhi between January 2001 and December 2013, were reviewed retrospectively. Descriptive statistics was used to analyze the data. Out of 646 patients, 62 (9.59% presented in shock. Stomal, peristomal, local and systemic complications were high in these patients. Primary closure was done in 212 (33.12 patients, primary ileostomy was created in 410 (64.06 patients, and resection and anastomosis was done in 24 (3.75 patients. Thirteen patients (2.01% died of typhoid intestinal perforation. To prevent complications of typhoid fever, in addition to control sanitation, it is also important to control quackery and malpractices. Awareness and education about the disease, its nature and complications will also be of great help.

The Molecular and Spatial Epidemiology of Typhoid Fever in Rural Cambodia.

Science.gov (United States)

Pham Thanh, Duy; Thompson, Corinne N; Rabaa, Maia A; Sona, Soeng; Sopheary, Sun; Kumar, Varun; Moore, Catrin; Tran Vu Thieu, Nga; Wijedoru, Lalith; Holt, Kathryn E; Wong, Vanessa; Pickard, Derek; Thwaites, Guy E; Day, Nicholas; Dougan, Gordon; Turner, Paul; Parry, Christopher M; Baker, Stephen

2016-06-01

Typhoid fever, caused by the bacterium Salmonella Typhi, is an endemic cause of febrile disease in Cambodia. The aim of this study was to better understand the epidemiology of pediatric typhoid fever in Cambodia. We accessed routine blood culture data from Angkor Hospital for Children (AHC) in Siem Reap province between 2007 and 2014, and performed whole genome sequencing (WGS) on the isolated bacteria to characterize the S. Typhi population. The resulting phylogenetic information was combined with conventional epidemiological approaches to investigate the spatiotemporal distribution of S. Typhi and population-level risk factors for reported disease. During the study period, there were 262 cases of typhoid within a 100 km radius of AHC, with a median patient age of 8.2 years (IQR: 5.1-11.5 years). The majority of infections occurred during the rainy season, and commune incidences as high as 11.36/1,000 in children aged typhoid fever in rural communes in Cambodia. Our data provide a platform for additional population-based typhoid fever studies in this location, and suggest that this would be a suitable setting in which to introduce a school-based vaccination programme with Vi conjugate vaccines.

Antibody response to the lipopolysaccharide and protein antigens of Salmonella typhi during typhoid infection

International Nuclear Information System (INIS)

Tsang, R.S.W.; Chau, P.Y.; Lam, S.K.

1981-01-01

Serum antibody responses to the lipopolysaccharide and protein antigens of S. typhi in typhoid patients were studied using a solid-phase radioimmunoassay technique with 125 I labelled anti-immunoglobulin antibody. Sera from 24 adult typhoid patients and 20 non-typhoid adult controls were compared. As a group, sera from typhoid patients showed increased IgA, IgG and IgM immunoglobulin levels and gave significantly higher anti-LPS and anti-protein antibody titres in all three major immunoglobulin classes than did non-typhoid controls. Levels of antibodies against LPS or protein in sera of typhoid patients were highly variable with a skew distribution. A good correlation was found between antibody titres to the LPS antigen and those to a protein antigen. No correlation, however, was found between the anti-LPS antibody titres measured by radioimmunoassay and the anti-O antibody titres measured by the Widal agglutination test. Titration of anti-LPS or anti-protein antibodies by radioimmunoassay was found to be more sensitive and specific than Widal test for the serological diagnosis of typhoid fever. The advantages of measuring antibody response by radioimmunoassay over conventional Widal test are discussed. (author)

Multifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination

Directory of Open Access Journals (Sweden)

Escott S

2013-02-01

Full Text Available Sarah Escott, Ahmad B Tarabishy, Frederick H DavidorfHavener Eye Institute, The Ohio State University, Columbus, OH, USAAbstract: The paper describes the first reported case of multifocal choroiditis following simultaneous hepatitis-A, typhoid, and yellow fever vaccinations. A 33-year-old male developed sudden onset of flashing lights and floaters in his right eye 3 weeks following hepatitis A, typhoid, and yellow fever vaccinations. Fundus examination and angiography confirmed the presence of multiple peripheral chorioretinal lesions. These lesions demonstrated characteristic morphologic changes over a period of 8 weeks which were consistent with a diagnosis of self-resolving multifocal choroiditis. Vaccine-induced intraocular inflammation has been described infrequently. We demonstrate the first case of self-resolving multifocal choroiditis following simultaneous administration of hepatitis A, yellow fever, and typhoid immunizations.Keywords: multifocal choroiditis, vaccination, hepatitis A, typhoid, yellow fever

Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia.

NARCIS (Netherlands)

Gasem, M.H.; Dolmans, W.M.V.; Keuter, M.; Djokomoeljanto, R.J.

2001-01-01

To identify risk factors for typhoid fever in Semarang city and its surroundings, 75 culture-proven typhoid fever patients discharged 2 weeks earlier from hospital and 75 controls were studied. Control subjects were neighbours of cases with no history of typhoid fever, not family members, randomly

The Behaviour of Fe Stable Isotopes Accompanying Fluid Migration in Subducted Serpentinite from the Zermatt-Saas Ophiolite of the Swiss Alps

Science.gov (United States)

Inglis, E.; Bouilhol, P.; Burton, K. W.; Debret, B.; Millet, M. A.; Williams, H. M.

2016-12-01

During subduction the destabilisation of hydrous serpentine group phases can generate significant fluid fluxes between the subducting slab and the overlying mantle wedge. Despite our knowledge of this, the exact process and nature of the fluids released during serpentinite devolatilisation remain poorly understood. This study presents new field observations alongside petrographic and geochemical data for metamorphic veins and host serpentinite from the Zermatt-Saas ophiolite from the Swiss Alps, which underwent high-pressure metamorphism during the Alpine orogeny. Samples were collected from the serpentinised ultramafic section of the Zermatt-Saas ophiolite, which is mainly comprised of variably foliated and sheared antigorite serpentine. High-pressure metamorphic veins hosted within the antigorite serpentinite, are observed within the least deformed part of the massif, occurring as cm scale laterally continuous channels or mm scale interconnected anastomosing networks. Preliminary high-precision Fe isotope data for the host antigorite serpentine yield a mean δ56Fe value of -0.09‰ ± 0.04‰ (n=3), notably lighter than previously measured Alpine and abyssal serpentinites (Debret et al., 2016). In contrast, samples of cm scale olivine-bearing veins display a mean δ56Fe value of 0.07 ± 0.05‰ (n=3), resolvably heavier than that of the host serpentinite. These preliminary results suggest preferential mobility of isotopically heavy Fe within the vein forming fluids, but at this stage it is unclear if this fluid is related to local devolatilisation of the host serpentinite or input from an external source. Debret et al., 2016. Isotopic evidence for iron mobility during subduction. Geology, v. 44, no. 3, pp. 215 -218.

Comparative Evaluation of Tubex TF (Inhibition Magnetic Binding Immunoassay) for Typhoid Fever in Endemic Area.

Science.gov (United States)

Khanna, Ashish; Khanna, Menka; Gill, Karamjit Singh

2015-11-01

Typhoid fever remains a significant health problem in endemic countries like India. Various serological tests for the diagnosis of typhoid fever are available commercially. We assessed the usefulness of rapid test based on magnetic particle separation to detect Immunoglobulin against Salmonella typhi O9 lipopolysaccharide. Aim of this study was to compare the sensitivity and specificity of widal test, typhidot and tubex TF test for the diagnosis of typhoid fever in an endemic country like India. Serum samples collected from 50 patients of typhoid fever, 50 patients of non typhoid fever and 100 normal healthy individuals residing in Amritsar were subjected to widal test, typhidot test and tubex TF test as per manufacturer's instructions. Data collected was assessed to find sensitivity and specificity of these tests in an endemic area. Significant widal test results were found positive in 68% of patients of typhoid fever and only 4% of non typhoid fever patients. Typhidot (IgM or IgG) was positive in 72% of typhoid fever patients and 10% and 6% in non typhoid fever and normal healthy individuals respectively. Tubex TF showed higher sensitivity of 76% and specificity of 96-99% which was higher than typhidot and comparable to widal test. This was the first evaluation of rapid tubex TF test in northern India. In countries which can afford high cost of test, tubex TF should be recommended for the diagnosis in acute stage of the disease in clinical setting. However, there is urgent need for a highly specific and sensitive test for the diagnosis of typhoid fever in clinical settings in endemic areas.

The burden of typhoid fever in low- and middle-income countries: A meta-regression approach.

Science.gov (United States)

Antillón, Marina; Warren, Joshua L; Crawford, Forrest W; Weinberger, Daniel M; Kürüm, Esra; Pak, Gi Deok; Marks, Florian; Pitzer, Virginia E

2017-02-01

Upcoming vaccination efforts against typhoid fever require an assessment of the baseline burden of disease in countries at risk. There are no typhoid incidence data from most low- and middle-income countries (LMICs), so model-based estimates offer insights for decision-makers in the absence of readily available data. We developed a mixed-effects model fit to data from 32 population-based studies of typhoid incidence in 22 locations in 14 countries. We tested the contribution of economic and environmental indices for predicting typhoid incidence using a stochastic search variable selection algorithm. We performed out-of-sample validation to assess the predictive performance of the model. We estimated that 17.8 million cases of typhoid fever occur each year in LMICs (95% credible interval: 6.9-48.4 million). Central Africa was predicted to experience the highest incidence of typhoid, followed by select countries in Central, South, and Southeast Asia. Incidence typically peaked in the 2-4 year old age group. Models incorporating widely available economic and environmental indicators were found to describe incidence better than null models. Recent estimates of typhoid burden may under-estimate the number of cases and magnitude of uncertainty in typhoid incidence. Our analysis permits prediction of overall as well as age-specific incidence of typhoid fever in LMICs, and incorporates uncertainty around the model structure and estimates of the predictors. Future studies are needed to further validate and refine model predictions and better understand year-to-year variation in cases.

Current antimicrobial sensitivity pattern of typhoidal salmonellae in a referral diagnostic centre

Directory of Open Access Journals (Sweden)

Umer Shujat

2016-03-01

Full Text Available Background: Infections caused by typhoidal salmonellae are an important public health concern in Pakistan. Inappropriate and injudicious use of fluoroquinolones has reduced their efficacy due to development of high level resistance. Aim: To ascertain the current susceptibility pattern of typhoidal salmonellae thus guiding the physicians for better management of typhoid patients.Materials and Methods: A study was conducted at our institution from January 2012 through December 2013 to investigate current susceptibility pattern of typhoidal salmonellae. Results: Out of 200 isolates, 107 (53.5% were identified as Salmonella Typhi and 93 (46.5% as Salmonella Paratyphi A. Sensitivities of Salmonella Typhi were as follows: ampicillin (48.6%, chloramphenicol (45.8%, co-trimoxazole (40.1%, ciprofloxacin (11.2%. Sensitivities of Salmonella Paratyphi A were: ampicillin (80.6%, chloramphenicol (89.2%, co-trimoxazole (90.3%, and ciprofloxacin (16.1%. No resistance was detected against third generation cephalosporins. Conclusions: Typhoidal salmonellae are still entirely susceptible to third generation cephalosporins in our setting. Marked rise in resistance to fluoroquinolones has reduced their empirical usage. Sensitivity of Salmonella Paratyphi A to conventional antityphoid drugs was encouraging.

Acceptability of oral typhoid vaccine in Thai children.

Science.gov (United States)

Mekmullica, Jutarat; Pancharoen, Chitsanu

2003-06-01

To determine the acceptability of oral typhoid vaccine to Thai children, 434 volunteers, aged 4-15 years (average age = 8.2 years), were assigned to take three capsules of oral typhoid vaccine (one capsule every other day). Success was defined as the subjects' being able to swallow all three capsules. Information concerning the subjects' level of education, eating habits, and ability to take medicines in a variety of preparations (syrups, tablets and capsules) was obtained. The overall success rate was 94.2%; the rates were 84.4%, 94.9%, and 100% in the age groups 4-6 years, 7-9 years, and 10-12 years respectively. The rates were 82%, 85.7%, 93.3%, 96.4%, 98.8%, 100% and 100% in the students of kindergarten 1, kindergarten 2, elementary grade 1, grade 2, grade 3, grade 4, and grade 5 respectively. There was a correlation between a child's prior ability to take tablets/capsules and his success in swallowing the oral typhoid vaccine.

[Report of Relapse Typhoid Fever Cases from Kolkata, India: Recrudescence or Reinfection?

Science.gov (United States)

Samajpati, Sriparna; Das, Surojit; Ray, Ujjwayini; Dutta, Shanta

2018-05-24

Three relapse cases were reported out of 107 hospital-attending typhoid cases within a period of 2 years (2014-2016) from Apollo Gleneagles Hospital, Kolkata, India. During the first episode of typhoid fever, 2 of the 3 cases were treated with ceftriaxone (CRO) for 7 days, and 1 was treated for 14 days. Six Salmonella Typhi (S. Typhi) isolates, obtained from the 3 patients during both typhoid episodes, were subjected to antimicrobial susceptibility testing, detection of quinolone resistance-determining region (QRDR) mutation and molecular subtyping by pulsed-field gel electrophoresis (PFGE), multiple-locus variable number tandem repeat analysis (MLVA), multilocus sequence typing (MLST), clustered regularly interspaced short palindromic repeats (CRISPR), and H58 haplotyping. Pairs of the S. Typhi strains isolated from two of the patients during the 1st and 2nd episodes were similar with respect to the antimicrobial resistance (AMR) profiles, QRDR mutations, and molecular subtypes; whereas, the S. Typhi strain pair isolated from the 3rd patient were different in their AMR profiles, QRDR mutations, and MLVA profiles. From these observations, it may be concluded that in spite of treating typhoid cases with CRO for 7-14 days, relapse of typhoid fever might occur. The article also showed the advantage of MLVA typing over PFGE, MLST, and CRISPR typing for the discrimination of strains isolated from the same patient in case of relapse of typhoid fever.

The death of Alexander the Great: malaria or typhoid fever?

Science.gov (United States)

Cunha, Burke A

2004-03-01

Alexander the Great had a profound effect on world history. His conquests covered the entire known world at the time, and he was responsible for the spread of Greek culture throughout the ancient world. In Babylon in 323 BC, Alexander died when he was nearly 33 years old. Possible explanations for his death have included alcoholic liver disease and strychnine poisoning, but little data support either condition as the cause of his death. Alexander most likely died from malaria or typhoid fever, which were rampant in ancient Babylon. The description of his final illness from the royal diaries is consistent with typhoid fever or malaria but is most characteristic of typhoid fever.

Latex agglutination test (LAT) for the diagnosis of typhoid fever.

Science.gov (United States)

Sahni, Gopal Shankar

2013-06-01

The efficacy of latex agglutination test in the rapid diagnosis of typhoid fever was studied and the result compared with that of blood culture. This study included 80 children suffering from typhoid fever, among which 40 were confirmed by blood culture isolation and 40 had possible typhoid fever based on high Widal's titre (a four-fold rise in the titre of antibody to typhi "O" and "H" antigen was considered as a positive Widal's test result). Eighty children, 40 with febrile illness confirmed to be other than typhoid and 40 normal healthy children were used as negative controls. The various groups were: (i) Study group ie, group I had 40 children confirmed by culture isolation of Salmonella typhi(confirmed typhoid cases). (ii) Control groups ie, (a) group II with 40 febrile controls selected from paediatrics ward where cause other than S typhi has been established, (b) group III with 40 afebrile healthy controls that were siblings of the children admitted in paediatric ward for any reason with no history of fever and TAB vaccination in the last one year, and (c) group IV with 40 children with high Widal's titre in paired sera sample. Widal's test with paired sera with a one week interval between collections were done in all 40 patients. Latex aggtutination test which could detect 900 ng/ml of antigen as observed in checker board titration, was positive in all 40 children from group I who had positive blood culture and in 30 children from group IV who had culture negative and had high Widal's titre positive. Latex agglutination test was positive in 4 children in group II and none in group III. Using blood culture positive cases as true positive and children in groups II and III as true negative, the test had a sensitivity of 100% and specificity of 96%. Latex agglutination test was found to be significantly sensitive (100%) and specific (96%) and could detect 75% more cases in group IV (possible typhoid cases). Thus latex agglutination test can be used for rapid

Diarrhea associated with typhoid fever

NARCIS (Netherlands)

Roy, S. K.; Speelman, P.; Butler, T.; Nath, S.; Rahman, H.; Stoll, B. J.

1985-01-01

To study the pathogenesis of diarrhea occurring with typhoid fever, we selected 42 patients with diarrhea and blood cultures positive for Salmonella typhi or Salmonella paratyphi A, but without diarrheal copathogens, for measurement of stool output and examination of fecal composition. The mean

Widal agglutination titre: a rapid serological diagnosis of typhoid fever in developing countries

International Nuclear Information System (INIS)

Aftab, R.; Khurshid, R.

2009-01-01

To study the reliability of a single Widal test and to find out the diagnostic significance of 'O' and 'H' agglutinin titre in the diagnosis of typhoid fever. Community-based case-control study conducted from Jan 2001 to June 2007. The blood samples were collected from the medical and out door department of Sir Ganga Ram Hospitals, Lahore. The diagnostic value of an acute phase single Widal agglutination test for suspected typhoid fever was evaluated in 733 consecutive patients with fever lasting 6 or more days. In 733 patients with fever 84 (11.45%) were positive for Widal test. A noteworthy rise 1/320 of H and/or O agglutinin titre was observed in 86 (11.3%) of patients with typhoid fever. In the absence of vaccination an elevated level of H and/or O agglutinin titre of 1: 320 is of diagnostic value for typhoid fever especially in our setting where a single sample of serum is relied on for the diagnosis of typhoid fever. (author)

Widal agglutination titre: a rapid serological diagnosis of typhoid fever in developing countries

Energy Technology Data Exchange (ETDEWEB)

Aftab, R [Fatima Jinnah Medical College Lahore, Lahore (Pakistan). Dept. of Pathology; Khurshid, R [Fatima Jinnah Medical College Lahore, Lahore (Pakistan). Dept. of Biochemistry

2009-01-15

To study the reliability of a single Widal test and to find out the diagnostic significance of 'O' and 'H' agglutinin titre in the diagnosis of typhoid fever. Community-based case-control study conducted from Jan 2001 to June 2007. The blood samples were collected from the medical and out door department of Sir Ganga Ram Hospitals, Lahore. The diagnostic value of an acute phase single Widal agglutination test for suspected typhoid fever was evaluated in 733 consecutive patients with fever lasting 6 or more days. In 733 patients with fever 84 (11.45%) were positive for Widal test. A noteworthy rise 1/320 of H and/or O agglutinin titre was observed in 86 (11.3%) of patients with typhoid fever. In the absence of vaccination an elevated level of H and/or O agglutinin titre of 1: 320 is of diagnostic value for typhoid fever especially in our setting where a single sample of serum is relied on for the diagnosis of typhoid fever. (author)

Comparison of the sensitivity of typhi dot test with blood culture in typhoid

Energy Technology Data Exchange (ETDEWEB)

Rizvi, Q [Hamdard College of Medicine, Karachi (Pakistan). Dept. of Pharmacology

2006-10-15

To evaluate the sensitivity of Typhi Dot test in comparison to Blood Culture for the diagnosis of Typhoid Fever in our setup. Fifty patients who fulfilled the clinical criteria of having Typhoid Fever. The data of all the patients was documented, and they were submitted to the Typhi Dot and Blood Culture tests, apart from other routine investigations. Out of the total 50 patients, 47(94%) had their Blood Culture positive for Typhoid bacillus, while in 49 (98%) the Typhi Dot test was positive. Two patients which were found positive on Typhi dot test, gave negative results on Blood Culture. One patient with the signs and symptoms of Typhoid Fever was found neither positive on Typhi Dot test nor upon Blood Culture. There was no significant difference between the results of Blood Culture and Typhi Dot test in the diagnosis of Typhoid Fever. However, Typhi Dot has the advantages of being less expensive and quicker in giving results with excellent sensitivity. (author)

Comparison of the sensitivity of typhi dot test with blood culture in typhoid

International Nuclear Information System (INIS)

Rizvi, Q.

2006-01-01

To evaluate the sensitivity of Typhi Dot test in comparison to Blood Culture for the diagnosis of Typhoid Fever in our setup. Fifty patients who fulfilled the clinical criteria of having Typhoid Fever. The data of all the patients was documented, and they were submitted to the Typhi Dot and Blood Culture tests, apart from other routine investigations. Out of the total 50 patients, 47(94%) had their Blood Culture positive for Typhoid bacillus, while in 49 (98%) the Typhi Dot test was positive. Two patients which were found positive on Typhi dot test, gave negative results on Blood Culture. One patient with the signs and symptoms of Typhoid Fever was found neither positive on Typhi Dot test nor upon Blood Culture. There was no significant difference between the results of Blood Culture and Typhi Dot test in the diagnosis of Typhoid Fever. However, Typhi Dot has the advantages of being less expensive and quicker in giving results with excellent sensitivity. (author)

The burden of typhoid fever in low- and middle-income countries: A meta-regression approach.

Directory of Open Access Journals (Sweden)

Marina Antillón

2017-02-01

Full Text Available Upcoming vaccination efforts against typhoid fever require an assessment of the baseline burden of disease in countries at risk. There are no typhoid incidence data from most low- and middle-income countries (LMICs, so model-based estimates offer insights for decision-makers in the absence of readily available data.We developed a mixed-effects model fit to data from 32 population-based studies of typhoid incidence in 22 locations in 14 countries. We tested the contribution of economic and environmental indices for predicting typhoid incidence using a stochastic search variable selection algorithm. We performed out-of-sample validation to assess the predictive performance of the model.We estimated that 17.8 million cases of typhoid fever occur each year in LMICs (95% credible interval: 6.9-48.4 million. Central Africa was predicted to experience the highest incidence of typhoid, followed by select countries in Central, South, and Southeast Asia. Incidence typically peaked in the 2-4 year old age group. Models incorporating widely available economic and environmental indicators were found to describe incidence better than null models.Recent estimates of typhoid burden may under-estimate the number of cases and magnitude of uncertainty in typhoid incidence. Our analysis permits prediction of overall as well as age-specific incidence of typhoid fever in LMICs, and incorporates uncertainty around the model structure and estimates of the predictors. Future studies are needed to further validate and refine model predictions and better understand year-to-year variation in cases.

Typhoid Fever and Acute Appendicitis: A Rare Association Not Yet Fully Formed

Directory of Open Access Journals (Sweden)

Daniel J. Sartori

2017-08-01

Full Text Available Infections caused by foodborne enteric pathogens including typhoidal and non-typhoidal Salmonella species can mimic symptoms of acute appendicitis. The association between such bacterial pathogens and pathology-proven acute appendicitis has been described, but this link is poorly understood. Here we describe a case of a young man with typhoid fever presenting with histology-proven acute appendicitis requiring urgent appendectomy, and provide a brief review of relevant literature to prompt more widespread recognition of this rare cause of a common surgical emergency.

Factors Associated with Non-typhoidal Salmonella Bacteremia versus Typhoidal Salmonella Bacteremia in Patients Presenting for Care in an Urban Diarrheal Disease Hospital in Bangladesh.

Directory of Open Access Journals (Sweden)

K M Shahunja

Full Text Available Non-typhoidal Salmonella (NTS and Salmonella enterica serovar Typhi bacteremia are the causes of significant morbidity and mortality worldwide. There is a paucity of data regarding NTS bacteremia in South Asia, a region with a high incidence of typhoidal bacteremia. We sought to determine clinical predictors and outcomes associated with NTS bacteremia compared with typhoidal bacteremia.We performed a retrospective age-matched case-control study of patients admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, between February 2009 and March 2013. We compared demographic, clinical, microbiological, and outcome variables of NTS bacteremic patients with age-matched S. Typhi bacteremic patients, and a separate comparison of patients with NTS bacteremia and patients with NTS gastroenteritis.Of 20 patients with NTS bacteremia, 5 died (25% case fatality, compared to none of 60 age-matched cases of S. Typhi bacteremia. In univariate analysis, we found that compared with S. Typhi bacteremia, cases of NTS bacteremia had more severe acute malnutrition (SAM in children under five years of age, less often presented with a duration of fever ≥ 5 days, and were more likely to have co-morbidities on admission such as pneumonia and clinical signs of sepsis (p<0.05 in all cases. In multivariable logistic regression, SAM, clinical sepsis, and pneumonia were independent risk factors for NTS bacteremia compared with S. Typhi bacteremia (p<0.05 in all cases. Notably, we found marked differences in antibiotic susceptibilities, including NTS strains resistant to antibiotics commonly used for empiric therapy of patients suspected to have typhoid fever.Diarrheal patients with NTS bacteremia more often presented with co-morbidities and had a higher case fatality rate compared to those with typhoidal bacteremia. Clinicians in regions where both typhoid and NTS bacteremia are prevalent need to be vigilant about the

Typhoid fever as a triggering factor in acute and intractable bronchial asthma attack.

Science.gov (United States)

Wardhana; Surachmanto, Eko E; Datau, E A

2013-10-01

Typhoid fever is an enteric infection caused by Salmonella typhi. In Indonesia, typhoid fever is endemic with high incidence of the disease. In daily practice we frequently have patients with bronchial asthma, and it is becoming worse when these patients get typhoid fever. After oral ingestion, Salmonella typhi invades the the intestine mucosa after conducted by microbial binding to epithelial cells, destroying the microfold cells (M cell) then passed through the lamina propria and detected by dendritic cells (DC) which express a variety of pathogen recognition receptors on the surfaces, including Toll-Like Receptor (TLR). expressed on macrophages and on intestinal epithelial cells inducing degradation of IB, and translocation of NF-B (Nuclear Factor-Kappa Beta). This process initiates the induction of pro-inflammatory gene expression profile adhesion molecules, chemokines, adhesion molecules, and other proteins that induce and perpetuate the inflammation in host cells then will induce acute ant intractable attack of bronchial asthma. The role of typhoid fever in bronchial asthma, especially in persons with acute attack of bronchial asthma, is not well understood. In this article, we will discuss the role of typhoid fever in the bronchial asthma patients which may cause bronchial asthma significantly become more severe even triggering the acute and intractable attack of bronchial asthma. This fact makes an important point, to treat completely the typhoid fever in patients with bronchial asthma.

Frequency of typhoid fever and its association with seasonal variations in Taxila, Pakistan

Directory of Open Access Journals (Sweden)

Naeem Bukhari

2016-08-01

Full Text Available Objective: To analyse seropositivity rates of salmonella with seasonal variations in the population of Taxila and the surrounding rural areas. Methods: The study was conducted among 760 suspected patients with symptoms of fever, headache, nausea and decreased white blood cells count screened for the typhoid fever. Blood samples collected from the suspected patients were tested for seropositivity by slide agglutination (Widal test and Immunochromatographic test, i.e. Typhidot. Results: From overall 760 suspected patients of typhoid fever only 192 (25.26% samples were positive for Widal and Typhidot test. The peak seropositivity rates were identified during the months of April–June, while decreased cases were observed from January to March. Age wise distribution of typhoid fever reflected that age groups of 10–15 years and 25–35 years were at higher risks of developing enteric fever with respect to age groups of 5–10 years and 61–70 years, respectively. On gender basis evaluation, females (24.49% were slightly at low risks of developing typhoid fever than males (25.9%. Conclusions: The present study highlights a higher burden of typhoid fever in Taxila and the surrounding areas population that directly reflects the poor hygienic condition and contamination of drinking water. The frequency of typhoid fever fluctuates with seasonal variations as higher rates found during the summer as compared to winter season.

Role of Abdominal Ultrasound in the Diagnosis of Typhoid Fever in Pediatric Patients

Directory of Open Access Journals (Sweden)

Niranjan Sahu

2016-12-01

Full Text Available An early diagnosis of typhoid fever caused by Salmonella typhi is difficult because of several spectra of clinical findings, identical to those of several other types of infections. A definitive diagnosis of typhoid fever is made by hemoculture as well as the Widal test. With pediatric patients, this life-threatening infection remains inherently long enough, demanding urgent attention. In typhoid fever, splenomegaly, enlarged mesenteric lymph nodes (MLNs, bowel wall thickening, acalculus cholecystitis, and hepatomegaly occur, which are diagnosed by the ultrasonography (USG test. USG is a noninvasive, easily available, economical, fairly acceptable, and fairly sensitive test. The high-resolution real-time gray-scale USG method has simplified the evaluation of pathologic conditions, with remarkable clarity; consequently, an accurate assessment of the associated lesions can be done. In typhoid-endemic areas, USG findings as cited above could be used for diagnosis of typhoid fever, particularly when serology is equivocal and hemocultures are negative or not available. It was evident from USG studies that 12 of 52 patients had calculus cholecystitis; these individuals as well as eight patients without cholecystitis having hemocultures negative for S. typhi were excluded from the study. The rest of the cases (n=32 were included in this USG-based study for evaluation of features specific for typhoid fever. The following observations were recorded: splenomegaly in 32 patients, enlarged MLNs in 30 patients, bowel wall thickening in 25 patients, acalculus cholecystitis in 20 patients, and hepatomegaly in 10 patients. It can be concluded that these USG features—hepatosplenomegaly, enlarged MLNs, bowel wall thickening, and acalculus cholecystitis—should strongly favor the diagnosis of typhoid.

Typhoid fever among hospitalized febrile children in Siem Reap, Cambodia.

Science.gov (United States)

Wijedoru, Lalith P M; Kumar, Varun; Chanpheaktra, Ngoun; Chheng, Kheng; Smits, Henk L; Pastoor, Rob; Nga, Tran Vu Thieu; Baker, Stephen; Wuthiekanun, Vanaporn; Peacock, Sharon J; Putchhat, Hor; Parry, Christopher M

2012-02-01

Typhoid fever was confirmed by positive blood culture in 5 (3.7%) of 134 febrile children hospitalized in Cambodia. Typhoid was suspected in an additional 25 (18.7 %) blood culture-negative children based on: a positive immunoglobulin M lateral flow assay (IgMFA) (16); a positive polymerase chain reaction (PCR) for Salmonella typhi (2); or clinical assessment (7). The specificity of the IgMFA and PCR assays requires further study.

Concurrent malaria and typhoid fever in the tropics: the diagnostic challenges and public health implications.

Science.gov (United States)

Uneke, C J

2008-06-01

Malaria and typhoid fever still remain diseases of major public health importance in the tropics. Individuals in areas endemic for both the diseases are at substantial risk of contracting both these diseases, either concurrently or an acute infection superimposed on a chronic one. The objective of this report was to systematically review scientific data from studies conducted in the tropics on concurrent malaria and typhoid fever within the last two decades (1987-2007), to highlight the diagnostic challenges and the public health implications. Using the MedLine Entrez-PubMed search, relevant publications were identified for the review via the key words Malaria and Typhoid fever, which yielded 287 entries as of January 2008. Most of the studies reviewed expressed concern that poor diagnosis continues to hinder effective control of concurrent malaria and typhoid fever in the tropics due to: non-specific clinical presentation of the diseases; high prevalence of asymptomatic infections; lack of resources and insufficient access to trained health care providers and facilities; and widespread practice of self-treatment for clinically suspected malaria or typhoid fever. There were considerably higher rates of concurrent malaria and typhoid fever by Widal test compared to the bacteriological culture technique. Although culture technique remains the gold standard in typhoid fever diagnosis, Widal test is still of significant diagnostic value provided judicious interpretation of the test is made against a background of pertinent information. Malaria could be controlled through interventions to minimize human-vector contact, while improved personal hygiene, targeted vaccination campaigns and intensive community health education could help to control typhoid fever in the tropics.

What Have We Learned From the Typhoid Fever Surveillance in Africa Program?

Science.gov (United States)

Baker, Stephen; Hombach, Joachim; Marks, Florian

2016-03-15

The Typhoid Fever Surveillance in Africa Program (TSAP) was established in 2009 to fill the data void concerning invasive Salmonella disease in sub-Saharan Africa, and to specifically estimate the burden of bloodstream infections caused by the key pathogen, Salmonella enterica serovar Typhi. TSAP has achieved this ambitious target, finding high incidences of typhoid fever in both rural and urban populations in several countries in sub-Saharan Africa. The results of TSAP will undoubtedly dictate the direction of future typhoid fever research in Africa, and at last provides a key piece of the disease burden jigsaw puzzle. With the dawn of new Vi conjugate vaccines against Salmonella Typhi, the next priority for the typhoid community must be providing the required data on these vaccines so they can be licensed and provided to those in high-risk groups and locations across sub-Saharan Africa. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Typhoid fever as a cause of opportunistic infection: case report

Directory of Open Access Journals (Sweden)

Tumminia Salvatore

2006-02-01

Full Text Available Abstract Background Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica subspecies enterica serotype typhi, which is acquired by ingestion of contaminated food and water. Each year the disease affects at least 16 million persons world-wide, most of whom reside in the developing countries of Southeast Asia and Africa. In Italy the disease is uncommon with a greater number of cases in Southern regions than in Northern ones. Case presentation We report on a 57-year-old Sri-Lankan male affected by typhoid fever, the onset of which was accompanied by oropharyngeal candidiasis. This clinical sign was due to a transient cell-mediated immunity depression (CD4+ cell count was 130 cells/mm3 probably caused by Salmonella typhi infection. Human immunodeficiency virus infection was ruled out. Diagnosis of typhoid fever was made by the isolation of Salmonella typhi from two consecutive blood cultures. The patient recovered after a ten days therapy with ciprofloxacin and his CD4+ cell count improved gradually until normalization within 3 weeks. Conclusion Our patient is the first reported case of typhoid fever associated with oropharyngeal candidiasis. This finding suggests a close correlation between Salmonella typhi infection and transitory immunodepression.

Challenges of establishing the correct diagnosis of outbreaks of acute febrile illnesses in Africa: the case of a likely Brucella outbreak among nomadic pastoralists, northeast Kenya, March-July 2005.

Science.gov (United States)

Ari, Mary D; Guracha, Argata; Fadeel, Moustafa Abdel; Njuguna, Charles; Njenga, M Kariuki; Kalani, Rosalia; Abdi, Hassan; Warfu, Osman; Omballa, Victor; Tetteh, Christopher; Breiman, Robert F; Pimentel, Guillermo; Feikin, Daniel R

2011-11-01

An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.

Kinematics of syn- and post-exhumational shear zones at Lago di Cignana (Western Alps, Italy): constraints on the exhumation of Zermatt-Saas (ultra)high-pressure rocks and deformation along the Combin Fault and Dent Blanche Basal Thrust

Science.gov (United States)

Kirst, Frederik; Leiss, Bernd

2017-01-01

Kinematic analyses of shear zones at Lago di Cignana in the Italian Western Alps were used to constrain the structural evolution of units from the Piemont-Ligurian oceanic realm (Zermatt-Saas and Combin zones) and the Adriatic continental margin (Dent Blanche nappe) during Palaeogene syn- and post-exhumational deformation. Exhumation of Zermatt-Saas (U)HP rocks to approximately lower crustal levels at ca. 39 Ma occurred during normal-sense top-(S)E shearing under epidote-amphibolite-facies conditions. Juxtaposition with the overlying Combin zone along the Combin Fault at mid-crustal levels occurred during greenschist-facies normal-sense top-SE shearing at ca. 38 Ma. The scarcity of top-SE kinematic indicators in the hanging wall of the Combin Fault probably resulted from strain localization along the uppermost Zermatt-Saas zone and obliteration by subsequent deformation. A phase of dominant pure shear deformation around 35 Ma affected units in the direct footwall and hanging wall of the Combin Fault. It is interpreted to reflect NW-SE crustal elongation during updoming of the nappe stack as a result of underthrusting of European continental margin units and the onset of continental collision. This phase was partly accompanied and followed by ductile bulk top-NW shearing, especially at higher structural levels, which transitioned into semi-ductile to brittle normal-sense top-NW deformation due to Vanzone phase folding from ca. 32 Ma onwards. Our structural observations suggest that syn-exhumational deformation is partly preserved within units and shear zones exposed at Lago di Cignana but also that the Combin Fault and Dent Blanche Basal Thrust experienced significant post-exhumational deformation reworking and overprinting earlier structures.

Severity of infection and seasonal variation of non-typhoid Salmonelle occurence in humans

DEFF Research Database (Denmark)

Gradel, K.O.; Dethlefsen, Claus; Schønheyder, H.C.

2007-01-01

Non-typhoid Salmonella infections may present as severe gastroenteritis necessitatinghospitalization and some patients become septic with bacteraemia. We hypothesized that theseasonal variation of non-typhoid Salmonella occurrence in humans diminishes with increasedseverity of infection. We...... examined the seasonal variation of non-typhoid Salmonella infections inthree patient groups with differing severity of infection: outpatients treated for gastroenteritis(n=1490); in-patients treated for gastroenteritis (n=492); and in-patients treated for bacteraemia(n=113). The study was population......-based and included all non-typhoid Salmonella patients ina Danish county from 1994 to 2003. A periodic regression model was used to compute thepeak-to-trough ratio for the three patient groups. The peak-to-trough ratios were 4·3 [95%confidence interval (CI) 3·6–5.0] for outpatients with gastroenteritis, 3·2 (95% CI...

Severe thrombocytopenia in a child with typhoid fever: a case report.

Science.gov (United States)

Al Reesi, Mohammed; Stephens, Glenn; McMullan, Brendan

2016-11-30

Although thrombocytopenia is common in typhoid fever, its course, response to treatment, and need for specific therapies such as platelet transfusion are not well characterized. We report a case of typhoid fever in a 4-year-old Asian male returned traveler, admitted with prolonged fever and found to have severe thrombocytopenia (platelets 16 × 10 9 /L). Despite appropriate antibiotic therapy, his platelet recovery was slow, but did not lead to complications and he did not require platelet transfusion. There is no consensus in the medical literature guiding the optimal management of severe thrombocytopenia in typhoid fever, but it may improve with conservative management, as in our case. The epidemiology and management of this condition merits further research to guide clinical practice.

Role of computed tomography of abdomen in difficult to diagnose typhoid fever: a case series.

Science.gov (United States)

Hafeez, Wajid; Rajalakshmi, S; Sripriya, S; Madhu Bashini, M

2018-04-01

Background and Aim Diagnosis of typhoid is challenging when blood cultures fail to isolate Salmonella species. We report our experience with interpreting computed tomography (CT) abdomen findings in a case series of typhoid fever. Methods The case series consisted of patients who had a CT abdomen done as part of their investigations and a final diagnosis of typhoid fever. The CT films were reviewed and findings evaluated for distinctive features. Results During 2011-2017, 11 patients met the inclusion criteria. Indication for CT was pyrexia of unknown origin in the majority of patients. Review of CT films revealed mesenteric lymphadenopathy (100%), terminal ileum thickening (85%), hepatosplenomegaly (45%), retroperitoneal lymphadenopathy (18%) and ascites (9%). Conclusions Enhancing discrete mesenteric lymphadenopathy and terminal ileum thickening are non-specific findings noted in typhoid fever. Absence of matted necrotic nodes and peritoneal thickening rule out tuberculosis and raise suspicion of typhoid fever in endemic regions.

The unrecognized burden of typhoid fever.

Science.gov (United States)

Obaro, Stephen K; Iroh Tam, Pui-Ying; Mintz, Eric Daniel

2017-03-01

Typhoid fever (TF), caused by Salmonella enterica serovar Typhi, is the most common cause of enteric fever, responsible for an estimated 129,000 deaths and more than 11 million cases annually. Although several reviews have provided global and regional TF disease burden estimates, major gaps in our understanding of TF epidemiology remain. Areas covered: We provide an overview of the gaps in current estimates of TF disease burden and offer suggestions for addressing them, so that affected communities can receive the full potential of disease prevention offered by vaccination and water, sanitation, and hygiene interventions. Expert commentary: Current disease burden estimates for TF do not capture cases from certain host populations, nor those with atypical presentations of TF, which may lead to substantial underestimation of TF cases and deaths. These knowledge gaps pose major obstacles to the informed use of current and new generation typhoid vaccines.

Impact of a Targeted Typhoid Vaccination Campaign Following Cyclone Tomas, Republic of Fiji, 2010

Science.gov (United States)

Scobie, Heather M.; Nilles, Eric; Kama, Mike; Kool, Jacob L.; Mintz, Eric; Wannemuehler, Kathleen A.; Hyde, Terri B.; Dawainavesi, Akanisi; Singh, Sheetalpreet; Korovou, Samuel; Jenkins, Kylie; Date, Kashmira

2014-01-01

After a category 4 cyclone that caused extensive population displacement and damage to water and sanitation infrastructure in Fiji in March 2010, a typhoid vaccination campaign was conducted as part of the post-disaster response. During June–December 2010, 64,015 doses of typhoid Vi polysaccharide vaccine were administered to persons ≥ 2 years of age, primarily in cyclone-affected areas that were typhoid endemic. Annual typhoid fever incidence decreased during the post-campaign year (2011) relative to preceding years (2008–2009) in three subdivisions where a large proportion of the population was vaccinated (incidence rate ratios and 95% confidence intervals: 0.23, 0.13–0.41; 0.24, 0.14–0.41; 0.58, 0.40–0.86), and increased or remained unchanged in 12 subdivisions where little to no vaccination occurred. Vaccination played a role in reducing typhoid fever incidence in high-incidence areas after a disaster and should be considered in endemic settings, along with comprehensive control measures, as recommended by the World Health Organization. PMID:24710618

Expression of intra- and extracellular granzymes in patients with typhoid fever.

Science.gov (United States)

de Jong, Hanna K; Garcia-Laorden, Maria Isabel; Hoogendijk, Arie J; Parry, Christopher M; Maude, Rapeephan R; Dondorp, Arjen M; Faiz, Mohammed Abul; van der Poll, Tom; Wiersinga, Willem Joost

2017-07-01

Typhoid fever, caused by the intracellular pathogen Salmonella (S.) enterica serovar Typhi, remains a major cause of morbidity and mortality worldwide. Granzymes are serine proteases promoting cytotoxic lymphocytes mediated eradication of intracellular pathogens via the induction of cell death and which can also play a role in inflammation. We aimed to characterize the expression of extracellular and intracellular granzymes in patients with typhoid fever and whether the extracellular levels of granzyme correlated with IFN-γ release. We analyzed soluble protein levels of extracellular granzyme A and B in healthy volunteers and patients with confirmed S. Typhi infection on admission and day of discharge, and investigated whether this correlated with interferon (IFN)-γ release, a cytokine significantly expressed in typhoid fever. The intracellular expression of granzyme A, B and K in subsets of lymphocytic cells was determined using flow cytometry. Patients demonstrated a marked increase of extracellular granzyme A and B in acute phase plasma and a correlation of both granzymes with IFN-γ release. In patients, lower plasma levels of granzyme B, but not granzyme A, were found at day of discharge compared to admission, indicating an association of granzyme B with stage of disease. Peripheral blood mononuclear cells of typhoid fever patients had a higher percentage of lymphocytic cells expressing intracellular granzyme A and granzyme B, but not granzyme K, compared to controls. The marked increase observed in extra- and intracellular levels of granzyme expression in patients with typhoid fever, and the correlation with stage of disease, suggests a role for granzymes in the host response to this disease.

Host-pathogen interactions in typhoid fever

NARCIS (Netherlands)

de Jong, H.K.

2015-01-01

This thesis focuses on host-pathogen interactions in Salmonella Typhi and Burkholderia pseudomallei infections and explores the interplay between these bacteria and the innate immune system. Typhoid fever is one of the most common causes of bacterial infection in low-income countries. With adequate

Risk factors for the development of severe typhoid fever in Vietnam.

Science.gov (United States)

Parry, Christopher M; Thompson, Corinne; Vinh, Ha; Chinh, Nguyen Tran; Phuong, Le Thi; Ho, Vo Anh; Hien, Tran Tinh; Wain, John; Farrar, Jeremy J; Baker, Stephen

2014-02-10

Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica serovar Typhi. Age, sex, prolonged duration of illness, and infection with an antimicrobial resistant organism have been proposed risk factors for the development of severe disease or fatality in typhoid fever. We analysed clinical data from 581 patients consecutively admitted with culture confirmed typhoid fever to two hospitals in Vietnam during two periods in 1993-1995 and 1997-1999. These periods spanned a change in the antimicrobial resistance phenotypes of the infecting organisms i.e. fully susceptible to standard antimicrobials, resistance to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole (multidrug resistant, MDR), and intermediate susceptibility to ciprofloxacin (nalidixic acid resistant). Age, sex, duration of illness prior to admission, hospital location and the presence of MDR or intermediate ciprofloxacin susceptibility in the infecting organism were examined by logistic regression analysis to identify factors independently associated with severe typhoid at the time of hospital admission. The prevalence of severe typhoid was 15.5% (90/581) and included: gastrointestinal bleeding (43; 7.4%); hepatitis (29; 5.0%); encephalopathy (16; 2.8%); myocarditis (12; 2.1%); intestinal perforation (6; 1.0%); haemodynamic shock (5; 0.9%), and death (3; 0.5%). Severe disease was more common with increasing age, in those with a longer duration of illness and in patients infected with an organism exhibiting intermediate susceptibility to ciprofloxacin. Notably an MDR phenotype was not associated with severe disease. Severe disease was independently associated with infection with an organism with an intermediate susceptibility to ciprofloxacin (AOR 1.90; 95% CI 1.18-3.07; p = 0.009) and male sex (AOR 1.61 (1.00-2.57; p = 0.035). In this group of patients hospitalised with typhoid fever infection with an organism with intermediate susceptibility to ciprofloxacin was

Descriptive epidemiology of typhoid fever during an epidemic in Harare, Zimbabwe, 2012.

Science.gov (United States)

Polonsky, Jonathan A; Martínez-Pino, Isabel; Nackers, Fabienne; Chonzi, Prosper; Manangazira, Portia; Van Herp, Michel; Maes, Peter; Porten, Klaudia; Luquero, Francisco J

2014-01-01

Typhoid fever remains a significant public health problem in developing countries. In October 2011, a typhoid fever epidemic was declared in Harare, Zimbabwe - the fourth enteric infection epidemic since 2008. To orient control activities, we described the epidemiology and spatiotemporal clustering of the epidemic in Dzivaresekwa and Kuwadzana, the two most affected suburbs of Harare. A typhoid fever case-patient register was analysed to describe the epidemic. To explore clustering, we constructed a dataset comprising GPS coordinates of case-patient residences and randomly sampled residential locations (spatial controls). The scale and significance of clustering was explored with Ripley K functions. Cluster locations were determined by a random labelling technique and confirmed using Kulldorff's spatial scan statistic. We analysed data from 2570 confirmed and suspected case-patients, and found significant spatiotemporal clustering of typhoid fever in two non-overlapping areas, which appeared to be linked to environmental sources. Peak relative risk was more than six times greater than in areas lying outside the cluster ranges. Clusters were identified in similar geographical ranges by both random labelling and Kulldorff's spatial scan statistic. The spatial scale at which typhoid fever clustered was highly localised, with significant clustering at distances up to 4.5 km and peak levels at approximately 3.5 km. The epicentre of infection transmission shifted from one cluster to the other during the course of the epidemic. This study demonstrated highly localised clustering of typhoid fever during an epidemic in an urban African setting, and highlights the importance of spatiotemporal analysis for making timely decisions about targetting prevention and control activities and reinforcing treatment during epidemics. This approach should be integrated into existing surveillance systems to facilitate early detection of epidemics and identify their spatial range.

Current trends of antimicrobial susceptibility of typhoidal salmonellae isolated at tertiary care hospital

International Nuclear Information System (INIS)

Zehra, N.M.; Irfan, F.

2017-01-01

To determine the current trend of antimicrobial susceptibility of typhoidal Salmonellae. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was carried out in the Department of Microbiology, PNS Shifa Hospital, Karachi, from January 2014 to December 2015. Methodology: Blood culture samples received from the wards and outpatient departments were included. Isolates of Salmonella were dealt with standard microbiological procedures. The antimicrobial sensitivity against the typhoidal Salmonellae was determined using Kirby-Bauer disc diffusion method as per the guidelines of Clinical and Laboratory Standards Institute (2013). Results: A total of 460 typhoidal Salmonellae were isolated; out of which 270 were Salmonella typhi and 190 were Salmonella paratyphiA. The percentage of MDR isolates of S. typhi was 57% and that of S. paratyphiA was 42%. None of the isolates were resistant to ceftriaxone, while sensitivity to ciprofloxacin (07% and 0% for S. typhiand S. paratyphiA, respectively) was very low. Conclusion: There is high percentage of MDR isolates of typhoidal Salmonellae in our region. The antimicrobial sensitivity of typhoidal Salmonellae to conventional agent has not improved enough to recommend their empirical use. There is almost complete resistance to fluoroquinolones as well, leaving very limited available treatment options. (author)

Review of the trends and causes of food borne outbreaks in Malaysia from 1988 to 1997.

Science.gov (United States)

Meftahuddin, T

2002-03-01

This paper examines the trend and possible contributing factors for the occurrence of the food borne diseases outbreaks in Malaysia. These diseases mainly are cholera, typhoid fever, hepatitis A, dysentery and food poisoning. The outbreaks still occur sporadically in certain high risk areas throughout the country. The incidence rate of all the other three major food borne diseases steadily declined from the year 1988 to 1997 except for food poisoning and cholera. Statistic of food poisoning from the year 1996 to 1997 showed that 66.5% of the outbreak occurred in schools whereas only 0.4% originated from the contaminated food sold at various public food outlets. The school age group is always more affected than the general population. Amongst the contributing factors identified are related to unhygienic food handling practices followed by inadequate safe water supply and poor environmental sanitation. A multisectoral approach between Ministry of Health and other government agencies or private agents needs to be undertaken in the management of the food borne diseases in order to curb the incidences of food borne diseases in Malaysia.

Epidemiology and risk factors for typhoid fever in Central Division, Fiji, 2014-2017: A case-control study.

Science.gov (United States)

Prasad, Namrata; Jenkins, Aaron P; Naucukidi, Lanieta; Rosa, Varanisese; Sahu-Khan, Aalisha; Kama, Mike; Jenkins, Kylie M; Jenney, Adam W J; Jack, Susan J; Saha, Debasish; Horwitz, Pierre; Jupiter, Stacy D; Strugnell, Richard A; Mulholland, E Kim; Crump, John A

2018-06-01

Typhoid fever is endemic in Fiji, with high reported annual incidence. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control. We identified and surveyed patients with blood culture-confirmed typhoid fever from January 2014 through January 2017. For each typhoid fever case we matched two controls by age interval, gender, ethnicity, and residential area. Univariable and multivariable analysis were used to evaluate associations between exposures and risk for typhoid fever. We enrolled 175 patients with typhoid fever and 349 controls. Of the cases, the median (range) age was 29 (2-67) years, 86 (49%) were male, and 84 (48%) lived in a rural area. On multivariable analysis, interrupted water availability (odds ratio [OR] = 2.17; 95% confidence interval [CI] 1.18-4.00), drinking surface water in the last 2 weeks (OR = 3.61; 95% CI 1.44-9.06), eating unwashed produce (OR = 2.69; 95% CI 1.48-4.91), and having an unimproved or damaged sanitation facility (OR = 4.30; 95% CI 1.14-16.21) were significantly associated with typhoid fever. Frequent handwashing after defecating (OR = 0.57; 95% CI 0.35-0.93) and using soap for handwashing (OR = 0.61; 95% CI 0.37-0.95) were independently associated with a lower odds of typhoid fever. Poor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce. Improved sanitation facilities and protection of surface water sources and produce from contamination by human feces are likely to contribute to typhoid control in Fiji.

[Some information regarding the historical development of typhoid fever in Chile].

Science.gov (United States)

Laval, Enrique

2017-10-01

During the historical development of typhoid fever in Chile, its confusion with other infectious diseases is particularly noteworthy, especially with murine typhus, a problem that was mainly resolved during the 1918 epidemic. The importance of chloramphenicol treatment is also highlighted, which meant an enormous improvement in typhoid/paratyphoid fevers, in combination with public health and health education actions that allowed to almost eliminate these infectious diseases in our country.

Immunoproteomic analysis of antibody in lymphocyte supernatant in patients with typhoid fever in Bangladesh.

Science.gov (United States)

Charles, Richelle C; Liang, Li; Khanam, Farhana; Sayeed, M Abu; Hung, Chris; Leung, Daniel T; Baker, Stephen; Ludwig, Albrecht; Harris, Jason B; Larocque, Regina C; Calderwood, Stephen B; Qadri, Firdausi; Felgner, Philip L; Ryan, Edward T

2014-03-01

We have previously shown that an assay based on detection of anti-Salmonella enterica serotype Typhi antibodies in supernatant of lymphocytes harvested from patients presenting with typhoid fever (antibody in lymphocyte supernatant [ALS] assay) can identify 100% of patients with blood culture-confirmed typhoid fever in Bangladesh. In order to define immunodominant proteins within the S. Typhi membrane preparation used as antigen in these prior studies and to identify potential biomarkers unique to S. Typhi bacteremic patients, we probed microarrays containing 2,724 S. Typhi proteins with ALS collected at the time of clinical presentation from 10 Bangladeshis with acute typhoid fever. We identified 62 immunoreactive antigens when evaluating both the IgG and IgA responses. Immune responses to 10 of these antigens discriminated between individuals with acute typhoid infection and healthy control individuals from areas where typhoid infection is endemic, as well as Bangladeshi patients presenting with fever who were subsequently confirmed to have a nontyphoid illness. Using an ALS enzyme-linked immunosorbent assay (ELISA) format and purified antigen, we then confirmed that immune responses against the antigen with the highest immunoreactivity (hemolysin E [HlyE]) correctly identified individuals with acute typhoid or paratyphoid fever in Dhaka, Bangladesh. These observations suggest that purified antigens could be used with ALS and corresponding acute-phase activated B lymphocytes in diagnostic platforms to identify acutely infected patients, even in areas where enteric fever is endemic.

Typhoid fever cases in the U.S. military.

Science.gov (United States)

Sorrell, Tia; Selig, Daniel J; Riddle, Mark S; Porter, Chad K

2015-10-14

Salmonella enterica, serovar Typhi (S. Typhi), a causative agent of enteric fever (typhoid fever), predominately affects populations in developing regions with poor access to clean food and water. In addition, travelers to these regions are at risk of exposure. We report the epidemiological characteristics of S. Typhi cases among active duty United States military personnel from 1998 to 2011 using data obtained from the Defense Medical Surveillance System. Cases were identified based on International Classification for Disease Ninth Edition - Clinical Modification codes. We identified a total of 205 cases S. Typhi for an incidence of 1.09 per 100,000 person-years. Cases were on average 31.7 years old, predominately married (n = 129, 62.9 %), Caucasian (n = 142, 69.3 %), male (n = 176, 85.9 %), and had a high school education (n = 101, 49.3 %). Of the identified cases, 122 had received a Typhoid vaccination within 4 years of diagnosis. This study provides an overview of enteric fever in the United States military. The incidence was similar to the general U.S. population except for increased incidence from 1998 to 2000, perhaps attributable to operational deployments in that period. Given that vaccination is an effective primary prevention measure against typhoid fever, active monitoring of pre-deployment vaccine history is warranted.

Early diagnosis of typhoid fever by nested PCR for flagellin gene of Salmonella enterica serotype Typhi.

Science.gov (United States)

Khan, S; Harish, B N; Menezes, G A; Acharya, N S; Parija, S C

2012-11-01

Typhoid fever caused by Salmonella Typhi continues to be a major health problem in spite of the use of antibiotics and the development of newer antibacterial drugs. Inability to make an early laboratory diagnosis and resort to empirical therapy, often lead to increased morbidity and mortality in cases of typhoid fever. This study was aimed to optimize a nested PCR for early diagnosis of typhoid fever and using it as a diagnostic tool in culture negative cases of suspected typhoid fever. Eighty patients with clinical diagnosis of typhoid fever and 40 controls were included in the study. The blood samples collected were subjected to culture, Widal and nested PCR targeting the flagellin gene of S. Typhi. The sensitivity of PCR on blood was found to be 100 per cent whereas the specificity was 76.9 per cent. The positive predictive value (PPV) of PCR was calculated to be 76.9 per cent with an accuracy of 86 per cent. None of the 40 control samples gave a positive PCR. Due to its high sensitivity and specificity nested PCR can be used as a useful tool to diagnose clinically suspected, culture negative cases of typhoid fever.

Cholestatic hepatitis in a patient with typhoid fever - a case report

Directory of Open Access Journals (Sweden)

Wijesiriwardena Bandula C

2011-10-01

Full Text Available Abstract Typhoid fever is a very common infectious disease, particularly in developing countries such as Sri Lanka. Although multiple organs are known to be affected by the disease, hepatic involvement could be considered the most important as studies have showed that it is associated with a higher relapse rate. We report a young patient who presented with fever and jaundice and found to have cholestatic hepatitis secondary to typhoid fever.

Clinical features and outcome of typhoid fever and invasive non-typhoidal salmonellosis in a tertiary hospital in Belgium: analysis and review of the literature.

Science.gov (United States)

Yombi, J C; Martins, L; Vandercam, B; Rodriguez-Villalobos, H; Robert, A

2015-08-01

Typhoid fever (TF) occurs rarely in industrialized countries because of advances in health care and improvement of drinking water. Conversely, non-typhoid salmonellosis (NTS) remains widespread, because of food contamination or asymptomatic carriage. Non-typhoid salmonellosis can be severe when becoming invasive non-typhoid salmonellosis (iNTS). Although established prognostic indicators of the two pathologies are different, direct comparisons between iNTS and TF in the literature remain scarce. The purpose of this study was to analyse and compare demographic, clinical features and outcome of hospitalized patients with TF and iNTS. Demographic, clinical features and outcome were retrospectively analysed in a series of patients hospitalized between 2007 and 2012. A total of 33 patients were enrolled, including 13 with established TF and 20 with iNTS. No differences between TF and iNTS patients were observed in incidence of fever, abdominal cramps, diarrhoea, headache, nausea and vomiting and duration of antibiotic therapy (≤ 7 days in both groups). Although the clinical outcome of TF patients was identical to that of iNTS patients, including incidence of complications, length of hospitalization and mortality (1/13 (7.7%) vs 2/20 (10%), P = 0.43), comorbidities were less frequent in the TF group than in the iNTS group (2/13 vs 15/20, P = 0.003). The clinical profile and outcome of TF patients are similar to those with iNTS. Although comorbidities are more often associated with iNTS, the results of our study suggest that clinical management of these two diseases should remain similar.

Typhoid Intestinal Perforation: 24 Perforations in One Patient

African Journals Online (AJOL)

Intestinal perforation is a common cause of peritonitis necessitating emergency surgical intervention. Perforation ... Mortality rates of typhoid intestinal perforation (TIP) cases are ... may be obscured clinical features with resultant delays in.

Estimated percentage of typhoid fever in adult pakistani population (TAP) study

International Nuclear Information System (INIS)

Mehboob, F.; Arshad, A.; Firdous, S.; Ahmed, S.; Rehma, S.

2013-01-01

Typhoid fever is a serious infection with high morbidity and mortality in untreated cases. It is one of the very common infections in developing countries due to various factors involving hygiene and sanitation. Objective: To determine the estimated percentage of typhoid fever in Pakistani population and to find the commonly prescribed antibiotics for the disease. Material and Methods: This cross sectional study was conducted on 1036 patients, selected from forty five general practitioner clinics, between June to October 2010. Patients of > 18 years of age with > 3 days history of fever (> 100 degree F) and high index of suspicion for typhoid fever were tested for typhoid fever using Typhidot kits and positive cases were recruited for monitoring response to treatment. The febrile patients with clear cut history of urinary or respiratory infect-ion, hypovolemic shock or hepatobiliary disease were excluded and not tested by typhidot kit. The antibiotics prescribed to study population by various general practitioners were noted. Data was analysed on SPSS. Results were expressed in percentages and proportions. Results: Total 1036 patients were recruited. Typhoidot test was negative in 63.9% and positive in 36.1% patients with highest percentages of positive cases in Karachi, Rawalpindi and Hyderabad. The maximum number of cases were reported in summer season especially from June to August. Most of the patients were between ages of 19 - 39 years. The commonest anti-biotics prescribed were Ofloxacin, Ciprofloxacin and Levofloxacin. Conclusion: Typhoid fever is very common infection in Pakistan caused by Salmonella typhi which is transmitted among humans through faecooral route. Disease can be controlled not only by antibiotics like fluoroquinolones but by patient education, improvement in hygiene and sanitation, safe supply of clean drinking water and prophylactic vaccination as well. However, timely diagnosis and appropriate management with proper antibiotics is the key

Estimated percentage of typhoid fever in adult pakistani population (TAP) study

Energy Technology Data Exchange (ETDEWEB)

Mehboob, F.; Arshad, A.; Firdous, S.; Ahmed, S.; Rehma, S. [Mayo Hospital, Lahore (Pakistan). Dept. of Medicine

2013-01-15

Typhoid fever is a serious infection with high morbidity and mortality in untreated cases. It is one of the very common infections in developing countries due to various factors involving hygiene and sanitation. Objective: To determine the estimated percentage of typhoid fever in Pakistani population and to find the commonly prescribed antibiotics for the disease. Material and Methods: This cross sectional study was conducted on 1036 patients, selected from forty five general practitioner clinics, between June to October 2010. Patients of > 18 years of age with > 3 days history of fever (> 100 degree F) and high index of suspicion for typhoid fever were tested for typhoid fever using Typhidot kits and positive cases were recruited for monitoring response to treatment. The febrile patients with clear cut history of urinary or respiratory infect-ion, hypovolemic shock or hepatobiliary disease were excluded and not tested by typhidot kit. The antibiotics prescribed to study population by various general practitioners were noted. Data was analysed on SPSS. Results were expressed in percentages and proportions. Results: Total 1036 patients were recruited. Typhoidot test was negative in 63.9% and positive in 36.1% patients with highest percentages of positive cases in Karachi, Rawalpindi and Hyderabad. The maximum number of cases were reported in summer season especially from June to August. Most of the patients were between ages of 19 - 39 years. The commonest anti-biotics prescribed were Ofloxacin, Ciprofloxacin and Levofloxacin. Conclusion: Typhoid fever is very common infection in Pakistan caused by Salmonella typhi which is transmitted among humans through faecooral route. Disease can be controlled not only by antibiotics like fluoroquinolones but by patient education, improvement in hygiene and sanitation, safe supply of clean drinking water and prophylactic vaccination as well. However, timely diagnosis and appropriate management with proper antibiotics is the key

The Molecular and Spatial Epidemiology of Typhoid Fever in Rural Cambodia.

Directory of Open Access Journals (Sweden)

Duy Pham Thanh

2016-06-01

Full Text Available Typhoid fever, caused by the bacterium Salmonella Typhi, is an endemic cause of febrile disease in Cambodia. The aim of this study was to better understand the epidemiology of pediatric typhoid fever in Cambodia. We accessed routine blood culture data from Angkor Hospital for Children (AHC in Siem Reap province between 2007 and 2014, and performed whole genome sequencing (WGS on the isolated bacteria to characterize the S. Typhi population. The resulting phylogenetic information was combined with conventional epidemiological approaches to investigate the spatiotemporal distribution of S. Typhi and population-level risk factors for reported disease. During the study period, there were 262 cases of typhoid within a 100 km radius of AHC, with a median patient age of 8.2 years (IQR: 5.1-11.5 years. The majority of infections occurred during the rainy season, and commune incidences as high as 11.36/1,000 in children aged <15 years were observed over the study period. A population-based risk factor analysis found that access to water within households and increasing distance from Tonle Sap Lake were protective. Spatial mapping and WGS provided additional resolution for these findings, and confirmed that proximity to the lake was associated with discrete spatiotemporal disease clusters. We confirmed the dominance of MDR H58 S. Typhi in this population, and found substantial evidence of diversification (at least seven sublineages within this single lineage. We conclude that there is a substantial burden of pediatric typhoid fever in rural communes in Cambodia. Our data provide a platform for additional population-based typhoid fever studies in this location, and suggest that this would be a suitable setting in which to introduce a school-based vaccination programme with Vi conjugate vaccines.

Identification of Novel Serodiagnostic Signatures of Typhoid Fever Using a Salmonella Proteome Array

Directory of Open Access Journals (Sweden)

Thomas C. Darton

2017-09-01

Full Text Available Current diagnostic tests for typhoid fever, the disease caused by Salmonella Typhi, are poor. We aimed to identify serodiagnostic signatures of typhoid fever by assessing microarray signals to 4,445 S. Typhi antigens in sera from 41 participants challenged with oral S. Typhi. We found broad, heterogeneous antibody responses with increasing IgM/IgA signals at diagnosis. In down-selected 250-antigen arrays we validated responses in a second challenge cohort (n = 30, and selected diagnostic signatures using machine learning and multivariable modeling. In four models containing responses to antigens including flagellin, OmpA, HlyE, sipC, and LPS, multi-antigen signatures discriminated typhoid (n = 100 from other febrile bacteremia (n = 52 in Nepal. These models contained combinatorial IgM, IgA, and IgG responses to 5 antigens (ROC AUC, 0.67 and 0.71 or 3 antigens (0.87, although IgA responses to LPS also performed well (0.88. Using a novel systematic approach we have identified and validated optimal serological diagnostic signatures of typhoid fever.

[Surveillance data on typhoid fever and paratyphoid fever in 2015, China].

Science.gov (United States)

Liu, F F; Zhao, S L; Chen, Q; Chang, Z R; Zhang, J; Zheng, Y M; Luo, L; Ran, L; Liao, Q H

2017-06-10

Objective: Through analyzing the surveillance data on typhoid fever and paratyphoid fever in 2015 to understand the related epidemiological features and most possible clustering areas of high incidence. Methods: Individual data was collected from the passive surveillance program and analyzed by descriptive statistic method. Characteristics on seasonal, regional and distribution of the diseases were described. Spatial-temporal clustering characteristics were estimated, under the retrospective space-time method. Results: A total of 8 850 typhoid fever cases were reported from the surveillance system, with incidence rate as 0.65/100 000. The number of paratyphoid fever cases was 2 794, with incidence rate as 0.21/100 000. Both cases of typhoid fever and paratyphoid fever occurred all year round, with high epidemic season from May to October. Most cases involved farmers (39.68 % ), children (15.89 % ) and students (12.01 % ). Children under 5 years showed the highest incidence rate. Retrospective space-time analysis for provinces with high incidence rates would include Yunnan, Guangxi, Guizhou, Hunan and Guangdong, indicating the first and second class clusters were mainly distributed near the bordering adjacent districts and counties among the provinces. Conclusion: In 2015, the prevalence rates of typhoid fever and paratyphoid fever were low, however with regional high prevalence areas. Cross regional transmission existed among provinces with high incidence rates which might be responsible for the clusters to appear in these areas.

Simple, rapid, and affordable point-of-care test for the serodiagnosis of typhoid fever

NARCIS (Netherlands)

Pastoor, Rob; Hatta, Mochammad; Abdoel, Theresia H.; Smits, Henk L.

2008-01-01

We developed a point-of-care test for the serodiagnosis of typhoid fever in the format of an immunochromatographic lateral flow assay. The flow assay for typhoid fever is based on the detection of Salmonella enterica serotype Typhi lipopolysaccharide-specific immunoglobulin M (IgM) antibodies. The

Dengue hemorrhagic fever and typhoid fever association based on spatial standpoint using scan statistics in DKI Jakarta

Science.gov (United States)

Hervind, Widyaningsih, Y.

2017-07-01

Concurrent infection with multiple infectious agents may occur in one patient, it appears frequently in dengue hemorrhagic fever (DHF) and typhoid fever. This paper depicted association between DHF and typhoid based on spatial point of view. Since paucity of data regarding dengue and typhoid co-infection, data that be used are the number of patients of those diseases in every district (kecamatan) in Jakarta in 2014 and 2015 obtained from Jakarta surveillance website. Poisson spatial scan statistics is used to detect DHF and typhoid hotspots area district in Jakarta separately. After obtain the hotspot, Fisher's exact test is applied to validate association between those two diseases' hotspot. The result exhibit hotspots of DHF and typhoid are located around central Jakarta. The further analysis used Poisson space-time scan statistics to reveal the hotspot in term of spatial and time. DHF and typhoid fever more likely occurr from January until May in the area which is relatively similar with pure spatial result. Preventive action could be done especially in the hotspot areas and it is required further study to observe the causes based on characteristics of the hotspot area.

Antimicrobial susceptibility pattern in children with typhoid fever and serotype of Salmonella typhi in Jakarta

Directory of Open Access Journals (Sweden)

Mirari Prasadajudio, Mulya Rahma Karyanti, Lia Waslia

2017-03-01

Full Text Available Objectives: Indonesia is known for high incidence of typhoid fever especially in children. This study aimed to observe antibiotic susceptibility in circulating Salmonella typhi serotypes in children with typhoid. Methods: A cross sectional study design was conducted. A total of 142 blood samples from children between 1-18 years old clinically diagnosed with suspected typhoid fever were recruited between January 2012 and July 2013 from six health centers in Jakarta. Confirmed cases were retrieved based on S. typhi isolate finding in blood culture. Antimicrobial susceptibility was investigated and PCR was used to detect S. typhi serotypes using fliB, fliC and aroC genes. Results: The prevalence of confirmed typhoid case based on isolate finding was 22 (15.5%. Twenty of S. typhi isolates expressed fliC gene carrying H:d allele, the other two expressed j allele, while only two samples expressed fliB, all showed no difference in pathogenicity and antimicrobial resistance. Conclusions: Circulating serotypes found in typhoid children in Jakarta, Indonesia are still susceptible even to the firstline antimicrobials. Thus, chloramphenicol, ampicillin and co-trimoxazole are still recommended. J Microbiol Infect Dis 2017; 7(1: 29-35

The use of antibiotics in hospitalized adult typhoid patients in an Indonesian hospital

Directory of Open Access Journals (Sweden)

Anggita Bunga Anggraini

2014-08-01

Full Text Available AbstrakLatar belakang:Demam tifoid menduduki peringkat ke tiga dari 10 besar penyakit terbanyak pada pasien rawat inap di rumah sakit (RS di Indonesia pada tahun 2010. Selain itu terdapat peningkatan resistensi dan kasus-kasus karier, dan relaps. Penelitian ini menyajikan hasil analisis data tentang penggunaan antibiotik pada pasien tifoid dewasa rawat inap di suatu RS di Indonesia. Metode: Data penelitian diekstrak dari rekam medik pasien tifoid dewasa yang dirawat inap di RS PMI Bogor periode Juli-Desember 2012. Analisis dilakukan dengan kualitatif (DU90% dan kuantitatif (DDD/shr dengan menggunakan metode ATC/DDD. Hasil: Dari 459 pasien tifoid dewasa rawat inap diperoleh DDD/shr pasien tifoid dewasa rawat inap yang menggunakan antibiotik selama dari Juli sampai Desember 2012 sebesar 6,35 DDD/shr. Seftriakson merupakan antibiotika yang dipakai tertinggi yang setara 4,10 DDD/shr, yang berarti bahwa di antara 100 pasien tifoid, 4 pasien memakai seftriakson 2 g setiap hari. Selanjutnya, obat pada segmen 10% lebih banyak dibandingkan pada segmen 90%. Di antara 26 jenis antibiotika, 7 jenis di antaranya termasuk pada segmen DU 90% yaitu seftriakson (64,54%; levofloksasin (13,90%; ciprofloksasin (3,57%; meropenem (2,80%; metronidazol (2,52%; ampisilin-sulbaktam (1,65%; dan sefditoren pivoksil (1,60%.Kesimpulan:Antibiotik seftriakson yang paling banyak digunakan pada perawatan tifoid pasien dewasa rawat inap di rumah sakit. (Health Science Indones 2014;1:40-3Kata kunci:antibiotik, tifoid, ATC/DDD, DU 90%AbstractBackground: Typhoid fever was the third ranked disease among the top 10 diseases in hospitalized patients in Indonesia in 2011. There were increased drug resistance, increased number of carrier, and number of relapse cases. This study aimed to analyze the use of antibiotics in hospitalized adult typhoid patients in a hospital in Indonesia. Methods: The data were extracted from medical records of drug use in adult typhoid patients hospitalized

Cost of illness due to typhoid Fever in pemba, zanzibar, East Africa.

Science.gov (United States)

Riewpaiboon, Arthorn; Piatti, Moritz; Ley, Benedikt; Deen, Jacqueline; Thriemer, Kamala; von Seidlein, Lorenz; Salehjiddawi, Mohammad; Busch, Clara Jana-Lui; Schmied, Wolfgang H; Ali, Said Mohammed; The Typhoid Economic Study Group GiDeok Pak Leon R Ochiai Mahesh K Puri Na Yoon Chang Thomas F Wierzba And John D Clemens

2014-09-01

The aim of this study was to estimate the economic burden of typhoid fever in Pemba, Zanzibar, East Africa. This study was an incidence-based cost-of-illness analysis from a societal perspective. It covered new episodes of blood culture-confirmed typhoid fever in patients presenting at the outpatient or inpatient departments of three district hospitals between May 2010 and December 2010. Cost of illness was the sum of direct costs and costs for productivity loss. Direct costs covered treatment, travel, and meals. Productivity costs were loss of income by patients and caregivers. The analysis included 17 episodes. The mean age of the patients, was 23 years (range=5-65, median=22). Thirty-five percent were inpatients, with a mean of 4.75 days of hospital stay (range=3-7, median=4.50). The mean cost for treatment alone during hospital care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH). The average societal cost was US$ 154.47 per typhoid episode. The major expenditure was productivity cost due to lost wages of US$ 128.02 (83%). Our results contribute to the further economic evaluation of typhoid fever vaccination in Zanzibar and other sub-Saharan African countries.

Revisiting typhoid fever surveillance in low and middle income countries: lessons from systematic literature review of population-based longitudinal studies.

Science.gov (United States)

Mogasale, Vittal; Mogasale, Vijayalaxmi V; Ramani, Enusa; Lee, Jung Seok; Park, Ju Yeon; Lee, Kang Sung; Wierzba, Thomas F

2016-01-29

The control of typhoid fever being an important public health concern in low and middle income countries, improving typhoid surveillance will help in planning and implementing typhoid control activities such as deployment of new generation Vi conjugate typhoid vaccines. We conducted a systematic literature review of longitudinal population-based blood culture-confirmed typhoid fever studies from low and middle income countries published from 1(st) January 1990 to 31(st) December 2013. We quantitatively summarized typhoid fever incidence rates and qualitatively reviewed study methodology that could have influenced rate estimates. We used meta-analysis approach based on random effects model in summarizing the hospitalization rates. Twenty-two papers presented longitudinal population-based and blood culture-confirmed typhoid fever incidence estimates from 20 distinct sites in low and middle income countries. The reported incidence and hospitalizations rates were heterogeneous as well as the study methodology across the sites. We elucidated how the incidence rates were underestimated in published studies. We summarized six categories of under-estimation biases observed in these studies and presented potential solutions. Published longitudinal typhoid fever studies in low and middle income countries are geographically clustered and the methodology employed has a potential for underestimation. Future studies should account for these limitations.

Cases of typhoid fever in Copenhagen region

DEFF Research Database (Denmark)

Barrett, Freja Cecille; Knudsen, Jenny Dahl; Johansen, Isik Somuncu

2013-01-01

Typhoid fever is a systemic illness which in high-income countries mainly affects travellers. The incidence is particularly high on the Indian subcontinent. Travellers who visit friends and relatives (VFR) have been shown to have a different risk profile than others. We wished to identify main...

Yellow Fever Outbreak - Kongo Central Province, Democratic Republic of the Congo, August 2016.

Science.gov (United States)

Otshudiema, John O; Ndakala, Nestor G; Mawanda, Elande-Taty K; Tshapenda, Gaston P; Kimfuta, Jacques M; Nsibu, Loupy-Régence N; Gueye, Abdou S; Dee, Jacob; Philen, Rossanne M; Giese, Coralie; Murrill, Christopher S; Arthur, Ray R; Kebela, Benoit I

2017-03-31

On April 23, 2016, the Democratic Republic of the Congo's (DRC's) Ministry of Health declared a yellow fever outbreak. As of May 24, 2016, approximately 90% of suspected yellow fever cases (n = 459) and deaths (45) were reported in a single province, Kongo Central Province, that borders Angola, where a large yellow fever outbreak had begun in December 2015. Two yellow fever mass vaccination campaigns were conducted in Kongo Central Province during May 25-June 7, 2016 and August 17-28, 2016. In June 2016, the DRC Ministry of Health requested assistance from CDC to control the outbreak. As of August 18, 2016, a total of 410 suspected yellow fever cases and 42 deaths were reported in Kongo Central Province. Thirty seven of the 393 specimens tested in the laboratory were confirmed as positive for yellow fever virus (local outbreak threshold is one laboratory-confirmed case of yellow fever). Although not well-documented for this outbreak, malaria, viral hepatitis, and typhoid fever are common differential diagnoses among suspected yellow fever cases in this region. Other possible diagnoses include Zika, West Nile, or dengue viruses; however, no laboratory-confirmed cases of these viruses were reported. Thirty five of the 37 cases of yellow fever were imported from Angola. Two-thirds of confirmed cases occurred in persons who crossed the DRC-Angola border at one market city on the DRC side, where ≤40,000 travelers cross the border each week on market day. Strategies to improve coordination between health surveillance and cross-border trade activities at land borders and to enhance laboratory and case-based surveillance and health border screening capacity are needed to prevent and control future yellow fever outbreaks.

Clinical and epidemiological features of typhoid fever in Pemba, Zanzibar: assessment of the performance of the WHO case definitions.

Science.gov (United States)

Thriemer, Kamala; Ley, Benedikt; Ley, Benedikt B; Ame, Shaali S; Deen, Jaqueline L; Pak, Gi Deok; Chang, Na Yoon; Hashim, Ramadhan; Schmied, Wolfgang Hellmut; Busch, Clara Jana-Lui; Nixon, Shanette; Morrissey, Anne; Puri, Mahesh K; Ochiai, R Leon; Wierzba, Thomas; Clemens, John D; Ali, Mohammad; Jiddawi, Mohammad S; von Seidlein, Lorenz; Ali, Said M

2012-01-01

The gold standard for diagnosis of typhoid fever is blood culture (BC). Because blood culture is often not available in impoverished settings it would be helpful to have alternative diagnostic approaches. We therefore investigated the usefulness of clinical signs, WHO case definition and Widal test for the diagnosis of typhoid fever. Participants with a body temperature ≥37.5°C or a history of fever were enrolled over 17 to 22 months in three hospitals on Pemba Island, Tanzania. Clinical signs and symptoms of participants upon presentation as well as blood and serum for BC and Widal testing were collected. Clinical signs and symptoms of typhoid fever cases were compared to other cases of invasive bacterial diseases and BC negative participants. The relationship of typhoid fever cases with rainfall, temperature, and religious festivals was explored. The performance of the WHO case definitions for suspected and probable typhoid fever and a local cut off titre for the Widal test was assessed. 79 of 2209 participants had invasive bacterial disease. 46 isolates were identified as typhoid fever. Apart from a longer duration of fever prior to admission clinical signs and symptoms were not significantly different among patients with typhoid fever than from other febrile patients. We did not detect any significant seasonal patterns nor correlation with rainfall or festivals. The sensitivity and specificity of the WHO case definition for suspected and probable typhoid fever were 82.6% and 41.3% and 36.3 and 99.7% respectively. Sensitivity and specificity of the Widal test was 47.8% and 99.4 both forfor O-agglutinin and H- agglutinin at a cut-off titre of 1:80. Typhoid fever prevalence rates on Pemba are high and its clinical signs and symptoms are non-specific. The sensitivity of the Widal test is low and the WHO case definition performed better than the Widal test.

Open study of short course Fleroxacin for Typhoid and Paratyphoid Fever

Directory of Open Access Journals (Sweden)

R. H.H. Nelwan

2002-03-01

Full Text Available The objective of this study was to evaluate clinical and bacteriological effect of short course fleroxacin in uncomplicated typhoid and paratyphoid fever patients. Four hundred mg of fleroxacin was given oraly once daily for a period of 3 to 5 days. The diagnosis of typhoid and paratyphoid fever was established by clinical picture as well as blood culture or Widal serology test. Thirty patients in whom the clinical picture was confirmed as a typhoid or paratyphoid infection were eligible for this investigation. They consisted of 15 males and 15 females ranging in age from 18-38 years average 27.5 years of whom 18 were diagnosed by blood culture consisting of 16 S.typhi positive cases and two S.paratyphi A, while 12 other cases were positively confirmed by serial Widal agglutination serology. These cases suffered from fever between 3-14 days with a minimum recorded body temperature elevation of 38.5 degrees Celsius. Clinical response with defervescence of fever was obtained in the positive blood culture group within 3 days (8 patients including 2 cases positive for S.paratyphi A and within two additional days (5 days in the remaining 10 cases. In the twelve cases with a positive serology for typhoid fever a clinical response was obtained for defervescence within 3 days (6 cases with 4 of these cases were on 3 days of fleroxacin and 2 cases on 5 days of fleroxacin. In the remaining 6 serologic positive cases fever resolved after 4-6 days with an average of 5 days with one on 3 days of fleroxacin and the rest (5 cases on 5 days of fleroxacin. All positive blood culture cases reverted to negative after the fleroxacin course. No relapse or carrier state was recorded in this serie. It may be concluded that a 3 to 5 days closely monitored course of fleroxacin has excellent clinical as well as bacteriological efficacy in noncomplicated typhoid and paratyphoid fever. (Med J Indones 2002; 11: 41-7Keywords: fluoroquinolones, enteric infections, short

Risk Analysis of Typhoid Fever Based on Personal Hygiene and Street Food Consumption Habit at Home

Directory of Open Access Journals (Sweden)

Hilda Nuruzzaman

2016-11-01

Full Text Available Typhoid fever is disease caused by Salmonella typhi bacteria transmission trought contaminated food and drink. Data from RSUD dr. Abdoer Rahem showing that from 2011–2013 typhoid fever case always increase and often happened to children age 5–14 years old. The objective research to analysis risk factor of typhoid fever according to snacking habit at school and at house of children age 7–12 years old. This research was observasional case control study. Data for case in this research are taken from medical record of ‘Unit Teratai’ for the past 1 year in RSUD dr. Abdoer Rahem Situbondo, whereas for control are case group. There are eighty person taken for this research as sample. This result was the risk of typhoid fever children which has habit of hand washing had after defecation at home OR 3.67 (1.29 < OR < 10.64, children which has habit of hand washing before eating had OR 4.33 (1.54 < OR < 12.44, children with short dirty fingernails had OR 7.79 (1.46 < OR < 46.18 frequent street food consumption OR 3.89 (1.39 < OR < 11.06, buy snack at food street OR 3.95 (1.40 < OR < 11.30, buy some snack with packing had OR 3.5 (1.26 < OR < 9.38. The conclusion is that habit hand washing after defecation, habit hand washing before eating, short dirty fingernail, frequent food street consumption, buy food street and buy some food with sealed packing can secrease the risk of typhoid fever for children age 7–12 years Keywords: typhoid fever, risk factor of typhoid fever, personal hygiene, street food consumption habit

Comparison of Strategies and Incidence Thresholds for Vi Conjugate Vaccines Against Typhoid Fever: A Cost-effectiveness Modeling Study.

Science.gov (United States)

Lo, Nathan C; Gupta, Ribhav; Stanaway, Jeffrey D; Garrett, Denise O; Bogoch, Isaac I; Luby, Stephen P; Andrews, Jason R

2018-02-12

Typhoid fever remains a major public health problem globally. While new Vi conjugate vaccines hold promise for averting disease, the optimal programmatic delivery remains unclear. We aimed to identify the strategies and associated epidemiologic conditions under which Vi conjugate vaccines would be cost-effective. We developed a dynamic, age-structured transmission and cost-effectiveness model that simulated multiple vaccination strategies with a typhoid Vi conjugate vaccine from a societal perspective. We simulated 10-year vaccination programs with (1) routine immunization of infants (aged typhoid fever and defined strategies as highly cost-effective by using the definition of a low-income country (defined as a country with a gross domestic product of $1045 per capita). We defined incidence as the true number of clinically symptomatic people in the population per year. Vi conjugate typhoid vaccines were highly cost-effective when administered by routine immunization activities through the EPI in settings with an annual incidence of >50 cases/100000 (95% uncertainty interval, 40-75 cases) and when administered through the EPI plus a catch-up campaign in settings with an annual incidence of >130 cases/100000 (95% uncertainty interval, 50-395 cases). The incidence threshold was sensitive to the typhoid-related case-fatality rate, carrier contribution to transmission, vaccine characteristics, and country-specific economic threshold for cost-effectiveness. Typhoid Vi conjugate vaccines would be highly cost-effective in low-income countries in settings of moderate typhoid incidence (50 cases/100000 annually). These results were sensitive to case-fatality rates, underscoring the need to consider factors contributing to typhoid mortality (eg, healthcare access and antimicrobial resistance) in the global vaccination strategy. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.

Orbital cellulitis in course of typhoid fever

International Nuclear Information System (INIS)

Nowacka, K.; Szreter, M.; Mikolajewicz, J.

1993-01-01

In 18 months girl with exophthalmus of the left eye and extensive swelling of the soft tissues in both orbits during continued fever was observed. Typhoid fever with a non-typical course and ophthalmic complications were diagnosed on the basis of serological tests. Complete cure after treatment with augmenting was obtained. (author)

Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

Science.gov (United States)

Wijedoru, Lalith; Mallett, Sue; Parry, Christopher M

2017-01-01

Background Differentiating both typhoid (Salmonella Typhi) and paratyphoid (Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point-of-care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)-recommended main diagnostic test for enteric fever. Objectives To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies. Selection criteria We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone). Data collection and analysis Two review authors independently extracted the test result data. We used a modified QUADAS-2 extraction form to assess methodological quality. We performed a meta-analysis when there were sufficient studies for the test and heterogeneity was reasonable. Main results Thirty-seven studies met the inclusion

Antibody response to the lipopolysaccharide and protein antigens of Salmonella typhi during typhoid infection. I. Measurement of serum antibodies by radioimmunoassay

Energy Technology Data Exchange (ETDEWEB)

Tsang, R S.W.; Chau, P Y; Lam, S K [Hong Kong Univ.; La Brooy, J T; Rowley, D [Adelaide Univ. (Australia)

1981-12-01

Serum antibody responses to the lipopolysaccharide and protein antigens of S. typhi in typhoid patients were studied using a solid-phase radioimmunoassay technique with /sup 125/I labelled anti-immunoglobulin antibody. Sera from 24 adult typhoid patients and 20 non-typhoid adult controls were compared. As a group, sera from typhoid patients showed increased IgA, IgG and IgM immunoglobulin levels and gave significantly higher anti-LPS and anti-protein antibody titres in all three major immunoglobulin classes than did non-typhoid controls. Levels of antibodies against LPS or protein in sera of typhoid patients were highly variable with a skew distribution. A good correlation was found between antibody titres to the LPS antigen and those to a protein antigen. No correlation, however, was found between the anti-LPS antibody titres measured by radioimmunoassay and the anti-O antibody titres measured by the Widal agglutination test. Titration of anti-LPS or anti-protein antibodies by radioimmunoassay was found to be more sensitive and specific than Widal test for the serological diagnosis of typhoid fever. The advantages of measuring antibody response by radioimmunoassay over conventional Widal test are discussed.

The role of abdominal ultrasound in the diagnosis of typhoid fever: an observational study.

Science.gov (United States)

Younis, Saeed Nadhim

2014-01-01

To study the usefulness of abdominal ultrasound in the diagnosis of typhoid fever and to determine the common ultrasound findings early in the course of the disease. Abdominal ultrasound examination was performed within the first week of initiation of symptoms in 350 cases with clinical diagnosis of typhoid fever. Subsequent ultrasound follow-up examination was done 15 days later (beginning of the third week). All the patients proved to have positive Widal test and Sallmonella culture. The study was performed in Erbil-Iraq from the period January 1993 to October 2010. The following ultrasound findings were reported: hepatomegaly (31.4%), prominent intrahepatic bile ducts (64.85%), splenomegaly (100%), mesenteric lymphadenopathy (42.85%), bowel wall thickening (35.71%), acalculous cholecystitis (16.28%), perforations (1.14%), and ascites in (3.4%). The current study showed that the findings are typical enough to justify initiation of treatment for typhoid fever when serology is equivocal and culture is negative, and is fairly safe to say that normal ultrasound examination early in the course of febrile illness rules out typhoid fever. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pulmonary affectation in a patient with typhoid fever; Compromiso pulmonar en un paciente con fiebre tifoidea

Energy Technology Data Exchange (ETDEWEB)

Duenas C, Carmelo; Martinez, Adel; Maza, Augusto

1997-04-01

Typhoid fever is a rare disease in the USA with no more of 500 cases per year. In Latin America, it occurs four to five times more frequently. Pulmonary symptoms are found in less than 20% of the cases. The development of pneumonia is more common in immunocompromised patients. In last 10 years, the frequency of typhoid pneumonia has increased because of the HIV epidemic and the advance of other forms of immunosuppression. We presented the case of a young adult male with typhoid multilobar pneumonia who did not have VIH infection or any demonstrated immunosuppression.

Social and Economic Burden Associated With Typhoid Fever in Kathmandu and Surrounding Areas: A Qualitative Study.

Science.gov (United States)

Kaljee, Linda M; Pach, Alfred; Garrett, Denise; Bajracharya, Deepak; Karki, Kshitu; Khan, Imran

2017-07-29

Typhoid fever is a significant contributor to infectious disease mortality and morbidity in low- and middle-income countries, particularly in South Asia. With increasing antimicrobial resistance, commonly used treatments are less effective and risks increase for complications and hospitalizations. During an episode of typhoid fever, households experience multiple social and economic costs that are often undocumented. In the current study, qualitative interview data from Kathmandu and surrounding areas provide important insights into the challenges that affect those who contract typhoid fever and their caregivers, families, and communities, as well as insight into prevention and treatment options for health providers and outreach workers. When considering typhoid fever cases confirmed by blood culture, our data reveal delays in healthcare access, financial and time costs burden on households, and the need to increase health literacy. These data also illustrate the impact of limited laboratory diagnostic equipment and tools on healthcare providers' abilities to distinguish typhoid fever from other febrile conditions and treatment challenges associated with antimicrobial resistance. In light of these findings, there is an urgent need to identify and implement effective preventive measures including vaccination policies and programs focused on at-risk populations and endemic regions such as Nepal. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Typhoid fever

DEFF Research Database (Denmark)

Wain, John; Hendriksen, Rene S.; Mikoleit, Matthew L.

2015-01-01

Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas...... with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main...... cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow...

Application of a point-of-care test for the serodiagnosis of typhoid fever in Nigeria and the need for improved diagnostics

NARCIS (Netherlands)

Smith, Stella Ifeanyi; Bamidele, Moses; Fowora, Muinah; Goodluck, Helen T.; Omonigbehin, Emmanuel A.; Akinsinde, Kehinde A.; Fesobi, Toun; Pastoor, Rob; Abdoel, Theresia H.; Smits, Henk L.

2011-01-01

There is an urgent need for affordable point-of-care diagnostics for the differentiation of febrile illnesses and the confirmation of typhoid in endemic countries. Blood samples were collected from febrile patients with clinical suspicion of typhoid and screened for typhoid fever using the Widal and

A case of typhoidal tularemia in a male Japanese farmer

Directory of Open Access Journals (Sweden)

Kiwamu Nakamura

2018-06-01

Full Text Available In Japan, most tularemia cases occur after contact with hares (hunting, cooking and involve the glandular or ulceroglandular form. Here, we present a case of typhoidal tularemia in a 72-year-old Japanese male farmer who presented with fever, fatigue, and right lower abdominal pain. Computed tomography revealed intestinal wall thickening at the ascending colon, pleural effusion, and ascites. Following an initial diagnosis of bacterial enteric infection, his symptoms deteriorated after a week-long cephalosporin treatment course. The patient lived in an area endemic for scrub typhus; the antibiotic was changed to a tetracycline on suspicion of scrub typhus infection. His symptoms rapidly improved after initiation of minocycline treatment. Later, blood tests revealed marked increases in serological tests against Francisella tularensis exclusively, and the patient was diagnosed with typhoidal tularemia. Typhoidal tularemia may be characterized by any combination of general symptoms, but does not exhibit the local manifestations associated with other forms of tularemia. The patient, in this case, had no direct contact with hares or other wild animals and did not present with local manifestations of tularemia. Physicians should consider this disease, especially when tick-borne disease is suspected in the absence of local wounds, eschar, ulcers, or lymphadenopathy.

An evaluation of purified Salmonella Typhi protein antigens for the serological diagnosis of acute typhoid fever

NARCIS (Netherlands)

Tran Vu Thieu, Nga; Trinh van, Tan; Tran Tuan, Anh; Klemm, Elizabeth J.; Nguyen Ngoc Minh, Chau; Voong Vinh, Phat; Pham Thanh, Duy; Ho Ngoc Dan, Thanh; Pham Duc, Trung; Langat, Pinky; Martin, Laura B.; Galan, Jorge; Liang, Li; Felgner, Philip L.; Davies, D. Huw; de Jong, Hanna K.; Maude, Rapeephan R.; Fukushima, Masako; Wijedoru, Lalith; Ghose, Aniruddha; Samad, Rasheda; Dondorp, Arjen M.; Faiz, Abul; Darton, Thomas C.; Pollard, Andrew J.; Thwaites, Guy E.; Dougan, Gordon; Parry, Christopher M.; Baker, Stephen

2017-01-01

The diagnosis of typhoid fever is a challenge. Aiming to develop a typhoid diagnostic we measured antibody responses against Salmonella Typhi (S. Typhi) protein antigens and the Vi polysaccharide in a cohort of Bangladeshi febrile patients. IgM against 12 purified antigens and the Vi polysaccharide

Serology of Typhoid Fever in an Area of Endemicity and Its Relevance to Diagnosis

Science.gov (United States)

House, Deborah; Wain, John; Ho, Vo A.; Diep, To S.; Chinh, Nguyen T.; Bay, Phan V.; Vinh, Ha; Duc, Minh; Parry, Christopher M.; Dougan, Gordon; White, Nicholas J.; Hien, Tran Tinh; Farrar, Jeremy J.

2001-01-01

Currently, the laboratory diagnosis of typhoid fever is dependent upon either the isolation of Salmonella enterica subsp. enterica serotype Typhi from a clinical sample or the detection of raised titers of agglutinating serum antibodies against the lipopolysaccharide (LPS) (O) or flagellum (H) antigens of serotype Typhi (the Widal test). In this study, the serum antibody responses to the LPS and flagellum antigens of serotype Typhi were investigated with individuals from a region of Vietnam in which typhoid is endemic, and their usefulness for the diagnosis of typhoid fever was evaluated. The antibody responses to both antigens were highly variable among individuals infected with serotype Typhi, and elevated antibody titers were also detected in a high proportion of serum samples from healthy subjects from the community. In-house enzyme-linked immunosorbent assays (ELISAs) for the detection of specific classes of anti-LPS and antiflagellum antibodies were compared with other serologically based tests for the diagnosis of typhoid fever (Widal TO and TH, anti-serotype Typhi immunoglobulin M [IgM] dipstick, and IDeaL TUBEX). At a specificity of ≥0.93, the sensitivities of the different tests were 0.75, 0.55, and 0.52 for the anti-LPS IgM, IgG, and IgA ELISAs, respectively; 0.28 for the antiflagellum IgG ELISA; 0.47 and 0.32 for the Widal TO and TH tests, respectively; and 0.77 for the anti-serotype Typhi IgM dipstick assay. The specificity of the IDeaL TUBEX was below 0.90 (sensitivity, 0.87; specificity, 0.76). The serological assays based on the detection of IgM antibodies against either serotype Typhi LPS (ELISA) or whole bacteria (dipstick) had a significantly higher sensitivity than the Widal TO test when used with a single acute-phase serum sample (P ≤ 0.007). These tests could be of use for the diagnosis of typhoid fever in patients who have clinical typhoid fever but are culture negative or in regions where bacterial culturing facilities are not available

Investigation of the response to the enterobacterial common antigen after typhoid vaccination

Directory of Open Access Journals (Sweden)

Arlete M. Milhomem

1987-03-01

Full Text Available Antibodies against the Salmonella typhi enterobacterial common antigen (ECA and the O and H antigens were investigated in sera from healthy male subjects who had been previously vaccinated with the typhoid vaccine. No serological response to ECA was observed. Sera from subjects not previously vaccinated presented titers of ECA hemagglutinins which quantitatively were related to the presence ofH titers, but not to O agglutinins but with no statistical significance. The results are discussed in relation to the possible protective immunological mechanisms in typhoid fever.

Evaluation Of Blood Collected From Clinically Diagnosed Typhoid ...

African Journals Online (AJOL)

Blood culture revealed that 216 (42.8%) bacterial pathogens were isolated from the Widal positive patients yielded out of which 101 (46.8%) isolates were of ... fatal illness such as malaria and other parasitaemia, non-typhoid salmonellosis, endocarditis and other gastro-intestinal infections may have been responsible.

Desirability for a typhoid fever vaccine among rural residents, Pemba Island, Tanzania.

Science.gov (United States)

Kaljee, Linda M; Pach, Alfred; Thriemer, Kamala; Ley, Benedikt; Jiddawi, Mohamed; Puri, Mahesh; Ochiai, Leon; Wierzba, Thomas; Clemens, John; Ali, Said M

2013-06-24

Surveillance data indicate that Salmonella enterica serotype Typhi (S. Typhi) is a significant cause of morbidity and mortality in Africa. With limited anticipated short-term improvements in sanitation and water infrastructure, targeted vaccination campaigns may be an important prevention tool for typhoid fever. A cross-sectional survey was conducted with 435 randomly selected households in four rural villages on Pemba Island, Tanzania. A dichotomous 'readiness to pay' variable was created to assess vaccine desirability. Data analyses included univariate and bivariate descriptive statistics and binary logistic regression. Bivariate outcomes (ANOVA, t-tests, and chi-square) and odds ratios with 95% confidence intervals are reported. A total of 66% respondents stated that they would pay for a typhoid fever vaccine in the future. Readiness to pay was not significantly associated with household expenditures. Readiness to pay was associated with use of local Primary Health Care Units (PHCUs) compared to use of cottage or district hospitals (OR 1.8 [95% CI, 1.2-2.7]: p=.007) and with knowledge of someone being sick from typhoid fever (OR 2.2 [95% CI, 1.0-4.5]: p=.039). Respondents perceiving prevention measures as more effective (OR 1.0 [95% CI, 1.0-1.2]: p=.009) were also more likely ready to pay. Preferred methods of communication of information about a typhoid fever vaccine included broadcasting via microphone ('miking'), radio, and door-to-door visits. With rapid increase in numbers of licensed and promising vaccines, policy makers and health administrators are faced with decisions regarding allocation of scarce health resources for competing interventions. Community residents need to be informed about diseases which may not be readily recognized, diagnosed, and treated. Perceived vulnerability to the disease may increase likelihood of vaccine desirability. A better local understanding of typhoid fever is needed for general prevention measures, increasing treatment

Typhoid fever in a Tertiary Hospital in Nigeria: Another look at the Widal agglutination test as a preferred option for diagnosis.

Science.gov (United States)

Enabulele, Osahon; Awunor, Simeon Nyemike

2016-01-01

Single Widal agglutination test rather than blood culture, is commonly employed to diagnose typhoid fever in Nigeria. We took another look at the Widal agglutination test as a preferred option for diagnosis of typhoid fever by determining the specificity and sensitivity of Widal agglutination test in febrile adult patients. Two hundred and seventy-one blood samples from consecutive adults (>18 years) with febrile illness attending the General Practice Clinic of the University of Benin Teaching Hospital were tested using the Widal agglutination test, blood culture, and malaria parasite test on each sample to establish the diagnosis of typhoid fever. Of the 271 blood samples 124 (45.76%) were positive following a Widal agglutination test, 60 (22.10%) blood samples grew Salmonella organisms on blood culture while 55 (20.29%) blood samples showed a co-infection of typhoid fever and malaria. A sensitivity of 35%, specificity of 51%, positive predictive value of 17%, and a negative predictive value of 73% were observed for Widal agglutination test as a diagnostic modality for typhoid fever infection. A single Widal agglutination test is not a valid diagnostic option for typhoid fever while co-infection with malaria parasite is the preponderant microbiological finding in typhoid fever infections. The severity of malaria parasitemia is associated with positive titers on Widal test.

diagnosis of malaria and typhoid fevers using basic tools

African Journals Online (AJOL)

userpc

retrospective analysis was conducted on the positivity rate for malaria parasite and typhoid fever among .... the size of the data, using a statistical software .... The frequency of the request for Malaria .... parameters vary with the change in the.

Laboratory evaluation of a simple and rapid latex agglutination assay for the serodiagnosis of typhoid fever

NARCIS (Netherlands)

Abdoel, Theresia H.; Pastoor, Rob; Smits, Henk L.; Hatta, Mochammad

2007-01-01

A latex agglutination assay for the serodiagnosis of typhoid fever was evaluated on samples collected from patients with clinical suspicion of typhoid fever in South Sulawesi, Indonesia, where the disease is endemic. The latex assay is very easy to use, gives a rapid result and may be used as a

A petro-structural review of the Zermatt-Saas Fee zone

Science.gov (United States)

Schenker, Filippo Luca; Markus Schmalholz, Stefan; Baumgartner, Lukas

2014-05-01

The Zermatt-Saas Fee zone (ZSZ) is an imbricate of fragments of blueschist- to eclogite-facies metabasalts and metagabbros, serpentinites and mélange zones containing blocks of the above mentioned rocks. The ZSZ is usually interpreted as a fragment of oceanic crust belonging to the Piemont-Ligurian (Tethyan) Ocean that was accreted into the Alpine nappe pile. In the last decades the discovery of several Ultra-High Pressure (UHP, >2.7 GPa at 550-600 °C from coesite bearing eclogites and diamond-bearing fluid inclusions in garnet) localities lead to the interpretation of deep subduction (> 100 km) of the ZSZ in the Eocene, and subsequent uplift from mantle depth with high exhumation rates (e.g. Amato et al., 1999). However, these high pressures are in apparent contrast to the regional metamorphic conditions that reflect pressures peaking at < 2 GPa for 550-600°C (blueschist and eclogite mineral assemblages in mafic rocks). These latter metamorphic conditions do not need anomalous high burial histories and exhumation velocities higher than the plate velocities. The magnitude and distribution of pressure in the tectonic units of the ZSZ are important for constraining dynamic models for the evolution of the ZSZ and the Western Alps. Before entering into dynamic models, we propose a petro-structural overview where the published petrological data on pressure and temperature are critically reviewed, and positioned on a geological map and cross section in order to integrate them into the proper structural and tectonic framework. The questions we seek to answer are: How is the pressure distributed within the main tectonic units and within the entire ZSZ? Do we observe sharp or gradual pressure gradients within the ZSZ? Can the UHP conditions be averaged/extended to the entire ZSZ? If not, do they correspond to conditions of observable subunits, or do they reflect anomalies in the pressure field? Answering these questions is fundamental to better understand the

Population-based incidence of typhoid fever in an urban informal settlement and a rural area in Kenya: implications for typhoid vaccine use in Africa.

Directory of Open Access Journals (Sweden)

Robert F Breiman

Full Text Available BACKGROUND: High rates of typhoid fever in children in urban settings in Asia have led to focus on childhood immunization in Asian cities, but not in Africa, where data, mostly from rural areas, have shown low disease incidence. We set out to compare incidence of typhoid fever in a densely populated urban slum and a rural community in Kenya, hypothesizing higher rates in the urban area, given crowding and suboptimal access to safe water, sanitation and hygiene. METHODS: During 2007-9, we conducted population-based surveillance in Kibera, an urban informal settlement in Nairobi, and in Lwak, a rural area in western Kenya. Participants had free access to study clinics; field workers visited their homes biweekly to collect information about acute illnesses. In clinic, blood cultures were processed from patients with fever or pneumonia. Crude and adjusted incidence rates were calculated. RESULTS: In the urban site, the overall crude incidence of Salmonella enterica serovar Typhi (S. Typhi bacteremia was 247 cases per 100,000 person-years of observation (pyo with highest rates in children 5-9 years old (596 per 100,000 pyo and 2-4 years old (521 per 100,000 pyo. Crude overall incidence in Lwak was 29 cases per 100,000 pyo with low rates in children 2-4 and 5-9 years old (28 and 18 cases per 100,000 pyo, respectively. Adjusted incidence rates were highest in 2-4 year old urban children (2,243 per 100,000 pyo which were >15-fold higher than rates in the rural site for the same age group. Nearly 75% of S. Typhi isolates were multi-drug resistant. CONCLUSIONS: This systematic urban slum and rural comparison showed dramatically higher typhoid incidence among urban children <10 years old with rates similar to those from Asian urban slums. The findings have potential policy implications for use of typhoid vaccines in increasingly urban Africa.

Association of carcinoma of the gallbladder with typhoid carriage in a typhoid endemic area using nested PCR.

Science.gov (United States)

Nath, Gopal; Singh, Yogesh Kumar; Kumar, Kailash; Gulati, Anil Kumar; Shukla, Vijay Kumar; Khanna, Ajay Kumar; Tripathi, Sunil Kumar; Jain, Ashok Kumar; Kumar, Mohan; Singh, Tej Bali

2008-08-30

Although well studied the association between chronic typhoid carrier state and carcinoma of the gallbladder (CaGB) remains unproven. The study was performed at a tertiary care medical center in North India and involved 52 patients with CaGB, 223 patients with benign gallbladder diseases, 508 healthy individuals and, 424 corpses. For the detection of Salmonella enterica serovar Typhi, hepatobiliary specimens were subjected to DNA extraction for specific nested- PCR amplification of the S. Typhi flagellin gene. Anti-Vi S. Typhi antibodies were detected in serum samples from patients by indirect haemagglutination. Thirty five of the 52 (67.3%) CaGB patients were PCR-positive for the S. Typhi flagellin gene; significantly higher than for patients with benign gallbladder diseases (95/223, 42.6%; p or = 160) in their serum were 20/52 (38.5%) for CaGB patients, 31/223 (13.9%) for patients with benign gallbladder diseases, and 47/508 (9.2%) for healthy individuals. Specific nested-PCR amplification of the S. Typhi flagellin gene in hepato-biliary specimens was more sensitive for detection of S. Typhi carriage than anti-Vi antibody titres in serum. The results demonstrate an association between typhoid carriage and gallbladder diseases, both CaGB and benign. S. Typhi specific immunosuppression is also suggested in patients with gallbladder diseases.

Serodiagnosis of Acute Typhoid Fever in Nigerian Pediatric Cases by Detection of Serum IgA and IgG Against Hemolysin E and Lipopolysaccharide.

Science.gov (United States)

Davies, D Huw; Jain, Aarti; Nakajima, Rie; Liang, Li; Jasinskis, Algis; Supnet, Medalyn; Felgner, Philip L; Teng, Andy; Pablo, Jozelyn; Molina, Douglas M; Obaro, Stephen K

2016-08-03

Inexpensive, easy-to-use, and highly sensitive diagnostic tests are currently unavailable for typhoid fever. To identify candidate serodiagnostic markers, we have probed microarrays displaying the full Salmonella enterica serovar Typhi (S. Typhi) proteome of 4,352 different proteins + lipopolysaccharides (LPSs), with sera from Nigerian pediatric typhoid and other febrile cases, Nigerian healthy controls, and healthy U.S. adults. Nigerian antibody profiles were broad (∼500 seropositive antigens) and mainly low level, with a small number of stronger "hits," whereas the profile in U.S. adults was typhoid cases. The response to LPS was also a strong discriminator of healthy controls and typhoid, although LPS did not discriminate between typhoid and nontyphoidal Salmonella (NTS) disease. As a first step toward the development of a point-of-care diagnostic, t1477 and LPS were evaluated on immunostrips. Both provided good discrimination between healthy controls and typhoid/NTS disease. Such a test could provide a useful screen for salmonellosis (typhoid and NTS disease) in suspected pediatric cases that present with undefined febrile disease. © The American Society of Tropical Medicine and Hygiene.

Analysis of TLR polymorphisms in typhoid patients and ...

African Journals Online (AJOL)

Ilakkia Sivaji

2016-01-20

Jan 20, 2016 ... implicated the genetic variations (polymorphisms) in TLR genes to influence the host susceptibility to infectious diseases. However, the available literature on TLR polymorphism and susceptibility to typhoid fever is unclear. Aim: This study aimed to investigate the polymorphism of TLRs 1, 2, 4 and 5 in ...

Comparison between DOT EIA IgM and Widal Test as early diagnosis of typhoid fever.

Science.gov (United States)

Begum, Z; Hossain, M A; Musa, A K; Shamsuzzaman, A K; Mahmud, M C; Ahsan, M M; Sumona, A A; Ahmed, S; Jahan, N A; Alam, M; Begum, A

2009-01-01

A recently developed DOT enzyme immunoassay known as "Typhidot" for detecting IgM antibody against 50 KDa OMP antigen of Salmonella typhi, was evaluated on 100 clinically suspected typhoid fever cases and 40 age-sex matched controls, in the Department of Microbiology, Mymensingh Medical College during, the period from June 2006 to July 2007. Blood culture, Widal test, and DOT EIA for IgM test were performed in all patients. Among 100 clinically suspected typhoid fever cases, 35 were subsequently confirmed on the basis of positive blood culture for S. typhi and/or significant rising titre of Widal test. The DOT EIA IgM test could produce results within 1 hour. The result of the DOT EIA IgM test showed a good diagnostic value for typhoid fever. The sensitivity, specificity, positive and negative predictive value of the test was found as 91.42%, 90.00%, 88.88% and 92.30% respectively. On the other hand corresponding values for Widal test were of 42.85%, 85.00%, 71.42% and 62.96% respectively. Thus, The DOT EIA IgM seems to be a practical alternative to Widal test for early diagnosis of typhoid fever.

Modelling typhoid risk in Dhaka metropolitan area of Bangladesh: the role of socio-economic and environmental factors.

Science.gov (United States)

Corner, Robert J; Dewan, Ashraf M; Hashizume, Masahiro

2013-03-16

Developing countries in South Asia, such as Bangladesh, bear a disproportionate burden of diarrhoeal diseases such as cholera, typhoid and paratyphoid. These seem to be aggravated by a number of social and environmental factors such as lack of access to safe drinking water, overcrowdedness and poor hygiene brought about by poverty. Some socioeconomic data can be obtained from census data whilst others are more difficult to elucidate. This study considers a range of both census data and spatial data from other sources, including remote sensing, as potential predictors of typhoid risk. Typhoid data are aggregated from hospital admission records for the period from 2005 to 2009. The spatial and statistical structures of the data are analysed and principal axis factoring is used to reduce the degree of co-linearity in the data. The resulting factors are combined into a quality of life index, which in turn is used in a regression model of typhoid occurrence and risk. The three principal factors used together explain 87% of the variance in the initial candidate predictors, which eminently qualifies them for use as a set of uncorrelated explanatory variables in a linear regression model. Initial regression result using ordinary least squares (OLS) were disappointing, this was explainable by analysis of the spatial autocorrelation inherent in the principal factors. The use of geographically weighted regression caused a considerable increase in the predictive power of regressions based on these factors. The best prediction, determined by analysis of the Akaike information criterion (AIC) was found when the three factors were combined into a quality of life index, using a method previously published by others, and had a coefficient of determination of 73%. The typhoid occurrence/risk prediction equation was used to develop the first risk map showing areas of Dhaka metropolitan area whose inhabitants are at greater or lesser risk of typhoid infection. This, coupled with

Helicobacter pylori infection and typhoid fever in Jakarta, Indonesia.

NARCIS (Netherlands)

Vollaard, A.M.; Verspaget, H.W.; Ali, S.; Visser, L.G.; Veenendaal, R.A.; Asten, H.A.G.H. van; Widjaja, S.; Surjadi, C.; Dissel, J.T. van

2006-01-01

We evaluated the association between typhoid fever and Helicobacter pylori infection, as the latter microorganism may influence gastric acid secretion and consequently increase susceptibility to Salmonella typhi infection. Anti-H. pylori IgG and IgA antibody titres (ELISA) and gastrin concentration

Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis.

Science.gov (United States)

Non, Lemuel R; Patel, Rupa; Esmaeeli, Amir; Despotovic, Vladimir

2015-11-01

Hemophagocytic lymphohistiocytosis (HLH) and rhabdomyolysis are rare complications of typhoid fever from Salmonella enterica serovar Typhi. Herein, we describe the clinical features in a 21-year-old female from India who presented to the intensive care unit with fever, severe pancytopenia, and rhabdomyolysis. © The American Society of Tropical Medicine and Hygiene.

Diagnosis and Treatment of Typhoid Fever and Associated Prevailing Drug Resistance in Northern Ethiopia.

Science.gov (United States)

Wasihun, Araya Gebreyesus; Wlekidan, Letemichael Negash; Gebremariam, Senay Aregawi; Welderufael, Abadi Luel; Muthupandian, Saravanan; Haile, Tadesse Dejenie; Dejene, Tsehaye Asmelash

2015-06-01

To determine diagnostic value of the Widal test, treatment pattern of febrile patients and antimicrobial drug susceptibility pattern of blood isolates. Using cross sectional methods, blood samples were collected for culture and Widal test from 502 febrile outpatients attending Mekelle hospital and Mekelle health center with similar symptoms to typhoid. Sensitivity, specificity for anti-TH and anti-TO titers using culture confirmed typhoid fever cases, and Kappa agreement between Titer and slide Widal tests were calculated. Treatment pattern of patients and antimicrobial susceptibility pattern of the blood isolates was assessed. From the 502 febrile patients, 8(1.6%) of them had culture-proven typhoid fever. However, patients who have results indicative of recent infection by O and H antigens of the Widal slide agglutination test were 343 (68.5%), with specificity and sensitivity of 33% and 100%, respectively. Over prescription of antibiotics was seen by Widal slide test for Ciprofloxacin 268 (76.1%), Amoxicillin- Clavulanic acid 9(2.6%), Amoxicillin 8(2.4%) and Chloranphenicol 8(2.4%). Tube titer positivity was seen in 23(5.3%) patients with 75% sensitivity and 95.8% specificity. Widal slide and Tube titer tests showed poor agreement for both antigens (kappa=0.02 for O) and (Kappa=0.09 for H). A single anti-TH titer of ≥ 1:160 and anti-TO titer ≥ 1:80 higher in our study showed an indication for typhoid fever infection. Drug resistance pattern of blood isolates ranges from 0-89.7% for gram positive and 0-100% for Gram negative, with an overall multi-drug resistance rate of 61.7%. Patients were wrongly diagnosed and treated for typhoid fever by Widal test. The tube titration method was relatively good but still had poor sensitivity. Blood isolates showed multi drug resistance, which may be due to the indiscriminate prescription as seen in this study. Based on our results, the slide Widal test is not helpful in the diagnosis of typhoid, hence other tests with

A Review of Prognostic Models on Diagnosis and Therapeutic Strategies of Typhoid Fever

Directory of Open Access Journals (Sweden)

Aslam Babar

2018-05-01

Full Text Available Background:      Typhoid infection is an insidious onset type of fever and some other gastrointestinal disorders which may have a fatal outcome. The causative agents are Salmonella typhi, Salmonella paratyphi A, and Salmonella paratyphi B.  Clinical features include, gradual rising fever, white coated tongue, and severe degree of malaise, drowsiness and pain in abdomen, perforation with bleeding in the intestines, shock and death. It involves mostly male victims of school going age. It is water born disease which spreads due to poor sanitation mostly in congested populated areas. According to World Health Organization sixteen to seventeen million typhoid fever cases were reported annually, out of which 600,000 died. Typhoid fever is 10 to 29 times more in subcontinent than China. Infection only occurs when food is handled by infected person. Isolated strains of Salmonella spp from suspected cases show resistance against routine antibiotics and the modern antibiotics are much more expensive and un affordable.Conclusion:    Need of this review is especially for Silver Nanoparticles (AgNPs manufactured by some types of fungi introduced by recent researchers have an edge to control or treat some sort of infections due to their antibacterial properties. In this study these (AgNPs in the form of suspension, give positive results against the Salmonella species. It enables us to treat the typhoid infection in a less expensive way.

The Typhoid Fever Surveillance in Africa Program (TSAP): Clinical, Diagnostic, and Epidemiological Methodologies.

Science.gov (United States)

von Kalckreuth, Vera; Konings, Frank; Aaby, Peter; Adu-Sarkodie, Yaw; Ali, Mohammad; Aseffa, Abraham; Baker, Stephen; Breiman, Robert F; Bjerregaard-Andersen, Morten; Clemens, John D; Crump, John A; Cruz Espinoza, Ligia Maria; Deerin, Jessica Fung; Gasmelseed, Nagla; Sow, Amy Gassama; Im, Justin; Keddy, Karen H; Cosmas, Leonard; May, Jürgen; Meyer, Christian G; Mintz, Eric D; Montgomery, Joel M; Olack, Beatrice; Pak, Gi Deok; Panzner, Ursula; Park, Se Eun; Rakotozandrindrainy, Raphaël; Schütt-Gerowitt, Heidi; Soura, Abdramane Bassiahi; Warren, Michelle R; Wierzba, Thomas F; Marks, Florian

2016-03-15

New immunization programs are dependent on data from surveillance networks and disease burden estimates to prioritize target areas and risk groups. Data regarding invasive Salmonella disease in sub-Saharan Africa are currently limited, thus hindering the implementation of preventive measures. The Typhoid Fever Surveillance in Africa Program (TSAP) was established by the International Vaccine Institute to obtain comparable incidence data on typhoid fever and invasive nontyphoidal Salmonella (iNTS) disease in sub-Saharan Africa through standardized surveillance in multiple countries. Standardized procedures were developed and deployed across sites for study site selection, patient enrolment, laboratory procedures, quality control and quality assurance, assessment of healthcare utilization and incidence calculations. Passive surveillance for bloodstream infections among febrile patients was initiated at thirteen sentinel sites in ten countries (Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania). Each TSAP site conducted case detection using these standardized methods to isolate and identify aerobic bacteria from the bloodstream of febrile patients. Healthcare utilization surveys were conducted to adjust population denominators in incidence calculations for differing healthcare utilization patterns and improve comparability of incidence rates across sites. By providing standardized data on the incidence of typhoid fever and iNTS disease in sub-Saharan Africa, TSAP will provide vital input for targeted typhoid fever prevention programs. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Low-level quinolone-resistance in multi-drug resistant typhoid

Energy Technology Data Exchange (ETDEWEB)

Mirza, S H; Khan, M A [Armed Forces Inst. of Pathology, Rawalpindi (Pakistan). Dept. of Microbiolgy

2008-01-15

To find out the frequency of low-level quinolone-resistance in Multi-Drug Resistant (MDR) typhoid using nalidixic acid screening disc. Blood was obtained from suspected cases of typhoid fever and cultured in to BacT/ALERT. The positive blood cultures bottles were subcultured. The isolates were identified by colony morphology and biochemical tests using API-20E galleries. Susceptibility testing of isolates was done by modified Kirby-Bauer disc diffusion method on Muellar Hinton Agar. For the isolates, which were resistant to nalidixic acid by disc diffusion method, Minimal Inhibitory Concentrations (MICs) of ciprofloxacin and nalidixic acid were determined by using the E-test strips. Disc diffusion susceptibility tests and MICs were interpreted according to the guidelines provided by National Committee for Control Laboratory Standard (NCCLS). A total of 21(65.5%) out of 32 isolates of Salmonellae were nalidixic acid-resistant by disk diffusion method. All the nalidixic acid-resistant isolates by disc diffusion method were confirmed by MICs for both ciprofloxacin and nalidixic acid. All the nalidixic acid-resistant isolates had a ciprofloxacin MIC of 0.25-1 microg/ml (reduced susceptibility) and nalidixic acid MICs > 32 microg (resistant). Out of all Salmonella isolates, 24 (75%) were found to be MDR, and all were S. typbi. Low-level quinolone-resistance in typhoid was high in this small series. Screening for nalidixic acid resistance with a 30 microg nalidixic acid disk is a reliable and cost-effective method to detect low-level fluoroquinolone resistance, especially in the developing countries. (author)

Low-level quinolone-resistance in multi-drug resistant typhoid

International Nuclear Information System (INIS)

Mirza, S.H.; Khan, M.A.

2008-01-01

To find out the frequency of low-level quinolone-resistance in Multi-Drug Resistant (MDR) typhoid using nalidixic acid screening disc. Blood was obtained from suspected cases of typhoid fever and cultured in to BacT/ALERT. The positive blood cultures bottles were subcultured. The isolates were identified by colony morphology and biochemical tests using API-20E galleries. Susceptibility testing of isolates was done by modified Kirby-Bauer disc diffusion method on Muellar Hinton Agar. For the isolates, which were resistant to nalidixic acid by disc diffusion method, Minimal Inhibitory Concentrations (MICs) of ciprofloxacin and nalidixic acid were determined by using the E-test strips. Disc diffusion susceptibility tests and MICs were interpreted according to the guidelines provided by National Committee for Control Laboratory Standard (NCCLS). A total of 21(65.5%) out of 32 isolates of Salmonellae were nalidixic acid-resistant by disk diffusion method. All the nalidixic acid-resistant isolates by disc diffusion method were confirmed by MICs for both ciprofloxacin and nalidixic acid. All the nalidixic acid-resistant isolates had a ciprofloxacin MIC of 0.25-1 microg/ml (reduced susceptibility) and nalidixic acid MICs > 32 microg (resistant). Out of all Salmonella isolates, 24 (75%) were found to be MDR, and all were S. typbi. Low-level quinolone-resistance in typhoid was high in this small series. Screening for nalidixic acid resistance with a 30 microg nalidixic acid disk is a reliable and cost-effective method to detect low-level fluoroquinolone resistance, especially in the developing countries. (author)

An evaluation of purified Salmonella Typhi protein antigens for the serological diagnosis of acute typhoid fever.

Science.gov (United States)

Tran Vu Thieu, Nga; Trinh Van, Tan; Tran Tuan, Anh; Klemm, Elizabeth J; Nguyen Ngoc Minh, Chau; Voong Vinh, Phat; Pham Thanh, Duy; Ho Ngoc Dan, Thanh; Pham Duc, Trung; Langat, Pinky; Martin, Laura B; Galan, Jorge; Liang, Li; Felgner, Philip L; Davies, D Huw; de Jong, Hanna K; Maude, Rapeephan R; Fukushima, Masako; Wijedoru, Lalith; Ghose, Aniruddha; Samad, Rasheda; Dondorp, Arjen M; Faiz, Abul; Darton, Thomas C; Pollard, Andrew J; Thwaites, Guy E; Dougan, Gordon; Parry, Christopher M; Baker, Stephen

2017-08-01

The diagnosis of typhoid fever is a challenge. Aiming to develop a typhoid diagnostic we measured antibody responses against Salmonella Typhi (S. Typhi) protein antigens and the Vi polysaccharide in a cohort of Bangladeshi febrile patients. IgM against 12 purified antigens and the Vi polysaccharide was measured by ELISA in plasma from patients with confirmed typhoid fever (n = 32), other confirmed infections (n = 17), and healthy controls (n = 40). ELISAs with the most specific antigens were performed on plasma from 243 patients with undiagnosed febrile disease. IgM against the S. Typhi protein antigens correlated with each other (rho > 0.8), but not against Vi (rho Typhoid patients exhibited higher IgM against 11/12 protein antigens and Vi than healthy controls and those with other infections. Vi, PilL, and CdtB exhibited the greatest sensitivity and specificity. Specificity and sensitivity was improved when Vi was combined with a protein antigen, generating sensitivities and specificities of 0.80 and >0.85, respectively. Applying a dynamic cut-off to patients with undiagnosed febrile disease suggested that 34-58% had an IgM response indicative of typhoid. We evaluated the diagnostic potential of several S. Typhi antigens; our assays give good sensitivity and specificity, but require further assessment in differing patient populations. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Single-layer closure of typhoid enteric perforation: Our experience ...

African Journals Online (AJOL)

Materials and Methods: We retrospectively studied the effects of single versus double layer intestinal closure after typhoid enteric perforation with peritonitis in 902 pediatric patients from September 2007 to April 2012. All the patients underwent laparotomy after resuscitation and antibiotic cover. The patients were divided ...

The Incidence and Management of Typhoid Fever in Nigeria ...

African Journals Online (AJOL)

Typhoid or enteric fever is caused by Salmonella typhi. It is largely a disease of developing nations due to their poor standard of hygiene and ... Symptoms such as diarrhoea, constipation, abdominal pain and encephalopathy may occur. Complications like intestinal perforation and gastrointestinal haemorrhage may occur ...

Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever.

Science.gov (United States)

Wijedoru, Lalith; Mallett, Sue; Parry, Christopher M

2017-05-26

Differentiating both typhoid (Salmonella Typhi) and paratyphoid (Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point-of-care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)-recommended main diagnostic test for enteric fever. To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas. We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies. We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone). Two review authors independently extracted the test result data. We used a modified QUADAS-2 extraction form to assess methodological quality. We performed a meta-analysis when there were sufficient studies for the test and heterogeneity was reasonable. Thirty-seven studies met the inclusion criteria and included a total of 5080 participants (range 50 to 1732). Enteric fever prevalence

A Meta-Analysis of Typhoid Diagnostic Accuracy Studies: A Recommendation to Adopt a Standardized Composite Reference.

Directory of Open Access Journals (Sweden)

Helen L Storey

Full Text Available Novel typhoid diagnostics currently under development have the potential to improve clinical care, surveillance, and the disease burden estimates that support vaccine introduction. Blood culture is most often used as the reference method to evaluate the accuracy of new typhoid tests; however, it is recognized to be an imperfect gold standard. If no single gold standard test exists, use of a composite reference standard (CRS can improve estimation of diagnostic accuracy. Numerous studies have used a CRS to evaluate new typhoid diagnostics; however, there is no consensus on an appropriate CRS. In order to evaluate existing tests for use as a reference test or inclusion in a CRS, we performed a systematic review of the typhoid literature to include all index/reference test combinations observed. We described the landscape of comparisons performed, showed results of a meta-analysis on the accuracy of the more common combinations, and evaluated sources of variability based on study quality. This wide-ranging meta-analysis suggests that no single test has sufficiently good performance but some existing diagnostics may be useful as part of a CRS. Additionally, based on findings from the meta-analysis and a constructed numerical example demonstrating the use of CRS, we proposed necessary criteria and potential components of a typhoid CRS to guide future recommendations. Agreement and adoption by all investigators of a standardized CRS is requisite, and would improve comparison of new diagnostics across independent studies, leading to the identification of a better reference test and improved confidence in prevalence estimates.

20 YEARS OF PROGRESS IN TYPHOID RESEARCH

Directory of Open Access Journals (Sweden)

Narain H. Punjabi

2012-09-01

Full Text Available In 1981, the reported number of cases of typhoid fever in Indonesia was 19,596, increasing to 26,606 m 1986, most of the increase was due to improved detection and recognition of the pathogen. A more realistic estimate of incidence for this underreported and underdiagnosed disease would be from 540,000 to 1,210,000 cases per year. This was based on results of a household survey done by Budiarso R. et al. in 1980 and 1986, and on result of a community surveillance done by Ruwido and Simanjuntak et al. from 1983-1988. These studies were done in Plaju, South Sumatera, representing an urban area and Paseh, West Java, representing a semi-rural area. The results showed that the incidence rate of typhoid fever in the semi rural area was 358/100,000 population/year, and between 760-810/100,000 population/year in the urban area. These studies also indicated that the high risk group in the population was school age children between ages of 3-19 years. From other observations, it is also noted that the case fatality in urbanized and growing areas of Indonesia, may be higher than it is reported in other areas of the world

A Randomised Trial Evaluating the Safety and Immunogenicity of the Novel Single Oral Dose Typhoid Vaccine M01ZH09 in Healthy Vietnamese Children

NARCIS (Netherlands)

Tran, T.H.; Nguyen, T.D.; Nguyen, T.T.; Ninh, T.T.V.; Tran, N.B.C.; Nguyen, V.M.H.; Tran, T.T.N.; Cao, T.T.; Pham, V.M.; Nguyen, T.C.B.; Tran, T.D.H.; Pham, V.T.; To, S.D.; Campbell, J.I.; Stockwell, E.; Schultsz, C.; Simmons, C.P.; Glover, C.; Lam, W.; Marques, F.; May, J.P.; Upton, A.; Budhram, R.; Dougan, G.; Farrar, J.; Nguyen, V.V.C.; Dolecek, C.

2010-01-01

Background: The emergence of drug resistant typhoid fever is a major public health problem, especially in Asia. An oral single dose typhoid vaccine would have major advantages. M01ZH09 is a live oral single dose candidate typhoid vaccine containing Salmonella enterica serovar Typhi (Ty2 aroC(-)

A forecast of typhoid conjugate vaccine introduction and demand in typhoid endemic low- and middle-income countries to support vaccine introduction policy and decisions.

Science.gov (United States)

Mogasale, Vittal; Ramani, Enusa; Park, Il Yeon; Lee, Jung Seok

2017-09-02

A Typhoid Conjugate Vaccine (TCV) is expected to acquire WHO prequalification soon, which will pave the way for its use in many low- and middle-income countries where typhoid fever is endemic. Thus it is critical to forecast future vaccine demand to ensure supply meets demand, and to facilitate vaccine policy and introduction planning. We forecasted introduction dates for countries based on specific criteria and estimated vaccine demand by year for defined vaccination strategies in 2 scenarios: rapid vaccine introduction and slow vaccine introduction. In the rapid introduction scenario, we forecasted 17 countries and India introducing TCV in the first 5 y of the vaccine's availability while in the slow introduction scenario we forecasted 4 countries and India introducing TCV in the same time period. If the vaccine is targeting infants in high-risk populations as a routine single dose, the vaccine demand peaks around 40 million doses per year under the rapid introduction scenario. Similarly, if the vaccine is targeting infants in the general population as a routine single dose, the vaccine demand increases to 160 million doses per year under the rapid introduction scenario. The demand forecast projected here is an upper bound estimate of vaccine demand, where actual demand depends on various factors such as country priorities, actual vaccine introduction, vaccination strategies, Gavi financing, costs, and overall product profile. Considering the potential role of TCV in typhoid control globally; manufacturers, policymakers, donors and financing bodies should work together to ensure vaccine access through sufficient production capacity, early WHO prequalification of the vaccine, continued Gavi financing and supportive policy.

Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia.

Science.gov (United States)

Gasem, M H; Dolmans, W M; Keuter, M M; Djokomoeljanto, R R

2001-06-01

To identify risk factors for typhoid fever in Semarang city and its surroundings, 75 culture-proven typhoid fever patients discharged 2 weeks earlier from hospital and 75 controls were studied. Control subjects were neighbours of cases with no history of typhoid fever, not family members, randomly selected and matched for gender and age. Both cases and controls were interviewed at home by the same trained interviewer using a standardized questionnaire. A structured observation of their living environment inside and outside the house was performed during the visit and home drinking water samples were tested bacteriologically. Univariate analysis showed the following risk factors for typhoid fever: never or rarely washing hands before eating (OR = 3.28; 95% CI = 1.41-7.65); eating outdoors at least once a week (OR = 3.00; 95% CI = 1.09-8.25); eating outdoors at a street food stall or mobile food vendor (OR = 3.86; 95% CI = 1.30-11.48); consuming ice cubes in beverage in the 2-week period before getting ill (OR = 3.00, 95% CI = 1.09-8.25) and buying ice cubes from a street vendor (OR = 5.82; 95% CI = 1.69-20.12). Water quality and living environment of cases were worse than that of controls, e.g. cases less often used clean water for taking a bath (OR = 6.50; 95% CI = 1.47-28.80), for brushing teeth (OR = 4.33; 95% CI = 1.25-15.20) and for drinking (OR = 3.67; 95% CI = 1.02-13.14). Cases tended to live in houses without water supply from the municipal network (OR=11.00; 95% CI = 1.42-85.2), with open sewers (OR = 2.80; 95% CI = 1.0-7.77) and without tiles in the kitchen (OR = 2.67; 95% CI = 1.04-6.81). Multivariate analysis showed that living in a house without water supply from the municipal network (OR = 29.18; 95% CI = 2.12-400.8) and with open sewers (OR = 7.19; 95% CI = 1.33-38.82) was associated with typhoid fever. Never or rarely washing hands before eating (OR = 3.97; 95% CI = 1.22-12.93) and being unemployed or having a part-time job (OR = 31.3; 95% CI = 3

Typhoid fever in children: Clinical presentation and risk factors ...

African Journals Online (AJOL)

and prevention (CDC) case definition for typhoid fever, between 1st. January and 31st December 2010, were consecutively reviewed using a structured questionnaire. Results: A total of 42 patients were admitted out of which 35 were analysed, the remaining 7 were excluded because consent was not obtained. The disease ...

A randomised trial evaluating the safety and immunogenicity of the novel single oral dose typhoid vaccine M01ZH09 in healthy Vietnamese children

NARCIS (Netherlands)

Tran, Tinh Hien; Nguyen, Thi Dung; Nguyen, Thanh Truong; Ninh, Thi Thanh Van; Tran, Nguyen Bich Chau; Nguyen, Van Minh Hoang; Tran, Thi Thu Nga; Cao, Thu Thuy; Pham, Van Minh; Nguyen, Thi Cam Binh; Tran, Thi Diem Ha; Pham, Van Toi; To, Song Diep; Campbell, James I.; Stockwell, Elaine; Schultsz, Constance; Simmons, Cameron P.; Glover, Clare; Lam, Winnie; Marques, Filipe; May, James P.; Upton, Anthony; Budhram, Ronald; Dougan, Gordon; Farrar, Jeremy; Nguyen, Van Vinh Chau; Dolecek, Christiane

2010-01-01

The emergence of drug resistant typhoid fever is a major public health problem, especially in Asia. An oral single dose typhoid vaccine would have major advantages. M01ZH09 is a live oral single dose candidate typhoid vaccine containing Salmonella enterica serovar Typhi (Ty2 aroC(-)ssaV(-)) ZH9 with

Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment.

Science.gov (United States)

Mogasale, Vittal; Maskery, Brian; Ochiai, R Leon; Lee, Jung Seok; Mogasale, Vijayalaxmi V; Ramani, Enusa; Kim, Young Eun; Park, Jin Kyung; Wierzba, Thomas F

2014-10-01

No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine. Copyright © 2014 Mogasale et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

The diagnostic accuracy of three rapid diagnostic tests for typhoid fever at Chittagong Medical College Hospital, Chittagong, Bangladesh.

Science.gov (United States)

Maude, Rapeephan R; de Jong, Hanna K; Wijedoru, Lalith; Fukushima, Masako; Ghose, Aniruddha; Samad, Rasheda; Hossain, Mohammed Amir; Karim, Mohammed Rezaul; Faiz, Mohammed Abul; Parry, Christopher M

2015-10-01

To determine the diagnostic accuracy of three rapid diagnostic tests (RDTs) for typhoid fever in febrile hospitalised patients in Bangladesh. Febrile adults and children admitted to Chittagong Medical College Hospital, Bangladesh, were investigated with Bact/Alert(®) blood cultures and real-time PCR to detect Salmonella enterica Typhi and Paratyphi A and assays for Rickettsia, leptospirosis and dengue fever. Acute serum samples were examined with the LifeAssay (LA) Test-it™ Typhoid IgM lateral flow assay detecting IgM antibodies against S. Typhi O antigen, CTKBiotech Onsite Typhoid IgG/IgM Combo Rapid-test cassette lateral flow assay detecting IgG and IgM antibodies against S. Typhi O and H antigens and SD Bioline line assay for IgG and IgM antibodies against S. Typhi proteins. In 300 malaria smear-negative febrile patients [median (IQR) age of 13.5 (5-31) years], 34 (11.3%) had confirmed typhoid fever: 19 positive by blood culture for S. Typhi (three blood PCR positive) and 15 blood culture negative but PCR positive for S. Typhi in blood. The respective sensitivity and specificity of the three RDTs in patients using a composite reference standard of blood culture and/or PCR-confirmed typhoid fever were 59% and 61% for LifeAssay, 59% and 74% for the CTK IgM and/or IgG, and 24% and 96% for the SD Bioline RDT IgM and/or IgG. The LifeAssay RDT had a sensitivity of 63% and a specificity of 91% when modified with a positive cut-off of ≥2+ and analysed using a Bayesian latent class model. These typhoid RDTs demonstrated moderate diagnostic accuracies, and better tests are needed. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

NNDSS - Table II. Salmonellosis (excluding typhoid fever and paratyphoid fever) to Shigellosis

Data.gov (United States)

U.S. Department of Health & Human Services — NNDSS - Table II. Salmonellosis (excluding typhoid fever and paratyphoid fever) to Shigellosis - 2018. In this Table, provisional cases of selected notifiable...

Further investigations on the epidemiology of fowl typhoid in Brazil.

Science.gov (United States)

Celis-Estupiñan, Anny Lucia Del Pilar; Batista, Diego Felipe Alves; Cardozo, Marita Vedovelli; Secundo de Souza, Andrei Itajahy; Rodrigues Alves, Lucas Bocchini; Maria de Almeida, Adriana; Barrow, Paul Andrew; Berchieri, Angelo; Caetano de Freitas Neto, Oliveiro

2017-08-01

Salmonella Gallinarum (SG) causes fowl typhoid (FT), a disease responsible for economic losses to the poultry industry worldwide. FT has been considered to be under control in Brazil; nevertheless, since 2012 it has frequently been identified in poultry farming of several Brazilian states. The present study was aimed at assessing (i) the pathogenicity of a SG strain recently isolated from an FT outbreak affecting chickens of both white and brown layers; (ii) the transmission of SG through eggs and hatching; (iii) the effects of antibiotic therapy on SG persistence in poultry tissues and on its vertical transmission and (iv) the genetic profiles of strains isolated over 27 years by Pulsed Field Gel Electrophoresis. Clinical signs, mortality and gross pathologies were very marked amongst brown-egg layers. In contrast, clinical manifestation of FT and mortality were barely present amongst the white-egg layers, although bacteria could be re-isolated from their tissues up to 35 days after infection. No bacteria were re-isolated from the laid eggs, so vertical transmission was not achieved, although newly hatched uninfected chicks became infected spontaneously after hatching. Antibiotic therapy was shown to be effective at reducing mortality, but was not able to clear infection or to favour SG transmission via eggs. Our pulsed field gel electrophoresis results revealed an endemic SG clone that may have been circulating in the Brazilian poultry flocks in the south and southeast regions for more than 20 years. The results suggest that the industrial incubation of SG-contaminated eggs could be one of the factors responsible for the spread of FT in Brazil.

Rapidly changing treatment options adding burden to the management of typhoid fever

Directory of Open Access Journals (Sweden)

Jaspal Kaur

2015-01-01

Full Text Available Typhoid fever continues to be a global public health problem. It is caused by the facultative intracellular organisms Salmonella enteric serotype Typhi and Salmonella paratyphi. Antimicrobial therapy is the mainstay for treatment of typhoid fever. Chloramphenicol, ampicillin, and cotrimoxazole had been in use for decades for treating enteric fever. But the emergence and rapid spread of drug resistance has resulted in rapid shift of treatment options from chloramphenicol to fluoroquinolones to third generation cephalosporins to azithromycin with tigecycline and carbapenems in line, thus adding burden to the health-care sector in developing countries. Rational and judicious antibiotic prescribing practices by health professionals are necessary to prevent further development of drug resistance and help in re-emergence of sensitive strains.

Expression of intra- and extracellular granzymes in patients with typhoid fever

NARCIS (Netherlands)

de Jong, Hanna K.; Garcia-Laorden, Maria Isabel; Hoogendijk, Arie J.; Parry, Christopher M.; Maude, Rapeephan R.; Dondorp, Arjen M.; Faiz, Mohammed Abul; van der Poll, Tom; Wiersinga, Willem Joost

2017-01-01

Background Typhoid fever, caused by the intracellular pathogen Salmonella (S.) enterica serovar Typhi, remains a major cause of morbidity and mortality worldwide. Granzymes are serine proteases promoting cytotoxic lymphocytes mediated eradication of intracellular pathogens via the induction of cell

Prevalence of malaria and typhoid co-infections in University of ...

African Journals Online (AJOL)

Mixed infection of malaria caused by Plasmodium species and typhoid fever caused by Salmonella species is often observed in areas where malaria is endemic, and the infection with Salmonella species has been considered by some medical and non-medical personnels to be associated with the malaria parasite infection ...

Surgical treatment of peritonitis due to typhoid fever in a Hospital in Mozambique

Directory of Open Access Journals (Sweden)

Arnulfo Gallego Mariño

2015-07-01

Full Text Available Background: Typhoid fever is a cause of peritonitis by perforation of the intestinal loops and provokes the death of many people; therefore it constitutes a health problem in Mozambique.Objective: To describe the patients operated on, with the diagnosis of peritonitis resulting from typhoid fever, at the surgery department of the Provincial Hospital in Quelimane, Zambezia Province, Mozambique, from November 1, 2011 to April 30, 2012.Methods: A descriptive study of the patients operated on with the diagnosis of peritonitis resulting from typhoid fever, at the hospital and period herein mentioned, was performed. The study population consisted of 96 patients who were operated on. The variables that were measured were: age, sex, onset of symptoms, total perforations, performed surgical treatment and complications.Results: Male patients of the 25 to 50 age group prevailed; most of them visited the service after 72 hours of the onset of symptoms; in 66 patients only one perforation was found and the surgical procedure mostly used was the suture of the perforation and the washout of the abdominal cavity.Conclusions: Most of the patients visited the service 72 hours after the onset of symptoms; they underwent surgery; and wound infection was the most frequent complication.

STUDY ON FEASIBILITY AND LOGISTICS OF VACCINATION WITH TYPHOID VI-VACCINE ON SCHOOL CHILDREN IN NORTH JAKARTA INDONESIA: ANALYSIS OF THE VACCINATION COST

Directory of Open Access Journals (Sweden)

Roy G.A. Massie

2012-11-01

Full Text Available Background: In recent years, Indonesia government has become increasingly concerned with the issues of financing childhood vaccines and immunization programs including vaccine for typhoid  fever. The objective of the analysis is to provide alternative resources and to provide understandable data generated from the Study on Feasibility and Logistics of Vaccination School Age Children With Typhoid Vi-Vaccine in North Jakarta Indonesia. Methods: The analysis was focus on measurement of the cost for vaccinating school children with Typhoid Vi-vaccine from 18 selected primary schools in North Jakarta. The primary source of data was generated from the actual expenditures that were used in the vaccine delivery program in Indonesia. Results: The Vaccination Cost from the Study on Feasibility and Logistics of Vaccination School Age Children with Typhoid Vi-Vaccine conducted by DOMI project is not applicable for public vaccination program. The program might be feasible to be delivered only in private health sector settings.   Key words: Immunization expenditure, vaccine for typhoid fever, North Jakarta Indonesia

Low and declining attack rates of imported typhoid fever in the Netherlands 1997-2014, in spite of a restricted vaccination policy

NARCIS (Netherlands)

Suryapranata, F. S. T.; Prins, M. [= Maria; Sonder, G. J. B.

2016-01-01

Typhoid fever mainly occurs in (sub) tropical regions where sanitary conditions remain poor. In other regions it occurs mainly among returning travelers or their direct contacts. The aim of this study was to evaluate the current Dutch guidelines for typhoid vaccination. Crude annual attack rates

Typhoid fever: hurdles to adequate hand washing for disease prevention among the population of a peri-urban informal settlement in Fiji.

Science.gov (United States)

Greenwell, James; McCool, Judith; Kool, Jacob; Salusalu, Mosese

2013-01-01

The Pacific island nation of Fiji Islands has high rates of endemic typhoid fever which is difficult to diagnose and often underreported. However, the majority of cases are preventable through use of safe water; adequate sanitation; vaccination; and, most sustainable of all, simple hygienic behaviour, such as hand washing with soap (HWWS). Despite many attempts by public health authorities, little progress has been made in the area of environmental adaptation and behaviour change. To explore perceptions of typhoid fever risk among urban squatters and behavioural determinants surrounding HWWS, indigenous Fijians living in informal settlements with high typhoid fever incidence were invited to participate in focus group discussions. In-depth interviews were conducted with community leaders. Perceptions of typhoid fever suggest confusion about risk factors, symptoms and communicability. Environmental barriers for hand washing were related to water and soap access. Standard social marketing approaches have been trialled with little clear evidence of impact. Despite this, we continue to advocate for the social and cultural determinants of typhoid prevention to remain central to future public health strategies. Despite behaviour change being notoriously difficult, we argue that community-driven behaviour adaptation initiatives based on sound epidemiological evidence and health communication theory are likely to have significant impact and greater likelihood of sustainability.

[Spatial and temporal clustering characteristics of typhoid and paratyphoid fever and its change pattern in 3 provinces in southwestern China, 2001-2012].

Science.gov (United States)

Wang, L X; Yang, B; Yan, M Y; Tang, Y Q; Liu, Z C; Wang, R Q; Li, S; Ma, L; Kan, B

2017-11-10

Objective: To analyze the spatial and temporal clustering characteristics of typhoid and paratyphoid fever and its change pattern in Yunnan, Guizhou and Guangxi provinces in southwestern China in recent years. Methods: The incidence data of typhoid and paratyphoid fever cases at county level in 3 provinces during 2001-2012 were collected from China Information System for Diseases Control and Prevention and analyzed by the methods of descriptive epidemiology and geographic informatics. And the map showing the spatial and temporal clustering characters of typhoid and paratyphoid fever cases in three provinces was drawn. SaTScan statistics was used to identify the typhoid and paratyphoid fever clustering areas of three provinces in each year from 2001 to 2012. Results: During the study period, the reported cases of typhoid and paratyphoid fever declined with year. The reported incidence decreased from 30.15 per 100 000 in 2001 to 10.83 per 100 000 in 2006(annual incidence 21.12 per 100 000); while during 2007-2012, the incidence became stable, ranging from 4.75 per 100 000 to 6.83 per 100 000 (annual incidence 5.73 per 100 000). The seasonal variation of the incidence was consistent in three provinces, with majority of cases occurred in summer and autumn. The spatial and temporal clustering of typhoid and paratyphoid fever was demonstrated by the incidence map. Most high-incidence counties were located in a zonal area extending from Yuxi of Yunnan to Guiyang of Guizhou, but were concentrated in Guilin in Guangxi. Temporal and spatial scan statistics identified the positional shifting of class Ⅰ clustering area from Guizhou to Yunnan. Class Ⅰ clustering area was located around the central and western areas (Zunyi and Anshun) of Guizhou during 2001-2003, and moved to the central area of Yunnan during 2004-2012. Conclusion: Spatial and temporal clustering of typhoid and paratyphoid fever existed in the endemic areas of southwestern China, and the clustering area

Evaluation of serological diagnostic tests for typhoid fever in Papua New Guinea using a composite reference standard.

Science.gov (United States)

Siba, Valentine; Horwood, Paul F; Vanuga, Kilagi; Wapling, Johanna; Sehuko, Rebecca; Siba, Peter M; Greenhill, Andrew R

2012-11-01

Typhoid fever remains a major global health problem. A major impediment to improving outcomes is the lack of appropriate diagnostic tools, which have not significantly improved in low-income settings for 100 years. We evaluated two commercially available rapid diagnostic tests (Tubex and TyphiDot), a prototype (TyphiRapid TR-02), and the commonly used single-serum Widal test in a previously reported high-burden area of Papua New Guinea. Samples were collected from 530 outpatients with axillary temperatures of ≥37.5°C, and analysis was conducted on all malaria-negative samples (n = 500). A composite reference standard of blood culture and PCR was used, by which 47 participants (9.4%) were considered typhoid fever positive. The sensitivity and specificity of the Tubex (51.1% and 88.3%, respectively) and TyphiDot (70.0% and 80.1%, respectively) tests were not high enough to warrant their ongoing use in this setting; however, the sensitivity and specificity for the TR-02 prototype were promising (89.4% and 85.0%, respectively). An axillary temperature of ≥38.5°C correlated with typhoid fever (P = 0.014). With an appropriate diagnostic test, conducting typhoid fever diagnosis only on patients with high-grade fever could dramatically decrease the costs associated with diagnosis while having no detrimental impact on the ability to accurately diagnose the illness.

The impact of migration and antimicrobial resistance on the transmission dynamics of typhoid fever in Kathmandu, Nepal: A mathematical modelling study.

Science.gov (United States)

Saad, Neil J; Bowles, Cayley C; Grenfell, Bryan T; Basnyat, Buddha; Arjyal, Amit; Dongol, Sabina; Karkey, Abhilasha; Baker, Stephen; Pitzer, Virginia E

2017-05-01

A substantial proportion of the global burden of typhoid fever occurs in South Asia. Kathmandu, Nepal experienced a substantial increase in the number of typhoid fever cases (caused by Salmonella Typhi) between 2000 and 2003, which subsequently declined but to a higher endemic level than in 2000. This epidemic of S. Typhi coincided with an increase in organisms with reduced susceptibility against fluoroquinolones, the emergence of S. Typhi H58, and an increase in the migratory population in Kathmandu. We devised a mathematical model to investigate the potential epidemic drivers of typhoid in Kathmandu and fit this model to weekly data of S. Typhi cases between April 1997 and June 2011 and the age distribution of S. Typhi cases. We used this model to determine if the typhoid epidemic in Kathmandu was driven by heightened migration, the emergence of organisms with reduced susceptibility against fluoroquinolones or a combination of these factors. Models allowing for the migration of susceptible individuals into Kathmandu alone or in combination with the emergence of S. Typhi with reduced susceptibility against fluoroquinolones provided a good fit for the data. The emergence of organisms with reduced susceptibility against fluoroquinolones organisms alone, either through an increase in disease duration or increased transmission, did not fully explain the pattern of S. Typhi infections. Our analysis is consistent with the hypothesis that the increase in typhoid fever in Kathmandu was associated with the migration of susceptible individuals into the city and aided by the emergence of reduced susceptibility against fluoroquinolones. These data support identifying and targeting migrant populations with typhoid immunization programmes to prevent transmission and disease.

Typhoid fever: hurdles to adequate hand washing for disease prevention among the population of a peri-urban informal settlement in Fiji

Directory of Open Access Journals (Sweden)

Mosese Salusalu

2013-01-01

Full Text Available Problem/context: The Pacific island nation of Fiji Islands has high rates of endemic typhoid fever which is difficult to diagnose and often underreported. However, the majority of cases are preventable through use of safe water; adequate sanitation; vaccination; and, most sustainable of all, simple hygienic behaviour, such as hand washing with soap (HWWS. Despite many attempts by public health authorities, little progress has been made in the area of environmental adaptation and behaviour change. Action: To explore perceptions of typhoid fever risk among urban squatters and behavioural determinants surrounding HWWS, indigenous Fijians living in informal settlements with high typhoid fever incidence were invited to participate in focus group discussions. In-depth interviews were conducted with community leaders. Outcome: Perceptions of typhoid fever suggest confusion about risk factors, symptoms and communicability. Environmental barriers for hand washing were related to water and soap access. Standard social marketing approaches have been trialled with little clear evidence of impact. Despite this, we continue to advocate for the social and cultural determinants of typhoid prevention to remain central to future public health strategies. Discussion: Despite behaviour change being notoriously difficult, we argue that community-driven behaviour adaptation initiatives based on sound epidemiological evidence and health communication theory are likely to have significant impact and greater likelihood of sustainability.

Studies to Control Endemic Typhoid Fever in Chile

Science.gov (United States)

1983-01-30

Bol. Inst. Bacteriol. Chile 1976; 18:33-37. 30. Escaff, M, Urbina, A, Mary, J. Contaminacion de repollos regados con aguas servidas. Agricultura...Tecnica 1979; 39:59-62. - 31. Lobos, H, Greive, R, Quijada, M, Brandt, H. Pesquisa del genero Vibrio en aguas servidas. Bol. Inst. Bact. Chile 1974; 16:40...REPORT #2 0") STUDIES TO CONTROL ENDEMIC TYPHOID N FEVER IN CHILE 0) ANNUAL REPORT U’ Contract Period 1/1/82-12/31/82 • I REPORT PREPARED BY: L

Blood culture-PCR to optimise typhoid fever diagnosis after controlled human infection identifies frequent asymptomatic cases and evidence of primary bacteraemia.

Science.gov (United States)

Darton, Thomas C; Zhou, Liqing; Blohmke, Christoph J; Jones, Claire; Waddington, Claire S; Baker, Stephen; Pollard, Andrew J

2017-04-01

Improved diagnostics for typhoid are needed; a typhoid controlled human infection model may accelerate their development and translation. Here, we evaluated a blood culture-PCR assay for detecting infection after controlled human infection with S. Typhi and compared test performance with optimally performed blood cultures. Culture-PCR amplification of blood samples was performed alongside daily blood culture in 41 participants undergoing typhoid challenge. Study endpoints for typhoid diagnosis (TD) were fever and/or bacteraemia. Overall, 24/41 (59%) participants reached TD, of whom 21/24 (86%) had ≥1 positive blood culture (53/674, 7.9% of all cultures) or 18/24 (75%) had ≥1 positive culture-PCR assay result (57/684, 8.3%). A further five non-bacteraemic participants produced culture-PCR amplicons indicating infection; overall sensitivity/specificity of the assay compared to the study endpoints were 70%/65%. We found no significant difference between blood culture and culture-PCR methods in ability to identify cases (12 mismatching pairs, p = 0.77, binomial test). Clinical and stool culture metadata demonstrated that additional culture-PCR amplification positive individuals likely represented true cases missed by blood culture, suggesting the overall attack rate may be 30/41 (73%) rather than 24/41 (59%). Several participants had positive culture-PCR results soon after ingesting challenge providing new evidence for occurrence of an early primary bacteraemia. Overall the culture-PCR assay performed well, identifying extra typhoid cases compared with routine blood culture alone. Despite limitations to widespread field-use, the benefits of increased diagnostic yield, reduced blood volume and faster turn-around-time, suggest that this assay could enhance laboratory typhoid diagnostics in research applications and high-incidence settings. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Low and declining attack rates of imported typhoid fever in the Netherlands 1997-2014, in spite of a restricted vaccination policy.

Science.gov (United States)

Suryapranata, F S T; Prins, M; Sonder, G J B

2016-12-01

Typhoid fever mainly occurs in (sub) tropical regions where sanitary conditions remain poor. In other regions it occurs mainly among returning travelers or their direct contacts. The aim of this study was to evaluate the current Dutch guidelines for typhoid vaccination. Crude annual attack rates (AR) per 100,000 Dutch travelers were calculated during the period 1997 to 2014 by dividing the number of typhoid fever cases by the estimated total number of travelers to a specific country or region. Regions of exposure and possible risk factors were evaluated. During the study period 607 cases of typhoid fever were reported. Most cases were imported from Asia (60%). Almost half of the cases were ethnically related to typhoid risk regions and 37% were cases visiting friends and relatives. The overall ARs for travelers to all regions declined significantly. Countries with the highest ARs were India (29 per 100,000), Indonesia (8 per 100,000), and Morocco (10 per 100,000). There was a significant decline in ARs among travelers to popular travel destinations such as Morocco, Turkey, and Indonesia. ARs among travelers to intermediate-risk areas according to the Dutch guidelines such as Latin America or Sub-Saharan Africa remained very low, despite the restricted vaccination policy for these areas compared to many other guidelines. The overall AR of typhoid fever among travelers returning to the Netherlands is very low and has declined in the past 20 years. The Dutch vaccination policy not to vaccinate short-term travelers to Latin-America, Sub-Saharan Africa, Thailand and Malaysia seems to be justified, because the ARs for these destinations remain very low. These results suggest that further restriction of the Dutch vaccination policy is justified.

Non-typhoidal Salmonella and Campylobacter infections among HIV-positive patients in Denmark

DEFF Research Database (Denmark)

Larsen, I.K.; Gradel, Kim Oren; Helms, M.

2011-01-01

Non-typhoidal Salmonella (NTS) and Campylobacter are common causes of diarrhoea in human immunodeficiency virus (HIV)-positive patients. To investigate if incidence has changed since the introduction of highly active antiretroviral therapy (HAART), we combined data from The Danish Surveillance Re...... population. Moreover our study suggests that there is an increased incidence of Campylobacter-related illness among homosexual men in the HIV-positive population.......Non-typhoidal Salmonella (NTS) and Campylobacter are common causes of diarrhoea in human immunodeficiency virus (HIV)-positive patients. To investigate if incidence has changed since the introduction of highly active antiretroviral therapy (HAART), we combined data from The Danish Surveillance...... Registry for Enteric Pathogens and The Danish National Hospital Registry. We found that the incidences of NTS- and Campylobacter-related illness among HIV-positive patients in Denmark have declined since the introduction of HAART, although the incidences remained higher compared to the background...

A comparative study of Widal test with blood culture in the diagnosis of typhoid fever in febrile patients.

Science.gov (United States)

Andualem, Gizachew; Abebe, Tamrat; Kebede, Nigatu; Gebre-Selassie, Solomon; Mihret, Adane; Alemayehu, Haile

2014-09-17

Typhoid fever is a major health problem in developing countries and its diagnosis on clinical ground is difficult. Diagnosis in developing countries including Ethiopia is mostly done by Widal test. However, the value of the test has been debated. Hence, evaluating the result of this test is necessary for correct interpretation of the result. The main aim of this study was to compare the result of Widal test and blood culture in the diagnosis of typhoid fever in febrile patients. Blood samples were collected from 270 febrile patients with symptoms clinically similar to typhoid fever and visiting St. Paul's General Specialized Hospitals from mid December 2010 to March 2011. Blood culture was used to isolate S.typhi and S.paratyphi. Slide agglutination test and tube agglutination tests were used for the determination of antibody titer. An antibody titer of ≥1:80 for anti TO and ≥1:160 for anti TH were taken as a cut of value to indicate recent infection of typhoid fever. One hundred and eighty six (68.9%) participants were females and eighty four (31.1%) were males. 7 (2.6%) cases of S. typhi and 4 (1.5%) cases of S. paratyphi were identified with the total prevalence of typhoid fever 4.1%. The total number of patients who have indicative of recent infection by either of O and H antigens Widal test is 88 (32.6%). The sensitivity, specificity, Positive predictive Value and Negative predictive Value of Widal test were 71.4%, 68.44%, 5.7% and 98.9% respectively. Widal test has a low sensitivity, specificity and PPV, but it has good NPV which indicates that negative Widal test result have a good indication for the absence of the disease.

Validation of the Dri-Dot Latex agglutination and IgM lateral flow assays for the diagnosis of typhoid fever in an Egyptian population

NARCIS (Netherlands)

Nakhla, Isabelle; El Mohammady, Hanan; Mansour, Adel; Klena, John D.; Hassan, Khaled; Sultan, Yehia; Pastoor, Rob; Abdoel, Theresia H.; Smits, Henk

2011-01-01

Laboratory confirmation of typhoid fever is essential for appropriate medical treatment. Blood culture is a standard test for diagnosis of typhoid fever, but well-equipped diagnostic facilities to perform culture are seldom available in endemic areas. We retrospectively compared 2 diagnostic field

Advancing the management and control of typhoid fever: a review of the historical role of human challenge studies.

Science.gov (United States)

Waddington, Claire S; Darton, Thomas C; Woodward, William E; Angus, Brian; Levine, Myron M; Pollard, Andrew J

2014-05-01

Typhoid infection causes considerable morbidity and mortality worldwide, particularly in settings where lack of clean water and inadequate sanitation facilitate disease spread through faecal-oral transmission. Improved understanding of the pathogenesis, immune control and microbiology of Salmonella Typhi infection can help accelerate the development of improved vaccines and diagnostic tests necessary for disease control. S. Typhi is a human-restricted pathogen; therefore animal models are limited in their relevance to human infection. During the latter half of the 20th century, induced human infection ("challenge") studies with S. Typhi were used effectively to assess quantitatively the human host response to challenge and to measure directly the efficacy of typhoid vaccines in preventing clinical illness. Here, the findings of these historic challenge studies are reviewed, highlighting the pivotal role that challenge studies have had in improving our understanding of the host-pathogen interaction, and illustrating issues relevant to modern typhoid challenge model design. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Comparisons of predictors for typhoid and paratyphoid fever in Kolkata, India

Directory of Open Access Journals (Sweden)

Deen Jacqueline L

2007-10-01

Full Text Available Abstract Background: Exposure of the individual to contaminated food or water correlates closely with the risk for enteric fever. Since public health interventions such as water improvement or vaccination campaigns are implemented for groups of individuals we were interested whether risk factors not only for the individual but for households, neighbourhoods and larger areas can be recognised? Methods: We conducted a large enteric fever surveillance study and analyzed factors which correlate with enteric fever on an individual level and factors associated with high and low risk areas with enteric fever incidence. Individual level data were linked to a population based geographic information systems. Individual and household level variables were fitted in Generalized Estimating Equations (GEE with the logit link function to take into account the likelihood that household factors correlated within household members. Results: Over a 12-month period 80 typhoid fever cases and 47 paratyphoid fever cases were detected among 56,946 residents in two bustees (slums of Kolkata, India. The incidence of paratyphoid fever was lower (0.8/1000/year, and the mean age of paratyphoid patients was older (17.1 years than for typhoid fever (incidence 1.4/1000/year, mean age 14.7 years. Residents in areas with a high risk for typhoid fever had lower literacy rates and economic status, bigger household size, and resided closer to waterbodies and study treatment centers than residents in low risk areas. Conclusion: There was a close correlation between the characteristics detected based on individual cases and characteristics associated with high incidence areas. Because the comparison of risk factors of populations living in high versus low risk areas is statistically very powerful this methodology holds promise to detect risk factors associated with diseases using geographic information systems.

Epidemiological Characteristics and Clinical Treatment Outcome of Typhoid Fever in Ningbo, China, 2005-2014: Pulsed-Field Gel Electorophoresis Results Revealing Great Proportion of Common Transmission Sources.

Science.gov (United States)

Song, Qifa; Yang, Yuanbin; Lin, Wenping; Yi, Bo; Xu, Guozhang

2017-09-25

We aimed to describe the molecular epidemiological characteristics and clinical treatment outcome of typhoid fever in Ningbo, China during 2005-2014. Eighty-eight Salmonella Typhi isolates were obtained from 307 hospitalized patients. Three prevalent pulsed-field gel electrophoresis (PFGE) patterns of 54 isolates from 3 outbreaks were identified. Overall, there were 64 (72.7%) isolates from clustered cases and 24 (27.3%) isolates from sporadic cases. Resistance to nalidixic acid (NAL) (n = 47; 53.4%) and ampicillin (AMP) (n = 40; 45.4%) and rare resistance to tetracycline (TET) (n = 2; 2.3%) and gentamicin (GEN) (n = 2; 2.3%) were observed. No isolates resistant to cefotaxime (CTX), chloramphenicol (CL), ciprofloxacin (CIP), and trimethoprim-sulfamethoxazole (SXT) were found. The occurrence of reduced sensitivity to CIP was 52.3% (n = 46). The medians of fever clearance time in cases with and without complications were 7 (interquartile range (IQR): 4-10) and 5 (IQR: 3-7) days (P = 0.001), respectively, when patients were treated with CIP or levofloxacin (LEV) and/or third-generation cephalosporins (CEP). Rates of serious complications were at low levels: peritonitis (2.3%), intestinal hemorrhage (6.8%), and intestinal perforation (1.1%). The present study revealed a long-term clustering trend with respect to PFGE patterns, occasional outbreaks, and the rapid spread of AMP resistance and decreased CIP susceptibility among S. Typhi isolates in recent years.

Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010

Directory of Open Access Journals (Sweden)

Geoffrey C. Buckle

2012-06-01

Full Text Available Typhoid and paratyphoid fever remain important causes of morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions and prevention and control strategies.

Typhoid fever complicated by intestinal perforation: a persisting fatal disease requiring surgical management

NARCIS (Netherlands)

Butler, T.; Knight, J.; Nath, S. K.; Speelman, P.; Roy, S. K.; Azad, M. A.

1985-01-01

In Bangladesh, clinical records of 323 patients with typhoid fever were reviewed to study the incidence, fatality, and optimal therapy of the complication of intestinal perforation. Fifteen patients (4.6%) developed intestinal perforation. Case-fatality rates were six of nine patients treated

Oral Challenge with Wild-Type Salmonella Typhi Induces Distinct Changes in B Cell Subsets in Individuals Who Develop Typhoid Disease.

OpenAIRE

Franklin R Toapanta; Paula J Bernal; Stephanie Fresnay; Laurence S Magder; Thomas C Darton; Claire Jones; Claire S Waddington; Christoph J Blohmke; Brian Angus; Myron M Levine; Andrew J Pollard; Marcelo B Sztein

2016-01-01

A novel human oral challenge model with wild-type Salmonella Typhi (S. Typhi) was recently established by the Oxford Vaccine Group. In this model, 104 CFU of Salmonella resulted in 65% of participants developing typhoid fever (referred here as typhoid diagnosis -TD-) 6?9 days post-challenge. TD was diagnosed in participants meeting clinical (oral temperature ?38?C for ?12h) and/or microbiological (S. Typhi bacteremia) endpoints. Changes in B cell subpopulations following S. Typhi challenge re...

Health at the Sub-catchment Scale: Typhoid and Its Environmental Determinants in Central Division, Fiji.

Science.gov (United States)

Jenkins, Aaron Peter; Jupiter, Stacy; Mueller, Ute; Jenney, Adam; Vosaki, Gandercillar; Rosa, Varanisese; Naucukidi, Alanieta; Mulholland, Kim; Strugnell, Richard; Kama, Mike; Horwitz, Pierre

2016-12-01

The impact of environmental change on transmission patterns of waterborne enteric diseases is a major public health concern. This study concerns the burden and spatial nature of enteric fever, attributable to Salmonella Typhi infection in the Central Division, Republic of Fiji at a sub-catchment scale over 30-months (2013-2015). Quantitative spatial analysis suggested relationships between environmental conditions of sub-catchments and incidence and recurrence of typhoid fever. Average incidence per inhabited sub-catchment for the Central Division was high at 205.9/100,000, with cases recurring in each calendar year in 26% of sub-catchments. Although the numbers of cases were highest within dense, urban coastal sub-catchments, the incidence was highest in low-density mountainous rural areas. Significant environmental determinants at this scale suggest increased risk of exposure where sediment yields increase following runoff. The study suggests that populations living on large systems that broaden into meandering mid-reaches and floodplains with alluvial deposition are at a greater risk compared to small populations living near small, erosional, high-energy headwaters and small streams unconnected to large hydrological networks. This study suggests that anthropogenic alteration of land cover and hydrology (particularly via fragmentation of riparian forest and connectivity between road and river networks) facilitates increased transmission of typhoid fever and that environmental transmission of typhoid fever is important in Fiji.

Rise and fall of outbreak-specific clone inside endemic pulsotype of Salmonella 4,[5],12:i:-; insights from high-resolution molecular surveillance in Emilia-Romagna, Italy, 2012 to 2015.

Science.gov (United States)

Morganti, Marina; Bolzoni, Luca; Scaltriti, Erika; Casadei, Gabriele; Carra, Elena; Rossi, Laura; Gherardi, Paola; Faccini, Fabio; Arrigoni, Norma; Sacchi, Anna Rita; Delledonne, Marco; Pongolini, Stefano

2018-03-01

Background and aimEpidemiology of human non-typhoid salmonellosis is characterised by recurrent emergence of new clones of the pathogen over time. Some clonal lines of Salmonella have shaped epidemiology of the disease at global level, as happened for serotype Enteritidis or, more recently, for Salmonella 4,[5],12:i:-, a monophasic variant of serotype Typhimurium. The same clonal behaviour is recognisable at sub-serotype level where single outbreaks or more generalised epidemics are attributable to defined clones. The aim of this study was to understand the dynamics of a clone of Salmonella 4,[5],12:i:- over a 3-year period (2012-15) in a province of Northern Italy where the clone caused a large outbreak in 2013. Furthermore, the role of candidate outbreak sources was investigated and the accuracy of multilocus variable-number tandem repeat analysis (MLVA) was evaluated. Methods: we retrospectively investigated the outbreak through whole genome sequencing (WGS) and further monitored the outbreak clone for 2 years after its conclusion. Results: The study showed the transient nature of the clone in the population, possibly as a consequence of its occasional expansion in a food-processing facility. We demonstrated that important weaknesses characterise conventional typing methods applied to clonal pathogens such as Salmonella 4,[5],12:i:-, namely lack of accuracy for MLVA and inadequate resolution power for PFGE to be reliably used for clone tracking. Conclusions : The study provided evidence for the remarkable prevention potential of whole genome sequencing used as a routine tool in systems that integrate human, food and animal surveillance.

Management of Typhoid Fever and Bacterial Meningitis by Chloramphenicol in Infants and Children

Directory of Open Access Journals (Sweden)

Gian Maria Pacifici

2018-01-01

Full Text Available Chloramphenicol inhibits protein synthesis in bacteria and is usually bacteriostatic but is bactericidal against Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitis. Chloramphenicol penetrates all body tissues well. The cerebrospinal fluid concentration averages 60% of the serum level, while brain levels are 9 times higher because of high lipid solubility of this drug. Chloramphenicol acts primarily by binding reversibly to the 50S ribosomal subunit. This antibiotic is the drug of choice for the treatment of typhoid and paratyphoid fevers and bacterial meningitis. Chloramphenicol possesses a broad-spectrum of antimicrobial activity. Strains are considered sensitive if they are inhibited by chloramphenicol concentrations of ≤ 8 µg/ml. Neisseria gonorrhea, Brucella species, Bordetella pertussis, gram-positive cocci, Clostridium species, and gram-negative rods including Bacillus fragilis are inhibited by chloramphenicol. Most anaerobic bacteria including Mycoplasma, Chlamydia, Rickettsiae, Vibrio cholera, Escherichia coli and Klebsiella pneumoniae are inhibited by this antibiotic. The doses of chloramphenicol are 40.5 mg/kg/day for neonates and 75.5 mg/kg/day for older children. The therapeutic concentrations of chloramphenicol are 10-25 µg/ml. Peak therapeutic concentrations are obtained in 60% and therapeutic trough concentrations are found in 42% of children. Children affected by typhoid fever are cu red by chloramphenicol and the sensitivity to this antibiotic is 100%. Acute bacterial meningitis is the most dangerous infections disease in children. The causative organisms are gram-positive and gram-negative bacteria, and chloramphenicol is effective in killing these microorganisms. The aim of this study is to review the management of typhoid fever and bacterial meningitis in infants and children by chloramphenicol.

Prevalence of malaria, typhoid, toxoplasmosis and rubella among febrile children in Cameroon.

Science.gov (United States)

Achonduh-Atijegbe, Olivia A; Mfuh, Kenji O; Mbange, Aristid H E; Chedjou, Jean P; Taylor, Diane W; Nerurkar, Vivek R; Mbacham, Wilfred F; Leke, Rose

2016-11-08

The current roll-out of rapid diagnostic tests (RDTs) in many endemic countries has resulted in the reporting of fewer cases of malaria-attributed illnesses. However, lack of knowledge of the prevalence of other febrile illnesses and affordable diagnostic tests means that febrile patients are not managed optimally. This study assessed the prevalence of commonly treatable or preventable febrile illnesses in children between 6 months and 15 years using rapid diagnostic tests at the point-of-care. Febrile children were enrolled between February-April 2014 at a health facility after obtaining informed consent from parent. Eligible participants were aged 6 months-15 years with a history of fever in the last 24 h or axillary temperature ≥38 °C at consultation. All participants were tested using RDTs for malaria, typhoid, toxoplasmosis and rubella. Malaria parasites were further identified by microscopy and PCR. Clinical and household characteristics were recorded and association with pathogens determined. Of the 315 children enrolled, the mean age was 5.8 ± 3.8 years. Stomach pain (41.2 %) was the most reported symptom. Prior to attending the health facility, 70.8 % had taken antipyretics, 27.9 % antimalarials, 11.4 % antibiotics and 13.3 % antifungal drugs. Among 315 children with fever, based on RDTs, 56.8 % were infected with malaria, 4.4 % with typhoid, 3.2 % with acute toxoplasmosis, and 1.3 % with rubella (all positive for rubella were in the same family and not vaccinated). All non-malarial infections were co-infections and approximately 30 % of the fever cases went un-diagnosed. Malaria prevalence by microscopy and PCR was 43.4 and 70.2 % respectively. The sensitivity and specificity of RDTs for the diagnosis of malaria were 75.98 and 100 % respectively, with 0.73 measurement agreement between RDTs and microscopy while that of RDT and PCR were 81 and 100 % respectively with a K value of 0.72. The use of Insecticide Treated Bednets was

Oral Wild-Type Salmonella Typhi Challenge Induces Activation of Circulating Monocytes and Dendritic Cells in Individuals Who Develop Typhoid Disease

OpenAIRE

Toapanta, Franklin R.; Bernal, Paula J.; Fresnay, Stephanie; Darton, Thomas C.; Jones, Claire; Waddington, Claire S.; Blohmke, Christoph J.; Dougan, Gordon; Angus, Brian; Levine, Myron M.; Pollard, Andrew J.; Sztein, Marcelo B.

2015-01-01

A new human oral challenge model with wild-type Salmonella Typhi (S. Typhi) was recently developed. In this model, ingestion of 104 CFU of Salmonella resulted in 65% of subjects developing typhoid fever (referred here as typhoid diagnosis -TD-) 5-10 days post-challenge. TD criteria included meeting clinical (oral temperature ≥38°C for ≥12 h) and/or microbiological (S. Typhi bacteremia) endpoints. One of the first lines of defense against pathogens are the cells of the innate immune system (e....

Evaluation of dipstick serologic tests for diagnosis of brucellosis and typhoid Fever in egypt

NARCIS (Netherlands)

Ismail, Tharwat F.; Smits, Henk; Wasfy, Momtaz O.; Malone, Joseph L.; Fadeel, Moustafa A.; Mahoney, Frank

2002-01-01

Two dipstick assays for the detection of Brucella- and typhoid-specific immunoglobulin M, recently developed by the Royal Tropical Institute of The Netherlands, were evaluated by use of 85 plasma samples from Egyptian patients. Both dipsticks were simple and accurate rapid diagnostic assays, and

Fitting outbreak models to data from many small norovirus outbreaks

Directory of Open Access Journals (Sweden)

Eamon B. O’Dea

2014-03-01

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

Study on Feasibility and Logistics of Vaccination with Typhoid Vi-vaccine on School Children in North Jakarta Indonesia: Analysis of the Vaccination Cost

OpenAIRE

Massie, Roy G.A

2011-01-01

Background: In recent years, Indonesia government has become increasingly concerned with the issues of financing childhood vaccines and immunization programs including vaccine for typhoid fever. The objective of the analysis is to provide alternative resources and to provide understandable data generated from the Study on Feasibility and Logistics of Vaccination School Age Children With Typhoid Vi-Vaccine in North Jakarta Indonesia. Methods: The analysis was focus on measurement of the cost ...

Pendekatan Cart untuk Mendapatkan Faktor yang Mempengaruhi Terjangkitnya Penyakit Demam Tifoid di Aceh Utara

Directory of Open Access Journals (Sweden)

Dina Yuanita

2010-05-01

research conducted to find factors that influence the outbreak of typhoid fever in NAD. research using the CART Method. The results of the analysis indicate that the main factor causing typhoid fever was drinking water reservoirs. The other factors are waste water reservoirs, the physical quality of drinking water, a habit washing hands with soap before eating, the bowel, the dump, gender, socioeconomic status, habits of washing hands with soap after defecation and health education.

Encephalitis in a traveller with typhoid fever: efficacy of corticosteroids.

Science.gov (United States)

Mellon, Guillaume; Eme, Anne-Line; Rohaut, Benjamin; Brossier, Florence; Epelboin, Loïc; Caumes, Eric

2017-09-01

Typhoid fever is a bacterial infection caused by Salmonella typhi or S. paratyphi, recognized as a classical cause of fever in returning travellers. However, neuropsychiatric presentations are rarely reported in travellers diagnosed in western countries, whereas they are more commonly described in patients treated in endemic areas. We describe such a case and discuss the pathophysiologic mechanisms of this complication. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Salmonella Typhi-specific multifunctional CD8+ T cells play a dominant role in protection from typhoid fever in humans.

Science.gov (United States)

Fresnay, Stephanie; McArthur, Monica A; Magder, Laurence; Darton, Thomas C; Jones, Claire; Waddington, Claire S; Blohmke, Christoph J; Angus, Brian; Levine, Myron M; Pollard, Andrew J; Sztein, Marcelo B

2016-03-01

Typhoid fever, caused by the human-restricted organism Salmonella Typhi (S. Typhi), is a major public health problem worldwide. Development of novel vaccines remains imperative, but is hampered by an incomplete understanding of the immune responses that correlate with protection. Recently, a controlled human infection model was re-established in which volunteers received ~10(3) cfu wild-type S. Typhi (Quailes strain) orally. Twenty-one volunteers were evaluated for their cell-mediated immune (CMI) responses. Ex vivo PBMC isolated before and up to 1 year after challenge were exposed to three S. Typhi-infected targets, i.e., autologous B lymphoblastoid cell-lines (B-LCL), autologous blasts and HLA-E restricted AEH B-LCL cells. CMI responses were evaluated using 14-color multiparametric flow cytometry to detect simultaneously five intracellular cytokines/chemokines (i.e., IL-17A, IL-2, IFN-g, TNF-a and MIP-1b) and a marker of degranulation/cytotoxic activity (CD107a). Herein we provide the first evidence that S. Typhi-specific CD8+ responses correlate with clinical outcome in humans challenged with wild-type S. Typhi. Higher multifunctional S. Typhi-specific CD8+ baseline responses were associated with protection against typhoid and delayed disease onset. Moreover, following challenge, development of typhoid fever was accompanied by decreases in circulating S. Typhi-specific CD8+ T effector/memory (TEM) with gut homing potential, suggesting migration to the site(s) of infection. In contrast, protection against disease was associated with low or no changes in circulating S. Typhi-specific TEM. These studies provide novel insights into the protective immune responses against typhoid disease that will aid in selection and development of new vaccine candidates.

High-pressure metamorphic age and significance of eclogite-facies continental fragments associated with oceanic lithosphere in the Western Alps (Etirol-Levaz Slice, Valtournenche, Italy)

Science.gov (United States)

Fassmer, Kathrin; Obermüller, Gerrit; Nagel, Thorsten J.; Kirst, Frederik; Froitzheim, Nikolaus; Sandmann, Sascha; Miladinova, Irena; Fonseca, Raúl O. C.; Münker, Carsten

2016-05-01

The Etirol-Levaz Slice in the Penninic Alps (Valtournenche, Italy) is a piece of eclogite-facies continental basement sandwiched between two oceanic units, the blueschist-facies Combin Zone in the hanging wall and the eclogite-facies Zermatt-Saas Zone in the footwall. It has been interpreted as an extensional allochthon from the continental margin of Adria, emplaced onto ultramafic and mafic basement of the future Zermatt-Saas Zone by Jurassic, rifting-related detachment faulting, and later subducted together with the future Zermatt-Saas Zone. Alternatively, the Etirol-Levaz Slice could be derived from a different paleogeographic domain and be separated from the Zermatt-Saas Zone by an Alpine shear zone. We present Lu-Hf whole rock-garnet ages of two eclogite samples, one from the center of the unit and one from the border to the Zermatt-Saas Zone below. These data are accompanied by a new geological map of the Etirol-Levaz Slice and the surrounding area, as well as detailed petrology of these two samples. Assemblages, mineral compositions and garnet zoning in both samples indicate a clockwise PT-path and peak-metamorphic conditions of about 550-600 °C/20-25 kbar, similar to conditions proposed for the underlying Zermatt-Saas Zone. Prograde garnet ages of the two samples are 61.8 ± 1.8 Ma and 52.4 ± 2.1 Ma and reflect different timing of subduction. One of these is significantly older than published ages of eclogite-facies metamorphism in the Zermatt-Saas Zone and thus contradicts the hypothesis of Mesozoic emplacement. The occurrence of serpentinite and metagabbro bodies possibly derived from the Zermatt-Saas Zone inside the Etirol-Levaz Slice suggests that the latter is a tectonic composite. The basement slivers forming the Etirol-Levaz Slice and other continental fragments were subducted earlier than the Zermatt-Saas Zone, but nonetheless experienced similar pressure-temperature histories. Our results support the hypothesis that the Zermatt-Saas Zone and the

High-throughput bacterial SNP typing identifies distinct clusters of Salmonella Typhi causing typhoid in Nepalese children

LENUS (Irish Health Repository)

Holt, Kathryn E

2010-05-31

Abstract Background Salmonella Typhi (S. Typhi) causes typhoid fever, which remains an important public health issue in many developing countries. Kathmandu, the capital of Nepal, is an area of high incidence and the pediatric population appears to be at high risk of exposure and infection. Methods We recently defined the population structure of S. Typhi, using new sequencing technologies to identify nearly 2,000 single nucleotide polymorphisms (SNPs) that can be used as unequivocal phylogenetic markers. Here we have used the GoldenGate (Illumina) platform to simultaneously type 1,500 of these SNPs in 62 S. Typhi isolates causing severe typhoid in children admitted to Patan Hospital in Kathmandu. Results Eight distinct S. Typhi haplotypes were identified during the 20-month study period, with 68% of isolates belonging to a subclone of the previously defined H58 S. Typhi. This subclone was closely associated with resistance to nalidixic acid, with all isolates from this group demonstrating a resistant phenotype and harbouring the same resistance-associated SNP in GyrA (Phe83). A secondary clone, comprising 19% of isolates, was observed only during the second half of the study. Conclusions Our data demonstrate the utility of SNP typing for monitoring bacterial populations over a defined period in a single endemic setting. We provide evidence for genotype introduction and define a nalidixic acid resistant subclone of S. Typhi, which appears to be the dominant cause of severe pediatric typhoid in Kathmandu during the study period.

Unraveling P-T-t-D Evolution of Zermatt-Saas Ophiolites from Valtournanche: from Ocean Opening to Mountain Building

Science.gov (United States)

Rebay, G.; Tiepolo, M.; Zanoni, D.; Langone, A.; Spalla, M. I.

2015-12-01

The Zermatt-Saas (ZS) Zone, formerly part of Tethyan oceanic crust and variously affected by oceanic metamorphism, is now part of the orogenic suture that developed in the Western European Alps during the Alpine subduction and collision. The ZS rocks preserve a dominant HP to UHP metamorphic imprint overprinted by greenschist facies metamorphism. The age of the oceanic protoliths is considered to be middle to upper Jurassic whereas the HP metamorphism is mostly considered to be Eocene. In upper Valtournanche ZS ophiolites, the dominant regional S2 foliation is mapped with spatial continuity in serpentinite, metarodingite and eclogite and is defined by HP/UHP parageneses in all lithotypes. It developed at 2.5 ± 0.3 GPa and 600 ± 20°C during Alpine subduction. S2 foliation of serpentinites wraps rare clinopyroxene and zircon relics. Trace element composition of clinopyroxene suggests that they crystallised from a melt in equilibrium with plagioclase: they most likely represent relicts of gabbroic assemblages. The clinopyroxene porphyroclasts have rims indented within S2 and compositions similar to fine-grained clinopyroxeneII defining S2, suggesting that they recrystallised during Alpine subduction. Zircon cores show, under CL, sector zoning typical of magmatic growth. U-Pb dates suggest their crystallisation during Middle Jurassic. Magmatic cores have thin fringe overgrowths parallel to the S2 foliation. U-Pb concordant analyses on these domains reveal an Upper Cretaceous-Paleocene crystallization most likely representing the HP to UHP Alpine re-equilibration. This suggests that some sections of the ZS have experienced HP to UHP metamorphism earlier than previously thought, opening new interpretative geodynamic scenarios. Remarkably, these new dates are similar to those recorded for the HP re-equilibration in the continental crust of the adjacent Austroalpine units (upper plate of the Alpine subduction system) and to those recorded for prograde metamorphism in

Disease Outbreak News

Science.gov (United States)

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

Disneyland Measles Outbreak

OpenAIRE

Palladino, Erica

2015-01-01

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

An evaluation of the applicability of gamma radiation for preparing typhoid fever vaccine

International Nuclear Information System (INIS)

Malafiej, E.; Lachmanowa, S.; Horoszewicz-Malafiej, A.; Politechnika Lodzka

1974-01-01

Using mouse protection test, two typhoid fever vaccines were comparatively tested for efficacy: that prepared by thermal inactivation and that treated with ionizing radiation. The experiments were performed with white mice BALB/c. Co 60 was used as the radiation source. Vaccine prepared by the thermal inactivation showed higher protective activity than the vaccine prepared by treatment with ionizing radiation. (author)

Treatment failure in a typhoid patient infected with nalidixic acid resistant S. enterica serovar Typhi with reduced susceptibility to Ciprofloxacin: a case report from Cameroon

Directory of Open Access Journals (Sweden)

Asonganyi Etienne DN

2005-06-01

Full Text Available Abstract Background Fluoroquinolones or third generation cephalosporins are the drugs of choice for the treatment of typhoid fever. Treatment failure with fluoroquinolones has been reported in Asia and Europe. We report a case of ciprofloxacin treatment failure in typhoid fever in Cameroon. Case presentation A 29-year-old female patient with suspected typhoid fever from Kumba, Cameroon, yielded growth of Salmonella enterica serovar Typhi in blood culture. The isolate was resistant to nalidixic acid but sensitive to ciprofloxacin by disc diffusion test. However, the patient did not respond to treatment with ciprofloxacin, although the isolate was apparently susceptible to ciprofloxacin. Conclusion Treatment failure with ciprofloxacin in our case indicates the presence of nalidixic acid resistant S. enterica serovar Typhi (NARST with reduced susceptibility to ciprofloxacin in Cameroon (Central Africa.

Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

Directory of Open Access Journals (Sweden)

Chalya Phillipo L

2012-03-01

Full Text Available Abstract Background Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting. Methods This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15. Results A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1. Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8% perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2% patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5% patients. The majority of patients (84.6% had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (P Conclusion

Evaluation of the Widal tube agglutination test for the diagnosis of typhoid fever among children admitted to a rural hdospital in Tanzania and a comparison with previous studies

Directory of Open Access Journals (Sweden)

Malahiyo Rajabu

2010-06-01

Full Text Available Abstract Background The diagnosis of typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi (S. typhi. However, a more rapid, simpler, and cheaper diagnostic method would be very useful especially in developing countries. The Widal test is widely used in Africa but little information exists about its reliability. Methods We assessed the performance of the Widal tube agglutination test among febrile hospitalized Tanzanian children. We calculated the sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV of various anti-TH and -TO titers using culture-confirmed typhoid fever cases as the "true positives" and all other febrile children with blood culture negative for S. typhi as the "true negatives." Results We found that 16 (1% of 1,680 children had culture-proven typhoid fever. A single anti-TH titer of 1:80 and higher was the optimal indicator of typhoid fever. This had a sensitivity of 75%, specificity of 98%, NPV of 100%, but PPV was only 26%. We compared our main findings with those from previous studies. Conclusion Among febrile hospitalized Tanzanian children with a low prevalence of typhoid fever, a Widal titer of ≥ 1:80 performed well in terms of sensitivity, specificity, and NPV. However a test with improved PPV that is similarly easy to apply and cost-efficient is desirable.

Challenges and Opportunities for Typhoid Fever Control: A Call for Coordinated Action.

Science.gov (United States)

Steele, A Duncan; Hay Burgess, Deborah C; Diaz, Zoey; Carey, Megan E; Zaidi, Anita K M

2016-03-15

The burden of enteric fever caused by Salmonella enterica serovars Typhi and Paratyphi is substantial and has high impact in toddlers and young children. This burden is relatively well documented in Asia, and this supplement provides new data on the substantial burden in several sub-Saharan African countries. Challenges in standardized surveillance and imperfect diagnostic tools have resulted in patchy local disease data, which are not well acknowledged or integrated into local country evidence and health awareness for decision making. There is a need to strengthen diagnostics for the generation of burden data in country. Furthermore, the guidelines and training for treatment of enteric fever cases in Africa are sorely needed to help mitigate the inappropriate use of antimicrobial treatment. Classic water safety and access to sanitation development remain powerful tools for the control of typhoid fever, yet the huge economic costs and long timelines are unlikely to provide a short- to middle-term solution. Emerging threats, including multidrug resistance and increasing urbanization in regions such as sub-Saharan Africa, warrant focused attention to shorter-term interventions including immunization, and must include vaccine strategies with the new typhoid conjugate vaccines. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Expression and function of S100A8/A9 (calprotectin) in human typhoid fever and the murine Salmonella model.

Science.gov (United States)

De Jong, Hanna K; Achouiti, Ahmed; Koh, Gavin C K W; Parry, Christopher M; Baker, Stephen; Faiz, Mohammed Abul; van Dissel, Jaap T; Vollaard, Albert M; van Leeuwen, Ester M M; Roelofs, Joris J T H; de Vos, Alex F; Roth, Johannes; van der Poll, Tom; Vogl, Thomas; Wiersinga, Willem Joost

2015-04-01

Typhoid fever, caused by the Gram-negative bacterium Salmonella enterica serovar Typhi, is a major cause of community-acquired bacteremia and death worldwide. S100A8 (MRP8) and S100A9 (MRP14) form bioactive antimicrobial heterodimers (calprotectin) that can activate Toll-like receptor 4, promoting lethal, endotoxin-induced shock and multi-organ failure. We aimed to characterize the expression and function of S100A8/A9 in patients with typhoid fever and in a murine invasive Salmonella model. S100A8/A9 protein levels were determined in acute phase plasma or feces from 28 Bangladeshi patients, and convalescent phase plasma from 60 Indonesian patients with blood culture or PCR-confirmed typhoid fever, and compared to 98 healthy control subjects. To functionally characterize the role of S100A8/A9, we challenged wildtype (WT) and S100A9-/- mice with S. Typhimurium and determined bacterial loads and inflammation 2- and 5- days post infection. We further assessed the antimicrobial function of recombinant S100A8/A9 on S. Typhimurium and S. Typhi replication in vitro. Typhoid fever patients demonstrated a marked increase of S100A8/A9 in acute phase plasma and feces and this increases correlated with duration of fever prior to admission. S100A8/A9 directly inhibited the growth of S. Typhimurium and S. Typhi in vitro in a dose and time dependent fashion. WT mice inoculated with S. Typhimurium showed increased levels of S100A8/A9 in both the liver and the systemic compartment but S100A9-/- mice were indistinguishable from WT mice with respect to bacterial growth, survival, and inflammatory responses, as determined by cytokine release, histopathology and organ injury. S100A8/A9 is markedly elevated in human typhoid, correlates with duration of fever prior to admission and directly inhibits the growth of S. Typhimurium and S. Typhi in vitro. Despite elevated levels in the murine invasive Salmonella model, S100A8/A9 does not contribute to an effective host response against S

Expression and function of S100A8/A9 (calprotectin in human typhoid fever and the murine Salmonella model.

Directory of Open Access Journals (Sweden)

Hanna K De Jong

2015-04-01

Full Text Available Typhoid fever, caused by the Gram-negative bacterium Salmonella enterica serovar Typhi, is a major cause of community-acquired bacteremia and death worldwide. S100A8 (MRP8 and S100A9 (MRP14 form bioactive antimicrobial heterodimers (calprotectin that can activate Toll-like receptor 4, promoting lethal, endotoxin-induced shock and multi-organ failure. We aimed to characterize the expression and function of S100A8/A9 in patients with typhoid fever and in a murine invasive Salmonella model.S100A8/A9 protein levels were determined in acute phase plasma or feces from 28 Bangladeshi patients, and convalescent phase plasma from 60 Indonesian patients with blood culture or PCR-confirmed typhoid fever, and compared to 98 healthy control subjects. To functionally characterize the role of S100A8/A9, we challenged wildtype (WT and S100A9-/- mice with S. Typhimurium and determined bacterial loads and inflammation 2- and 5- days post infection. We further assessed the antimicrobial function of recombinant S100A8/A9 on S. Typhimurium and S. Typhi replication in vitro. Typhoid fever patients demonstrated a marked increase of S100A8/A9 in acute phase plasma and feces and this increases correlated with duration of fever prior to admission. S100A8/A9 directly inhibited the growth of S. Typhimurium and S. Typhi in vitro in a dose and time dependent fashion. WT mice inoculated with S. Typhimurium showed increased levels of S100A8/A9 in both the liver and the systemic compartment but S100A9-/- mice were indistinguishable from WT mice with respect to bacterial growth, survival, and inflammatory responses, as determined by cytokine release, histopathology and organ injury.S100A8/A9 is markedly elevated in human typhoid, correlates with duration of fever prior to admission and directly inhibits the growth of S. Typhimurium and S. Typhi in vitro. Despite elevated levels in the murine invasive Salmonella model, S100A8/A9 does not contribute to an effective host response

Antibiotic resistance, integrons and Salmonella genomic island 1 among non-typhoidal Salmonella serovars in The Netherlands.

NARCIS (Netherlands)

Vo, An T T; Duijkeren, Engeline van; Fluit, Ad C; Wannet, Wim J B; Verbruggen, Anjo J; Maas, Henny M E; Gaastra, Wim

2006-01-01

The objective of this study was to investigate the antimicrobial resistance patterns, integron characteristics and gene cassettes as well as the presence of Salmonella genomic island 1 (SGI1) in non-typhoidal Salmonella (NTS) isolates from human and animal origin. Epidemiologically unrelated Dutch

Rhabdomyolysis Complicating Typhoid Fever in A Child and Review of the Literature.

Science.gov (United States)

Snelling, Peter James; Moriarty, Paul; Vaska, Vikram L; Levitt, David; Nourse, Clare

2017-09-01

Typhoid fever is an important cause of morbidity and mortality in the developing world, particularly in children, but is infrequently observed in the developed world and can occur in patients without a significant travel history. Rhabdomyolysis as a complication has rarely been reported, and never in a child. A child with Salmonella enterica serovar Typhi septicemia, complicated by rhabdomyolysis, encephalopathy and pancreatitis is described and all 15 reported cases to date are summarized.

Temporal fluctuation of multidrug resistant salmonella typhi haplotypes in the mekong river delta region of Vietnam.

Directory of Open Access Journals (Sweden)

Kathryn E Holt

2011-01-01

Full Text Available typhoid fever remains a public health problem in Vietnam, with a significant burden in the Mekong River delta region. Typhoid fever is caused by the bacterial pathogen Salmonella enterica serovar Typhi (S. Typhi, which is frequently multidrug resistant with reduced susceptibility to fluoroquinolone-based drugs, the first choice for the treatment of typhoid fever. We used a GoldenGate (Illumina assay to type 1,500 single nucleotide polymorphisms (SNPs and analyse the genetic variation of S. Typhi isolated from 267 typhoid fever patients in the Mekong delta region participating in a randomized trial conducted between 2004 and 2005.the population of S. Typhi circulating during the study was highly clonal, with 91% of isolates belonging to a single clonal complex of the S. Typhi H58 haplogroup. The patterns of disease were consistent with the presence of an endemic haplotype H58-C and a localised outbreak of S. Typhi haplotype H58-E2 in 2004. H58-E2-associated typhoid fever cases exhibited evidence of significant geo-spatial clustering along the Sông H u branch of the Mekong River. Multidrug resistance was common in the established clone H58-C but not in the outbreak clone H58-E2, however all H58 S. Typhi were nalidixic acid resistant and carried a Ser83Phe amino acid substitution in the gyrA gene.the H58 haplogroup dominates S. Typhi populations in other endemic areas, but the population described here was more homogeneous than previously examined populations, and the dominant clonal complex (H58-C, -E1, -E2 observed in this study has not been detected outside Vietnam. IncHI1 plasmid-bearing S. Typhi H58-C was endemic during the study period whilst H58-E2, which rarely carried the plasmid, was only transient, suggesting a selective advantage for the plasmid. These data add insight into the outbreak dynamics and local molecular epidemiology of S. Typhi in southern Vietnam.

Orbital cellulitis in course of typhoid fever; Zapalenie tkanki oczodolowej w przebiegu duru brzusznego

Energy Technology Data Exchange (ETDEWEB)

Nowacka, K; Szreter, M; Mikolajewicz, J [Centrum Zdrwowia Dziecka, Warsaw (Poland)

1994-12-31

In 18 months girl with exophthalmus of the left eye and extensive swelling of the soft tissues in both orbits during continued fever was observed. Typhoid fever with a non-typical course and ophthalmic complications were diagnosed on the basis of serological tests. Complete cure after treatment with augmenting was obtained. (author) 10 refs, 2 figs

Orbital cellulitis in course of typhoid fever; Zapalenie tkanki oczodolowej w przebiegu duru brzusznego

Energy Technology Data Exchange (ETDEWEB)

Nowacka, K.; Szreter, M.; Mikolajewicz, J. [Centrum Zdrwowia Dziecka, Warsaw (Poland)

1993-12-31

In 18 months girl with exophthalmus of the left eye and extensive swelling of the soft tissues in both orbits during continued fever was observed. Typhoid fever with a non-typical course and ophthalmic complications were diagnosed on the basis of serological tests. Complete cure after treatment with augmenting was obtained. (author) 10 refs, 2 figs

Combined rapid (TUBEX test for typhoid-paratyphoid A fever based on strong anti-O12 response: design and critical assessment of sensitivity.

Directory of Open Access Journals (Sweden)

Meiying Yan

Full Text Available Rapid diagnostics can be accurate but, often, those based on antibody detection for infectious diseases are unwittingly underrated for various reasons. Herein, we described the development of a combined rapid test for two clinically-indistinguishable bacterial diseases, typhoid and paratyphoid A fever, the latter fast emerging as a global threat. By using monoclonal antibodies (mAbs to bacterial antigens of known chemical structures as probes, we were able to dissect the antibody response in patients at the level of monosaccharides. Thus, a mAb specific for a common lipopolysaccharide antigen (O12 found in both the causative organisms was employed to semi-quantify the amounts of anti-O12 antibodies present in both types of patients in an epitope-inhibition particle-based (TUBEX immunoassay. This colorimetric assay detected not only anti-O12 antibodies that were abundantly produced, but also, by steric hindrance, antibodies to an adjoining epitope (O9 or O2 in the typhoid or paratyphoid bacillus, respectively. Sensitivity and, particularly, reaction intensities, were significantly better than those obtained using an anti-O9 or anti-O2 mAb-probe in the examination of paired sera from 22 culture-confirmed typhoid patients (sensitivity, 81.8% vs 75.0% or single sera from 36 culture-confirmed paratyphoid patients (52.8% vs 28.6, respectively. Importantly, sensitivity was better (97.1% for typhoid, 75.0% for paratyphoid if allowance was made for the absence of relevant antibodies in certain specimens as determined by an independent, objective assay (ELISA--such specimens might have been storage-denatured (especially the older paratyphoid samples or procured from non-responders. Benchmarking against ELISA, which revealed high concordance between the two tests, was useful and more appropriate than comparing with culture methods as traditionally done, since antibody tests and culture target slightly different stages of these diseases. Paired sera

Serum bactericidal assay for the evaluation of typhoid vaccine using a semi-automated colony-counting method.

Science.gov (United States)

Jang, Mi Seon; Sahastrabuddhe, Sushant; Yun, Cheol-Heui; Han, Seung Hyun; Yang, Jae Seung

2016-08-01

Typhoid fever, mainly caused by Salmonella enterica serovar Typhi (S. Typhi), is a life-threatening disease, mostly in developing countries. Enzyme-linked immunosorbent assay (ELISA) is widely used to quantify antibodies against S. Typhi in serum but does not provide information about functional antibody titers. Although the serum bactericidal assay (SBA) using an agar plate is often used to measure functional antibody titers against various bacterial pathogens in clinical specimens, it has rarely been used for typhoid vaccines because it is time-consuming and labor-intensive. In the present study, we established an improved SBA against S. Typhi using a semi-automated colony-counting system with a square agar plate harboring 24 samples. The semi-automated SBA efficiently measured bactericidal titers of sera from individuals immunized with S. Typhi Vi polysaccharide vaccines. The assay specifically responded to S. Typhi Ty2 but not to other irrelevant enteric bacteria including Vibrio cholerae and Shigella flexneri. Baby rabbit complement was more appropriate source for the SBA against S. Typhi than complements from adult rabbit, guinea pig, and human. We also examined the correlation between SBA and ELISA for measuring antibody responses against S. Typhi using pre- and post-vaccination sera from 18 human volunteers. The SBA titer showed a good correlation with anti-Vi IgG quantity in the serum as determined by Spearman correlation coefficient of 0.737 (P measure functional antibody titers against S. Typhi in sera from human subjects immunized with typhoid vaccines. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Salmonella Diagnosis and Treatment

Science.gov (United States)

... Typhi (Typhoid Fever) Associated with Frozen Mamey Fruit Pulp Hartford and Baildon Infections Associated with Restaurant Chain ... Button Related Links Multistate Foodborne Outbreaks Gastrointestinal (Enteric) Diseases from Animals Division of Foodborne, Waterborne, and Environmental ...

Adapting existing experience with aquifer vulnerability and groundwater protection for Africa

CSIR Research Space (South Africa)

Robins, NS

2007-01-01

Full Text Available Africa today, and guidelines for risk assessment and groundwater protection (including protection zoning) exist, these are not always adhered to. For example, in Sep- tember 2005 an outbreak of typhoid in the town of Delmas in Mpumalanga killed... at least four people. Large parts of the town are supplied by boreholes drilled into a karstic dolomitic aquifer. The water is chlorinated before being made available for public supply. Following an earlier out- break of typhoid in 1993...

Evaluation of a simple and rapid dipstick assay for the diagnosis of typhoid fever in Indonesia

NARCIS (Netherlands)

Gasem, M. Hussein; Smits, Henk L.; Goris, Marga G. A.; Dolmans, Wil M. V.

2002-01-01

To support the clinical diagnosis of typhoid fever in Indonesia, where most hospitals and health centres have no facilities for culture, a rapid dipstick assay for the detection of Salmonella typhi-specific IgM antibodies was evaluated on serum samples from 127 patients clinically suspected of

Human genetic variation in VAC14 regulates Salmonella invasion and typhoid fever through modulation of cholesterol.

Science.gov (United States)

Alvarez, Monica I; Glover, Luke C; Luo, Peter; Wang, Liuyang; Theusch, Elizabeth; Oehlers, Stefan H; Walton, Eric M; Tram, Trinh Thi Bich; Kuang, Yu-Lin; Rotter, Jerome I; McClean, Colleen M; Chinh, Nguyen Tran; Medina, Marisa W; Tobin, David M; Dunstan, Sarah J; Ko, Dennis C

2017-09-12

Risk, severity, and outcome of infection depend on the interplay of pathogen virulence and host susceptibility. Systematic identification of genetic susceptibility to infection is being undertaken through genome-wide association studies, but how to expeditiously move from genetic differences to functional mechanisms is unclear. Here, we use genetic association of molecular, cellular, and human disease traits and experimental validation to demonstrate that genetic variation affects expression of VAC14, a phosphoinositide-regulating protein, to influence susceptibility to Salmonella enterica serovar Typhi ( S Typhi) infection. Decreased VAC14 expression increased plasma membrane cholesterol, facilitating Salmonella docking and invasion. This increased susceptibility at the cellular level manifests as increased susceptibility to typhoid fever in a Vietnamese population. Furthermore, treating zebrafish with a cholesterol-lowering agent, ezetimibe, reduced susceptibility to S Typhi. Thus, coupling multiple genetic association studies with mechanistic dissection revealed how VAC14 regulates Salmonella invasion and typhoid fever susceptibility and may open doors to new prophylactic/therapeutic approaches.

Interferon-driven alterations of the host's amino acid metabolism in the pathogenesis of typhoid fever.

Science.gov (United States)

Blohmke, Christoph J; Darton, Thomas C; Jones, Claire; Suarez, Nicolas M; Waddington, Claire S; Angus, Brian; Zhou, Liqing; Hill, Jennifer; Clare, Simon; Kane, Leanne; Mukhopadhyay, Subhankar; Schreiber, Fernanda; Duque-Correa, Maria A; Wright, James C; Roumeliotis, Theodoros I; Yu, Lu; Choudhary, Jyoti S; Mejias, Asuncion; Ramilo, Octavio; Shanyinde, Milensu; Sztein, Marcelo B; Kingsley, Robert A; Lockhart, Stephen; Levine, Myron M; Lynn, David J; Dougan, Gordon; Pollard, Andrew J

2016-05-30

Enteric fever, caused by Salmonella enterica serovar Typhi, is an important public health problem in resource-limited settings and, despite decades of research, human responses to the infection are poorly understood. In 41 healthy adults experimentally infected with wild-type S. Typhi, we detected significant cytokine responses within 12 h of bacterial ingestion. These early responses did not correlate with subsequent clinical disease outcomes and likely indicate initial host-pathogen interactions in the gut mucosa. In participants developing enteric fever after oral infection, marked transcriptional and cytokine responses during acute disease reflected dominant type I/II interferon signatures, which were significantly associated with bacteremia. Using a murine and macrophage infection model, we validated the pivotal role of this response in the expression of proteins of the host tryptophan metabolism during Salmonella infection. Corresponding alterations in tryptophan catabolites with immunomodulatory properties in serum of participants with typhoid fever confirmed the activity of this pathway, and implicate a central role of host tryptophan metabolism in the pathogenesis of typhoid fever. © 2016 Blohmke et al.

Formative research and development of an evidence-based communication strategy: the introduction of Vi typhoid fever vaccine among school-aged children in Karachi, Pakistan.

Science.gov (United States)

Pach, Alfred; Tabbusam, Ghurnata; Khan, M Imran; Suhag, Zamir; Hussain, Imtiaz; Hussain, Ejaz; Mumtaz, Uzma; Haq, Inam Ul; Tahir, Rehman; Mirani, Amjad; Yousafzai, Aisha; Sahastrabuddhe, Sushant; Ochiai, R Leon; Soofi, Sajid; Clemens, John D; Favorov, Michael O; Bhutta, Zulfiqar A

2013-01-01

The authors conducted formative research (a) to identify stakeholders' concerns related to typhoid fever and the need for disease information and (b) to develop a communication strategy to inform stakeholders and address their concerns and motivate for support of a school-based vaccination program in Pakistan. Data were collected during interactive and semi-structured focus group discussions and interviews, followed by a qualitative analysis and multidisciplinary consultative process to identify an effective social mobilization strategy comprised of relevant media channels and messages. The authors conducted 14 focus group discussions with the parents of school-aged children and their teachers, and 13 individual interviews with school, religious, and political leaders. Parents thought that typhoid fever was a dangerous disease, but were unsure of their children's risk. They were interested in vaccination and were comfortable with a school-based vaccination if conducted under the supervision of trained and qualified staff. Teachers and leaders needed information on typhoid fever, the vaccine, procedures, and sponsors of the vaccination program. Meetings were considered the best form of information dissemination, followed by printed materials and mass media. This study shows how qualitative research findings can be translated into an effective social mobilization and communication approach. The findings of the research indicated the importance of increasing awareness of typhoid fever and the benefits of vaccination against the disease. Identification and dissemination of relevant, community-based disease and vaccination information will increase demand and use of vaccination.

Epidemiology, clinical manifestations, and molecular typing of salmonella typhi isolated from patients with typhoid fever in Lebanon.

Science.gov (United States)

Kanj, Souha S; Kanafani, Zeina A; Shehab, Marwa; Sidani, Nisreen; Baban, Tania; Baltajian, Kedak; Dakdouki, Ghenwa K; Zaatari, Mohamad; Araj, George F; Wakim, Rima Hanna; Dbaibo, Ghassan; Matar, Ghassan M

2015-06-01

The objective of this study was to examine the epidemiology and the clinical manifestations of typhoid fever as well as the susceptibility and strain relatedness of Salmonella typhi isolates in Lebanon from 2006 to 2007. A total of 120 patients with typhoid fever were initially identified from various areas of the country based on positive culture results for S. typhi from blood, urine, stools, bone marrow and/or positive serology. Clinical, microbiological and molecular analysis was performed on cases with complete data available. These results indicated that drinking water was an unlikely mode of transmission of the infection. Despite increasing reports of antimicrobial resistance among S. typhi isolates, the vast majority of these isolates were susceptible to various antibiotic agents, including ampicillin, cephalosporins, quinolones, and trimethoprim/sulfamethoxazole. Molecular analysis of the isolates revealed a predominance of one single genotype with no variation in distribution across the geographical regions. Copyright © 2014 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Interferon-driven alterations of the host’s amino acid metabolism in the pathogenesis of typhoid fever

Science.gov (United States)

Jones, Claire; Waddington, Claire S.; Zhou, Liqing; Hill, Jennifer; Clare, Simon; Mukhopadhyay, Subhankar; Schreiber, Fernanda; Roumeliotis, Theodoros I.; Yu, Lu; Ramilo, Octavio; Sztein, Marcelo B.; Kingsley, Robert A.; Levine, Myron M.

2016-01-01

Enteric fever, caused by Salmonella enterica serovar Typhi, is an important public health problem in resource-limited settings and, despite decades of research, human responses to the infection are poorly understood. In 41 healthy adults experimentally infected with wild-type S. Typhi, we detected significant cytokine responses within 12 h of bacterial ingestion. These early responses did not correlate with subsequent clinical disease outcomes and likely indicate initial host–pathogen interactions in the gut mucosa. In participants developing enteric fever after oral infection, marked transcriptional and cytokine responses during acute disease reflected dominant type I/II interferon signatures, which were significantly associated with bacteremia. Using a murine and macrophage infection model, we validated the pivotal role of this response in the expression of proteins of the host tryptophan metabolism during Salmonella infection. Corresponding alterations in tryptophan catabolites with immunomodulatory properties in serum of participants with typhoid fever confirmed the activity of this pathway, and implicate a central role of host tryptophan metabolism in the pathogenesis of typhoid fever. PMID:27217537

Efficacy and safety of vi-tetanus toxoid conjugated typhoid vaccine (PedaTyph™) in Indian children: School based cluster randomized study.

Science.gov (United States)

Mitra, Monjori; Shah, Nitin; Ghosh, Apurba; Chatterjee, Suparna; Kaur, Iqbal; Bhattacharya, Nisha; Basu, Suparna

2016-04-02

Vi polysaccharide typhoid vaccines cannot be used in children vaccine prepared by binding Vi to tetanus toxoids (Vi-TT) induces protective levels even in children safety following vaccination with a Vi-TT vaccine in children 6 months to 12 years of age. Overall, 1765 subjects were recruited from two registered municipal urban slums of southern Kolkata. Most of the children of the slum dwellers attended the schools in the locality which was selected with permission from the school authority. Schools were randomly divided into vaccinated (Test group) and unvaccinated group (Control group). Children and their siblings of test group received 2-doses of PedaTyph™ vaccine at 6 weeks interval. Control group received vaccines as per national guidelines. Adverse events (AEs) were examined after 30 minutes, 1 month and clinical events were observed till 12 months post-vaccination. Incidence of culture positive typhoid fever in the control group was 1.27% vis-a-vis none in vaccine group during 12 months. In subgroup evaluated for immunogenicity, an antibody titer value of 1.8 EU/ml (95% CI: 1.5 EU/ml, 2.2 EU/ml), 32 EU/ml (95% CI: 27.0 EU/ml, 39.0 EU/ml) and 14 EU/ml (95% CI: 12.0 EU/ml, 17.0 EU/ml) at baseline, 6 weeks and 12 months, respectively was observed. Sero-conversion among the sub-group was 100% after 6 weeks of post-vaccination and 83% after 12 months considering 4-fold rise from baseline. The efficacy of vaccine was 100 % (95% CI: 97.6%, 100%) in the first year of follow-up with minimal AEs post vaccination. Vi conjugate typhoid vaccine conferred 100% protection against typhoid fever in 1765 children 6 months to 12 years of age with high immunogenicity in a subgroup from the vaccine arm.

Typhoid fever in young children in Bangladesh: clinical findings, antibiotic susceptibility pattern and immune responses.

Directory of Open Access Journals (Sweden)

Farhana Khanam

2015-04-01

Full Text Available Children bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S. Typhi bacteremia, and antimicrobial susceptibility patterns of isolated strains.As a marker of recent infection, we have previously characterized antibody-in-lymphocyte secretion (TPTest during acute typhoid fever in adults. We similarly assessed membrane preparation (MP IgA responses in young children at clinical presentation, and then 7-10 days and 21-28 days later. We also assessed plasma IgA, IgG and IgM responses and T cell proliferation responses to MP at these time points. We compared responses in young children (1-5 years with those seen in older children (6-17 years, adults (18-59 years, and age-matched healthy controls.We found that, compared to age-matched controls patients in all age cohorts had significantly more MP-IgA responses in lymphocyte secretion at clinical presentation, and the values fell in all groups by late convalescence. Similarly, plasma IgA responses in patients were elevated at presentation compared to controls, with acute and convalescent IgA and IgG responses being highest in adults. T cell proliferative responses increased in all age cohorts by late convalescence. Clinical characteristics were similar in all age cohorts, although younger children were more likely to present with loss of appetite, less likely to complain of headache compared to older cohorts, and adults were more likely to have ingested antibiotics. Multi-drug resistant strains were present in approximately 15% of each age cohort, and 97% strains had resistance to nalidixic acid.This study demonstrates that S. Typhi bacteremia is associated with comparable clinical courses, immunologic responses in various age cohorts, including in young children, and that TPTest

Emerging nalidixic acid and ciprofloxacin resistance in non-typhoidal Salmonella isolated from patients having acute diarrhoeal disease

International Nuclear Information System (INIS)

Panhotra, B.R.; Saxena, A.K.; Al-Arabi, Ali M.

2004-01-01

Non-typhoidal Salmonella are one of the key etiological agents of diarrhoeal disease. The appearence of multiple drung resistance along with resistance to quinolones in this bacterium poses a serious therapeutic problem. We determined the prevalence of nalidixic acid and ciprofloxacin resistance in non-typhodial Salmonella isolated from faecal samples of patients with acute diarroheal disease attending the outpatient and inpatient department of a hospital in Saudi Arabia during the years 1999 to 2002. Non-typhodial Salmonella were isolated from faecal samples. Antimicrobial susceptibility was tested by the disc diffusion test. MICs to nalidixic acid and ciprofloxacinwere determined by the agar dilution method. During the study period , 524 strains of non-typhoidal Salmonella were isolated. Strains belonging to serogroup C1were the commonest (41.4%) followed by serogroups B and D (15.6% and 14.5%, respectively). Resistance to ampicillin was observed in 22.9% and to trimethoprim/sulphamethoxazole in 18.5%of the strains. Nalidixic acid resistance was encounterd in 9.9% and ciprofloxacin esistance in 2.3% of the strains. Resistance to nalidixic acid significantly increased from 0.1% in 1999 to 5.51% in 2002 ( p=0.0007)and ciprofloxacin resistance increased significantly from 0.1% in 1999 to 0.9% in 2002( p=0.0001). MICs to nalidixic acid and ciprofloxacin were determined among 29 nalidixic acid-resistant strains of non-typhoidal salmonella isolated during 2002. The MIC was >256 ug /ml to nalidixic acid and 8 to 16 ug/ml to ciprofloxacin. The increasing rate of antimicrobial resistance encountered among non-tyophoidal Salmonella necessiate the judicious use of these drugs in humans. Moreover, these findings support the concern that the use of quinolones in animal feed may lead to an increasein resistance and should should be restricted. (author)

Evaluation of the Diagnostic Accuracy of a Typhoid IgM Flow Assay for the Diagnosis of Typhoid Fever in Cambodian Children Using a Bayesian Latent Class Model Assuming an Imperfect Gold Standard

Science.gov (United States)

Moore, Catrin E.; Pan-Ngum, Wirichada; Wijedoru, Lalith P. M.; Sona, Soeng; Nga, Tran Vu Thieu; Duy, Pham Thanh; Vinh, Phat Voong; Chheng, Kheng; Kumar, Varun; Emary, Kate; Carter, Michael; White, Lisa; Baker, Stephen; Day, Nicholas P. J.; Parry, Christopher M.

2014-01-01

Rapid diagnostic tests are needed for typhoid fever (TF) diagnosis in febrile children in endemic areas. Five hundred children admitted to the hospital in Cambodia between 2009 and 2010 with documented fever (≥ 38°C) were investigated using blood cultures (BCs), Salmonella Typhi/Paratyphi A real-time polymerase chain reactions (PCRs), and a Typhoid immunoglobulin M flow assay (IgMFA). Test performance was determined by conventional methods and Bayesian latent class modeling. There were 32 cases of TF (10 BC- and PCR-positive cases, 14 BC-positive and PCR-negative cases, and 8 BC-negative and PCR-positive cases). IgMFA sensitivity was 59.4% (95% confidence interval = 41–76), and specificity was 97.8% (95% confidence interval = 96–99). The model estimate sensitivity for BC was 81.0% (95% credible interval = 54–99). The model estimate sensitivity for PCR was 37.8% (95% credible interval = 26–55), with a specificity of 98.2% (95% credible interval = 97–99). The model estimate sensitivity for IgMFA (≥ 2+) was 77.9% (95% credible interval = 58–90), with a specificity of 97.5% (95% credible interval = 95–100). The model estimates of IgMFA sensitivity and specificity were comparable with BCs and better than estimates using conventional analysis. PMID:24218407

"In the Fall of the Year We Were Troubled with Some Sickness": Typhoid Fever Deaths, Sherman Institute, 1904.

Science.gov (United States)

Keller, Jean A.

1999-01-01

Driven by his vision of the ideal American Indian vocational boarding school, Harwood Hall, an experienced administrator of Indian boarding schools, lobbied Congress to build Sherman Institute, which opened in Riverside, California, in 1902. A master of public relations, Hall downplayed the illness and deaths of students when typhoid fever swept…

Forecasting typhoid fever incidence in the Cordillera administrative region in the Philippines using seasonal ARIMA models

Science.gov (United States)

Cawiding, Olive R.; Natividad, Gina May R.; Bato, Crisostomo V.; Addawe, Rizavel C.

2017-11-01

The prevalence of typhoid fever in developing countries such as the Philippines calls for a need for accurate forecasting of the disease. This will be of great assistance in strategic disease prevention. This paper presents a development of useful models that predict the behavior of typhoid fever incidence based on the monthly incidence in the provinces of the Cordillera Administrative Region from 2010 to 2015 using univariate time series analysis. The data used was obtained from the Cordillera Office of the Department of Health (DOH-CAR). Seasonal autoregressive moving average (SARIMA) models were used to incorporate the seasonality of the data. A comparison of the results of the obtained models revealed that the SARIMA (1,1,7)(0,0,1)12 with a fixed coefficient at the seventh lag produces the smallest root mean square error (RMSE), mean absolute error (MAE), Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC). The model suggested that for the year 2016, the number of cases would increase from the months of July to September and have a drop in December. This was then validated using the data collected from January 2016 to December 2016.

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

Directory of Open Access Journals (Sweden)

Mohammed A. Soghaier

2013-10-01

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

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

Science.gov (United States)

Soghaier, Mohammed A; Hagar, Ahmed; Abbas, Mohammed A; Elmangory, Mutasim M; Eltahir, Khalid M; Sall, Amadou A

2013-10-01

Sudan is subject to repeated outbreaks, including Viral Hemorrhagic Fever (VHF), which is considered to be a very serious illness. Yellow Fever (YF) outbreaks in Sudan have been reported from the 1940s through 2005. In 2012, a new outbreak of YF occurred in the Darfur region. To identify the potential for an outbreak, to diagnose the disease and to be able to recognize its cause among the initial reported cases. >This is a descriptive and investigative field study that applies standard communicable disease outbreak investigation steps. The study involved clinical, serological, entomological and environmental surveys. The field investigation confirmed the outbreak and identified its cause to be YF. National surveillance systems should be strong enough to detect VHFs in a timely manner. Local health facilities should be prepared to promptly treat the initial cases because the case fatality ratios (CFRs) are usually very high among the index cases. Copyright © 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Development of a Live Attenuated Bivalent Oral Vaccine Against Shigella sonnei Shigellosis and Typhoid Fever.

Science.gov (United States)

Wu, Yun; Chakravarty, Sumana; Li, Minglin; Wai, Tint T; Hoffman, Stephen L; Sim, B Kim Lee

2017-01-15

Shigella sonnei and Salmonella Typhi cause significant morbidity and mortality. We exploited the safety record of the oral, attenuated S. Typhi vaccine (Ty21a) by using it as a vector to develop a bivalent oral vaccine to protect against S. sonnei shigellosis and typhoid fever. We recombineered the S. sonnei form I O-antigen gene cluster into the Ty21a chromosome to create Ty21a-Ss, which stably expresses S. sonnei form I O antigen. To enhance survivability in the acid environment of the stomach, we created an acid-resistant strain, Ty21a-AR-Ss, by inserting Shigella glutaminase-glutamate decarboxylase systems coexpressed with S. sonnei form I O-antigen gene. Mice immunized intranasally with Ty21a-AR-Ss produced antibodies against S. sonnei and S. Typhi, and survived lethal intranasal S. sonnei challenge. This paves the way for proposed good manufacturing practices manufacture and clinical trials intended to test the clinical effectiveness of Ty21a-AR-Ss in protecting against S. sonnei shigellosis and typhoid fever, as compared with the current Ty21a vaccine. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

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

DEFF Research Database (Denmark)

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

2016-01-01

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

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.

Selection tool for foodborne norovirus outbreaks.

Science.gov (United States)

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

2009-01-01

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

Outbreak Column 16: Cognitive errors in outbreak decision making.

Science.gov (United States)

Curran, Evonne T

2015-01-01

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

VNTR molecular typing of salmonella enterica serovar typhi isolates in Kathmandu valley

Directory of Open Access Journals (Sweden)

B Acharya

2012-03-01

Full Text Available Background: Typhoid fever continues to be a worldwide health problem, especially in developing countries. Effective epidemiological surveillance is needed to monitor the presence and spread of disease. Materials and Methods: Variable number tandem repeats (VNTR was performed for Salmonella enterica serovar typhi by multiplex-PCR in 28 Nepalese isolates of sporadic typhoid fever. Results: From all 28 total isolates, we could identify 12 VNTR profiles among the isolates, signifying multiple variants in circulation within the region. Conclusion: The VNTR-based typing assay for serovar typhi isolates can be used during an outbreak of enteric fever. The typing could eventually form the basis of an effective epidemiological surveillance system for developing rational strategies to control typhoid fever. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6026 JPN 2012; 2(3: 220-223

Cases of typhoid fever in Copenhagen region: a retrospective study of presentation and relapse.

Science.gov (United States)

Barrett, Freja Cecille; Knudsen, Jenny Dahl; Johansen, Isik Somuncu

2013-08-11

Typhoid fever is a systemic illness which in high-income countries mainly affects travellers. The incidence is particularly high on the Indian subcontinent. Travellers who visit friends and relatives (VFR) have been shown to have a different risk profile than others. We wished to identify main characteristics for travellers infected with S. Typhi considering both clinical and laboratory findings in order to provide for faster and better diagnostics in the future. The outcome of treatment, especially concerning relapse, was evaluated as well. Retrospectively collected data from 19 adult cases of typhoid fever over a 5-year period at the Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Denmark. The patients were young adults, presenting with symptoms within a month after travelling. 84% were returned from travelling in the Indian subcontinent. 17 out of 19 patients were VFR-travellers. The main symptoms were fever (100%), gastrointestinal symptoms (84%), headache (58%) and dry cough (26%). Laboratory findings showed elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH) in all cases and elevated alanine transaminase (ALAT) in 47% of cases. In primary cases 4 isolates were fully susceptible to ciprofloxacin, the remaining were intermediate susceptible. Relapse occurred in 37% of the cases and only in cases where the patient was infected by a strain with intermediate susceptibility. Better pre-travel counselling should be given to VFR-travellers. The main symptoms and laboratory findings confirm previous findings. The relapse rate was unexpected high and could be correlated to ciprofloxacin-resistance.

Forecasting rodent outbreaks in Africa

DEFF Research Database (Denmark)

Leirs, Herwig; Verhagen, Ron; Verheyen, Walter

1996-01-01

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

TOWARDS MODELING DISEASE OUTBREAK NOTIFICATION SYSTEMS

OpenAIRE

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

2014-01-01

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

Typhoid fever causing haemophagocytic lymphohistiocytosis in a non-endemic country - first case report and review of the current literature.

Science.gov (United States)

Sánchez-Moreno, Paula; Olbrich, Peter; Falcón-Neyra, Lola; Lucena, Jose Manuel; Aznar, Javier; Neth, Olaf

2018-06-07

Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication. Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data. The literature search revealed 17 articles (22 patients). Fifteen patients were eligible for data analysis (53.4% children). All patients had fever and pancytopenia. Transaminases and LDH were frequently elevated (46.6%). Salmonella typhi was detected mainly by blood culture (64.3%). All the patients received antibiotics whereas immunomodulation (dexamethasone) was used in two cases. A high suspicion index for this condition is needed even in non-endemic areas. The addition of immunmodulation to standard antimicrobial therapy should be considered in selected cases. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Certain peculiarities of the prevalence of typhoid fever under conditions of the environmental pollution

Energy Technology Data Exchange (ETDEWEB)

Toichuev, R. M.; Mamytova, M. [Institute of Medical Problems of the Southern Branch, Osh(Kyrgyzstan)

2012-09-15

Full text: To study the prevalence of typhoid fever (TF) in the south of the Kyrgyz Republic and to detect TF 'hot-spots'. Materials and methods: A total of 170 patients with the confirmed diagnosis of TF admitted in 2010-2011 were subjected to analysis. To study the epidemiological features of the TF under the conditions of the environmental pollution with radionuclides, we have calculated the morbidity rate of TF per 100000 population. The present work was done under the ISTC Project KR-1516. Results and Discussion: The south of the Kyrgyz Republic is characterized by climate and geographical peculiarities and different altitudes (400 - 7495 m). Hot humid climate which is typical for the south of the Republic is favorable for the development of a population of various microbes. Almost all infectious diseases including typhoid fever are reported in the south of the Republic. A total of 82 patients with TF were reported in 2010 in the south of the Republic. Of them, 36 were children (43.9%). In 2011, 88 patients were reported; of them, 32 (36.3%) patients were children. In the town of Osh, 2 cases were reported in 2010, morbidity rate was 0.8 cases per 100000 adult population and 1.5 cases per 100000 child population (children under 14). In Batken Province - 2 cases (0.5 and 1.4 cases per 100000 population), in Osh Province, 7 cases of TF were reported in 2010; morbidity rates were as follows: 0.6 cases per 100000 adult population and 0.5 cases per 100000 child population. A total of 71 patients with TF were recorded in Jalal-Abad Province. Of them, 31 patients were children under 14. Morbidity rates were 6.9 and 9.2, respectively, i.e. 12-17 times higher as compared to the other provinces of the Republic. In 2011, TF morbidity rate was 8.3 among the adult population of the Republic, and 9.2 - among the child population. No TF cases were reported in the town of Osh in 2011. In Batken Province - 1 case (0.2 per 100000 adult population), in Osh Province, 1 case

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

Science.gov (United States)

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

2016-01-01

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

Development of ELISAs for diagnosis of acute typhoid fever in Nigerian children.

Directory of Open Access Journals (Sweden)

Jiin Felgner

2017-06-01

Full Text Available Improved serodiagnostic tests for typhoid fever (TF are needed for surveillance, to facilitate patient management, curb antibiotic resistance, and inform public health programs. To address this need, IgA, IgM and IgG ELISAs using Salmonella enterica serovar Typhi (S. Typhi lipopolysaccharide (LPS and hemolysin E (t1477 protein were conducted on 86 Nigerian pediatric TF and 29 non-typhoidal Salmonella (NTS cases, 178 culture-negative febrile cases, 28 "other" (i.e., non-Salmonella pediatric infections, and 48 healthy Nigerian children. The best discrimination was achieved between TF and healthy children. LPS-specific IgA and IgM provided receiver operator characteristic areas under the curve (ROC AUC values of 0.963 and 0.968, respectively, and 0.978 for IgA+M combined. Similar performance was achieved with t1477-specific IgA and IgM (0.968 and 0.968, respectively; 0.976 combined. IgG against LPS and t1477 was less accurate for discriminating these groups, possibly as a consequence of previous exposure, although ROC AUC values were still high (0.928 and 0.932, respectively. Importantly, discrimination between TF and children with other infections was maintained by LPS-specific IgA and IgM (AUC = 0.903 and 0.934, respectively; 0.938 combined, and slightly reduced for IgG (0.909, while t1477-specific IgG performed best (0.914. A similar pattern was seen when comparing TF with other infections from outside Nigeria. The t1477 may be recognized by cross-reactive antibodies from other acute infections, although a robust IgG response may provide some diagnostic utility in populations where incidence of other infections is low, such as in children. The data are consistent with IgA and IgM against S. Typhi LPS being specific markers of acute TF.

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.

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

Science.gov (United States)

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

2010-08-01

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

Effect of travel distance on household demand for typhoid vaccines: implications for planning.

Science.gov (United States)

Kim, Dohyeong; Lauria, Donald T; Poulos, Christine; Dong, Baiqing; Whittington, Dale

2014-01-01

Typhoid fever causes millions of illnesses and hundreds of thousands of deaths yearly. Vaccinations would mitigate this problem, but the users would probably have to pay some or most of the cost. Several willingness-to-pay studies have assessed the effect of price on private demand to provide a basis for financial planning of campaigns, but the effect of travel distance, which is a potentially important determinant of demand, has not been studied. This paper thus has two objectives: (i) conduct a willingness-to-pay survey to assess the effects of distance, price and other variables on the private demand for typhoid vaccinations in a rural township of China where a campaign is under consideration; and (ii) embed the demand function in a mathematical model to address three planning questions; should each village have its own clinic, would one clinic be best or should the number of clinics be something in-between? Private vaccine demand was found to depend on and be inelastic with respect to both price and travel distance. A 1-km increase in distance caused the number of vaccinations demanded to decrease the same as a $0.5 increase in price. Thus, the marginal rate of substitution was $0.5 per km. A single clinic would be best for the township only if diseconomies of scale in supplying vaccinations exceeded the marginal rate of substitution. Otherwise, multiple clinics close to users would be optimal. Thus, deciding the number, location and capacities of clinics for vaccination planning is as important as deciding what price(s) to charge. Copyright © 2013 John Wiley & Sons, Ltd.

Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

Directory of Open Access Journals (Sweden)

Julia Harrington

2013-01-01

Full Text Available Background. Dengue outbreaks are occurring with increasing frequency and intensity. Evidence-based epidemic preparedness and effective response are now a matter of urgency. Therefore, we have analysed national and municipal dengue outbreak response plans. Methods. Thirteen country plans from Asia, Latin America and Australia, and one international plan were obtained from the World Health Organization. The information was transferred to a data analysis matrix where information was extracted according to predefined and emerging themes and analysed for scope, inconsistencies, omissions, and usefulness. Findings. Outbreak response planning currently has a considerable number of flaws. Outbreak governance was weak with a lack of clarity of stakeholder roles. Late timing of responses due to poor surveillance, a lack of combining routine data with additional alerts, and lack of triggers for initiating the response weakened the functionality of plans. Frequently an outbreak was not defined, and early response mechanisms based on alert signals were neglected. There was a distinct lack of consideration of contextual influences which can affect how an outbreak detection and response is managed. Conclusion. A model contingency plan for dengue outbreak prediction, detection, and response may help national disease control authorities to develop their own more detailed and functional context specific plans.

Using a Human Challenge Model of Infection to Measure Vaccine Efficacy: A Randomised, Controlled Trial Comparing the Typhoid Vaccines M01ZH09 with Placebo and Ty21a.

Science.gov (United States)

Darton, Thomas C; Jones, Claire; Blohmke, Christoph J; Waddington, Claire S; Zhou, Liqing; Peters, Anna; Haworth, Kathryn; Sie, Rebecca; Green, Christopher A; Jeppesen, Catherine A; Moore, Maria; Thompson, Ben A V; John, Tessa; Kingsley, Robert A; Yu, Ly-Mee; Voysey, Merryn; Hindle, Zoe; Lockhart, Stephen; Sztein, Marcelo B; Dougan, Gordon; Angus, Brian; Levine, Myron M; Pollard, Andrew J

2016-08-01

Typhoid persists as a major cause of global morbidity. While several licensed vaccines to prevent typhoid are available, they are of only moderate efficacy and unsuitable for use in children less than two years of age. Development of new efficacious vaccines is complicated by the human host-restriction of Salmonella enterica serovar Typhi (S. Typhi) and lack of clear correlates of protection. In this study, we aimed to evaluate the protective efficacy of a single dose of the oral vaccine candidate, M01ZH09, in susceptible volunteers by direct typhoid challenge. We performed a randomised, double-blind, placebo-controlled trial in healthy adult participants at a single centre in Oxford (UK). Participants were allocated to receive one dose of double-blinded M01ZH09 or placebo or 3-doses of open-label Ty21a. Twenty-eight days after vaccination, participants were challenged with 104CFU S. Typhi Quailes strain. The efficacy of M01ZH09 compared with placebo (primary outcome) was assessed as the percentage of participants reaching pre-defined endpoints constituting typhoid diagnosis (fever and/or bacteraemia) during the 14 days after challenge. Ninety-nine participants were randomised to receive M01ZH09 (n = 33), placebo (n = 33) or 3-doses of Ty21a (n = 33). After challenge, typhoid was diagnosed in 18/31 (58.1% [95% CI 39.1 to 75.5]) M01ZH09, 20/30 (66.7% [47.2 to 87.2]) placebo, and 13/30 (43.3% [25.5 to 62.6]) Ty21a vaccine recipients. Vaccine efficacy (VE) for one dose of M01ZH09 was 13% [95% CI -29 to 41] and 35% [-5 to 60] for 3-doses of Ty21a. Retrospective multivariable analyses demonstrated that pre-existing anti-Vi antibody significantly reduced susceptibility to infection after challenge; a 1 log increase in anti-Vi IgG resulting in a 71% decrease in the hazard ratio of typhoid diagnosis ([95% CI 30 to 88%], p = 0.006) during the 14 day challenge period. Limitations to the study included the requirement to limit the challenge period prior to treatment to 2

Arthur Conan Doyle (1859-1930): Physician during the typhoid epidemic in the Anglo-Boer War (1899-1902).

Science.gov (United States)

Cirillo, Vincent J

2014-02-01

When the Anglo-Boer War broke out in October 1899, Arthur Conan Doyle, a retired ophthalmologist, was already famous as the creator of Sherlock Holmes. Motivated by patriotism and adventure, Doyle joined the medical staff of a private field hospital endowed by philanthropist John Langman (1846-1928). Langman Hospital opened in Bloemfontein, South Africa, at the height of that city's typhoid fever epidemic which raged from April to June 1900. There were nearly 5000 cases of typhoid and 1000 deaths but official statistics do not truly reflect the magnitude of the suffering. Doyle argued that the British Army had made a major mistake by not making antityphoid inoculation compulsory. Because of the new vaccine's side effects, 95% of the soldiers refused immunization. Despite his strong opinions, Doyle failed to press the issue of compulsory inoculation when he testified before two Royal Commissions investigating the medical and military management of the war in South Africa. One can only imagine how the army might have benefited from the new idea of prophylactic vaccination in preventive medicine if Doyle had not let these opportunities slip away. As a consequence, antityphoid inoculation was still voluntary when Great Britain entered World War I in August 1914.

Overlapping epidemiologies of hepatitis A and typhoid fever: the needs of the traveler.

Science.gov (United States)

Luxemburger, Christine; Dutta, Anil K

2005-04-01

Hepatitis A and typhoid fever are endemic infectious diseases in many parts of the world. They share a common, simple mode of transmission--the fecal--oral route-associated with poor hygiene. The low endemicity of both diseases in developed countries, and the rise in travel to exotic destinations for business and leisure, mean that increasing numbers of travelers are being exposed to infection. Effective, established vaccines are available against both diseases, and recently new formulations combining both vaccines in one injection have been licensed. We review the present epidemiologic situation for both diseases, to determine the necessity to routinely vaccinate travelers against both diseases.

TYPHOID FEVER WITH FATAL OUTCOME IN PEOPLE WITH SEVERE TROPHOLOGICAL FAILURE IN EXTREME CONDITIONS

Directory of Open Access Journals (Sweden)

Yu. I. Lyashenko

2017-01-01

Full Text Available For purpose of clinical and morphological characterization of typhoid fever with fatal outcome was perform analysis of medical documentation as well as postmortem studies of internal tissues in 36men aged 21 to 34 years with severe body weight loss and in the conditions of combat stress in period from 1983 to 1985. The results of the study find a number of clinical and pathomorphological features of typhoid fever in patients with body weight deficiency that were in extreme conditions. Focal changes of the central nervous system were detected. The defeat of the respiratory system was characterized from the first days of the disease by bronchitis, and in the subsequent development of pneumonia, plevritis and empyema of the pleura. Majority of patients had symptoms of cardiovascular and renal failure. In died in the first week of the disease and in 2/3 parts – in a later period were combined with the symptoms of infectious-toxic encephalopathy and severe acute respiratory failure. All died had postmortem dystrophic changes of cardiomyocytes, and in patients had fatal outcome in 2–5 weeks – also focal or diffuse myocarditis. In a third of the patients who died, the disease was complicated by intestinal perforations. In a number of cases, peritonitis was a consequence of necrosis of mesenteric lymph nodes. In all patients with a fatal outcome, hemorrhagic (thrombohemorrhagic syndrome was diagnosed. A significant proportion of patients posthumously detected signs of sepsis and other complications, many of which could be the cause of death.

Pre-outbreak forest conditions mediate the effects of spruce beetle outbreaks on fuels in subalpine forests of Colorado.

Science.gov (United States)

Mietkiewicz, Nathan; Kulakowski, Dominik; Veblen, Thomas T

2018-03-01

Over the past 30 years, forest disturbances have increased in size, intensity, and frequency globally, and are predicted to continue increasing due to climate change, potentially relaxing the constraints of vegetation properties on disturbance regimes. However, the consequences of the potentially declining importance of vegetation in determining future disturbance regimes are not well understood. Historically, bark beetles preferentially attack older trees and stands in later stages of development. However, as climate warming intensifies outbreaks by promoting growth of beetle populations and compromising tree defenses, smaller diameter trees and stands in early stages of development now are being affected by outbreaks. To date, no study has considered how stand age and other pre-outbreak forest conditions mediate the effects of outbreaks on surface and aerial fuel arrangements. We collected fuels data across a chronosequence of post-outbreak sites affected by spruce beetle (SB) between the 1940s and the 2010s, stratified by young (130 yr) post-fire stands. Canopy and surface fuel loads were calculated for each tree and stand, and available crown fuel load, crown bulk density, and canopy bulk densities were estimated. Canopy bulk density and density of live canopy individuals were reduced in all stands affected by SB, though foliage loss was proportionally greater in old stands as compared to young stands. Fine surface fuel loads in young stands were three times greater shortly (fuels decreased to below endemic (i.e., non-outbreak) levels. In both young and old stands, the net effect of SB outbreaks during the 20th and 21st centuries reduced total canopy fuels and increased stand-scale spatial heterogeneity of canopy fuels following outbreak. Importantly, the decrease in canopy fuels following outbreaks was greater in young post-fire stands than in older stands, suggesting that SB outbreaks may more substantially reduce risk of active crown fire when they affect

Superior Sagittal Sinus Thrombosis Complicating Typhoid Fever in a Teenager

Directory of Open Access Journals (Sweden)

P. O. Okunola

2012-01-01

Full Text Available Cerebral venous sinus (sinovenous thrombosis (CSVT is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST. We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

[Formation and persistence of L-variants of Salmonella typhi in experimental typhoid and in carriers].

Science.gov (United States)

Levina, G A; Prozorovskiĭ, S V; Iagud, S L; Grumman, M I; Gorelov, A L

1981-07-01

The possibility of the induction and persistence of S. typhi L-forms in the process of experimental typhoid infection and carriership has been studied in rabbits. This study has revealed that the process of L-transformation leading to the appearance of the imbalanced growth forms and unstable L-forms of S. typhi in the organism of the animals infected with S. typhi culture may occur under the conditions of carriership. Such changed forms can be detected in the organism of the animals 18 months after the primary infection.

Enhanced detection rate of typhoid fever among clinically suspected patients in a tertiary referral hospital in Dhaka, Bangladesh using nested polymerase chain reaction technology.

Science.gov (United States)

Khan, S; Miah, M R; Khatun, S

2015-12-01

A nested polymerase chain reaction (PCR) specific for Salmonella enterica subspecies enteric serovar Typhi was used for the detection of the pathogen, in blood. This study was done during the period of March 2013 to February 2014. A total of 80 clinically suspected cases of typhoid fever were included in the study. Blood was collected from all participating individuals. Nested PCR targeting the flagellin gene (fliC) of Salmonella Typhi & blood culture were done for each of the cases. The positivity rate of PCR & blood culture was 70%& 20% respectively. The positivity rate of PCR was significantly higher than blood culture (Ptyphoid fever cases on the basis of clinical features but with negative cultures. We conclude that the PCR technique could be used as a novel diagnostic method of typhoid fever, particularly in culture-negative cases in an endemic country like Bangladesh.

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

Science.gov (United States)

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

2017-10-13

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

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

Science.gov (United States)

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

2018-03-01

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

Activation of Salmonella Typhi-specific regulatory T cells in typhoid disease in a wild-type S. Typhi challenge model.

OpenAIRE

Monica A McArthur; Stephanie Fresnay; Laurence S Magder; Thomas C Darton; Claire Jones; Claire S Waddington; Christoph J Blohmke; Gordon Dougan; Brian Angus; Myron M Levine; Andrew J Pollard; Marcelo B Sztein

2015-01-01

Salmonella Typhi (S. Typhi), the causative agent of typhoid fever, causes significant morbidity and mortality worldwide. Currently available vaccines are moderately efficacious, and identification of immunological responses associated with protection or disease will facilitate the development of improved vaccines. We investigated S. Typhi-specific modulation of activation and homing potential of circulating regulatory T cells (Treg) by flow and mass cytometry using specimens obtained from a h...

Salmonella Typhi genomics: envisaging the future of typhoid eradication.

Science.gov (United States)

Yap, Kien-Pong; Thong, Kwai Lin

2017-08-01

Next-generation whole-genome sequencing has revolutionised the study of infectious diseases in recent years. The availability of genome sequences and its understanding have transformed the field of molecular microbiology, epidemiology, infection treatments and vaccine developments. We review the key findings of the publicly accessible genomes of Salmonella enterica serovar Typhi since the first complete genome to the most recent release of thousands of Salmonella Typhi genomes, which remarkably shape the genomic research of S. Typhi and other pathogens. Important new insights acquired from the genome sequencing of S. Typhi, pertaining to genomic variations, evolution, population structure, antibiotic resistance, virulence, pathogenesis, disease surveillance/investigation and disease control are discussed. As the numbers of sequenced genomes are increasing at an unprecedented rate, fine variations in the gene pool of S. Typhi are captured in high resolution, allowing deeper understanding of the pathogen's evolutionary trends and its pathogenesis, paving the way to bringing us closer to eradication of typhoid through effective vaccine/treatment development. © 2017 John Wiley & Sons Ltd.

Using a Human Challenge Model of Infection to Measure Vaccine Efficacy: A Randomised, Controlled Trial Comparing the Typhoid Vaccines M01ZH09 with Placebo and Ty21a.

Directory of Open Access Journals (Sweden)

Thomas C Darton

2016-08-01

Full Text Available Typhoid persists as a major cause of global morbidity. While several licensed vaccines to prevent typhoid are available, they are of only moderate efficacy and unsuitable for use in children less than two years of age. Development of new efficacious vaccines is complicated by the human host-restriction of Salmonella enterica serovar Typhi (S. Typhi and lack of clear correlates of protection. In this study, we aimed to evaluate the protective efficacy of a single dose of the oral vaccine candidate, M01ZH09, in susceptible volunteers by direct typhoid challenge.We performed a randomised, double-blind, placebo-controlled trial in healthy adult participants at a single centre in Oxford (UK. Participants were allocated to receive one dose of double-blinded M01ZH09 or placebo or 3-doses of open-label Ty21a. Twenty-eight days after vaccination, participants were challenged with 104CFU S. Typhi Quailes strain. The efficacy of M01ZH09 compared with placebo (primary outcome was assessed as the percentage of participants reaching pre-defined endpoints constituting typhoid diagnosis (fever and/or bacteraemia during the 14 days after challenge. Ninety-nine participants were randomised to receive M01ZH09 (n = 33, placebo (n = 33 or 3-doses of Ty21a (n = 33. After challenge, typhoid was diagnosed in 18/31 (58.1% [95% CI 39.1 to 75.5] M01ZH09, 20/30 (66.7% [47.2 to 87.2] placebo, and 13/30 (43.3% [25.5 to 62.6] Ty21a vaccine recipients. Vaccine efficacy (VE for one dose of M01ZH09 was 13% [95% CI -29 to 41] and 35% [-5 to 60] for 3-doses of Ty21a. Retrospective multivariable analyses demonstrated that pre-existing anti-Vi antibody significantly reduced susceptibility to infection after challenge; a 1 log increase in anti-Vi IgG resulting in a 71% decrease in the hazard ratio of typhoid diagnosis ([95% CI 30 to 88%], p = 0.006 during the 14 day challenge period. Limitations to the study included the requirement to limit the challenge period prior to treatment to

Whole Genome Sequence Analysis of Salmonella Typhi Isolated in Thailand before and after the Introduction of a National Immunization Program.

Directory of Open Access Journals (Sweden)

Zoe A Dyson

2017-01-01

Full Text Available Vaccines against Salmonella Typhi, the causative agent of typhoid fever, are commonly used by travellers, however, there are few examples of national immunization programs in endemic areas. There is therefore a paucity of data on the impact of typhoid immunization programs on localised populations of S. Typhi. Here we have used whole genome sequencing (WGS to characterise 44 historical bacterial isolates collected before and after a national typhoid immunization program that was implemented in Thailand in 1977 in response to a large outbreak; the program was highly effective in reducing typhoid case numbers. Thai isolates were highly diverse, including 10 distinct phylogenetic lineages or genotypes. Novel prophage and plasmids were also detected, including examples that were previously only reported in Shigella sonnei and Escherichia coli. The majority of S. Typhi genotypes observed prior to the immunization program were not observed following it. Post-vaccine era isolates were more closely related to S. Typhi isolated from neighbouring countries than to earlier Thai isolates, providing no evidence for the local persistence of endemic S. Typhi following the national immunization program. Rather, later cases of typhoid appeared to be caused by the occasional importation of common genotypes from neighbouring Vietnam, Laos, and Cambodia. These data show the value of WGS in understanding the impacts of vaccination on pathogen populations and provide support for the proposal that large-scale typhoid immunization programs in endemic areas could result in lasting local disease elimination, although larger prospective studies are needed to test this directly.

High occurrence and unusual serotype diversity of non-typhoidal Salmonella in non-clinical niches, Angola.

Science.gov (United States)

Antunes, P; Campos, J; Mourão, J; Ribeiro, T G; Novais, C; Peixe, L

2017-04-01

Non-typhoidal Salmonella is an important burden, particularly in developing countries of the African region. We report for the first time in Angola, a sub-Saharan African country with commercial/travel relationships with Europe, an unexpectedly high occurrence of Salmonella (n = 12/63, 19%) from a high diversity of sources, particularly farm and wild animals. The detection of diverse serotypes (n = 12), involving putative new S. enterica subsp. salamae serotypes, is also of note, reinforcing the need for a comprehensive surveillance in Angola critical to identify animal/food/environmental sources of salmonellosis with impact on animal health, local people, tourists and exported products.

Gastroenteritis outbreaks on cruise ships

DEFF Research Database (Denmark)

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

2017-01-01

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

Measles outbreak linked to European B3 outbreaks, Wales, United Kingdom, 2017.

Science.gov (United States)

Currie, Jonny; Davies, Llion; McCarthy, Joanne; Perry, Malorie; Moore, Catherine; Cottrell, Simon; Bowley, Mererid; Williams, Chris; Shankar, Ananda Giri; Stiff, Rhianwen

2017-10-01

The United Kingdom achieved interrupted endemic measles transmission for 36 months in 2016. Despite this, ongoing challenges from sporadic measles cases typically imported from abroad remain. We summarise a B3 measles genotype outbreak in south-east Wales occurring between May and September 2017, linked with other European outbreaks, and lessons learnt. Seventeen confirmed cases and one probable case occurred principally in education and healthcare-settings. Six confirmed cases attended healthcare settings when infectious, without being isolated.

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting.

Science.gov (United States)

Beig, Farzana K; Ahmad, Faraz; Ekram, Mohd; Shukla, Indu

2010-01-01

Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. Blood culture was positive in only 27.3% of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90% (95% CI = 74.4-96.5), 100% (95% CI = 90.1-100), 100% (95% CI = 87.5-100), and 92.1% (95% CI = 79.2-97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7% (95% CI = 70.3-94.7), 85.7% (95% CI = 70.6-93.7), 83.9% (95% CI = 67.4-92.9), 88.2% (95% CI = 73.4-95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3% (95% CI = 19.8- 36.3), 64.6% (95% CI = 55.3-72.9), 89.1% (95% CI = 81.9-93.7), 80.9% (95% CI = 72.6-87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2% (95% CI = 69.4-94.5)] followed by Diazo [79% (95% CI = 61.6-90.2)], Widal [41.4% (95% CI = 25.5-59.3)] and blood culture [31% (95% CI = 17.3-49.2)]. Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.

Oral Wild-Type Salmonella Typhi Challenge Induces Activation of Circulating Monocytes and Dendritic Cells in Individuals Who Develop Typhoid Disease.

Directory of Open Access Journals (Sweden)

Franklin R Toapanta

2015-06-01

Full Text Available A new human oral challenge model with wild-type Salmonella Typhi (S. Typhi was recently developed. In this model, ingestion of 104 CFU of Salmonella resulted in 65% of subjects developing typhoid fever (referred here as typhoid diagnosis -TD- 5-10 days post-challenge. TD criteria included meeting clinical (oral temperature ≥38°C for ≥12 h and/or microbiological (S. Typhi bacteremia endpoints. One of the first lines of defense against pathogens are the cells of the innate immune system (e.g., monocytes, dendritic cells -DCs-. Various changes in circulating monocytes and DCs have been described in the murine S. Typhimurium model; however, whether similar changes are present in humans remains to be explored. To address these questions, a subset of volunteers (5 TD and 3 who did not develop typhoid despite oral challenge -NoTD- were evaluated for changes in circulating monocytes and DCs. Expression of CD38 and CD40 were upregulated in monocytes and DCs in TD volunteers during the disease days (TD-0h to TD-96h. Moreover, integrin α4β7, a gut homing molecule, was upregulated on monocytes but not DCs. CD21 upregulation was only identified in DCs. These changes were not observed among NoTD volunteers despite the same oral challenge. Moreover, monocytes and DCs from NoTD volunteers showed increased binding to S. Typhi one day after challenge. These monocytes showed phosphorylation of p38MAPK, NFkB and Erk1/2 upon stimulation with S. Typhi-LPS-QDot micelles. In contrast, monocytes from TD volunteers showed only a moderate increase in S. Typhi binding 48 h and 96 h post-TD, and only Erk1/2 phosphorylation. This is the first study to describe different activation and migration profiles, as well as differential signaling patterns, in monocytes and DCs which relate directly to the clinical outcome following oral challenge with wild type S. Typhi.

Norovirus: U.S. Trends and Outbreaks

Science.gov (United States)

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

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

Science.gov (United States)

Newkirk, Ryan; Hedberg, Craig; Bender, Jeff

2011-03-01

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

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.

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

Science.gov (United States)

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

2013-06-28

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

Early diagnosis of typhoid by pcr for flic-d gene of salmonella typhi in patients taking antibiotics

International Nuclear Information System (INIS)

Munir, T.; Razak, S.

2015-01-01

To compare PCR (Polymerase Chain Reaction) with blood culture, typhi-dot and Widal test for the diagnosis of typhoid in patients taking antibiotics. Study Design: Cross-sectional, comparative study. Place and Duration of Study: National University of Sciences and Technology, Islamabad, Pakistan, from April 2013 to August 2014. Methodology: One hundred and five patients were included in the study. Blood was collected and inoculated into tryptone soya broth for culture. Any growth obtained was identified by API 20 E and confirmed by Salmonellaanti-sera. Typhi-dot and Widal test were also done on all the samples. DNA extraction was done and PCR was carried out. Results: Among the 105 patients, 79 (75.2%) were males and 26 (24.8%) were females, with mean age of 20.64 ± 4 years. Typhi-dot was positive in 58 (55.2%) and negative in 47 (44.8%) patients. Blood widal test was positive in 27 (25.7%) and negative in 78 (74.3%) patients. Salmonella Typhi was positive on blood culture in only one (1%) patient. PCR for Salmonella Typhi was positive in 102 (97.1%) and negative in 3 (2.9%) patients. Positive cases detected by PCR were significantly higher as compared to Typhi-dot (p < 0.001), blood Widal test (p < 0.001) and blood culture (p < 0.001). Conclusion: Positivity rate of PCR was significantly higher as compared to blood culture, Typhi-dot or Widal test for diagnosing typhoid in patients who were already taking antibiotics. (author)

Reporting and Surveillance for Norovirus Outbreaks

Science.gov (United States)

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

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

Salmonella outbreak among railway and airline passengers.

Science.gov (United States)

Hatakka, M

1992-01-01

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

Designing and implementing an electronic dashboard for disease outbreaks response - Case study of the 2013-2014 Somalia Polio outbreak response dashboard.

Science.gov (United States)

Kamadjeu, Raoul; Gathenji, Caroline

2017-01-01

In April 2013, a case of wild polio virus (WPV) was detected in the Somalia capital Mogadishu. This inaugurated what is now referred to as the 2013-2014 Horn of Africa Polio outbreak with cases reported in Somalia, Kenya and Ethiopia. By the notification of the last polio case in August 2014, 223 cases of WPV had been reported in Somalia, Kenya and Ethiopia of which 199 in Somalia alone. The outbreak response required timely exchange of information between the outbreak response coordination unit (in Nairobi) and local staff located in multiple locations inside the country. The need to track and timely respond to information requests, to satisfy the information/data needs of polio partners and to track key outbreak response performance indicators dictated the need to urgently set up an online dashboard. The Somalia Polio Room dashboard provided a graphical display of the polio outbreak data to track progress and inform decision making. The system was designed using free and open sources components and seamlessly integrated existing polio surveillance data for real time monitoring of key outbreak response performance indicators. In this article, we describe the design and operation of an electronic dashboard for disease surveillance in an outbreak situation and used the lessons learned to propose key design considerations and functional requirements for online electronic dashboards for disease outbreak response.

Faster Detection of Poliomyelitis Outbreaks to Support Polio Eradication.

Science.gov (United States)

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

2016-03-01

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

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

Science.gov (United States)

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

2018-05-18

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

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

Science.gov (United States)

Kozísek, F; Jeligová, H; Dvoráková, A

2009-08-01

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

Comparison of the Performance of the TPTest, Tubex, Typhidot and Widal Immunodiagnostic Assays and Blood Cultures in Detecting Patients with Typhoid Fever in Bangladesh, Including Using a Bayesian Latent Class Modeling Approach.

Science.gov (United States)

Islam, Kamrul; Sayeed, Md Abu; Hossen, Emran; Khanam, Farhana; Charles, Richelle C; Andrews, Jason; Ryan, Edward T; Qadri, Firdausi

2016-04-01

There is an urgent need for an improved diagnostic assay for typhoid fever. In this current study, we compared the recently developed TPTest (Typhoid and Paratyphoid Test) with the Widal test, blood culture, and two commonly used commercially available kits, Tubex and Typhidot. For analysis, we categorized 92 Bangladeshi patients with suspected enteric fever into four groups: S. Typhi bacteremic patients (n = 28); patients with a fourfold change in Widal test from day 0 to convalescent period (n = 7); patients with Widal titer ≥1:320 (n = 13) at either acute or convalescent stage of disease; and patients suspected with enteric fever, but with a negative blood culture and Widal titer (n = 44). We also tested healthy endemic zone controls (n = 20) and Bangladeshi patients with other febrile illnesses (n = 15). Sample size was based on convenience to facilitate preliminary analysis. Of 28 S. Typhi bacteremic patients, 28 (100%), 21 (75%) and 18 (64%) patients were positive by TPTest, Tubex and Typhidot, respectively. In healthy endemic zone controls, the TPTest method was negative in all, whereas Tubex and Typhidot were positive in 3 (15%) and 5 (25%), respectively. We then estimated sensitivity and specificity of all diagnostic tests using Bayesian latent class modeling. The sensitivity of TPTest, Tubex and Typhidot were estimated at 96.0% (95% CI: 87.1%-99.8%), 60.2% (95% CI: 49.3%-71.2%), and 59.6% (95% CI: 50.1%-69.3%), respectively. Specificity was estimated at 96.6% (90.7%-99.2%) for TPTest, 89.9% (79.6%-96.8%) for Tubex, and 80.0% (67.7%-89.7%) for Typhidot. These results suggest that the TPTest is highly sensitive and specific in diagnosing individuals with typhoid fever in a typhoid endemic setting, outperforming currently available and commonly used alternatives.

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

Science.gov (United States)

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

2014-01-01

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

Typhidot M and Diazo test vis-à-vis blood culture and Widal test in the early diagnosis of typhoid fever in children in a resource poor setting

Directory of Open Access Journals (Sweden)

Farzana K Beig

Full Text Available OBJECTIVE: Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. METHODS: Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. RESULTS: Blood culture was positive in only 27.3% of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90% (95% CI = 74.4-96.5, 100% (95% CI = 90.1-100, 100% (95% CI = 87.5-100, and 92.1% (95% CI = 79.2-97.3 respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7% (95% CI = 70.3-94.7, 85.7% (95% CI = 70.6-93.7, 83.9% (95% CI = 67.4-92.9, 88.2% (95% CI = 73.4-95.3 respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3% (95% CI = 19.8- 36.3, 64.6% (95% CI = 55.3-72.9, 89.1% (95% CI = 81.9-93.7, 80.9% (95% CI = 72.6-87.2 respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2% (95% CI = 69.4-94.5] followed by Diazo [79% (95% CI = 61.6-90.2], Widal [41.4% (95% CI = 25.5-59.3] and blood culture [31% (95% CI = 17.3-49.2]. CONCLUSION: Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.

Molecular Diagnostic Analysis of Outbreak Scenarios

Science.gov (United States)

Morsink, M. C.; Dekter, H. E.; Dirks-Mulder, A.; van Leeuwen, W. B.

2012-01-01

In the current laboratory assignment, technical aspects of the polymerase chain reaction (PCR) are integrated in the context of six different bacterial outbreak scenarios. The "Enterobacterial Repetitive Intergenic Consensus Sequence" (ERIC) PCR was used to analyze different outbreak scenarios. First, groups of 2-4 students determined optimal…

Outbreak of ocular toxoplasmosis in Coimbatore, India

Directory of Open Access Journals (Sweden)

Palanisamy Manikandan

2006-01-01

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

MRSA outbreak at a transplantation unit

Directory of Open Access Journals (Sweden)

RMC Romanelli

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

Investigating Listeria Outbreaks

Centers for Disease Control (CDC) Podcasts

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

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.

Outbreak or Epidemic? How Obama's Language Choice Transformed the Ebola Outbreak Into an Epidemic.

Science.gov (United States)

Gesser-Edelsburg, Anat; Shir-Raz, Yaffa; Bar-Lev, Oshrat Sassoni; James, James J; Green, Manfred S

2016-08-01

Our aim was to examine in what terms leading newspapers' online sites described the current Ebola crisis. We employed a quantitative content analysis of terms attributed to Ebola. We found and analyzed 582 articles published between March 23 and September 30, 2014, on the online websites of 3 newspapers: The New York Times, Daily Mail, and Ynet. Our theoretical framework drew from the fields of health communication and emerging infectious disease communication, including such concepts as framing media literacy, risk signatures, and mental models. We found that outbreak and epidemic were used interchangeably in the articles. From September 16, 2014, onward, epidemic predominated, corresponding to when President Barack Obama explicitly referred to Ebola as an epidemic. Prior to Obama's speech, 86.8% of the articles (323) used the term outbreak and only 8.6% (32) used the term epidemic. Subsequently, both terms were used almost the same amount: 53.8% of the articles (113) used the term outbreak and 53.3% (112) used the term epidemic. Effective communication is crucial during public health emergencies such as Ebola, because language framing affects the decision-making process of social judgments and actions. The choice of one term (outbreak) over another (epidemic) can create different conceptualizations of the disease, thereby influencing the risk signature. (Disaster Med Public Health Preparedness. 2016;10:669-673).

Infection control during filoviral hemorrhagic fever outbreaks

Directory of Open Access Journals (Sweden)

N Raabe Vanessa

2012-01-01

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

A Classification System for Hospital-Based Infection Outbreaks

Directory of Open Access Journals (Sweden)

Paul S. Ganney

2010-01-01

Full Text Available Outbreaks of infection within semi-closed environments such as hospitals, whether inherent in the environment (such as Clostridium difficile (C.Diff or Methicillinresistant Staphylococcus aureus (MRSA or imported from the wider community (such as Norwalk-like viruses (NLVs, are difficult to manage. As part of our work on modelling such outbreaks, we have developed a classification system to describe the impact of a particular outbreak upon an organization. This classification system may then be used in comparing appropriate computer models to real outbreaks, as well as in comparing different real outbreaks in, for example, the comparison of differing management and containment techniques and strategies. Data from NLV outbreaks in the Hull and East Yorkshire Hospitals NHS Trust (the Trust over several previous years are analysed and classified, both for infection within staff (where the end of infection date may not be known and within patients (where it generally is known. A classification system consisting of seven elements is described, along with a goodness-of-fit method for comparing a new classification to previously known ones, for use in evaluating a simulation against history and thereby determining how ‘realistic’ (or otherwise it is.

A classification system for hospital-based infection outbreaks.

Science.gov (United States)

Ganney, Paul S; Madeo, Maurice; Phillips, Roger

2010-12-01

Outbreaks of infection within semi-closed environments such as hospitals, whether inherent in the environment (such as Clostridium difficile (C.Diff) or Methicillin-resistant Staphylococcus aureus (MRSA) or imported from the wider community (such as Norwalk-like viruses (NLVs)), are difficult to manage. As part of our work on modelling such outbreaks, we have developed a classification system to describe the impact of a particular outbreak upon an organization. This classification system may then be used in comparing appropriate computer models to real outbreaks, as well as in comparing different real outbreaks in, for example, the comparison of differing management and containment techniques and strategies. Data from NLV outbreaks in the Hull and East Yorkshire Hospitals NHS Trust (the Trust) over several previous years are analysed and classified, both for infection within staff (where the end of infection date may not be known) and within patients (where it generally is known). A classification system consisting of seven elements is described, along with a goodness-of-fit method for comparing a new classification to previously known ones, for use in evaluating a simulation against history and thereby determining how 'realistic' (or otherwise) it is.

Measles & rubella outbreaks in Maharashtra State, India

Science.gov (United States)

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

2016-01-01

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

Effect of ionizing radiation on the antigenic composition of typhoid bacteria

International Nuclear Information System (INIS)

Sinilova, N.G.; Nikolaeva, L.A.; Tumanyan, M.A.

1978-01-01

Changes in the antigenic composition of typhoid bacteria occurring during the exposure of microbial suspension to different doses of gamma radiation ( 60 Co) ranging between 0.5 and 3.0 Mrad were studied. Immunoelectrophoresis in agar was used to determine the antigenic composition of different samples of irradiated bacteria. The antigenic composition of bacteria irradiated with doses up to 2.5 Mrad was found to be similar to that of non-irradiated bacteria. Antigens demonstrated by means of Vi, H and O antisera are preserved in these bacteria. However, all irradiated bacteria in general slightly differ from non-irradiated bacteria; this is manifest in a different configuration and position of the precipitation lines in the cathodic part of the immunophoreograms. The content of the component migrating rapidly towards the cathode, evidently the O antigen in the R form, in the irradiated bacteria increases with the dose of radiation. No new serologically active substances, non-existent in non-irradiated bacteria, were found to appear in the process of irradiation. (author)

Studies on disturbed carbohydrate tolerance during typhoid infection, using immunoradiometric technique

International Nuclear Information System (INIS)

Elhawey, A.; Elnabarawy, F.; Megahed, Y.M.; Abdelaal, M.; Hashem, A.

1992-01-01

During acute febrile illness of infections, origin in diabetics is commonly accompanied by deterioration in control of the blood glucose and increased insulin requirements. A similar phenomenon can be demonstrated in nondiabetic individuals during acute infections of bacterial or viral origin. Nondiabetic infections, result in a decrease in carbohydrate intolerance, hyperinsulinemia, and the finding is consistent with the presence of insulin resistance. These disturbances were studied in 20 patients suffering typhoid fever during and after the febrile period. In order to access the state of transient insulin resistance, blood glucose, plasma insulin and insulin receptors were estimated estimated. The results revealed a decrease in the number of insulin receptors hyperinsulinemia and hyperglycemia as recorded during the febrile period, with return to normal levels after drop of fever. The elucidation of the changes in the glucose, insulin levels and insulin receptors seems seems very important in patients with infections in order to achieve good prognosis and to avoid complications especially in cases resistant to specific therapy.4 tab., 4 fig

Studies on disturbed carbohydrate tolerance during typhoid infection, using immunoradiometric technique

Energy Technology Data Exchange (ETDEWEB)

Elhawey, A; Elnabarawy, F; Megahed, Y M; Abdelaal, M; Hashem, A

1992-01-01

During acute febrile illness of infections, origin in diabetics is commonly accompanied by deterioration in control of the blood glucose and increased insulin requirements. A similar phenomenon can be demonstrated in nondiabetic individuals during acute infections of bacterial or viral origin. Nondiabetic infections, result in a decrease in carbohydrate intolerance, hyperinsulinemia, and the finding is consistent with the presence of insulin resistance. These disturbances were studied in 20 patients suffering typhoid fever during and after the febrile period. In order to access the state of transient insulin resistance, blood glucose, plasma insulin and insulin receptors were estimated estimated. The results revealed a decrease in the number of insulin receptors hyperinsulinemia and hyperglycemia as recorded during the febrile period, with return to normal levels after drop of fever. The elucidation of the changes in the glucose, insulin levels and insulin receptors seems seems very important in patients with infections in order to achieve good prognosis and to avoid complications especially in cases resistant to specific therapy.4 tab., 4 fig.

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

Science.gov (United States)

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

2015-07-01

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

[Hospital hygiene - outbreak management of nosocomial infections].

Science.gov (United States)

Kerwat, Klaus; Wulf, Hinnerk

2012-04-01

According to §6, section 3 of the German Protection against Infections Act [Infektionsschutzgesetz (IfSG)] an outbreak is defined as the occurrence in large numbers of nosocomial infections for which an epidemiological relationship is probable or can be assumed. About 2-10% of nosocomial infections in hospitals (about 5% in intensive care wards) occur within the framework of an outbreak. The heaped occurrence of nosocomial infections can be declared according to the prescribed surveillance of nosocomial infections (§23 IfSG) when, in the course of this assessment, a statistically significant increase in the rate of infections becomes apparent. On the other hand, the occurrence of an outbreak can also be recognized through the vigilance of all involved personnel and a general sensibilization towards this subject. The names of patients involved in outbreaks need not be reported to the responsible health authorities. As a consequence of the report the health authorities become involved in the investigation to determine the cause and its elimination, and to provide support and advice. The outbreak management should be oriented on the respective recommendations of the Robert Koch Institute. © Georg Thieme Verlag Stuttgart · New York.

An outbreak of Salmonella gastroenteritis in an urban jail.

Science.gov (United States)

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

1988-12-01

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

A review of critical care nursing and disease outbreak preparedness.

Science.gov (United States)

Makamure, Miranda; Makamure, Muriel; Mendiola, Williane; Renteria, Daisy; Repp, Melissa; Willden, Azshwee

2013-01-01

The impact of disease outbreaks continues to increase globally. As frontline staff, critical care nurses (CCNs) are more likely to be confronted with the need to care for affected patients. With different pathological diseases emerging, CCNs play an integral role in disease outbreaks. The advanced skill set of CCNs is pivotal in the management and care of patients during an outbreak. Lack of planning and preparation before disease outbreaks leads to detrimental patient outcomes. Panic, chaos, and fear for personal safety cause stress and anxiety for unprepared nurses. However, this problem can be resolved. Comprehensive planning, training, and education can better prepare intensive care unit nurses for disease outbreaks. This article reviews some of the current literature on intensive care unit nurse preparedness for disease outbreaks in the United States. This article also offers strategies that may be used to better prepare CCNs for disease outbreaks.

Antimicrobial residues and resistance against critically important antimicrobials in non-typhoidal Salmonella from meat sold at wet markets and supermarkets in Vietnam.

OpenAIRE

Nhung, NT; Van, NTB; Cuong, NV; Duong, TTQ; Nhat, TT; Hang, TTT; Nhi, NTH; Kiet, BT; Hien, VB; Ngoc, PT; Campbell, J; Thwaites, G; Carrique-Mas, J

2017-01-01

Excessive antimicrobial usage and deficiencies in hygiene in meat production systems may result in undesirable human health hazards, such as the presence of antimicrobial drug residues and non-typhoidal Salmonella (NTS), including antimicrobial resistant (AMR) NTS. Recently, Vietnam has witnessed the emergence of integrated intensive animal production systems, coexisting with more traditional, locally-sourced wet markets. To date no systematic studies have been carried out to compare health h...

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

Energy Technology Data Exchange (ETDEWEB)

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

1994-01-01

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

Management of Nosocomial Scabies, an Outbreak of Occupational Disease

NARCIS (Netherlands)

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

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

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

Directory of Open Access Journals (Sweden)

Pär Bjelkmar

2017-04-01

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

Control Measures Used during Lymphogranuloma Venereum Outbreak, Europe

Science.gov (United States)

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

2008-01-01

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

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.

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.

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.

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

Science.gov (United States)

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

2015-01-01

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

Typing of Salmonella enterica serovar Saintpaul: an outbreak investigation

DEFF Research Database (Denmark)

Baggesen, Dorte Lau; Wegener, Henrik Caspar; Christensen, J.P.

1996-01-01

factor, antibiogram typing, plasmid profiling, ribotyping and pulsed field gel electrophoresis, in order to identify the most probable source of infection. After typing, the source of the investigated outbreak remains obscure because so far no isolates with traits of the outbreak strain have been...... explanation for the failure to find isolates with traits of the outbreak strain could be the presence of a third, but so far unidentified, source. The present investigation illustrates the necessity of using more than one epidemiological typing method for outbreak investigation. This is especially important...

Outbreaks and Investigations

Science.gov (United States)

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

Cholera outbreak in districts around Lake Chilwa, Malawi: Lessons ...

African Journals Online (AJOL)

Cholera is endemic in Malawi with seasonal outbreaks during the wet season. People living around Lake Chilwa rely on the lake for their water supply. From May 2009 to May 2010, a cholera outbreak occurred in fishing communities around Lake Chilwa. This paper describes the outbreak response and lessons learned for ...

A Comparison of Non-Typhoidal Salmonella from Humans and Food Animals Using Pulsed-Field Gel Electrophoresis and Antimicrobial Susceptibility Patterns

Science.gov (United States)

Sandt, Carol H.; Fedorka-Cray, Paula J.; Tewari, Deepanker; Ostroff, Stephen; Joyce, Kevin; M’ikanatha, Nkuchia M.

2013-01-01

Salmonellosis is one of the most important foodborne diseases affecting humans. To characterize the relationship between Salmonella causing human infections and their food animal reservoirs, we compared pulsed-field gel electrophoresis (PFGE) and antimicrobial susceptibility patterns of non-typhoidal Salmonella isolated from ill humans in Pennsylvania and from food animals before retail. Human clinical isolates were received from 2005 through 2011 during routine public health operations in Pennsylvania. Isolates from cattle, chickens, swine and turkeys were recovered during the same period from federally inspected slaughter and processing facilities in the northeastern United States. We found that subtyping Salmonella isolates by PFGE revealed differences in antimicrobial susceptibility patterns and, for human Salmonella, differences in sources and invasiveness that were not evident from serotyping alone. Sixteen of the 20 most common human Salmonella PFGE patterns were identified in Salmonella recovered from food animals. The most common human Salmonella PFGE pattern, Enteritidis pattern JEGX01.0004 (JEGX01.0003ARS), was associated with more cases of invasive salmonellosis than all other patterns. In food animals, this pattern was almost exclusively (99%) found in Salmonella recovered from chickens and was present in poultry meat in every year of the study. Enteritidis pattern JEGX01.0004 (JEGX01.0003ARS) was associated with susceptibility to all antimicrobial agents tested in 94.7% of human and 97.2% of food animal Salmonella isolates. In contrast, multidrug resistance (resistance to three or more classes of antimicrobial agents) was observed in five PFGE patterns. Typhimurium patterns JPXX01.0003 (JPXX01.0003 ARS) and JPXX01.0018 (JPXX01.0002 ARS), considered together, were associated with resistance to five or more classes of antimicrobial agents: ampicillin, chloramphenicol, streptomycin, sulfonamides and tetracycline (ACSSuT), in 92% of human and 80% of food

DNA biosensor for detection of Salmonella typhi from blood sample of typhoid fever patient using gold electrode modified by self-assembled monolayers of thiols

Science.gov (United States)

Suryapratiwi, Windha Novita; Paat, Vlagia Indira; Gaffar, Shabarni; Hartati, Yeni Wahyuni

2017-05-01

Electrochemical biosensors are currently being developed in order to handle various clinical problems in diagnosing infectious diseases caused by pathogenic bacteria, or viruses. On this research, voltammetric DNA biosensor using gold electrode modified by thiols with self-assembled monolayers had been developed to detect a certain sequence of Salmonella typhi DNA from blood sample of typhoid fever patient. Thiol groups of cysteamines (Cys) and aldehyde groups from glutaraldehydes (Glu) were used as a link to increase the performance of gold electrode in detecting guanine oxidation signal of hybridized S. typhi DNA and ssDNA probe. Standard calibration method was used to determine analytical parameters from the measurements. The result shown that, the detection of S. typhi DNA from blood sample of typhoid fever patient can be carried out by voltammetry using gold electrode modified by self-assembled monolayers of thiols. A characteristic oxidation potential of guanine using Au/Cys/Gluwas obtained at +0.17 until +0.20 V. Limit of detection and limit of quantification from this measurements were 1.91μg mL-1 and 6.35 μg mL-1. The concentration of complement DNA from sample was 6.96 μg mL-1.

[Norovirus outbreaks in hospitals and nursing homes in Catalonia, Spain].

Science.gov (United States)

Godoy, Pere; Domínguez, Angela; Alvarez, Josep; Camps, Neus; Barrabeig, Irene; Bartolomé, Rosa; Sala, María Rosa; Ferre, Dolors; Pañella, Helena; Torres, Joan; Minguell, Sofía; Alsedà, Miquel; Pumares, Analía

2009-01-01

The low infectious dose and multiple transmission routes favour the appearance of norovirus outbreaks. The objective of this study was to compare the incidence of norovirus outbreaks in hospitals and nursing homes in Catalonia. A descriptive study of norovirus outbreaks between 15/10/2004 and 30/10/2005 was carried out. An epidemiological survey was completed for each outbreak. Norovirus in clinical samples was determined by PCR techniques. The incidence in each centre and the annual incidence of outbreaks by centre were calculated. Differences were calculated using the chi-square test and the Student's t test, taking a p value of > 0.05 as significant. Seventeen outbreaks (6 in hospitals and 11 in nursing homes) were detected. The global attack rate was 33.4% (652/1951) and was slightly higher in nursing homes (35.2%) than in hospitals (31.4%). A total of 94.1% (16/17) of outbreaks were caused by person-to-person transmission and only 5.9% (1/17) by foods. The mean number of days between the first and last case was 11.4 (SD = 6.9). The mean duration of symptoms was 2.39 days (SD=1.6), and was higher hospitals, 2.63 (SD=1.7), than in nursing homes, 1.97 (SD=1.7) (p < 0.0001). Norovirus is responsible for a large number of outbreaks due to person-to-person transmission. Control should be standardized to reduce the number and duration of outbreaks.

Nanopore Sequencing as a Rapidly Deployable Ebola Outbreak Tool.

Science.gov (United States)

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

2016-02-01

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

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

DEFF Research Database (Denmark)

Anniballi, Fabrizio; Fiore, Alfonsina; Löfström, Charlotta

2013-01-01

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

Tuberculosis Outbreak Investigations in the U.S.

Centers for Disease Control (CDC) Podcasts

2011-02-22

In this podcast, Dr Kiren Mitruka, medical officer with CDC's Tuberculosis Outbreak Investigations team, discusses tuberculosis outbreak investigations in the U.S. from 2002-2008.  Created: 2/22/2011 by National Center for Emerging Zoonotic and Infectious Diseases (NCEZID).   Date Released: 3/22/2011.

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

Localised transmission hotspots of a typhoid fever outbreak in the ...

African Journals Online (AJOL)

abp

2017-10-27

Oct 27, 2017 ... The practice of sharing a latrine with more than five families was higher among cases in the camps (8% versus. 3%). None of the observed latrines of the cases in camps and only. 3% of cases in the general population had materials to improve hand hygiene (soap, mud, ash) or water for washing hands at a.

Grasshopper species composition shifts following a severe rangeland grasshopper outbreak

Science.gov (United States)

Little is known about how grasshopper species abundances shift during and following severe outbreaks, as sampling efforts usually end when outbreaks subside. Grasshopper densities, species composition and vegetation have infrequently been sampled during and after a severe outbreak in the western U.S...

A mass vaccination campaign targeting adults and children to prevent typhoid fever in Hechi; Expanding the use of Vi polysaccharide vaccine in Southeast China: A cluster-randomized trial

Directory of Open Access Journals (Sweden)

Yang Hong-hui

2005-05-01

Full Text Available Abstract Background One of the goals of this study was to learn the coverage, safety and logistics of a mass vaccination campaign against typhoid fever in children and adults using locally produced typhoid Vi polysaccharide (PS and group A meningococcal PS vaccines in southern China. Methods The vaccination campaign targeted 118,588 persons in Hechi, Guangxi Province, aged between 5 to 60 years, in 2003. The study area was divided into 107 geographic clusters, which were randomly allocated to receive one of the single-dose parenteral vaccines. All aspects regarding vaccination logistics, feasibility and safety were documented and systematically recorded. Results of the logistics, feasibility and safety are reported. Results The campaign lasted 5 weeks and the overall vaccination coverage was 78%. On average, the 30 vaccine teams gave immunizations on 23 days. Vaccine rates were higher in those aged ≤ 15 years (90% than in adolescents and young adults (70%. Planned mop-up activities increased the coverage by 17%. The overall vaccine wastage was 11%. The cold chain was maintained and documented. 66 individuals reported of adverse events out of all vaccinees, where fever (21%, malaise (19% and local redness (19% were the major symptoms; no life-threatening event occurred. Three needle-sharp events were reported. Conclusion The mass immunization proved feasible and safe, and vaccine coverage was high. Emphasis should be placed on: injection safety measures, community involvement and incorporation of mop-up strategies into any vaccination campaign. School-based and all-age Vi mass immunizations programs are potentially important public health strategies for prevention of typhoid fever in high-risk populations in southern China.

The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014.

Science.gov (United States)

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

2016-01-01

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

Estimated Cost to a Restaurant of a Foodborne Illness Outbreak.

Science.gov (United States)

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

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

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

Science.gov (United States)

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

2011-01-01

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

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

Science.gov (United States)

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

2010-08-01

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

Molecular Investigation of Tularemia Outbreaks, Spain, 1997–2008

Science.gov (United States)

Ariza-Miguel, Jaime; Johansson, Anders; Fernández-Natal, María Isabel; Martínez-Nistal, Carmen; Orduña, Antonio; Rodríguez-Ferri, Elías F.; Hernández, Marta

2014-01-01

Tularemia outbreaks occurred in northwestern Spain in 1997–1998 and 2007–2008 and affected >1,000 persons. We assessed isolates involved in these outbreaks by using pulsed-field gel electrophoresis with 2 restriction enzymes and multilocus variable number tandem repeat analysis of 16 genomic loci of Francisella tularensis, the cause of this disease. Isolates were divided into 3 pulsotypes by pulsed-field gel electrophoresis and 8 allelic profiles by multilocus variable number tandem repeat analysis. Isolates obtained from the second tularemia outbreak had the same genotypes as isolates obtained from the first outbreak. Both outbreaks were caused by genotypes of genetic subclade B.Br:FTNF002–00, which is widely distributed in countries in central and western Europe. Thus, reemergence of tularemia in Spain was not caused by the reintroduction of exotic strains, but probably by persistence of local reservoirs of infection. PMID:24750848

Identification by PCR of non-typhoidal Salmonella enterica serovars associated with invasive infections among febrile patients in Mali.

Directory of Open Access Journals (Sweden)

Sharon M Tennant

2010-03-01

Full Text Available In sub-Saharan Africa, non-typhoidal Salmonella (NTS are emerging as a prominent cause of invasive disease (bacteremia and focal infections such as meningitis in infants and young children. Importantly, including data from Mali, three serovars, Salmonella enterica serovar Typhimurium, Salmonella Enteritidis and Salmonella Dublin, account for the majority of non-typhoidal Salmonella isolated from these patients.We have extended a previously developed series of polymerase chain reactions (PCRs based on O serogrouping and H typing to identify Salmonella Typhimurium and variants (mostly I 4,[5],12:i:-, Salmonella Enteritidis and Salmonella Dublin. We also designed primers to detect Salmonella Stanleyville, a serovar found in West Africa. Another PCR was used to differentiate diphasic Salmonella Typhimurium and monophasic Salmonella Typhimurium from other O serogroup B, H:i serovars. We used these PCRs to blind-test 327 Salmonella serogroup B and D isolates that were obtained from the blood cultures of febrile patients in Bamako, Mali.We have shown that when used in conjunction with our previously described O-serogrouping PCR, our PCRs are 100% sensitive and specific in identifying Salmonella Typhimurium and variants, Salmonella Enteritidis, Salmonella Dublin and Salmonella Stanleyville. When we attempted to differentiate 171 Salmonella Typhimurium (I 4,[ 5],12:i:1,2 strains from 52 monophasic Salmonella Typhimurium (I 4,[5],12:i:- strains, we were able to correctly identify 170 of the Salmonella Typhimurium and 51 of the Salmonella I 4,[5],12:i:- strains.We have described a simple yet effective PCR method to support surveillance of the incidence of invasive disease caused by NTS in developing countries.

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

Science.gov (United States)

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

2016-12-24

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

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.

Outbreak of caliciviruses in the Singapore military, 2015.

Science.gov (United States)

Neo, Freddy Jun Xian; Loh, Jimmy Jin Phang; Ting, Peijun; Yeo, Wei Xin; Gao, Christine Qiu Han; Lee, Vernon Jian Ming; Tan, Boon Huan; Ng, Ching Ging

2017-11-14

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. 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). 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. 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.

Model-specification uncertainty in future forest pest outbreak.

Science.gov (United States)

Boulanger, Yan; Gray, David R; Cooke, Barry J; De Grandpré, Louis

2016-04-01

Climate change will modify forest pest outbreak characteristics, although there are disagreements regarding the specifics of these changes. A large part of this variability may be attributed to model specifications. As a case study, we developed a consensus model predicting spruce budworm (SBW, Choristoneura fumiferana [Clem.]) outbreak duration using two different predictor data sets and six different correlative methods. The model was used to project outbreak duration and the uncertainty associated with using different data sets and correlative methods (=model-specification uncertainty) for 2011-2040, 2041-2070 and 2071-2100, according to three forcing scenarios (RCP 2.6, RCP 4.5 and RCP 8.5). The consensus model showed very high explanatory power and low bias. The model projected a more important northward shift and decrease in outbreak duration under the RCP 8.5 scenario. However, variation in single-model projections increases with time, making future projections highly uncertain. Notably, the magnitude of the shifts in northward expansion, overall outbreak duration and the patterns of outbreaks duration at the southern edge were highly variable according to the predictor data set and correlative method used. We also demonstrated that variation in forcing scenarios contributed only slightly to the uncertainty of model projections compared with the two sources of model-specification uncertainty. Our approach helped to quantify model-specification uncertainty in future forest pest outbreak characteristics. It may contribute to sounder decision-making by acknowledging the limits of the projections and help to identify areas where model-specification uncertainty is high. As such, we further stress that this uncertainty should be strongly considered when making forest management plans, notably by adopting adaptive management strategies so as to reduce future risks. © 2015 Her Majesty the Queen in Right of Canada Global Change Biology © 2015 Published by John

Cost of dengue outbreaks: literature review and country case studies

Science.gov (United States)

2013-01-01

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

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

Science.gov (United States)

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

2016-01-01

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

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

Directory of Open Access Journals (Sweden)

Jan-Willem H Dik

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

Crisis prevention and management during SARS outbreak, Singapore.

Science.gov (United States)

Quah, Stella R; Hin-Peng, Lee

2004-02-01

We discuss crisis prevention and management during the first 3 months of the severe acute respiratory syndrome (SARS) outbreak in Singapore. Four public health issues were considered: prevention measures, self-health evaluation, SARS knowledge, and appraisal of crisis management. We conducted telephone interviews with a representative sample of 1,201 adults, > or = 21 years of age. We found that sex, age, and attitude (anxiety and perception of open communication with authorities) were associated with practicing preventive measures. Analysis of Singapore's outbreak improves our understanding of the social dimensions of infectious disease outbreaks.

[Outbreaks of viral hepatitis E in the Czech Republic?].

Science.gov (United States)

Trmal, Josef; Pavlík, Ivo; Vasícková, Petra; Matejícková, Ladislava; Simůnková, Lenka; Luks, Stanislav; Pazderková, Jana

2012-05-01

Until recently, viral hepatitis E (VHE) has typically been an imported infection, related to travel to developing countries. A number of travel-unrelated VHE cases currently diagnosed in the Czech Republic. Outcomes of the epidemiological investigations of two VHE outbreaks associated with the consumption of pork and pork products at pig-slaughtering feasts are presented. Thirteen cases have been reported in the first outbreak and eight cases in the second outbreak. The epidemiological investigations are described and the experience gained in analysing suspected biological specimens is presented. The source of infection has not been identified in the first outbreak while in the other one, a link between human cases and infection in farm pigs was revealed for the first time. Although the epidemiological investigation may not always lead to the detection of the VHE source, it must be conducted in any outbreak and can only be successful when done in cooperation of the public health authorities with the veterinary health agency.

Measles Outbreak among Unvaccinated Children in Bajura

Directory of Open Access Journals (Sweden)

S Sitaula

2010-12-01

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

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

Directory of Open Access Journals (Sweden)

Cindy Perscheid

2018-04-01

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

Human angiostrongyliasis outbreak in Dali, China.

Science.gov (United States)

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

2009-09-22

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

Building test data from real outbreaks for evaluating detection algorithms.

Science.gov (United States)

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

2017-01-01

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

Building test data from real outbreaks for evaluating detection algorithms.

Directory of Open Access Journals (Sweden)

Gaetan Texier

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

Identification of Five Novel Salmonella Typhi-Specific Genes as Markers for Diagnosis of Typhoid Fever Using Single-Gene Target PCR Assays

Directory of Open Access Journals (Sweden)

Yuan Xin Goay

2016-01-01

Full Text Available Salmonella Typhi (S. Typhi causes typhoid fever which is a disease characterised by high mortality and morbidity worldwide. In order to curtail the transmission of this highly infectious disease, identification of new markers that can detect the pathogen is needed for development of sensitive and specific diagnostic tests. In this study, genomic comparison of S. Typhi with other enteric pathogens was performed, and 6 S. Typhi genes, that is, STY0201, STY0307, STY0322, STY0326, STY2020, and STY2021, were found to be specific in silico. Six PCR assays each targeting a unique gene were developed to test the specificity of these genes in vitro. The diagnostic sensitivities and specificities of each assay were determined using 39 S. Typhi, 62 non-Typhi Salmonella, and 10 non-Salmonella clinical isolates. The results showed that 5 of these genes, that is, STY0307, STY0322, STY0326, STY2020, and STY2021, demonstrated 100% sensitivity (39/39 and 100% specificity (0/72. The detection limit of the 5 PCR assays was 32 pg for STY0322, 6.4 pg for STY0326, STY2020, and STY2021, and 1.28 pg for STY0307. In conclusion, 5 PCR assays using STY0307, STY0322, STY0326, STY2020, and STY2021 were developed and found to be highly specific at single-gene target resolution for diagnosis of typhoid fever.

Identification of Five Novel Salmonella Typhi-Specific Genes as Markers for Diagnosis of Typhoid Fever Using Single-Gene Target PCR Assays.

Science.gov (United States)

Goay, Yuan Xin; Chin, Kai Ling; Tan, Clarissa Ling Ling; Yeoh, Chiann Ying; Ja'afar, Ja'afar Nuhu; Zaidah, Abdul Rahman; Chinni, Suresh Venkata; Phua, Kia Kien

2016-01-01

Salmonella Typhi ( S . Typhi) causes typhoid fever which is a disease characterised by high mortality and morbidity worldwide. In order to curtail the transmission of this highly infectious disease, identification of new markers that can detect the pathogen is needed for development of sensitive and specific diagnostic tests. In this study, genomic comparison of S . Typhi with other enteric pathogens was performed, and 6 S . Typhi genes, that is, STY0201, STY0307, STY0322, STY0326, STY2020, and STY2021, were found to be specific in silico . Six PCR assays each targeting a unique gene were developed to test the specificity of these genes in vitro . The diagnostic sensitivities and specificities of each assay were determined using 39 S . Typhi, 62 non-Typhi Salmonella , and 10 non- Salmonella clinical isolates. The results showed that 5 of these genes, that is, STY0307, STY0322, STY0326, STY2020, and STY2021, demonstrated 100% sensitivity (39/39) and 100% specificity (0/72). The detection limit of the 5 PCR assays was 32 pg for STY0322, 6.4 pg for STY0326, STY2020, and STY2021, and 1.28 pg for STY0307. In conclusion, 5 PCR assays using STY0307, STY0322, STY0326, STY2020, and STY2021 were developed and found to be highly specific at single-gene target resolution for diagnosis of typhoid fever.

The highly virulent 2006 Norwegian EHEC O103:H25 outbreak strain is related to the 2011 German O104:H4 outbreak strain.

Directory of Open Access Journals (Sweden)

Trine M L'Abée-Lund

Full Text Available In 2006, a severe foodborne EHEC outbreak occured in Norway. Seventeen cases were recorded and the HUS frequency was 60%. The causative strain, Esherichia coli O103:H25, is considered to be particularly virulent. Sequencing of the outbreak strain revealed resemblance to the 2011 German outbreak strain E. coli O104:H4, both in genome and Shiga toxin 2-encoding (Stx2 phage sequence. The nucleotide identity between the Stx2 phages from the Norwegian and German outbreak strains was 90%. During the 2006 outbreak, stx(2-positive O103:H25 E. coli was isolated from two patients. All the other outbreak associated isolates, including all food isolates, were stx-negative, and carried a different phage replacing the Stx2 phage. This phage was of similar size to the Stx2 phage, but had a distinctive early phage region and no stx gene. The sequence of the early region of this phage was not retrieved from the bacterial host genome, and the origin of the phage is unknown. The contaminated food most likely contained a mixture of E. coli O103:H25 cells with either one of the phages.

Re-examination of immune response and estimation of anti-Vi IgG protective threshold against typhoid fever-based on the efficacy trial of Vi conjugate in young children.

Science.gov (United States)

Szu, Shousun C; Klugman, Keith P; Hunt, Steven

2014-04-25

The capsular polysaccharide of Salmonella enterica serovar Typhi, Vi antigen, is an essential virulence factor and a protective antigen. Similar to other polysaccharide vaccines, the protective action of Vi, both to the polysaccharide alone or when presented as a conjugate, is mediated by serum IgG Vi antibodies. The evaluation of Vi capsular polysaccharide based vaccines to prevent typhoid fever would be significantly facilitated by the identification of a "protective level" of serum antibodies to Vi antigen. The protective level of anti-Vi IgG against typhoid fever was derived from the protective efficacy and immune response of a Vi-rEPA conjugate vaccine efficacy trial. The estimation was derived by two methods: correlation of the percent efficacy and the antibody distribution profile in the vaccine group at a given period of observation, and use of the relative ratio of anti-Vi IgG levels between the vaccine and placebo groups greater or equal to the Relative Risk of typhoid fever used in the efficacy determination. Both methods predicted a similar range of a minimum protective level of anti-Vi IgG between 1.4 and 2.0μg/ml (short term threshold). When applying a protective threshold of 10μg/ml at 6 months post immunization, an IgG level in excess of 1.4μg/ml was achieved by 90% of children at 46 months post immunization, consistent with an 89% level of protection over the duration of the study. We thus suggest that the proportion of children with Vi IgG>10μg/ml (long term threshold) 6 months after immunization may reflect the proportion protected over at least a 4 year period. The current assignment of an anti-Vi IgG protective level may be of value when evaluating vaccine performance of future Vi conjugate vaccines. Published by Elsevier Ltd.

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...

Detection and forecasting of oyster norovirus outbreaks: recent advances and future perspectives.

Science.gov (United States)

Wang, Jiao; Deng, Zhiqiang

2012-09-01

Norovirus is a highly infectious pathogen that is commonly found in oysters growing in fecally contaminated waters. Norovirus outbreaks can cause the closure of oyster harvesting waters and acute gastroenteritis in humans associated with consumption of contaminated raw oysters. Extensive efforts and progresses have been made in detection and forecasting of oyster norovirus outbreaks over the past decades. The main objective of this paper is to provide a literature review of methods and techniques for detecting and forecasting oyster norovirus outbreaks and thereby to identify the future directions for improving the detection and forecasting of norovirus outbreaks. It is found that (1) norovirus outbreaks display strong seasonality with the outbreak peak occurring commonly in December-March in the U.S. and April-May in the Europe; (2) norovirus outbreaks are affected by multiple environmental factors, including but not limited to precipitation, temperature, solar radiation, wind, and salinity; (3) various modeling approaches may be employed to forecast norovirus outbreaks, including Bayesian models, regression models, Artificial Neural Networks, and process-based models; and (4) diverse techniques are available for near real-time detection of norovirus outbreaks, including multiplex PCR, seminested PCR, real-time PCR, quantitative PCR, and satellite remote sensing. The findings are important to the management of oyster growing waters and to future investigations into norovirus outbreaks. It is recommended that a combined approach of sensor-assisted real time monitoring and modeling-based forecasting should be utilized for an efficient and effective detection and forecasting of norovirus outbreaks caused by consumption of contaminated oysters. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

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

2017-01-01

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

Swine flu - A pandemic outbreak

Directory of Open Access Journals (Sweden)

Jini George

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

Additional value of typing Noroviruses in gastroenteritis outbreaks in Amsterdam, The Netherlands.

Science.gov (United States)

Koek, A G; Bovée, L P M J; van den Hoek, J A R; Bos, A J; Bruisten, S M

2006-02-01

In Amsterdam, 17 of the 55 gastroenteritis (GI) outbreaks reported from January 2002 to May 2003 were confirmed to be caused by noroviruses (NV). In this study, we describe the molecular epidemiology of a group of nine outbreaks associated with a catering firm and two outbreaks, 5 months apart, in an Amsterdam hospital. All outbreaks were typed to confirm their linkage, and the hospital-related cases were studied to see if the two outbreaks were caused by one persisting NV strain or by a reintroduction after 5 months. For the outbreaks associated with the catering firm one NV genogroup I strain was found which was identical in sequence among customers and employees of the caterer. This was not the strain that predominantly circulated in 2002/2003 in and around Amsterdam, which was the NV genogroup II4 "new variant" (GgII4nv) strain. In the Amsterdam hospital, the two outbreaks were caused by this predominant GgII4nv type, and we argue that NV was most likely reintroduced in the second outbreak from the Amsterdam community.

Mitigating measles outbreaks in West Africa post-Ebola.

Science.gov (United States)

Truelove, Shaun A; Moss, William J; Lessler, Justin

2015-01-01

The Ebola outbreak in 2014-2015 devastated the populations, economies and healthcare systems of Guinea, Liberia and Sierra Leone. With this devastation comes the impending threat of outbreaks of other infectious diseases like measles. Strategies for mitigating these risks must include both prevention, through vaccination, and case detection and management, focused on surveillance, diagnosis and appropriate clinical care and case management. With the high transmissibility of measles virus, small-scale reactive vaccinations will be essential to extinguish focal outbreaks, while national vaccination campaigns are needed to guarantee vaccination coverage targets are reached in the long term. Rapid and multifaceted strategies should carefully navigate challenges present in the wake of Ebola, while also taking advantage of current Ebola-related activities and international attention. Above all, resources and focus currently aimed at these countries must be utilized to build up the deficit in infrastructure and healthcare systems that contributed to the extent of the Ebola outbreak.

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

Science.gov (United States)

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

2011-09-23

Since 1971, CDC, the Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data related to occurrences and causes of waterborne disease outbreaks associated with drinking water. This surveillance system is the primary source of data concerning the scope and health effects of waterborne disease outbreaks in the United States. Data presented summarize 48 outbreaks that occurred during January 2007--December 2008 and 70 previously unreported outbreaks. WBDOSS includes data on outbreaks associated with drinking water, recreational water, water not intended for drinking (WNID) (excluding recreational water), and water use of unknown intent (WUI). Public health agencies in the states, U.S. territories, localities, and Freely Associated States are primarily responsible for detecting and investigating outbreaks and reporting them voluntarily to CDC by a standard form. Only data on outbreaks associated with drinking water, WNID (excluding recreational water), and WUI are summarized in this report. Outbreaks associated with recreational water are reported separately. A total of 24 states and Puerto Rico reported 48 outbreaks that occurred during 2007--2008. Of these 48 outbreaks, 36 were associated with drinking water, eight with WNID, and four with WUI. The 36 drinking water--associated outbreaks caused illness among at least 4,128 persons and were linked to three deaths. Etiologic agents were identified in 32 (88.9%) of the 36 drinking water--associated outbreaks; 21 (58.3%) outbreaks were associated with bacteria, five (13.9%) with viruses, three (8.3%) with parasites, one (2.8%) with a chemical, one (2.8%) with both bacteria and viruses, and one (2.8%) with both bacteria and parasites. Four outbreaks (11.1%) had unidentified etiologies. Of the 36 drinking water--associated outbreaks, 22 (61.1%) were outbreaks of

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

Science.gov (United States)

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

2017-11-01

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

Developing a climate-based risk map of fascioliasis outbreaks in Iran

Directory of Open Access Journals (Sweden)

Mansour Halimi

2015-09-01

Full Text Available Summary: The strong relationship between climate and fascioliasis outbreaks enables the development of climate-based models to estimate the potential risk of fascioliasis outbreaks. This work aims to develop a climate-based risk map of fascioliasis outbreaks in Iran using Ollerenshaw's fascioliasis risk index incorporating geographical information system (GIS. Using this index, a risk map of fascioliasis outbreaks for the entire country was developed. We determined that the country can be divided into 4 fascioliasis outbreak risk categories. Class 1, in which the Mt value is less than 100, includes more than 0.91 of the country's area. The climate in this class is not conducive to fascioliasis outbreaks in any month. Dryness and low temperature in the wet season (December to April are the key barriers against fascioliasis outbreaks in this class. The risk map developed based on climatic factors indicated that only 0.03 of the country's area, including Gilan province in the northern region of Iran, is highly suitable to fascioliasis outbreaks during September to January. The Mt value is greater than 500 in this class. Heavy rainfall in the summer and fall, especially in Rasht, Astara and Bandar Anzaly (≥1000 mm/year, creates more suitable breeding places for snail intermediate hosts. Keywords: Ollerenshaw fascioliasis risk index, Climate, Gilan province, Iran

Developing a climate-based risk map of fascioliasis outbreaks in Iran.

Science.gov (United States)

Halimi, Mansour; Farajzadeh, Manuchehr; Delavari, Mahdi; Arbabi, Mohsen

2015-01-01

The strong relationship between climate and fascioliasis outbreaks enables the development of climate-based models to estimate the potential risk of fascioliasis outbreaks. This work aims to develop a climate-based risk map of fascioliasis outbreaks in Iran using Ollerenshaw's fascioliasis risk index incorporating geographical information system (GIS). Using this index, a risk map of fascioliasis outbreaks for the entire country was developed. We determined that the country can be divided into 4 fascioliasis outbreak risk categories. Class 1, in which the Mt value is less than 100, includes more than 0.91 of the country's area. The climate in this class is not conducive to fascioliasis outbreaks in any month. Dryness and low temperature in the wet season (December to April) are the key barriers against fascioliasis outbreaks in this class. The risk map developed based on climatic factors indicated that only 0.03 of the country's area, including Gilan province in the northern region of Iran, is highly suitable to fascioliasis outbreaks during September to January. The Mt value is greater than 500 in this class. Heavy rainfall in the summer and fall, especially in Rasht, Astara and Bandar Anzaly (≥ 1000 mm/year), creates more suitable breeding places for snail intermediate hosts. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

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.

Ebola virus outbreak, updates on current therapeutic strategies.

Science.gov (United States)

Elshabrawy, Hatem A; Erickson, Timothy B; Prabhakar, Bellur S

2015-07-01

Filoviruses are enveloped negative-sense single-stranded RNA viruses, which include Ebola and Marburg viruses, known to cause hemorrhagic fever in humans with a case fatality of up to 90%. There have been several Ebola virus outbreaks since the first outbreak in the Democratic Republic of Congo in 1976 of which, the recent 2013-2015 epidemic in Guinea, Liberia, and Sierra Leone is the largest in recorded history. Within a few months of the start of the outbreak in December 2013, thousands of infected cases were reported with a significant number of deaths. As of March 2015, according to the Centers for Disease Control and Prevention, there have been nearly 25,000 suspected cases, with 15,000 confirmed by laboratory testing, and over 10,000 deaths. The large number of cases and the high mortality rate, combined with the lack of effective Food and Drug Administration-approved treatments, necessitate the development of potent and safe therapeutic measures to combat the current and future outbreaks. Since the beginning of the outbreak, there have been considerable efforts to develop and characterize protective measures including vaccines and antiviral small molecules, and some have proven effective in vitro and in animal models. Most recently, a cocktail of monoclonal antibodies has been shown to be highly effective in protecting non-human primates from Ebola virus infection. In this review, we will discuss what is known about the nature of the virus, phylogenetic classification, genomic organization and replication, disease transmission, and viral entry and highlight the current approaches and efforts, in the development of therapeutics, to control the outbreak. Copyright © 2015 John Wiley & Sons, Ltd.

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

Directory of Open Access Journals (Sweden)

John M Drake

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

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.

An Outbreak of Foodborne Botulism in Ontario

Directory of Open Access Journals (Sweden)

Mona R Loutfy

2003-01-01

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

Summary of Notifiable Diseases, United States, 1993.

Science.gov (United States)

1994-10-21

Parsonnet J, Greene KD, Gerber AR, et al. Shigella dysenteriaetype 1 infections in U.S. travellers to Mexico . Lancet 1989:543-5. Ries AA, Wells JG...typhoid vaccination: information for the practic- ing physician. JAMA 1991;265(6):756-9. xvi Varicella CDC. Varicella outbreak in a women’s prison...Kentucky. MMWR 1989;38(37):635-6,641-2. Gershon AA, LaRussa R Hardy I, Steinberg S, Silverstein S. Varicella vaccine: the American expe- rience. J

Measles outbreaks affecting children in Jewish ultra-orthodox communities in Jerusalem

Science.gov (United States)

STEIN-ZAMIR, C.; ZENTNER, G.; ABRAMSON, N.; SHOOB, H.; ABOUDY, Y.; SHULMAN, L.; MENDELSON, E.

2008-01-01

SUMMARY In 2003 and 2004 two measles outbreaks occurred in Jewish ultra-orthodox communities in Jerusalem. The index case of the first outbreak (March 2003) was a 2-year-old unvaccinated child from Switzerland. Within 5 months, 107 cases (mean age 8·3±7·5 years) emerged in three crowded neighbourhoods. The first cases of the second outbreak (June 2004) were in three girls aged 4–5 years in one kindergarten in another community. By November 2004, 117 cases (mean age 7·3±6·5 years) occurred. The virus genotypes were D8 and D4 respectively. Altogether, 96 households accounted for the two outbreaks, with two or more patients per family in 79% of cases. Most cases (91·5%) were unvaccinated. Immunization coverage was lower in outbreak than in non-outbreak neighbourhoods (88·3% vs. 90·3%, P=0·001). Controlling the outbreaks necessitated a culture-sensitive approach, and targeted efforts increased MMR vaccine coverage (first dose) to 95·2%. Despite high national immunization coverage (94–95%), special attention to specific sub-populations is essential. PMID:17433131

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

Directory of Open Access Journals (Sweden)

Werber Dirk

2012-02-01

Full Text Available Abstract 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

The importance of waterborne disease outbreak surveillance in the United States

Directory of Open Access Journals (Sweden)

Gunther Franz Craun

2012-12-01

Full Text Available Analyses of the causes of disease outbreaks associated with contaminated drinking water in the United States have helped inform prevention efforts at the national, state, and local levels. This article describes the changing nature of disease outbreaks in public water systems during 1971-2008 and discusses the importance of a collaborative waterborne outbreak surveillance system established in 1971. Increasing reports of outbreaks throughout the early 1980s emphasized that microbial contaminants remained a health-risk challenge for suppliers of drinking water. Outbreak investigations identified the responsible etiologic agents and deficiencies in the treatment and distribution of drinking water, especially the high risk associated with unfiltered surface water systems. Surveillance information was important in establishing an effective research program that guided government regulations and industry actions to improve drinking water quality. Recent surveillance statistics suggest that prevention efforts based on these research findings have been effective in reducing outbreak risks especially for surface water systems.

Mumps outbreak in Israel's highly vaccinated society: are two doses enough?

Science.gov (United States)

Anis, E; Grotto, I; Moerman, L; Warshavsky, B; Slater, P E; Lev, B

2012-03-01

Mumps outbreaks in recent years have given rise to questions about the effectiveness of the mumps vaccine. This study examined the epidemiological data from a recent mumps outbreak in Israel and from outbreaks in other countries with high vaccination coverage, and considered whether long-established vaccination policies designed to protect against mumps are in need of revision. Of over 5000 case patients in the Israeli outbreak, half of whom were in the Jerusalem health district, nearly 40% were aged ≥15 years and, of those whose vaccination status was known, 78% had been fully vaccinated for their age - features similar to those in recent mumps outbreaks in Europe and North America. The epidemiological and laboratory evidence suggests that many previously vaccinated adolescents and young adults are now susceptible to mumps because their vaccine-based immunity has waned. Booster vaccination programmes for those at high risk of infection during mumps outbreaks - particularly those in congregate living environments - merit priority consideration.

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.

Literature Review of Associations among Attributes of Reported Drinking Water Disease Outbreaks

Directory of Open Access Journals (Sweden)

Grant Ligon

2016-05-01

Full Text Available Waterborne disease outbreaks attributed to various pathogens and drinking water system characteristics have adversely affected public health worldwide throughout recorded history. Data from drinking water disease outbreak (DWDO reports of widely varying breadth and depth were synthesized to investigate associations between outbreak attributes and human health impacts. Among 1519 outbreaks described in 475 sources identified during review of the primarily peer-reviewed, English language literature, most occurred in the U.S., the U.K. and Canada (in descending order. The outbreaks are most frequently associated with pathogens of unknown etiology, groundwater and untreated systems, and catchment realm-associated deficiencies (i.e., contamination events. Relative frequencies of outbreaks by various attributes are comparable with those within other DWDO reviews, with water system size and treatment type likely driving most of the (often statistically-significant at p < 0.05 differences in outbreak frequency, case count and attack rate. Temporal analysis suggests that while implementation of surface (drinking water management policies is associated with decreased disease burden, further strengthening of related policies is needed to address the remaining burden attributed to catchment and distribution realm-associated deficiencies and to groundwater viral and disinfection-only system outbreaks.

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

Science.gov (United States)

2013-01-01

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

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

Science.gov (United States)

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

2013-07-31

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

A large rubella outbreak with spread from the workplace to the community.

Science.gov (United States)

Danovaro-Holliday, M C; LeBaron, C W; Allensworth, C; Raymond, R; Borden, T G; Murray, A B; Icenogle, J P; Reef, S E

2000-12-06

Childhood vaccination has reduced rubella disease to low levels in the United States, but outbreaks continue to occur. The largest outbreak in the past 5 years occurred in Nebraska in 1999. To examine risk factors for disease, susceptibility of the risk population, role of vaccine failure, and the need for new vaccination strategies in response to the Nebraska rubella outbreak. Investigation of 83 confirmed rubella cases occurring in Douglas County, Nebraska, between March 23 and August 24, 1999; serosurvey of 413 pregnant women in the outbreak locale between October 1998 and March 1999 (prior to outbreak) and April and November 1999 (during and after outbreak). Case characteristics, compared with that of the general county population; area childhood rubella vaccination rates; and susceptibility among pregnant women before vs during and after the outbreak. All 83 rubella cases were unvaccinated or had unknown vaccination status and fell into 3 groups: (1) 52 (63%) were young adults (median age, 26 years), 83% of whom were born in Latin American countries where rubella vaccination was not routine. They were either employed in meatpacking plants or were their household contacts. Attack rates in the plants were high (14.4 per 1000 vs 0. 19 per 1000 for general county population); (2) 16 (19%), including 14 children (9 of whom were aged pregnant women, susceptibility rates were 13% before the outbreak and 11% during and after the outbreak. Six (25%) of 24 susceptible women tested were seropositive for rubella IgM. Rubella vaccination rates were 90.2% for preschool children and 99.8% for school-aged children. A large rubella outbreak occurred among unvaccinated persons in a community with high immunity levels. Crowded working and living conditions facilitated transmission, but vaccine failure did not. Workplace vaccination could be considered to prevent similar outbreaks. JAMA. 2000;284:2733-2739.

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

Science.gov (United States)

Kamata, N; Kamata, N

2002-04-01

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

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.

Human angiostrongyliasis outbreak in Dali, China.

Directory of Open Access Journals (Sweden)

Shan Lv

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

Molecular Characterization of Two Major Dengue Outbreaks in Costa Rica.

Science.gov (United States)

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

2016-07-06

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

An isolated outbreak of diphtheria in South Africa, 2015.

Science.gov (United States)

Mahomed, S; Archary, M; Mutevedzi, P; Mahabeer, Y; Govender, P; Ntshoe, G; Kuhn, W; Thomas, J; Olowolagba, A; Blumberg, L; McCarthy, K; Mlisana, K; DU Plessis, M; VON Gottberg, A; Moodley, P

2017-07-01

An outbreak of respiratory diphtheria occurred in two health districts in the province of KwaZulu-Natal in South Africa in 2015. A multidisciplinary outbreak response team was involved in the investigation and management of the outbreak. Fifteen cases of diphtheria were identified, with ages ranging from 4 to 41 years. Of the 12 cases that were under the age of 18 years, 9 (75%) were not fully immunized for diphtheria. The case fatality was 27%. Ninety-three household contacts, 981 school or work contacts and 595 healthcare worker contacts were identified and given prophylaxis against Corynebacterium diphtheriae infection. A targeted vaccination campaign for children aged 6-15 years was carried out at schools in the two districts. The outbreak highlighted the need to improve diphtheria vaccination coverage in the province and to investigate the feasibility of offering diphtheria vaccines to healthcare workers.

Longevity and fecundity of Dichroplus maculipennis (Orthoptera, Acrididae at non-outbreaking and outbreaking situations Longevidade e fecundidade de Dichroplus maculipennis (Orthoptera: Acrididae: Melanoplinae em situações de "non-outbreaking" e "outbreaking"

Directory of Open Access Journals (Sweden)

Yanina Mariottini

2011-09-01

Full Text Available Dichroplus maculipennis is one of the most characteristic and damaging grasshopper species of Argentina, mainly in areas of the Pampas and Patagonia regions. We estimated and compared the longevity and fecundity of adult female D. maculipennis under controlled conditions (30ºC, 14L:10D, 40% RH from individuals collected as last instar nymphs (VI in the field and with a known recent history of low and high density conditions. Densities of D. maculipennis at the collecting sites were 0.95 individuals per m² in 2006 and 46 ind/m² in 2009, representing non-outbreaking and outbreaking situations, respectively. Adult female longevity in 2006 (67.96 ± 3.2 days was significantly higher (p 0.05. The fecundity curves showed that the highest values were at weeks 11 and 13 for the 2006 females, and at week 6 for those of 2009. Since the daily oviposition rate at low and high densities was not significantly different, the diminished fecundity rate at high density is attributable to their reduced longevity.O gafanhoto Dichroplus maculipennis é um dos mais característicos e prejudiciales da Argentina, principalmente nas regiões das Pampas e da Patagonia. O objetivo deste estudo foi estimar e comparar a longevidade e fecundidade das fêmeas adultas do D. maculipennis sob condições controladas (30ºC, 14 luz: 10 obscuridad, 40% RH a partir do indivíduos coletados em campo como ultimo estadio ninfal (VI e con historia recente conocida de baixas e altas densidades. As densidades de D. maculipennis nos locais de coleta foram de 0.95 indivíduos por m² em 2006 e 46 indivíduos/m² em 2009, representando situações de "non-outbreaking" e "outbreaking", respectivamente. A longevidade das fêmeas adultas em 2006 (67.96 ± 3.2 dias foi significamente maior (p 0.05. No entanto, as baixas taxas de fecundidade das fêmeas em densidades elevadas, se devem, provavelmente à longevidade reduzida.

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

Science.gov (United States)

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

2018-03-01

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

Investigation of Phenolic Compounds and Antioxidant Activity of Mentha spicata L. subsp. spicata and M. longifolia (L.) L. subsp. typhoides (Briq.) Harley Decoction and Infusion

OpenAIRE

ÖZER, Züleyha

2018-01-01

In present study, we report phenolic compounds and antioxidant activity of decoctionand infusion of Mentha spicata L. subsp. spicataand M. longifolia (L.) L. subsp. typhoides (Briq.) Harley. The quantitativeamounts of the phenolic contents were determined by LC-MS/MS.  The main compounds and amounts of M. spicata weredetermined as follow for decoction; caffeic acid, quercetagetin-3,6-dimethyletherand penduletin (4126.6; 2141.5; 1472.7 mg/kg dried herba, respectively), for infusion;fumaric aci...

An outbreak of enterotoxigenic Escherichia coli (ETEC) infection in Norway, 2012: a reminder to consider uncommon pathogens in outbreaks involving imported products.

Science.gov (United States)

MacDonald, E; Møller, K E; Wester, A L; Dahle, U R; Hermansen, N O; Jenum, P A; Thoresen, L; Vold, L

2015-02-01

We investigated an outbreak of gastroenteritis following a Christmas buffet served on 4-9 December 2012 to ~1300 hotel guests. More than 300 people were reported ill in initial interviews with hotel guests. To identify possible sources of infection we conducted a cohort investigation through which we identified 214 probable cases. Illness was associated with consumption of scrambled eggs (odds ratio 9·07, 95% confidence interval 5·20-15·84). Imported chives added fresh to the scrambled eggs were the suspected source of the outbreak but were unavailable for testing. Enterotoxigenic Escherichia coli (ETEC) infection was eventually confirmed in 40 hotel guests. This outbreak reinforces that ETEC should be considered in non-endemic countries when the clinical picture is consistent and common gastrointestinal pathogens are not found. Following this outbreak, the Norwegian Food Safety Authority recommended that imported fresh herbs should be heat-treated before use in commercial kitchens.

A Methanol Intoxication Outbreak From Recreational Ingestion of Fracking Fluid.

Science.gov (United States)

Collister, David; Duff, Graham; Palatnick, Wesley; Komenda, Paul; Tangri, Navdeep; Hingwala, Jay

2017-05-01

Single-patient methanol intoxications are a common clinical presentation, but outbreaks are rare and usually occur in settings in which there is limited access to ethanol and methanol is consumed as a substitute. In this case report, we describe an outbreak of methanol intoxications that was challenging from a public health perspective and discuss strategies for managing such an outbreak. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2018-01-05

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

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

Directory of Open Access Journals (Sweden)

Assaf Anyamba

2012-01-01

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

GHOST: global hepatitis outbreak and surveillance technology.

Science.gov (United States)

Longmire, Atkinson G; Sims, Seth; Rytsareva, Inna; Campo, David S; Skums, Pavel; Dimitrova, Zoya; Ramachandran, Sumathi; Medrzycki, Magdalena; Thai, Hong; Ganova-Raeva, Lilia; Lin, Yulin; Punkova, Lili T; Sue, Amanda; Mirabito, Massimo; Wang, Silver; Tracy, Robin; Bolet, Victor; Sukalac, Thom; Lynberg, Chris; Khudyakov, Yury

2017-12-06

Hepatitis C is a major public health problem in the United States and worldwide. Outbreaks of hepatitis C virus (HCV) infections associated with unsafe injection practices, drug diversion, and other exposures to blood are difficult to detect and investigate. Effective HCV outbreak investigation requires comprehensive surveillance and robust case investigation. We previously developed and validated a methodology for the rapid and cost-effective identification of HCV transmission clusters. Global Hepatitis Outbreak and Surveillance Technology (GHOST) is a cloud-based system enabling users, regardless of computational expertise, to analyze and visualize transmission clusters in an independent, accurate and reproducible way. We present and explore performance of several GHOST implemented algorithms using next-generation sequencing data experimentally obtained from hypervariable region 1 of genetically related and unrelated HCV strains. GHOST processes data from an entire MiSeq run in approximately 3 h. A panel of seven specimens was used for preparation of six repeats of MiSeq libraries. Testing sequence data from these libraries by GHOST showed a consistent transmission linkage detection, testifying to high reproducibility of the system. Lack of linkage among genetically unrelated HCV strains and constant detection of genetic linkage between HCV strains from known transmission pairs and from follow-up specimens at different levels of MiSeq-read sampling indicate high specificity and sensitivity of GHOST in accurate detection of HCV transmission. GHOST enables automatic extraction of timely and relevant public health information suitable for guiding effective intervention measures. It is designed as a virtual diagnostic system intended for use in molecular surveillance and outbreak investigations rather than in research. The system produces accurate and reproducible information on HCV transmission clusters for all users, irrespective of their level of bioinformatics

Typing of Typhoidal Salmonella Using Extraction of Water Soluble Whole Cell Proteins and Analysing by SDS-PAGE

Directory of Open Access Journals (Sweden)

R. Yousefi Mashouf

2005-10-01

Full Text Available Introduction & Objective : Salmonella is one of the most important genus of Enterobacteriacea family. The aim of this study was typing of typhoidal Salmonella by SDS-PAGE and comparing the results with those of serotyping method.Materials and Methods: In this study, 4 reference strains of Salmonella species, 5 reference strains of Enterobacteriacea family and 100 clinical isolates of Salmonella that were previously collected from laboratories of Hamadan medical centers were studied. Serotyping of strains were performed by Biomereux and Difco monovalent antisera. Whole-cell proteins of strains were also separated on 10% poly acrylamide gel. Gels were stained by Coomassie Brilliant Blue and analyzed by densitometry. Results: Of 100 cases of Salmonella species, 43 cases (43% were S. typhi, 20 cases (20% were S. typhymurium, 12 cases (12% were S. para typhi B, 10 cases (10% were S. para typhi C, S. para typhi A 1 case (1% and other cases were non-typhoidal Salmonella. The results of serotyping were compared with the results obtained by SDS-PAGE. Many protein bands from 220 KDa to 18.5 KDa were detected by SDS-PAGE and they were used to differentiate the strains. S. typhi serotypes were divided into 5 sub-species and S. para typhi B and C were divided each into 3 sub-species. Protein profiles of the reference strains of Salmonella were compared with protein profiles of Enterobacteriaceae species and showed some differences in major protein bands, however, they had a very similar protein band in 43 KDa area. Conclusion: Since our data was able to divide Salmonella species to sub-types and differentiate them from Enterobacteriacea species, we concluded that analsying SDS-PAGE profile of water soluble whole-cell proteins can be used for typing of these organisms and it is comparble with serotyping, nevertheless, further researches are needed to establish SDS-PAGE method and to replace it with serotyping method.

Giardiasis in Bergen. Outbreak and clinical consequences.

OpenAIRE

Wensaas, Knut-Arne

2011-01-01

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

An Outbreak of Sheep Pox in Zabajkalskij kray of Russia.

Science.gov (United States)

Maksyutov, R A; Gavrilova, E V; Agafonov, A P; Taranov, O S; Glotov, A G; Miheev, V N; Shchelkunov, S N; Sergeev, A N

2015-08-01

In this study, we investigated recent sheep pox outbreaks that occurred in Ononsky and Borzunsky regions of Zabajkalskij kray of Russia. The outbreaks involved in 2756 animals of which 112 were infected and 3 were slaughtered. Samples of injured skin of infected sheep were analysed by electron microscopy and CaPV-specific P32 gene amplification. Following sequence analysis of entire P32 gene showed that both specimens were identical to the sequence of several sheep poxvirus isolates from China and India. The close location of China to the last decade's Russian outbreaks suggest that possible future outbreaks in Russia could occur along the border regions with countries where sheep and goat pox are not controlled. © 2013 Blackwell Verlag GmbH.

Hydrogen outbreak of Zirconium Molybdate Hihydrate

International Nuclear Information System (INIS)

Miura, Yasuhiko; Fukuda, Kazuhiro; Ochi, Eiji

2008-01-01

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

Landscape Epidemiology of Tularemia Outbreaks in Sweden

Science.gov (United States)

Svensson, Kerstin; Bäck, Erik; Eliasson, Henrik; Berglund, Lennart; Granberg, Malin; Karlsson, Linda; Larsson, Pär; Forsman, Mats

2009-01-01

Summer outbreaks of tularemia that occurred from 1995 through 2005 in 2 locations in Sweden affected 441 persons. We performed an epidemiologic investigation of these outbreaks using a novel strategy, involving high-resolution genotyping of Francisella tularensis isolates obtained from 136 patients (using 18 genetic markers developed from 6 F. tularensis genome sequences) and interviews with the patients. Strong spatial associations were found between F. tularensis subpopulations and the places of disease transmission; infection by some subpopulations occurred within areas as small as 2 km2, indicating unidentified environmental point sources of tularemia. In both locations, disease clusters were associated with recreational areas beside water, and genetic subpopulations were present throughout the tularemia season and persisted over years. High-resolution genotyping in combination with patients’ statements about geographic places of disease transmission provided valuable indications of likely sources of infection and the causal genotypes during these tularemia outbreaks. PMID:19961673

Cholera Outbreaks in Urban Bangladesh In 2011.

Science.gov (United States)

Haque, Farhana; Hossain, M Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd; Rahman, Mahmudur; Luby, Stephen P

In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae . The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate approaches for ensuring safe drinking

Influenza outbreak during Sydney World Youth Day 2008: the utility of laboratory testing and case definitions on mass gathering outbreak containment.

Directory of Open Access Journals (Sweden)

Sebastiaan J van Hal

Full Text Available BACKGROUND: Influenza causes annual epidemics and often results in extensive outbreaks in closed communities. To minimize transmission, a range of interventions have been suggested. For these to be effective, an accurate and timely diagnosis of influenza is required. This is confirmed by a positive laboratory test result in an individual whose symptoms are consistent with a predefined clinical case definition. However, the utility of these clinical case definitions and laboratory testing in mass gathering outbreaks remains unknown. METHODS AND RESULTS: An influenza outbreak was identified during World Youth Day 2008 in Sydney. From the data collected on pilgrims presenting to a single clinic, a Markov model was developed and validated against the actual epidemic curve. Simulations were performed to examine the utility of different clinical case definitions and laboratory testing strategies for containment of influenza outbreaks. Clinical case definitions were found to have the greatest impact on averting further cases with no added benefit when combined with any laboratory test. Although nucleic acid testing (NAT demonstrated higher utility than indirect immunofluorescence antigen or on-site point-of-care testing, this effect was lost when laboratory NAT turnaround times was included. The main benefit of laboratory confirmation was limited to identification of true influenza cases amenable to interventions such as antiviral therapy. CONCLUSIONS: Continuous re-evaluation of case definitions and laboratory testing strategies are essential for effective management of influenza outbreaks during mass gatherings.

In vivo expression of Salmonella enterica serotype Typhi genes in the blood of patients with typhoid fever in Bangladesh.

Directory of Open Access Journals (Sweden)

Alaullah Sheikh

2011-12-01

Full Text Available Salmonella enterica serotype Typhi is the cause of typhoid fever. It is a human-restricted pathogen, and few data exist on S. Typhi gene expression in humans.We applied an RNA capture and amplification technique, Selective Capture of Transcribed Sequences (SCOTS, and microarray hybridization to identify S. Typhi transcripts expressed in the blood of five humans infected with S. Typhi in Bangladesh. In total, we detected the expression of mRNAs for 2,046 S. Typhi genes (44% of the S. Typhi genome in human blood; expression of 912 genes was detected in all 5 patients, and expression of 1,100 genes was detected in 4 or more patients. Identified transcripts were associated with the virulence-associated PhoP regulon, Salmonella pathogenicity islands, the use of alternative carbon and energy sources, synthesis and transport of iron, thiamine, and biotin, and resistance to antimicrobial peptides and oxidative stress. The most highly represented group were genes currently annotated as encoding proteins designated as hypothetical, unknown, or unclassified. Of the 2,046 detected transcripts, 1,320 (29% of the S. Typhi genome had significantly different levels of detection in human blood compared to in vitro cultures; detection of 141 transcripts was significantly different in all 5 patients, and detection of 331 transcripts varied in at least 4 patients. These mRNAs encode proteins of unknown function, those involved in energy metabolism, transport and binding, cell envelope, cellular processes, and pathogenesis. We confirmed increased expression of a subset of identified mRNAs by quantitative-PCR.We report the first characterization of bacterial transcriptional profiles in the blood of patients with typhoid fever. S. Typhi is an important global pathogen whose restricted host range has greatly inhibited laboratory studies. Our results suggest that S. Typhi uses a largely uncharacterized genetic repertoire to survive within cells and utilize alternate

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

Science.gov (United States)

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

2014-12-01

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

An outbreak of Salmonella Typhimurium infections in Denmark, Norway and Sweden, 2008.

Science.gov (United States)

Bruun, T; Sørensen, G; Forshell, L P; Jensen, T; Nygard, K; Kapperud, G; Lindstedt, B A; Berglund, T; Wingstrand, A; Petersen, R F; Müller, L; Kjelsø, C; Ivarsson, S; Hjertqvist, M; Löfdahl, S; Ethelberg, S

2009-03-12

In November-December 2008, Norway and Denmark independently identified outbreaks of Salmonella Typhimurium infections characterised in the multiple-locus variable number of tandem repeats analysis (MLVA) by a distinct profile. Outbreak investigations were initiated independently in the two countries. In Denmark, a total of 37 cases were identified, and multiple findings of the outbreak strain in pork and pigs within the same supply chain led to the identification of pork in various forms as the source. In Norway, ten cases were identified, and the outbreak investigation quickly indicated meat bought in Sweden as the probable source and the Swedish authorities were alerted. Investigations in Sweden identified four human cases and two isolates from minced meat with the distinct profile. Subsequent trace-back of the meat showed that it most likely originated from Denmark. Through international alert from Norway on 19 December, it became clear that the Danish and Norwegian outbreak strains were identical and, later on, that the source of the outbreaks in all three countries could be traced back to Danish pork. MLVA was instrumental in linking the outbreaks in the different countries and tracing the source. This outbreak illustrates that good international communication channels, early alerting mechanisms, inter-sectoral collaboration between public health and food safety authorities and harmonised molecular typing tools are important for effective identification and management of cross-border outbreaks. Differences in legal requirements for food safety in neighbouring countries may be a challenge in terms of communication with consumers in areas where cross-border shopping is common.

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.

Diphtheria outbreak with high mortality in northeastern Nigeria.

Science.gov (United States)

Besa, N C; Coldiron, M E; Bakri, A; Raji, A; Nsuami, M J; Rousseau, C; Hurtado, N; Porten, K

2014-04-01

SUMMARY A diphtheria outbreak occurred from February to November 2011 in the village of Kimba and its surrounding settlements, in Borno State, northeastern Nigeria. We conducted a retrospective outbreak investigation in Kimba village and the surrounding settlements to better describe the extent and clinical characteristics of this outbreak. Ninety-eight cases met the criteria of the case definition of diphtheria, 63 (64.3%) of whom were children aged diphtheria. None of the 98 cases received diphtheria antitoxin, penicillin, or erythromycin during their illness. The overall case-fatality ratio was 21.4%, and was highest in children aged 0-4 years (42.9%). Low rates of immunization, delayed clinical recognition of diphtheria and absence of treatment with antitoxin and appropriate antibiotics contributed to this epidemic and its severity.

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

Science.gov (United States)

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

2009-01-01

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

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.

Outbreaks of gastroenteritis linked to lettuce, Denmark, January 2010

DEFF Research Database (Denmark)

Ethelberg, S.; Lisby, M.; Bottiger, B.

2010-01-01

At least 11 linked outbreaks of gastroenteritis with a total of 260 cases have occurred in Denmark in mid January 2010. Investigations showed that the outbreaks were caused by norovirus of several genotypes and by enterotoxigenic Escherichia coli. Lettuce of the lollo bionda type grown in France...

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015.

Science.gov (United States)

Kabwama, Steven Ndugwa; Bulage, Lilian; Nsubuga, Fred; Pande, Gerald; Oguttu, David Were; Mafigiri, Richardson; Kihembo, Christine; Kwesiga, Benon; Masiira, Ben; Okullo, Allen Eva; Kajumbula, Henry; Matovu, Joseph K B; Makumbi, Issa; Wetaka, Milton; Kasozi, Sam; Kyazze, Simon; Dahlke, Melissa; Hughes, Peter; Sendagala, Juliet Nsimire; Musenero, Monica; Nabukenya, Immaculate; Hill, Vincent R; Mintz, Eric; Routh, Janell; Gómez, Gerardo; Bicknese, Amelia; Zhu, Bao-Ping

2017-01-05

On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a "strange disease" that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. From 17 February-12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (OR M-H  = 8.90; 95%CI = 1.60-49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (OR M-H  = 4.60; 95%CI: 1.90-11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.

Mining the key predictors for event outbreaks in social networks

Science.gov (United States)

Yi, Chengqi; Bao, Yuanyuan; Xue, Yibo

2016-04-01

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

Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system.

Science.gov (United States)

Ashbaugh, Hayley R; Kuang, Brandon; Gadoth, Adva; Alfonso, Vivian H; Mukadi, Patrick; Doshi, Reena H; Hoff, Nicole A; Sinai, Cyrus; Mossoko, Mathias; Kebela, Benoit Ilunga; Muyembe, Jean-Jacques; Wemakoy, Emile Okitolonda; Rimoin, Anne W

2017-09-01

Ebola virus disease (EVD) can be clinically severe and highly fatal, making surveillance efforts for early disease detection of paramount importance. In areas with limited access to laboratory testing, the Integrated Disease Surveillance and Response (IDSR) strategy in the Democratic Republic of Congo (DRC) may be a vital tool in improving outbreak response. Using DRC IDSR data from the nation's four EVD outbreak periods from 2007-2014, we assessed trends of Viral Hemorrhagic Fever (VHF) and EVD differential diagnoses reportable through IDSR. With official case counts from active surveillance of EVD outbreaks, we assessed accuracy of reporting through the IDSR passive surveillance system. Although the active and passive surveillance represent distinct sets of data, the two were correlated, suggesting that passive surveillance based only on clinical evaluation may be a useful predictor of true cases prior to laboratory confirmation. There were 438 suspect VHF cases reported through the IDSR system and 416 EVD cases officially recorded across the outbreaks examined. Although collected prior to official active surveillance cases, case reporting through the IDSR during the 2007, 2008 and 2012 outbreaks coincided with official EVD epidemic curves. Additionally, all outbreak areas experienced increases in suspected cases for both malaria and typhoid fever during EVD outbreaks, underscoring the importance of training health care workers in recognising EVD differential diagnoses and the potential for co-morbidities. © 2017 John Wiley & Sons Ltd.

Investigation of outbreaks of Pneumocystis jirovecii pneumonia in two Scottish renal units.

Science.gov (United States)

Inkster, T; Dodd, S; Gunson, R; Imrie, L; Spalding, E; Packer, S; Deighan, C; Daly, C; Coia, J; Imtiaz, T; McGuffie, C; Wilson, R; Bal, A M

2017-06-01

Pneumocystis jirovecii is recognized as an opportunistic pathogen. In recent years, human-to-human transmission of P. jirovecii has been demonstrated. However, outbreaks of P. jirovecii infections are not well defined because the epidemiological setting that facilitates transmission is not fully understood. This article describes two outbreaks of P. jirovecii pneumonia (PCP) in renal transplant patients in the West of Scotland. In total, 25 patients in two geographically contiguous locations were affected. Allele B was identified as the dominant type, along with allele A3. It was not possible to determine the exact reason for clustering of cases, although the outpatient clinic setting featured in one of the outbreaks. The outbreaks ceased with the use of trimethoprim-sulphamethoxazole prophylaxis; the target populations that received prophylaxis were different in the two outbreaks. Infection control teams should be alert to the possibility of outbreaks of PCP. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

A comprehensive database of the geographic spread of past human Ebola outbreaks.

Science.gov (United States)

Mylne, Adrian; Brady, Oliver J; Huang, Zhi; Pigott, David M; Golding, Nick; Kraemer, Moritz U G; Hay, Simon I

2014-01-01

Ebola is a zoonotic filovirus that has the potential to cause outbreaks of variable magnitude in human populations. This database collates our existing knowledge of all known human outbreaks of Ebola for the first time by extracting details of their suspected zoonotic origin and subsequent human-to-human spread from a range of published and non-published sources. In total, 22 unique Ebola outbreaks were identified, composed of 117 unique geographic transmission clusters. Details of the index case and geographic spread of secondary and imported cases were recorded as well as summaries of patient numbers and case fatality rates. A brief text summary describing suspected routes and means of spread for each outbreak was also included. While we cannot yet include the ongoing Guinea and DRC outbreaks until they are over, these data and compiled maps can be used to gain an improved understanding of the initial spread of past Ebola outbreaks and help evaluate surveillance and control guidelines for limiting the spread of future epidemics.

Outbreak of Diarrhetic Shellfish Poisoning Associated with Mussels, British Columbia, Canada

Science.gov (United States)

Taylor, Marsha; McIntyre, Lorraine; Ritson, Mark; Stone, Jason; Bronson, Roni; Bitzikos, Olga; Rourke, Wade; Galanis, Eleni

2013-01-01

In 2011, a Diarrhetic Shellfish Poisoning (DSP) outbreak occurred in British Columbia (BC), Canada that was associated with cooked mussel consumption. This is the first reported DSP outbreak in BC. Investigation of ill individuals, traceback of product and laboratory testing for toxins were used in this investigation. Sixty-two illnesses were reported. Public health and food safety investigation identified a common food source and harvest area. Public health and regulatory agencies took actions to recall product and notify the public. Shellfish monitoring program changes were implemented after the outbreak. Improved response and understanding of toxin production will improve management of future DSP outbreaks. PMID:23697950

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 ...

Molecular Investigation into a Malaria Outbreak in Cusco, Peru: Plasmodium falciparum BV1 Lineage is Linked to a Second Outbreak in Recent Times

Science.gov (United States)

Okoth, Sheila Akinyi; Chenet, Stella M.; Arrospide, Nancy; Gutierrez, Sonia; Cabezas, Cesar; Matta, Jose Antonio; Udhayakumar, Venkatachalam

2016-01-01

In November 2013, a Plasmodium falciparum malaria outbreak of 11 cases occurred in Cusco, southern Peru, where falciparum malaria had not been reported since 1946. Although initial microscopic diagnosis reported only Plasmodium vivax infection in each of the specimens, subsequent examination by the national reference laboratory confirmed P. falciparum infection in all samples. Molecular typing of four available isolates revealed identity as the B-variant (BV1) strain that was responsible for a malaria outbreak in Tumbes, northern Peru, between 2010 and 2012. The P. falciparum BV1 strain is multidrug resistant, can escape detection by PfHRP2-based rapid diagnostic tests, and has contributed to two malaria outbreaks in Peru. This investigation highlights the importance of accurate species diagnosis given the potential for P. falciparum to be reintroduced to regions where it may have been absent. Similar molecular epidemiological investigations can track the probable source(s) of outbreak parasite strains for malaria surveillance and control purposes. PMID:26483121

Polio outbreak investigation and response in Somalia, 2013.

Science.gov (United States)

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

2014-11-01

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

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

Science.gov (United States)

2010-11-05

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

Genomic epidemiology of the Escherichia coli O104:H4 outbreaks in Europe, 2011

DEFF Research Database (Denmark)

Grad, Yonatan H; Lipsitch, Marc; Feldgarden, Michael

2012-01-01

The degree to which molecular epidemiology reveals information about the sources and transmission patterns of an outbreak depends on the resolution of the technology used and the samples studied. Isolates of Escherichia coli O104:H4 from the outbreak centered in Germany in May-July 2011, and the ...... that purged diversity in the German isolates, variation in mutation rates in the two E. coli outbreak populations, or uneven distribution of diversity in the seed populations that led to each outbreak....... remarkably little diversity, with only two single nucleotide polymorphisms (SNPs) found in isolates from four individuals. Surprisingly, we found much greater diversity (19 SNPs) in isolates from seven individuals infected in the French outbreak. The German isolates form a clade within the more diverse...... French outbreak strains. Moreover, five isolates derived from a single infected individual from the French outbreak had extremely limited diversity. The striking difference in diversity between the German and French outbreak samples is consistent with several hypotheses, including a bottleneck...

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

Science.gov (United States)

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

2010-10-01

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

Outbreak of Vibrio parahaemolyticus Sequence Type 120, Peru, 2009.

Science.gov (United States)

Gonzalez-Escalona, Narjol; Gavilan, Ronnie G; Toro, Magaly; Zamudio, Maria L; Martinez-Urtaza, Jaime

2016-07-01

In 2009, an outbreak of Vibrio parahaemolyticus occurred in Piura, Cajamarca, Lambayeque, and Lima, Peru. Whole-genome sequencing of clinical and environmental samples from the outbreak revealed a new V. parahaemolyticus clone. All the isolates identified belonged to a single clonal complex described exclusively in Asia before its emergence in Peru.

Additional value of typing Noroviruses in gastroenteritis outbreaks in Amsterdam, The Netherlands

NARCIS (Netherlands)

Koek, A. G.; Bovée, L. P. M. J.; van den Hoek, J. A. R.; Bos, A. J.; Bruisten, S. M.

2006-01-01

In Amsterdam, 17 of the 55 gastroenteritis (GI) outbreaks reported from January 2002 to May 2003 were confirmed to be caused by noroviruses (NV). In this study, we describe the molecular epidemiology of a group of nine outbreaks associated with a catering firm and two outbreaks, 5 months apart, in

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.

Assessment of the response to cholera outbreaks in two districts in Ghana.

Science.gov (United States)

Ohene, Sally-Ann; Klenyuie, Wisdom; Sarpeh, Mark

2016-11-02

Despite recurring outbreaks of cholera in Ghana, very little has been reported on assessments of outbreak response activities undertaken in affected areas. This study assessed the response activities undertaken in two districts, Akatsi District in Volta Region and Komenda-Edina-Eguafo-Abirem (KEEA) Municipal in Central Region during the 2012 cholera epidemic in Ghana. We conducted a retrospective assessment of the events, strengths and weaknesses of the cholera outbreak response activities in the two districts making use of the WHO cholera evaluation tool. Information sources included surveillance and facility records, reports and interviews with relevant health personnel involved in the outbreak response from both district health directorates and health facilities. We collected data on age, sex, area of residence, date of reporting to health facility of cholera cases, district population data and information on the outbreak response activities and performed descriptive analyses of the outbreak data by person, time and place. The cholera outbreak in Akatsi was explosive with a high attack rate (AR) of 374/100,000 and case fatality rate (CFR) of 1.2 % while that in KEEA was on a relatively smaller scale AR of 23/100,000 but with a high case fatality rate of 18.8 %. For both districts, we identified multiple strengths in the response to the outbreak including timely notification of the district health officials which triggered prompt investigation of the suspected outbreak facilitating confirmation of cholera and initiation of public health response activities. Others were coordination of the activities by multi-sectoral committees, instituting water, sanitation and hygiene measures and appropriate case management at health facilities. We also found areas that needed improvement in both districts including incomplete surveillance data, sub-optimal community based surveillance considering the late reporting and the deaths in the community and the inadequate

Waterborne norovirus outbreak in a municipal drinking-water supply in Sweden.

Science.gov (United States)

Riera-Montes, M; Brus Sjölander, K; Allestam, G; Hallin, E; Hedlund, K-O; Löfdahl, M

2011-12-01

During Easter 2009, almost 200 people resident in a small Swedish village fell ill with gastrointestinal symptoms. We conducted a retrospective cohort study and a molecular investigation in order to identify the source of the outbreak. Residents living in households connected to the public water network were at an increased risk of developing disease (relative risk 4·80, 95% confidence interval 1·68-13·73) compared to those with no connection to the public network. Norovirus genotype GI.3 was identified in stool samples from six patients and in a sample from the public water network. Contamination of one of the wells supplying the public water network was thought to be the source of the outbreak. This is a description of a norovirus outbreak linked to a municipal drinking-water supply in Sweden. Information from epidemiological and molecular investigations is of utmost importance to guide outbreak control measures and to prevent future outbreaks.

Identification and control of a poliomyelitis outbreak in Xinjiang, China.

Science.gov (United States)

Luo, Hui-Ming; Zhang, Yong; Wang, Xin-Qi; Yu, Wen-Zhou; Wen, Ning; Yan, Dong-Mei; Wang, Hua-Qing; Wushouer, Fuerhati; Wang, Hai-Bo; Xu, Ai-Qiang; Zheng, Jing-Shan; Li, De-Xin; Cui, Hui; Wang, Jian-Ping; Zhu, Shuang-Li; Feng, Zi-Jian; Cui, Fu-Qiang; Ning, Jing; Hao, Li-Xin; Fan, Chun-Xiang; Ning, Gui-Jun; Yu, Hong-Jie; Wang, Shi-Wen; Liu, Da-Wei; Wang, Dong-Yan; Fu, Jian-Ping; Gou, Ai-li; Zhang, Guo-Min; Huang, Guo-Hong; Chen, Yuan-Sheng; Mi, Sha-Sha; Liu, Yan-Min; Yin, Da-Peng; Zhu, Hui; Fan, Xin-Chun; Li, Xin-Lan; Ji, Yi-Xin; Li, Ke-Li; Tang, Hai-Shu; Xu, Wen-Bo; Wang, Yu; Yang, Wei-Zhong

2013-11-21

The last case of infection with wild-type poliovirus indigenous to China was reported in 1994, and China was certified as a poliomyelitis-free region in 2000. In 2011, an outbreak of infection with imported wild-type poliovirus occurred in the province of Xinjiang. We conducted an investigation to guide the response to the outbreak, performed sequence analysis of the poliovirus type 1 capsid protein VP1 to determine the source, and carried out serologic and coverage surveys to assess the risk of viral propagation. Surveillance for acute flaccid paralysis was intensified to enhance case ascertainment. Between July 3 and October 9, 2011, investigators identified 21 cases of infection with wild-type poliovirus and 23 clinically compatible cases in southern Xinjiang. Wild-type poliovirus type 1 was isolated from 14 of 673 contacts of patients with acute flaccid paralysis (2.1%) and from 13 of 491 healthy persons who were not in contact with affected persons (2.6%). Sequence analysis implicated an imported wild-type poliovirus that originated in Pakistan as the cause of the outbreak. A public health emergency was declared in Xinjiang after the outbreak was confirmed. Surveillance for acute flaccid paralysis was enhanced, with daily reporting from all public and private hospitals. Five rounds of vaccination with live, attenuated oral poliovirus vaccine (OPV) were conducted among children and adults, and 43 million doses of OPV were administered. Trivalent OPV was used in three rounds, and monovalent OPV type 1 was used in two rounds. The outbreak was stopped 1.5 months after laboratory confirmation of the index case. The 2011 outbreak in China showed that poliomyelitis-free countries remain at risk for outbreaks while the poliovirus circulates anywhere in the world. Global eradication of poliomyelitis will benefit all countries, even those that are currently free of poliomyelitis.

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

OpenAIRE

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

2010-01-01

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

Pertussis outbreak in northwest Ireland, January - June 2010.

LENUS (Irish Health Repository)

Barret, A S

2010-09-02

We report a community pertussis outbreak that occurred in a small town located in the northwest of Ireland. Epidemiological investigations suggest that waning immunity and the absence of a booster dose during the second year of life could have contributed to the outbreak. The report also highlights the need to reinforce the surveillance of pertussis in Ireland and especially to improve the clinical and laboratory diagnosis of cases.

Internet and free press are associated with reduced lags in global outbreak reporting.

Science.gov (United States)

McAlarnen, Lindsey; Smith, Katherine; Brownstein, John S; Jerde, Christopher

2014-10-30

Global outbreak detection and reporting have generally improved for a variety of infectious diseases and geographic regions in recent decades. Nevertheless, lags in outbreak reporting remain a threat to the global human health and economy. In the time between first occurrence of a novel disease incident and public notification of an outbreak, infected individuals have a greater possibility of traveling and spreading the pathogen to other nations. Shortening outbreak reporting lags has the potential to improve global health by preventing local outbreaks from escalating into global epidemics. Reporting lags between the first record and the first public report of an event were calculated for 318 outbreaks occurring 1996-2009. The influence of freedom of the press, Internet usage, per capita health expenditure, and cell phone subscriptions, on the timeliness of outbreak reporting was evaluated. Freer presses and increasing Internet usage correlate with reduced time between the first record of an outbreak and the public report. Increasing Internet usage reduced the expected reporting lag from more than one month in nations without Internet users to one day in those where 75 of 100 people use the Internet. Advances in technology and the emergence of more open and free governments are associated with to improved global infectious disease surveillance.

Comparative study of four time series methods in forecasting typhoid fever incidence in China.

Science.gov (United States)

Zhang, Xingyu; Liu, Yuanyuan; Yang, Min; Zhang, Tao; Young, Alistair A; Li, Xiaosong

2013-01-01

Accurate incidence forecasting of infectious disease is critical for early prevention and for better government strategic planning. In this paper, we present a comprehensive study of different forecasting methods based on the monthly incidence of typhoid fever. The seasonal autoregressive integrated moving average (SARIMA) model and three different models inspired by neural networks, namely, back propagation neural networks (BPNN), radial basis function neural networks (RBFNN), and Elman recurrent neural networks (ERNN) were compared. The differences as well as the advantages and disadvantages, among the SARIMA model and the neural networks were summarized and discussed. The data obtained for 2005 to 2009 and for 2010 from the Chinese Center for Disease Control and Prevention were used as modeling and forecasting samples, respectively. The performances were evaluated based on three metrics: mean absolute error (MAE), mean absolute percentage error (MAPE), and mean square error (MSE). The results showed that RBFNN obtained the smallest MAE, MAPE and MSE in both the modeling and forecasting processes. The performances of the four models ranked in descending order were: RBFNN, ERNN, BPNN and the SARIMA model.

Comparative study of four time series methods in forecasting typhoid fever incidence in China.

Directory of Open Access Journals (Sweden)

Xingyu Zhang

Full Text Available Accurate incidence forecasting of infectious disease is critical for early prevention and for better government strategic planning. In this paper, we present a comprehensive study of different forecasting methods based on the monthly incidence of typhoid fever. The seasonal autoregressive integrated moving average (SARIMA model and three different models inspired by neural networks, namely, back propagation neural networks (BPNN, radial basis function neural networks (RBFNN, and Elman recurrent neural networks (ERNN were compared. The differences as well as the advantages and disadvantages, among the SARIMA model and the neural networks were summarized and discussed. The data obtained for 2005 to 2009 and for 2010 from the Chinese Center for Disease Control and Prevention were used as modeling and forecasting samples, respectively. The performances were evaluated based on three metrics: mean absolute error (MAE, mean absolute percentage error (MAPE, and mean square error (MSE. The results showed that RBFNN obtained the smallest MAE, MAPE and MSE in both the modeling and forecasting processes. The performances of the four models ranked in descending order were: RBFNN, ERNN, BPNN and the SARIMA model.

How Will Climate Change Impact Cholera Outbreaks?

Science.gov (United States)

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

2014-12-01

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

Identification of resistance and virulence factors in an epidemic Enterobacter hormaechei outbreak strain

NARCIS (Netherlands)

Paauw, A.; Caspers, M.P.M.; Leverstein-van Hall, M.A.; Schuren, F.H.J.; Montijn, R.C.; Verhoef, J.; Fluit, A.C.

2009-01-01

Bacterial strains differ in their ability to cause hospital outbreaks. Using comparative genomic hybridization, Enterobacter cloacae complex isolates were studied to identify genetic markers specific for Enterobacter cloacae complex outbreak strains. No outbreak-specific genes were found that were

A comprehensive database of the geographic spread of past human Ebola outbreaks

Science.gov (United States)

Mylne, Adrian; Brady, Oliver J.; Huang, Zhi; Pigott, David M.; Golding, Nick; Kraemer, Moritz U.G.; Hay, Simon I.

2014-01-01

Ebola is a zoonotic filovirus that has the potential to cause outbreaks of variable magnitude in human populations. This database collates our existing knowledge of all known human outbreaks of Ebola for the first time by extracting details of their suspected zoonotic origin and subsequent human-to-human spread from a range of published and non-published sources. In total, 22 unique Ebola outbreaks were identified, composed of 117 unique geographic transmission clusters. Details of the index case and geographic spread of secondary and imported cases were recorded as well as summaries of patient numbers and case fatality rates. A brief text summary describing suspected routes and means of spread for each outbreak was also included. While we cannot yet include the ongoing Guinea and DRC outbreaks until they are over, these data and compiled maps can be used to gain an improved understanding of the initial spread of past Ebola outbreaks and help evaluate surveillance and control guidelines for limiting the spread of future epidemics. PMID:25984346

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

Science.gov (United States)

Teo, C G

2018-01-01

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

Seroincidence of non-typhoid Salmonella infections: convenience vs. random community-based sampling.

Science.gov (United States)

Emborg, H-D; Simonsen, J; Jørgensen, C S; Harritshøj, L H; Krogfelt, K A; Linneberg, A; Mølbak, K

2016-01-01

The incidence of reported infections of non-typhoid Salmonella is affected by biases inherent to passive laboratory surveillance, whereas analysis of blood sera may provide a less biased alternative to estimate the force of Salmonella transmission in humans. We developed a mathematical model that enabled a back-calculation of the annual seroincidence of Salmonella based on measurements of specific antibodies. The aim of the present study was to determine the seroincidence in two convenience samples from 2012 (Danish blood donors, n = 500, and pregnant women, n = 637) and a community-based sample of healthy individuals from 2006 to 2007 (n = 1780). The lowest antibody levels were measured in the samples from the community cohort and the highest in pregnant women. The annual Salmonella seroincidences were 319 infections/1000 pregnant women [90% credibility interval (CrI) 210-441], 182/1000 in blood donors (90% CrI 85-298) and 77/1000 in the community cohort (90% CrI 45-114). Although the differences between study populations decreased when accounting for different age distributions the estimates depend on the study population. It is important to be aware of this issue and define a certain population under surveillance in order to obtain consistent results in an application of serological measures for public health purposes.

Population control methods in stochastic extinction and outbreak scenarios.

Directory of Open Access Journals (Sweden)

Juan Segura

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

Population control methods in stochastic extinction and outbreak scenarios.

Science.gov (United States)

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

2017-01-01

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

Response to a large rotavirus outbreak on South Tarawa, Kiribati, 2013