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Acute Campylobacter jejunii gastroenteritis in Majorca (Baelaric Isles, Spain)
PUBLIC HEALTH
29s
“ACUTE CAMPYLOBACTER JEJUNII GASTROENTERITIS IN MAIORCA (BAELARIC ISLES. SPAIN).” Antonia Calm& and 1. F. Martinez, Centro National de Epidemiologia, Madrid, Spain. I. Marti, Surveillance Epidemiology Section, Baleario Isles, Spain. Introduction: Campylohacter is one of the most common causes of acute
“AN OUTBREAK OF GASTROENTERITIS CAUSED BY C+ ARDIA LAMBLIA IN A DAY-CARE CENTER FOR CHILDREN IN SPAIN.” Gloria Hertin&, J. F. Martinez, and L. E. Visser, Centro National de Epidemiologia, Madrid, Spain. M. Subirars, J. Cano and M. Garcia-Hortelano, Centro de Investigaciones Clinicas.
diarrhea, with a high percentage of infections associated with chicken consumption. Outbreaks are not frequently reported however. In many cases, transmission routes remain unknown due to a combination of cross-contamination and low infective dose. In November 1995, seven cases of acute Campylohacter diarrhea in Majorca were reported. An investigation was conducted to ascertain if this was an outbreak, and to identify the transmission routes and epidemiologic features of the infection. Methodology: Campylobacter jejunii isolates from feces sampled hetween September and November 1995 in Majorca were compared with figures for the previous three years. Links hetween reported cases were investigated and a case-control study conducted. Cases were defined as any person with acute Campylobacter diarrhea in Majorca from September 1 through November 30, and controls as any person without diarrhea in the same period. Three controls per case, matched hy age, were selected at random from the Health Authority vaccmation database. Mantel-Haenszel’s Odds Ratio (OR) with 95% Conhdence Intervals (Cl) and Chi-Square (x1) test were calculated.
Introduction: In Spain up until now, no outbreaks of gastroenteritis in daycare centers for children caused by Giardia lamhlia, have been published, in contrast with other countries. This study investigates such an outbreak, especially for risk factors associated with the mode of transmission. Methodology: The case dehnition was based on confirmation of the pathogen in the stools. Different questionnaires were administered to the parents and the staff of the center. A case-control study, with controls selected from the same class and the same sex, and using the questionnaire for the staff, and an environmental study were carried out. Stool specimens were obtained from all children and staff, and also from family members of cases. Results: A total of 83 children (ages four months to four years) attended this center, divided in five classes (4 of them with cases). Between April and July of 1996, 21 cases were detected (18 children, 2 family members, and one worker who is also a family member). The most important symptoms recorded were: diarrhea (380/o), anorexia (25%), abdominal cramps (19%) and fever (19%). 38% of the cases were asymptomatic. The class most affected had a case attack rate of 53X, and attended to children who used diapers and were in toilet training. This was also the only class lacking an appropriate dumping place for stools and urine. In the case-control study, risk factors as the use of diapers (OR 1, 95% CI: 0.29-6), producing stools in the center (OR 1.78,95X CI: 0.37-8.77) use of pacifier or thumb sucking (OR 1, 95%) CI: 0.24-5) were analyzed, hut no risk factor was significant, possibly due to our small numbers. Food was ruled out as risk factor just as other training activities. Conclusion: In this outbreak of Giardia lamhlia the transmissmn route was person to person. To he a toddler was the most relevant factor, in comhination with inadequate conditions for the disposal of excreta. The study results are compatible with the available literature. In the control of the outbreak the improvement of the structural deficiencies and the intensification of hygienic measurements were emphasized.
Results: Sixty-one Campylobacter were wlated (44.2% of all isolates). Comparison with the precedmg three years did not reveal any difference (x’ = 2.48, p = 0.47). Reported cases showed neither time/space clustering nor any other links. The case-control study involved 25 cases and 62 controls. Sienificant associations of illness were found with: huvine noultrv at a chain store (OR = 4.36, 95% Cl: 1.42-13.83); and other c&e; of diarrhea in the family (OR = 11.39, 95% Cl: 2.75-54.56). Conclusions: Campybbacter is responsible for a large number of cases of acute diarrhea in Majorca, requiring ongoing epidemiological surveillance and investigation of case clustering. While neither the number of cases nor their time/space presentation indicated an outbreak, there was a strong association with a chain store. Measures were therefore taken and a specific program implemented. Since association between cases and family members with diarrhea suggests that Campylobacter causes domestic outbreaks, further investigatmn is called for.
“OUTBREAK OF CRYPTOSPORIDIUM IN A DRUG-ABUSE DETOXIFICATION CENTER IN THE PROVINCE OF LEON (SPAIN).” Luis Gon&ez. Centro National de Epidemiologia, Madrid, Spain. Introduction:
Cryptosporidium has been recognized as a cause of disease in humans smce 1976 and, in recent years, has regularly been identified as the cause of gastroenteritis in persons with and without immunodeficiency. In the second half of December 1995, an outbreak of Cryptosporidium was reported in a drug-abuse detoxification center in Le6n province. In such a population this parasite could cause a serious problem. Methodology: A retrospective cohort study was organized. Using questionnaire-based interviews with all inmates and staff, data was gathered on person, place, time and symptoms of disease. Additionally, the following were carried out: an environmental study of the center; microbiologic and parasitologic testing of feces In a sample from primary cases; and a parasitologic study of feces of all persons involved in the center. Samples from the different water supplies were analyzed and the water-catchment system inspected. Information was also collected on animals in the vicinity and the water supply system. Results: The index case registered symptoms on December 20. The epidemic curve peaked on December 26, 27 ( me d’tan case) and 28. The overall attack rate was 50% When existing pathology was taken into consideration, the attack rate was: 4O’Yo m r es’d I en t s with previous hepatitis B; 51.4% in those with previous hepatitis C; and 50% in those who were HIV+. A Relative Risk > 1 was only found in those with hepatitis C, though this was not statistically significant. Parasitologic analysis revealed Cryptosporidium cysts in 45 of the 53 feces samples analyzed, suggesting an infection level of 84.90% at the center, 5 1.1% of which fulfilled the original case defimtion. Cysts of Cryptosporidium were detected in the water supply system and in excreta of animals grazing close to the water-catchment system. Conclusions: Investigation of a waterborne outbreak of Cryptosporidium led to the paraslte heing identified in drinking water and in animals close to the system. No association was found with pre-existing disease or immune system status. A great number of infected subjects had no clinical symptoms, which was important in a specific center of this type. Research into the importance of carriers and the duration of this condition is called for. A water contamination surveillance system ought to he set up, if only for centers such as this.
“INVESTIGATION BREAK IN ARUA Kalyebbi, V. Owiny, Schools
Without
Introduction:
OF A PNEUMONIC PLAGUE OUTDISTRICT, UGANDA, JUNE 1996.” S. W. E. Maniple, and M. White. Uganda Public Health
Walls,
Kampala,
Uganda.
Arua is a rural district in the northwestern part of Uganda and has a population of 637,941. The district borders Nebbi which ia endemic for plague, having reported 350 cases in 1995. An outbreak of pneumonia was reported in May 1996 and we investigated it. The objectives were to identify the aetiologic agent and stop the transmission. Main Outcome Measure(s): A case control study was done. A case was a person with sudden onset of fever, headache, cough with hemoptysis and chest pain. A control was a well person of the same age plus or minus 5 years and sex from the same household, or the closest household. Sputum, pleural aspirate and blood were taken for laboratory analysis. An environmental survey of 70 homesteads was done. Results: The outbreak started on the 20th of May 1996 but was not reported untd early June because residents attributed it to witchcraft. Before intervention, the case fatality ratio was 9 deaths in 9 cases (100%); after intervention the case fatality ratio was O/13 (0%). There was a median of 3 days between onset and death. Fifty-five percent were male. Sputum, blood and pleural aspirate from 3 cases showed bipolar gram-negative coccohacilli. Matched chi square test showed having a case in a house was associated with acquiring plague (maximum likelihood estimation) odds ratio 6.56 (95% exact confidence interval 1.04-70.49). All the respondents had seen rats and fleas in their houses while 99% of the houses were of temporary nature, had holes and crevices on the walls and floors. All compounds were untidy. Conclusion: This was pneumonic plague. Intervention controlled the outbreak within 2 weeks. Health education was recommended. Crowded places like markets, schools and churches were closed. Health education was conducted to change people’s beliefs that the outbreak was due to witchcraft. All cases were put on tetracycline. All close contacts like relatives and health workers were put on prophylactic tetracycline.
29s
“ACUTE CAMPYLOBACTER JEJUNII GASTROENTERITIS IN MAIORCA (BAELARIC ISLES. SPAIN).” Antonia Calm& and 1. F. Martinez, Centro National de Epidemiologia, Madrid, Spain. I. Marti, Surveillance Epidemiology Section, Baleario Isles, Spain. Introduction: Campylohacter is one of the most common causes of acute
“AN OUTBREAK OF GASTROENTERITIS CAUSED BY C+ ARDIA LAMBLIA IN A DAY-CARE CENTER FOR CHILDREN IN SPAIN.” Gloria Hertin&, J. F. Martinez, and L. E. Visser, Centro National de Epidemiologia, Madrid, Spain. M. Subirars, J. Cano and M. Garcia-Hortelano, Centro de Investigaciones Clinicas.
diarrhea, with a high percentage of infections associated with chicken consumption. Outbreaks are not frequently reported however. In many cases, transmission routes remain unknown due to a combination of cross-contamination and low infective dose. In November 1995, seven cases of acute Campylohacter diarrhea in Majorca were reported. An investigation was conducted to ascertain if this was an outbreak, and to identify the transmission routes and epidemiologic features of the infection. Methodology: Campylobacter jejunii isolates from feces sampled hetween September and November 1995 in Majorca were compared with figures for the previous three years. Links hetween reported cases were investigated and a case-control study conducted. Cases were defined as any person with acute Campylobacter diarrhea in Majorca from September 1 through November 30, and controls as any person without diarrhea in the same period. Three controls per case, matched hy age, were selected at random from the Health Authority vaccmation database. Mantel-Haenszel’s Odds Ratio (OR) with 95% Conhdence Intervals (Cl) and Chi-Square (x1) test were calculated.
Introduction: In Spain up until now, no outbreaks of gastroenteritis in daycare centers for children caused by Giardia lamhlia, have been published, in contrast with other countries. This study investigates such an outbreak, especially for risk factors associated with the mode of transmission. Methodology: The case dehnition was based on confirmation of the pathogen in the stools. Different questionnaires were administered to the parents and the staff of the center. A case-control study, with controls selected from the same class and the same sex, and using the questionnaire for the staff, and an environmental study were carried out. Stool specimens were obtained from all children and staff, and also from family members of cases. Results: A total of 83 children (ages four months to four years) attended this center, divided in five classes (4 of them with cases). Between April and July of 1996, 21 cases were detected (18 children, 2 family members, and one worker who is also a family member). The most important symptoms recorded were: diarrhea (380/o), anorexia (25%), abdominal cramps (19%) and fever (19%). 38% of the cases were asymptomatic. The class most affected had a case attack rate of 53X, and attended to children who used diapers and were in toilet training. This was also the only class lacking an appropriate dumping place for stools and urine. In the case-control study, risk factors as the use of diapers (OR 1, 95% CI: 0.29-6), producing stools in the center (OR 1.78,95X CI: 0.37-8.77) use of pacifier or thumb sucking (OR 1, 95%) CI: 0.24-5) were analyzed, hut no risk factor was significant, possibly due to our small numbers. Food was ruled out as risk factor just as other training activities. Conclusion: In this outbreak of Giardia lamhlia the transmissmn route was person to person. To he a toddler was the most relevant factor, in comhination with inadequate conditions for the disposal of excreta. The study results are compatible with the available literature. In the control of the outbreak the improvement of the structural deficiencies and the intensification of hygienic measurements were emphasized.
Results: Sixty-one Campylobacter were wlated (44.2% of all isolates). Comparison with the precedmg three years did not reveal any difference (x’ = 2.48, p = 0.47). Reported cases showed neither time/space clustering nor any other links. The case-control study involved 25 cases and 62 controls. Sienificant associations of illness were found with: huvine noultrv at a chain store (OR = 4.36, 95% Cl: 1.42-13.83); and other c&e; of diarrhea in the family (OR = 11.39, 95% Cl: 2.75-54.56). Conclusions: Campybbacter is responsible for a large number of cases of acute diarrhea in Majorca, requiring ongoing epidemiological surveillance and investigation of case clustering. While neither the number of cases nor their time/space presentation indicated an outbreak, there was a strong association with a chain store. Measures were therefore taken and a specific program implemented. Since association between cases and family members with diarrhea suggests that Campylobacter causes domestic outbreaks, further investigatmn is called for.
“OUTBREAK OF CRYPTOSPORIDIUM IN A DRUG-ABUSE DETOXIFICATION CENTER IN THE PROVINCE OF LEON (SPAIN).” Luis Gon&ez. Centro National de Epidemiologia, Madrid, Spain. Introduction:
Cryptosporidium has been recognized as a cause of disease in humans smce 1976 and, in recent years, has regularly been identified as the cause of gastroenteritis in persons with and without immunodeficiency. In the second half of December 1995, an outbreak of Cryptosporidium was reported in a drug-abuse detoxification center in Le6n province. In such a population this parasite could cause a serious problem. Methodology: A retrospective cohort study was organized. Using questionnaire-based interviews with all inmates and staff, data was gathered on person, place, time and symptoms of disease. Additionally, the following were carried out: an environmental study of the center; microbiologic and parasitologic testing of feces In a sample from primary cases; and a parasitologic study of feces of all persons involved in the center. Samples from the different water supplies were analyzed and the water-catchment system inspected. Information was also collected on animals in the vicinity and the water supply system. Results: The index case registered symptoms on December 20. The epidemic curve peaked on December 26, 27 ( me d’tan case) and 28. The overall attack rate was 50% When existing pathology was taken into consideration, the attack rate was: 4O’Yo m r es’d I en t s with previous hepatitis B; 51.4% in those with previous hepatitis C; and 50% in those who were HIV+. A Relative Risk > 1 was only found in those with hepatitis C, though this was not statistically significant. Parasitologic analysis revealed Cryptosporidium cysts in 45 of the 53 feces samples analyzed, suggesting an infection level of 84.90% at the center, 5 1.1% of which fulfilled the original case defimtion. Cysts of Cryptosporidium were detected in the water supply system and in excreta of animals grazing close to the water-catchment system. Conclusions: Investigation of a waterborne outbreak of Cryptosporidium led to the paraslte heing identified in drinking water and in animals close to the system. No association was found with pre-existing disease or immune system status. A great number of infected subjects had no clinical symptoms, which was important in a specific center of this type. Research into the importance of carriers and the duration of this condition is called for. A water contamination surveillance system ought to he set up, if only for centers such as this.
“INVESTIGATION BREAK IN ARUA Kalyebbi, V. Owiny, Schools
Without
Introduction:
OF A PNEUMONIC PLAGUE OUTDISTRICT, UGANDA, JUNE 1996.” S. W. E. Maniple, and M. White. Uganda Public Health
Walls,
Kampala,
Uganda.
Arua is a rural district in the northwestern part of Uganda and has a population of 637,941. The district borders Nebbi which ia endemic for plague, having reported 350 cases in 1995. An outbreak of pneumonia was reported in May 1996 and we investigated it. The objectives were to identify the aetiologic agent and stop the transmission. Main Outcome Measure(s): A case control study was done. A case was a person with sudden onset of fever, headache, cough with hemoptysis and chest pain. A control was a well person of the same age plus or minus 5 years and sex from the same household, or the closest household. Sputum, pleural aspirate and blood were taken for laboratory analysis. An environmental survey of 70 homesteads was done. Results: The outbreak started on the 20th of May 1996 but was not reported untd early June because residents attributed it to witchcraft. Before intervention, the case fatality ratio was 9 deaths in 9 cases (100%); after intervention the case fatality ratio was O/13 (0%). There was a median of 3 days between onset and death. Fifty-five percent were male. Sputum, blood and pleural aspirate from 3 cases showed bipolar gram-negative coccohacilli. Matched chi square test showed having a case in a house was associated with acquiring plague (maximum likelihood estimation) odds ratio 6.56 (95% exact confidence interval 1.04-70.49). All the respondents had seen rats and fleas in their houses while 99% of the houses were of temporary nature, had holes and crevices on the walls and floors. All compounds were untidy. Conclusion: This was pneumonic plague. Intervention controlled the outbreak within 2 weeks. Health education was recommended. Crowded places like markets, schools and churches were closed. Health education was conducted to change people’s beliefs that the outbreak was due to witchcraft. All cases were put on tetracycline. All close contacts like relatives and health workers were put on prophylactic tetracycline.