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A summary of reported foodborne disease incidents in Sweden, 1992 to 1997

JOURNAL OF FOOD PROTECTION 2000年第10期63卷 1315-1320页

作者： Lindqvist, R Andersson, Y de Jong, B Norberg, P Natl Food Adm S-75126 Uppsala Sweden Swedish Inst Infect Dis Dept Epidemiol SE-17182 Solna Sweden

Reports of foodborne disease incidents in Sweden from 1992 to 1997 are summarized. The results are based on reports from the municipal environmental and public health authorities to the National Food Administration and from medical authorities to the Swedish Institute for Infectious Diseases Control. A total of 555 incidents, of which 84% were outbreaks, were reported, involving 11,076 ill people. In 66% of the incidents, no disease agent was determined. Bacterial agents were implicated in 25% and viruses in 8% of the incidents. Calicivirus was the most reported agent both in terms of incidents and cases. Mixed dishes was the food category most often implicated in outbreaks, and smorgasbord and casserole or stews were the subcategories that caused the most cases. The place of consumption was unknown in 8% of the incidents. In about 60% of the incidents, the implicated food was consumed in commercial food establishments;in approximately 20% of incidents, it was consumed at home. The average annual incidence of reported foodborne disease in Sweden was estimated to be 21 cases per 100,000. The average annual incidence of reported foodborne salmonellosis and campylobacteriosis was estimated to be 2.0 and 0.6 cases per 100,000, respectively. The awareness and motivation to report foodborne diseases need to be improved, but additional sources of information are needed to counteract some of the limitations of reporting discussed in this work.

关键词：嵌杯病毒科/分离和提纯嵌杯病毒科感染/流行病学弯曲杆菌感染/流行病学疾病暴发流行/预防和控制疾病暴发流行/统计学和数值数据食品污染/统计学和数值数据食品微生物学食物传播疾病/流行病学食物传播疾病/微生物学发病率沙门菌食物中毒/流行病学瑞典/流行病学人类

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Statistical process control geometric Q-chart for nosocomial infection surveillance

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第4期28卷 314-320页

作者： Quesenberry, CP QUE Technol Inc Raleigh NC 27609 USA N Carolina State Univ Raleigh NC 27695 USA

Several authors have proposed the use of statistical process control charting methods for the surveillance of endemic rates of nosocomial infections. The principal goal of such a charting program is to recognize any increase of the endemic rate to an epidemic rare as soon as possible after the change occurs. However, many of the statistical process control charting methods that have been proposed are based on classical charting principles that are effective largely for processes for which sufficient historical data are available. These methods require that a fairly large data set, taken while the infection rate was stable at a low endemic value, must be available to begin the charting process. These data are used both to confirm the appropriateness of the probability distribution and to make a control chart for the infection process based on the distribution. However, such data sets are often not available. The purpose of this article is to inform and demonstrate to readers that recent research in statistics has developed modem statistical process control methods that can be used effectively with or without such prior data. These methods make possible much more effective nosocomial infection surveillance programs that will give timely warnings of the onsets of epidemics or evidence of the effectiveness of infection control initiatives. These warnings will permit earlier correction initiatives and thus avoid much liability.

关键词：梭菌难辨交叉感染/预防和控制疾病暴发流行/预防和控制小肠结肠炎伪膜性/流行病学小肠结肠炎伪膜性/预防和控制感染控制/方法感染控制/统计学和数值数据模型统计学北卡罗来纳人群监测人类

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Management of endemic outbreaks of scabies with allethrin, permethrin, and ivermectin

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INTERNATIONAL JOURNAL OF DERMATOLOGY 2000年第6期39卷 463-470页

作者： Paasch, U Haustein, UF Univ Leipzig Dept Dermatol D-7010 Leipzig Germany

Background At three residences for the elderly, recurrent scabies infestations became out of control. Due to the failure of repeated, nonsynchronized therapeutic efforts with conventional external anti-scabies treatments, an eradication program had to be developed. We describe a protocol for the management of outbreaks of scabies. Methods According to the clinical examination and microscopically identified mites, all individuals of the population (IOP: patients, staff, and family members) were divided into two groups: (a) healthy and infested IOP;and (b) cases with crusted scabies. The first group was treated simultaneously once with external scabicides (allethrin or permethrin). All others were hospitalized and treated either with systemic ivermectin or with the latter in combination with permethrin. Results In 252 IOP living in three residences for the elderly, clinical signs of scabies were reported in 91.5%, 78.5%, and 15.4% of the patients (age 55-97 years;mean, 80.5 years), 54.1%, 32.9%, and 16.6% of staff members, and in 7%, 3%, and 0% of family members. The infested IOP showed crusted scabies (index cases) in 5.3%, 5.0%, and 1.7%, common scabies in 43.1%, 36.7%, and 7.1%, and postscabiotic dermatitis in 10.3%, 7.6%, and 3.5%. In 99.2% of the synchronously treated IOP in group (a) (n = 240), the conventional treatment with permethrin cream 5% or allethrin spray was effective. Group (b) (n = 12) received ivermectin (12 mg) once (n = 5) or twice (n = 7) after an interval of 8 days. One index case received permethrin three times. Conclusions Outbreaks of scabies in populations of elderly people require special management for disease control. Synchronous treatment with external permethrin cream 5% or allethrin spray, including all IOP once, and close control offers a time-saving, cheap, and reliable method. Crusted scabies should be treated by oral administration of ivermectin once or twice after an interval of 8 days. Additional applications of permethrin and me

关键词：丙烯除虫菊素/投药和剂量丙烯除虫菊素/化学疾病暴发流行/预防和控制用药计划表德国/流行病学老人疗养院杀虫药/投药和剂量杀虫药/化学伊维菌素/投药和剂量伊维菌素/化学医护疗养所扑灭司林除虫菊酯类/投药和剂量除虫菊酯类/化学疥疮/流行病学疥疮/病理学疥疮/预防和控制头皮皮肤病/流行病学头皮皮肤病/病理学头皮皮肤病/预防和控制构效关系老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Potential impact of tuberculosis vaccines as epidemic control agents

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CLINICAL INFECTIOUS DISEASES 2000年第Sup3期30卷 S316-S322页

作者： Lietman, T Blower, SM Univ Calif San Francisco Francis I Proctor Fdn San Francisco CA 94143 USA Univ Calif San Francisco Dept Ophthalmol San Francisco CA 94143 USA Univ Calif San Francisco Dept Med San Francisco CA USA Univ Calif San Francisco Dept Microbiol & Immunol San Francisco CA 94143 USA

We use 2 simple mathematical models (one a preexposure vaccine model and the other a postexposure vaccine model) to provide general insight into the effects of vaccination on tuberculosis epidemics. We discuss how these models can be used as health policy tools: to identify which vaccines are "equivalent," to design control strategies, and to predict the epidemiological impact of different vaccination strategies. Our results show that even moderately effective vaccines could have a significant effect on reducing tuberculosis epidemics if they can be coupled with moderate to high treatment rates. We suggest that both preexposure and postexposure tuberculosis vaccines can be used to help eliminate tuberculosis in developing countries. In developed countries, only a preexposure vaccine (used in combination with a high level of treatment) would be necessary to eliminate tuberculosis.

关键词：卡介苗疾病暴发流行/预防和控制模型生物学结核肺/流行病学结核肺/预防和控制接种人类

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An outbreak of Legionella micdadei pneumonia in transplant patients:: Evaluation, molecular epidemiology, and control

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AMERICAN JOURNAL OF MEDICINE 2000年第4期108卷 290-295页

作者： Knirsch, CA Jakob, K Schoonmaker, D Kiehlbauch, JA Wong, SJ Della-Latta, P Whittier, S Layton, M Scully, B Columbia Univ Coll Phys & Surg Dept Med Div Infect Dis New York NY USA Columbia Presbyterian Med Ctr Div Hosp Epidemiol New York NY 10032 USA New York State Dept Hlth Wadsworth Ctr Albany NY USA Columbia Univ Coll Phys & Surg Dept Pathol New York NY USA New York City Dept Hlth New York NY 10013 USA

PURPOSE: To describe a nosocomial outbreak of Legionella micdadei pneumonia in transplant patients and to characterize the source of the outbreak and the control measures utilized. SUBJECTS AND METHODS: We performed retrospective Legionella micdadei serologic testing to enhance case finding in transplant patients with pneumonia that lacked a documented microbial etiology, as well as prospective environmental surveillance of water sites and testing for Legionella in clinical specimens. RESULTS: During a 3-month period, 12 cases of Legionella micdadei pneumonia were identified either by culture or serologic testing among 38 renal and cardiac transplant patients. Lesionella micdadei isolates from hot water sources were found by pulsed-held gel electrophoresis to have a DNA banding pattern that was identical to the isolates from the first 3 culture-positive cases and from 2 cases that occurred 16 months later. CONCLUSIONS: Hospitals caring for organ transplant recipients and other immunosuppressed patients must be aware of the possibility of environmental sources of outbreaks of Legionella infection. A first-line screen with the Legionella urine antigen test will identify Legionella pneumophila serogroup 1. However, specific cultures in outbreak situations should be considered to identify other Legionella pneumophila serotypes and the nonpneumophila Legionella species. Am J Med. 2000;108:290 -295, (C) 2000 by Excerpta Medica, Inc.

关键词：交叉感染/流行病学交叉感染/预防和控制疾病暴发流行/预防和控制电泳凝胶脉冲场流行病学分子心脏移植感染控制/方法肾移植军团病杆菌属/遗传学军团病杆菌属/分离和提纯军团病/流行病学军团病/微生物学军团病/预防和控制纽约市/流行病学手术后并发症/流行病学手术后并发症/微生物学回顾性研究成年人女(雌)性人类男(雄)性中年人

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Clinical assay of N-duopropenide alcohol solution on hand application in newborn and pediatric intensive care units:: Control of an outbreak of multiresistant Klebsiella pneumoniae in a newborn intensive care unit with this measure

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第3期29卷 162-167页

作者： Herruzo-Cabrera, R Garcia-Caballero, J Martin-Moreno, JM Graciani-Perez-Regadera, MA Perez-Rodriguez, J Univ Autonoma Madrid Dept Prevent Med Madrid Spain Univ Madrid Hosp La Paz Prevent Med Unit Madrid 3 Spain Univ Madrid Hosp La Paz Pediat & Newborn Intens Care Units Madrid 3 Spain

Outbreaks of gram-negative colonization (generally by antibiotic-resistant enterobacteria) are common in newborn intensive care units (NICUs), and control methods are not always effective, We studied the effectiveness of an alcohol solution of N-duopropenide (NDP) in vivo (germicidal effect on flora of teams in the NICU and the pediatric intensive care unit. vs handwashing with nonantiseptic soap) and its effect on the control of a multiresistant (MR) Klebsiella pneumoniae outbreak in our NICU that had persisted for 13 months, despite the use of classic control measures. For educational purposes, we also performed 4 prevalence studies of microbial hand flora in NICU staff (two before and two after introducing NDP). The alcohol solution of NDP was highly germicidal in vivo, destroying microorganisms better than classic handwashing on the hands of 69 health care staff of our NICU and PICU. The flora in both units was reduced from an average of 63% to an average of 95%. Application of this disinfectant to the hands of health care workers after handling newborns helped to eliminate the MR Klebsiella strain in our NICU, (relative risk compared with the period preceding use of the disinfectant: 8.6, with 95% confidence intervals, 4.8-145.5). Four prevalence studies of hand microbial contamination, before and after NDP introduction in the NICU, showed a significant reduction of enterobacteriaceae, mainly MR K pneumoniae, in health care workers. In conclusion, NDP in alcohol was very effective in vivo. It proved to be a useful complementary measure to handwashing and reduced exogenous microorganism transmission in a unit with a heavy patient-care workload.

关键词： 2-丙醇醛类方差分析集落计数微生物疾病暴发流行/预防和控制消毒药(剂) 抗药性多药洗手/方法重症监护病房新生儿重症监护病房儿科克雷伯菌感染/流行病学克雷伯菌感染/微生物学克雷伯菌感染/预防和控制克雷伯菌肺炎/分离和提纯比值比季胺类化合物危险溶液西班牙/流行病学时间因素儿童人类婴儿新生

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Economic aspects of food-borne outbreaks and their control

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BRITISH MEDICAL BULLETIN 2000年第1期56卷 133-141页

作者： Roberts, JA Univ London London Sch Hyg & Trop Med Collaborat Ctr Econ Infect Dis Hlth Serv Res Unit Dept Publ Hlth & Policy London WC1 7HT England

This paper begins with a discussion of the definition of an outbreak. It considers the portion of outbreaks in the general pattern of food-borne infectious disease. The methods used to identify outbreaks are described and the importance of the potential benefits and the economic impact of outbreak recognition and control and are discussed. The paper concludes by illustrating the economic impact of intervention using three infectious diseases botulism, Salmonella and Escherichia coli O157 as case studies of outbreaks.

关键词：成本及成本分析疾病报告疾病暴发流行/经济学疾病暴发流行/预防和控制食物传播疾病/诊断食物传播疾病/经济学食物传播疾病/流行病学人类

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The importance of immediate destruction in epidemics of foot and mouth disease

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RESEARCH IN VETERINARY SCIENCE 2000年第2期69卷 189-196页

作者： Howard, SC Donnelly, CA Univ Oxford Dept Zool Wellcome Trust Ctr Epidemiol Infect Dis Oxford OX1 3FY England

Foot and mouth disease is still prevalent in many parts of the world, as emphasised by the recent devastating epidemic in pig farms in Taiwan. A discrete time mechanistic model has been used to describe the spread of infection in both this epidemic and the 1967 to 1968 epidemic in the UK. The force of infection and basic reproduction number are estimated and the sensitivity of these results to the distributions of both the latent and infectious periods of the disease is examined. Epidemic simulations were performed to evaluate the disease control policy whereby all herds are slaughtered on the same day as disease confirmation. These simulations showed that implementing this policy could have resulted in a dramatic reduction (of over 60 per cent) in the number of pig farms affected in the Taiwan epidemic. It is thus imperative that the necessary resources are available to implement this policy, should an outbreak occur. (C) 2000 Harcourt publishers Ltd.

关键词：牛疾病/流行病学疾病暴发流行/预防和控制安乐死/兽医学口蹄疫/流行病学大不列颠/流行病学回顾性研究猪猪疾病/流行病学台湾/流行病学动物牛

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Temporal aspects of the epidemic of bovine spongiform encephalopathy in Great Britain: holding-associated risk factors for the disease

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VETERINARY RECORD 2000年第12期147卷 319-325页

作者： Wilesmith, JW Ryan, JBM Stevenson, MA Morris, RS Pfeiffer, DU Lin, D Jackson, R Sanson, RL Vet Labs Agcy Dept Epidemiol Weybridge KT15 3NB Surrey England Massey Univ Inst Vet Anim & Biomed Sci Palmerston North New Zealand AgriQual New Zealand Palmerston North New Zealand

The objectives of this study were first to describe the pattern of the epidemic of bovine spongiform encephalopathy (BSE) in Great Britain in terms of the temporal change in the proportion of all cattle holdings that had experienced at least one confirmed case of ass to lune 30, 1997, and secondly to identify risk factors that influenced the date of onset of a holding's first confirmed BSE case. The analyses were based on the population of British cattle at risk, derived from agricultural census data collected between 1986 and 1996, and the BSE case data collected up to lune 30, 1997 The unit of interest was the cattle holding and included all those recorded at least once on annual agricultural censuses conducted between lune 30, 1986, and lune 30, 1996. The outcome of interest was the date on which clinical signs were recorded in a holding's first confirmed case of BSE, termed the BSE onset date. Univariate and multivariate survival analysis techniques were used to describe the temporal pattern of the epidemic. The BSE epidemic in Great Britain started in November 1986, with the majority of affected holdings having their BSE onset date after February 1992. After adjusting for the effect of the size and type of holding;holdings in the south of England (specifically those in the Eastern, South east and South west regions) had 2.22 to 2.43 (95 per cent confidence interval [CI] 2.07 to 2.58) times as great a monthly hazard of having a BSE index case as holdings in Scotland. After adjusting for the effect of region and type of holding, holdings with more than 53 adult cattle had 5.91 (95 per cent CI 5.62 to 6.21) times as great a monthly hazard of having a BSE index case as holdings with seven to 21 adult cattle. Dairy holdings had 3.06 (95 per cent CI 2.96 to 3.16) times as great a monthly hazard of having a BSE index case as beef suckler holdings. These analyses show that there were different rates of onset in different regions and in holdings of different sizes and t

关键词：牛疾病/诊断牛疾病/流行病学牛疾病/治疗疾病暴发流行/预防和控制疾病暴发流行/统计学和数值数据疾病暴发流行/兽医学脑病牛海绵状/诊断脑病牛海绵状/流行病学脑病牛海绵状/治疗动物房回顾性研究危险因素存活率分析时间因素动物牛

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Infection control in long-term care facilities

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CLINICAL INFECTIOUS DISEASES 2000年第3期31卷 752-756页

作者： Nicolle, LE Univ Manitoba Hlth Sci Ctr Dept Internal Med St Boniface Gen Hosp Winnipeg MB R3A 1R9 Canada

Infections are common in long-term care facilities. The most frequent endemic infections are urinary infection, respiratory infection, and skin and soft tissue infections. Outbreaks also occur frequently, and some facilities have a high prevalence of colonization of residents with antimicrobial-resistant organisms. Our understanding of infections and the development of infection-control programs for long-term care facilities have progressed greatly over the past 15 years. Whereas the occurrence of infections has been described and specific guidelines for infection-control programs in long-term care facilities have been developed, there is still limited evaluation of the effectiveness of programs or specific interventions to support prioritization of infection-control resources. In addition, the spectrum of patients and care delivered in longterm care facilities continues to evolve. Increasingly, chronic care patients, including those requiring chronic respirator therapy, dialysis, or percutaneous feeding tubes, are cared for in these facilities. Our understanding of prevention of infection in these patients remains limited. Important questions include what interventions may prevent endemic infections, what are the most effective means to identify outbreaks early, and what interventions may minimize the prevalence of antimicrobial-resistant organisms. Programs to optimize antimicrobial use need to be developed. Thus, although progress in understanding and practice has been made, important questions remain.

关键词：疾病暴发流行/预防和控制老人疗养院/标准感染控制/方法感染控制/标准长期医疗医护疗养所/标准患病率呼吸道感染/流行病学呼吸道感染/微生物学皮肤疾病/流行病学皮肤疾病/微生物学泌尿道感染/流行病学泌尿道感染/微生物学老年人老年人 80以上女(雌)性人类男(雄)性

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