RESUMEN
Acute flaccid paralysis (AFP) surveillance data from India were analysed to examine sensitivity of poliovirus isolation from stool specimens and the added sensitivity obtained from collection of a second stool specimen. Analysis was restricted to Indian AFP cases, 1998-2000, with two adequate stool specimens. The proportion of cases confirmed with wild poliovirus isolation by the second specimen only was calculated, regardless of specimen quality. Overall specimen sensitivity (1998-2000) was 81% using the first specimen, 78% using the second, and 96% using both. Sensitivity increased from 1998 to 2000, with slightly higher sensitivity each year for the first specimen. The second specimen increased sensitivity by 15% overall and contributed more when the first specimen was collected late or was in poor condition. As wild poliovirus disappears, increased sensitivity provided by a second stool specimen may reduce the risk of missing circulating virus.
Asunto(s)
Heces/virología , Paraplejía/epidemiología , Poliomielitis/epidemiología , Poliovirus/aislamiento & purificación , Poliovirus/patogenicidad , Vigilancia de la Población , Humanos , India/epidemiología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Manejo de EspecímenesRESUMEN
With the launch of the Universal Immunisation Programme in India in 1985, childhood immunisation was provided to children in all districts of the country in a phased manner by 1990. Surveillance for vaccine preventable diseases (VPD) including polio was started at the same time with monthly reporting from the districts to the Ministry of Health and Family Welfare (MOHFW), Government of India (GOI). In 1995, the Pulse Polio Immunisation (PPI) campaign was launched with the objective of polio eradication. Prior to 1997, surveillance for polio was directed at finding clinical polio cases by passive reporting from health facilities. There was no active surveillance for all cases of acute flaccid paralysis (AFP). In 1996, a scheme for the surveillance of AFP was drawn up. With the support of the Danish and US governments and Rotary International, 59 surveillance medical officers (SMOs) were hired, trained, and posted throughout the country in October 1997 to establish active surveillance of AFP. The number of SMOs was increased to 108 in August 1999. The SMOs along with their government counterparts established 10,069 reporting units nationwide by the end of November 1999 reporting weekly the occurrence of AFP cases to the district, state, and national levels; timely case investigation and collection of stool specimens from AFP cases; linkages to support the polio laboratory network; and extensive training of government counterparts. Data reported to the national level is analysed and put on an internet website which is updated every two weeks. Annualised rates of reported non-polio AFP have increased from 0.22 per 100,000 children aged < 15 years in 1997 to 1.57 in 1999. The number of polio cases associated with isolation of wild poliovirus decreased from 1404 in the third trimester of 1998 to 664 in the third trimester of 1999, yet widespread transmission of wild polioviruses persists throughout the country.
Asunto(s)
Países en Desarrollo , Poliomielitis/prevención & control , Vigilancia de la Población , Adolescente , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Programas de Inmunización , Incidencia , India , Lactante , Masculino , Poliomielitis/epidemiologíaRESUMEN
Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases. The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP). In October 1997, 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11,533 units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted. Data reported at the national level are analysed and distributed weekly. Annualized rates of non-polio AFP increased from 0.22 per 100,000 children aged under 15 years in 1997 to 1.39 per 100,000 in 1999. The proportion of cases with two adequate stools collected within two weeks of the onset of paralysis increased from 34% in 1997 to 68% in 1999. The number of polio cases associated with the isolation of wild poliovirus decreased from 211 in the first quarter of 1998 to 77 in the first quarter of 1999. Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh. In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized.
Asunto(s)
Poliomielitis/prevención & control , Vigilancia de la Población/métodos , Adolescente , Niño , Preescolar , Humanos , Programas de Inmunización , India/epidemiología , Lactante , Hipotonía Muscular , Parálisis/epidemiología , Parálisis/virología , Poliomielitis/epidemiología , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Desarrollo de ProgramaRESUMEN
BACKGROUND: Previous case-control studies of neonatal tetanus (NNT), a leading cause of infant mortality in developing countries, have suggested that antimicrobials applied after delivery to the umbilical cord stump may protect against this disease. However, assessment of their protective effect has been limited by the low prevalence of antimicrobial use in developing countries. METHODS: We conducted a population-based, matched, case-control study to assess the use of antimicrobials and other factors potentially related to NNT in rural parts of Bangladesh. We studied 359 cases (infants who were normal at birth but who died between the 3rd and 30th day of life after an illness characterized by signs of NNT), each matched to three living controls for gender, residence, and date of birth. RESULTS: In univariate analyses, the application of either antibiotics or disinfectants at delivery, and the continuous or any application of disinfectants were protective against NNT. The application of antibiotics at delivery (odds ratio [OR] = 0.21, P = 0.019), hand washing by the delivery attendant (OR = 0.64, P = 0.005), and prior maternal immunization with tetanus toxoid (OR = 0.50, P < 0.001) remained protective in conditional logistic-regression analyses. Application of animal dung to the umbilical stump (OR = 2.31, P = 0.047) was hazardous. CONCLUSIONS: Effective and inexpensive topical antimicrobials provide a new prevention opportunity that could be used by traditional birth attendants and mothers to provide additional benefits to NNT control programmes based on maternal immunization with tetanus toxoid. Promotion of hygienic delivery and cord-care practices and increasing tetanus toxoid coverage remain cornerstones for the prevention of NNT deaths.
PIP: Neonatal tetanus (NNT) is a leading cause of infant mortality in developing countries. Findings from previous case-control studies of NNT have suggested that antimicrobials applied following delivery to the umbilical cord stump may protect against the disease. However, assessment of their protective effect has been hampered by the low prevalence of antimicrobial use in developing countries. The authors conducted a population-based, matched, case-control study to assess the use of antimicrobials and other factors potentially related to NNT in rural parts of Bangladesh. 359 cases were studied, infants who were normal at birth but who died between the 3rd and 30th day of life after an illness characterized by signs of NNT. Each case was matched to 3 living controls for gender, residence, and date of birth. Univariate analyses found the application of either antibiotics or disinfectants at delivery, and the continuous or any application of disinfectants to protect against NNT. The application of antibiotics at delivery, hand washing by the delivery attendant, and prior maternal immunization with tetanus toxoid remained protective in conditional logistic-regression analyses. The application of animal dung to the umbilical stump was hazardous.
Asunto(s)
Antibacterianos/uso terapéutico , Tétanos/prevención & control , Administración Tópica , Antibacterianos/administración & dosificación , Estudios de Casos y Controles , Parto Obstétrico , Desinfectantes/uso terapéutico , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Oportunidad RelativaRESUMEN
A total of 1,500 small mammals were collected and tested for antibodies cross-reactive to Sin Nombre virus (Hantavirus: Bunyaviridae) at 89 sites in a 1,600 km2 study area of southern Florida. More than 95% of the 123 seropositive animals were cotton rats (Sigmodon hispidus), suggesting infection by Black Creek Canal Virus, although seroreactive Rattus rattus (5 of 294) and Peromyscus gossypinus (1 of 39) also were captured. Crude seroprevalence in S. hispidus was 11%. Seroprevalence increased with body size and was more common in male (18%; n=451) than in female (6%; n=593) cotton rats. Infection within S. hispidus populations was widespread throughout the study area. Prevalence ranged from 0% to 60% at sites where more than five cotton rats were sampled but was not only a function of sample size. Sites with seropositive cotton rats were geographically clustered compared with sites with no seropositive cotton rats. Clustering was not due to the spatial distribution of sites with few animals, season of collection, or sex bias of animals captured at these sites. However, sites with no seropositive animals had an excess of animals in the intermediate size class (60-99 g) and a deficit of the largest and smallest animals. These data suggest that population structure within the habitat mosaic may play a significant role in the spatial distribution of hantavirus infection in local populations of reservoir species.
Asunto(s)
Infecciones por Hantavirus/veterinaria , Orthohantavirus/aislamiento & purificación , Sigmodontinae/virología , Animales , Anticuerpos Antivirales/sangre , Reservorios de Enfermedades , Femenino , Florida , Orthohantavirus/inmunología , Infecciones por Hantavirus/inmunología , Infecciones por Hantavirus/transmisión , Humanos , Masculino , Ratones , Muridae/virología , Peromyscus/virología , Ratas , Zoonosis/transmisión , Zoonosis/virologíaRESUMEN
CONTEXT: Acidic foods such as orange juice have been thought to be unlikely vehicles of foodborne illness. OBJECTIVE: To investigate an outbreak of Salmonella enterica serotype Hartford (Salmonella Hartford) infections among persons visiting a theme park in Orlando, Fla, in 1995. DESIGN: Review of surveillance data, matched case-control study, laboratory investigation, and environmental studies. SETTING: General community. PARTICIPANTS: The surveillance case definition was Salmonella Hartford or Salmonella serogroup C1 infection in a resident of or a visitor to Orlando in May or June 1995. In the case-control study, case patients were limited to theme park hotel visitors and controls were matched to case patients by age group and hotel check-in date. MAIN OUTCOME MEASURES: Risk factors for infection and source of implicated food. RESULTS: Sixty-two case patients from 21 states were identified. Both Salmonella Hartford and Salmonella enterica serotype Gaminara (Salmonella Gaminara) were isolated from stool samples of 1 ill person. Thirty-two case patients and 83 controls were enrolled in the case-control study. Ninety-seven percent of case patients had drunk orange juice in the theme park vs 54% of controls (matched odds ratio, undefined; 95% confidence interval, 5.2 to undefined). The orange juice was unpasteurized and locally produced. Salmonella Gaminara was isolated from 10 of 12 containers of orange juice produced during May and July, indicating ongoing contamination of juice probably because of inadequately sanitized processing equipment. CONCLUSIONS: Unpasteurized orange juice caused an outbreak of salmonellosis in a large Florida theme park. All orange juice was recalled and the processing plant closed. Pasteurization or other equally effective risk-management strategies should be used in the production of all juices.
Asunto(s)
Bebidas/microbiología , Citrus/microbiología , Brotes de Enfermedades , Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella enterica/aislamiento & purificación , Estudios de Casos y Controles , Métodos Epidemiológicos , Florida/epidemiología , Industria de Procesamiento de Alimentos , Humanos , Intoxicación Alimentaria por Salmonella/etiología , SerotipificaciónRESUMEN
This study assessed accuracy of (a) recording Vibrio vulnificus infection on death certificates and (b) International Classification of Disease (ICD)-9 codes for V. vulnificus. Patients with microbiologically confirmed V. vulnificus infection were identified as part of co-ordinated surveillance in four USA Gulf Coast states between 1989 and 1993. Of 60 deaths, 51 death certificates were reviewed and V. vulnificus was recorded as the immediate cause of death on 11 (22%). There was no ICD-9 code for V. vulnificus infection, thus no patients had an ICD-9 code indicating V. vulnificus infection. Of 23 certificates where V. vulnificus was recorded on the death certificate, only 5 (22%) were coded for Gram-negative, septicaemia. This study highlights the importance of teaching physicians how to provide epidemiologically meaningful data on death certificates and the need for accurate ICD mortality codes.
Asunto(s)
Certificado de Defunción , Vibriosis/mortalidad , Vibrio/clasificación , Centers for Disease Control and Prevention, U.S. , Humanos , Vigilancia de la Población , Estados UnidosRESUMEN
OBJECTIVE: A prospective cohort study was performed to identify risk factors for seabather's eruption. METHODS: Study participants were recruited at four beaches in Palm Beach County, Florida, during three weekends of May and June 1993. Participants were interviewed by telephone after 48 hours regarding medical history, beach activities, development of rashes, and use of possible preventive measures. RESULTS: Seabather's eruption, defined by the occurrence of a rash within two days of exposure to seawater, was reported by 114 (16%) of 735 respondents. The strongest predictor of seabather's eruption was a past history of the condition. Children less than 16 years of age were also at increased risk, as were surfers. Showering with one's bathing suit off was a useful protective measure. CONCLUSION: The study's findings suggest that when the seasonal risk of seabather's eruption is present, children, people with a history of seabather's eruption, and surfers are at greatest risk. During the sea lice season, seabathers can minimize their risk by showering with their bathing suits off after seabathing. Length of the time spent in water was not significantly associated with seabather's eruption.
Asunto(s)
Dermatitis/etiología , Escifozoos , Agua de Mar/efectos adversos , Natación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Dermatitis/prevención & control , Femenino , Florida , Humanos , Lactante , Larva , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Estaciones del Año , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
BACKGROUND: In January 1995, Florida experienced the largest outbreak of oyster-associated gastroenteritis ever reported. METHODS: We interviewed both the cohort of persons from 38 gatherings where illness was reported and a sample of harvesters and harvest-area residents. Oysters were traced by means of tags and dealer records, and water quality measures in harvest areas were reviewed. We examined stool specimens for small round structured viruses by means of electron microscopy and amplification of RNA by reverse-transcriptase polymerase chain reaction. We also tested serum specimens for antibodies to Norwalk virus. RESULTS: Of 223 oyster eaters, 58% (129/223) became ill, compared with 3% (2/76) of non-oyster eaters (relative risk, 22; 95% confidence interval, 5.6-87.0). Most oyster eaters (67% [149/223]) ate only cooked (grilled, stewed, or fried) oysters. Oyster eaters who reported eating only thoroughly cooked oysters were as likely to become ill as those who ate raw oysters (relative risk, 0.68; 95% confidence interval, 0.45-1.0; P = .1). In 29 clusters, implicated oysters were from Apalachicola Bay, Florida. A community outbreak occurred in 2 bayside communities before the oyster harvest, leading to an increase in the reportedly common practice of overboard dumping of feces. Small round structured viruses were identified in the stool specimens of 2 harvest-area residents and 9 persons from 8 clusters. Results of water quality tests for fecal coliforms were within acceptable limits. CONCLUSIONS: This large outbreak of gastroenteritis associated with oysters may have resulted from overboard dumping of feces during a community outbreak of diarrheal illness. Our findings of acceptable water quality measures for fecal contamination and the lack of appreciable protective effect from cooking leave the consumer with no assurance of safety.
Asunto(s)
Brotes de Enfermedades , Gastroenteritis/epidemiología , Gastroenteritis/etiología , Mariscos/efectos adversos , Adolescente , Adulto , Anciano , Niño , Preescolar , Culinaria , Femenino , Florida/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Microbiología del AguaRESUMEN
The epidemiology of 690 Vibrio infections reported in Florida during 1981-1993 is described. Most infections resulted in one of three clinical syndromes: gastroenteritis (51%), wound infections (24%), or primary septicemia (17%). Case-fatality rates were 1% for gastroenteritis, 5% for wound infections, and 44% for primary septicemia. While gastroenteritis had little seasonal variation, 91% of primary septicemias and 86% of wound infections occurred from April through October, mostly due to the seasonality of Vibrio vulnificus and Vibrio parahaemolyticus infections. Infected wounds were largely a result of occupational activities around seawater. Some 68% of gastroenteritis cases and 83% of the primary septicemias were associated with raw oyster consumption. Preexisting liver disease was present in 48% of patients with primary septicemia and was associated with a fatal outcome in both wound infections (relative risk [RR], 28.3; 95% confidence interval [CI], 6.3-127.5; P < .0001) and primary septicemia (RR, 1.9; 95% CI, 1.2-3.1; P < .01).
Asunto(s)
Bacteriemia/epidemiología , Gastroenteritis/epidemiología , Vibriosis/epidemiología , Infección de Heridas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bacteriemia/microbiología , Bacteriemia/mortalidad , Niño , Preescolar , Femenino , Florida/epidemiología , Gastroenteritis/microbiología , Gastroenteritis/mortalidad , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ostreidae , Prevalencia , Factores de Riesgo , Estaciones del Año , Mariscos , Vibriosis/microbiología , Vibriosis/mortalidad , Infección de Heridas/microbiología , Infección de Heridas/mortalidadRESUMEN
Hantavirus pulmonary syndrome (HPS) is a recently recognized viral zoonosis. The first recognized cases were caused by a newly described hantavirus. Sin Nombre virus (previously known as Muerto Canyon virus), isolated from Peromyscus maniculatus (deer mouse). We describe a 33-year-old Floridian man who resided outside the ecologic range of P maniculatus but was found to have serologic evidence of a hantavirus infection during evaluation of azotemia associated with adult respiratory distress syndrome. Small mammal trapping conducted around this patient's residence demonstrated the presence of antihantaviral antibodies in 13% of Sigmodon hispidus [cotton rat). Serologic testing using antigen derived from the Black Creek Canal hantavirus subsequently isolated from this rodent established that this patient was acutely infected with this new pathogenic American hantavirus. HPS is not confined to the geographical distribution of P maniculatus and should be suspected in individuals with febrile respiratory syndromes, perhaps associated with azotemia, throughout the continental United States.
Asunto(s)
Síndrome Pulmonar por Hantavirus/diagnóstico , Orthohantavirus/clasificación , Lesión Renal Aguda/virología , Adulto , Animales , Anticuerpos Antivirales/sangre , ADN Viral/análisis , ADN Viral/genética , Florida , Orthohantavirus/genética , Orthohantavirus/inmunología , Síndrome Pulmonar por Hantavirus/virología , Humanos , Masculino , Ratones , Edema Pulmonar/virología , Ratas , Síndrome de Dificultad Respiratoria/virología , Sigmodontinae/virología , Uremia/virología , ZoonosisRESUMEN
Two three-stage cluster surveys were conducted in South Dade County, Florida, 14 months apart, to assess recovery following Hurricane Andrew. Response rates were 75 per cent and 84 per cent. Sources of assistance used in recovery from Hurricane Andrew differed according to race, per capita income, ethnicity, and education. Reports of improved living situation post-hurricane were not associated with receiving relief assistance, but reports of a worse situation were associated with loss of income, being exploited, or job loss. The number of households reporting problems with crime and community violence doubled between the two surveys. Disaster relief efforts had less impact on subjective long-term recovery than did job or income loss or housing repair difficulties. Existing sources of assistance were used more often than specific post-hurricane relief resources. The demographic make-up of a community may determine which are the most effective means to inform them after a disaster and what sources of assistance may be useful.
Asunto(s)
Desastres , Necesidades y Demandas de Servicios de Salud , Sistemas de Socorro/organización & administración , Etnicidad , Florida , Humanos , Evaluación de Programas y Proyectos de Salud , Clase Social , Problemas SocialesRESUMEN
Two population-based surveys of South Dade County, Florida, were conducted after Hurricane Andrew to compare hurricane-related symptoms of mental distress and describe the impact of mental health outreach teams. Households were selected by three-stage cluster sampling and findings from the two surveys, 13 months apart, were compared. Response rates were 75 per cent and 84 per cent. The prevalence of symptoms of mental distress decreased over time. However, in the households contacted by the teams (25 per cent of sample), the prevalence of symptoms (50 per cent) did not differ from households not contacted (43 per cent). Households contacted by teams that reported symptoms were just as likely to have been referred for help by the teams (72 per cent) as those without symptoms (68 per cent). Households reporting symptoms were equally likely to get counselling regardless of whether the teams visited. Mental health teams had no significant impact on mental health symptoms or the use of mental health services. Alternative approaches to mental health outreach teams need to be explored.
Asunto(s)
Adaptación Psicológica , Servicios Comunitarios de Salud Mental/organización & administración , Intervención en la Crisis (Psiquiatría)/organización & administración , Desastres , Florida/epidemiología , Estudios de Seguimiento , Accesibilidad a los Servicios de Salud , Humanos , Trastornos Mentales/epidemiologíaRESUMEN
STUDY OBJECTIVE: To rapidly obtain population-based estimates of needs in the early aftermath of Hurricane Andrew in South Florida. METHODS: We used a modified cluster-sampling method (the Expanded Programme on Immunization [EPI] method) for three surveys. We selected a systematic sample of 30 quarter-mile square clusters for each survey and, beginning from a random start, interviewed members of seven consecutive occupied households in each cluster. Two surveys were of the most affected area (1990 population, 32,672) at three and ten days after the hurricane struck; one survey was of a less affected area (1990 population, 15,576) seven days after the hurricane struck. MEASUREMENTS AND MAIN RESULTS: Results were available within 24 hours of beginning each survey. Initial findings emphasized the need for restoring utilities and sanitation and helped to focus medical relief on primary care and preventive services. The second survey of the most affected area showed improvement in the availability of food, water, electricity, and sanitation (P < or = .05). There was no evidence of disease outbreaks. CONCLUSION: For the first time, the EPI method provided population-based information to guide and evaluate relief operations after a sudden-impact natural disaster. An improvement over previous approaches, the EPI method warrants further evaluation as a needs assessment tool in acute disasters.
Asunto(s)
Desastres , Servicios Médicos de Urgencia/organización & administración , Necesidades y Demandas de Servicios de Salud , Adulto , Anciano , Preescolar , Análisis por Conglomerados , Servicios Médicos de Urgencia/métodos , Florida , Humanos , Lactante , Persona de Mediana Edad , Servicios Preventivos de Salud , Atención Primaria de Salud , MuestreoRESUMEN
OBJECTIVE: The purpose of the study was to investigate infection with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) among patients in a dermatology practice. METHODS: Historical cohort, matched case-control, and cross-sectional survey methods were used. RESULTS: The age-specific incidence of reported HBV infection in the practice from 1985 through 1991 was more than 12 times the expected rate. The dermatologist was not an HBV carrier. He practiced neither universal precautions nor sterile surgical technique. Seroprevalence of markers for HBV infection was highest (36.8%) among patients who had had surgery on the same day that HBV was apparently acquired by an index case; seroprevalence was near the expected background level for patients not exposed to index cases. Of HBV-infected patients with known dates of onset, 72% had had surgery during their incubation periods. All of 30 HBV antigen specimens tested were of the same subtype. None of the patients tested, including 74 patients exposed to surgery on the same day as a patient with acquired immunodeficiency syndrome, had evidence of HIV infection. CONCLUSIONS: HBV, but not HIV, was transmitted from patient to patient by the dermatologist's failure to apply either universal precautions or sterile surgical technique.
Asunto(s)
Infección Hospitalaria/transmisión , Dermatología , Brotes de Enfermedades , Infecciones por VIH/transmisión , Hepatitis B/transmisión , Visita a Consultorio Médico , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios de Cohortes , Infección Hospitalaria/sangre , Infección Hospitalaria/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Hepatitis B/sangre , Hepatitis B/epidemiología , Humanos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Prevalencia , Estudios Seroepidemiológicos , Esterilización/estadística & datos numéricos , Precauciones UniversalesRESUMEN
The incubation period of Legionnaires' disease in five patients was traced to attendance at conventions in a hotel in the Orlando, Florida, area between January 6 and February 2, 1992. The five case patients (mean age, 69 years) were older than 55 randomly chosen controls (mean age, 53 years) who had also attended one of the same conventions (p = 0.007). All case patients were males, as were 40% of the controls (p = 0.01). No significant differences in exposures were found between case patients and controls, but all case patients and 65% of the controls reported exposure to a decorative fountain in the hotel lobby. Water from the fountain was the only one of 55 environmental specimens to test positive for Legionella. Both the environmental isolate and the only clinical isolate were Legionella pneumophila serogroup 1, with identical patterns identified on monoclonal antibody subtyping and pulsed-field gel electrophoresis (PFGE) of genomic restriction fragments. The fountain's recirculating system had been irregularly maintained, and water in the fountain may have been heated by submersed lighting. These findings demonstrate the utility of monoclonal antibody subtyping and PFGE of genomic restriction fragments in assessing the significance of environmental isolates of L. pneumophila, especially when other epidemiologic findings are inconclusive. They also show that decorative fountains may be a potential source of infection with L. pneumophila, and emphasize the need for standard maintenance and disinfection procedures.
Asunto(s)
Brotes de Enfermedades , Legionella pneumophila/genética , Enfermedad de los Legionarios/epidemiología , Microbiología del Agua , Anciano , Estudios de Casos y Controles , Congresos como Asunto , Humanos , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/transmisión , Masculino , Persona de Mediana Edad , Epidemiología MolecularRESUMEN
Seventy-two cases of Vibrio vulnificus infection from raw oysters were reported from 1981-1992; 36 (50%) patients died, making this infection the leading cause of reported deaths from foodborne illness in Florida. The bacterium naturally occurs in coastal waters and may contaminate legally harvested and properly handled shellfish. Infection, usually by ingestion of contaminated raw oysters, can cause severe illness especially in individuals with preexisting liver disease. They are at 80 times greater risk of illness and over 200 times greater risk of death. The case fatality rate (63%) among patients with liver diseases was over 2.5 times the rate (23%) among those without liver disease. Infections usually occurred during the warm weather months and presented as fulminant septicemia, often complicated by necrotizing cutaneous lesions. Early treatment with antibiotics, debridement and amputation when necessary may improve survival. Prevention relies upon educating patients regarding risk and thorough cooking of shellfish.