scholarly journals 2452. Outbreak of Candidemia Associated With a Contaminated Intravenous (IV) Anesthetic in an Adult Intensive Care Unit (ICU) in San Luis Potosí, México.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S848-S848 ◽  
Author(s):  
Carlos Portales-Castillo ◽  
Javier Araujo-Meléndez ◽  
Pedro Torres-González ◽  
Mariana Mancilla-González
Keyword(s):  
Early Recognition ◽  
Case Fatality ◽  
Case Control ◽  
Fungal Species ◽  
Case Definition ◽  
Control Measures ◽  
Epidemiological Surveillance ◽  
Effective Control ◽  
Adult Intensive Care Unit ◽  
Outbreak Case

Abstract Background In June 2018, an unusual number of candidemia-associated sepsis cases were diagnosed in sedated patients hospitalized in the 12-bed adult ICU of a teaching hospital in Mexico. The pre-outbreak candidemia rate had been calculated at 0.66 cases/100 ICU admissions for the previous 3 years. Methods We performed a case–control and microbiological study designed to trace the source of the outbreak. Case definition included adult patients with systemic inflammatory response syndrome and Candida species isolated on BC (blood cultures). The rest of the patients in the ICU within the study period (6/12/2018–6/22/2018) were used as controls. Results A total of 5 cases and 19 controls were included in the study. Demographic and clinical characteristics were similar between groups, except for SOFA scores (Table 1). Differences in median SOFA scores between groups were statistically significant (7.5 in cases and 3 in controls (p = 0.02)). After review of common medications used between cases, propofol infusion use (5/5 in cases and 6/19 in controls) was calculated as the strongest risk factor for candidemia (OR 22.84 (p = 0.04)). In-use propofol infusions available at the time were stopped and sent for culture as were unopened vials stored in the pharmacy from the lot being used in the ICU. Intrinsical contamination with bacterial and fungal species related to the outbreak was identified (Table 3). Case fatality rate during the outbreak was 80% (4/5) Conclusion Lethal infections due to contaminated medications, including propofol, have been reported worldwide. Propofol is a potential source for infections given its lipophilic nature that promotes microbial growth. This likely remains an underecognized problem that deserves awareness for early recognition. Epidemiological surveillance in our hospital prompted our case–control study and the subsequent implementation of effective control measures including rapid notification to hospital and national authorities (COFEPRIS), elimination of the identified contaminated lot, and increased promotion of both hand hygiene and adequate IV medication handling techniques among staff. Disclosures All authors: No reported disclosures.

Risk Factors Associated With Dengue Fever Outbreak in Taiz Governorate, Yemen, 2018: Case-control Study

2021 ◽  
Author(s):  
Abdulkareem Ali Hussein Nassar ◽  
Amr Abdulaziz Torbosh ◽  
Yassin Abdulmalik Mahyoub ◽  
Mohammed Abdullah Al Amad
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Case Control Study ◽  
Significant Risk ◽  
Case Fatality ◽  
Case Control ◽  
Case Definition ◽  
P Value ◽  
Factors Associated ◽  
Control Study

Abstract Background: Dengue Fever (DF) is a significant health problem in Yemen especially in the coastal areas. On November 6, 2018, Taiz governorates surveillance officer notified the Ministry of Public Health and Population on an increase in the number of suspected DF in Al Qahirah and Al Mudhaffar districts, Taiz governorate. On November 7, 2018, Field Epidemiology Training Program sent a team to perform an investigation. The aims were to confirm and describe the outbreak by person, place and time in Taiz governorate, and identify its risk factors.Methodology: Descriptive and case-control study (1:2 ratio) were conducted. WHO case definition was used to identify cases in Al Qahirah or Al Mudhaffar districts during August-November 2018. Control was selected from the same districts who did not suffer from DF. Predesigned questionnaire was used to collect data related to sociodemographic, behavioral and environmental characteristics. Bivariate and multivariate backward stepwise analyses were used. The adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. A P value < 0.05 was considered as the cut point for statistically significant. Epi info version 7.2 was used.Results: A total of 50 DF cases were found. Almost 52% were males and 76% were <30 years of age. The overall attack rate was 1/10,000 of the population. Case fatality rate was 4%. In multivariate analysis, not working (aOR = 26.6, 95% CI: 6.8–104.7), not using mosquito repellent (aOR = 13.9, 95% CI:1.4–136.8), wearing short sleeves/pants (aOR = 27.3, 95% CI: 4.8–156.8), poor sanitation (aOR = 5.4, 95% CI: 1.4–20.3), presence of outdoor trees (aOR = 13.2, 95% CI: 2.8–63.0) and houses without window nets (aOR = 15.7, 95% CI: 3.9–63.4) were statistically significant risk factors associated with DF outbreak. Eleven 11 (58%) of blood samples were positive for DF IgM.Conclusions: DF outbreak in Al Qahirah and Al Mudhaffar districts, Taiz governorate was confirmed. This study provides evidence-based information regarding the identified risk factors that contributed to the occurrence of this outbreak. Raising community awareness on the importance of personal protection measures and improving the sanitation services are strongly recommended.

scholarly journals Outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to raw drinking milk resolved by rapid application of advanced pathogen characterisation methods, England, August to October 2017

2019 ◽  
Vol 24 (16) ◽  
Author(s):  
Juli Treacy ◽  
Claire Jenkins ◽  
Karthik Paranthaman ◽  
Frieda Jorgensen ◽  
Doris Mueller-Doblies ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Genetic Relatedness ◽  
Control Measures ◽  
Public Access ◽  
Epidemiological Surveillance ◽  
Effective Control ◽  
Whole Genome Sequencing Data ◽  
Sequencing Data ◽  
Drinking Milk

An outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 occurred on the Isle of Wight between August and October 2017. Of the seven cases linked to the outbreak, five were identified through the statutory notification process and two were identified through national surveillance of whole genome sequencing data. Enhanced surveillance questionnaires established a common link to a farm, and link to the likely food vehicle, raw drinking milk (RDM). Microbiological investigations, including PCR, identified the presence of STEC O157:H7 in samples of RDM. Analysis of core genome single nucleotide polymorphism (SNP) data of STEC O157:H7 from human stool specimens, animal faecal samples and RDM demonstrated a one SNP difference between isolates, and therefore close genetic relatedness. Control measures that were put in place included suspension of sales and recall of RDM, as well as restrictions on public access to parts of the farm. Successful integration of traditional epidemiological surveillance and advanced laboratory methods for the detection and characterisation of STEC O157:H7 from human, animal and environmental samples enabled prompt identification of the outbreak vehicle and provided evidence to support the outbreak control team’s decision-making, leading to implementation of effective control measures in a timely manner.

scholarly journals Malaria Outbreak Facilitated by Appearance of Vector-Breeding Sites after Heavy Rainfall and Inadequate Preventive Measures: Nwoya District, Northern Uganda, February–May 2018

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Godfrey Nsereko ◽  
Daniel Kadobera ◽  
Denis Okethwangu ◽  
Joyce Nguna ◽  
Damian Rutazaana ◽  
...  
Keyword(s):  
Heavy Rainfall ◽  
Case Control Study ◽  
Preventive Measures ◽  
Case Fatality ◽  
Case Control ◽  
Control Measures ◽  
Northern Uganda ◽  
Entire Study ◽  
Breeding Sites ◽  
Control Study

Background. Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, Northern Uganda, exceeding expected limits and thereby requiring epidemic response. We investigated this outbreak to estimate its magnitude, identify exposure factors for transmission, and recommend evidence-based control measures. Methods. We defined a malaria case as onset of fever in a resident of Anaka subcounty, Koch Goma subcounty, and Nwoya Town Council, Nwoya District, with a positive rapid diagnostic test or microscopy for malaria from 1 February to 25 May 2018. We reviewed medical records in all health facilities of affected subcounties to find cases. In a case-control study, we compared exposure factors between case-persons and asymptomatic controls matched by age and village. We also conducted entomological assessments on vector density and behavior. Results. We identified 3,879 case-persons (attack rate [AR] = 6.5%) and two deaths (case-fatality rate = 5.2/10,000). Females (AR = 8.1%) were more affected than males (AR = 4.7%) (p<0.0001). Of all age groups, 5–18 years (AR = 8.4%) were most affected. Heavy rain started in early March 2018, and a propagated outbreak followed in the first week of April 2018. In the case-control study, 55% (59/107) of case-persons and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H = 5.6, 95% CI = 3.0–11); 25% (27/107) of case-persons and 51% (55/107) of controls wore full extremity covering clothes during evening hours (ORM-H = 0.30, 95% CI = 0.20–0.60); 71% (76/107) of case-persons and 85% (91/107) of controls slept under a long-lasting insecticide-treated net (LLIN) 14 days before symptom onset (ORM-H = 0.43, 95% CI = 0.22–0.85); 37% (40/107) of case-persons and 52% (56/107) of controls had access to at least one LLIN per 2 household members (ORM-H = 0.54, 95% CI = 0.30–0.97). Entomological assessment indicated active breeding sites in the entire study area; Anopheles gambiae sensu lato species were the predominant vector. Conclusion. Increased vector-breeding sites after heavy rainfall and inadequate malaria preventive measures were found to have contributed to this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites in the area.

scholarly journals Experiential learnings from the Nipah virus outbreaks in Kerala towards containment of infectious public health emergencies in India

2020 ◽  
Vol 148 ◽  
Author(s):  
Rima R. Sahay ◽  
Pragya D. Yadav ◽  
Nivedita Gupta ◽  
Anita M. Shete ◽  
Chandni Radhakrishnan ◽  
...  
Keyword(s):  
State Government ◽  
Single Case ◽  
Point Of Care ◽  
Nipah Virus ◽  
Case Fatality ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Hospital Infection Control ◽  
Kerala State

Abstract Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.

scholarly journals Three Consecutive Waves of Cholera Outbreak in Ethiopia (2015- 2017): Explanatory Analysis

2020 ◽  
Vol 30 (4) ◽  
Author(s):  
Neamin Tesfay ◽  
Mengistu Biru
Keyword(s):  
Case Fatality ◽  
Secondary Data ◽  
Case Definition ◽  
Control Measures ◽  
Watery Diarrhea ◽  
Health Authorities ◽  
Time Period ◽  
Disease Occurrence ◽  
Public Health Authorities ◽  
Epidemiological Trends

BACKGROUND: Cholera is an acute epidemic infectious disease. It is characterized by watery diarrhea, extreme loss of fluid and electrolytes, and severe dehydration. Ethiopia faced three consecutive waves of cholera outbreaks: nearly all regional states and city administrations, with the exception of one, were affected. The study was conducted with the aim of describing the epidemiology of the outbreak within the defined three years.METHODS: Secondary data review was conducted along with explanatory methods of analysis individual patient data reported from different corners of the country in the time period of 2015 –2017. Cases were identified using the case definition stated on the national guideline for cholera control in Ethiopia.RESULT: A total of 36,154 cholera cases and 246 deaths were reported (overall case-fatality rate [CFR=0.7%] affecting all regions of the country except Gambella). The outbreak began in 2015 with 238 cases and 2 deaths [CFR=0.8%]. The largest outbreak during the period under this study occurred in 2016, with 29,338 cases and 188 deaths [CFR=0. 6%]. Following a decline in disease occurrence, the country experienced a resurgence of epidemic cholera during 2017 (6,578 cases and 56 deaths; CFR, 0.9%), which declined rapidly to a few cases. AR was higher in males [37.01/100,000] and persons in the age group of 15–44years [44.10/100,000] in 2016.CONCLUSION: The outbreak affected nearly every corner of the country. Taken together, the epidemiological trends of cholera in Ethiopia showed an annual decrement in frequency and length of outbreaks during the 3 years under review. The recent decreases in cholera case counts may reflect cholera control measures put in place by public health authorities of the national Ministry of Health.

scholarly journals Measles outbreak in Dubrovnik-Neretva County, Croatia, May to June 2018

2020 ◽  
Vol 25 (7) ◽  
Author(s):  
Morana Tomljenovic ◽  
Mato Lakic ◽  
Tatjana Vilibic-Cavlek ◽  
Sanja Kurecic Filipovic ◽  
Vesna Visekruna Vucina ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Case Definition ◽  
Control Measures ◽  
Rt Pcr ◽  
Serum Samples ◽  
Extensive Search ◽  
Measles Outbreak ◽  
History Of ◽  
Definition Of ◽  
Outbreak Case

In May 2018, measles was introduced in the Dubrovnik region by an adult who recently travelled to Kosovo*. Control measures and an outbreak investigation were implemented: 15 epidemiologically-linked cases met the outbreak case definition of a visitor/resident of Dubrovnik-Neretva County with laboratory-confirmed measles and symptom onset beginning on May 19. New cases were identified through hospitals and primary care physicians. Throat swabs, urine and/or serum samples were collected from outbreak cases. RT-PCR detection of viral RNA and IgM/IgG was used to confirm infection. The median age of cases was 33 years, with one 8 month-old infant. Vaccination status was unknown for 9 cases, three were unvaccinated, one case had history of one dose and two cases reported receiving two doses of measles-containing vaccine. There were 11 hospitalisations and one person developed pneumonia. Control teams undertook an extensive search of contacts and implemented a range of control measures. Despite the outbreak occurring at the beginning of the summer tourism season, it was contained and did not spread to neighbouring regions. With continuing measles transmission in Europe, even small outbreaks create a burden on the health system in countries which have eliminated measles, and illustrate the importance of maintaining high immunisation coverage.

scholarly journals Detection and Identification of Mycobiota Associated with Rice in Three Districts of Iraq

2016 ◽  
Vol 5 (1) ◽  
pp. 11-27
Author(s):  
Hamdia Z. Ali ◽  
Hadi M. Aboud ◽  
Naeem S. Dheyab ◽  
AbdulRahman AbdulQader ◽  
Ameera S. Mohammed ◽  
...  
Keyword(s):  
Nutritional Value ◽  
Fungal Species ◽  
Control Measures ◽  
Effective Control ◽  
Curvularia Lunata ◽  
Internal Transcribed Spacer Region ◽  
Detection And Identification ◽  
Exserohilum Rostratum ◽  
Yield Quality ◽  
Bipolaris Spicifera

The reduction of yield, quality, and nutritional value of grain cereals by different fungal species is of great concern around the world. A comprehensive investigation was made on fungal mycobiota in rice from three provinces; Baghdad, Al-Najaf and Al-Qadisiyah of Iraq surveyed during the growing season 2014-2015. Fields were selected due to their location near the Euphrates and Tigris Rivers. Mycological analysis indicated that there were a difference rates in disease infection due to various fungal species. Predominant fungal species identified as Bipolaris spicifera, Curvularia lunata, Fusarium spp., Nigrospora oryzae, Exserohilum rostratum, Alternaria spp. and Thanatephorus cucumeris. Confirmation of the associated fungal species was further accomplished by analysis of their ribosomal DNA and internal transcribed spacer region sequences. The present study provides a detailed description of the associated fungal species, which may help in understanding the population dynamics and in developing effective control measures.

scholarly journals Visual Exploratory Analysis of COVID-19 Pandemic: One Year After the Outbreak

2021 ◽  
Author(s):  
Amril Nazir ◽  
Suleyman Ulusoy ◽  
Lujaini Lotfi
Keyword(s):  
Case Fatality ◽  
International Travel ◽  
Control Measures ◽  
Contact Tracing ◽  
Effective Control ◽  
Control School ◽  
One Year ◽  
Restrictive Measures ◽  
The Impact ◽  
Spearman Test

Background Since the beginning of the year 2020, governments across the globe have taken different measures to handle the Covid-19 outbreak. Many different policies and restrictive measures were implemented to prevent transmission outspread, to reduce the impacts of the outbreak (i.e., individual, social, and economic), and to provide effective control measures. Although it has been more than one year already after the outbreak, very little studies have been done to examine the long-term effects and impact of the pandemic, and to examine the government intervention variables that are most effective and least effective. Such analysis is critical to determine the best practices in support of policy decisions. Methods Visual exploratory data analysis (V-EDA) is highly recommended to evaluate the impact of the pandemic since it offers a user's friendly data visualization model that allows one to observe visual patterns on trends. The V-EDA was conducted on one-year data for the COVID-19 Pandemic- one year after the outbreak between 1st January and 31 December 2020. The data were analyzed using the student's t-test to verify if there was a statistical difference between two independent groups and the Spearman test was used to analyze the correlation coefficient between two quantitative data, as well as their positive or negative inclination. Findings We found that high-testing countries had more cases per million than low-testing countries. However, for low-testing countries, there was a positive correlation between the testing level and the number of cases per million. This suggests that countries that had tested more, did it in a preventive manner while countries with fewer tests may have a higher number of cases than confirmed. In the poorest developing countries, the reduced new cases coincide with the reduction in conducted tests, which was not observed in the high-testing countries. Among the restrictive measures analyzed, a higher population aged 70 or more and lower GDP per capita was related to a higher case fatality ratio. Restrictive measures reduce the number of new cases after four weeks, indicating the minimum time required for the measures to have a positive effect. Finally, public event cancellation, international travel control, school closing, contact tracing, and facial coverings were the most important measures to reduce the virus spread. As a result, it was observed that countries with the lowest number of cases had a higher stringency index.

Characterizing the effectiveness of COVID-19 mitigation measures: A data-centric approach (Preprint)

2020 ◽  
Author(s):  
Lukman Olagoke ◽  
Ahmet E. Topcu
Keyword(s):  
Control Measure ◽  
Control Measures ◽  
World Health ◽  
Mitigation Measures ◽  
Effective Control ◽  
The World ◽  
Decision Making Processes ◽  
And Performance ◽  
Health Organization ◽  
The Impact

BACKGROUND COVID-19 represents a serious threat to both national health and economic systems. To curb this pandemic, the World Health Organization (WHO) issued a series of COVID-19 public safety guidelines. Different countries around the world initiated different measures in line with the WHO guidelines to mitigate and investigate the spread of COVID-19 in their territories. OBJECTIVE The aim of this paper is to quantitatively evaluate the effectiveness of these control measures using a data-centric approach. METHODS We begin with a simple text analysis of coronavirus-related articles and show that reports on similar outbreaks in the past strongly proposed similar control measures. This reaffirms the fact that these control measures are in order. Subsequently, we propose a simple performance statistic that quantifies general performance and performance under the different measures that were initiated. A density based clustering of based on performance statistic was carried out to group countries based on performance. RESULTS The performance statistic helps evaluate quantitatively the impact of COVID-19 control measures. Countries tend show variability in performance under different control measures. The performance statistic has negative correlation with cases of death which is a useful characteristics for COVID-19 control measure performance analysis. A web-based time-line visualization that enables comparison of performances and cases across continents and subregions is presented. CONCLUSIONS The performance metric is relevant for the analysis of the impact of COVID-19 control measures. This can help caregivers and policymakers identify effective control measures and reduce cases of death due to COVID-19. The interactive web visualizer provides easily digested and quick feedback to augment decision-making processes in the COVID-19 response measures evaluation. CLINICALTRIAL Not Applicable

scholarly journals COVID-19 and Its Symptoms’ Panoply: A Case-Control Study of 919 Suspected Cases in Locked-Down Ovar, Portugal

2021 ◽  
pp. 1-8
Author(s):  
Regina Sá ◽  
Tiago Pinho-Bandeira ◽  
Guilherme Queiroz ◽  
Joana Matos ◽  
João Duarte Ferreira ◽  
...  
Keyword(s):  
Large Scale ◽  
Case Control Study ◽  
Statistical Significance ◽  
Case Control ◽  
Case Definition ◽  
Suspected Case ◽  
Risk Characteristics ◽  
Increased Risk ◽  
Wide Range ◽  
Control Study

<b><i>Background:</i></b> Ovar was the first Portuguese municipality to declare active community transmission of SARS-CoV-2, with total lockdown decreed on March 17, 2020. This context provided conditions for a large-scale testing strategy, allowing a referral system considering other symptoms besides the ones that were part of the case definition (fever, cough, and dyspnea). This study aims to identify other symptoms associated with COVID-19 since it may clarify the pre-test probability of the occurrence of the disease. <b><i>Methods:</i></b> This case-control study uses primary care registers between March 29 and May 10, 2020 in Ovar municipality. Pre-test clinical and exposure-risk characteristics, reported by physicians, were collected through a form, and linked with their laboratory result. <b><i>Results:</i></b> The study population included a total of 919 patients, of whom 226 (24.6%) were COVID-19 cases and 693 were negative for SARS-CoV-2. Only 27.1% of the patients reporting contact with a confirmed or suspected case tested positive. In the multivariate analysis, statistical significance was obtained for headaches (OR 0.558), odynophagia (OR 0.273), anosmia (OR 2.360), and other symptoms (OR 2.157). The interaction of anosmia and odynophagia appeared as possibly relevant with a borderline statistically significant OR of 3.375. <b><i>Conclusion:</i></b> COVID-19 has a wide range of symptoms. Of the myriad described, the present study highlights anosmia itself and calls for additional studies on the interaction between anosmia and odynophagia. Headaches and odynophagia by themselves are not associated with an increased risk for the disease. These findings may help clinicians in deciding when to test, especially when other diseases with similar symptoms are more prevalent, namely in winter.

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