Outbreak of wound botulism in people who inject drugs, Norway, October to November 2013.

In October and November 2013, four cases of wound botulism were confirmed in people who inject drugs (PWID) in Norway. Two additional cases are suspected. Because of the international distribution pathways for heroin ­ the likely source of the outbreak ­ healthcare workers and public health authorities in other countries should remain vigilant for wound botulism in PWID. This outbreak serves as a reminder that countries should ensure access to botulinum antitoxin in case of outbreak situations.

Evidence of protective effect of BCG vaccination in persons at low risk of tuberculosis in Nordic countries.

SETTING: Norway, Sweden, Denmark and Finland have low incidence rates (IRs) of tuberculosis (TB) but the use of bacille Calmette-Guérin (BCG) vaccination has varied. OBJECTIVE: To assess if different IRs among persons at low risk in the four countries could be related to the different use of BCG vaccination, and to estimate the number of adolescent BCG vaccinations needed to prevent one case of TB in Norway. DESIGN: The study period was 1996-2005. In part A, IRs for cases classified as 'born in country/national' in the EuroTB database in all four countries were calculated. In part B, the IRs among persons born in Norway and Sweden with two parents from low-incidence countries were calculated for cases registered in the respective national TB registers. In both parts, IRs and IR ratios among 0-14-year-olds and 15-29-year-olds were compared and related to different BCG vaccination policies. RESULTS AND CONCLUSIONS: Our results are consistent with a protective effect of newborn BCG vaccination in native-born 0-14-year-olds in Finland, and of adolescent BCG vaccination in 15-29-year-olds in Norway. The Norwegian BCG vaccination programme conferred 61-64% protection to 15-29-year-olds; however, 21699-25125 vaccinations were needed to prevent one case.

Disseminated and chronic Lyme borreliosis in Norway, 1995 - 2004.

Lyme borreliosis is the most common tickborne infection in Norway. All clinical manifestations of Lyme borreliosis other than erythema migrans are notifiable to Folkehelseinstituttet, the Norwegian Institute of Public Health. During the period 1995-2004 a total of 1506 cases of disseminated and chronic Lyme borreliosis were reported. Serological tests were the basis for laboratory diagnosis in almost all cases. The annual numbers of cases showed no clear trend over the period, but varied each year between 120 and 253 cases, with the highest number of cases reported in 2004. Seventy five per cent of cases with information on time of onset were in patients who fell ill during the months of June to October. There was marked geographical variation in reported incidence rates, with the highest rates reported from coastal counties in southern and central Norway. Fifty six per cent of the cases were in males and 44% in females. The highest incidence rate was found in children aged between 5 and 9 years. Neuroborreliosis was the most common clinical manifestation (71%), followed by arthritis/arthralgia (22%) and acrodermatitis chronica atrophicans (5%). Forty six per cent of patients were admitted to hospital. Prevention of borreliosis in Norway relies on measures to prevent tick bites, such as use of protective clothing and insect repellents, and early detection and removal of ticks. Antibiotics are generally not recommended for prophylaxis after tick bites in Norway.

[Tick-borne encephalitis in Norway]. / Flåttbåren encefalitt i Norge.

BACKGROUND: Tick-borne encephalitis is caused by a virus that is transmitted to man by tick-bite. The virus is found in central and eastern parts of Europe and also in Sweden. MATERIAL AND METHODS: We report the first two cases of tick-borne encephalitis resulting from transmission of virus in Norway. RESULTS: Both patients had been to the island of Tromøy on the south coast of Norway. The course of the disease was very different in the two patients. One patient had significant neurological dysfunction. The other patient had intense headache, but no motor dysfunction. Both patients had reduced general health and fever, and leukocytosis and increased protein was found in the spinal fluid. The incubation period is most often 1 to 2 weeks. The disease may have a bi-phasic course with initial fever, headache and muscle pain. One week later symptoms of encephalitis follow. Subclinical infection is common, especially in children. One third of patients get permanent sequelae after encephalitis. Diagnosis is made by demonstration of antibodies in serum. Treatment is symptomatic. INTERPRETATION: These two patients indicate that there may be a reservoir of TBE virus in Norway.

Early changes in peripheral blood T cell subsets induced by antiretroviral treatment of human immunodeficiency virus-1 positive individuals.

Human immunodeficiency virus (HIV)-1 infection causes a gradual decline in peripheral blood CD4+ T cells. Shortly after the primary infection, an expansion of the activated memory CD8+ T-cell pool is also observed paralleling increased levels of plasma viraemia. In the present study we investigated the immediate effects of zidovudine therapy on peripheral blood T-cell subsets during the first 3 weeks of therapy in a group of HIV-1 positive individuals receiving influenza vaccine. HIV-1 positive individuals who received vaccine, but no treatment, were included as controls. Both the number of CD4+ and CD8+ T cells increased during the first week of therapy in parallel with a decline in plasma viraemia. The majority of CD4+ T cells contributing to this expansion expressed CD28, CD45RO and Fas, whereas the expanded CD8+ T cells were predominantly CD28-, CD45RO+, CD38+, Fas+ and Fas+ (CD95). We propose that the increase in the number of activated memory T cells observed in peripheral blood immediately after the onset of antiretroviral treatment is most likely caused by the redistribution of cells from various lymphoid organs in response to decreased levels of viral load in these compartments. The degree of T-cell redistribution is probably dependent on the magnitude of virus suppression.

[Tularemia after tick bite in Vestfold]. / Tularemi etter flåttbitt i Vestfold.

Direct contact with rodents or their faeces is a well-known risk factor for contracting tularaemia in Norway. Both insects and ticks can act as vectors of tularaemia, but transmission by this route has not previously been described in this country. We report three cases of serologically confirmed ulceroglandular tularaemia on a small island in Southern Norway, an area in which tularaemia has not previously been known to occur. Tick bites preceded infection in two of the patients. The third patient may also have become infected through a tick or insect bite. Diagnosis was made late in all cases, causing a delay in appropriate treatment. Two of the patients were successfully treated with ciprofloxacin. Our experience and previous reports suggest that quinolones should be considered as the first choice of drugs in the treatment of tularaemia in Norway.

[Pseudomonas aeruginosa as a cause of urinary tract infections]. / Pseudomonas aeruginosa som årsak til urinveisinfeksjon.

The aim of this study was to investigate risk factors for urinary tract infection with Pseudomonas aeruginosa, the course of such infection and the therapeutic approach among doctors. A total av 56 patients were included. Identified risk factors were old age, institutionalization, obstruction or other dysfunction of the urinary tract, use of urinary tract catheters and treatment with broad spectrum antibiotics. Urinary tract infection with P aeruginosa has a tendency to persist or relapse. The therapeutic approach varied widely.