Investigation of a cluster of syphilis among heterosexuals in an English town.

A cluster of five (3 primary and 2 early latent) cases of syphilis were identified in young heterosexuals in the east of England. Three were symptomatic at presentation. No further cases linked to this cluster have been diagnosed since June 2010. Effective partner notification is key to the identification and treatment of infected contacts.

Usefulness of porA sequencing in distinguishing sporadic and linked cases of serogroup B invasive meningococcal disease in Suffolk, United Kingdom, December 2009 to January 2010.

A cluster of three fatal cases of invasive meningococcal disease due to Neisseria meningitidis serogroup Bin a town in Suffolk, United Kingdom, during December 2009 to January 2010 was reported to the local Health Protection Unit. This paper describes the investigation undertaken to identify any potential epidemiological links among the cases, to determine if this was an outbreak and to consider whether to implement community-wide interventions and control measures. Case epidemiological information in addition to serogroup and genosubtyping (porA gene sequencing) data of the infecting organism was gathered on all cases in this reported cluster. Genosubtyping was also retrospectively requested for all serogroup B cases confirmed in Suffolk during 2009. Extensive investigation failed to establish an epidemiological link among the cluster of fatal cases of serogroup B invasive meningococcal disease in Suffolk. By demonstrating a number of distinct strains, the genosubtyping of isolates proved to be useful in the public health management of this incident by serving to exclude a community outbreak and preventing unnecessary mass chemoprophylaxis.

Outbreak of hepatitis A infection among intravenous drug users in Suffolk and suspected risk factors.

A prolonged outbreak of hepatitis A infection amongst drug users in Suffolk prompted a study of the natural immunity against hepatitis A in this population, and a retrospective analysis of the relationship between specific drug-taking behaviours and the risk of hepatitis A infection. Prior to the outbreak, age-specific seroprevalence of hepatitis A IgG in drug users was similar to that amongst blood donors in the region. Of those without effective immunity, intravenous drug users, multiple drug users and those injecting frequently were more likely to have developed hepatitis. The reported frequency of equipment sharing and the number of injecting partners were not related to the risk of infection. The potential for blood-to-blood, and a suggested faecal-blood transmission were considered to be important in propagating the outbreak in this population. We suggest that a single dose of hepatitis A vaccine administered opportunistically should be used in outbreaks involving drug users.

Outbreak of hepatitis A spread by contaminated drinking glasses in a public house.

Ten cases of hepatitis A were associated with a public house whose barman had chronic non-infectious diarrhoea and had served drinks while incubating hepatitis A himself. Eight cases had drunk in the public house in the two weeks before the barman became ill, had no other risk factors for hepatitis A infection, and were regarded as primary cases. Two other cases had visited the pub during the same period, but were classified as secondary cases because they became ill later and were contacts of primary cases. Sexual transmission was excluded. Fomite transmission by contamination of glasses was a more likely route of spread of the infection among the eight primary cases than food or contaminated surfaces in the toilet.

Fatal outcome of transmission of hepatitis B from an e antigen negative surgeon.

Investigation of the death of a 77 year old woman from acute hepatitis B infection revealed that she had undergone orthopaedic surgery two and a half months earlier. The surgeon was found to be a hepatitis B surface antigen carrier, hepatitis B e antigen (HBeAg)negative, but with antibodies to HBeAg. Viruses from the surgeon and the patient were identical, apart from a single nucleotide substitution. Both had a precore mutation, which prevents expression of e antigen. A look back exercise was undertaken on the patients operated on by the surgeon during the previous year. The surgeon had performed exposure prone procedures on 253 patients, 188 of whom provided blood specimens. No HBsAg carriers were detected, and no serological markers of recent transmission were found.

Outbreak of cryptosporidiosis associated with a swimming pool in Andover.

An outbreak of eight cases of cryptosporidiosis in Hampshire over a period of eight weeks in the summer of 1996 was linked to use of one swimming pool. Cryptosporidial oocysts were not isolated from samples of backwash, but the presence of enterobius ova indicated faecal contamination and a case control study including the first four primary cases suggested an association with immersion in the pool. Even in small outbreaks case control studies can provide useful supportive evidence as to the possible source of infection.

Outbreak of acute hepatitis A among homosexual men in East London.

We report an outbreak of hepatitis A among homosexual men. There was no indication of a common source outbreak or any connection with foreign travel. It is likely that infection was sexually acquired.

Rectum carried drugs may spread hepatitis A among drug addicts.

An hepatitis A epidemic among 36 persons, mainly drug addicts, occurring over an 18-week period, is described. There were indications that smuggling and transportation of narcotic drugs in the rectum started the outbreak, either through direct contamination of the drug or manipulation of the drug resulting in contaminated fingers.

Serological evidence of Chlamydia trachomatis infection in non-immunocompromised adults with pneumonia.

Serological evidence of Chlamydia trachomatis infection in three non-immunocompromised adults with pneumonia is presented. Complement fixation (CF) tests indicated chlamydial infections in all three patients. These illnesses would have been erroneously regarded as ornithosis if microimmunofluorescence (Micro-IF) tests had not been performed because the CF test detects genus-specific antibodies while the Micro-IF test reveals species-specific antibodies.