RESUMO
In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.
Assuntos
Surtos de Doenças , Contaminação de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Frutas/intoxicação , Vírus da Hepatite A/genética , Hepatite A/epidemiologia , Adolescente , Adulto , Pré-Escolar , Busca de Comunicante , Estudos Epidemiológicos , Europa (Continente)/epidemiologia , União Europeia , Feminino , Doenças Transmitidas por Alimentos/diagnóstico , Doenças Transmitidas por Alimentos/virologia , Alimentos Congelados/intoxicação , Alimentos Congelados/virologia , Frutas/virologia , Hepatite A/virologia , Vírus da Hepatite A/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
An aseptic meningitis outbreak emerged in two regions in Bulgaria in 2012 and echovirus 30 (E30) was established as the aetiological agent by cell culture isolation, serological test, and molecular-based techniques. A total of 157 patients with aseptic meningitis were investigated, of which 117 were confirmed as having E30-associated disease. Molecular analysis of 12 E30 isolates revealed 99-100% nucleotide and amino-acid identity between them and a close correlation with a Greek strain involved in an E30 outbreak in 2012. Children aged 5-14 years were mainly affected, which could reflect the absence of E30 epidemics in Bulgaria for a period of 11 years. The first case with E30 isolation (a 2-year-old patient from Plovdiv) was notified at the end of April 2012. This was most likely the index case, from which the spread of the virus started, causing sporadic cases first, which later led to an aseptic meningitis outbreak facilitated by person-to-person viral transmission.
Assuntos
Surtos de Doenças , Infecções por Echovirus/epidemiologia , Enterovirus Humano B/isolamento & purificação , Meningite Asséptica/epidemiologia , Adolescente , Adulto , Sequência de Aminoácidos , Bulgária/epidemiologia , Criança , Pré-Escolar , Infecções por Echovirus/virologia , Enterovirus Humano B/genética , Humanos , Lactente , Pessoa de Meia-Idade , Filogenia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de RNA , Adulto JovemRESUMO
In June 2008 an outbreak of gastroenteritis was registered in Sunny Beach resort situated on the Black Sea coast in Bulgaria, affecting 14 employees of a hotel, five of whom tested positive for Salmonella Enteritidis. During June-July 2008 four sporadic S. Enteritidis cases were also reported and two of them were foreign tourists. In the same period S. Enteritidis cases connected with travel to Bulgaria were reported to the European Centre for Disease Prevention and Control (ECDC) from Finland, United Kingdom, Sweden, Germany and Norway. We describe a study performed to find out relatedness between Bulgarian and Finnish S. Enteritidis isolates using phage typing (PT) and pulse-field gel electrophoresis (PFGE). Fifteen S. Enteritidis isolates from Bulgaria and 195 from Finland (including 28 from travellers to Bulgaria) were phage typed. Within Bulgarian isolates four different PTs were found and PT6c with eight strains was predominant. Nineteen out of 28 strains isolated from the Finns visiting Bulgaria belonged also to PT6c. PFGE typing (with one enzyme) of all S. Enteritidis PT6c strains (8 Bulgarian and 19 Finnish isolates) showed indistinguishable PFGE profile. The typing results thus demonstrated a link between Bulgarian and Finnish S. Enteritidis isolates. We conclude that S. Enteritidis PT6c was the cause of salmonella outbreak in Sunny Beach and was exported to Finland, and likely to the United Kingdom, Norway, Sweden and Germany.