Preventing household transmission of Shiga toxin-producing Escherichia coli O157 infection: promptly separating siblings might be the key.

BACKGROUND: Preventing household transmission of Shiga toxin-producing Escherichia coli O157 (STEC O157) infection is important because of the ease of interpersonal transmission and the potential disease severity. METHODS: We conducted a retrospective cohort study of households associated with an outbreak of STEC O157 infection in South Wales, United Kingdom, in autumn 2005. We investigated whether characteristics of the primary case patient or the household were predictors for secondary household transmission of STEC O157 infection. Furthermore, we estimated the proportion of cases that might be prevented by isolation (e.g., hospitalization) of the primary case patient immediately after the microbiological diagnosis and the number of patients with STEC O157 who would need to be isolated to prevent 1 case of hemolytic uremic syndrome. Based on dates of symptom onset, case patients in households were classified as having primary, coprimary, or secondary infection. Secondary cases were considered to be preventable if the secondary case patient's symptoms started >1 incubation period (4 days) after the date of microbiological diagnosis of the primary case. RESULTS: Eighty-nine (91%) of 98 eligible households were enrolled. Among 20 households (22%), 25 secondary cases were ascertained. Thirteen secondary cases (56%) occurred in siblings of the primary case patients; hemolytic uremic syndrome developed in 4 of these siblings. Presence of a sibling (risk ratio, 3.8; 95% confidence interval, 0.99-14.6) and young age (<5 years) of the primary case patient (risk ratio, 2.03; 95% confidence interval, 0.99-41.6) were independent predictors for households in which secondary cases occurred. Of the 15 secondary cases for which complete information was available, 7 (46%) might have been prevented. When restricting isolation to primary case patients who were aged <10 years and who had a sibling, we estimated the number of patients who would need to be isolated to prevent 1 case of hemolytic uremic syndrome to be 47 patients (95% confidence interval, 16-78 patients). CONCLUSIONS: Promptly separating pediatric patients with STEC O157 infection from their young siblings should be considered.

Lack of serologic evidence of Neospora caninum in humans, England.

Retrospective testing of 3,232 serum samples from the general population and 518 serum samples from a high-risk group showed no evidence of human exposure to Neospora caninum in England. Results were obtained by using immunofluorescence antibody testing and ELISA to analyze frequency distribution.

Toxoplasma and coxiella infection and psychiatric morbidity: a retrospective cohort analysis.

BACKGROUND: It has been suggested that infection with Toxoplasma gondii is associated with slow reaction and poor concentration, whilst infection with Coxiella burnetii may lead to persistent symptoms of fatigue. METHODS: 425 farmers completed the Revised Clinical Interview Schedule (CIS-R) by computer between March and July 1999 to assess psychiatric morbidity. Samples of venous blood had been previously collected and seroprevalence of T. gondii and C. burnetii was assessed. RESULTS: 45% of the cohort were seropositive for T. gondii and 31% were positive for C. burnetii. Infection with either agent was not associated with symptoms reflecting clinically relevant levels of concentration difficulties, fatigue, depression, depressive ideas or overall psychiatric morbidity. CONCLUSIONS: We do not provide any evidence that infection with Toxoplasma gondii or Coxiella burnetii is associated with neuropsychiatric morbidity, in particular with symptoms of poor concentration or fatigue. However, this is a relatively healthy cohort with few individuals reporting neuropsychiatric morbidity and therefore the statistical power to test the study hypotheses is limited.

Unusually high impact of influenza B during the early 2012-2013 influenza season in Wales--epidemiology and clinical analysis of the first 100 cases.

BACKGROUND: Influenza B is often regarded as the milder form of the disease. The early 2012-2013 season in Wales saw the highest rate of influenza B-associated primary care consultations since 1994-1995 and considerable hospitalisations. OBJECTIVES: This report summarises features of the first 100 confirmed cases during 2012-2013 in Wales. METHODS: Case information was sourced from routine laboratory testing and virological surveillance. RESULTS AND CONCLUSIONS: Influenza B (Yamagata lineage) viruses dominated, mainly affecting younger adults, admission to critical care was unexpectedly common. Low vaccine uptake amongst at-risk patients may have contributed to the burden of influenza in secondary care in Wales.

Enhanced surveillance of primary measles mumps and rubella (MMR) immunisation in Wales.

In England and Wales routinely available data measure uptake of the measles mumps and rubella (MMR) vaccine at 2 years. This results in a delay in detecting change in uptake of the vaccine, which is scheduled at 12 months of age. The predictive value of uptake at 15-17 months is limited by the greater variability in uptake between quarters at the younger age. This can be overcome by presenting the data as a four-quarter annual rolling average. Uptake of the MMR vaccine at 2 years of age in Wales is predicted to stabilise at around 84% in the first three quarters of 2002.

Mycobacterium bovis infection, United Kingdom.

We describe the first documented spillover of bovine tuberculosis from animals into the human population of the United Kingdom since the resurgence of the disease in cattle in the country. This finding suggests that there may be a small risk for transmission to humans, making continued vigilance particularly necessary.

Q fever outbreak in industrial setting.

An outbreak of Q fever occurred in South Wales, United Kingdom, from July 15 through September 30, 2002. To investigate the outbreak a cohort and nested case-control study of persons who had worked at a cardboard manufacturing plant was conducted. The cohort included 282 employees and subcontractors, of whom 253 (90%) provided blood samples and 214 (76%) completed questionnaires. Ninety-five cases of acute Q fever were identified. The epidemic curve and other data suggested an outbreak source likely occurred August 5-9, 2002. Employees in the factory's offices were at greatest risk for infection (odds ratio 3.46; 95% confidence interval 1.38-9.06). The offices were undergoing renovation work around the time of likely exposure and contained straw board that had repeatedly been drilled. The outbreak may have been caused by aerosolization of Coxiella burnetii spore-like forms during drilling into contaminated straw board.

Vero cytotoxin-producing Escherichia coli O157 gastroenteritis in farm visitors, North Wales.

An outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC O157) gastroenteritis in visitors to an open farm in North Wales resulted in 17 primary and 7 secondary cases of illness. E. coli O157 Vero cytotoxin type 2, phage type 2 was isolated from 23 human cases and environmental animal fecal samples. A case-control study of 16 primary case-patients and 36 controls (all children) showed a significant association with attendance on the 2nd day of a festival, eating ice cream or cotton candy (candy floss), and contact with cows or goats. On multivariable analysis, only the association between illness and ice cream (odds ratio [OR]=11.99, 95% confidence interval [CI] 1.04 to 137.76) and cotton candy (OR=51.90, 95% CI 2.77 to 970.67) remained significant. In addition to supervised handwashing, we recommend that foods on open farms only be eaten in dedicated clean areas and that sticky foods be discouraged.