A tuberculosis contact investigation involving a large number of contacts tested with interferon-gamma release assay at a nursing school: Kanagawa, Japan, 2012.

In May 2012, a teacher of a nursing school with about 300 staff members and students in Japan was diagnosed with sputum smear-positive pulmonary tuberculosis (TB), leading to an investigation involving nearly 300 contacts. We describe the contacts' closeness to the index TB patient and the likelihood of TB infection and disease. A case of TB was defined as an individual with positive bacteriological tests or by a physician diagnosis of TB. A latent TB infection (LTBI) case was defined as an individual who had a positive interferon-gamma release assay (IGRA). A total of 283 persons screened with IGRA were analysed. Eight persons (2.8%, 95% confidence interval [CI]: 1.2-5.4) tested positive by IGRA; one student who had intermediate (less than 10 hours) contact with the index patient was found to have pulmonary TB by chest X-ray. The positivity in IGRA among staff members with very close contact with the index patient (4 of 21, 19%, 95% CI: 5.4-42%) with a statistically significant relative risk of 17 (95% CI: 2.0-140) was high compared with that of the intermediate contacts (1 of 88, 1.1% [95% CI: 0.028-6.2]). There was a statistically significant trend in the risk of TB infection and closeness with the index patient among the staff members and students (P < 0.00022). In congregate settings such as schools, the scope of contact investigation may have to be expanded to detect a TB case among those who had brief contact with the index patient.

Outbreak of Enterohemorrhagic Escherichia coli O157:H7 Infection Associated with Minced Meat Cutlets Consumption in Kanagawa, Japan.

An outbreak of enterohemorrhagic Escherichia coli (EHEC) O157:H7 infection occurred in October 2016 in Kanagawa, Japan. A total of 61 patients and 17 asymptomatic cases of EHEC O157:H7 infection were confirmed by laboratory testing. Among them, 24 patients were hospitalized and 4 developed hemolytic-uremic syndrome. An epidemiological investigation revealed that this outbreak of EHEC O157:H7 infection was associated with the consumption of uncooked minced meat cutlets that were sold frozen at branches of a supermarket chain. The implicated uncooked meat cutlets were made of a mixture of minced beef, pork, onions, and eggs. All 40 meat cutlets tested from one particular batch were positive for EHEC O157:H7. The patterns observed on pulsed-field gel electrophoresis of strains isolated from the affected patients and meat cutlets were identical. The bacterial counts of EHEC O157:H7 and E. coli in meat cutlets ranged from 2.3 to 110 most-probable-number (MPN)/g and from 240 to 4,600 MPN/g, respectively. There are currently no national regulatory standards to ensure the safety of these types of meat products in Japan. Consumers should ensure that such products are cooked thoroughly and that safe food handling procedures are used to prevent infection.