Legionella transmission from an outdoor fountain in Oslo, Norway. / Legionellose etter smitte fra fontenen på Youngstorget.

BACKGROUND: Most cases of legionellosis in Norway are acquired outside the country. This was a domestic case from an unusual source. CASE PRESENTATION: A man in his thirties was admitted with pneumonia early in the summer. He developed respiratory failure before recovering. Cultures from his lower airways grew Legionella pneumophila serogroup 1. Samples from his home and workplace did not identify Legionella. On further questioning it was discovered that the patient regularly sat beside an outdoor fountain during his breaks from work. Samples from the fountain identified high numbers of L. pneumophila serogroup 1, sequence type 256. Full genome sequencing showed that isolates from the patient and fountain were identical. The fountain used recirculated water with small amounts of chlorine. High outdoor temperatures in Oslo may have facilitated growth of Legionella in the fountain. INTERPRETATION: To our knowledge, this is the first published case of Legionella transmission from an outdoor fountain.

Wanting to or having to - a qualitative study of experiences and attitudes towards migrant screening for tuberculosis in Norway.

BACKGROUND: This study assesses how tuberculosis (TB) screening is perceived by immigrants in Norway. Screening is mandatory for people arriving from high incidence countries. To attend screening, immigrants have to contact the health system after receiving an invitation by letter. The proportion of non-attenders is not known, and there are no sanctions for not attending. Generally, only persons who test positive receive test results. The study explores users' experiences, attitudes and motivations for attending or not attending TB screening, and perceived barriers and enablers. METHODS: We conducted six focus group discussions and three individual interviews with 34 people from 16 countries in Africa, Asia and Europe. Interviews were recorded and transcribed, and data was coded following a general inductive approach: All transcribed text data was closely read through, salient themes were identified and categories were created and labelled. The data was read through several times and the category system was subsequently revised. RESULTS: Most appreciated the opportunity to be tested for a severe disease and were generally positive towards the healthcare system. At the same time, many were uncomfortable with screening, particularly due to the fear and stigma attached to TB. All experienced practical problems related to language, information, and accessing facilities. Having to ask others for help made them feel dependent and vulnerable. Positive and negative attitudes simultaneously created ambivalence. Many wanted "structuring measures" like sanctions to help attendance. Many said that not receiving results left them feeling anxious. CONCLUSIONS: In order to adapt the system and improve trust and patient uptake, all aspects of the screening should be taken into account. Ambivalence towards screening probably has a negative impact on screening uptake and should be sought reduced. A combination of ambivalence and a wish for "structuring measures" leads the authors to conclude that mandatory screening is a reasonable measure. However, since mandatory screening negatively impacts patient autonomy, and because of fear, stigma and practical problems, the health system should empower users by improving communication and access to services. In addition, it is recommended that negative test results are also communicated to the users.

[Use of coercion pursuant to the Communicable Diseases Act 1995-2013]. / Tvangstiltak etter smittevernloven 1995-2013.

BACKGROUND: The Communicable Diseases Act came into force in 1995. The Act authorises coercive examination and isolation of infected individuals. We wished to investigate how the provisions on coercion in this Act have been practised. MATERIAL AND METHOD: We reviewed all the cases that had been processed by the National Commission for Communicable Diseases from 1995 to the end of 2013. We contacted doctors in regional health enterprises to collect information on any emergency decisions having been made. We collected information from the tuberculosis register on treatment outcomes for tuberculosis, and investigated how many patients disappeared from treatment during 1995-2013. RESULTS: The communicable diseases commission had treated 15 cases involving a total of 12 individuals. Nine of these suffered from contagious pulmonary tuberculosis, one had primary tuberculosis, one was suspected of having tuberculosis and one was HIV positive. Three of the patients had multidrug-resistant tuberculosis. The commission made two decisions on coercive examination/brief isolation and nine on coercive isolation, as well as two decisions on extended isolation. No decisions were made regarding coercive treatment. Only four of the nine patients with contagious pulmonary tuberculosis completed the treatment sequence. One emergency decision has been made since 2006. INTERPRETATION: The provisions on coercion have been practised restrictively. Amendments to them should be considered, especially with regard to the opportunity to make emergency decisions on isolation of persons with a known diagnosis. There is a need for clearer regulations regarding extended isolation, and the time needed for processing of cases involving requests for a decision by the communicable diseases commission should be reduced.

[Cases of MRSA in nursing homes in Oslo 2005-11]. / MRSA-funn i sykehjem i Oslo 2005-11.

BACKGROUND: The number of infections caused by MRSA has increased substantially in Norway in the past decade. It is an objective to prevent MRSA from becoming established in nursing homes and hospitals. The purpose of the article is to describe the features of the development of MRSA cases found in nursing homes in Oslo. MATERIALS AND METHOD: We carried out a retrospective study of registered cases of MRSA (both sufferers and carriers) in Oslo in 2005-11. Data were obtained from the City of Oslo municipal health services' MRSA database and from genotyping carried out at Akershus University Hospital. RESULTS: The annual number of cases of MRSA found in Oslo increased during the period 2005-11 from 92 in 2005 to 268 in 2011, a total of 1198 cases. Of these, 224 cases (19%) were registered in nursing homes, distributed among 22 institutions, 158 residents and 66 staff, with an average of 32 cases annually (14-58 spread). Twenty-eight of 50 nursing homes had no cases of MRSA, while 159 of the cases were related to outbreaks of MRSA. Three of 20 outbreaks affected residents only. The nursing home isolates consisted of 40 different spa types, of which 160 (71%) of the isolates were clustered in three clonal complexes. The most common spa type t304 was found in 116 (52%) of the cases. INTERPRETATION: Cases of MRSA in Oslo in total increased sharply from 2005 to 2011, while the number of cases in nursing homes was stable. It is, however, uncertain whether this reflects the actual incidence.

[How to combat HIV, tuberculosis and malaria?]. / Hvordan bekjempe hiv, tuberkulose og malaria?

BACKGROUND: In year 2 000, the United Nations (UN) agreed on eight millennium development goals (MDGs). Goal number 6 is to combat HIV/AIDS, malaria and other communicable diseases, including tuberculosis. The aim of this paper is to provide an overview of current status and prognosis for this MDG, and to discuss strategies that need to be implemented to reach the goal. MATERIAL AND METHODS: The article is mainly based on publications from the UN or WHO-affiliated organizations. RESULTS: The global HIV prevalence rate has remained at 0.8 % for the last ten years, but the total infected population is still increasing. Access to treatment has increased considerably, but only 28 % of those in need of treatment (and living in developing countries), received it in 2007. Global tuberculosis incidence and prevalence rates of tuberculosis are falling, but not in Europe and Africa. For malaria, there is more uncertainty, but there seems to be a declining incidence in many countries. INTERPRETATION: The MDG for HIV/AIDS cannot be reached by treatment alone, continued emphasis on prevention and more specific prevention strategies is necessary. The global targets for tuberculosis can be reached, but probably not in Africa; in addition, multi-resistant tuberculosis is increasing. Modern combination treatment, impregnated bednets and indoor residual spraying has led to a substantial reduction in the prevalence of malaria during few years in African countries.

[An outbreak of MRSA in a nursing home in Oslo]. / Et MRSA-utbrudd i et sykehjem i Oslo.

BACKGROUND: Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) represent an increasing problem in Norway, also in nursing homes and other institutions for long-term care. We describe an outbreak of MRSA in a nursing home in Oslo 2004-5. MATERIAL AND METHODS: The nursing home has six wards with 185 beds. The building is old, all rooms have toilets and sinks, but showers are shared. Standard screening procedures were carried out according to the national MRSA guide and by using the nursing home's infection control programme. Later on we used more extensive screening of staff and patients. RESULTS: The outbreak started in a ward for short-term care, but spread to a ward for patients with dementia after some months. Ten patients, seven staff members and two relatives of infected persons were diagnosed with MRSA. All bacteria probably belonged to the same strain. Four staff members and five patients who were infected had pre-existing wounds or eczema. The nursing home was declared free of MRSA 20 months after the outbreak started, but one member of staff remained a carrier for two years, and one patient became a chronic carrier of MRSA. During the first six months, infected patients were restricted to their rooms, and standard eradication procedures were carried out for five days. Later on, we introduced cohort isolation for infected, exposed and recently treated patients, a different screening routine, a prolonged eradication procedure, restrictions on staff working elsewhere and more stringent precautions for visitors. INTERPRETATION: An old building and insufficient isolation procedures during the first phase of the outbreak contributed to spreading MRSA and prolonging the outbreak. Cohort isolation seemed to be the most important measure to control the outbreak. All nursing homes should have a designated single patient room for contact precautions. Long-term carriers of MRSA in nursing homes represent a big challenge.