Risk of infectious gastroenteritis in young children living in Québec rural areas with intensive animal farming: results of a case-control study (2004-2007).

This study was designed to evaluate the epidemiology of severe gastroenteritis in children living in Québec rural areas with intensive livestock activities. From September 2005 through June 2007, 165 cases of gastroenteritis in children aged from 6 months to 5 years, hospitalized or notified to the public health department were enrolled, and 326 eligible controls participated. The parents of cases and controls were asked questions about different gastroenteritis risk factors. The quality of the drinking water used by the participants was investigated for microbial indicators as well as for four zoonotic bacterial pathogens (Campylobacter spp, Escherichia coli, Salmonella spp and Yersinia spp) and two enteric parasites (Cryptosporidium spp and Giardia spp). From 134 stool specimen analysed, viruses were detected in 82 cases (61%), while 28 (21%) were found with at least one of the bacteria investigated, and five cases were infected by parasites. Campylobacteriosis was the main bacterial infection (n = 15), followed by Salmonella sp (n = 7) and E. coli O157:H7 (n = 5) among cases with bacterial gastroenteritis. No significant difference was found between cases and controls regarding the quality of water consumed; the frequency of faecal contamination of private wells was also similar between cases and controls. Considering the total cases (including those with a virus), no link was found between severe gastroenteritis and either being in contact with animals or living in a municipality with the highest animal density (4th quartile). However, when considering only cases with a bacterial or parasite infection (n = 32), there was a weak association with pig density that was not statistically significant after adjusting for potential confounders. Contact with domestic, zoo or farm animals were the only environmental factor associated with the disease.

Association between potential zoonotic enteric infections in children and environmental risk factors in Quebec, 1999-2006.

This study was designed to evaluate the association of potential zoonotic gastroenteritis in children, and specifically giardiasis, salmonellosis and campylobacteriosis, with environmental risk factors in rural areas of Quebec. Notified cases of gastroenteritis in children of 0-4 years of age reported in the period of 1999 through 2006 from municipalities in southern Quebec with <100,000 inhabitants were investigated. Negative binomial regression models accounting for overdispersion and adjusted for clustering were used to estimate relative risks (RR) associated with livestock densities and drinking water quality. Analyses revealed that, during this period, 2500 cases of gastroenteritis were reported in children of 0-4 years, including 819 cases of giardiasis, 690 of salmonellosis and 852 of campylobacteriosis. The incidence rate associated with all potential zoonotic agents reported was 163 cases/100,000 children-years and this was statistically associated with cattle density: RR Quartile 4/Quartile 1 (Q4/Q1) = 1.92, 95% CI = 1.43-2.58. When estimated specifically for each pathogen, incidence rates of giardiasis (RR Q4/Q1 = 1.79, 95% CI = 1.11-2.87), salmonellosis (RR Q4/Q1 = 1.64, 95% CI = 1.15-2.33) and campylobacteriosis (RR Q4/Q1 = 2.43, 95% CI = 1.60-3.68) were also associated with cattle density, with a monotonic increase of RR with increasing animal density. Giardiasis incidence was also positively associated with a poor drinking water quality, although no statistically significant association was found. Our results suggest that, in rural Quebec, bacterial and parasitic enteric infections in young children may be zoonoses related to environmental risk factors and especially cattle production.

Reduced susceptibility to penicillin among pneumococci causing invasive infection in children - Canada, 1991 to 1998.

OBJECTIVE: To determine, over time, the rate and serotypes of pneumococci with reduced penicillin susceptibility obtained from children with invasive infection. DESIGN: Active, hospital-based, multicentre surveillance spanning from 1991 to 1998. SETTING: Eleven Canadian tertiary care paediatric facilities located from coast to coast. POPULATION STUDIED: 1847 children with invasive pneumococcal infection whose isolates (from a normally sterile site) were available for serotyping and standardized testing for penicillin susceptibility at the National Centre for Streptococcus. MAIN RESULTS: The prevalence of reduced penicillin susceptibility increased from 2.5% of 197 cases in 1991 to 13.0% of 276 cases in 1998. In the latter year, 8.7% of isolates had intermediate level resistance, and 4.3% had high level resistance. Since they were first detected in 1992, strains with high level resistance have been encountered only sporadically at most centres, but by 1998, all centres but two had encountered examples. Of 40 isolates with high level resistance and 101 isolates with intermediate level resistance, serotypes matched those included in new seven-valent conjugate vaccines for children in 97.5% and 79.2% of cases, respectively. CONCLUSIONS: Pneumococci with reduced susceptibility to penicillin are increasing in frequency across Canada among children with invasive infection. The Immunization Monitoring Program, Active data indicate that new conjugate vaccines could help to curb infections due to pneumococci with reduced susceptibility to penicillin but are unlikely to control completely the problem of antibiotic resistance.

The Immunization Monitoring Program Active (IMPACT) prospective five year study of Canadian children hospitalized for chickenpox or an associated complication.

BACKGROUND: Varicella vaccine was approved for use in Canada in 1998. A major goal of universal varicella vaccine programs is to reduce severe infection and associated complications. Baseline data are essential against which to judge the effectiveness of routine childhood immunization. OBJECTIVE: To describe morbidity and mortality among children hospitalized for chickenpox. Methods. From January 1, 1991, to March 31, 1996, chickenpox admissions to 11 pediatric referral centers were actively identified. Patient and illness characteristics were compared for 3 subgroups defined by prior health: healthy; unhealthy but immunocompetent; immunocompromised. RESULTS: Of 861 cases 488 (56.7%) were healthy, 75(8.7%) were unhealthy and 298 (34.6%) were immunocompromised. The immunocompromised children differed from healthy/unhealthy cases in mean age (6.4 vs. 4.0/4.6 years, respectively, P < 0.0001); median interval from rash onset to admission (2 vs. 5/5 days, P < 0.0001); complication rate (20% vs. 90%/79%; P = 0.001); and rate of acyclovir therapy (98% vs. 24%/39%; P = 0.001). Unhealthy vs. healthy cases had a higher frequency (P < 0.01) of intensive care (13.3% vs. 4.7%), ventilation (9.3% vs. 2.0%) and death (4% vs. 0.2%). CONCLUSION: These data provide a baseline for morbidity/mortality resulting from chickenpox before varicella vaccine use in Canada.

Morbidity of pertussis in adolescents and adults.

The effect of age on the clinical presentation of pertussis was assessed in 664 adolescent and adult cases. Complications were more frequent in adults than in adolescents (28% vs. 16%). Pneumonia occurred in 2% of patients <30 years old but in 5%-9% of older patients. Urinary incontinence occurred in 34% of women >/=50 years old. Duration of cough, risk of sinusitis, and number of nights with disturbed sleep increased with smoking and asthma. The secondary attack rate in other household members >/=12 years was 11%. Pertussis in secondary case patients was less severe than in index case patients but presented with classic symptoms. The main source of infection in adolescents was schoolmates or friends; in adults it was workplace or their children. Teachers and health care workers had a greater risk of pertussis than did the general population. The burden of disease appears to increase with age, with smoking, and with asthma.

Importance of pfkA for rapid growth of Enterobacter cloacae during colonization of crop seeds.

Enterobacter cloacae A-11 is a prototrophic, glycolytic mutant of strain 501R3 with a single transposon insertion in pfkA. The populations of strain A-11 on cucumber and radish seeds were smaller than the populations of strain 501R3 in natural soil, but the populations of these two strains on pea, soybean, sunflower, and sweet corn seeds were similar (D. P. Roberts, P. D. Dery, I. Yucel, J. Buyer, M. A. Holtman, and D. Y. Kobayashi, Appl. Environ. Microbiol. 65:2513-2519, 1999). The net effect of the mutation in pfkA in vitro was a shift from rapid growth on certain carbohydrates detected in seed exudates to much slower growth on other carbohydrates, amino acids, and organic acids. The impact of the mutation in pfkA was greatest on the growth rate of E. cloacae on the seeds that released the smallest quantities of fructose, other carbohydrates, and amino acids. Corn, pea, soybean, and sunflower seeds released total amounts of carbohydrates and amino acids at rates that were approximately 10- to 100-fold greater than the rates observed with cucumber and radish seeds for the first 24 h after inhibition began. The growth rate of strain A-11 was significantly less (50% less) than the growth rate of strain 501R3 on radish seeds, and the growth rate of strain A-11 was too low to estimate on cucumber seeds in sterile sand for the first 24 h after inhibition began. The growth rate of strain A-11 was also significantly lower on soybean seeds, but it was only 17% lower than the growth rate of strain 501R3. The growth rates of strains 501R3 and A-11 were similar on pea, sunflower, and corn seeds in sterile sand for the first 30 h after imbibition began. Large reductions in the growth rates of strain A-11 on seeds were correlated with subsequent decreased levels of colonization of seeds compared to the levels of colonization of strain 501R3. The strain A-11 populations were significantly smaller than the strain 501R3 populations only on radish and cucumber seeds. The mutation in pfkA appears to decrease the level of colonization by E. cloacae for seeds that release small quantities of reduced carbon compounds by decreasing the size of the pool of compounds that support rapid growth by this bacterium.

Epidemiological features of pertussis in hospitalized patients in Canada, 1991-1997: report of the Immunization Monitoring Program--Active (IMPACT).

To assess the morbidity associated with the continued high levels of pertussis, we studied all children <2 years of age who were admitted to the 11 Immunization Monitoring Program--Active (IMPACT) centers, which constitute 85% of Canada's tertiary care pediatric beds. In the 7 years preceding implementation of acellular pertussis vaccine, a total of 1,082 pertussis cases were reported, of which 49.1% were culture-confirmed. The median age of the patients was 12.4 weeks; 78.9% of cases were in children <6 months of age. Complications of pertussis were common: pneumonia was reported in 9.4% of cases, new seizures in 2.3%, and encephalopathy in 0.5%. There were 10 deaths (0.9%), all in children < or =6 months of age. Duration of hospitalization was longer (9.3 days vs. 4.9 days; P = .001) and intensive care was required more frequently (19.2% vs. 4.9%; P = .001) in infants under <6 months of age than in those > or =6 months. Pertussis continues to cause significant morbidity and occasional mortality in Canada, particularly in young infants.

Cost of chickenpox in Canada: part I. Cost of uncomplicated cases.

OBJECTIVE: The purpose of this study was to assess the direct medical costs and productivity losses associated with uncomplicated chickenpox (no hospitalization) in Canada. METHODS: A total of 179 otherwise healthy 1- to 9-year-old children with active chickenpox were recruited from schools, day care centers, and physician offices in 5 provinces. Direct medical (physician contacts, medication, and diagnostic tests) and nonmedical (personal expenses including child care) resources expended during the illness were determined by caregiver interview. Productivity losses attributable to the disease were determined by assessing caregiver time lost from work and daily activities. Unit costs for all resources were obtained from sources in 2 provinces, and per-patient treatment costs were determined from the patient, Ministry of Health, and societal perspectives. RESULTS: From a societal perspective, the per-case cost for children from 1 to 4 years of age and from 5 to 9 years of age was $370.2 and $236.5, respectively. Direct medical costs accounted for 10% of the total costs in both groups. The largest cost driver in patient care was caregiver productivity losses, which amounted to $316.5 in the younger age group and to $182.7 in the older age group. Based on an estimated yearly incidence of 344 656 cases of uncomplicated chickenpox in Canada, the total annual societal burden of the disease can be estimated at $109.2 million, with a cost to the Ministry of Health of $11.2 million. CONCLUSION: Chickenpox is one of the last common childhood diseases prevalent in Canada, and the uncomplicated disease, despite its rather benign course, imparts a large annual economic burden.

Role of pfkA and general carbohydrate catabolism in seed colonization by Enterobacter cloacae.

Enterobacter cloacae A-11 is a transposon mutant of strain 501R3 that was deficient in cucumber spermosphere colonization and in the utilization of certain carbohydrates (D. P. Roberts, C. J. Sheets, and J. S. Hartung, Can. J. Microbiol. 38:1128-1134, 1992). In vitro growth of strain A-11 was reduced or deficient on most carbohydrates that supported growth of strain 501R3 but was unaffected on fructose, glycerol, and all amino acids and organic acids tested. Colonization by strain A-11 was significantly reduced (P

Failure of physicians to consider the diagnosis of pertussis in children.

To determine the ability of physicians to make a diagnosis of pertussis and factors associated with improved diagnosis, 8,235 children from 88 child care centers and 14 elementary schools from Quebec City, Quebec, Canada, were evaluated by using a questionnaire completed by parents and a medical record review. Children must have consulted a physician to be included in the evaluation. There were 558 children meeting the surveillance case definition and 416 meeting a modified World Health Organization case definition who consulted a physician. A diagnosis of pertussis was considered in 24%-26% of children meeting either case definition, made in 12%-14%, and reported for 6%. Pertussis diagnosis was significantly associated with having a history of pertussis exposure (P < or = .003), four pertussis-related symptoms (P < .001), and a cough for > or = 5 weeks (P < or = .05) and consulting in a hospital setting (P < or = .03). The proportion of cases of pertussis diagnosed and reported is low even when children present with classical symptoms.

Effectiveness of a whole cell pertussis vaccine in child-care centers and schools.

BACKGROUND: Pertussis has substantially increased in Quebec, Canada, since 1990. We estimated pertussis vaccine effectiveness and vaccine coverage in child-care centers and elementary schools. METHODS: Two retrospective cohort studies were simultaneously conducted. One included 4482 children attending 88 public child-care centers and the other included 3429 pupils in 14 elementary schools. Cough and pertussis symptoms were assessed through a questionnaire and medical records; immunization status was ascertained by examination of written records. RESULTS: In child-care centers 95% of children had received at least three vaccine doses at the beginning of the follow-up; in schools more than 98% of pupils had received at least 4 doses. With > or = 4 doses of vaccine and a standard case definition used for surveillance (cough > or = 2 weeks, > or = 1 pertussis symptom and no other apparent cause for cough), vaccine effectiveness was estimated at 61% (95% confidence interval, 44 to 72%) in child-care centers and at 60% (95% confidence interval, 10 to 82%) in schools. With the same number of doses but a case definition requiring a cough > or = 5 weeks, vaccine effectiveness increased to 71% (95% confidence interval, 49 to 83) in child-care centers and to 86% (95% confidence interval, 66 to 94%) in schools. CONCLUSIONS: The increase in pertussis in Quebec is not caused by a low vaccine coverage. A low vaccine effectiveness may contribute to the resurgence of pertussis in the past decade.

Isolation and modulation of growth of a colonization-impaired strain of Enterobacter cloacae in cucumber spermosphere.

Enterobacter cloacae A-46 was isolated for use in an environmental containment strategy for genetically modified derivative strains with enhanced biocontrol activity. The population of E. cloacae A-46, a transposon mutant of the plant-beneficial bacterium E. cloacae 501R3, increased 10-fold (significant increase at P < or = 0.05) in cucumber spermosphere when applied to cucumber seeds along with casamino acids. In contrast, strain A-46 was incapable of proliferation in cucumber spermosphere in the absence of casamino acids. Populations of strain A-46 also failed to increase in corn, cowpea, sunflower, and wheat spermospheres in the absence of casamino acids, while populations of strain 501R3 increased 3162-, 512-, 1698-, and 93-fold, respectively. In addition, the persistence of strain A-46 in corn, cucumber, and sunflower rhizospheres and in natural soil was greatly reduced compared with the parental strain 501R3.

Use of DAPI for anastomosis group typing of strains of the fungus Rhizoctonia solani.

Strains of Rhizoctonia solani, a common soil-borne, pathogenic fungus of plants, are assigned to one of 11 anastomosis groups (AGs) based on the occurrence of imperfect fusions (anastomoses) between hyphae of a non-typed strain and a tester strain of one of the 11 AG's. Imperfect fusion is characterized by the death of one or more cells in each of the hyphae involved in the fusion. Although hyphae from branches of the same strain of R. solani may fuse with each other (self-fusion), cell death does not occur. Cell death is accompanied by nuclear degradation and granulation, or plasmolysis of the cytoplasm, which often is not visible using brightfield microscopy. When the DNA-binding fluorochrome DAPI (4',6-diamidino-2-phenylindole) is used and the hyphal fusions viewed under fluorescence microscopy, no nuclei are observed in fused hyphal cells from two strains of the same AG of R. solani. Because DAPI reacts only with living nuclei, lack of staining is presumptive evidence that the fused cells are dead as a result of imperfect fusion. The use of DAPI reduces the time required for making AG determinations compared to standard methods because it eliminates the need to assess cell wall dissolution and cytoplasmic fusion. Also, it is not necessary to trace the hyphae involved in the fusion to their respective origins to ensure that self-fusion has not occurred.

[Major measles epidemic in the region of Quebec despite a 99% vaccine coverage]. / Epidémie majeure de rougeole dans la région de Québec malgré une couverture vaccinale de 99%.

The 1989 measles outbreak in the province of Quebec has been largely attributed to an incomplete vaccination coverage. In the Quebec City area (pop. 600,000) 1,363 confirmed cases of measles did occur. A case-control study conducted to evaluate risk factors for measles allowed us to estimate vaccination coverage. It was measured in classes where cases did occur during the outbreak. This population included 8,931 students aged 5 to 19 years old. The 563 cases and a random sample of two controls per case selected in the case's class were kept for analysis. The vaccination coverage among cases was at least 84.5%. Vaccination coverage for the total population was 99.0%. Incomplete vaccination coverage is not a valid explanation for the Quebec City measles outbreak.