An outbreak of severe infections with community-acquired MRSA carrying the Panton-Valentine leukocidin following vaccination.

BACKGROUND: Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination. METHODS AND FINDINGS: We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage. CONCLUSIONS: We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings.

Effectiveness of community based campaign for larvae reduction in Ben Tre province

A community based campaign for larvae reduction was organized in 3 communes Hoa Loc, An Thoi, Tan Trung of Mo Cay district, Ben Tre province in 2002. The results: the model of campaign expressed clearly the effectiveness and feasibility in larvae and mosquitos density’ reduction immediately after implementing. Furthermore, launching three to four campaigns times per year can maintain its effectiveness in long time. To gain the most effectiveness, all methods were urged implementing for changes in people’s behaviours and close combination between government, health training communication and regulations

The compatibility and adequacy between clinical and hematological standards in the cases with Dengue Haemorrhagic Fever in An Giang in 2002

A descriptive prospective study of hospitalized Dengue including Dengue Fever (OF) and Dengue Haemorrhagic Fever (DHF) was undertaken in An Giang General Hospital. An Giang Province from April 2002 to May 2003. A first blood sample (BS) will be taken on admission to detect dengue antibody by Elisa (IgM and IgG) and virus isolation. The second BS will be drawn on discharge with the same test. If the patient is discharged before day 10th after the onset of fever, a third BS will be planned, for IgM and IgG too. In the hospital, all patients will be follow-up adequate platelet count and haematocrit. - There is 1009 patient selected (less than 15 years old), 5 DHF deaths due to DHF and 4 deaths due to others. Classification of the Dengue hospitalized cases: DF (28. 5%), DHF (49%) and DSS (10%). - The highest positive IgM rate is belong to DSS patient group (89%) and then DHF, the lowest rate is DF (34%). The virus isolated rate of the DSS patient group is highest (16.8%), and then DF (14.6%). DEN2 is predominant (with 84% of all virus isolated), and then DEN4 (8.8%). - On the admission, there are the overload for Dengue diagnosis. 12% cases with DF/DHF on the admission but they are typhoid fever, measles and viral infection on the discharge. - Clinical and laboratory findings are the more severe (thrombocytopenia and haemoconcentration), the more positive IgM rate and virus isolated. - For the correspondences between DF, DHF diagnosis. Clinical and laboratory findings according to WHO criteria: there are only 22.2% of DHF satisfied 4/4 WHO criteria, 39.2% satisfied 3/4 criteria and ultrasound is the test supported for these DF, DHF cases. - 71% confirmed DHF cases and 26% confirmed DSS cases have not thrombocytopenia and haemoconcentration. - The haemorrhagic manifestation just appear in 46.6% of DHF cases, even if DSS cases, there are only 56.2% cases have got the haemorrhagic manifestations.

Epidemic of influenza A H5 N1 virus in humans occurred in South Vietnam

Epidemic of influenza A H5 N1 virus in humans occurred in South Vietnam from 12/2003 up to now there were 287 suspected cases and 24 confirmed cases, included 20 deaths with case-fatality rate was very high (83.33%). Based on epidemical surveillance and laboratory, we believed that cases usually appear by the end of year and the beginning of the next year at the same time of the winter in North Vietnam, and the dry season in the South Vietnam. It was distributed sporadically in different regions, including highland, urban areas and rural areas of the Mekong delta. Almost of the confirmed cases were young (average 16,17 years old). The rate of ethnic patients with H5N1(+) were high 25%. There has been no evidence of human to human transmission, but there were some risk factors associated with the confirmed cases were: contact directly with the sick/dead poultry (OR=3.39; p=0.034), eating the sick/dead poultry (OR=4.28; p= 0.025), person in family prepared chicken that was sick and died for cooking (OR=5.2; p=0.01).

Effectiveness of community-based campaign for reduction of larvae source in Ben Tre province

A new pilot model - community based campaign for source reduction was implemented in Hoa Loc commune (Mo Cay district, Ben Tre province). Fives campaigns were carried out during rainy season in the year 2002 with strong participation of local authorities, school and other social unions. Fives steps of campaign model included (1) Organizing; (2) Training; (3) Communicating before campaign; (4) Launching campaign; (5) Monitoring and assessing. Results: The entomological index in the implemented communes was lower than communes having participants. A model - community based campaign for source reduction was effective and feasible, at the same time having long effectiveness after 3-4 folds/year

Present situation about using sources of water in 3 provinces of Mekong delta, 2002

The study about using water sources in diet in community was performed at 3 provinces of Mekong Delta in January 2002. The total number of investigated households were 1639, the samples were collected by investigating 30 groups method. The investigating about major water source using diet showed that on average, about 70% (35-92%) of households used river water, 17.6% (2.0-48%) used tap water and 10.8% (0-20.8%) used rain water. 40% of points used the river water to supply water with community, far latrine-fishpond from 10m, 26% was closed cattle-breeding cage (under 10m). The river water-processing method was alum accumulation, the pasteurization rate without chloramine was nearly 80% and about 20% of households used non-boiled drinking-water. The rate of households used boring well was very low (2-4%), 10% of households entered using processed river water because they were very poor

The importance of leptospirosis in Southeast Asia.

The importance of leptospirosis in Southeast Asia was assessed in conjunction with other studies supported by the U.S. Naval Medical Research Unit No. 2 (US NAMRU-2), Jakarta, Republic of Indonesia. These included studies of hospital-based, acute clinical jaundice in Indonesia, Lao PDR, and Socialist Republic of Vietnam; nonmalarial fever in Indonesia; and hemorrhagic fever in Cambodia. Background prevalence estimates of leptospiral infection were obtained by a cross-sectional, community-based study in Lao PDR. Laboratory testing methods involved serology, microscopic agglutination test, and reverse-transcriptase polymerase chain reaction. Suggestive evidence of recent leptospiral infections was detected in 17%, 13%, and 3% of patients selected on the basis of non-hepatitis A through E jaundice, nonmalarial fever, and hemorrhagic fever (in the absence of acute, dengue viral infections). Leptospiral IgG antibody, reflective of prior infections, was detected in 37% of human sera, collected in Lao PDR. The predominant leptospiral serogroups identified from cases with clinical jaundice were Hurstbridge, Bataviae, and Icterohaemorrhagiae tonkini LT 96 69. Among the nonmalarial febrile cases, Bataviae was the most frequently recognized serogroup. Pyrogenes and Hurstbridge were the principal serogroups among the hemorrhagic fever case subjects. These findings further attest to the relative importance of clinical leptospirosis in Southeast Asia. The wide spectrum of clinical signs and symptoms associated with probable, acute, leptospiral infections contributes to the potential of significant underreporting.