Cluster of botulism among Dutch tourists in Turkey, June 2008.

In June 2008, three Dutch tourists participating in a mini-cruise in Turkey needed urgent repatriation for antitoxin treatment because of symptoms of botulism. Because there was a shortage of antitoxin in the Netherlands, an emergency delivery was requested from the manufacturer in Germany. An outbreak investigation was initiated into all nine cruise members, eight of whom developed symptoms. C. botulinum type B was isolated in stool culture from four of them. No other patients were notified locally. Food histories revealed locally purchased unprocessed black olives, consumed on board of the ship, as most likely source, but no left-overs were available for investigation. C. botulinum type D was detected in locally purchased canned peas, and whilst type D is not known to be a cause of human intoxication, its presence in a canned food product indicates an inadequate preserving process. With increasing tourism to areas where food-borne botulism is reported regularly special requests for botulism antitoxin may become necessary. Preparing an inventory of available reserve stock in Europe would appear to be a necessary and valuable undertaking.

A persistent problem with scabies in and outside a nursing home in Amsterdam: indications for resistance to lindane and ivermectin.

An ongoing outbreak of scabies in and outside a nursing home in Amsterdam is described. Despite standard treatment with lindane and ivermectin, many recurrences were observed which suggested resistance to these drugs. After treatment with 5% permethrine, the patients were finally cured.

[Possible exposure to rabies in anamnesis: rabies advice in the Netherlands]. / Mogelijke blootstelling aan rabiës in de anamnese: rabiesadvisering in Nederland.

Anamnestic incidences of four patients have highlighted the potential risk ofexposure to rabies. The first patient was a 30-year-old woman who rescued a bat from the mouth of her dog; it bit her on the right wrist. In the Netherlands, bats may be infected with the Lyssa virus. The Preparedness and Response Unit (PRU) of the Centre for Infectious Disease Control (CIDC) advised human rabies immunoglobulin (HRIG) and a full vaccination programme. The second patient was a 37-year-old woman, who caught a 'sick' squirrel and was subsequently bitten on her left hand. The advice was not to use post exposure prophylaxis since rabies is not prevalent amongst squirrels in the Netherlands. The third patient, a 55-year-old man, was bitten on his right calf by a dog in Sri Lanka. He was treated with HRIG and given the full vaccination course. The fourth patient was a 14-month-old boy who was scratched on the face by a cat in Turkey. He immediately received the first vaccination and upon return to the Netherlands was treated with HRIG and the other vaccinations. All patients remained without symptoms. A structured approach for risk assessment of each potential rabies incident is possible. It requires balancing a number of criteria: the species of animal, the endemicity of rabies in a country, the observed health or vaccination status of an animal, whether the animal can be tested for rabies, if the exposure was provoked or unprovoked, the type of injury and its location on the body of the injured, and the time interval between administration of HRIG and vaccine. In the Netherlands all health care providers are expected to perform a proper risk assessment. They may seek advice from regional health departments (Municipal Health Services), who, in turn, can be assisted by the PRU. HRIG and vaccine are only provided by the National Vaccine Institute in Bilthoven.

[Large-scale, acute, bacterial gastroenteritis caused by the enterotoxin of Staphylococcus aureus after a barbecue]. / Grootschalige, acute bacteriële gastro-enteritis door enterotoxine van Staphylococcus aureus na een barbecue.

UNLABELLED: EPIDEMIOLOGICAL OBSERVATION: On a warm day, during a barbecue that was attended by over 100 guests, a large number became rapidly ill with signs of acute gastroenteritis within a few hours after eating the prepared food. The characteristic symptoms were nausea, vomiting, syncope and in some cases in a later stage, diarrhoea. Sixty patients were transferred to hospitals. INVESTIGATION: Investigation revealed that the cause of this outbreak of gastroenteritis was an enterotoxin-A-producing strain of Staphylococcus aureus in a noodle dish. Both the food residues and the faeces from patients contained genotypically identical strains of S. aureus. They all had the gene for the gastroenteritis-inducing enterotoxin A from S. aureus. CONCLUSION: This case shows that the timely involvement of the different health authorities responsible for intervening in explosions of food poisoning is crucial for the clarification and treatment of such large-scale outbreaks. In the investigation of this outbreak, the municipal health authority co-operated with regional laboratories and the Food and Consumer Product Safety Authority/Inspectorate for Health Protection and Veterinary Public Health.