Intercontinental spread of a genetically distinctive complex of clones of Neisseria meningitidis causing epidemic disease.

Strains of Neisseria meningitidis responsible for an epidemic of meningococcal disease occurring in Norway since the mid-1970s and for recent increases in the incidence of disease in several other parts of Europe have been identified by multilocus enzyme electrophoresis as members of a distinctive group of 22 closely related clones (the ET-5 complex). Clones of this complex have also colonized South Africa, Chile, Cuba, and Florida, where they have been identified as the causative agents of recent outbreaks of meningococcal disease. There is strong circumstantial evidence that outbreaks of disease occurring in Miami in 1981 and 1982 were caused in large part by bacteria that reached Florida via human immigrants from Cuba.

An outbreak of epidemic diarrhoea in adults caused by a new rotavirus in Anhui Province of China in the summer of 1983.

Shexian County of Anhui Province in East China experienced a severe outbreak of nonbacterial diarrhoea in May and June of 1983. Over 20,0000 cases were reported. Most were adults of 20 to 50 years old. The isolated virus was morphologically indistinguishable from ordinary infantile rotavirus, but CF and ELISA tests showed that the new virus lacked the common group-A antigen shared by ordinary rotavirus. Nine of 10 convalescent-phase and three paired sera of patients showed antibody positive, with a greater than four-fold antibody rise against new rotavirus in the CF test. Seventeen faecal samples from patients showed identical, and special, electropherotype. They all had a double-stranded RNA with 11 discrete segments. The RNA profiles were quite different from those of reference rotavirus Wa strain and ordinary infantile rotaviruses. Third and 4th segments were near to each other, 5th and 6th segments were very close, but 7th, 8th, and 9th segments were widely separated. This study indicates the new virus can be identified as part of a new group of rotaviruses. This new rotavirus has been incriminated as the causative agent of the epidemic.

Institutional outbreaks of rotavirus diarrhoea: potential role of fomites and environmental surfaces as vehicles for virus transmission.

To assess the potential of fomites and environmental surfaces as vehicles in the transmission of rotaviral diarrhoea, disks (1 cm diameter) of various porous and non-porous materials were contaminated with about 10(5) plaque-forming units of the Wa strain of human rotavirus (HRV) suspended in faecal matter. The contaminated disks were then held for 10 days at either room temperature (22 +/- 2 degrees C) or 4 degrees C with the relative humidity (RH) at the high (85 +/- 5%), medium (50 +/- 5%) or low (25 +/- 5%) level. Survival was longer on non-porous surfaces at the lower temperature and at lower humidity. In contrast, survival on porous surfaces was very variable; better on cotton-polyester than on poster card or paper currency on which HRV survived very poorly. These results suggest that under the right environmental conditions, HRV-contaminated objects could play a role in the transmission of rotavirus infections in hospitals, nursing homes and day-care centres.

Infection with influenza A H1N1. 1. Production and persistence of antibody.

Three outbreaks of influenza caused by influenza A H1N1 occurred in a boys' boarding school in 1978, 1979 and 1983. The serological response to infection with variants of the H1N1 virus was studied by radial haemolysis and haemagglutination inhibition after primary infection and reinfection. The persistence of this antibody was also studied. Infection in 1978 resulted in the production of persistent antibody to both the haemagglutinin and neuraminidase of the homotypic strain. Antibody which cross-reacted with later variants of the virus was less frequently produced, the peak response was delayed and such antibody persisted less well. Infection in 1979 resulted in a similar response to that observed in 1978 after primary infection. Reinfection resulted in a broad response in all cases. In 1983 all infected boys produced antibody which reacted with the homotypic strain but only approximately one-third of primary infections produced antibody which reacted with the A/USSR/92/77 strain. The neuraminidase of the A/USSR strain failed to detect one third of the primary infections. Reinfection again resulted in a broad response.

Infection with influenza A H1N1. 2. The effect of past experience on natural challenge.

Following its reintroduction in 1978 influenza A H1N1 spread widely in the child population. By the autumn of 1979, 75% of 11-year olds entering a boys' boarding school had detectable antibody. The protective effect of previous experience could be assessed during two outbreaks in the school. In the first outbreak in 1979, 90% of those known to have been infected in the previous year were protected against reinfection. In 1983 after strains of the H1N1 subtype had undergone antigenic drift a large outbreak occurred. It was estimated that past infection conferred protection against clinical influenza in 55%. Where past infection resulted in the presence of antibody which reacted with the outbreak strain the attack rate was further reduced. A large number of sub-clinical infections was detected in all groups.

Comparative studies of H3N2 influenza virus strains isolated in May-June, 1982, and in the subsequent epidemic in February, 1983: antigenic and genome analysis.

Comparative studies have been undertaken on the H3N2 influenza virus strains isolated in Leningrad in May-June, 1982 and those isolated in the subsequent winter epidemic in February, 1983. Analysis of the isolates with ferret antisera against standard influenza viruses of the H3N2 subtype and with monoclonal antibodies against A/Bangkok/1/79 virus revealed a considerable but similar degree of heterogeneity in the HA antigenic specificity of the strains isolated in the spring-summer, 1982, as in the winter, 1983, periods and also a close resemblance between the antigenic specificities of the strains of these two epidemics. However comparative genome analysis of the strains using cRNA:vRNA hybridization technique revealed that in terms of the gene homology, the influenza virus strains which circulated in the spring-summer period of 1982 resembled the strains responsible for the previous rather than subsequent epidemic.

Dengue in Puerto Rico, 1977: public health response to characterize and control an epidemic of multiple serotypes.

The largest and most extensive documented dengue epidemic in Puerto Rico struck an estimated 355,000 Puerto Rican residents from July-December 1977. The mixed epidemic of dengue types 2 and 3 coincided with a Caribbean pandemic of dengue type 1, first introduced into the western hemisphere in early 1977 and into Puerto Rico in the fall of that year. Health officials assembled a team to assess the epidemic and mounted a campaign to end it. Attempts to monitor the incidence and spread of dengue were confounded by simultaneous co-circulation of influenza virus, underscoring problems in formulating public health strategies dependent on nonspecific clinical and epidemiologic case criteria, and the need for rapid and reliable diagnostic capabilities. Despite co-circulation of multiple dengue serotypes, a risk factor associated with severe and fatal dengue hemorrhagic fever (DHF) in Southeast Asia, hospital and death certificate surveillance disclosed no cases of DHF in Puerto Rico. The epidemic serves as a reminder that when preventive measures are impossible or infeasible, developed countries with high living standards may be susceptible to large scale epidemics of infectious diseases.

Epidemic Coxsackie B virus infection in Johannesburg, South Africa.

A particularly extensive epidemic of Coxsackie B3 virus infection occurred in Johannesburg in the spring and summer of 1984. A total of 142 positive cases were diagnosed by isolation of the virus from stools and other specimens (60) or by serology (82). Coxsackie B3 accounted for 87% of the isolations and was also the dominant serotype on serology. The outbreak involved predominantly children and young adults, with no apparent sex differences being noted. The majority of specimens came from the white population and no significant difference in age or sex distribution could be observed between the two race groups. The major clinical presentation in the white group was Bornholm disease followed by cardiac involvement and then meningoencephalitis. In the black group, however, myocarditis was the major clinical presentation, which is of particular interest taking into account the extremely high incidence of acute rheumatic carditis in this population and the prevalence of chronic cardiomyopathy.

An epidemic of acute diarrhoea in rural southern India associated with echovirus type 11 infection.

An epidemic of diarrhoea with two distinct waves affected a village of 1375 people in southern India in 1983. The first wave of the epidemic, from the last week of December 1982, had a sharp peak in January 1983 and was over by March. Echovirus type 11 was isolated from patients, who also had a serum antibody response to the virus. During the second wave of the epidemic, from May to September 1983, the clinical features were different and Shigella flexneri was isolated without significant viral isolates. Infection during the first wave did not protect from the second wave. Virus isolation was in human intestinal tumour-derived differentiated epithelial cell lines; such cell lines may be useful for the isolation and identification of enteroviruses in clinical samples.

Type A influenza (H2N2) viruses isolated in Leningrad in 1980.

In April-May 1980, two independent outbreaks of influenza-like illness occurred in Leningrad among children's-home children aged from 3 months to 2 years (of 68 children under observation, 50 became ill) and among boarding-school pupils aged 15-17 years (of 50 pupils under observation, 13 became ill). A total of five influenza A virus strains were derived from one clinically healthy and three affected children of the children's home. Similar viruses were obtained from one affected boarding-school pupil and from an infected woman aged 24 years (a sporadic case within a household). On the basis of laboratory findings, all these seven strains were identified as influenza A H2N2 subtype strains. Six of the affected children showed significant seroconversion only to H2 haemagglutinin from February to May 1980. Type A influenza H2N2 virus was isolated from three persons, including the sporadic case, who also showed significant seroconversion to H2 haemagglutinin. H2N2 influenza A virus was isolated on two occasions, at a 7-day interval, from the girl N. Ju. Laboratory findings obtained from the study of the viruses isolated using up-to-date immunological and molecular-biochemical techniques enable us to conclude the following. The A/Leningrad/80 isolates belong to H2N2 sero-subtype. The viruses isolated are similar but not identical to the A/Singapore/I/57 reference strain in details of polypeptide and gene composition.

Epidemic of LAV/HTLV III infection in drug addicts in Milan: serological survey and clinical follow-up.

A clinico-epidemiological study is reported concerning a group of 306 parenteral drug addicts (PDAs), 71 of whom were affected with the lymphadenopathy syndrome (LAS); all were followed-up between 1981 and 1984. Although full-blown acquired immune deficiency syndrome (AIDS) was observed only in one case, none of the other patients examined have undergone complete recovery so far. The results of our study point to a wide circulation of LAV/HTLV III among our group of PDAs, starting at least as early as 1981 and preceding by a few months the development of clinical signs and symptoms of LAS. A peak incidence of the latter was observed during the winter of 1983/1984, running parallel with a marked increase in seropositives for LAV/HTLV III antibody. Drug addiction, sexual promiscuity and a low standard of living all seem to play a decisive role in the spread of the infection and, consequently, of the diseases related to it (LAS, AIDS-related complex and AIDS). In fact, PDAs appear to represent the major source of the disease in Italy.

Moraxella lacunata isolated from epidemic conjunctivitis among teen-aged females.

An epidemic follicular conjunctivitis affecting teen-aged females has been studied. Moraxella lacunata was isolated from 11% of the patients, a frequency far above the rate found in other types of chronic conjunctivitis. The condition is suggested to be the chronic follicular conjunctivitis (Axenfeld) due to Moraxella lacunata.

Variation of Neisseria gonorrhoeae protein II among isolates from an outbreak caused by a single gonococcal strain.

Gonococci isolated from localized urogenital infections usually possess one or more protein II (P.II) species in the outer membrane, but the structural and antigenic variation of these proteins among different gonococcal strains has made it difficult to determine if specific proteins of the P.II class are associated with particular sites or types of infection. A recent outbreak of gonorrhea in Durham, N.C., was unusual in that over 200 isolates were derived from a single strain, which provided an opportunity to address these questions. The P.II profile of 54 isolates was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of outer membrane proteins. At least seven distinct P.II proteins were seen; no single protein or combination of proteins predominated in the different isolates, and there was no association of P.II profile with site of isolation. Gonococci recovered from the same patient at different times had different P.II profiles, confirming that P.II variation occurred in vivo.

Field outbreaks of colibacillosis of turkeys associated with hemorrhagic enteritis virus.

In a study of field material and a survey conducted by the authors, typical signs of colibacillosis of 6-to-12-week-old poults included sudden onset, listlessness, rales, and high mortality. Signs persisted for about 2 weeks and were often followed by a low incidence of lameness caused by Escherichia coli. Gross lesions included enlarged and congested spleens and livers, and dilated discolored black or purple duodenal loops. Microscopic lesions included splenic and hepatic congestion. In some birds (freshly killed and fixed immediately), the epithelium at the tips of the duodenal villi was sloughing, but in other birds the villi were intact and normal in appearance. Splenic enlargement, the presence of intranuclear splenic inclusions similar to those found in hemorrhagic enteritis (HE), and the isolation of HE virus from some of the field spleens all indicated that inapparent HE infection often occurs at approximately the same time as this type of colibacillosis. It is therefore believed that HE infection often exacerbates colibacillosis of older poults.

Human parvovirus (B19) and erythema infectiosum.

An outbreak of erythema infectiosum ("fifth disease") was studied in Fukuoka, Japan, in 1980-1981. Human parvovirus (HPV) antigen was not detected in any patients, but anti-HPV, measured by countercurrent immunoelectrophoresis, was found in 33 of 34 affected children and in 21 (15%) of 141 children of the same ages without the disease. Immunoglobulin M class anti-HPV was present in all 25 children with erythema infectiosum tested. In a survey of hospital patients, the prevalence of anti-HPV detected by CIE was 12% in the cohort 5 to 9 years of age, 19% in the cohort 10 to 14 years, and 32 to 55% in the cohorts greater than or equal to 30 years. The antibody reactions in the cases of erythema infectiosum, which were already well established at the onset of disease, indicate that HPV was the cause of the outbreak.

Characterization of Nigerian strains of Newcastle disease virus.

Newcastle disease virus was isolated from outbreaks of the disease in vaccinated and unvaccinated poultry flocks representing commercial and backyard farms in different parts of Nigeria. On characterization, all 12 isolates were found to be velogenic.

Comparative electrophoretic study of polypeptides of influenza A/H3N2 viruses isolated in circumscribed geographical areas.

Two distinct groups of influenza A/H3N2 viruses, closely related to A/Bangkok/1/79 and to A/Belgium/2/81, have been chosen from viruses isolated in Italy during 1981 to 1983 with the aim of analysing the biochemical composition of their polypeptides. The strains of each group have shown differences in electrophoretic migration rates in one or more proteins in comparison to the prototype viruses. Polypeptide mobility variations among isolates from circumscribed geographical areas and from single outbreaks have also been observed. In particular, there was a high degree of variability in the NS1 protein. The detection of biochemical differences among identical antigenic variants, probably the result of point mutations in polypeptide sequences or of genetic reassortment among different co-circulating human viruses, is a further expression of the peculiar ability of the influenza A virus to exhibit variation in internal proteins during its circulation.

An outbreak of gastroenteritis due to Escherichia coli 0142 H6 in a neonatal department.

An outbreak of gastroenteritis due to Escherichia coli 0142 H6 in a neonatal ward is described. The epidemic affected 16 of 24 infants (infection-rate 66 per cent), of whom one died due to necrotizing enterocolitis. Administration of antibiotics was of limited value in treatment or in eradicating E. coli 0142 H6 from the stools. Termination of the epidemic was only accomplished by isolating the patients, accompanied by strict hygienic measures, including the use of disposable gloves. Gastroenteritis due to this organism occurred only in prematurely born infants during the first 2 weeks of life.