RESUMEN
In April 2009, influenza A(H1N1)pdm09 virus infection was confirmed in a person who had been symptomatic while traveling on a commercial flight from Mexico to the United Kingdom. Retrospective public health investigation and contact tracing led to the identification of 8 additional confirmed cases among passengers and community contacts of passengers.
Asunto(s)
Viaje en Avión , Trazado de Contacto , Subtipo H1N1 del Virus de la Influenza A/clasificación , Gripe Humana/epidemiología , Humanos , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/transmisión , Vigilancia de Guardia , Encuestas y CuestionariosRESUMEN
In summer 2011, two outbreaks of a unique, multidrug-resistant strain of Salmonella enterica serovar Typhimurium phage type 120 (DT120) occurred mainly in the Midlands, England. The first outbreak occurred among guests attending a wedding in July 2011 ('Wedding outbreak'), followed by a more geographically dispersed outbreak in August and September 2011 ('Midlands outbreak'). Fifty-one cases were confirmed. Detailed epidemiological and environmental health investigations suggested that pork was the most likely source of both outbreaks. All human samples and one pork sample showed the specific multiple-locus variable-number tandem-repeat analysis (MLVA) profile 3-11-12-NA-0211, with at most two loci variations. Trace-back investigations suggested a link to a butcher's shop and a pig farm in the East Midlands. The investigations highlight the utility of molecular analysis (MLVA) in supporting epidemiological investigations of outbreaks caused by S. Typhimurium DT120. Safe handling and cooking of pork by food business operators and consumers are key interventions to prevent future outbreaks.
Asunto(s)
Brotes de Enfermedades , Enfermedades Transmitidas por los Alimentos/epidemiología , Gastroenteritis/epidemiología , Carne/microbiología , Infecciones por Salmonella/epidemiología , Salmonella typhimurium/aislamiento & purificación , Adolescente , Adulto , Anciano , Animales , Tipificación de Bacteriófagos , Niño , Preescolar , Estudios de Cohortes , Farmacorresistencia Bacteriana Múltiple , Inglaterra/epidemiología , Femenino , Microbiología de Alimentos , Enfermedades Transmitidas por los Alimentos/microbiología , Gastroenteritis/microbiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Repeticiones de Minisatélite/genética , Estudios Retrospectivos , Infecciones por Salmonella/microbiología , Salmonella typhimurium/genética , Porcinos , Adulto JovenRESUMEN
OBJECTIVES: To determine the factors that influence non-consultant hospital doctors (NCHDs) in their decision to prescribe antimicrobial agents. METHODS: A qualitative study using semi-structured interviews centred on a life grid tracking the medical career of 22 NCHDs employed by a university teaching hospital in the west of Ireland. RESULTS: Early in their careers NCHD prescribing is based primarily on the immediate influence of more senior colleagues. Recollection of formalized undergraduate teaching and hospital guidelines are a very minor influence. As their career progressed and they exercise greater autonomy, personal experience becomes the major influence on prescribing decisions. Hospital guidelines are a minor influence. Participants consider that undergraduate teaching needs to be more practical and taught in a way that is easier to apply to on-ward situations and that hospital prescribing guidelines need to be presented in a 'user-friendly' format and adherence to the guidelines needs to be promoted. CONCLUSIONS: The key influences on antimicrobial prescribing by NCHDs are informal. New approaches are required to ensure that formal training and hospital guidelines on antimicrobial prescribing are more influential in shaping antimicrobial prescribing practice.