Communicable disease report. CDR review最新文献

In a one month period in the summer of 1993 a community outbreak of Escherichia coli O157 infection affected six children living within an area of 1.5 miles radius in south west London. Three children developed haemolytic uraemic syndrome, one of whom died. E. coli O157 phage type 2 was isolated from faeces in five cases and serological tests showed the sixth child had antibodies to E. coli O157 lipopolysaccharide. E. coli O157 phage type 2 was isolated from a faecal specimen from this child's mother who was a secondary case. Three of the cases, whose onset dates were within three days of each other, had all been exposed to a paddling pool where disinfection procedures were found to be inadequate. Samples of water taken from this pool contained E. coli, although not the O157 serotype. A fourth case had played at a different paddling pool in the three days before becoming ill. Action has been taken to improve disinfection procedures at municipal paddling pools in the London borough concerned.

Many different kinds of recreational and therapeutic pools now exist and all have the potential to transmit infection. This paper offers a brief review of reports of pool associated infections, along with short descriptions of the different kinds of pool and of the disinfection and filtration systems designed to minimise the possible transmission of infection by pool water. An outline of pool monitoring is included together with the rationale of microbiological testing and current microbiological guidelines. Good management is important; a well managed pool with an adequate disinfectant level, a pH value within the recommended range, regular filter backwashing, and satisfactory microbiological parameters will not present a significant infection risk. If management or design is poor, conditions can occur in which bathers become infected. Most infections reported in association with pools happen in these circumstances.

We have reviewed all general outbreaks of infection due to Vero cytotoxin producing Escherichia coli (VTEC) O157 reported in England and Wales from 1992 to 1994. One hundred and seventy-three people were affected in 18 outbreaks, compared with 76 people in seven outbreaks in the preceding three years (1989 to 1991). Outbreaks occurred throughout England and Wales. Thirty-eight per cent of cases were admitted to hospital, 21% developed haemolytic uraemic syndrome, and 3% died. VTEC O157 infection causes particular concern because of its serious complications--haemorrhagic colitis and haemolytic uraemic syndrome, its capacity to spread from person to person as well as by food and water, and its reservoir in dairy and beef cattle.

Projections of the future incidence of AIDS cases are needed for planning purposes, to help set research priorities, and to describe the most likely pattern of transmission of HIV infection in the past that underlies the observed and projected incidence of AIDS. Earlier reports of projections for England and Wales were published in 1988, 1990, and 1993. During 1995 a group of experts has worked, using AIDS case reports to the end of December 1994, to make new projections to the end of 1999. The expert group concludes that, after adjustment for underreporting, there will be between 1840 and 2300 new cases of AIDS in England and Wales in 1997, and between 1760 and 2455 new AIDS cases in 1999. For planning purposes, a figure of 2025 new AIDS cases is projected for 1997, and 2010 for 1999. The planning projections for new AIDS cases in 1997 and 1999 among the main exposure categories, after adjustment for underreporting, are as follows: homo/bisexual males 1305 and 1235, people exposed heterosexually 490 and 525, and injecting drug users 140 and 155. Between 1995 and 1999, it is expected that new AIDS cases may fall by 7% in homo/bisexual males, and rise by 25% in the heterosexual exposure category and by 29% in injecting drug users. The incidence of AIDS in the children of mothers infected with HIV is expected to rise steadily from 30 new cases in 1994 to 45 in 1997 and 55 in 1999. New cases in recipients of contaminated blood or blood factors are expected to fall to 35 in 1997 and 30 in 1999, compared with a peak 10 years earlier of over 70 new cases each year. It is projected that 4010 AIDS cases will be alive in England and Wales at the end of 1999, and that the same number of people will be alive with other forms of severe HIV disease. Since 1989 the proportion of reported AIDS cases who live in the NHS Thames regions has remained constant at between 70% and 75%. We expect this concentration of AIDS cases in the south east, particularly within London, to remain unchanged. Compared with the report published in June 1993, the planning projections for 1997 are 37% lower for cases acquired heterosexually, and the upper boundary of the range in this exposure category has fallen from 1140 to 495. The reduction in the planning projection has resulted from a substantial decline in the rate of increase in the number of new AIDS cases arising each year from heterosexual exposure. The range of uncertainty has narrowed largely because more extensive seroprevalence data are now available. For homo/bisexual males, the planning projection for 1997 has fallen by 3%, because the 1993 report presented an over optimistic view of the extent to which patients received treatment and prophylaxis before the onset of AIDS, since such management became available in 1988. Unlike the 1993 working group, the 1995 working group has access to data from several years on the uptake of treatment and prophylaxis given before the diagnosis of AIDS. It is estimated that about

This report summarises the information obtained by surveillance of influenza in England and Wales from October 1994 to June 1995 (weeks 40/94 to 25/95). Influenza B viruses were responsible for most infections, with moderate activity occurring throughout the winter, peaking in February. Influenza A became more active towards the end of the winter, and laboratory reports reached a peak in May (week 21/95). Influenza activity was seen first in Wales, then England, followed by Scotland. An increase in 'total respiratory disease' was reported in December 1994 by the Birmingham Research Unit of the Royal College of General Practitioners (RCGP) in England and Wales. This was probably due largely to an increase in reports of acute bronchitis, and was concurrent with the annual increase in respiratory syncytial virus infection which is often associated with bronchiolitis. Circulating influenza viruses were antigenically similar to components of the vaccine chosen for 1994/95. This report summarises the recommendations for the 1995/96 influenza vaccine.

In May 1995 a department of public health medicine was informed of an outbreak of respiratory and gastrointestinal illness in a local school. Eighty-three pupils and staff were affected out of a total of 247 people--an attack rate of 34%. The outbreak was investigated, control measures were instigated, and the outbreak subsided. Pupils and staff were surveyed and faecal specimens were collected. Blood specimens from a sample of pupils were examined serologically. No organisms were isolated from faecal specimens. Nine of the 18 blood specimens taken showed raised antibody titres against influenza A. This labour intensive investigation revealed a community outbreak of influenza A. Investigations in schools can be useful in community surveillance.