Communicable disease report. CDR review最新文献

Thirty-six cases of Salmonella enteritidis phage type (PT) 4 infection, mainly in children, were notified in one local authority in the two weeks beginning on 23 October 1995. Twenty-four cases and 42 controls nominated by cases were included in a case control study, which showed a significant association between illness and the consumption of marshmallow confectionery from a bakery. S. enteritidis PT4 was isolated from samples of the marshmallow, and all isolates had the same plasmid and pulsed field gel electrophoresis profiles. The marshmallow had been made using raw egg white, which shows that not all caterers follow the Department of Health's advice.

Sixty-one out of 105 elderly people who received a meal from a meals on wheels service developed a diarrhoeal illness. Twenty-seven of the 61 were admitted to hospital and three died. Epidemiological evidence suggested that food poisoning was associated with eating strawberry mousse made with raw eggs. Salmonella enteritidis phage type 4 was identified as the causative organism.

The epidemiology of general outbreaks of infectious intestinal disease associated with domestic catering for large numbers is described and compared with foodborne outbreaks in other settings. From 1 January 1992 to 31 December 1994, the PHLS Communicable Disease Surveillance Centre identified 101 foodborne general outbreaks of infectious intestinal disease associated with domestic catering in England and Wales (16% of all foodborne outbreaks). Salmonella species were associated with 77 of the 101 outbreaks and S. enteriditis phage type 4 accounted for 57. Small round structured viruses were implicated in five outbreaks, Clostridium perfringens in four, Bacillus cereus in two, and Campylobacter sp and Escherichia coli in one each. No pathogen was identified in 11 outbreaks. Outbreaks occurred most commonly in summer. The commonest vehicles implicated were poultry/eggs in 44 outbreaks, desserts in 13, and meat/meat products in nine. Salad/vegetables, sauces, and fish/shellfish were each implicated in eight outbreaks. Raw shell eggs were implicated in a fifth of outbreaks. Inappropriate storage was the commonest fault, reported in association with 50 outbreaks (ambient temperature for long periods before serving in 29), inadequate heat treatment was reported in 35, cross contamination in 28, an infected food handler in 11, and other faults in 14. Outbreaks associated with catering on domestic premises were independently more likely than outbreaks in other settings to be associated with salmonellas, inappropriate storage of food, and consumption of poultry, eggs, or sauces. Public health services need to direct messages about the use, preparation, and storage of food to those who cater on domestic premises.

Three hundred and seventy-eight passengers reported gastroenteritis during four cruises in the western Mediterranean on consecutive weeks of 1995. The rate at which cases were reported each day increased on the fourth cruise. The ship's owner commissioned an epidemiological investigation from the PHLS Communicable Disease Surveillance Centre. Cases reported explosive vomiting and diarrhoea, which lasted from 24 hours to five days, and were suggestive of viral gastroenteritis. No food handlers reported illness, but enquiries suggested that some had been ill and treated themselves. No bacterial pathogens were isolated from faecal specimens provided by cases or from water, food, and environmental samples taken from the galley. Small round structured viruses (SRSV) were identified by reverse transcriptase polymerase chain reaction in two faecal specimens and one specimen of vomit from people who became ill during the fourth cruise. SRSV was also identified in one faecal specimen by electron microscopy. Environmental inspection revealed inappropriate food handling, hygiene, and storage. During one 24 hour period no chlorine was detectable in the water. A case control study conducted on the fourth cruise sought details of exposure to various foodstuffs, unbottled water, and various parts of the ship. No significant associations were found between illness and any exposures. The evidence strongly suggested a continuing outbreak of SRSV infection transmitted from person to person. Some passengers remained on board for a second week and could have transmitted their infection to new arrivals. The ship was cleared and disinfected at the end of the fourth cruise in order to interrupt transmission. Fewer than 10 cases presented in each of the fifth and sixth cruises.

The number of HIV infections prevalent in the United Kingdom (UK) at the end of 1994 have been estimated. Estimates of the future annual incidence and prevalence of AIDS and severe HIV disease have been calculated for the UK by combining recently published projections for Scotland with projections produced for England and Wales adjusted to account for Northern Ireland. The number of HIV infections prevalent in the UK at the end of 1994 was estimated to be about 23,000, 36% of them undiagnosed. It was estimated that 52% of prevalent infections were in homo/bisexual men, and 32% were in people exposed through heterosexual intercourse. Between 2100 and 2190 new cases of AIDS are expected to be reported in the UK each year from 1995 to 1999. It is predicted that a 30% rise in the number of cases exposed through heterosexual intercourse and a 17% rise in cases who inject drugs will be balanced by a 7% fall in cases among homo/bisexual men. Prevalent AIDS cases in the UK are expected to rise by 15%, from 3740 at the end of 1995 to 4290 at the end of 1999. The number of people expected to be living with severe HIV disease, including AIDS, will also rise by about 15%, from 7545 at the end of 1995 to 8650 at the end of 1999.

Surveillance of measles in the Republic of Ireland has relied until now on notifications of clinically diagnosed infections and a manual system for monitoring coverage. In the light of a measles epidemic predicted in the United Kingdom in 1995, it was considered timely to review the epidemiology of measles and obtain baseline seroepidemiological data on measles immunity in Cork City in the Republic of Ireland. The age specific prevalence of measles IgG in saliva from 2000 schoolchildren aged 5 to 15 years was determined. The study also compared susceptibility rates in children with and without a history of measles vaccination or infection. Histories provided by parents were found to be unreliable in informing vaccination practice, as 79 of the 102 seronegative children would have been classified as immune. The proportion of children immune to measles, as gauged by seropositivity, was 91.9% in children aged 5 to 10 years and 95.8% in 11 to 15 year olds. The implications of the study results are discussed in relation to future prevention and control strategies.

People who live in nursing homes are at particular risk of influenza and its complications. Immunisation can reduce the incidence, duration, and severity of influenza and prevent outbreaks in institutions, but there is no established system to monitor vaccine uptake. In the late summer of 1995, all 31 nursing homes in South Glamorgan were sent an immunisation register and matrons were asked to record the immunisation histories of their residents. Thirty homes responded; vaccine uptake among their residents averaged 77%. Most residents were immunised by mid-November, in good time for the anticipated influenza season. The method we used to monitor immunisation uptake was simple and efficient, yielding almost complete enumeration of the study population, and could be adapted for use elsewhere to monitor vaccine coverage in this high risk group each year.

Readers and authors of scientific material need and deserve to know how journal editors select and prepare papers for publication. Editors need to keep track of their procedures to avoid delay and ensure that there is always material to publish. This paper presents data on the time taken for the 48 papers published in the Communicable Disease Report Review in 1995 to be processed. The mean time from receipt to publication was five months. All papers were sent out to at least one referee and most to two. This paper describes the editorial process and suggests the adoption of blinded peer review.

This report summarises information collected for the surveillance of influenza virus infection in England and Wales from October 1995 to June 1996 (weeks 40/95 to 25/96). Total respiratory disease' activity, as reported by the Birmingham Research Unit of the Royal College of General Practitioners, rose to peaks in weeks 48/95, 51/95, and 01/96. The first peak coincided with a peak in "influenza and flu-like illness'. The subsequent peaks were accounted for by an increase in reports of acute bronchitis, including bronchiolitis, and may have been associated with the annual rise in infections with respiratory syncytial virus. Influenza A virus was responsible for most infections, with moderate activity occurring in the early part of the winter, peaking in December (week 48/95). Influenza A subtype H3N2 predominated until week 07/96, after which subtype H1N1 accounted for most infections. Influenza activity was first seen in central and northern England, followed by the south of England, Wales, and Scotland. Circulating influenza viruses were antigenically similar to the components of the 1995/96 vaccine. International surveillance during 1995/96 has led to a different H3N2 component being included in the influenza vaccine recommended for 1996/97.