Results: Amongst 122 cases, 54% (n = 66) were female and 6% (n = 7) laboratory-confirmed. The median age of the cases was 11 years (range 2-83 years), with 79% (n = 102) being children under the age of 14 years. Salmonella species were detected in 37% (10/27) of water samples and geographic information system (GIS) mapping showed clustering of cases in Tswaing-Kgwaripe and Vlakplaas villages. Six isolates were available for WGS analysis, with resulting data showing that five of the six isolates were genetically related. Phylogenetic analysis showed that the five isolates clustered together were genetically related showing < 22 single nucleotide polymorphisms when compared to each other. Conclusion:Molecular epidemiology of isolates suggests a common source outbreak, supported by the detection of Salmonella species from water sources. Consumption of water from contaminated open water sources, because of ongoing interruption of municipal water supply, was the likely cause of the outbreak. The investigation highlights the importance of consistent safe water supply and the ability of district surveillance systems to identify and contain outbreaks.
Purpose: A cluster of necrotising enterocolitis (NEC) cases among newborns admitted to neonatal ward at a Gauteng Province hospital was reported to the National Institute for Communicable Diseases on 4/4/2018. An investigation was conducted to determine the possible cause/source of the outbreak and implement prevention and control measures and make recommendation for prevention of future outbreaks in this setting. Methods & Materials:A cross-sectional study was conducted to describe the clinical, epidemiological and environmental characteristics and determine possible source/cause of the outbreak among newborns admitted to a neonatal ward in March to June 2018. Blood cultures (Bacterial/fungal blood stream infections), bacterial (Salmonella, Shigella and Campylobacter and enterohemorrhagic Escherichia coli species) stool cultures and real-time polymerase chain reaction for enteric viruses (rotavirus, astrovirus, sapovirus, norovirus and adenovirus) was carried out.Results: A total of 37 cases, including 35 (95%) premature and two (5%) full-term babies were reported. Of the 37; eight (22%) died, 20 (54%) discharged, three (8%) transferred to other hospitals, six (16%) were still admitted. Twenty-one (57%) had stage IIA disease, nine (24%) stage IIB, three (8%) stage IIIA and four (11%) stage IIIB. Children aged <1 month accounted for 89% (n = 33) of the cases. Eleven (30%) cases were fed breast milk, 10 (27%) were formula fed and 12 (32%) were on mixed feeding, while feeding type was unknown in four cases (11%). Blood cultures were performed in 33 cases (89%); no bacterial/fungal growth in 16 cases (48%), various pathogens were isolated in 16 cases (48%). Stool samples were tested in 17 cases (46%), none of the enteric pathogens tested for were isolated. Bacillus cereus and Streptococcus species were isolated in different brands of prepared and unprepared formula milk.Conclusion: Although the aetiology and source of the outbreak has not been established, the isolation of B. cereus and Streptococcus species in formula milk is concerning. However, these findings should be interpreted with caution as toxin production tests were not done, B. cereus and Streptococcus species were not tested for in stools and the investigations are ongoing. Strengthening and strict adherence to infection prevention and control practices are recommended to prevent horizontal spread of potential pathogens.
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