SUMMARYIn August 1988 an increase was noted in the number of cases of cryptosporidiosis identified by the microbiology laboratory at Doncaster Royal Infirmary. By 31 October, 67 cases had been reported. Preliminary investigations implicated the use of one of two swimming pools at a local sports centre and oocysts were identified in the pool water. Inspection of the pool revealed significant plumbing defects which had allowed ingress of sewage from the main sewer into the circulating pool water. Epidemiological investigation confirmed an association between head immersion and illness. The pools were closed when oocysts were identified in the water and extensive cleaning and repair work was undertaken. The pool water was retested for cryptosporidial oocysts and found to be negative before the pool reopened.
This descriptive study investigated an outbreak of hepatitis A virus (HAV) infection among injecting drug users (IDUs) and their contacts. Twenty-seven cases of acute HAV infection were identified in a 5-month period. Connections with the local injecting drug using (IDU) population were established for 25 of the cases of whom 14 admitted to injecting drug use. HAV RNA genotyping revealed two HAV variants, closely related to variants found in Scandinavian IDUs and in South East Asia. The study demonstrates that once HAV enters the IDU population extensive outbreaks are possible. We recommend that all IDUs should be tested for HAV and hepatitis B virus (HBV) infections and offered combined hepatitis A and B vaccines if non-immune.
Objectives-To ascertain all cases of paralytic poliomyelitis in England and Wales during and to determine the source of infection in each case.Design Results-Of 54 suspected cases of poliomyelitis, 33 were excluded, leaving 21 cases, of which 13 were vaccine associated (nine recipient and four contact) cases, five were imported cases, and three were cases whose source of infection was unknown. No cases due to indigenous wild polioviruses were identified; two were imported cases due to wild viruses. One patient died during the acute phase of the illness, and two children with previously unrecognised severe congenital immune deficiency died between one and two months after the onset of paralysis after the first or second dose of oral polio vaccine. The estimated risk of vaccine associated paralysis is 1-46 per million for the first dose, 049 for the second, zero for the third and fourth doses, and 033 for the fifth.Conclusions-Indigenous wild poliovirus seems to have been eradicated, although wild virus may be imported; improved surveillance of suspected cases including immediate notification and characterisation of the virus to ensure that eradication is maintained is essential.
SummaryDuring July 1991, a single laboratory reported an increased number of an unusual salmonella isolate. An outbreak control team was convened. A case was defined as an individual with diarrhoea from whose faecal sample Salmonella hadar was isolated after 1 July 1991. By 30 July, 90 isolates had been identified and 57 persons interviewed including 39 primary cases. Interviews failed to identify any common features among the cases. A review of the laboratory procedures revealed that the selenite enrichment medium was inoculated using the spoon from the stool collection kit after it was used to emulsify the faecal sample with saline for microscopy. Salmonella hadar was isolated from this saline. Once this practice was stopped, no further isolates of S. hadar were made. This pseudo-outbreak is a powerful reminder to verify the existence of an outbreak, especially when epidemiological data are inconsistent.
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