RESUMO
An outbreak of Salmonella serogroup Saphra (S. saphra) infections was studied by laboratory-based surveillance, case-control and trace-back studies, and a survey of cantaloupe preparation practices. Twenty-four patients with S. saphra infections had illness onsets between 23 February and 15 May 1997; 75% were
Assuntos
Surtos de Doenças , Frutas/microbiologia , Infecções por Salmonella/epidemiologia , Salmonella/isolamento & purificação , Adulto , California/epidemiologia , Estudos de Casos e Controles , Criança , Intervalos de Confiança , Daucus carota , Eletroforese em Gel de Campo Pulsado , Humanos , México , Razão de Chances , Infecções por Salmonella/transmissãoRESUMO
OBJECTIVES: To determine the cause of increased central venous catheter-associated (CVC) bloodstream infection (BSI) rates in a cohort of pediatric hematology /oncology patients receiving home health care (HHC). METHODS: A retrospective cohort study of hematology/oncology patients with CVCs receiving HHC from January 1992 through November 1994. RESULTS: Of 182 patients with CVCs identified during the study period, 58 (32%) acquired 90 BSIs during 75,085 CVC days. BSI rates increased significantly from 1992 through 1994 (0.8 vs 1.0 vs 1.7 BSIs per 1000 CVC days; p < 0.005). Known risk factors, including catheter type, patient age less than 5 years, sex, or diagnosis, were not associated with increased BSI rates. After introduction of needleless devices for CVC access to the HHC regimen in May 1993, BSI rates increased 80% (from 0.81 to 1.46 BSIs/1000 CVC days, relative risk 1.8; p < 0.02). The only other significant risk factor was the race of the patient. White children had the lowest BSI rate before and after needleless-device introduction (0.4 vs 0.9 BSIs/1000 CVC days; p > 0.1), whereas black patients had the highest, unaffected by the introduction of these devices (2.5 BSIs/1000 CVC days). Both Hispanic (0.5 vs 1.6 BSIs/1000 CVC days) and Asian-American children's (0.4 vs 1.5 BSIs/1000 CVC days) BSI rates increased threefold and fourfold after the introduction of needleless devices. CONCLUSIONS: Our data suggest that pediatric hematology/oncology patients receiving HHC via needleless devices may have an increased risk of BSIs, and this risk may vary by race. We hypothesize that prevention of BSIs may require consideration of cultural, ethnic, and language differences when parents are trained to provide care for their children with CVCs in the home.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Grupos Raciais , Sepse/etiologia , Adolescente , Adulto , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Feminino , Doenças Hematológicas/tratamento farmacológico , Humanos , Lactente , Masculino , Agulhas , Neoplasias/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Epidemic cholera continues in Peru. Since 1991, cholera surveillance in Peru has been based mainly on clinical recognition. To determine the proportion of reported cholera patients who actually have cholera and to evaluate the clinical case definition used in surveillance, we cultured rectal swabs from patients presenting with acute diarrhea in March 1992 in Trujillo, Peru. Of 197 patients meeting the clinical case definition, 174 (88%) had confirmed Vibrio cholerae O1 infection. In this epidemic setting, watery diarrhea of sudden onset in a person of any age presenting for treatment is highly predictive of cholera. Of note, 90% of the current V. cholerae O1 El Tor isolates were of serotype Ogawa, while a year earlier, all were of serotype Inaba.
Assuntos
Cólera/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Valor Preditivo dos Testes , Sorotipagem , Vibrio cholerae/classificação , Vibrio cholerae/isolamento & purificaçãoRESUMO
In late January 1991, epidemic cholera appeared in Peru. Within 2 months, 7922 cases and 17 deaths occurred in Piura, a Peruvian city of 361,868. A hospital-based culture survey showed that 79%-86% of diarrhea cases were cholera. High vibriocidal antibody titers were detected in 34% of the asymptomatic population. A study of 50 case-patients and 100 matched controls demonstrated that cholera was associated with drinking unboiled water (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.7-8.9), drinking beverages from street vendors (OR, 14.6; CI, 4.2-51.2), and eating food from street vendors (OR, 24.0; CI, 3.0-191). In a second study, patients were more likely than controls to consume beverages with ice (OR, 4.0; CI, 1.1-18.3). Ice was produced from municipal water. Municipal water samples revealed no or insufficient chlorination, and fecal coliform bacteria were detected in samples from 6 of 10 wells tested. With epidemic cholera spreading throughout Latin America, these findings emphasize the importance of safe municipal drinking water.
Assuntos
Cólera/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Cólera/transmissão , Ingestão de Líquidos , Fezes/microbiologia , Feminino , Microbiologia de Alimentos , Humanos , Gelo , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , População Urbana , Vibrio cholerae/classificação , Vibrio cholerae/imunologia , Vibrio cholerae/isolamento & purificação , Microbiologia da Água , Abastecimento de ÁguaRESUMO
To assess the prevalence of human T cell lymphotropic virus type 1 and 2 (HTLV-1/2) infections among potentially high-risk populations in the city of Tijuana, Mexico, the prevalence of specific antibodies was determined and information on risk behaviors was obtained between June and October 1988. The study involved 631 presumably healthy individuals, randomly selected from a study population recruited sequentially from prisoners, prostitutes, and injecting drug users (IDUs), and randomly from homosexual and bisexual men. The presence of HTLV-1/2 antibodies was determined by enzyme immunoassay and an immunofluorescence method, and positive reactions were confirmed by a radioimmunoprecipitation assay and Western blot. The prevalence of HTLV-1/2 was 2% (2 of 105) among prostitutes, 7% (29 of 410) among prisoners, 1% (1 of 105) among homosexual/bisexual men, and 21% (22 of 106) among IDUs. To properly identify the specific HTLV type, a subsequent sample of 41 imprisoned IDUs were voluntarily and anonymously recruited in June 1990 and asked to donate 20 ml of whole blood. Twenty-two percent (9 of 41) were serologically positive for HTLV-1/2, and polymerase chain reaction analysis performed on peripheral blood mononuclear cells identified HTLV-2 as the specific virus prevalent in this group. Two individuals were positive for human immunodeficiency virus type 1 (HIV-1). One of these individuals was coinfected with HTLV-2.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Anticorpos Anti-HTLV-II/sangue , Infecções por HTLV-II/epidemiologia , Comportamentos Relacionados com a Saúde , Fatores Etários , Transfusão de Sangue , Estudos Transversais , Feminino , Infecções por HTLV-I/complicações , Infecções por HTLV-II/complicações , Humanos , Masculino , México/epidemiologia , Prevalência , Prisioneiros , Fatores de Risco , Comportamento Sexual , Infecções Sexualmente Transmissíveis/complicações , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
In January 1991, epidemic cholera appeared in Peru and quickly spread to many other Latin American countries. Because reporting of cholera cases was often delayed in some areas, the scope of the epidemic was unclear. An assessment of the conduct of surveillance for cholera in several countries identified some recurrent problems involving surveillance case definitions, laboratory surveillance, surveillance methods, national coordination, and data management. A key conclusion is that a simple, well-communicated cholera surveillance system in place during an epidemic will facilitate prevention and treatment efforts. We recommend the following measures: a) simplify case definitions for cholera; b) focus on laboratory surveillance of patients with diarrhea primarily in the initial stage of the epidemic; c) use predominantly the "suspect" case definition when the number of "confirmed" cases rises; d) transmit weekly the numbers of cases, hospitalized patients, and deaths to regional and central levels; e) analyze data frequently and distribute a weekly or biweekly summary; and f) report the number of cholera cases promptly to the World Health Organization.