The SARS outbreak in a general hospital in Tianjin, China – the case of super-spreader
SH. X. WANGYinghua LiBingyang SunShuangshung ZhangWeijun ZhaoMaoti WeiKexin ChenXinrong ZhaoZ. L. ZhangMurray KrahnAngela M. CheungPeter Wang
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Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a high case-fatality rate and devastating socio-economic impact. In this report we summarized the results from an epidemiological investigation of a SARS outbreak in a hospital in Tianjin, between April and May 2003. We collected epidemiological and clinical data on 111 suspect and probable cases of SARS associated with the outbreak. Transmission chain and outbreak clusters were investigated. The outbreak was single sourced and had eight clusters. All SARS cases in the hospital were traced to a single patient who directly infected 33 people. The patients ranged from 16 to 82 years of age (mean age 38.5 years); 38.7% were men. The overall case fatality in the SARS outbreak was 11.7% (13/111). The outbreak lasted around 4 weeks after the index case was identified. SARS is a highly contagious condition associated with substantial case fatality; an outbreak can result from one patient in a relatively short period. However, stringent public health measures seemed to be effective in breaking the disease transmission chain.Keywords:
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Objective To present the critical strategy and measures with the surveillance on foodborne disease outbreaks in Guangzhou,2006-2008. Method Data collected by Foodborne Disease Outbreaks Surveillance and Reporting System (FDOSR) of Guangzhou was analyzed on season,month,pathogen,food,meal place,reason,and so on. Results Total 189 foodborne disease outbreaks were reported,resulting 2678 cases and 6 deaths,with 14. 17 illnesses per outbreak, attack rate 13. 47% , and fatality rate 0. 22% . 166 outbreaks ( 87. 83% ) were ascertained of pathogens, with microorganisms of most outbreaks (58. 20% ) and cases (70. 95% ),poisonous propagations of largest deaths (66. 67% ). microorganisms accounted for the highest cases per outbreaks (17. 27 cases),while chemical agents of maximum at attack rate (91. 83% ),poisonous propagations of largest fatality rate (1. 86% ). Conclusion Efficiency and quality of FDOSR for correct prevention should be improved to reduce the burden of foodborne disease.
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Ebola is a deadly virus that causes frequent disease outbreaks in the human population. In this study, we analyse its rate of new introductions, case fatality ratio, and potential to spread from person to person. The analysis is performed for all completed outbreaks and for a scenario where these are augmented by a more severe outbreak of several thousand cases. The results show a fast rate of new outbreaks, a high case fatality ratio, and an effective reproductive ratio of just less than 1.
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The outbreak of severe acute respiratory syndrome (SARS) began after the index case was admitted on 1 March 2003. We profile the cases suspected to have acquired the infection in Tan Tock Seng Hospital (TTSH), focussing on major transmission foci, and also describe and discuss the impact of our outbreak control measures.Using the World Health Organization (WHO) case definitions for probable SARS adapted to the local context, we studied all cases documented to have passed through TTSH less than 10 days prior to the onset of fever. Key data were collected in liaison with clinicians and through a team of onsite epidemiologists.There were 105 secondary cases in TTSH. Healthcare staff (57.1%) formed the majority, followed by visitors (30.5%) and inpatients (12.4%). The earliest case had onset of fever on 4 March 2003, and the last case, on 5 April 2003. Eighty-nine per cent had exposures to 7 wards which had cases of SARS that were not isolated on admission. In 3 of these wards, major outbreaks resulted, each with more than 20 secondary cases. Attack rates amongst ward-based staff ranged from 0% to 32.5%. Of 13 inpatients infected, only 4 (30.8%) had been in the same room or cubicle as the index case for the ward.The outbreak of SARS at TTSH showed the challenges of dealing with an emerging infectious disease with efficient nosocomial spread. Super-spreading events and initial delays in outbreak response led to widespread dissemination of the outbreak to multiple wards.
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Outbreaks cause significant morbidity and mortality in healthcare settings. Current testing methods can identify specific viral respiratory pathogens, yet the approach to outbreak management remains general. Our aim was to examine pathogen-specific trends in respiratory outbreaks, including how attack rates, case fatality rates and outbreak duration differ by pathogen between hospitals and long-term care (LTC) and retirement homes (RH) in Ontario. Confirmed respiratory outbreaks in Ontario hospitals and LTC/RH reported between September 1, 2007, and August 31, 2017, were extracted from the integrated Public Health Information System (iPHIS). Median attack rates and outbreak duration and overall case fatality rates of pathogen-specific outbreaks were compared in both settings. Over the 10-year surveillance period, 9,870 confirmed respiratory outbreaks were reported in Ontario hospitals and LTC/RH. Influenza was responsible for most outbreaks (32% in LTC/RH, 51% in hospitals), but these outbreaks were shorter and had lower attack rates than most non-influenza outbreaks in either setting. Human metapneumovirus, while uncommon (<4% of outbreaks) had high case fatality rates in both settings. Attack rates and case fatality rates varied by pathogen, as did outbreak duration. Development of specific outbreak management guidance that takes into account pathogen and healthcare setting may be useful to limit the burden of respiratory outbreaks.
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To evaluate the control of a 2009 pandemic influenza A(H1N1) outbreak in an international school,and provide scientific evidence for the control of 2009 pandemic influenza A(H1N1) outbreak.Non pharmaceutical interventions,such as school closure,isolation and treatment of cases,were carried out.A questionnaire survey was conducted among the students and teachers to identify the infection source.Throat swabs were taken form the all cases for testing.The outbreak was caused by an imported case from Singapore.Twelve cases of 2009 pandemic influenza virus infections were reported during this outbreak lasted for 8 day.The attack rate was 2.61%(12/460).The generation time was 65.2 hours(range 32-96 hours).School was closed for 7 days when attack rate reached 0.89%(4/46).The outbreak was caused by an imported case.Early school closure(attack rate﹤1%) could effectively control the outbreak of 2009 pandemic influenza A(H1N1),and provide theoretical evidence for the control of influenza pandemic.
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An outbreak of dengue type 2 infection occurred in the Pacific island Kingdom of Tonga in 1974 and an outbreak of dengue type 1 occurred there in 1975. The 1974 outbreak was characterized by relatively mild clinical disease with few hemorrhagic manifestations, a low attack rate, and relatively low viremia levels. The 1975 outbreak was characterized by relatively severe disease with frequent hemorrhagic manifestations and a high attack rate. The differences between the outbreaks could not be attributed to differences in abudance of, or susceptibility to infection of, mosquito vectors or to the prior immune status or other characteristics of the human population. It appeared that a difference in viral virulence was the most likely explanation.
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Severe acute respiratory syndrome (SARS) is a newly emerged infectious disease with a high case-fatality rate and devastating socio-economic impact. In this report we summarized the results from an epidemiological investigation of a SARS outbreak in a hospital in Tianjin, between April and May 2003. We collected epidemiological and clinical data on 111 suspect and probable cases of SARS associated with the outbreak. Transmission chain and outbreak clusters were investigated. The outbreak was single sourced and had eight clusters. All SARS cases in the hospital were traced to a single patient who directly infected 33 people. The patients ranged from 16 to 82 years of age (mean age 38.5 years); 38.7% were men. The overall case fatality in the SARS outbreak was 11.7% (13/111). The outbreak lasted around 4 weeks after the index case was identified. SARS is a highly contagious condition associated with substantial case fatality; an outbreak can result from one patient in a relatively short period. However, stringent public health measures seemed to be effective in breaking the disease transmission chain.
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To investgate the relationship between epidemiological diagnosis and fatality rate in patients with severe acute respiratory syndrome (SARS).Epidemiological evidences and the outcomes of 304 patients with confirmed SARS were retrospectively analyzed. Patients included highly contagious cases, cluster cases, and sporadic cases.The case fatality rate was 8.2%. The fatality rate had a tendency of increase in an order of sporadic cases, cluster cases, and highly contagious cases (3.9%, 11.4%, and 17.2%, respectively, chi2trend=7.561, P < 0.01). Chi square-test also proved that the fatality rate was higher in older people (chi2trend=27.024, P < 0.01) and in male (male vs female: 12.2% vs 5.5%). A logistic regression model showed that the epidemiological evidence, age, and gender were correlated to fatality rate. By observing changes of the odds ratio for epidemic evidence, age, and gender using forward method, we found epidemic evidence was an independent risk factor related to fatality rate in SARS patients.The epidemiological evidence is an independent factor related to fatality rate in SARS patients. Highly contagious case has a worse prognosis and higher fatality rate than sporadic cases and cluster cases.
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Abstract Hantavirus pulmonary syndrome (HPS) is an endemic disease in Argentina, one of the most affected countries in the Americas. Andes virus (ANDV) is the main Orthohantavirus species causing HPS in Argentina. In this study, the geographical distribution, clinical presentation, and epidemiological features of HPS from all endemic regions of Argentina were analyzed. We focused on the clinical and epidemiological data from 533 HPS cases confirmed during the period 2009 to 2017 by the National Reference Laboratory for Hantavirus. A case‐fatality rate of 21.4% was registered, and most of the cases presented a severe clinical picture requiring intensive care treatment (84%). Since HPS first detection in 1995 the case‐fatality rate showed a general trend towards a decrease. After more than 22 years of experience in HPS diagnosis and surveillance, we discuss some possible factors implicated in this tendency. This clinical and epidemiological analysis gives a global perspective, being useful to detect trends and patterns, to update preventive actions at a national level, and evaluate their impact on public health.
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