Eurosurveillance - Volume 16, Issue 15, 14 April 2011

This report describes 326 cases of nosocomial transmission of measles with 286 cases among non-healthcare workers who acquired the disease in a hospital setting. Between October 2009 and April 2010, 40 healthcare workers from seven different regions in Bulgaria have contracted the disease.

We conducted an unmatched retrospective case-control study to investigate an upsurge of non-travel-related sporadic cases of infection with Salmonella enterica subsp. enterica serotype Enteritidis phage type 14b with antimicrobial resistance to nalidixic acid and partial resistance to ciprofloxacin (S. Enteritidis PT 14b NxCpL) that was reported in England from 1 September to 31 December 2009. We analysed data from 63 cases and 108 controls to determine whether cases had the same sources of infection as those found through investigation of 16 concurrent local food-borne outbreaks in England and Wales. Multivariable logistic regression analysis adjusting for age and sex identified food consumption at restaurants serving Chinese or Thai cuisine (odds ratio (OR): 4.4; 95% CI: 1.3-14.8; p=0.02), egg consumed away from home (OR: 5.1; 95% CI: 1.3-21.2; p=0.02) and eating vegetarian foods away from home (OR: 14.6; 95% CI: 2.1-99; p=0.006) as significant risk factors for infection with S. Enteritidis PT 14b NxCp_L. These findings concurred with those from the investigation of the16 outbreaks, which identified the same Salmonella strain in eggs from a specified source outside the United Kingdom. The findings led to a prohibition of imports from this source, in order to control the outbreak. .

An outbreak of food poisoning (emetic syndrome) occurred in three kindergartens (A, B and C) in Berlin, Germany, on 3 December 2007 after an excursion during which food was served. We conducted a retrospective cohort study among the kindergarten children and personnel who participated in the trip. The overall attack rate among the 155 participants was 30%. It was 31% among the 137 children (aged two to six years) and 17% among adults (n=18). The consumption of rice pudding was significantly associated with disease. Among those who ate rice pudding, the attack rate was 36%, compared with 0% for non-eaters (relative risk: infinite, p<0.001, aetiological fraction: 100%), but differed significantly between kindergartens A (43%), B (61%) and C (3%), probably because groups were served from different pots. Bacillus cereus sensu stricto was identified from one vomit sample. The clinical and epidemiological characteristics suggest that B. cereus emetic toxin (cereulide) was the causative agent, although it could not be proven in the single vomit isolate. Inadequate food handling most probably led to the outbreak. Single-portion ready-to-eat rice pudding was recommended for subsequent excursions and no further cases of food poisoning occurred.

Several public health crises in Europe have led to sustained outbreaks, political problems, or have generated social alarm. For this reason, a nationwide study was conducted in Spain with the objective to determine which public health events provoke the most frequent crises, to reach a consensus regarding the appropriate actions to be taken when responding to public health crises, and to provide recommendations for their management. The events which had most frequently provoked crises between 1999 and 2004 were identified. A consensus was obtained by public health experts from the 17 Autonomous Regions of Spain and the National Epidemiological Centre using the RAND/UCLA method which combines the Nominal Groups and Delphi techniques. Legionellosis, foodborne diseases, severe acute respiratory syndrome (SARS), bovine spongiform encephalopathy (BSE), bioterrorism, meningococcal meningitis, tuberculosis, heat waves, and influenza epidemics were found to be cause for most public health crises. In Spain, 75% of the crises identified by senior public health experts from the Autonomous Regions involved infectious diseases. Factors triggering a crisis included the type of disease, social alarm, population affected, and the course of action taken by public institutions and reporting in the media. There was consensus that correct information, qualified personnel, availability of standardised protocols for investigation and control, information distribution, and setting up of 'crisis offices' were actions with a positive effect regarding crisis resolution. Appropriate management of outbreaks or other situations being perceived as a risk to health can mitigate or even contain the generation of public health crises.