Outbreak, Surveillance and Investigation Reports
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Item Scombrotoxin Food Poisoning Outbreak among Frozen Seafood Factory Workers Samut Prakan Province, Thailand, July 2007(Outbreak, Surveillance and Investigation Reports, 2010-05-24) Nalinee Hongchumpon; Ouppapong T; Pungsakul J; Hanta A; Pawan W; Chalamaat M; Ngamnak C; Wongsawan P; Thonghong A; Purahong S; Iamsirithaworn SBackground: Scombroid Food Poisoning or histamine food poisoning is caused by consumption of foods that contain high level of histamine such as spoiled fish of families Scombridae and Scomberesocidae. Most commonly found in the U.S., and New Zealand, however, never been reported in Thailand. On 24 July 2007, Bureau of Epidemiology received a notification from Samutprakarn Provincial Health Office that 28 cases of food poisoning cases, 3 hospitalized, occurs among employees in frozen seafood factory in Samutprakarn Province. We conducted investigation during 24-25 July 2007 to confirm outbreak, verify diagnosis, define etiologic agent and implement control and prevention measure. Methods: We reviewed medical records of cases and interviewed cases and factory staff during active case finding. An unmatched case-control study was conducted among factory employees. Cases were defined as employees who worked at frozen seafood factory on 21 July 2007 with two major symptoms or one major symptom plus two minor symptoms. Major symptoms included nausea, vomiting, flushing, diarrhea, abdominal cramps, oral numbness, extremity numbness, dry mouth, rash, itching and swelling. Minor symptoms included headache, diplopia, fever and fatigue. Controls were selected by systematic sampling of employees listed in factory records. Left-over fermented tunas were sent for bacterial culture and histamine assay. Results: Overall attack rate was 8.4% (89/1,054). The mean age of cases was 31.2 years (SD=7.3). Common symptoms included headache (71.9%), dry mouth (59.6%), fatigue (59.6%), nausea (58.4%), and diarrhea (53.9%). The median incubation period was 120 minutes (Interquartile range: 60-180 minutes). Most cases were recovered within 8-12 hours. Eating fried fermented tuna was identified as a strong risk factor of food poisoning (OR=59.5, 95%CI=9.8-2409.1). Dose-response relationship between getting illness and consuming fried fermented tuna was identified (pItem Mushroom poisoning surveillance analysis, Yunnan province, China, 2001-2006(Outbreak, Surveillance and Investigation Reports, 2010-06-02) Lei Chen; W Tangkanakul; L Lu; XQ Liu; C Jiraphongsa; S JetanasenBackground: In Yunnan, China, 17,000 tons of mushrooms are harvested annually. Yunnan is home to at least 150 poisonous species of mushrooms. From 1985 to 2000, 378 mushroom poisoning events were reported, including 326 deaths. In 2004, China established new reporting criteria and report forms. We undertook a descriptive study of mushroom poisoning in Yunnan from 2001-2006. Methods: We reviewed surveillance data from 2001-2006. We analyzed all investigation forms submitted from 2004-2006, including data on mushroom species. County level climactic and demographic data were collected and analyzed for association with mushroom poisoning. Double-entry was performed and data was analyzed using Epi Info 3.3.2. Results: From 2001-2006, 97 events including 662 cases and 148 deaths were reported. The overall case fatality rate was 22.4 % (Mean: 30.7%; SD: 15.7). The mortality rates due to mushroom poisoning in 2001-2006 were 0, 0.01, 0.03, 0.07, 0.17, and 0.06 per 100,000 respectively. Most (86.6 %) events occurred from May to August. Most events occurred in rural settings and were limited to a single household. Counties reporting events had higher average rainfall and lower average income compared to non-reporting counties. All poisoning were associated with ingestion of wild mushrooms, and the Amanita group was the most commonly implicated type. Majority (94.3%) of events was associated with serving fresh mushrooms, and 97.3% of suspected mushrooms were picked by the victims themselves in rural areas. Most (91.6%) victims sought health care service, and majority (65.6%) went to primary care facilities for initial management. Conclusion: Mushroom poisoning is the most common lethal food poisoning with a high CFR in Yunnan. However, the mortality is low. Mushroom poisoning was likely underestimated prior to 2004 due to lack of food poisoning reporting criteria. Event-based surveillance has limited sensitivity and probably overestimates CFR. Prevention efforts are hindered by the difficulty of identifying mushroom species in the field. Cultivated mushroom could be the safer alternatives but altering eating customs is difficult.Item Cluster of Fatal Cardiopulmonary Failure among Children Caused by an Emerging Strain of Enterovirus 71, Nakhorn Ratchasima Province, Thailand, 2006(Outbreak, Surveillance and Investigation Reports, 2010-06-02) Rome Buathong; W Hanshoaworakul; D Sutdan; S Iamsirithaworn; Y Pongsuwanna; P Puthawathana; M O'Reilly; K UngchusakBackground: Fatal outcomes following enteroviral infection are rare in Thailand. In late June 2006, four deaths among children with fever and cardiopulmonary failure were reported from Nakhorn Ratchasima Province. We conducted an investigation to identify the etiology and to implement control measures. Methods: Medical records of the four fatal cases were reviewed. Active case finding was conducted in the affected district. A case was defined as a child aged 38oC) and/or Hand Foot and Mouth Disease (HFMD) during July5th-August 5th, 2006. Laboratory investigation included viral isolation from stool, throat and nasopharyngeal swabs. Paired sera were tested for Enterovirus 71 antibody by microneutralization technique. Nucleotide sequencing was done in virus isolated from a confirmed fatal case and electron microscopy was evaluated in autopsy case. Results: The four fatal cases ranged in age from 4 to 39 months; three were male. Illness onset occurred between June 22nd and 25th, 2006. Two cases resided in the same district and had a history of close contact - hugging and kissing. All cases exhibited abrupt onset of high (39-41oC) fever, tachycardia, acute dyspnea, respiratory failure and coma. Bilateral pulmonary edema without cardiomegaly was noted on all chest roentegrams. In a case that autopsy was performed, an infiltration with mononuclear cells was found in the brainstem and cardiac tissues. An enterovirus 71 isolated from the stool of one case was subsequently identified as serogroup C4, Shenzhen strain. Of 39 children surveyed, 20.5% (3 HFMD and 5 non-HFMD) exhibited positive antibodies to enterovirus 71. An electron microscopic study of formalin-fixed tissues in a fatal 4-month-old case revealed viral-like particle, average 20 nm in diameter with spherical structure in brain tissue but without any findings cardiac or lungs tissues. Conclusions: An emerging strain of enterovirus 71 (C4, Shenzhen) was likely the cause of this outbreak. Control measures including improved personal and environmental hygiene and isolation of sick children at home were implemented. Pediatricians were informed about atypical clinical characteristics of enterovirus 71. A surveillance has been established nationwide for fever and pulmonary edema cases among children below 15 years of age.Item Human Streptococcus suis outbreak in Phayao province, Thailand, 2007(Outbreak, Surveillance and Investigation Reports, 2010-06-02) Naretrit Khadthasrima; T Hannwong; P Thammawitjaya; D Pingsusean; B Akkanij; A Jaikhar; P Paungmali; P Yudee; S Wongyai; S Samerchea; S Tipsriraj; S Pruksakorn; D Sutdan; T Noimoh; M Chalamaat; P Samitsuwan; T Chuxnum; D AreechokchaiBackground: On May 1st, 2007, the Bureau of Epidemiology received a report of a cluster of five patients with bacteremia and meningitis of unknown cause, including two deaths, from Hospital A. An investigation was performed to determine the etiology and source of the outbreak, and to recommend preventive measures. Methods: A suspected case-patient was defined as a person in village 4, 5 or 9 of Thung Kluai subdistrict, Phusang district, Phayao province who had fever and at least one of following signs or symptoms of severe myalgia, severe headache, nausea/vomiting, diarrhea, arthalgia, ecchymosis, neck stiffness, seizure, alteration of consciousness between April 12th-May11th, 2007. A confirmed case-patient was suspected case that subsequently had laboratory confirmation of S. suis. Specimens from case-patients were tested by culture, biochemical test and PCR. An environmental survey was conducted around the areas of epidemiological interest, pig domestication and food preparation processes. We conducted a case-control study to determine risk factors for persons who become ill with S.suis infection. Controls were chosen from the people in those villages by simple random sampling. Results: In total, 50 suspected case-patients were identified. The male to female ratio was 1.3: 1, median age was 49 years (range: 10-77). Common clinical signs and symptoms included severe myalgia (84%) and severe headache (58%). Initial cases developed symptoms on April 25th, 2007. The mean time from ate implicated item to onset of symptom was 6 days (range: 1-9). We found ten of them had positive from hemoculture and specified S. suis serotype 2 based on biochemical test and PCR. Twenty six of suspected case-patients were positive from serological test. Eating raw pig blood was a statistically significant risk factor (OR=24.8; 95%CI 1.46 - 423.53). Overall case fatality rate was 6%. Conclusion/Interventions: This was the first large scale outbreak of S. suis serotype 2 infections reported in Thailand. Risk factors for this outbreak included eating raw pig blood. Appropriate food preparation was promoted. Enhanced S.suis case surveillance was implemented.Item Jellyfish Envenomation Events in Selected Coastal Provinces of Thailand 1998-2008(Outbreak, Surveillance and Investigation Reports, 2010-05-24) Chaninan Sonthichai; Tikumrum S; Smithsuwan P; Bussarawit S; Sermgew T; O’Reilly M; Siriarayaporn PBackground: Lethal jellyfish envenomation has occurred sporadically in Thailand for years, but limited data exists describing the public health burden of envenomation, or the presence of the most dangerous types of jellyfish (Cubazoan,or box jellyfish) in Thailand. We conducted an investigation to study morbidity and mortality of jellyfish envenomation, identify species and implement prevention measures. Methods: A descriptive study was conducted by medical records review in 2 coastal provinces. A case was defined as a jellyfish envenomation injury documented by a medical professional from 2003-2008. Events were analyzed by place, time, age, gender and severity. Jellyfish specimens were collected by local fishermen and speciated by marine biologists. Results: From 2003-2008, 54 cases occurred, including 1 death. Of cases, 49% were 21-40 years old; median age was 26 years. Thai to foreigner ratio was 2.6:1; male to female ratio was 1:1.2. The most frequent sites of attack were leg (28.7%), forearm (15.1%), foot (12.3%) and hand (12.3%). Symptoms included burning pain (36.7%), pain (26.5%) and respiratory discomfort (18.4%). Signs included erythema (51.2%), burning (19.5%) and swelling (12.2%). Twenty-three percent required hospitalization. Number of events peaked in April for Trat and May for Krabi province. Of 12 jellyfish specimens collected from Trat, marine biologists identified all as Cubazoan (box jellyfish). Conclusion: Jellyfish envenomation is a significant public health problem in the coastal provinces. Global warming could increase the scope of this problem. Based upon this investigation, the Bureau of Epidemiology is developing public health jellyfish warnings for four coastal provinces. Vinegar, which denatures the cysts which contain venom, should be available in all beach areas. Fishermen should wear long sleeves and gloves.Item Description of the First Pandemic Influenza A (H1N1) Cases in Vietnam, June-July 2009(Outbreak, Surveillance and Investigation Reports, 2010-05-13) Nguyen Van Binh; Department of Communicable Disease Control, Ministry of Health, Hanoi, Vietnam; Lan PT; Department of Communicable Disease Control, Ministry of Health, Hanoi, Vietnam; Tinh PT; Field Epidemiology Training Program, Ministry of Health, Hanoi, Vietnam; Nguyen TMN; Field Epidemiology Training Program, Ministry of Health, Hanoi, VietnamNot availableItem Traceback of Thai Baby Corn Implicated in Danish and Australian Shigellosis Outbreaks: Findings and Implications for Control, August 2007(Outbreak, Surveillance and Investigation Reports, 2010-05-24) Sasithorn Tikhamram; Thammavijya P.; Seewilai U; Siri-arayaporn PBackground: Bureau of Epidemiology (BOE), Ministry of Public Health received notification from International Food Safety Authorities Network (INFOSAN) on September 4th and 13th, 2007 about there were 218 shigellosis cases reported in different parts of Denmark during 6-20 August, 2007 and 12 shigellosis cases in Queensland and Victoria of Australia during 9-27 August,2007. Both outbreaks suspected imported baby corn from Thailand. BOE, Ministry of Agriculture and Cooperative (MAC) and local SRRT went to investigation during September 4th - 20th, 2007 for confirm epidemiological linkage of both outbreaks, to identify source of contamination in suspected baby corn, to give recommendation for prevention and control. Methods: We used descriptive study to observed production of baby corn in factories that relate to Denmark and Australia's outbreak. We had data collection by contact Ministry of Agriculture and Cooperative and INFOSAN for sharing information, interview workers in related factories and farms about history of illness and working process, observed environment in linkage factories and sample collection by rectal swabs, hand swabs, environment and equipment sent to National Institute of Health for bacterial culture. Result: Denmark and Australia were imported suspected baby corn from A packing house of Thailand. Producing process of A packing house divide to three parts; farms, collecting house and packing house. Their collecting houses showed that there were many potential points of contamination in A packing house and their collecting houses. The workers in farms and packing house part were not direct contact with baby corn; the collecting houses had highest risk for contamination since the workers use bar hand to contact with the already peeled baby corns. However, the packing house has weakness for disinfection of the baby corns; lower concentrate of disinfectant if high contaminate before that, it can't disinfect. Laboratory result of the totally 373 samples from rectal swabs, hand swabs, environmental and equipment swabs were not found Shigellsa sonnei. Conclusion: Shigellosis outbreaks in Denmark and Australia related baby corn imported from Thailand, most likely possible source of both outbreaks was baby corn from the chain of A packing house. Process of highest risk of contamination was at A's collecting house and some defect in the disinfection process, it can't disinfects to bacterial contaminate in baby corn.Item Health System and Pandemic Influenza Preparedness: Results from Rapid Situation Analysis (RSA) in Jakarta and Bali(Outbreak, Surveillance and Investigation Reports, 2010-05-13) Wiku Adisasmito; Department of Health Policy and Administration, Faculty of Public Health, University of Indonesia, UI Campus, IndonesiaAim This research aims to highlights key issues pertaining to the pandemic preparedness program and challenges arising from health system context. Methods The rapid situational analysis involved review of secondary evidence, conducting interviews with a range of key stakeholders and the analysis, synthesis and triangulation of primary and secondary data. The interviews were conducted by research team members of the Faculty of Public Health University of Indonesia \& London School of Hygiene \& Tropical Medicine. The rapid situational analysis visit in Jakarta and Bali took place from 10th - 14th November 2008. Results The AI control and pandemic preparedness activities rely heavily on the health system infrastructure particularly the public sector to function. The available network of hospitals, health centers, public health offices, and public health facilities has enabled the country to respond to the emergence of human cases of avian influenza. Conclusions AI surveillance, case investigation, case management, and community control have been integrated as a part of health system functions.