The aim of our study was to examine the scabies incidence in the Croatian population and to analyse potential related factors.
This mixed ecological study is based on a retrospective medical record ...review. National data from communicable disease reports was sourced and analysed for an 11-year period (2007-2017), with more focus on the period 2014-2017. Descriptive statistics were used to calculate trends. Differences between the groups were studied using Chi-square test and Kendall's tau (τ) correlation coefficient. Levels of significance were set at p<0.05 or p<0.01.
From 2007 to 2017, scabies infestation in Croatia increased by 6-fold, particularly affecting children and young adults (19 years or younger). In the period 2014-2017, border counties which are part of migration flows were the counties with the highest average scabies incidences. A linear trend of increase in the number of tourists, immigrants and scabies infestations was noted on the national level for the analysed period, although a significant association was not observed. Regarding outbreaks of scabies within institutions, more than 80% of outbreaks occurred in institutions for adults. In the capital, Zagreb, the crude incidence rate increased 3-fold between 2014 and 2017.
The increased incidence of scabies, large disparities between counties, and prolonged outbreaks within families due to under-recognition and misdiagnoses points to a need for increased awareness among health practitioners. To the best of our knowledge, this is the first recent epidemiologic analysis on this topic, not only in Croatia but within the wider geographic region as well.
Introduction. In May of 2012, we investigated a food-borne Clostridium perfringens outbreak in Slovenia involving a single kitchen and five venues, with 477 exposed persons.
Methods. In order to ...identify the causative agent, vehicle of infection and source of contamination, we conducted microbiological and environmental investigations and an analytical cohort study (n = 138).
Results. The case definition in the outbreak was met by 104 persons. Predominant symptoms were diarrhoea, nausea and abdominal cramps. Median incubation time and duration of illness were 12 and 22.5 hours respectively. Stool samples were collected from 18 persons and in 13 C. perfringens spores were present; enterotoxin was detected in 9 persons. PCR and PFGE analysis of isolates from a cook with earlier onset time, who did not consume the implicated food, and cases from four venues showed the same strain of C. perfringens type A (with cpe-gene), indistinguishable by PFGE analysis. No food samples could be obtained. An analytical study showed that one food item (French salad) was the most likely vehicle of infection (RR: 6.35; 95% CI: 1.62-24.90).
Conclusions. This was the largest C. perfringens outbreak in Slovenia to date. Proper analytical study in combination with detailed laboratory investigation with genotypisation enabled us to identify a causative agent, vehicle of infection and possible source of contamination. Fast response and interdisciplinary collaboration led to timely implementation of control measures. These have led to the kitchen acquiring new equipment and improving staff knowledge of risks and processes, thus reducing the likelihood of future reoccurrences
Uvod. V maju 2012 smo preiskovali izbruh okužb s Clostridium perfringens, prenesenih s hrano, v katerega so bile vpletene ena kuhinja in pet lokaciji s 477 izpostavljenimi osebami.
Metode. Da bi ugotovili povzročitelja, pot prenosa in vir kontaminacije, smo izvedli laboratorijsko in okoljsko preiskavo ter analitično kohortno raziskavo (n = 138).
Rezultati. Definiciji primera v izbruhu so ustrezale 104 osebe. Prevladujoči simptomi so bili: driska, slabost in trebušni krči. Mediana časa inkubacije in trajanja bolezni je bila 12 ur in 22,5 ure. Vzorci blata so bili odvzeti 18 osebam; pri 13 so bile prisotne spore C. perfringens, enterotoksin je bil zaznan pri 9 osebah. PCR- in PFGE-analiza izolatov kuharja z zgodnejšim časom pojava obolenja, ki ni užival impliciranih živil, in primerov s štirih lokacij sta pokazali enak sev C. perfringens tipa A (s cpe genom), ki se ni razlikoval pri analizi PFGE. Vzorcev živil ni bilo mogoče pridobiti. Analitična študija je pokazala, da je bila najverjetnejša pot prenosa okužbe eno izmed živil (francoska solata) (RT: 6,35; 95% IZ: 1,62-24,90).
Zaključek. To je bil največji izbruh s C. perfringens v Sloveniji do zdaj. Ustrezna analitična raziskava v kombinaciji s podrobno laboratorijsko preiskavo z genotipizacijo nam je omogočila identifikacijo povzročitelja, pot prenosa okužbe in mogoč vir kontaminacije. Hiter odziv in interdisciplinarno sodelovanje je pripeljalo do pravočasne implementacije nadzornih ukrepov. Ti so privedli do nabave nove opreme v kuhinji, izboljšanja znanja osebja o tveganjih in procesih ter s tem zmanjšali verjetnost za ponovitve v prihodnje
An investigation of a waterborne outbreak caused by microbiological contamination of the drinking water supply system Background: An outbreak of acute gastroenteritis occurred in March and April 2010 ...in the town of Menges where drinking tap water was contaminated, affecting an area with 3000 residents. The aim was to assess the extent of the outbreak, identify the etiological agents and test the hypothesis that drinking unboiled water from the distribution system was the vehicle for the outbreak, and if necessary to initiate appropriate control measures. Methods: A retrospective cohort study including 160 randomly selected households (20% of the affected residents) was conducted. A case was a resident of Menges developing either diarrhoea, vomiting or abdominal pain. Results: The overall attack rate was 31.3%. The epidemic curve showed a clear peak in the number of cases suggesting a common point source exposure. Residents who consumed unboiled tap water were 4.8 times (95% CI 0.7-32.7) more likely to become ill than the non-exposed. Drinking unboiled water, brushing teeth and eating raw fruit and vegetables washed with unboiled tap water was associated with gastroenteritis (RR 3.1 (CI 95% 1.5-6.5), 3.1 (CI 95% 1.2-8.1) and 2.3 (CI 95% 1.2-4.3)). There was a dose-response relationship between the volume of unboiled tap water drunk and the attack rate among the residents. Norovirus and Rotavirus were detected in the water samples, as well as in stool samples from the cases. Conclusion: The results suggest that the vehicle of transmission was contaminated drinking water. Residents of affected area were advised to temporarily boil tap water. Because of continuous problems with water from the distribution system, building a new one from other water sources was considered. PUBLICATION ABSTRACT
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