Outbreak of Verotoxigenic E. Coli (VTEC): Winnipeg
Increased VTEC activity well over expected amounts was observed in the Winnipeg Health Region (WHR) during the summer of 2006. Seventy-seven (77) cases were reported in the WHR between 1 January and 30 September 2006; 15-20 cases are expected in this time period and only 10-15 cases would be expected in the WHR during the summer period. Similarly, VTEC cases were elevated during the summer of 2006 in rural Manitoba and in other provinces across Canada. Further analysis by the Public Health Agency of Canada uncovered no common source of VTEC for this increased background level of activity throughout Canada, and no common PFGE strains between provinces. Two VTEC outbreaks in the USA linked to consumption of contaminated spinach and lettuce respectively were not related to the Winnipeg VTEC outbreak, as they were caused by entirely different VTEC strains (PFGE patterns) not seen in any of the Winnipeg cases. The working hypothesis created to guide the WRHA public health interventions postulated that VTEC strains possibly originating from the slaughterhouse that owns and supplies a certain processor (processor Y) entered the food chain sometime early in the month of August 2006. The most likely source would have been a bovine carcass that had been contaminated with fecal material. Further, it was hypothesized that VTECcontaminated meat would have been supplied to a certain retailer (retailer X) by processor Y. Inadequate cleaning of the industrial grinder and inadequate food handling practices initially observed at retailer X could have amplified and perpetuated VTEC contamination of meat products, increasing the probability that retailer X would have supplied its daily clients (restaurants A, B, C and D) with contaminated raw ground beef. In addition, restaurant inspection reports revealed that, in some of these restaurants, raw ground beef was stored at improper temperatures that could have resulted in the further amplification of VTEC. Inadequate food handling practices were also observed in all of these restaurants, potentially contributing to the transmission of VTEC to customers through cross-contamination of ground beef-containing and possibly other food products. The full report can be accessed online at: http://www.wrha.mb.ca/media/news/070124.php.
Source: Winnipeg Regional Health Authority, 24 January 2007

Influenza and the Influenza Vaccine: Alabama and Michigan
The U.S. Advisory Committee on Immunization Practices (ACIP) recommends influenza immunization among United States health care workers (HCWs) to reduce the spread of influenza to and from workers and patients. Despite these recommendations, influenza immunization coverage of health care workers is less than 50%. Eight focus groups of registered nurses (RNs) were conducted in Birmingham, Alabama (n = 34) and Detroit, Michigan (n = 37). In each city, the focus groups consisted of 2 groups each of vaccinated and unvaccinated RNs. These focus groups revealed that many nurses were concerned about influenza vaccine effectiveness and safety; their lack of information about the vaccine plays a part in their willingness to promote it to patients. Unvaccinated nurses tended to be less aware of the ACIP recommendations for HCW vaccination, and overall, nurses were not aware of the rationale for HCW vaccination. Attitudes were mixed regarding mandatory influenza vaccination programs, including the hope that such programs would result in higher vaccination rates and concern about potential disciplinary action if vaccine was declined. Participants believed that increasing convenience was the key to increasing HCW vaccination. The findings confirm the importance of comprehensive approaches that combine education and convenience, and suggest that emphasizing the rationale for HCW vaccination may contribute to increasing vaccination rates.
Source: American Journal of Infection Control, Volume 35, Issue 1, February 2007

Invasive Group B Streptococcal Infection in Infants: Malawi
Group B streptococci (GBS) are a recently identified cause of neonatal sepsis in Malawi. In Queen Elizabeth Central Hospital, Blantyre, Malawi, during May 2004-June 2005, GBS were isolated from routine blood and cerebrospinal fluid cultures from 57 infants. The incidence of early (EOD) and late onset (LOD) invasive GBS disease was 0.92 and 0.89 cases per 1,000 live births, respectively. Sepsis (52%) was the most common manifestation of EOD; meningitis (43%) and sepsis (36%) were the principal manifestations of LOD. The case-fatality rate was 33% overall (38% EOD, 29% LOD). Serotypes Ia and III were responsible for 77% of disease. All isolates were susceptible to penicillin, but 21% were resistant to erythromycin. The rate and manifestations of neonatal GBS disease in Malawi are similar to those in industrialized countries, but the case-fatality rate is higher than in industrialized countries. Effective locally relevant prevention strategies are needed.
Source: Emerging Infectious Diseases, Volume 13, No. 2, February 2007

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.