Donato Greco

Ebola Hemorrhagic Fever Transmission and Risk Factors of Contacts, Uganda

From August 2000 through January 2001, a large epidemic of Ebola hemorrhagic fever occurred in Uganda, with 425 cases and 224 deaths. Starting from three laboratory-confirmed cases, we traced the chains of transmission for three generations, until we reached the primary case-patients (i.e., persons with an unidentified source of infection). We then prospectively identified the other contacts in whom the disease had developed. To identify the risk factors associated with transmission, we interviewed both healthy and ill contacts (or their proxies) who had been reported by the case-patients (or their proxies) and who met the criteria set for contact tracing during surveillance. The patterns of exposure of 24 case-patients and 65 healthy contacts were defined, and crude and adjusted prevalence proportion ratios (PPR) were estimated for different types of exposure. Contact with the patient’s body fluids (PPR = 4.61%, 95% confidence interval 1.73 to 12.29) was the strongest risk factor, although transmission through fomites also seems possible.

EPIDEMIOLOGY OF CHOLERA IN ITALY IN 1973

Abstract From August through October, 1973, 278 cases of bacteriologically confirmed cholera were reported to the Italian Ministry of Health. Epidemiological investigation of the three epidemic foci—the coastal regions of Campania and Puglia, and the province of Cagliari in Sardinia— revealed that the cases occurred in explosive outbreaks. Mussels were probably vehicles of Vibrio cholerae infection in Campania, and other bivalves probably transmitted cholera in Sardinia. Other types of raw seafood were probably vehicles of infection in Puglia. Most of the scattered cases reported from other parts of Italy were associated with travel in Campania or Puglia shortly before the onset of illness. Almost all cases were in adults, with a preponderance of men. In Campania and Puglia a history of gastric surgery was significantly more common among patients interviewed than among members of their households or paired controls.

Outbreak of Paralytic Poliomyelitis in Albania, 1996: High Attack Rate Among Adults and Apparent Interruption of Transmission Following Nationwide Mass Vaccination

After >10 years without detection of any cases of wild virus-associated poliomyelitis, a large outbreak of poliomyelitis occurred in Albania in 1996. A total of 138 paralytic cases occurred, of which 16 (12%) were fatal. The outbreak was due to wild poliovirus type 1, isolated from 69 cases. An attack rate of 10 per 100,000 population was observed among adults aged 19-25 years who were born during a time of declining wild poliovirus circulation and had been vaccinated with two doses of monovalent oral poliovirus vaccines (OPVs) that may have been exposed to ambient temperatures for prolonged periods. Control of the epidemic was achieved by two rounds of mass vaccination with trivalent oral poliovirus vaccine targeted to persons aged 0-50 years. This outbreak underscores the ongoing threat of importation of wild poliovirus into European countries, the importance of delivering potent vaccine through an adequate cold chain, and the effectiveness of national OPV mass vaccination campaigns for outbreak control.

Recurrence of pelecypod-associated cholera in Sardinia.

From Oct. 30 to Nov. 7, 1979, 10 people in the Sardinian province of Cagliari had onset of bacteriologically confirmed cholera. Two symptom-free excretors of Vibrio cholerae O:1 were detected in household contacts of the patients. There were no deaths. All but 1 of the 12 people with V. cholerae O:1 infection gave a history of recent consumption of marine bivalves known locally as arselle (pelecypods). Triplicate matched neighbourhood controls for each of the first 7 cases identified were also interviewed; none had recently eaten arselle. V. cholerae O:1 was also recovered from samples of water and bivalves obtained from a lagoon on the outskirts of the city of Cagliari. Arselle had also been implicated as the vehicle of transmission in 1973 in the last outbreak of cholera in Sardinia. It seems unlikely that cholera transmission had persisted locally in the interim.

Tuberculosis in Kindergarten and Primary School, Italy, 2008–2009

An outbreak of tuberculosis (TB) in Italy involved 19 schoolchildren with active TB and 43 with latent infection. The source of the outbreak was a school assistant born in Italy who had a family history of TB. This outbreak highlights the need for maintaining clinical and public health expertise in countries with low TB incidence.

A DIFFERENCE IN RELATIVE EFFICACY OF TWO DTaP VACCINES IN CONTINUED BLINDED OBSERVATION OF CHILDREN FOLLOWING A CLINICAL TRIAL. • 1021

In 1992-94, a randomized, double blind, placebo-controlled clinical trial of two acellular and one whole-cell pertussis vaccines was conducted in Italy. Each acellular vaccine (one manufactured by SmithKline Beecham [SB] and one by Chiron Biocine [CB]) contained filamentous hemagglutinin, pertactin and inactive pertussis toxin, the latter being detoxified by formalin and glutaraldehyde in SB DTaP and genetically detoxified in CB DTaP. Primary immunization at 2, 4 and 6 months of age provided an efficacy for each DTaP of 84% in preventing confirmed pertussis of 21 or more days of paroxysmal cough, over an average of 17 months of follow-up. The incidence rate ratio (IRR) of pertussis in recipients of SB and CB vaccines was 1.0 with 37 cases in 4,481 children and 36 cases in 4,452, respectively. In 1995, during additional blinded follow-up of the same cohorts through September 30, a total of 53 pertussis cases have been diagnosed in DTaP recipients through an average age of 35 months. Thirty-five cases of confirmed pertussis occurred in SB DTaP recipients in the nine-month period and 18 cases in CB DTaP recipients. Although initially both vaccines exhibited equivalent high efficacy, in a further period of observation the incidence in CB DTaP recipients was significantly lower. Table