Management and investigation of viral gastroenteritis nosocomial outbreaks: lessons learned from a recent outbreak, Greece, 2012.

BACKGROUND: A nosocomial outbreak in a 740-bed hospital in Athens, Greece, was investigated in January-February 2012. METHODS: Recommendations on infection control measures were given and two case-control studies were conducted among patients (study A) and health care workers (HCWs) (study B). Compliance to control measures was evaluated. RESULTS: The absence of a routine recording system of nosocomial-acquired gastroenteritis cases led to a 10 days delay in outbreak identification. In total, 63 gastroenteritis cases were identified; 30 HCWs and 33 patients. In the multivariable analysis of study A the disease incidence among patients was statistical significantly associated with a prior incident of vomitus in their room (OR=7.96, 95% CI=1.29-49.2). In study B, the incidence was associated with the history of direct contact with a symptomatic patient (OR=3.03, 95%CI 1.01-9.12). Twenty one (75%) of the symptomatic HCWs reported absence from work for a median of 2 days (range: 1-4). Seven (25.0%) continued to work despite being symptomatic. Only, 11.1% of patients were isolated or cohorted after developing symptoms. In-hospital virological testing was not feasible and one specimen sent to a university laboratory was positive for norovirus. CONCLUSIONS: An appropriately designed protocol regarding the detection, the management and the laboratory investigation of nosocomial gastroenteritis outbreaks should be followed in order effective containment to be reassured. Hippokratia 2014; 18 (3): 204-208.

Prevalence of Crimean-Congo hemorrhagic fever virus antibodies in Greek residents in the area where the AP92 strain was isolated.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a viral disease with fatality rate up to 30%. Up to date, only one CCHF case has been reported in Greece, while a distinct virus strain (AP92) had been isolated in 1975 from ticks in Imathia prefecture, northern Greece. The aim of the present study was to estimate the CCHF virus (CCHFV) seroprevalence among humans residing in the prefecture of Imathia, and the neighboring prefecture of Pella, and to investigate the risk factors associated with the seropositivity. MATERIAL AND METHODS: A total of 277 persons randomly selected from the general population were tested for the presence of CCHFV IgG antibodies. Additional 51 persons belonging in groups with risk for acquisition of CCHFV infection (19 slaughterhouse workers and 32 hunters) were also tested. All participants filled in a questionnaire related to demographics and probable risk factors (e.g. occupation, former tick bite, animal contact). RESULTS: Six of the 277 (2.2%) persons were found to carry CCHFV IgG antibodies: 3 in Imathia and 3 in Pella prefecture, resulting in seroprevalence of 1.7% and 2.9%, respectively. History of tick bite, residence in a hilly territory and increased age were significantly associated with CCHFV seropositivity. None of the slaughterers was found IgG-positive, while CCHFV IgG antibodies were detected in a 67-year old hunter who reported agricultural activities and a former tick bite. CONCLUSIONS: A relatively low seroprevalence is observed in the area where the AP92 strain has been isolated, with tick bite being significantly associated with CCHFV seropositivity. Further studies in ticks in the area will show whether are they infected by the AP92 strain or other more pathogenic CCHFV strains and at which rate.