HCV iatrogenic and intrafamilial transmission in Greater Cairo, Egypt.

OBJECTIVES: To document hepatitis C virus (HCV) intrafamilial transmission and assess its relative importance in comparison to other current modes of transmission in the country with the largest HCV epidemic in the world. HCV intrafamilial transmission was defined as HCV transmission among relatives living in the same household. DESIGN: Case-control study. Cases were adult patients with acute hepatitis C diagnosed in two 'fever hospitals' of Cairo. Controls were adult patients with acute hepatitis A diagnosed in the same two hospitals, and family members of cases. All consenting household members of cases provided blood for HCV serological and RNA testing. Homology of viral sequences (NS5b region) within households was used to ascertain HCV intrafamilial transmission. Exposures at risk for HCV during the 1-6 months previous to onset of symptoms were assessed in all cases and controls. RESULTS: From April 2002 to June 2007, 100 cases with acute hepatitis C, and 678 controls (416 household members and 262 patients with acute hepatitis A) were recruited in the study. Factors independently associated with HCV infection and their attributable fractions (AFs) were the following: having had a catheter (OR=5.0, 95% CI=1.4 to 17.8; AF=6.7%), an intravenous perfusion (OR=5.8, 95% CI=2.5 to 13.3; AF=20.1%), stitches (OR=2.0, 95% CI=1.3 to 6.6; AF=10.7%), gum treatment (OR=3.7, 95% CI=1.1 to 11.9; AF=3.8%) and being illiterate (OR=2.4, 95% CI=1.4 to 4.4). Of the 100 cases, 18 had viraemic HCV-infected household members. Three long-married (>15 years) couples were infected with virtually identical sequences and none of the three index patients reported any exposure at risk, suggesting HCV intra-familial transmission. CONCLUSION: While three new HCV infections out of 100 could be linked to intra-familial transmission, parenteral iatrogenic transmission (dental care included) was accountable for 34.6% of these new infections. Thus, the relative contribution of intrafamilial transmission to HCV spread seems to be limited.

Waterborne outbreak among Spanish tourists in a holiday resort in the Dominican Republic, August 2002.

On 3 September 2002, the Spanish national centre of epidemiology (Centro Nacional de Epidemiologia--CNE) was alerted to a high number of gastroenteritis cases in Spanish tourists who had travelled to a hotel in Punta Cana on different days during august 2002. Entamoeba hystolitica cysts have been visualised by microscopy in the stools of several patients that sought medical attention in the Dominican Republic. The CNE informed the health authorities in the Dominican Republic and conducted in conjunction an epidemiological investigation. A descriptive study of the 76 initial cases estimated a mean illness duration of 5.1+2.9 days and a exposure period of 3.6+2.2 days. Following a retrospective cohort study, the attack rate was found to be 32.4%. Consequently, 216 (95% CI=114.75-317.25) spanish tourists had probably developed the illness. Stool samples were collected in Spain from untreated patients who still felt unwell. None of the samples were positive for E.hystolitica. On 10 September, a hygiene inspection was undertaken at the hotel. Samples of the ice and meals served at the buffet that day, yielded coliform bacteria. Consumption of water from the resort water system was the only risk factor associated with the symptoms (RR= 3.55; 95% CI =1.13-10.99). To avoid similar outbreaks occurring again at the hotel, it is essential to regularly monitor the water quality and to improve food handling hygiene standards. Basic food hygiene training for food handlers should be mandatory. An international guideline for the management foodborne and waterborne outbreaks among tourists in holiday resorts should be drawn up, involving all competent authorities of both destination and tourist origin countries.

Brucellosis outbreak due to unpasteurized raw goat cheese in Andalucia (Spain), January - March 2002.

Eleven brucellosis cases were identified in three municipalities of Cordoba (Andalucia, Spain). A case-control study was conducted, selecting three cases per control. Persons having eaten unpasteurized raw goat cheese produced in a farmhouse located in the epidemic territory, were at higher risk for presenting brucellosis (OR=21.6, IC95%=1.6-639.8). Brucella melitensis serovar 3 was identified in clinical specimens and in goat tissue and milk samples from the herd's farmhouse. Preventive measures were implemented and the outbreak was stopped after the withdrawal of all suspicious cheeses from the market, additional sanitation of the farmhouse and health promotion activities.