Introduction Norovirus outbreaks frequently occur in communities and institutional settings acquiring a particular significance in armed forces where prompt reporting is critical. Here we describe the epidemiological, clinical and laboratorial investigation of a multicentre gastroenteritis outbreak that was detected simultaneously in three Portuguese army units with a common food supplier, Lisbon region, between 5 and 6 December 2017.
Methods Questionnaires were distributed to all soldiers stationed in the three affected army units, and stool specimens were collected from soldiers with acute gastrointestinal illness. Stool specimens were tested for common enteropathogenic bacteria by standard methods and screened for a panel of enteric viruses using a multiplex real-time PCR assay. Food samples were also collected for microbiological analysis. Positive stool specimens for norovirus were further genotyped.
Results The three simultaneous acute gastroenteritis outbreaks affected a 31 (3.5%) soldiers from a total of 874 stationed at the three units and lasted for 2 days. No secondary cases were reported. Stool specimens (N=11) were negative for all studied enteropathogenic agents but tested positive for norovirus. The recombinant norovirus GII.P16-GII.4 Sydney was identified in all positive samples with 100% identity.
Conclusions The results are suggestive of a common source of infection plausibly related to the food supplying chain. Although centralisation of food supplying in the army has economic advantages, it may contribute to the multifocal occurrence of outbreaks. A rapid intervention is key in the mitigation of outbreak consequences and in reducing secondary transmission.
Simultaneous norovirus outbreak in three Portuguese bases in the Lisbon region, December 2017
Journal of the Royal Army Medical Corps
António Lopes-João1, J R Mesquita2,3, R de Sousa4, M Oleastro4, C Penha-Gonçalves1and M S J Nascimento3,5
A retrospective study involving 25 national hospitals led to the detection of an outbreak that occurred between March 2009 and February 2012. The amount of time between the start of the outbreak and its detection was 16 months.
Of the 30 cases of listeriosis reported, 27 were in the Lisbon and Vale do Tejo region. Two cases were maternal/neonatal infections and one resulted in fetal loss. The mean age of the non-maternal/neonatal cases was 59 years (standard deviation: 17); 13 cases were more than 65 years-old. The case fatality rate was 36.7%. All cases were caused by molecular serogroup IVb isolates indistinguishable by pulsed-field gel electrophoresis and ribotype profiles. Collaborative investigations with the national health and food safety authorities identified cheese as the probable source of infection, traced to a processing plant. The magnitude of this outbreak, the first reported food-borne listeriosis outbreak in Portugal, highlights the importance of having an effective listeriosis surveillance system in place for early detection and resolution of outbreaks, as well as the need for a process for the prompt submission of Listeria monocytogenes isolates for routine laboratory typing.
Cheese-related listeriosis outbreak, Portugal, March 2009 to February 2012
Euro Surveill. 2015;20(17):pii=21104
Magalhães R, Almeida G, Ferreira V, Santos I, Silva J, Mendes MM, Pita J, Mariano G, Mâncio I, Sousa MM, Farber J, Pagotto F, Teixeira P.
Brucellosis, which is also known as Malta Fever, Rock Fever or Mediterranean Fever, is most often contracted from unpasteurized milk or milk products such as cheese. The disease leads to parasites in the host’s bloodstream and episodes may last weeks, months or even years. It causes potentially recurrent episodes of high fever, sweating and related anemia.
At least four of the victims of the outbreak have been hospitalized in the neighboring city of Porto, a spokesperson from the Northern Regional Health Administration told the Expresso newspaper.