Legionnaires’ Disease Outbreak in Murcia, Spain

An explosive outbreak of Legionnaires’ disease occurred in Murcia, Spain, in July 2001. More than 800 suspected cases were reported; 449 of these cases were confirmed, which made this the world’s largest outbreak of the disease reported to date. Dates of onset for confirmed cases ranged from June 26 to July 19 , with a case-fatality rate of 1%. The epidemic curve and geographic pattern from the 600 completed epidemiologic questionnaires indicated an outdoor point-source exposure in the northern part of the city. A case-control study matching 85 patients living outside the city of Murcia with two controls each was undertaken to identify the outbreak source; the epidemiologic investigation implicated the cooling towers at a city hospital. An environmental isolate from these towers with an identical molecular pattern as the clinical isolates was subsequently identified and supported that epidemiologic conclusion

Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries.

In developing countries, acquired bacterial resistance to antimicrobial agents is common in isolates from healthy persons and from persons with community-acquired infections. Complex socioeconomic and behavioral factors associated with antibiotic resistance, particularly regarding diarrheal and respiratory pathogens, in developing tropical countries, include misuse of antibiotics by health professionals, unskilled practitioners, and laypersons; poor drug quality; unhygienic conditions accounting for spread of resistant bacteria; and inadequate surveillance

Violence, Selection and Infant Mortality in Congo

This paper documents the effects of the recent civil war in the Democratic Republic of Congo on mortality both in utero and during the first year of life. It instruments for conflict intensity using a mineral price index, which exploits the exogenous variation in the potential value of mineral resources generated by changes in world mineral prices to predict the geographic distribution of the conflict. Using estimates of civil war exposure on mortality across male and female newborn to assess their relative health, it provides evidence of culling effect (in utero selection) as a consequence of in utero shocks

The unseen face of humanitarian crisis in Eastern Democratic Republic of Congo: was nutritional relief properly targeted?

STUDY OBJECTIVE—Comparison of children's nutritional status in refugee populations with that of local host populations, one year after outbreak refugee crisis in the North Kivu region of Democratic Republic of Congo.
DESIGN—Cross sectional surveys.
SETTING—Temporary and other settlements, in the town of Goma and surrounding rural areas.
SUBJECTS—Anthropometric indicators of nutritional status and presence or absence of oedema were measured among 5121 children aged 6( )to 59 months recruited by cluster sampling with probability proportional to size, between June and August 1995.
RESULTS—Children in all locations demonstrated a typical pattern of growth deficit relative to international reference. Prevalence of acute malnutrition (wt/ht < −2 Z score) was higher among children in the rural non-refugee populations (3.8 and 5.8%) than among those in the urban non-refugee populations (1.4%) or in the refugee population living in temporary settlements (1.7%). Presence of oedema was scarcely noticed in camps (0.4%) while it was a common observation at least in the most remote rural areas (10.1%). As compared with baseline data collected in 1989, there is evidence that nutritional status was worsening in rural non-refugee populations.
CONCLUSIONS—Children living in the main town or in the refugee camps benefited the most from nutritional relief while those in the rural non-refugee areas were ignored. This is a worrying case of inequity in nutritional relief.


Keywords: malnutrition; disasters; equit