Cyclosporiasis Outbreak in Germany Associated with the Consumption of Salad

This outbreak is the first foodborne cyclosporiasis outbreak reported from central Europe. The illness was reported in 34 persons who attended luncheons at a German restaurant. The overall attack rate was 85% (34/40). The only foods associated with significant disease risk were two salad side dishes prepared from lettuce imported from southern Europe and spiced with fresh green leafy herbs (p=0.0025)

A cluster of multidrug-resistant Mycobacterium tuberculosis among patients arriving in Europe from the Horn of Africa: a molecular epidemiological study.

BACKGROUND: The risk of tuberculosis outbreaks among people fleeing hardship for refuge in Europe is heightened. We describe the cross-border European response to an outbreak of multidrug-resistant tuberculosis among patients from the Horn of Africa and Sudan. METHODS: On April 29 and May 30, 2016, the Swiss and German National Mycobacterial Reference Laboratories independently triggered an outbreak investigation after four patients were diagnosed with multidrug-resistant tuberculosis. In this molecular epidemiological study, we prospectively defined outbreak cases with 24-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) profiles; phenotypic resistance to isoniazid, rifampicin, ethambutol, pyrazinamide, and capreomycin; and corresponding drug resistance mutations. We whole-genome sequenced all Mycobacterium tuberculosis isolates and clustered them using a threshold of five single nucleotide polymorphisms (SNPs). We collated epidemiological data from host countries from the European Centre for Disease Prevention and Control. FINDINGS: Between Feb 12, 2016, and April 19, 2017, 29 patients were diagnosed with multidrug-resistant tuberculosis in seven European countries. All originated from the Horn of Africa or Sudan, with all isolates two SNPs or fewer apart. 22 (76%) patients reported their travel routes, with clear spatiotemporal overlap between routes. We identified a further 29 MIRU-VNTR-linked cases from the Horn of Africa that predated the outbreak, but all were more than five SNPs from the outbreak. However all 58 isolates shared a capreomycin resistance-associated tlyA mutation. INTERPRETATION: Our data suggest that source cases are linked to an M tuberculosis clone circulating in northern Somalia or Djibouti and that transmission probably occurred en route before arrival in Europe. We hypothesise that the shared mutation of tlyA is a drug resistance mutation and phylogenetic marker, the first of its kind in M tuberculosis sensu stricto. FUNDING: The Swiss Federal Office of Public Health, the University of Zurich, the Wellcome Trust, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), the Medical Research Council, BELTA-TBnet, the European Union, the German Center for Infection Research, and Leibniz Science Campus Evolutionary Medicine of the Lung (EvoLUNG)

A cluster of multidrug-resistant Mycobacterium tuberculosis among patients arriving in Europe from the Horn of Africa: a molecular epidemiological study

SummaryBackground The risk of tuberculosis outbreaks among people fleeing hardship for refuge in Europe is heightened. We describe the cross-border European response to an outbreak of multidrug-resistant tuberculosis among patients from the Horn of Africa and Sudan. Methods On April 29 and May 30, 2016, the Swiss and German National Mycobacterial Reference Laboratories independently triggered an outbreak investigation after four patients were diagnosed with multidrug-resistant tuberculosis. In this molecular epidemiological study, we prospectively defined outbreak cases with 24-locus mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) profiles; phenotypic resistance to isoniazid, rifampicin, ethambutol, pyrazinamide, and capreomycin; and corresponding drug resistance mutations. We whole-genome sequenced all Mycobacterium tuberculosis isolates and clustered them using a threshold of five single nucleotide polymorphisms (SNPs). We collated epidemiological data from host countries from the European Centre for Disease Prevention and Control. Findings Between Feb 12, 2016, and April 19, 2017, 29 patients were diagnosed with multidrug-resistant tuberculosis in seven European countries. All originated from the Horn of Africa or Sudan, with all isolates two SNPs or fewer apart. 22 (76%) patients reported their travel routes, with clear spatiotemporal overlap between routes. We identified a further 29 MIRU-VNTR-linked cases from the Horn of Africa that predated the outbreak, but all were more than five SNPs from the outbreak. However all 58 isolates shared a capreomycin resistance-associated tlyA mutation. Interpretation Our data suggest that source cases are linked to an M tuberculosis clone circulating in northern Somalia or Djibouti and that transmission probably occurred en route before arrival in Europe. We hypothesise that the shared mutation of tlyA is a drug resistance mutation and phylogenetic marker, the first of its kind in M tuberculosis sensu stricto. Funding The Swiss Federal Office of Public Health, the University of Zurich, the Wellcome Trust, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), the Medical Research Council, BELTA-TBnet, the European Union, the German Center for Infection Research, and Leibniz Science Campus Evolutionary Medicine of the Lung (EvoLUNG)

Weiterentwicklung des Bestimmungsverfahrens fuer die Parasiten Cryptosporidium sp. und Giardia lamblia in Wasser. T. 2: Simultaner Vitalitaetsnachweis fuer beide Parasiten Abschlussbericht

SIGLEAvailable from TIB Hannover: F01B1594+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung und Forschung, Berlin (Germany)DEGerman

Large Q fever outbreak due to sheep farming near residential areas, Germany, 2005

In June 2005 Coxiella burnetii-infected sheep, grazing and lambing on a meadow bordering a residential area, caused a large Q fever outbreak (331 cases) in Germany. Our outbreak investigation provided attack rates (AR) by distance between residence and meadow, sex and age groups. The AR of people living within 50 m of the meadow was 11·8%. It decreased the further the residence was from the meadow, falling to 1·3% at 350–400 m distance (RR 8·7, 95% CI 4·5–17·1). The AR was higher in men (RR 1·4, 95% CI 1·1–1·8). In the 25–64 years age group, the AR was 2·3 times higher compared to other age groups (95% CI 1·7–3·0). The distance-related AR showed a relationship between risk of infection and living close to the meadow. Ongoing urbanization will probably lead to further Q fever outbreaks, hence prevention activities undertaken by animal and public health practitioners should be aligned and strengthened

Ein internationales MDR-TB-Cluster bei jungen Geflüchteten vom Horn von Afrika

Seit Frühjahr 2016 wurden in mehreren Mitgliedsstaaten der Europäischen Union (EU) und der Schweiz Erkrankungen an MDR-TB beobachtet, die ein seltenes Resistenzprofil gegenüber Zweitrangmedikamenten aufweisen. Dies veranlasste die für Mykobakterien zuständigen nationalen Referenzzentren in Deutschland und der Schweiz zu weiterführenden Untersuchungen. Die Patienten stammten alle aus Ländern vom Horn von Afrika, überwiegend aus Somalia. Bis November 2018 konnten in Deutschland 23 Fälle dem Geschehen zugeordnet werden. Im Epidemiologischen Bulletin 48/2018 werden Ablauf und Vorgehen sowie Erfahrungen, Erkenntnisse und Herausforderungen bei der Untersuchung dieses MDR-TB-Clusters aus der Perspektive des öffentlichen Gesundheitsdienstes (ÖGD) in Deutschland geschildert.Peer Reviewe

Ein internationales MDR-TB-Cluster bei jungen Geflüchteten vom Horn von Afrika

Peer Reviewe