A Large-Scale Community-Based Outbreak of Paratyphoid Fever Caused by Hospital-Derived Transmission in Southern China
| العنوان: | A Large-Scale Community-Based Outbreak of Paratyphoid Fever Caused by Hospital-Derived Transmission in Southern China |
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| المؤلفون: | Shuyu Wu, Bo Pang, Zhigang Wang, Baowei Diao, Biao Kan, John D. Klena, Bo Yang, Shu-kun Wang, Rusong Yang, Xiaohe Zhang, Yanhua Zhou, Meiying Yan |
| المصدر: | PLoS Neglected Tropical Diseases, Vol 9, Iss 7, p e0003859 (2015) PLoS Neglected Tropical Diseases |
| بيانات النشر: | Public Library of Science (PLoS), 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Veterinary medicine, China, Agricultural Irrigation, Time Factors, lcsh:Arctic medicine. Tropical medicine, Adolescent, lcsh:RC955-962, Wastewater, Disease Outbreaks, Young Adult, Risk Factors, Epidemiology, Paratyphoid Fever, Vegetables, medicine, Odds Ratio, Humans, Aged, Cross Infection, Farmers, Transmission (medicine), business.industry, lcsh:Public aspects of medicine, Paratyphoid fever, Public Health, Environmental and Occupational Health, Salmonella paratyphi A, Outbreak, lcsh:RA1-1270, Middle Aged, medicine.disease, Hospitals, Infectious Diseases, Southern china, Case-Control Studies, Etiology, Food Microbiology, Female, business, Water Microbiology, Research Article |
| الوصف: | Background Since the 1990s, paratyphoid fever caused by Salmonella Paratyphi A has emerged in Southeast Asia and China. In 2010, a large-scale outbreak involving 601 cases of paratyphoid fever occurred in the whole of Yuanjiang county in China. Epidemiological and laboratory investigations were conducted to determine the etiology, source and transmission factors of the outbreak. Methodology/Principal Findings A case-control study was performed to identify the risk factors for this paratyphoid outbreak. Cases were identified as patients with blood culture–confirmed S. Paratyphi A infection. Controls were healthy persons without fever within the past month and matched to cases by age, gender and geography. Pulsed-field gel electrophoresis and whole-genome sequencing of the S. Paratyphi A strains isolated from patients and environmental sources were performed to facilitate transmission analysis and source tracking. We found that farmers and young adults were the populations mainly affected in this outbreak, and the consumption of raw vegetables was the main risk factor associated with paratyphoid fever. Molecular subtyping and genome sequencing of S. Paratyphi A isolates recovered from improperly disinfected hospital wastewater showed indistinguishable patterns matching most of the isolates from the cases. An investigation showed that hospital wastewater mixed with surface water was used for crop irrigation, promoting a cycle of contamination. After prohibition of the planting of vegetables in contaminated fields and the thorough disinfection of hospital wastewater, the outbreak subsided. Further analysis of the isolates indicated that the origin of the outbreak was most likely from patients outside Yuanjiang county. Conclusions This outbreak is an example of the combined effect of social behaviors, prevailing ecological conditions and improper disinfection of hospital wastewater on facilitating a sustained epidemic of paratyphoid fever. This study underscores the critical need for strict treatment measures of hospital wastewater and the maintenance of independent agricultural irrigation systems in rural areas. Author Summary Typhoid and paratyphoid fever remain public health concerns for developing countries. From May 2010 to June 2011, a large-scale outbreak involving 601 cases of paratyphoid fever occurred in China. Epidemiological and laboratory investigations were conducted to determine the etiology, source and transmission factors of the outbreak. Farmers and young adults were the populations mainly affected in this outbreak, and the consumption of raw vegetables was the main risk factor associated with paratyphoid fever. We found that hospital wastewater mixed with surface water was used for vegetable irrigation. The contaminated water from hospitals combined with the regional habit of eating uncooked vegetables lead to the massive outbreak of paratyphoid. After prohibition of the planting of vegetables in contaminated fields and the thorough disinfection of hospital wastewater, the outbreak subsided. Molecular subtyping and whole-genome sequencing of S. Paratyphi A isolates recovered from improperly disinfected hospital wastewater showed indistinguishable patterns matching most of the isolates from the cases. Further analysis of the isolates indicated that the origin of the outbreak was most likely from patients outside Yuanjiang county. This study underscores the critical need for strict treatment measures of hospital wastewater and the maintenance of independent agricultural irrigation systems in rural areas. |
| اللغة: | English |
| تدمد: | 1935-2735 1935-2727 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::63571ff052bf8b251334873fc50aaed7 http://europepmc.org/articles/PMC4506061?pdf=render |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....63571ff052bf8b251334873fc50aaed7 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19352735 19352727 |
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