High Attack Rate Research Articles

Predator Ants of the Date Palm Termite <i>Microcerotermes diversus</i> Silvestri and Effects of ant Morphometric Characteristics on ant Functional Response

Scouting for formicidae presence in Microcerotermes diversus galleries was conducted from March to September 2014 in 10 date palm trees located in the Omaltomire region of Khuzestan Province, Iran. Measurements and morphological observations were made of 20 ant workers. For the in vitro predation test, M. diversus nymphs (n = 10 per replicate) were placed in a petri dish. Then, live freshly field-collected worker of ants were added. After 24 h, the number termite nymphs that were fully or partially devoured was determined. Five ants, including Plagiolepis pallescens , Polyrhachis lacteipennis , Pheidole teneriffana , Crematogaster antaris , and Monomorium destructor were predators of termites in date palm orchards. P. lacteipennis and P. teneriffana , and P. pallescens , C. antaris , and M. destructor , showed Type II and Type III functional responses, respectively. The highest predation efficiency, and the lowest handing time coupled with the highest attack rate by predators was recorded for P. lacteipennis and P. teneriffana , and C. antaris and M. destructor , respectively. Predator ant characteristics measured include: HL-Head length; HW-head width; SL-scape length; EL-eye length; PW-pronotal width; WL-thorax length; GL-gaster length; TL-total length; FL-femur length. HL, HW, SL, EL and FL showed positive effects on the functional response parameters. Results showed that termite defense capabilities declined with increasing of ant predation efficiency.

Vaccine and Therapeutic Options To Control Chikungunya Virus.

Beginning in 2004, chikungunya virus (CHIKV) went from an endemic pathogen limited to Africa and Asia that caused periodic outbreaks to a global pathogen. Given that outbreaks caused by CHIKV have continued and expanded, serious consideration must be given to identifying potential options for vaccines and therapeutics. Currently, there are no licensed products in this realm, and control relies completely on the use of personal protective measures and integrated vector control, which are only minimally effective. Therefore, it is prudent to urgently examine further possibilities for control. Vaccines have been shown to be highly effective against vector-borne diseases. However, as CHIKV is known to rapidly spread and generate high attack rates, therapeutics would also be highly valuable. Several candidates are currently being developed; this review describes the multiple options under consideration for future development and assesses their relative advantages and disadvantages.

Functional response and predation rate of Amblyseius swirskii (Acari: Phytoseiidae) at three constant temperatures

Functional response and predation rate of Amblyseius swirskii (Athias-Henriot) on eggs of Tetranychus urticae Koch were determined on strawberry under laboratory conditions (70 ± 10% R.H. and 16L:8D h) and three constant temperatures of 25, 30 and 35°C. The type of functional response was affected by temperature. Type III functional response was determined for adult female of A. swirskii at 25°C, whereas type II was observed at 30 and 35°C. The longest handling time ( T h ) (0.6 ± 0.005) was observed at 25°C and the shortest handling time (0.46 ± 0.003) and higher attack rate ( a ) (0.56 ± 0.054) were observed at 35°C. Handling time ( T h ) decreased from 25 to 35°C. Temperature had a significant effect on the daily and total predation rates of each different stages: the predation rate increased from larva to adult and with temperature from 25 to 35°C, and the maximal value being reached at 35°C. The maximal predation capacity of female was about 40 eggs per day per females at 35°C. The results of this study showed the effect of temperature on functional response and predation rate of A. swirskii .

Epidemiological and ecological determinants of Zika virus transmission in an urban setting.

The Zika virus has emerged as a global public health concern. Its rapid geographic expansion is attributed to the success of Aedes mosquito vectors, but local epidemiological drivers are still poorly understood. Feira de Santana played a pivotal role in the Chikungunya epidemic in Brazil and was one of the first urban centres to report Zika infections. Using a climate-driven transmission model and notified Zika case data, we show that a low observation rate and high vectorial capacity translated into a significant attack rate during the 2015 outbreak, with a subsequent decline in 2016 and fade-out in 2017 due to herd-immunity. We find a potential Zika-related, low risk for microcephaly per pregnancy, but with significant public health impact given high attack rates. The balance between the loss of herd-immunity and viral re-importation will dictate future transmission potential of Zika in this urban setting.

Symptoms and risk factors of Cryptosporidium hominis infection in children: data from a large waterborne outbreak in Sweden

Cryptosporidium is a major cause of diarrheal disease worldwide. In developing countries, this infection is endemic and in children, associated with growth faltering and cognitive function deficits, with the most severe impact on those aged <2 years. Little has been reported about symptoms and risk factors for children in industrialized countries, although the disease incidence is increasing in such regions. In November 2010, a large waterborne outbreak of C. hominis occurred in the city of Östersund in Sweden. Approximately 27,000 of the 60,000 inhabitants were symptomatic. We aimed to describe duration of symptoms and the risk factors for infection with C. hominis in children aged <15 years in a Western setting. Within 2 months after a boil water advisory, a questionnaire was sent to randomly selected inhabitants of all ages, including 753 children aged <15 years. Those with ≥3 loose stools/day were defined as cases of diarrhoea. The response rate was 70.3%, and 211 children (39.9%) fulfilled the case definition. Mean duration of diarrhoea was 7.5 days (median 6, range 1–80 days). Recurrence, defined as a new episode of diarrhoea after ≥2 days of normal stools, occurred in 52.5% of the cases. Significant risk factors for infection, besides living within the distribution area of the contaminated water plant, included a high level of water consumption, male sex, and a previous history of loose stools. The outbreak was characterized by high attack and recurrence rates, emphasizing the necessity of water surveillance to prevent future outbreaks.

A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda

BackgroundIn May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. We conducted an investigation to identify the mode of transmission to guide control measures.MethodsWe defined a suspected case as onset of acute watery diarrhoea from 1 February 2015 onwards in a Kasese resident. A confirmed case was a suspected case with Vibrio cholerae O1 El Tor, serotype Inaba cultured from a stool sample. We reviewed medical records to find cases. We conducted a case-control study to compare exposures among confirmed case-persons and asymptomatic controls, matched by village and age-group. We conducted environmental assessments. We tested water samples from the most affected area for total coliforms using the Most Probable Number (MPN) method.ResultsWe identified 183 suspected cases including 61 confirmed cases of Vibrio cholerae 01; serotype Inaba, with onset between February and July 2015. 2 case-persons died of cholera. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in the 5–14 year age group (4.1/10,000). The outbreak started in Bwera Sub-County bordering the Democratic Republic of Congo and spread eastward through sustained community transmission. The first case-persons were involved in cross-border trading. The case-control study, which involved 49 confirmed cases and 201 controls, showed that 94% (46/49) of case-persons compared with 79% (160/201) of control-persons drank water without boiling or treatment (ORM-H=4.8, 95% CI: 1.3–18). Water collected from the two main sources, i.e., public pipes (consumed by 39% of case-persons and 38% of control-persons) or streams (consumed by 29% of case-persons and 24% control-persons) had high coliform counts, a marker of faecal contamination. Environmental assessment revealed evidence of open defecation along the streams. No food items were significantly associated with illness.ConclusionsThis prolonged, community-wide cholera outbreak was associated with drinking water contaminated by faecal matter and cross-border trading. We recommended rigorous disposal of patients’ faeces, chlorination of piped water, and boiling or treatment of drinking water. The outbreak stopped 6 weeks after these recommendations were implemented.

Public health response and lessons learned from the 2014 chikungunya epidemic in Grenada

ABSTRACTIn June 2014, the first cases of chikungunya virus (CHIKV) were diagnosed on the island of Carriacou, part of the tri-island state of Grenada. In the three months that followed, CHIKV spread rapidly, with conservative estimates of the population infected of at least 60%. Multiple challenges were encountered in the battle to manage the spread and impact of this high–attack rate virus, including 1) limited indigenous laboratory diagnostic capabilities; 2) an under-resourced health care system; 3) a skeptical general public, hesitant to accept facts about the origin and mode of transmission of the new virus; and 4) resistance to the vector control strategies used. Lessons learned from the outbreak included the need for 1) a robust and reliable epidemiological surveillance system; 2) effective strategies for communicating with the general population; 3) exploration of other methods of mosquito vector control; and 4) a careful review of all health care policies and protocols to ensure that effective, organized responses are triggered when an infectious outbreak occurs.

Epidemiological and economic impact of pandemic influenza in Chicago: Priorities for vaccine interventions.

The study objective is to estimate the epidemiological and economic impact of vaccine interventions during influenza pandemics in Chicago, and assist in vaccine intervention priorities. Scenarios of delay in vaccine introduction with limited vaccine efficacy and limited supplies are not unlikely in future influenza pandemics, as in the 2009 H1N1 influenza pandemic. We simulated influenza pandemics in Chicago using agent-based transmission dynamic modeling. Population was distributed among high-risk and non-high risk among 0–19, 20–64 and 65+ years subpopulations. Different attack rate scenarios for catastrophic (30.15%), strong (21.96%), and moderate (11.73%) influenza pandemics were compared against vaccine intervention scenarios, at 40% coverage, 40% efficacy, and unit cost of $28.62. Sensitivity analysis for vaccine compliance, vaccine efficacy and vaccine start date was also conducted. Vaccine prioritization criteria include risk of death, total deaths, net benefits, and return on investment. The risk of death is the highest among the high-risk 65+ years subpopulation in the catastrophic influenza pandemic, and highest among the high-risk 0–19 years subpopulation in the strong and moderate influenza pandemics. The proportion of total deaths and net benefits are the highest among the high-risk 20–64 years subpopulation in the catastrophic, strong and moderate influenza pandemics. The return on investment is the highest in the high-risk 0–19 years subpopulation in the catastrophic, strong and moderate influenza pandemics. Based on risk of death and return on investment, high-risk groups of the three age group subpopulations can be prioritized for vaccination, and the vaccine interventions are cost saving for all age and risk groups. The attack rates among the children are higher than among the adults and seniors in the catastrophic, strong, and moderate influenza pandemic scenarios, due to their larger social contact network and homophilous interactions in school. Based on return on investment and higher attack rates among children, we recommend prioritizing children (0–19 years) and seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies. Based on risk of death, we recommend prioritizing seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies.

Differences among avocado cultivars in susceptibility to polyphagous shot hole borer (Euwallacea spec.)

AbstractPolyphagous shot hole borer (PSHB) (Euwallacea spec.; Coleoptera: Curculionidae: Scolytinae) has recently invaded southern California, USA. Along with its associated fungi, the beetle causes branch dieback and tree mortality in more than 200 host tree species, including avocado (Persea americana Mill., Lauraceae) and many important native, urban landscape, and nursery stock trees. As PSHB spreads into the avocado‐growing regions of southern California, there is a pressing need for more information for effective management of the insect/fungus complex. The objective of this study was to examine avocado cultivars to see whether there were differences in susceptibility to attack and gallery development from PSHB. We conducted choice and no‐choice trials with cut branches in the laboratory, artificially infested avocado saplings with PSHB, and also surveyed attack rates for two cultivars of field‐grown avocado subject to natural attack by PSHB. Laboratory and field trials showed similar patterns for preference among avocado cultivars indicated by beetle attack rates and gallery formation. Among the common commercial cultivars, Fuerte, Gwen, and Bacon most often had lower attack rates and lower rates of gallery formation. Zutano most frequently indicated high attack rates and much gallery formation, indicating that it may be the most susceptible to PHSB of the commercial cultivars.

Safety and immunogenicity of Bio Pox™, a live varicella vaccine (Oka strain) in Indian children: A comparative multicentric, randomized phase II/III clinical trial

ABSTRACTVaricella or chickenpox is a highly contagious disease with a high secondary attack rate. Almost 30% of Indian adolescents lack protective antibodies against varicella, emphasizing the need of routine varicella immunization. The Oka VZV is a well-established, safe and efficacious vaccine strain that is highly immunogenic and produces lifelong protective immunity. The present multicentric, open label, randomized, controlled Phase II/III study, compared the Bio Pox™ (indigenous investigational vaccine) with a licensed vaccine, Varivax™[a] Please note that this article refers to the product named VARIVAX as manufactured by Changchun Keygen Biological Products Ltd., China and marketed in India by VHB Life Sciences Limited, Mumbai, and not the product VARIVAX® owned by Merck Sharp & Dohme Corp., Rahway, New Jersey, USA. Merck Sharp & Dohme Corp. have asked us to make clear that the product manufactured by Changchun Keygen Biological Products Ltd. is unrelated to and is not sponsored, endorsed or otherwise authorised by Merck Sharp & Dohme Corp., for its safety and immunogenicity profile in 252 healthy subjects in the age group of 1–12 y (cohort I: 6–12 years, II:1–6 years) in 3 tertiary medical institutions. Antibodies were measured by VZV Glycoprotein Enzyme Linked Immunoassay (IgG ELISA) kit. Seroconversion percentage in children having pre-vaccination anti VZV IgG titer <10 mIU/mL (< 5 gp ELISA units/mL) were 80% for Bio Pox™ and 77% for Varivax™ (p = 0.692). The seroconversion rate in the group receiving Bio Pox™ was non-inferior to the group that received Varivax™. There were mild local reactions for both the vaccines; none of the patient had fever or required hospitalization or medication. The Bio Pox™ was found to be safe and immunogenic in children against VZV infection.

지문 영상 복원 기반의 스마트 기기 지문 스머지 공격 연구

지문 인증은 개인의 고유한 지문 특징 정보를 바탕으로 사용자를 식별하기 때문에 유출이나 분실, 망각의 위험이 없으며 편리하고 안전하여 여러 스마트 기기에 적용되고 있다. 하지만 스마트 기기를 사용한 후 남아있는 지문의 흔적은 스머지 공격에 취약하다. 본 논문에서는 사용자의 스마트 기기 사용 패턴을 분석하고 스마트 기기에 남아있는 지문 스머지를 이용하여 손상된 지문 영상을 복원하는 기법을 제안한다. 스마트 기기 사용 시 빈번하게 보이는 행동 패턴으로 구성된 시나리오에서 지문 스머지를 수집 및 복원하였으며 복원 지문 영상을 이용한 스머지 공격의 유효성에 대하여 실험하였다. 실험 결과, 지문 인증 시스템에서 높은 공격 성공률을 보였으며 스머지 공격에 취약함을 실증적으로 검증하였다. Fingerprint authentication identifies individuals based on user specific information. It is widely used as it is convenient, secure and has no risk of leakage, loss, or forgotten. However, the latent fingerprints remaining on the smart device's surface are vulnerable to smudge attacks. We analyze the usage patterns of individuals using smart device and propose methods to reconstruct damaged fingerprint images using fingerprint smudges. We examine the feasibility of smudge attacks with frequent usage situations by reconstructing fingerprint smudges collected from touch screens. Finally, we empirically verify the vulnerability of fingerprint authentication systems by showing high attack rates.

Functional and numerical responses of Stethorus tridens Gordon (Coleoptera: Coccinellidae) preying on Tetranychus bastosi Tuttle, Baker & Sales (Acari: Tetranychidae) on physic nut (Jatropha curcas)

Coccinellids of the tribe Stethorini specialize in preying on mites, especially tetranychids, and are widely studied for control of pest mites in various crops around the world. The present study determined the functional and numerical responses of female Stethorus tridens Gordon (Coleoptera: Coccinellidae) to various densities of eggs, larvae, nymphs and adults of the pest mite Tetranychus bastosi Tuttle, Baker & Sales (Acari: Tetranychidae) feeding on physic nut, Jatropha curcas. The predator consumed significantly more eggs and larvae than other prey stages and showed a type III functional response to eggs and larvae, and a type II functional response to nymphs and adults. The highest attack rate and the shortest handling time were obtained on eggs and larvae of T. bastosi. Stethorus tridens consumed proportionately more prey of all stages at lower densities, indicating that S. tridens might be more effective in suppressing mite populations at low densities. The numerical response of S. tridens was maximal on high densities of adult T. bastosi.

Infectious diarrheal disease caused by contaminated well water inChinese schools: A systematic review and meta-analysis.

BackgroundIn China, waterborne outbreaks of infectious diarrheal disease mainly occur in schools, and contaminated well water is a common source of pathogens. The objective of this review was to present the attack rates, durations of outbreak, pathogens of infectious diarrheal disease, and sanitary conditions of wells in primary and secondary schools in China, and to analyze risk factors and susceptibility of school children.MethodsRelevant articles and reports were identified by searching PubMed, Web of Science, China National Knowledge Infrastructure, China Information System for Disease Control and Prevention, and the Chinese Field Epidemiology Training Program. Essential information, including urban/rural areas, school types, attack rates, pathogens, durations of outbreak, report intervals, and interventions were extracted from the eligible articles. Wilcoxon signed-rank test, Kruskal–Wallis H test, and Spearman correlation test were conducted in statistical analyses. Sex- and age-specific attack rate ratios were calculated as pooled effect sizes.ResultsWe screened 2188 articles and retrieved data of 85 outbreaks from 1987 to 2014. Attack rates of outbreaks in rural areas (median, 12.63 cases/100 persons) and in primary schools (median, 14.54 cases/100 persons) were higher than those in urban areas (median, 5.62 cases/100 persons) and in secondary schools (median, 8.74 cases/100 persons) (P = 0.004 and P = 0.013, respectively). Shigella, pathogenic Escherichia coli, and norovirus were the most common pathogens. Boys tended toward higher attack rates than girls (sex-specific attack rate ratio, 1.13; 95% CI, 1.00–1.29, P = 0.05). Unsanitary conditions of water wells were reported frequently, and unhealthy behavior habits were common in students.ConclusionSchool children were susceptible to waterborne disease in China. Chinese government should make efforts to improve access to safe water in schools. Health education promotion and conscientiousness of school leaders and teachers should be enhanced.

Quantitative Analysis of Long-Term Mass Rearing of Neoseiulus californicus (Acari: Phytoseiidae) on Almond Pollen.

Long-term feeding effects of the almond pollen on the life table parameters of Neoseiulus californicus McGregor were assessed after 5, 10, and 20 generations after introduction in the rearing arena. Furthermore, to evaluate behavioral characteristics of the mass-reared predator (strain A) in face with the real prey, functional and numerical responses of the predator to different densities of the twospotted spider mite nymphs were determined, and the obtained data were compared with those reared on twospotted spider mite (strain T). Long-term rearing did not significantly affect total fecundity of N. californicus (ranged from 37.79 to 41.91 eggs). Nevertheless, preadult duration in the 5th generation was significantly longer than the 10th and 20th generations. The intrinsic rate of increase (r) in the 10th (0.2056 d-1) and 20th (0.2201 d-1) generations had not significant difference together. However, the r value slightly dropped in the 5th generation (0.1706 d-1) because of the irregular offering of fresh pollen to the rearing colonies before that. Both strains of N. californicus exhibited a type II functional response; however, the N. californicus reared on the almond pollen (strain A) had a higher attack rate (a) and shorter handling time (Th). The individuals reared on the almond pollen had a greater size than those reared on twospotted spider mite; its higher predation potential is probably due to this characteristic. Consequently, the rearing of N. californicus on the almond pollen positively affected its attributes including high survivorship, body size, and fecundity, and subsequently higher potential to control twospotted spider mite.

Influenza A(H1N1)pdm09 outbreak detected in inter-seasonal months during the surveillance of influenza-like illness in Pune, India, 2012-2015.

An outbreak of influenza A(H1N1)pdm09 was detected during the ongoing community-based surveillance of influenza-like illness (ILI). Among reported 119 influenza A(H1N1)pdm09 cases (59 cases in the year 2012 and 60 cases in 2015) in summer months, common clinical features were fever (100%), cough (90·7%), sore throat (85·7%), nasal discharge (48·7%), headache (55·5%), fatigue (18·5%), breathlessness (3·4%), and ear discharge (1·7%). Rise in ILI cases were negatively correlated with the seasonal factors such as relative humidity (Karl Pearson's correlation coefficient, i.e. r = -0·71 in the year 2012 and r = -0·44 in the year 2015), while rise in ILI cases were positively correlated with the temperature difference (r = 0·44 in the year 2012 and r = 0·77 in the year 2015). The effective reproduction number R, was estimated to be 1·30 in 2012 and 1·64 in 2015. The study highlights the rise in unusual influenza activity in summer month with high attack rate of ILI among children aged ⩽9 years. Children in this age group may need special attention for influenza vaccination. Influenza A(H1N1)pdm09 outbreak was confirmed in inter-seasonal months during the surveillance of ILI in Pune, India, 2012-2015.

Invasive meningococcal disease in Navarra in the era of a meningococcal C vaccine

Abstract Introduction Systematic childhood vaccination against meningococcus C has had a considerable impact on meningococcal invasive disease (MID). The aim of this study is to perform an analysis on the epidemiology, the clinical features, and the factors associated with a worse prognosis of MID, in the era of a meningococcal C vaccine. Material and methods The study included confirmed cases of MID in children less than 15 years of age in Navarra, Spain, between 2008 and 2014. The risk of death or permanent sequelae was evaluated according to the presence of clinical features and analytical parameters at diagnosis. Results The average annual incidence was 7.9 cases per 100 000 children, with the highest attack rate in children Conclusion The MID continues to be a significant cause of morbidity and mortality in children. Therefore, new advances are needed in the prevention, early diagnosis, and detection of the factors associated with poor prognosis.

Human parvovirus B19 nosocomial outbreak in healthcare personnel in a paediatric ward at a national tertiary referral centre in Thailand

Nosocomial outbreaks of parvovirus B19 (pB19) have been reported, but they rarely occur among healthcare personnel (HCP). Susceptibility among pregnant HCP was the major concern. An outbreak of pB19 among HCP is described in a paediatric ward with a cross-sectional serologic study in all HCP and patients exposed to the outbreak. Acute infection was diagnosed by polymerase chain reaction or positive anti-parvovirus B19 IgM. Among 48 HCP (three pregnant) and 22 patients included in the outbreak serologic study, 11 (23%) HCP and two (9%) patients had acute infection. Of these, six HCP and no patients were symptomatic. Clinical manifestations included itchy rash (100%) and joint pain following resolution of rash (67%), with median rash duration of four days. Forty percent of HCP and 50% of patients had positive anti-parvovirus IgG, indicating previously immune status. HCP with acute infection and HCP who were susceptible without infection were younger than HCP with previous immunity (mean age 32.2 vs 40.5 years, respectively; P=0.003). The attack rate was 38% among HCP and 18% among patients who were susceptible, respectively. The outbreak ended within two weeks following strict droplet precaution and segregation of symptomatic HCP. Parvovirus B19 infection may cause nosocomial outbreak with high attack rate among HCP. Outbreak control with droplet precaution was highly effective.

Inference and forecast of H7N9 influenza in China, 2013 to 2015.

The recent emergence of A(H7N9) avian influenza poses a significant challenge to public health in China and around the world; however, understanding of the transmission dynamics and progression of influenza A(H7N9) infection in domestic poultry, as well as spillover transmission to humans, remains limited. Here, we develop a mathematical model–Bayesian inference system which combines a simple epidemic model and data assimilation method, and use it in conjunction with data on observed human influenza A(H7N9) cases from 19 February 2013 to 19 September 2015 to estimate key epidemiological parameters and to forecast infection in both poultry and humans. Our findings indicate a high outbreak attack rate of 33% among poultry but a low rate of chicken-to-human spillover transmission. In addition, we generated accurate forecasts of the peak timing and magnitude of human influenza A(H7N9) cases. This work demonstrates that transmission dynamics within an avian reservoir can be estimated and that real-time forecast of spillover avian influenza in humans is possible.

An outbreak of acute GII.17 norovirus gastroenteritis in a long-term care facility in China: The role of nursing assistants.

More than 30 residents and nursing assistants in a geriatric nursing hospital developed acute gastroenteritis from December 7th to December 18th, 2014 in Shanghai, China. An immediate epidemiological investigation was conducted to identify the etiological agent of the outbreak, mode of transmission and the risk factors. Cases were investigated according to an epidemiological questionnaire. Samples from cases, highly transmissible environmental surfaces and drinking water were collected for pathogens detection. A retrospective cohort study was conducted to explore the transmission mode. A total of 34 cases were affected in this acute gastroenteritis outbreak, including 23 residents, 9 nursing assistants and 2 doctors. 13 out of 30 samples were positive for GII.17 norovirus, no other pathogen was detected. Nursing assistants who developed gastroenteritis symptoms had a higher attack rate in residents they cared than those who did not develop any gastroenteritis symptoms (p<0.001). The acute gastroenteritis outbreak was caused by GII.17 norovirus. Person-to-person close contact and contaminated environmental surfaces were the probable transmission route. Nursing assistants were considered to play an important role in the secondary spread of norovirus. The poor medical skill and personal hygiene habits of nursing assistants in China should be paid attention and improved urgently which is critically important to prevent hospital infections.

Epidemiology and Management of Seasonal Influenza Outbreaks in Long-Term Care Facilities in the Health Service Executive East Area of Ireland During the 2013-2014 Influenza Season

We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of &lt;40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity.