[Infectious Diseases News Brief]

Infectious Syphilis: British Columbia (B.C.)
BC continues to experience one of North America's largest per capita infectious syphilis outbreaks. The number of infectious syphilis cases in BC has increased dramatically from 18 cases in 1996 to 177 cases in 2001. The outbreak has been consistently associated with the sex trade in Vancouver's downtown eastside. Over 50% of cases have been reported from sex workers and their customers, and nearly 60% were likely infected. The remaining cases have involved gay men, heterosexuals who do not use condoms consistently, street youth and sexually active injection-drug users. Several cases have been acquired by British Columbians while traveling in Asia and Central America. Although cases have been heavily concentrated in Vancouver's downtown eastside, the rest of the lower mainland has seen an increase in cases as well. There have been clusters of syphilis cases on Vancouver Island and in the North. The epidemic has affected both genders, most age categories and all ethnic groups. Active syphilis infection is known to increase the likelihood of HIV and syphilis co-infection. Two babies were born with congenital syphilis in 2001.
Source: BC Centre for Disease Control, News Release, 11 March 2002.

Streptococcus pneumoniae Conjunctivitis: New Hampshire
New Hampshire is experiencing an outbreak of conjunctivitis attributed to an unusual nontypeable strain of S. pneumoniae. During 1 to 14 February 2002, approximately 100 students presented to a college's student health service with clinical signs of conjunctivitis. The cause of conjunctivitis was initially thought to be viral. However, because of the high number of cases, eye cultures were collected from 12 consecutive students; S. pneumoniae was isolated from cultures of all 12 students. Among 5,060 students enrolled for the winter term, 493 (9.7%) students had probable pneumococcal conjunctivitis, and 81 (1.6%) had confirmed pneumococcal conjunctivitis. The attack rate was highest among freshmen (18.0%) followed by sophomores (14.9%), juniors (12.8%), seniors (12.0%), and graduate students (1.7%). A systematic clinical examination of 80 students with conjunctivitis found that most reported eye crusting on awakening. The findings of eye examinations were variable, ranging from mildly inflamed conjunctiva with a clear watery discharge to severe conjunctival inflammation with purulent discharge and preauricular adenopathy. Students were treated with topical antibiotics. Strains were resistant to erythromycin but susceptible to bacitracin, sulfonamides, and quinolones. Thirty strains were sent to the Centers for Disease Control and Prevention (CDC) for serotyping but could not be typed using the Quellung reaction. Viral cell cultures of specimens from 70 students were negative for adenovirus. Local primary-care physicians and ophthalmologists were notified about the outbreak and asked to obtain cultures from patients presenting with conjunctivitis and to report cases to the investigating team. A student health service 'listserv' was used to notify other student health services in the United States about the outbreak. As of 13 March the student health service was still reporting new cases of conjunctivitis.
Source: Morbidity and Mortality Weekly Report, Vol. 51, No. 10, 15 March 2002.

Clostridium sordellii Infection: United States (Update)
As of 11 March 2002, CDC has received 26 reports of bacterial infections associated with musculoskeletal tissue allografts including the previously reported cases. Thirteen (50%) of the 26 patients were infected with Clostridium spp. (C. septicum [12], C. sordellii [one]). Allografts that were implicated in Clostridium spp. infections were tendons used for anterior cruciate ligament (ACL) reconstruction (8), femoral condyles (2), bone (2), and meniscus (one). Eleven (85%) of the allografts were frozen and two (15%) were fresh (femoral condyles). All allografts were processed aseptically but did not undergo terminal sterilization. In 11 of these 13 cases, additional evidence (e.g., common donors or cultures of nonimplanted tissue) implicated the allograft as the source of the infection. CDC has requested additional information for the other two cases. The median age of the 13 patients was 35 years (range: 15 to 52 years); onset of symptoms occurred at a median of 8.5 days (range: 2 to 85 days) following allograft implantation. One patient died. A single tissue-processing company had been implicated in 14 of the 26 cases, including the fatal one.
Source: Morbidity and Mortality Weekly Report, Vol. 51, No. 10, 15 March 2002.

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.

[Infectious Diseases News Brief]