An inappropriate cross-connection between sewage- and drinking-water pipelines contaminated tap water in a Finnish town, resulting in an extensive waterborne gastroenteritis outbreak in this developed country. According to a database and a line-list, altogether 1222 subjects sought medical care as a result of this exposure. Seven pathogens were found in patient samples of those who sought treatment. To establish the true disease burden from this exposure, we undertook a population-based questionnaire investigation with a control population, infrequently used to study waterborne outbreaks. The study covered three areas, contaminated and uncontaminated parts of the town and a control town. An estimated 8453 residents fell ill during the outbreak, the excess number of illnesses being 6501. Attack rates were 53% [95% confidence interval (CI) 49.5-56.4] in the contaminated area, 15.6% (95% CI 13.1-18.5) in the uncontaminated area and 6.5% (95% CI 4.8-8.8) in the control population. Using a control population allowed us to differentiate baseline morbidity from the observed morbidity caused by the water contamination, thus enabling a more accurate estimate of the disease burden of this outbreak.
In February 1999, an outbreak of listeriosis caused by Listeria monocytogenes serotype 3a occurred in Finland. All isolates were identical. The outbreak strain was first isolated in 1997 in dairy butter. This dairy began delivery to a tertiary care hospital (TCH) in June 1998. From June 1998 to April 1999, 25 case patients were identified (20 with sepsis, 4 with meningitis, and 1 with abscess; 6 patients died). Patients with the outbreak strain were more likely to have been admitted to the TCH than were patients with other strains of L. monocytogenes (60% vs. 8%; odds ratio, 17.3; 95% confidence interval, 2.8-136.8). Case patients admitted to the TCH had been hospitalized longer before cultures tested positive than had matched controls (median, 31 vs. 10 days; P=.008). An investigation found the outbreak strain in packaged butter served at the TCH and at the source dairy. Recall of the product ended the outbreak.
To determine the etiologic agents in children with acute lower respiratory infection.
A survey of a series of patients.
General pediatric hospital serving an urban population with and without referrals in Helsinki, Finland.
135 Finnish children aged 2 months to 15 years (mean, 1.75 years), with clinically defined acute lower respiratory infection (with difficulty of breathing), or found to have fever and a pneumonic infiltrate on chest roentgenogram.
Consecutive sample on voluntary basis.
Of 121 children with adequate samples, an etiologic diagnosis could be established in 84 (70%): 30 (25%) had bacterial, 30 (25%) viral, and 24 (20%) mixed infections. Antibody assays alone identified the agent in 91% of positive cases.
Bacterial infections are common but generally underestimated in acute lower respiratory infection; serologic methods add significantly to their detection.
Finland has, until recently, had a very low incidence of hepatitis B infection, reflected in transmission mainly amongst adolescent and adult age-groups with high-risk behaviour. Several recent local outbreaks of acute hepatitis B in Finland may indicate a change in the epidemiology of this infection. We examine time trends of hepatitis B notifications to the new national infectious disease registry. We also analyse all hepatitis B cases notified over the 2-y period from 1 January 1995 to 31 December 1997 by age, sex, place of residence, country of birth and reported route of transmission. The reported incidence of acute hepatitis B increased 3-fold over this period. The main reported route of transmission was related to injecting drug use, although a significant proportion of adolescent female cases was reportedly infected through heterosexual intercourse. A critical evaluation of the current targeted vaccination approach and other prevention policies is required.
A total of 177 tuberculosis cases of individuals not infected with human immunodeficiency virus diagnosed during the years 1984-1990 at the Helsinki University Central Hospital were reviewed retrospectively to compare the clinical presentation of tuberculosis in patients immunocompromised because of treatment (n = 35) with patients with other underlying conditions (n = 60) and with those without known predisposing factors (n = 82). In immunosuppressed patients compared with other patients, tuberculosis was more frequently disseminated (40% vs. 12%, P
Bone marrow transplantation recipients who were cytomegalovirus (CMV) seropositive and/or had a CMV seropositive donor were randomized for treatment with CMV hyperimmune plasma (n = 27) or no treatment at all (n = 27). The CMV hyperimmune plasma had neutralization titers greater than 250 and enzyme-linked immunosorbent assay titers greater than 18,000. Plasma (200 mg/kg body weight) was given on four occasions (during 2 days) from day 3 to day 76 after transplantation. Patient characteristics were similar in the two groups. After transplantation, the median CMV titers increased with greater than 100% in the group receiving the CMV plasma and decreased to less than 50% in the controls (p less than 0.01). Asymptomatic CMV infections occurred in 26% of the patients in the plasma group and 33% of the controls. The frequency of patients with symptomatic CMV infections was also the same in the two groups (51% vs 33%). Three patients each in the two groups developed CMV-associated interstitial pneumonitis. Patient survival and causes of death were similar in the two groups. To conclude, no beneficial effect of CMV hyperimmune plasma was seen in patients at high risk of developing CMV infections.
This paper describes 2 outbreaks of hepatitis A infection in Finland, a very low endemic area of hepatitis A infection, where a large proportion of the population is now susceptible to infection by hepatitis A virus (HAV). The first outbreak involved people attending several schools and day-care centres; the second employees of several bank branches in a different city. The initial investigation revealed that both were related to food distributed widely from separate central kitchens. Two separate case-control studies implicated imported salad food items as the most likely vehicle of infection. HAV was detected in the stool of cases from both outbreaks using reverse-transcriptase polymerase chain reaction; however, comparison of viral genome sequences proved that the viruses were of different origin and hence the outbreaks, although occurring simultaneously, were not linked. Foodborne outbreaks of HAV may represent an increasing problem in populations not immune to HAV.
The Mycobacterium tuberculosis genotypes obtained from elderly Finns were assessed and compared with those obtained from younger Finns to comprehend the epidemiology of tuberculosis (TB) in Finland. From 2008 to 2011, a total of 1021 M. tuberculosis isolates were characterized by spoligotyping and 15-locus mycobacterial interspersed repetitive units-variable number tandem repeat typing. In total, 733 Finnish-born cases were included in the study, of which 466 (64%) were born before 1945 (older Finns). Of these, 63 (14%) shared an M. tuberculosis genotype with foreign-born or younger Finnish cases (born after 1945), and 59 (13%) shared a genotype with older Finnish cases. Eighty-five per cent had a unique genotypic profile while 70% belonged to T or Haarlem families, suggesting that ongoing transmission is infrequent among young and elderly Finns. Simultaneous reactivation of TB among older Finns was the most likely cause for clustering. As most isolates belonged to Haarlem or T, Finland was most likely affected by a similar TB epidemic at the beginning of the twentieth century as that seen in Sweden and Norway. Younger Finns were significantly more likely to be clustered (56% versus 27%, p
The objectives of the first national prevalence survey on healthcare-associated infections (HAIs) in Finland were to assess the extent of HAI, distribution of HAI types, causative organisms, prevalence of predisposing factors and use of antimicrobial agents. The voluntary survey was performed during February-March 2005 in 30 hospitals, including tertiary and secondary care hospitals and 10 (25%) other acute care hospitals in the country. The overall prevalence of HAI was 8.5% (703/8234). Surgical site infection was the most common HAI (29%), followed by urinary tract infection (19%) and primary bloodstream infection or clinical sepsis (17%). HAI prevalence was higher in males, among intensive care and surgical patients, and increased with age and severity of underlying illness. The most common causative organisms, identified in 56% (398/703) of patients with HAIs, were Escherichia coli (13%), Staphylococcus aureus (10%) and Enterococcus faecalis (9%). HAIs caused by multi-resistant microbes were rare (N = 6). A total of 122 patients were treated in contact isolation due to the carriage of multi-resistant microbes. At the time of the survey, 19% of patients had a urinary catheter, 6% central venous line and 1% were ventilated. Antimicrobial treatment was given to 39% of patients. These results can be used for prioritising infection control measures and planning more detailed incidence surveillance of HAI. The survey was a useful tool to increase the awareness of HAI in participating hospitals and to train infection control staff in diagnosing HAIs.
Little is known about the sensitivity of surveillance for tuberculosis after integration of formerly dedicated tuberculosis surveillance and control into the general health care system, an integration which took place in Finland in 1987. We compared routine laboratory notifications to the National Infectious Disease Register (NIDR) for Mycobacterium tuberculosis from January 1, 1995, to December 31, 1996, with data collected independently from all laboratories offering M. tuberculosis culture, and with data from patient records. 1059 culture-positive cases were found. The overall sensitivity of the NIDR was 93 % (984/1059). The positive predictive value of a culture-positive case in the NIDR to be a true culture-confirmed case was 99%. For the culture-confirmed cases in the NIDR, one or more physician notification forms had been submitted for 89%. A highly sensitive notification system for culture-positive tuberculosis can be achieved in an integrated national infectious disease surveillance system based on laboratory notification.