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The aim of the current study was to assess the epidemiological situation concerning the emergence of a pertussis outbreak, as well as potential contributing factors and vaccine effectiveness. A retrospective epidemiological description and an analysis of the outbreak among students were performed. The basic school in Adavere had a total of 150 students in 2003. Of these, 54 cases of pertussis, with median age 12 y, all corresponding to clinical case definition, were identified with an attack rate of 36%. Regarding confirmation of the diagnosis, out of all clinical cases, 18 were confirmed by laboratory testing (2 by isolation of B. pertussis and 16 serologically based on single sera) and 36 with epidemiological linkage only. Of all the students with pertussis, 35 (65%) had received 4 doses and 6 (11%) 3 doses of DTwP vaccine; 13 (24%) students had received fewer than 3 doses or were unvaccinated. The contributing factors in generating this outbreak were close epidemiological contacts, late identification of pertussis diagnosis in the primary, secondary and later cases, as well as a too late initiated active surveillance. In this outbreak, low vaccine effectiveness and low vaccination coverage also played an important role.

Faecal short-chain fatty acids (SCFAs) were determined in children with shigellosis (n=22) or salmonellosis ( n = 11) prior to treatment and 5 d and 10 d after treatment with an antibacterial drug (TMP-SMX or Polymyxin, 5 d), or Lactobacillus GG (10'' -10" CFUld, 10 d), or both had been started. At admission the SCFA concentrations were very low. Acetic, propionic and iso-valeric acid were significantly higher in shigellosis than in salmonellosis. The SCFA concentrations increased significantly during treatment, reaching those of adults by the 5th day and exceeding them by the 10th day, and showed no difference between the diseases after the 1st day. Adminsitration of Lactobacillus GG resulted in increased concentration of propionic acid by the 5th day of treatment and difference in iso-caproic acid in the 10th day samples: it was not found in any child who had received Lactobacillus GG but was present in half of the samples from the group treated solely with antibacterial drug. Iso-caproic acid is not found in healthy adults and may be indicative of Clostridium dificile. The disturbances in microbial ecology of the gut in enteric infections may have different characteristics depending on the aetiological agent. Treatment with Lactobacillus GG promotes recovery of the ecosystem as reflected by the faecal SCFAs.

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