P Ruutu's research while affiliated with Finnish Institute for Health and Welfare and other places
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Publications (174)
Background
The shortage of FFP2 and FFP3 respirators posed a serious threat to the operation of the healthcare system at the onset of the COVID-19 pandemic.AimOur aim was to develop and validate a large-scale facility that uses hydrogen peroxide vapour for the decontamination of used respirators.MethodsA multidisciplinary and multisectoral ad hoc g...
We describe the epidemiology of tuberculosis (TB) and characterized Mycobacterium tuberculosis (M. tuberculosis) isolates to evaluate transmission between foreign-born and Finnish-born populations. Data on TB cases were obtained from the National Infectious Disease Register and denominator data on legal residents and their country of birth from the...
Background:
Major transition in tuberculosis (TB) epidemiology is taking place in many European countries including Finland. Monitoring treatment outcome of TB cases is important for identifying gaps in the national TB control program, in order to strengthen the system. The aim of the study was to identify potential risk factors for non-successful...
Background:
In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception cen...
Background:
International and national travelling has made the rapid spread of infectious diseases possible. Little information is available on the role of major traffic hubs, such as airports, in the transmission of respiratory infections, including seasonal influenza and a pandemic threat. We investigated the presence of respiratory viruses in t...
Background:
Tuberculosis (TB) in foreign-born residents is increasing in many European countries including Finland. We conducted enhanced TB surveillance to collect supplementary information on TB cases among recent immigrants and their children to provide data for revising TB control policies in Finland to take into account the decrease in native...
Background
We investigated the epidemiology and prevalence of potential risk factors of tuberculosis (TB) recurrence in a population-based registry cohort of 8084 TB cases between 1995 and 2013. Methods
An episode of recurrent TB was defined as a case re-registered in the National Infectious Disease Register at least 360 days from the date of the i...
Recurrent tuberculosis (TB) is caused by an endogenous re-activation of the same strain of Mycobacterium tuberculosis (relapse) or exogenous infection with a new strain (re-infection). Recurrence of TB in Finland was analysed in a population-based, 19-year study, and genotyping was used to define relapse and re-infection. The M. tuberculosis isolat...
Increasing immigration from high tuberculosis (TB) incidence countries is a challenge for surveillance and control in Finland. Here, we describe the epidemiology of TB in immigrants by using national surveillance data. During 1995–2013, 7030 (84·7%) native and 1199 (14·4%) immigrant cases were identified. The proportion of immigrant cases increased...
Whole genome sequencing (WGS) is a new powerful technology for characterisation of bacterial genomes and has been used successfully to investigate Mycobacterium tuberculosis isolates associated with tuberculosis (TB) outbreaks and to elucidate mutations conferring drug resistance [1–6]. Enhanced contact investigation and improved diagnosis and trea...
The Mycobacterium tuberculosis genotypes obtained from elderly Finns were assessed and compared to those obtained from younger Finns to comprehend the epidemiology of tuberculosis (TB) in Finland. From 2008-2011, a total of 1021 M. tuberculosis isolates were characterized by spoligotyping and MIRU-VNTR-15. In total, 733 Finnish-born cases were incl...
Significance
Although pneumococcal conjugate vaccines (PCVs) are widely available in industrialized nations, the cost of these vaccines and the strategy of universal vaccination of infants, as endorsed by the World Health Organization, are daunting obstacles to the adoption of these vaccines in developing countries. Using spatial epidemiological me...
In industrialized countries the majority of tuberculosis (TB) cases are linked to immigration. In Finland, most cases are still Finnish born but the number of foreign born cases is steadily increasing. In this 4-year population based study, the TB situation in Finland was characterized by a genotypic analysis of Mycobacterium tuberculosis isolates....
Background:
The economic effects of waterborne outbreaks have rarely been reported. A large waterborne outbreak occurred in the town of Nokia in Finland in 2007 with half of the population in the contaminated area suffering from gastroenteritis. We studied the healthcare costs of this outbreak.
Methods:
Healthcare costs were studied using regist...
Bloodstream infections (BSI) are a major cause of mortality, morbidity and medical cost, but few population-based studies have concomitantly evaluated BSI incidence and mortality. Data on BSI episodes reported to national, population-based surveillance by all clinical microbiology laboratories in Finland during 2004-07 were linked to vital statisti...
Hand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial.
A total of 21 clusters (683 persons) were randomized to imp...
In October 2011 in Finland, two persons fell ill with symptoms compatible with botulism after having eaten conserved olives stuffed with almonds. One of these two died. Clostridium botulinum type B and its neurotoxin were detected in the implicated olives by PCR and mouse bioassay, respectively. The olives were traced back to an Italian manufacture...
![of self-reported new symptoms [n (%)] from 28 November 2007 to 20...](profile/Mikko-Virtanen-4/publication/51837206/figure/tbl1/AS:601709281816582@1520470080291/of-self-reported-new-symptoms-n-from-28-November-2007-to-20-January-2008-in-the_Q320.jpg)
Waterborne outbreaks offer an opportunity to study joint symptoms after a simultaneous exposure. In November 2007, a gastroenteritis outbreak due to faecal contamination of tap water took place in a Finnish town. The purpose of this study was to evaluate the occurrence of joint symptoms after the outbreak.
The authors conducted a controlled, popula...
Infection control (IC) in hospitals depends on adequate human resources and organization. The aim of the study was to assess the IC resources and activities in Finnish acute care hospitals. A questionnaire covering information on hospital characteristics, IC staff and surveillance activities in 2008 was mailed to all Finnish acute care hospitals. A...
The first infection caused by pandemic influenza A(H1N1)2009 virus was confirmed in Finland on 10 May 2009. The spread of the disease and its impact were monitored using several surveillance systems, such as the national infectious disease register, notifications of clusters of influenza, influenza-like or influenzarelated illnesses, as well as vir...
The multidrug-resistant tuberculosis (MDR-TB) epidemic in Eastern Europe bordering Finland has raised worries concerning the risk of disease in near-frontier contacts.
Our aim was to find out the amount of multidrug resistance, characterise the resistance profiles and evaluate the outcome of treatment. In addition, we analysed the isolates by molec...
Evolutionary rate of entire HA gene. The number of nucleotide and amino acid changes between the HA of Finnish pandemic viruses and the vaccine strain A/California/07/2009 are shown as a function of time. The trend lines have been drawn using Microsoft Office Excel 2003. The number of nucleotide changes are shown in blue and in amino acid changes i...
In Finland, the first infections caused by the 2009 pandemic influenza A(H1N1) virus were identified on May 10. During the next three months almost all infections were found from patients who had recently traveled abroad. In September 2009 the pandemic virus started to spread in the general population, leading to localized outbreaks and peak epidem...
Phylogenetic tree of entire HA gene of the 2009 pandemic influenza A(H1N1) strains from Finland. All sequences included in the phylogenetic tree were 1701 nucleotides long. The horizontal lines are proportional to the number of nucleotide changes. The phylogenetic tree was constructed using the Neighbor-Joining method with Mega software version 4....
In a previous study we observed an increasing trend in candidemia in Finland in the 1990s. Our aim was now to investigate further population-based secular trends, as well as outcome, and evaluate the association of fluconazole consumption and prophylaxis policy with the observed findings.
We analyzed laboratory-based surveillance data on candidemia...
SUMMARYAn 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 w...
Information about the risk of invasive pneumococcal infection (IPI) among adults with asthma is limited and inconsistent. To evaluate this association, a population-based case-control study was conducted.
Cases of IPI (Streptococcus pneumoniae isolated from blood or cerebrospinal fluid) were identified through national, population-based laboratory...
We investigated the treatments given, the outcome and the patient- and treatment-system dependent factors affecting treatment outcome in a national two-year cohort of culture-verified extra-pulmonary tuberculosis cases in Finland.
Medical records of all cases in 1995 - 1996 were abstracted to assess treatment and outcome, using the European recomme...
Weekly report of exposure and symptoms of respiratory or gastrointestinal infection and absence from work due to infections. The questionnaire is sent weekly to participants electronically.
The questionnaire of behavioral habits.
Background
Acute infectious diseases are major causes of short periods of days off from work, day care and school. These diseases are mainly caused by viruses and hands have a key role in their transmission. Thus, hypothetically, they can be controlled with means of intensified hand hygiene. In this study we aim to elucidate the effect of acute inf...
Contagion risk survey implemented for potential participants in the form of an electronic questionnaire.
An international collaboration was established in 1996 to monitor the impact of routine Haemophilus influenzae type b (Hib) vaccination on invasive H. influenzae disease; 14 countries routinely serotype all clinical isolates. Of the 10,081 invasive H. influenzae infections reported during 1996-2006, 4,466 (44%, incidence 0.28 infections/100,000 pop...
To develop a clinical algorithm that can be used to identify pneumonia deaths in young infants in developing countries and estimate the disease burden in this population.
Infants younger than 60 days hospitalized with signs of severe pneumonia who underwent clinical, microbiologic and radiological evaluation were the subjects. Stepwise logistic reg...
Immunity to poliovirus, diphtheria and Haemophilus influenzae type b (Hib) was studied in 16 adult recipients of a bone marrow transplant from an HLA-identical sibling donor in order to evaluate the need for revaccinations. T-cell depletion was not done in any case. The donors and patients were studied before bone marrow transplantation (BMT) and t...
We studied the epidemiology of nosocomial candidaemia by assessing the incidence and outcome of illness and causative species in a large Finnish tertiary care centre during 1987-2004. A total of 364 episodes were observed; annual incidence varied between 0.26 per 10,000 patient-d in 2000 and 0.59 in 1989. The most common species were C. albicans (6...
Pneumococcus is a leading cause of childhood pneumonia worldwide. Pneumococcal conjugate vaccines (PCV) have demonstrated efficacy against childhood invasive pneumococcal disease (IPD) and pneumonia in the United States and Africa. No information is available from Asia on the impact of PCV on childhood pneumonia.
We conducted a randomized, placebo-...
To determine whether the rate of Clostridium difficile-associated disease (CDAD) and CDAD-related deaths were increasing in Finland, we analyzed registry data from 1996 through 2004. We determined the number of hospital discharges that had a diagnosis code specific for CDAD from the International Classification of Diseases, 10th revision: "enteroco...
We conducted a prospective study in order to compare ultrasonography, computed tomography and magnetic resonance imaging in the detection of liver foci in patients with acute leukaemia and clinical suspicion of hepatic candidiasis. 28 adult patients fulfilling set entry criteria after recovery from neutropenia were studied. Lesions in the liver wer...
Background: In November 2007, a large gastroenteritis outbreak due to faecal contamination of water supply took place in the city Nokia (pop. 30 000), Finland. A large volume of treated waste water was mixed with clean mains water by accident, polluting the water of one third of the city. Methods: The magnitude, disease spectrum and microbial cause...
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 te...
ICD-9 and ICD-10 codes used in defining underlying conditions for data in the National Hospital Discharge database.
The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for persons aged < 65 years with chronic medical conditions. We evaluated the risk and mortality from invasive pneumococcal disease (IPD) among persons with and without the underlying medical conditions which are considered PPV23 indications.
Population-based data on all episo...
Recommendation for the use of 23-valent pneumococcal polysaccharide vaccine in Finland.
Table 1. Table 2.
The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different interventi...
Modern molecular methods help us to understand the transmission and epidemiology of Mycobacterium tuberculosis.
To analyse the molecular epidemiology of drug-resistant tuberculosis (TB), and to characterise isoniazid (INH) and rifampicin (RMP) resistance conferring mutations in Finland during 1995-2004.
A total of 3959 new M. tuberculosis isolates...
We evaluated regional variation and trends in invasive pneumococcal infections (IPI) in Finland by using data from national, population-based laboratory surveillance and number of blood and cerebrospinal fluid (CSF) cultures performed by all microbiology laboratories during 1995-2002. The overall annualized IPI incidence was 10.6/100,000 (range by...
A national, population-based laboratory surveillance of bloodstream infections (BSI) in Finland was performed. Blood-culturing rates were determined from data from clinical microbiology laboratories and trends in rates were evaluated using Poisson regression. During 1995-2002, 51,510 cases of BSI were notified; the annual incidence increased from 1...
To determine predictors of death among children 2-59 months old admitted to hospital with severe pneumonia.
Prospective observational study from April 1994 to May 2000 to investigate serious infections in children less than 5 years old admitted to a tertiary care government hospital in a rural province in central Philippines. The quality of clinica...
The characteristics, risk factors, and outcome of patients with nosocomial pneumococcal bacteremia (NPB) have not been described in large, population-based studies.
All episodes of invasive pneumococcal infections reported by Finnish clinical microbiology laboratories (positive blood or cerebrospinal fluid culture) from January 1, 1995, through Dec...
Over 6 years, 1667 children aged 2-59 months admitted for pneumonia [1287 severe and 380 very severe] were studied. The case fatality rate (CFR) in children with severe pneumonia was 2.1% and 14.3% with CNS infection, with very severe pneumonia the CFR was 18.9%, 10.4% in those with hypoxemia and 43.6% with CNS infection. High CFRs were associated...
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The HLA-identical sibling donors of 111 bone marrow transplantation (BMT) recipients were randomised to receive or not to receive tetanus-diphtheria (T-d), Haemophilus influenzae type b (Hib), and inactivated poliovirus (IPV) vaccines 2-10 weeks before BM harvest. Fifty-three (DV+ group) recipients received the graft from a vaccinated donor and 58...
We investigated the patient- and treatment-system dependent factors affecting treatment outcome in a two-year cohort of all treated culture-verified pulmonary tuberculosis (TB) cases to establish a basis for improving outcomes.
Medical records of all cases in 1995 - 1996 were abstracted to assess outcome of treatment. Outcome was divided into three...
This paper describes the clinical profile and aetiology of bacterial meningitis in infants and children less than 5 y old admitted to a rural general hospital in the Philippines. A total of 989 infants and children 0-59 months old with suspected meningitis using a standardized guideline based on clinical signs and symptoms were prospectively enroll...
We investigated the treatments given and the outcome in a national cohort of culture-verified pulmonary tuberculosis cases in Finland. Our aim was to find out how adequate TB treatment was, and the outcome of treatment. Medical records of all culture-verified pulmonary tuberculosis cases in 1995 - 1996 were abstracted to assess treatment and outcom...
To determine the bacterial etiology, clinical presentation and risk factors for outcome of serious community-acquired infections in young infants.
Infants younger than 60 days, admitted for severe pneumonia or suspected sepsis/meningitis were prospectively evaluated using complete blood count, blood culture, chest radiograph, cerebrospinal fluid (C...
Pneumococcal disease (Pnc) is responsible for invasive pneumococcal disease (IPD)--mainly meningitis and septicaemia--and is an infection of public health importance in Europe. Following the licensure of an effective conjugate vaccine (PCV) in Europe, several European countries, including France, Germany, the Netherlands, Norway, Spain and the Unit...
During 1998-2002, 124 microbiologically confirmed infections caused by shigatoxigenic Escherichia coli (STEC) were reported in Finland. Of these, 25 (20%) were associated with recent foreign travel. Temporal, geographical and type distribution of the domestically acquired infections (n=99) caused by strains of serogroup O157 (n=52) and non-O157 (n=...
Infection due to Streptococcus pneumoniae (Pneumococcus) (Pnc) is an important cause of invasive clinical manifestations such as meningitis, septicaemia and pneumonia, particularly in young children and the elderly. A 23-valent polysaccharide Pnc vaccine (PPV) has been available for many years and a 7-valent conjugate Pnc vaccine (PCV) has been lic...
In August 1998, an outbreak of campylobacteriosis occurred in one municipality in northern Finland. A 10% random sample of residents (population 15 000) was selected through the National Population Registry for a survey conducted by using postal questionnaires. Cases were defined as residents of the municipality with onset of acute gastroenteritis...
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 Mycobacteriu...
In Finland, Staphylococcus aureus bloodstream infections are caused predominantly (>99%) by methicillin-sensitive strains. In this study, laboratory-based surveillance data on Staphylococcus aureus bloodstream infections occurring in Finland from 1995 to 2001 were analyzed. Preceding hospitalizations for all persons with Staphylococcus aureus blood...
During 2001, 89 culture-confirmed cases of Yersinia pseudotuberculosis were reported in Finland; 55 (62%) were serotype O:1, and 34 (38%) were serotype O:3. Four major pulsed-field gel electrophoresis
profiles were identified. A case-control study of 25 case patients and 71 healthy controls identified eating outside the home
as a risk factor for in...
We studied the species distribution and antimicrobial susceptibility of viridans streptococci (VS) isolates causing nosocomial bloodstream infections (BSIs) in Finnish hospitals.
Patients with nosocomial BSIs due to VS were identified through a hospital-wide prospective laboratory-based surveillance in two university and two regional hospitals duri...
The vehicles and sources of Yersinia pseudotuberculosis infection are unknown. In Finland, clinical microbiology laboratories routinely report Y. pseudotuberculosis isolations and submit isolates for serotype analysis. In October 1998, the number of serotype O:3 infections increased markedly.
Case patients with culture-confirmed Y. pseudotuberculos...
We developed a new competitive EIA method for the demonstration of pneumococcal capsular polysaccharides from respiratory samples. The pediatric types 4, 6B, 9V, 14, 18C, 19F and 23F were selected for this study, because these capsular polysaccharides were included in the first heptavalent pneumococcal conjugate vaccines, which were used in the Fin...
Campylobacter jejuni isolates (n = 533) from domestic cases diagnosed in Finland during a 3-month peak period were studied. The highest rate was observed among those 70-74 years of age. Domestic C. jejuni isolates were especially frequent in the eastern districts. Six serotypes covered 61% of all C. jejuni isolates.
Since 1995, the incidence of Chlamydia trachomatis infection has been increasing in Finland, although there have been no major changes in public sexually transmitted disease (STD) services or screening practice.
The objective was to study whether the change in C. trachomatis incidence is significant and to identify specific risk groups.
The inciden...
In Finland, S. aureus bloodstream infections (BSI) are mostly caused by methicillin-sensitive strains; prevalence of methicillin-resistance in S. aureus is very low (<1%). We analyzed laboratory-based surveillance data on S. aureus BSIs from the National Infectious Disease Register from 1995 to 2001 and previous hospitalizations for all persons wit...
To determine the occurrence and clinical characteristics of reactive arthritis (ReA) after an outbreak of Yersinia pseudotuberculosis serotype O:3 infection.
From 15 October to 6 November 1998, a widespread outbreak of Y pseudotuberculosis serotype O:3 occurred in Finland. A questionnaire on musculoskeletal symptoms was mailed to 38 patients with i...
We analyzed laboratory-based surveillance candidemia data from the National Infectious Disease Register in Finland and reviewed cases of candidemia from one tertiary-care hospital from 1995 to 1999. A total of 479 candidemia cases were reported to the Register. The annual incidence rose from 1.7 per 100,000 population in 1995 to 2.2 in 1999. Specie...