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Biomedical subjects

J L Faoagali

Publications and source records attributed to J L Faoagali.

At least 19 recordsLinked to original sources
PubMed1997

Further observations on the immune response to recombinant hepatitis B vaccine after administration to aboriginal and Torres Strait Island children.

OBJECTIVE: To determine the prevalence of markers of hepatitis B virus (HBV) immunity and infection at 5 years of age in Aboriginal and Torres Strait Island children who were fully vaccinated in infancy, and to examine the response to a booster dose of hepatitis B vaccine in those children who had no detectable immunity despite vaccination. METHODOLOGY: A cross-sectional study of serological markers to HBV in a sample of 239 Aboriginal and Torres Strait Island children, with a mean age of 5.7 years, who were fully vaccinated in infancy. The antibody response to a booster dose of hepatitis B vaccine was determined in those children in the sample who had no markers of either immunity to HBV or infection with HBV. RESULTS: Of the 239 children, 6% (95% CI 4-10%) had been infected and, of these, four were HBV surface antigen (HBsAg) positive. Of the remaining 224 children, only 41% (95% CI 35-48%) had evidence of immunity (i.e. an antibody to HBV surface antigen (anti-HBs) level of > or = 10 miu/mL) to HBV. Of the children with no detectable immunity (i.e. anti-HBs < 10 miu/mL), 113 were followed up after receiving a booster dose of hepatitis B vaccine. Of these, 84% (95% CI 76-90%) had an anamnestic response (i.e. anti-HBs < 10 miu/mL following the booster dose). Therefore 16% (95% CI 10-24%) still had no detectable immunity following the booster dose. CONCLUSIONS: This study provides further evidence that Aboriginal and Torres Strait Island children have a suboptimal response to recombinant hepatitis B vaccine. It also indicates that a considerable number of Aboriginal and Torres Strait Island children in the study age cohort have been exposed to HBV. However, despite these concerns, this study and historical data provide strong evidence that there has been a marked reduction in the prevalence of HBV infection and carriage in previously 'high risk' Aboriginal and Torres Strait Island children since the introduction of hepatitis B vaccines. Aboriginal and Torres Strait Island children who have been fully vaccinated in infancy do not require a booster dose of hepatitis B vaccine at school entry.

Australia↗
PubMed1996

Comparison of four methods for quantitative measurement of hepatitis B viral DNA.

AIMS/METHODS: Four assays for measuring HBV-DNA quantitatively have been compared with regard to sensitivity, precision and linearity. The methods were 125I-labelled solution hybridisation assay (liquid hybridisation, Abbott), an ELISA-based chemiluminescent RNA-DNA hybrid assay (RNA-DNA, Digene), a chemiluminescent branching oligonucleotide assay (bDNA, Chiron) and a membrane hybridisation assay using slot-blot equipment (slot blot). RESULTS: The bDNA assay was linear over three orders of magnitude and was the most sensitive assay, being approximately ten times more sensitive than the other assays, so that samples negative on RNA-DNA, liquid hybridisation and slot blot gave quantifiable results on bDNA. Furthermore, intra- and inter-assay variability showed that the bDNA and liquid hybridisation assays had the greatest precision, with coefficients of variation of 6.6% to 11.5% and 2.3% to 10.5%, respectively. However, the nominated amounts of HBV DNA in the standards (from all assays) were not reproducible in the other assays, such that amounts measured with bDNA would give values approximately twice that of RNA-DNA and 60 times that of liquid hybridisation. CONCLUSIONS: The recently developed bDNA assay has advantages compared with the other assays in quantitating samples with low levels of virus present. In addition, since the assays vary considerably by a number of criteria, the method of measurement should always be reported.

DNA, Viral↗
PubMed1995

Chickenpox outbreak among the staff of a large, urban adult hospital: costs of monitoring and control.

Chickenpox is a highly infectious disease of childhood, but there are increasing reports of occurrence in adults. A recent community epidemic of chickenpox resulted in 20 documented cases of adult chickenpox in a large metropolitan hospital. Nine of these cases resulted from direct exposure to an index patient and four were in tertiary contacts of the three index patients associated with the nosocomial outbreak. A total of 165.6 person-days of work were lost (estimated $18,000 cost) as a result of this outbreak, and 70 infection control unit person-hours were required during the investigation and control. This article reports a nosocomial epidemic and reviews guidelines for identification and control of adult chickenpox in a large hospital complex.

Adult↗
PubMed1995

Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated aboriginal and Torres Strait Island children.

OBJECTIVE: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland. METHODOLOGY: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles. RESULTS: Only 54% (95% CI 44-63%) of the children had adequate immunity (> or = 10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% CI 96-100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of > or = 1:8) to poliovirus 2, only 93% (95% CI 86-96%) and 60% (95% CI 50-69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% CI 90-98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles. CONCLUSIONS: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.

Antibodies, Viral↗
PubMed1994

Are thermolabile splints a source of nosocomial infection?

The aim of this study was to determine whether thermolabile splints used on burned patients became colonized with microbes from the underlying burn or were capable of contaminating burn wounds, and to determine whether the current thermoplastic splint decontamination regimen was effective at removing contaminating bacteria. One hundred and thirty-one standardized swab samples were collected from 28 splints before and after cleaning, and from burn wounds of 10 patients. Qualitative bacterial cultures and identification of isolates were performed. Just over one third of all splints sampled before cleaning were contaminated with bacteria. This compared with over half of the burn wound samples and 17% of the splints sampled after cleaning. Most of the isolates were Gram-positive species including coagulase-negative staphylococci (18), Staphylococcus aureus (12), Bacillus spp. (17) and one isolate of viridans streptococcus. Only five Gram-negative isolates were detected. On only one occasion did the wound and the splint before cleaning have the same organism isolated. Cold disinfection every 24 h was adequate to decontaminate thermolabile splints used on burn patients provided the burn bacterial count was low and care was taken to handle the splints in order to avoid re-contaminating them with health care workers' flora. Thermolabile splints could be a source of burn colonization microbes, but with adequate ward cleaning they were not found to be a problem in our practice.

Burns↗
PubMed1994

Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan.

Evaluating hand wash products in terms of user acceptability and effectiveness against methicillin-resistant Staphylococcus aureus (MRSA) has been part of a long-term strategy to eliminate endemic MRSA from the neonatal intensive care unit at the Royal Women's Hospital (Brisbane). Following the introduction of a new hand wash disinfectant (triclosan 1% wt/vol), new cases of MRSA colonization were monitored for 12 months. In addition, the use of antibiotics, the incidence of multi-resistant Gram-negative cultures and neonatal infections were noted. No changes were made to any procedures or protocols during the trial. All babies colonized with MRSA had been discharged from the nursery within 7 months of the introduction of triclosan and in the subsequent 9 months no new MRSA isolates had been reported. Reduction in the use of vancomycin has resulted in a cost saving of approximately $A17,000. The total number of Gram-negative isolates has not increased, although Pseudomonas aeruginosa is now reported more often. Compared with the previous 12 months, fewer antibiotics were prescribed and fewer nosocomial infections recorded (P < 0.05).

Colony Count, Microbial↗
PubMed1992

Ten years' experience with methicillin-resistant Staphylococcus aureus in a large Australian hospital.

The Royal Brisbane Hospital (RBH) is a 1200-bed teaching hospital with acute, general and specialist units for adult patients. Methicillin-resistant Staphylococcus aureus (MRSA) was first detected at the RBH in 1975 and the number of new patients colonized and infected increased from one in 1975 to 720 in 1989, with a peak of 811 in 1987. Virulence may be inferred from blood culture isolates. Between 1979 and 1989 the number of patients with S. aureus bacteraemia increased from 40 to 138 per year. The percentage of these isolates which were MRSA varied from a low of 4% in 1980 to a peak of 37% in 1984 with 28% in 1989. The control attempts, sensitivity patterns, sources of the isolates and their probable impact and importance will be discussed.

Australia↗
PubMed1991

Gastrointestinal bleeding with influenza virus.

Seven children who presented during the influenza A(H1N1) epidemic of 1988 are described. After a typical influenzal illness, they developed haematemesis of varying severity. Endoscopy revealed haemorrhagic gastritis. Laboratory evidence of influenza A(H1N1) virus infection was present. Two children died as a result of their illness. The association of virus and gastrointestinal haemorrhage is explored.

Child↗
PubMed1991

Poor response to a recombinant hepatitis B vaccine in dialysis patients.

Eighty-three dialysis patients were inoculated with 20 micrograms of the recombinant derived hepatitis B vaccine Engerix-B at o, I and 6 months. Twenty-seven (32.5%) became seropositive for anti-HBs antibody after the third inoculation. Of the 56 non-responders, 48 received a 40 micrograms booster dose of vaccine 6 weeks after completion of the initial course and a further eight seroconverted. Six months after the third inoculation only 18/71 patients retested (25.3%) had demonstrable antibodies. We were unable to identify clinical or laboratory parameters separating responders from non responders to the vaccine. We recommend regular checks of anti-HBs status of vaccinated patients as it cannot be assumed that even initial responders retain their immunity. Those infection control procedures known to have decreased the incidence of hepatitis B infection in dialysis units should not be relaxed.

Adult↗
PubMed1990

Endemic methicillin-resistant Staphylococcus aureus in a special care baby unit: a 2 year review.

During January 1987, methicillin-resistant Staphylococcus aureus (MRSA) was isolated for the first time from a baby admitted to the special care baby unit of a large metropolitan hospital. Over a 2 year period, of 1574 babies admitted to the unit, at least 573 (36.4%) became colonized with the organism. Only nine (1.6%) developed significant infectious morbidity and one baby died. Minor infections occurred in a further 35 (6.1%). The outbreak remained uncontrolled despite rigid infection control measures. Subsequent emphasis on hand washing, in-service education and provision of weekly review of the MRSA colonization rates have failed to eliminate the organism from the unit.

Cross Infection↗
PubMed1989

An in-use comparison of chlorhexidine gluconate 4% w/v, glycol-poly-siloxane plus methylcellulose and a liquid soap in a special care baby unit.

The effectiveness and harshness of three hand-wash agents, chlorhexidine gluconate 4%, glycol-poly-siloxane gel and a bland liquid soap were studied in-use in a Special Care Baby Unit (SCBU). Each product was used for consecutive 2-week periods by the same groups of 8 health care workers among the 56 in the SCBU. The first group had normal skin, the second had 'sensitive skin' and the third group were known MRSA nasal carriers. Blood agar and methicillin mannitol salt agar were inoculated before and after hand washing and differences in colony counts calculated. Nursing activities before washing were graded from clean to dirty on an eight-point scale and correlated with before-wash colony counts. Product acceptability was assessed with a self-reporting questionnaire. Chlorhexidine was the most effective product in reducing skin microflora but users preferred to wash with the gel preparation. The sensitive-skin group achieved the best effects from washing, irrespective of the product used. Nasal carriers of MRSA recorded the lowest reduction levels of methicillin-resistant organisms but achieved the same reduction levels as the normal-skin group for other microflora. No relationship could be established between the pre-wash activity and the pre-wash colony count. The weekly MRSA colonization rate in neonates on the SCBU remained unaffected by any of the products tested.

Chlorhexidine↗
PubMed1986

Interruption of vertical transmission of hepatitis B virus with gamma B immunoglobulin in Christchurch.

This paper reports the results of administration of a course of three 1 ml intramuscular injections of anti-HBs immunoglobulin to the babies of HBsAg positive mothers recognised during pregnancy over a period 1982-1985. Fifty-nine hepatitis B surface antigen patients were detected during the four years of the study but only 29 were able to be followed up fully. The results of intervention, its efficacy and the problems associated with this are detailed.

Carrier State↗
PubMed1986

Colonoscopy and bacteraemia: an experience in 50 patients.

There is little consensus concerning the incidence of bacteraemia during colonoscopy and the need for antibiotic prophylaxis in susceptible patients. Hepatic abscesses in one patient which may have been related to prior colonoscopic examinations led the authors to carry out a prospective study of 50 patients undergoing colonoscopy. Multiple blood cultures were carried out to maximise the positive yield of transient bacteraemia and to attempt to determine the time when bacteraemia is most likely to occur. Five patients had positive blood cultures. In two patients S epidermidis was isolated, but only from the precolonoscopic blood sample. In three subjects enteric organisms were cultured from blood samples obtained during the procedure. In one of these three the same organism was cultured from the preendoscopic blood sample so that in only two patients (4%) could the bacteraemia be attributed to the colonoscopy. These results would suggest that the risk of bacteraemia during colonoscopy is low.

Adult↗