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PubMed1998

Resurgence of sexually transmitted diseases in Russia and eastern Europe.

The reasons for the outbreak of syphilis and other STDs in the former USSR are investigated in this article. The most important of those are of socioeconomic, biomedical, and organizational origin. The dramatic changes in society has led to changes in the strategy of the dermatovenereologic service. The role of departments of anonymous testing and treatment in controlling the STDs epidemic is discussed. This article also contains statistical data concerning the STDs morbidity in Russia and Eastern Europe during the last years.

Disease Outbreaks↗
PubMed1993

Antenatal survey for the seroprevalence of HTLV-1 infections in the West Midlands, England.

The sera of 3522 women who attended an antenatal clinic in Birmingham, England were tested anonymously for antibodies against HTLV-1. Samples from 5 women (0.14%) were positive, one serum showed indeterminate reactivity. Two of the women (0.06%) were born in the West Indies (of Afro-Caribbean ethnic origin), one (0.03%) in Africa (of African ethnic origin), and three (0.09%) were white Caucasian women born in the UK. Thus, HTLV-1 infection in pregnant women in the UK, though comparatively rare, is not negligible. As transmission of HTLV-1 to the newborn via breast milk has been observed and as seropositive mothers can be advised to refrain from breastfeeding or to treat their milk, the question of routine screening for HTLV-1 infection during antenatal care is discussed.

Adolescent↗
PubMed2001

Immunization strategies to control a community-wide hepatitis A epidemic.

One fifth of 527 cases of hepatitis A occurred in self-identified injection drug users during a community-wide epidemic in Spokane County (Washington) in 1997-8. We hypothesized that an immunization campaign targeted at illicit drug users could control the epidemic. Starting in May 1998, hepatitis A vaccine was provided to individuals in jails and other sites frequented by illicit drug users. Volunteers at vaccination sites were surveyed about risk. Serial convenience samples of jail inmates who denied previous vaccination were anonymously tested for hepatitis A virus (HAV) immunoglobulin G (IgG). From May to December 1998, 2765 high-risk individuals were vaccinated against hepatitis A. The proportion of HAV IgG seropositive inmates increased from 30% to more than 50%. Our findings suggest that vaccination along with naturally occurring infection increased the rate of hepatitis A immunity among illicit drug users during the final months of the epidemic. This supports the hypothesis that targeted immunization of high risk groups may shorten the natural history of a community-wide epidemic.

Adult↗
PubMed2002

Prevalence of hepatitis C among injectors in Scotland 1989-2000: declining trends among young injectors halt in the late 1990s.

We previously reported a continual decline in anti-HCV prevalence among young injectors from Glasgow and Lothian between 1990 and 1997. The original study was extended to ascertain if the anti-HCV prevalence among injectors from Glasgow, Lothian, Tayside and Grampian had changed since 1997. Residual sera from injectors who had undergone attributable anti-HIV testing were tested anonymously for anti-HCV. In all four regions, no significant changes in prevalence were found among those aged < 25 years during the late 1990s (Glasgow 1997-9/00: 43%-41%; Lothian 1997-9: 13%-17%; Tayside 1997-9: 45%-35%; Grampian 1996-9: 28%-29%). Among those aged > or = 25 years, significant decreases in prevalence were only observed in Glasgow (1997-9/00: 79%-72%, P = 0.03) and Lothian (1997-9: 54%-45%, P = 0.05). The findings highlight that existing harm reduction measures, acknowledged as having helped to reduce the spread of HCV, are not sufficient to bring this epidemic under control and reduce transmission to sporadic levels.

Adolescent↗
PubMed2000

Seroprevalence of HIV and HTLV in a representative sample of the Spanish population.

HIV and HTLV seroprevalence was determined by means of unlinked anonymous testing of 2144 sera, originally obtained from primary care patients by representative sampling of the Spanish population aged 15-39 years in 1996. HIV-1 seroprevalence was 4.3 per 1000 population in the 15-39 years age group [95% confidence interval (CI), 1.5-10.7] and 5.6 per 1000 (95% CI, 1.8-15.3) in the 20-39 years age group. Seroprevalence proved higher in males and urban residents. No antibodies to HIV-2 and HTLV-I were detected in any of the sera studied. However, presence of antibodies to HTLV-II was confirmed in one serum sample, while HTLV seroreactivity, though detected in another, could not be typed. The two HTLV-positive results equated to a seroprevalence of 1.9 per 1000 in the 20-39 years age group (95% CI, 0.3-8.6). HIV-I seroprevalence was consistent with previous estimates yielded by back-calculation. The level of HTLV seroprevalence found suggests endemicity.

Adolescent↗
PubMed1998

Multi-site samples of injecting drug users in Edinburgh: prevalence and correlates of risky injecting practices.

AIMS: To estimate the frequency of injecting and prevalence of equipment sharing and other risky injecting practices among intravenous drug users (IDUs) and to identify correlates of these behaviours. DESIGN: Three cross-sectional surveys of IDUs by face-to-face interview in the years 1992-94. SETTING: Multiple treatment and non-treatment sites throughout the city of Edinburgh, Scotland, UK. PARTICIPANTS: Six hundred and thirty-four interviews of 480 IDUs who reported having injected a drug in the previous six months. MEASUREMENTS: Self-reports of drug-taking behaviours, service contact, sexual behaviour and HIV knowledge, and anonymous testing of saliva for HIV antibodies. FINDINGS: Only 18% had injected at least daily. Thirty-five per cent had accepted or passed on used equipment. Eighty-five per cent of subjects recruited from non-treatment sites were receiving treatment for their drug taking. Multivariate analyses indicated that risky injecting was associated with a consistent history of sharing, polydrug injecting, injecting in prison, having recently started injecting, and recent experience of methadone detoxification. CONCLUSIONS: Injecting frequency and equipment sharing have declined substantially in Edinburgh during the past 10 years and are low compared to other cities in the United Kingdom and elsewhere. These improvements have occurred in the context of remarkably high levels of drug treatment service contact. Our findings support the international evidence indicating that IDUs have modified their injecting habits significantly without completely eliminating this form of HIV risk. High levels of service contact in Edinburgh provide ample opportunities to instigate further HIV prevention measures which target identifiable subgroups of IDUs who persist in risky injecting.

Adolescent↗
PubMed1998

A comparison of the prevalence of HIV infection and injecting risk behaviour in urban and rural samples in Scotland.

AIMS: To compare the prevalence of HIV infection and injecting risk behaviour among injecting drug users from urban and rural areas. DESIGNS: Two samples of injecting drug users were recruited using a multi-site sampling strategy. Respondents were first interviewed by trained interviewers then specimens of saliva were collected for anonymous testing for antibodies to HIV. SETTING: Respondents were recruited from drug treatment services and street sites. PARTICIPANTS: Respondents were eligible for inclusion in the study if they had "ever" injected a drug and were currently using drugs. MEASUREMENTS: Measurements taken included self-reported patterns of drug use and injecting risk behaviour. Specimens of saliva were tested for the presence of HIV infection using GACELISA with reactive specimens confirmed by Western blot analysis. FINDINGS: Our data indicate that there are two separate populations which are geographically discrete but broadly similar in profile and current injecting risk behaviour. The prevalence of HIV infection among IDUs from Dundee city was found to be 26.8% (95% CI, 20.2%-33.0%) compared with 3.7% (95% CI, 0.13%-15.8%) for IDUs from rural Tayside. This marked difference in prevalence of HIV infection we attribute to a high level of injecting risk among urban IDUs between 1980 and 1984, limited migration from the urban epicentre of infection and a reluctance among rural IDUs to share with IDUs outside their immediate social and kinship networks. CONCLUSIONS: Although current levels of injecting risk behaviour are similar in our urban and rural samples, rural IDUs may be less likely to contract HIV from their fellow injectors because of the lower prevalence of HIV infection and more closed sharing networks within the rural population. The implications of this for the development and expansion of drug services are considered.

Adult↗
PubMed1990

Seroprevalence rates of human immunodeficiency virus infection at sentinel hospitals in the United States. The Sentinel Hospital Surveillance Group.

BACKGROUND AND METHODS: To evaluate the epidemiology of infection with human immunodeficiency virus type 1 (HIV-1) in selected urban communities in the United States, we instituted active surveillance at sentinel hospitals by anonymous testing of samples of blood specimens for HIV-1 antibody. To reflect better the rates of HIV-1 seroprevalence in the communities served by the sentinel hospitals, we excluded specimens from all patients with diagnoses that are often associated with HIV infection. RESULTS: From January 1988 to June 1989, 89,547 specimens were tested at 26 hospitals in 21 cities. The overall rate of HIV-1 seroprevalence was 1.3 percent, but it ranged from 0.1 to 7.8 percent according to hospital (median, 0.7 percent). The age distribution of persons seropositive for HIV-1 was similar across hospitals and closely paralleled that of persons with the acquired immunodeficiency syndrome (AIDS). In areas of low seroprevalence, HIV-1 infections were highly concentrated among men. However, the male-to-female ratio (median, 7.0) decreased steadily with an increasing overall rate of seroprevalence (P less than 0.001); at the five hospitals with the highest rates of seroprevalence, the median male-to-female ratio was only 2.9. The median black-to-white ratio of HIV-1 seroprevalence was 1.8, but at hospitals with low rates of seroprevalence the rates in blacks and whites were nearly equal. At two hospitals in the communities with the highest prevalence of AIDS, 1.1 to 3.8 percent of adolescents 15 to 19 years old and 18 to 22 percent of all men 25 to 44 years old were seropositive for HIV-1. CONCLUSIONS: In these sentinel, urban populations there is tremendous variation in the rate of HIV-1 infection (over 70-fold). The very high seroprevalence at some sentinel hospitals indicates the need for routine screening for HIV-1 infection among some groups of patients, regardless of clinical presentation.

AIDS Serodiagnosis↗
PubMed2001

Seroprevalence of hepatitis C infection among health care personnel in Beirut, Lebanon.

BACKGROUND: Health care workers are at risk of contracting hepatitis C virus (HCV) infection more than the general population, and chronic HCV infection may be asymptomatic. Therefore, the purpose of this study was to determine the seroprevalence of HCV among health care workers at St Georges-Orthodox Hospital, the first study done for a major teaching hospital in Lebanon. METHODS: Health care personnel at St Georges-Orthodox Hospital, Beirut, were offered anonymous testing for anti-HCV antibody. Seroprevalence rates of health care personnel were compared with the rates of blood donors screened during the same year. RESULTS: Of the 502 persons screened, 13 (2.60%) initially tested either positive or doubtful-positive by the SM-HCV rapid test; 2 (0.4%) were confirmed positive by 2 commercial enzyme-linked immunosorbent assay kits and reverse transcriptase-polymerase chain reaction. This prevalence rate was comparable with the rate obtained for blood donors (n = 600) during the same period. CONCLUSION: The seroprevalence of HCV infection among health care workers at St Georges-Orthodox Hospital was similar to the rate observed in local blood donors, which suggests that the occupational risk of HCV infection was low.

Adult↗
PubMed2001

Trends in HCV prevalence among injecting drug users in Glasgow and Edinburgh during the era of needle/syringe exchange.

In 1998, we reported that anti-HCV prevalence among injectors from Glasgow had declined between 1990 and 1995. We set out to ascertain if the anti-HCV prevalence among injectors from Edinburgh had declined similarly during this period and if there had been any trend in prevalence among injectors from both cities since 1995. Residual sera from both cities' injecting drug users who had undergone named HIV testing were identified, linked to age band and gender information and tested anonymously for anti-HCV. Among Edinburgh's injectors, significant (p < 0.0001) decreases in anti-HCV prevalence from 69% (1989/90) to 13% (1997) and from 80% (1989/90) to 54% (1997) were seen in those aged < 25 y and > or = 25 y, respectively. Among Glasgow's injectors, a significant (p < 0.0001) decrease in prevalence from 91% (1990) to 43% (1997) was seen only among those aged < 25 y. Of both cities' 15-19 y olds, sampled during 1995-97, 17% (24/139) were anti-HCV-positive. The findings suggest that the incidence of HCV among young injectors continued to decrease during the 1990s--the era of needle/syringe exchange and other interventions--but is still too high. Further investigative and preventive work is required.

Adult↗
PubMed2006

Improving PBLs in the International Medical University: defining the 'good' PBL facilitator.

Students' perception of the role and characteristics of a good problem-based learning (PBL) facilitator were assessed in the same study in which students were exposed to the 'Flying a Kite Approach' to PBL. A pre-tested anonymous questionnaire addressed the good qualities of a facilitator as well as the negative aspects. Although faculty and students' perceptions of 'good 'and 'bad' attributes generally agreed, it is clear that students still prefer facilitators who talk more, i.e. explain unclear facts or correct them when their facts are wrong. Content experts are also preferred over non-content experts.

Evaluation Studies as Topic↗
PubMed2001

Maternal and neonatal seroprevalence of hepatitis B surface antigen (HBsAg) in Benin City, Nigeria.

The seroprevalence of maternal and neonatal hepatitis B surface antigen (HBsAg) was determined prospectively through unlinked anonymous testing of volunteers at delivery at the University of Benin Teaching Hospital, Benin City, Nigeria. Six hundred and forty (320 mother-cord blood pairs) samples were assayed for HBsAg using hepatitis B latex test kit (Biotech Laboratory Ltd, UK). Repeatedly reactive samples were confirmed by the use of ELISA kit (Wellcome Laboratory, UK). None of these women had had a blood transfusion or hepatitis B vaccination in the past, and none was an intravenous drug abuser. The maternal seroprevalence was 2.19%. This means one of every 45 pregnant women was a carrier of the antigen. The neonatal seroprevalence and the vertical transmission rate were 0.96% and 42.86%, respectively. The endemicity of this occasionally fatal disease is thus being propagated. We advocate universal free screening and immunisation of our pregnant women and their infants as part of the antenatal and childhood immunization programmes. Healthcare providers should be vaccinated routinely.

Journal Article↗
PubMed2002

Thyroid peroxidase antibodies in dried blood specimens of newborns.

Previous studies have disclosed that a substantial percentage of infants from mothers with thyroid autoimmunity have antibodies to thyroid peroxidase (TPOAb) at birth. Furthermore, these antibodies have been shown to be of maternal origin. In view of this we thought it would be of interest to determine the prevalence of TPOAb in newborns from an unselected population of women. This was done by retrieving stored dried blood specimens from 240 full-term healthy infants, which had been obtained during 1999 for routine newborn screening. Ten percent of the randomly selected specimens tested TPOAb positive. Thyroid function in the mothers could not be evaluated because all specimens had been tested anonymously. In summary, our results indicate that a significant percentage of newborns were TPOAb positive. It is unclear at this time whether such antibodies reflected maternal thyroid autoimmunity and/or other autoimmune disorders. However, the close association between autoimmune thyroid disease and TPOAb positivity raises the possibility of abnormal thyroid function in some of the mothers.

Antibodies↗
PubMed1993

AIDS in the Republic of China, 1992.

From May 1985 to December 1992, a total of 5,931,032 serum samples from eight population groups were tested for antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing is carried out for blood donors, military recruits, immigrants, and prisoners. The other population groups were tested anonymously with consent. A total of 407 samples were seropositive. Of those HIV carriers, 63 developed AIDS: 37 were homosexuals, 6 were hemophiliacs, 1 was an intravenous drug user, 15 were heterosexuals, and 4 had no known risk factors. Although the prevalence of HIV infection and AIDS in Taiwan has remained low, the increase since 1988 has been rapid. Before 1987, all of the 48 persons with HIV infection were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from homosexuals to heterosexuals and the number of intravenous drug users surpassing the number of hemophiliacs. Among the 63 patients with AIDS, 59 were male and only 4 were female; 53 have died (3 committed suicide).

Acquired Immunodeficiency Syndrome↗
PubMed1993

Comparison of voluntary and blinded human immunodeficiency virus type 1 (HIV-1) seroprevalence surveys in a high prevalence sexually transmitted disease clinic population.

To compare the seroprevalence of and risk factors for human immunodeficiency virus infection (HIV) among patients attending a public sexually transmitted disease clinic, the authors conducted both voluntary and blinded seroprevalence surveys between June 1989 and August 1990. For the voluntary survey, every twenty-fifth patient attending the clinic for a new problem was invited to receive anonymous testing for HIV antibody. For the blinded survey, sera obtained for syphilis serologies from 2,297 (86%) of the 2,682 patients attending the clinic for a new problem were tested for HIV antibody after all personal identifiers were removed. Of the 946 eligible patients, 631 (66.7%) agreed to participate in the voluntary survey. Black men were significantly less likely to participate than other men and women (p < 0.0001). The prevalence of HIV antibody was 25% greater in the blinded survey than in the voluntary survey (15.2% and 11.4%, respectively, p < 0.05). This difference was due primarily to black homosexual/bisexual men, who had a 12.7-fold greater risk of HIV infection in the blinded survey than in the voluntary survey. These results suggest that blinded seroprevalence surveys may provide a better prevalence estimate of HIV infection than voluntary surveys. The greater risk for HIV infection observed among homosexual and bisexual black men, who were tested only in the blinded serosurvey, suggests that efforts to increase voluntary testing for HIV infection in this group should be developed.

Adolescent↗
PubMed1997

Hepatitis B and C in doctors and dentists in Nigeria.

We surveyed a random sample (n = 75) of doctors and dentists at University College Hospital, Ibadan, Nigeria. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis Be antigen (HBeAG), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV), by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. The majority of the doctors and dentists use universal precaution for protection against viral hepatitis on < 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons, dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) had not received prior HBV vaccination. Unvaccinated personnel were more likely to be surgeons, dentists, < 37 years of age, and have fewer years of professional activity (p < 0.05). After logistic regression, only fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). To reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when the doctors and dentists carry out procedures on their patients, and all health-care workers should be vaccinated with HBV vaccine and the HCV vaccine, when it becomes available.

Adult↗
PubMed1997

The HIV epidemic in Zambia: socio-demographic prevalence patterns and indications of trends among childbearing women.

OBJECTIVE: To examine socio-demographic HIV prevalence patterns and trends among childbearing women in Zambia. DESIGN: Repeated cross-sectional surveys. METHODS: Personal interviews and unlinked anonymous testing of blood samples of women attending antenatal care in selected areas. RESULTS: The 1994 data includes information from 27 areas and a total of 11,517 women. The HIV prevalence among urban residents appeared with moderate variation at a very high level (range 25-32%, comparing provinces). The geographical variation was more prominent in rural populations (range 8-16%) and was approximately half the prevalence level of the urban populations. With the exception of the 15-19 years age-group, HIV infection was found to rise sharply with increasing educational attainment (odds ratio, 3.1; confidence interval, 2.6-3.8) when contrasting extreme educational levels. Although the assessment of trends is somewhat restricted, the available information indicates stable prevalence levels in most populations over the last 2-4 years. CONCLUSIONS: The data showed extremely high HIV prevalence levels among childbearing women. Longer time-intervals between surveys are needed, however, in order to verify the stability in prevalence identified by this study. The tendency to changing differentials by social status is suggested as a possible sign of an ongoing process of significant behavioural change.

Adolescent↗
PubMed2002

Ethnic disparity in HIV prevalence and zidovudine treatment among childbearing women and pediatric AIDS cases in California.

OBJECTIVE: To compare, by ethnicity, the prevalence of HIV and zidovudine treatment among a cross-sectional survey of childbearing women in California in 1998, and the number of pediatric AIDS cases from 1998 to 2001. METHODS: Blood specimens, collected via infant heel-stick for metabolic screening during the third quarter of 1998, were anonymously tested for HIV antibody. Positive specimens were subsequently tested for evidence of zidovudine therapy. Pediatric AIDS cases with diagnosis dates from 1998 to 2001 were obtained from the AIDS case registry. RESULTS: Of the 119 108 specimens tested, 77 (0.65 per 1000) were HIV-antibody positive. Most (37.7%) of the 77 HIV-positive specimens were from newborns of African-American mothers, followed closely by Latina mothers (35.1%). The absence of zidovudine therapy was highest for Latina and African-American women, 29.6 and 24.1%, respectively. Latino and African-American children accounted for the majority of California pediatric AIDS cases diagnosed between 1998 and 2001. CONCLUSION: Innovative approaches are needed to increase the rate of zidovudine therapy among African-American and Latina HIV-infected childbearing women. These could include a shorter-course zidovudine regimen or rapid HIV testing and counselling of women in late-term pregnancy.

Adult↗