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How complete and accurate is meningococcal disease notification?

Effective public health control of meningococcal disease (meningococcal meningitis and septicaemia) is dependent on complete, accurate and speedy notification. Using capture-recapture techniques this study assesses the completeness, accuracy and timeliness of meningococcal notification in a health authority. The completeness of meningococcal disease notification was 94.8% (95% confidence interval 93.2% to 96.2%); 91.2% of cases in 2001 were notified within 24 hours of diagnosis, but 28.0% of notifications in 2001 were false positives. Clinical staff need to be aware of the public health implications of a notification of meningococcal disease, and of failure of, or delay in notification. Incomplete or delayed notification not only leads to inaccurate data collection but also means that important public health measures may not be taken. A clinical diagnosis of meningococcal disease should be carefully considered between the clinician and the consultant in communicable disease control (CCDC). Otherwise, prophylaxis may be given unnecessarily, disease incidence inflated, and the benefits of control measures underestimated. Consultants in communicable disease control (CCDCs), in conjunction with clinical staff, should de-notify meningococcal disease if the diagnosis changes.

Adolescent↗

Reconsidering the underestimated burden caused by neglected tropical diseases.

It is generally acknowledged that the burden caused by neglected tropical diseases needs to be reassessed. Not only are there several important diseases unaccounted for, but new information suggests they have a more substantial impact on health than initially thought. Looking at the tropical diseases as a group makes sense: they tend to cluster in the same poor populations and, to make progress with their control, they will have to be dealt with in an integrated manner. Measuring the effect of such integrated control is likely to reveal the real impact of tropical diseases on human health and wellbeing.

Cluster Analysis↗

[Surveillance of communicable diseases in the European Union].

Important developments are taking place in the Public Health framework in the European Union (EU). A number of international surveillance networks have been developed between the countries of the EU. The European Commission has initiated horizontal and disease specific programmes in the field of infectious disease surveillance. These have stimulated European co-operation for prevention and control of infectious diseases. Much topical information can be found on several Internet pages. The challenge is to set up networks for all public health relevant infectious diseases.

Communicable Disease Control↗

Emerging infectious diseases in an island ecosystem: the New Zealand perspective.

Several unique features characterize infectious disease epidemiology in New Zealand. Historically, well-organized, government-run control programs have eliminated several zoonoses. More recently, however, communicable disease control has been mixed. Rates of rheumatic fever, tuberculosis, and enteric infectious are high, and rates of meningococcal disease are increasing. These diseases are over-represented in New Zealanders of Polynesian descent, who generally live in more deprived and overcrowded conditions than do those of European descent. Measles and pertussis epidemics are recurring because of inadequate vaccine coverage, despite a well-developed childhood immunization program. A progressive response to the HIV epidemic has resulted in relatively low rates of infection, particularly among injecting drug users; however, the response to other sexually transmitted infections has been poor. A key challenge for the future is to build on successful strategies and apply them to persisting and emerging infectious disease threats in a small, geographically isolated country with limited economic resources.

Animals↗

[Zoonotic infections in humans. Review of the epidemiological situation in Germany].

Zoonoses are infectious diseases that can be transmitted from vertebrate animals to humans. Their significance lies in the large number of cases that occur, the high case fatality ratio of certain zoonoses, and the potential for some pathogens as yet restricted to animal hosts to cross the species barrier and infect humans. Changing habits in food production (for example, intensive animal husbandry) and food consumption as well as demographic, climatic, and ecological factors contribute to the spread of zoonotic pathogens. Several zoonoses are notifiable in Germany according to the Protection Against Infection Act enacted 1 January 2001. The European Commission issued a new directive on the monitoring of zoonoses and zoonotic agents on 17 November 2003. There is ongoing need to develop further measures to prevent and control zoonotic diseases on a national as well as international basis.

Communicable Disease Control↗

Pertussis: herd immunity and vaccination coverage in St Lucia.

In a single complete epidemic in St Lucia, an island too small to support constant clinical pertussis, the pertussis case rates in small communities (villages and small towns) with differing levels of vaccination coverage of young children were compared. The association between greater vaccination coverage and greater herd immunity was clear, despite the imperfect protection given to individuals. An analysis in terms of population dynamics is evidence against the theory that endemic subclinical pertussis maintains transmission in a highly vaccinated population. We suggest that with a homogeneous vaccination coverage of 80% of 2-year-old children pertussis might be eradicated from the island, and that this is a practicable experiment.

Adolescent↗

Severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress that has been made towards understanding the virus-SARS coronavirus (SARS-CoV)-and the disease. We will also highlight the progress that has been made towards developing vaccines and therapies The concerted and coordinated response that contained SARS is a triumph for global public health and provides a new paradigm for the detection and control of future emerging infectious disease threats.

Animals↗

Practices of infectious disease prevention and management during hematopoietic stem cell transplantation: a survey from the European group for blood and marrow transplantation.

Protocols for the prevention of infections after allogeneic or autologous hemopoietic stem cell transplantations are usual. A questionnaire was sent out to the members of the European Group for Bone and Marrow Transplantation (EBMT) in the spring of 1999. A total of 308 questionnaires from 180 centers were returned. Both allogeneic and autologous transplantation was reported from 128 centers, and allogeneic or autologous transplantation alone from four and 48 centers, respectively. Hemopoietic stem cell transplantation is still a domain of university hospitals. Intensive measures of isolation are usual. Allotransplantation is commonly performed in single rooms with HEPA-filtered air on special wards. However, even in the autologous setting, extensive measures of isolation are commonly used. This observation could be explained by historical developments and by the fact that nearly all centers for allogeneic transplantation perform both allogeneic and autologous transplantations, and thus similar measures are used in both settings. Other measures are usual but heterogeneous due to lack of clinical trials in this field. Drug prophylaxis during transplantation is mostly carried out with quinolones, TMP/SMZ, fluconazole, acyclovir, and pentamidine. Differences in drug prophylaxis after engraftment and in the use of different venous accesses do reflect the requirements after engraftment and discharge of patients from the transplant unit. The intensity of measures in autologous stem cell reinfusion does not reflect the development during the last decade. For cost effectiveness and convenience, it is necessary to abolish senseless measures. It is necessary to investigate anti-infectious strategies separately for allogeneic transplantation and other modalities of anti-cancer treatment in future.

Anti-Infective Agents↗

Design and analysis issues in cluster-randomized trials of interventions against infectious diseases.

This paper discusses the application of the cluster-randomized trial (CRT) design to evaluate the effectiveness of interventions against infectious diseases. In addition to the usual rationale for this design, there are a number of other advantages that are peculiar to the study of infectious diseases. In particular, CRTs are able to measure the overall effect of an intervention at the population level, capturing both the direct effect of an intervention on an individual's susceptibility to infection, and also the indirect effects due to changes in risks of transmission to other individuals, or to the mass effect or 'herd immunity' resulting from intervening in a large proportion of the population. We briefly review published CRTs of interventions against infectious diseases, most of which have been conducted in the developing countries where such diseases predominate. The focus is on trials in which communities or other large groupings are randomized, and in which impacts on infectious disease incidence or mortality are assessed. We then discuss three issues that are of special relevance to CRTs of infectious diseases. First, issues relating to the definition and size of clusters; secondly, the role of matching or stratification, and the choice of matching factors; and thirdly, the definition of direct and indirect effects of intervention, and methods of assessing these components in a CRT. We conclude by outlining some areas for future research.

Biometry↗