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PubMed1999

Australia's notifiable diseases status, 1997. Annual report of the National Notifiable Diseases Surveillance System.

In 1997 there were 89,579 notifications to the National Notifiable Diseases Surveillance System. A notable feature of 1997 was the pertussis outbreak which peaked towards the end of the year and resulted in 10,668 cases being notified. The highest number of notifications received was for hepatitis C (unspecified) with 19,692 notifications; this is the first year for which data have been reported for New South Wales and South Australia for this disease category. The number of measles cases rose after the low number reported in 1996 but is still well below the number reported in the outbreak years of 1993 and 1994. Rubella notifications continued to decline in 1997. Notifications of Haemophilus influenzae type b appeared to have stabilised at a low rate, having declined markedly after introduction of the conjugated vaccine in 1992. The number of cases of campylobacteriosis remained steady after having risen for several years. Notifications of hepatitis A cases rose considerably, much of this being due to one outbreak in New South Wales. The number of cases of salmonellosis rose while shigellosis numbers dropped slightly. Notifications for chlamydial infection and gonococcal infection continued to rise, whilst those for syphilis continued to fall.

Australia↗
PubMed2004

Australia's notifiable diseases status, 2002: Annual report of the National Notifiable Diseases Surveillance System.

There were 57 infectious diseases notifiable at the national level in Australia in 2002. States and territories reported 100,278 cases of infectious diseases to the National Notifiable Diseases Surveillance System (NNDSS), a fall of 4 per cent compared to the number of notifications in 2001. In 2002, the most frequently notified diseases were, sexually transmitted infections (31,929 reports, 32% of total notifications), gastrointestinal infections (26,708 reports, 27% of total notifications) and bloodborne infections (23,741, 24%). There were 11,711 (12% of total) cases of vaccine preventable diseases, 3,052 (3% of total) cases of vectorborne diseases, 1,155 (1% of total) cases of zoonotic infections, two cases of quarantinable diseases (Vibrio cholerae O1) and 1,980 cases of other bacterial diseases, notified to NNDSS. Compared to 2001, notifications of sexually transmitted infections increased by 16 per cent and gastrointestinal infections by 2 per cent while bloodborne infections fell by 18 per cent. The number of notifications of chlamydial infection and Q fever were the highest since 1991 and 1995 respectively. By contrast, the number of notification for hepatitis A and measles were the lowest since 1991. For other notifiable diseases, the number of notifications was within the range of the five years between 1997 and 2002 (range = five-year mean plus or minus two standard deviations). This report also includes 2002 summary data on communicable diseases from other surveillance systems including the Laboratory Virology and Serology Reporting Scheme and sentinel general practitioner schemes.

Adolescent↗
PubMed1999

The 1996 pertussis epidemic in New Zealand: descriptive epidemiology.

AIM: To describe the 1996 pertussis epidemic. METHODS: Hospitalisation, notification and laboratory data were used to describe the 1996 pertussis epidemic and compare it with previous epidemics. RESULTS: The 1996 epidemic spanned 24 months. The crude hospitalisation rate from 1 June 1995 to 31 May 1997, was 10.1 per 100,000 person years, being highest for children aged six weeks to two months (42 to 90 days old inclusive; 1402 per 100,000). The 1996 epidemic involved more hospitalisations than the 1991 and 1986 epidemics, and a greater proportion for children under the age of one year (77%), compared to previous epidemics (60-70%). There were no deaths. Pertussis only became notifiable from 1 June 1996. The crude notification rate for the following twelve months was 19.8 per 100,000 (equivalent hospitalisation rate 6.7 per 100,000); children aged six weeks to two months of age had the highest notification rate (531 per 100,000; equivalent hospitalisation rate 1021 per 100,000). In 1996-97, children aged under 15 months accounted for 21% of notifications, but 82% of hospitalisations. Europeans tended to have higher rates of notifications than non-Europeans, but lower rates of hospitalisation. CONCLUSIONS: New Zealand continues to experience high rates of pertussis as a result of inadequate immunisation coverage. The increase in hospitalisations during the 1996 epidemic may reflect a real increase in the population-based incidence, or other changes (e.g. hospitalisation practice, increase in vulnerable children with poor access to primary care). Improved rates, accuracy and completeness of pertussis notifications will improve the ability of notification data to accurately describe future epidemics and estimate vaccine effectiveness. Further debate is required regarding the aims of pertussis immunisation; accelerating the timing of the first three doses and adding further doses of pertussis vaccine on the national immunisation schedule; and the role of acellular pertussis vaccines. In the meantime, the priority must be increasing on-time immunisation coverage.

Adolescent↗
PubMedDate not supplied

[Estimate of underreporting of infectious diseases through a sentinel network of pediatricinas in the area of local health unit of Florence].

The aim of this study was to evaluate the underreporting of some infectious diseases in the pediatric population in the Local Health Unit of Florence in the period 15.09.1997-14.09.1998. Data from the current notification system and from an a hoc sentinel network were used. Nine family pediatricians voluntarily participated in the sentinel network, notifying all cases of measles, mumps, pertussis, rubella, scarlet fever and chickenpox diagnosed in the population of children under their professional responsibility, in the period of the study. Chickenpox was the most frequent disease (2,043 cases equal to 73.5% of total notifications). The notification rate for chickenpox obtained with the sentinel network was 41.6 per 1,000 children, meanwhile the notification rate obtained with the current notification system was 23.7 per 1,000. The notification rate for scarlet fever was 24.1 per 1,000 with the sentinel network and 6.0 per 1000 with the current notification system. The underreporting for the two diseases was respectively 43% and 75%. Voluntary participation of physicians in sentinel network guarantees data of good quality, making these networks very useful tools for the epidemiologic evaluation of infectious diseases with benign prognosis.

Adolescent↗
PubMed2004

[Surveillance of hepatitis A in the Netherlands 1993-2002].

OBJECTIVE: To survey trends in data on hepatitis A using information from the notification system of the Municipal Medical and Health Services 1993-2002. DESIGN: Retrospective, descriptive. METHOD: Data collected from the notification system of the Dutch Municipal and Medical Services were analyzed. RESULTS: From 1993 to 2002, 64.4%, 6.5% and 11.5% of infections were contracted in the Netherlands, Turkey and Morocco, respectively. Although the absolute number of cases was highest for young people under the age of 16 infected in the Netherlands, incidence rates showed that the children of immigrants infected in Turkey or Morocco were at highest risk, followed by adult immigrants from Turkey and Morocco. In addition, a seasonal trend was observed starting with an increase in the number of notifications of young travellers infected in Turkey and Morocco during their summer holiday, followed by a steep increase in notifications of young people infected in the Netherlands in autumn. This was followed later in the year by a slight increase in notifications of adults who acquired the infection in the Netherlands. However, between 1993-2002 the total number of notifications was halved. This decrease was mainly restricted to infections acquired in the Netherlands. In recent years, fewer outbreaks have been reported in schools, households and families. In 2001, a peak of notifications from the homosexual scene was observed. There was a continued trend in the rise of the mean age of hepatitis-A onset. CONCLUSION: Risk of hepatitis A is highest for the children of immigrants travelling to Turkey or Morocco in the summer months. Secondary cases in the Netherlands are in strong decline, especially in schools and families. However, the almost stable incidence of infections among young people of Turkish or Moroccan extraction stresses the continued importance of immunization of this group before they travel. The continuing trend in the rise of the mean age of hepatitis-A onset deserves attention because of the increasing risk of mortality of the disease amongst older people.

Adolescent↗
PubMed2004

Preliminary results from the new HIV surveillance system in France.

In addition to AIDS surveillance, data on HIV infection are necessary to better follow the dynamics of the epidemic. We report the first results of France's mandatory anonymous HIV notification system, which is linked to a virological surveillance of recent HIV infections and of circulating HIV types, groups and subtypes. HIV notifications are initiated by microbiologists who create an anonymous code of patient's identity. Clinicians complete the notification form with epidemiological and clinical data. Notifications are sent to the local health authorities and passed to the Institut de Veille Sanitaire (InVS). Laboratories voluntarily send sera from newly diagnosed HIV infected persons on dried blood spots to the national HIV reference laboratory where an immunoassay for recent infection (< or = 6 months) and a serotyping assay for the determination of group and subtype are done. The virological results are then merged at the InVS with the information from the mandatory reporting. Of the first 1301 new HIV diagnoses reported in 2003, 43% were in women, and overall, 53% were in heterosexuals, of whom 47% were of sub-Saharan African origin. MSM accounted for 36% of male notifications. A dried blood spot was available for 64% of new HIV diagnoses. Evidence of recent infection was found for 38%, ranging from 22% in IDUs to 58% in MSM. Twenty-six percent of infections in sub-Saharan migrants were recent infections. HIV-1 accounted for 98% of all notifications: 48% of these were non-B subtypes. The first results of the HIV notification system indicate that heterosexual transmission is the predominant mode of transmission and that persons originating from sub-Saharan Africa are particularly affected. Over half of infections shown to be recently acquired were in MSM; this may indicate an increased HIV incidence in this population.

Adult↗
PubMed2006

SmiNet-2: Description of an internet-based surveillance system for communicable diseases in Sweden.

Electronic systems for communicable diseases surveillance enhance quality by simplifying reporting, improving completeness, and increasing timeliness. In this article we outline the ideas and technologies behind SmiNet-2, a new comprehensive regional/national system for communicable disease surveillance in Sweden. The system allows for reporting from physicians (web form) and laboratories (direct from lab data system) over the internet. Using a unique personal identification number, SmiNet-2 automatically merges clinical and laboratory notifications to case records. Privileged users, at national and county level, work against a common central server containing all notifications and case records. In addition, SmiNet-2 has separate county servers with tools for outbreak investigations, contact tracing and case management. SmiNet-2 was first used in September 2004. Individual counties receive up to 90% of all notifications electronically. In its first year, SmiNet-2 received 54 980 clinical notifications and 32,765 laboratory notifications, which generated 58,891 case records. Since most clinicians in Sweden have easy access to the internet, a general web-based reporting has been feasible, and it is anticipated that within a few years all reporting to SmiNet-2 will be over the internet. In this context, some of the major advantages of SmiNet-2 when compared with other systems are timeliness in the dataflow (up to national level), the full integration of clinical and laboratory notifications, and the capability to handle more than 50 diseases with tailor-made notification forms within one single system.

Communicable Diseases↗
PubMed1998

Impact of managers' personal determinants in notifying workplace hazards.

Notification about work hazards is a legal requirement in advanced industrial countries, but workers have claimed, that in many cases, they do not receive enough information regarding risks, exposure, and medical problems. The recent professional literature on the subject has explored the ways in which notification is delivered without sufficiently considering the psychological incentives and barriers that may affect managers in transmitting risk information. The present study aimed at examining managers' personal determinants and notification of work hazards in a sample of 106 managers and 460 workers in 40 departments of three industrial plants in Israel. Results of our study showed that both managers and workers perceived the importance of the delivery of safety information as quite high (means of 3.43 and 3.7, respectively, out of 5), with managers reporting that they rely primarily on personal modes of communication. Immediate supervisors were regarded by both groups as the most important persons in notification. Managers having past experience in treating injured workers notified more, primarily using personal notification. The most important personal determinants that positively predicted managers' notification were their sense of self-efficacy and positive expectation of notification. Outcome denial and coping by distancing were negatively correlated with notifying about these risks.

Adult↗
PubMed1996

Selective or universal neonatal BCG immunization: what policy for a district with a high incidence of tuberculosis?

In the United Kingdom, BCG immunization of neonates provides good protection against military and meningeal disease, and probably against other forms of tuberculosis, in all ethnic groups. Serious adverse reactions to BCG immunization are rare. Cost-effectiveness studies of BCG immunization in neonates have not been reported and "universal' BCG immunization is not recommended in the United Kingdom. The Department of Health does recommend immunization for children and infants of immigrants from countries with a high prevalence of tuberculosis. There are problems associated with such a "selective' policy, as determining what is "high' prevalence and thus defining "at risk' groups is difficult, and there may be political and practical difficulties in its implementation. This may result in low coverage in eligible groups. A "universal' policy of BCG immunization for all neonates may be politically more acceptable and easier to implement in districts with high tuberculosis notification rates. Although there is no cost-effectiveness data to determine at what tuberculosis notification rate a universal policy should be adopted, an universal policy has been suggested for districts with overall notification rate of greater than 40 per 100,000. Within districts there may be large variations in tuberculosis notification rates between different areas. This is becoming more common with the amalgamation and merger of smaller districts into new larger purchasing organizations. New River Health Authority is such a district formed by the amalgamation of the former districts of Haringey with a high tuberculosis notification rate, and Enfield with a lower TB notification rate. In order to maximize coverage in the "at risk' neonates, a different neonatal BCG policy has been adopted in the two areas. This has been possible because of the flexibility of the mechanisms for contracting with different provider units. Although the overall notification rate was not thought to be sufficiently high to justify a "universal' neonatal policy throughout the district, a "universal' policy has been instituted in the main provider unit in the former district Haringey. A "selective' policy, subject to ongoing evaluation to ensure high coverage, continues to be operated by the main provider unit in the former district of Enfield.

BCG Vaccine↗
PubMed1992

Completeness of cancer and death follow-up obtained through the National Health Service Central Register for England and Wales.

For the last 20 years the National Health Service Central Register (NHSCR) has been used as the principal source of follow-up for mortality, and often for cancer incidence, in many cohort and clinical follow-up studies in England and Wales. Completeness of notification of childhood cancer registrations and deaths from the NHSCR was investigated by comparison between cancers and deaths notified to the Childhood Cancer Research Group (CCRG) from this source and notifications received directly from regional cancer registries and the national death registry. Six thousand, seven hundred and seventy-six (91.8%) of 7,379 cancers incident 1971-84, and 588 (95.8%) of 614 deaths occurring 1953-88, were successfully notified. Failures in cancer notification occurred mainly between the regional cancer registries and the National Cancer Register (3.3%), and between the National Cancer Register and the NHSCR (3.0%). An additional 1.9% of cancer notifications failed between the NHSCR and the CCRG. Incompleteness of registration of childhood cancers by regional cancer registries was estimated to be 4.7%. A total of 12.5% of incident childhood cancers were not notified by NHSCR. Incompleteness of notification may be greater for adults, for whom registration and record linkage may be more difficult. Failures in death notifications occurred mostly because deaths entered on the NHSCR were not notified to the CCRG (3.3%). This incompleteness of notification needs to be taken into account in the interpretation of published studies and in the analysis of studies using NHSCR flagging. It also implies similar incompleteness in published national cancer survival data, which use the same system of flagging. Nevertheless it is a notable achievement that NHSCR has successfully monitored such a high proportion of a population of 50 million people, by entirely clerical procedures, for 40 years.

Adult↗
PubMedDate not supplied

A decade of European field trials with genetically modified plants.

This article analyzes the development of notifications of genetically modified plants field trials in the European Union from 1991 to 2001, based on the data collected at the European level in the Summary Notification Information Format database. During this time period, a total of 1687 field trial notifications were received. The number of field trial notifications dropped by 76% between 1998 and 2001, mainly due to the de facto moratorium in place since 1999. Input traits (77%) dominated the field trial notifications during the last decade, while output traits were relevant in only 18% of all notifications, with a decreasing relevance during the last six years. In particular, field trial notifications on molecular farming were almost absent in the EU. Large companies focused their field trials on crops with a high grown area in the European Union and resistance traits, while public institutions showed interest in a large diversity of plants and traits. Finally, some conclusions on future impacts of the results of the study are drawn in this article.

Agriculture↗
PubMed2006

Impact of HIV infection on the epidemiology of tuberculosis in a peri-urban community in South Africa: the need for age-specific interventions.

BACKGROUND: In August 2005, the World Health Organization declared the tuberculosis (TB) epidemic in Africa to be a regional emergency. Current TB-control measures are failing, largely as a result of the human immunodeficiency virus (HIV) epidemic. Evaluation of additional control interventions requires detailed understanding of the epidemiological relationship between these diseases at the community level. METHODS: We examined age- and sex-specific trends in TB notifications and their association with the prevalence of HIV infection in a peri-urban township in South Africa during 1996-2004. Denominators for TB notifications were derived from population census data. The local TB-control program used the World Health Organization directly observed treatment, short-course (DOTS) strategy. RESULTS: TB notification rates increased 2.5-fold during the period, reaching a rate of 1468 cases per 100,000 persons in 2004 (P=.007, by test for trend); the estimated population prevalence of HIV infection increased from 6% to 22% during the same period. After stabilization of prevalence of HIV infection, the TB notification rate continued to increase steeply, indicating ongoing amplification of the TB epidemic. In 2004, at least 50% of children aged 0-9 years who developed TB were HIV infected. Annual TB notification rates among adolescents increased from 0 cases in 1996-1997 to 436 cases per 100,000 persons in 2003-2004, and these increases were predominantly among female. However, 20-39-year-old persons were affected most, with TB notification rates increasing from 706 to 2600 cases per 100,000 persons among subjects in their 30s. In contrast, TB rates among persons aged >50 years did not change. CONCLUSIONS: HIV infection is driving the TB epidemic in this population, and use of the DOTS strategy alone is insufficient. TB notifications have reached unprecedented levels, and additional targeted, age-specific interventions for control of TB and HIV infection in such populations are needed.

Adolescent↗
PubMedDate not supplied

Changes in immune and psychological measures as a function of anticipation and reaction to news of HIV-1 antibody status.

We assessed changes in psychological and immunological functioning during 5-week periods preceding and following notification of serostatus among gay males taking the HIV-1 antibody test. Forty-six asymptomatic homosexual men between the ages of 18 and 40 yrs were recruited from a gay men's organization and through advertisements in a local newspaper. Measures of cell-mediated immunity (lymphocyte phenotypic markers, mitogen responsivity, and natural killer cell cytotoxicity) and psychological functioning (state anxiety, intrusive thoughts, and avoidant behaviors) were obtained at baseline, five weeks later and 72 hr before serostatus notification, and 1 week, 3 weeks and 5 weeks postnotification. Results suggested a dissociation between psychological and immunological phenomena among seropositives wherein lymphocyte proliferative responses to the mitogens phytohemagglutinin (PHA) and pokeweed mitogen (PWM) remained unchanged in the face of significant increases in state anxiety and intrusive thoughts following serostatus notification. These findings suggested that asymptomatic HIV-1 infected individuals, even at the earliest stages of infection, may be unable to mount an immune response to potent psychosocial stressors (i.e., serostatus notification), due perhaps, to the fact that the viral contribution to immune functioning overrides any influence of environmental stimuli. Among the seronegative subjects studied, blastogenic responses to PHA and PWM were depressed at baseline (relative to a group of age and gender-matched controls who were not undergoing HIV-1 antibody testing) but PHA values returned to normal values 5 weeks later. Natural killer (NK) cell cytotoxicity and CD4+CD45R+ inducer cell counts appeared to parallel these changes in seronegatives. Seropositives did display fluctuations in NK cell cytotoxicity that were similar to those noted for seronegatives. Correlational analyses suggested that individual differences in anxiety responses at the time of notification of seropositivity predicted subsequent (1-week lag) declines in NK cell cytotoxicity but not other functional markers. Although most seropositives displayed clinical levels of anxiety, intrusive thoughts and avoidant responses during the week of serostatus notification, these measures returned to their initial nonclinical baseline levels within 5 weeks after notification in both the seropositive and seronegative groups.

AIDS Serodiagnosis↗
PubMed1989

The effects of the scheme for BCG vaccination of schoolchildren in England and Wales and the consequences of discontinuing the scheme at various dates.

The aims of this paper were to estimate the numbers of tuberculosis notifications in young white adults which will be prevented in the next 25 years by the schools BCG vaccination scheme, and to assess the numbers of additional notifications if the scheme were to be discontinued. Assuming that in the white ethnic group in England and Wales the decline in tuberculosis notification rates (8-10% per year for ages less than 45 years) and efficacy of BCG vaccination (75-80%) are maintained, it is estimated that the scheme for BCG vaccination of schoolchildren with its present coverage will prevent 217 notifications in those aged 15-29 years in 1993, 119 in 1998, and 69 in 2003. The epidemiological consequences of stopping the BCG in schools scheme, whenever this occurs, would be a substantial slowing of the rate of decline of tuberculosis notifications, confined almost entirely to the 15-29 years age group, for a period of about 15 years, after which the steeper decline would resume. If the scheme stopped at the end of 1991 the annual number of additional notifications would slowly increase to a maximum of just over 80 about 15 years later, and then decrease. For stopping at the end of 1996 the maximum annual number of additional notifications would be about 50.

Adolescent↗
PubMedDate not supplied

[Chagas' disease in São Paulo State: a comparative study between systematic search and inhabitants' report of bugs in the area under entomological surveillance].

Entomological surveillance of Chagas' disease in São Paulo State has adopted a scheme that uses the locality as a unit for field work. Actions are prioritized according to infestation levels obtained by systematic search of triatomine (routine actions), bugs in areas with high infestation levels and in houses whose inhabitants report the presence of the bugs (reply to notification). The most prevalent triatominic species in Sao Paulo State at present are Triatoma sordida and Panstrongylus megistus. A comparative study of infestation levels obtained in houses and surroundings in routine search and replies to notification in the two-year periods of 90/91, 92/93 and 94/95, has shown average percentage positivity of 1.3 indoors in routine activity and 6.2 in the reply to notification. For the house surroundings the values were 8.6 and 18.2 respectively, no differences being found between the two-year periods. Replies to notification showed average percentage positivity (focus) in 26% of the houses. It was verified that the notifications had come from localities with prior infestation levels equal to zero (I = O), intermediary infestation levels (I < 5) and high infestation levels (I > 5), although the percentages of positive replies to notification were higher in those localities with high prior infestation levels. These results reinforce the importance of notification in the surveillance of vector species of the invasive type like those currently prevalent in Sao Paulo State.

Animals↗
PubMed2005

Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia.

OBJECTIVE: To compare trends and rates of HIV and sexually transmitted infections in Indigenous and non-Indigenous people of Western Australia. DESIGN AND SETTING: Analysis of WA notification data for chlamydia, gonorrhoea, and primary and secondary syphilis in 2002, and for HIV infections from 1983 to 2002. MAIN OUTCOME MEASURES: Rates of HIV and sexually transmitted infection by Indigenous status. RESULTS: In 2002, there were 3046 notifications for chlamydia, 1380 for gonorrhoea and 64 for syphilis. When information on Indigenous status was available, Indigenous people accounted for 41% of chlamydia and 76% of gonorrhoea notifications, with Indigenous:non-Indigenous age-standardised rate ratios of 16 (95% CI, 14-17) and 77 (95% CI, 67-88), respectively. Indigenous people accounted for 90.6% of syphilis notifications (age-standardised Indigenous:non-Indigenous rate ratio, 242 [95% CI, 104-561]). From 1985 to 2002, HIV notification rates for non-Indigenous people in WA declined and rates for Indigenous people increased. From 1994 to 2002, there were 421 notifications of HIV infection in WA residents, 52 (12.4%) in Indigenous people and 369 (87.6%) in non-Indigenous people. Indigenous people accounted for 39% and 6.2% of all notifications in WA females and males, respectively. The Indigenous:non-Indigenous rate ratios were 18 (95% CI, 12-29) for females and 2 (95% CI, 1-3) for males. CONCLUSIONS: Indigenous Western Australians are at greater risk of HIV transmission than non-Indigenous people. Strategies to prevent further HIV infection in Indigenous Australians should include control of sexually transmitted infections.

Adolescent↗
PubMed2001

[Nursing interagency referral forms are important for cooperation within the nursing profession upon patient transfer from hospital to home care].

The purpose of this study was to clarify factors concerning hospital discharge notification in Shizuoka. The subjects, nurses at 146 hospitals and 93 public health centers or municipal health centers, were surveyed by means of a questionnaire. The data were analyzed by the chi-squared test and multiple logistic linear regression analysis. The results showed that hospital discharge notification was provided by 92.6% of hospitals having a hospital discharge notification form, but only 7.4% of hospitals without such a form. There was a significant difference in hospital discharge notification between hospitals with and without a nursing interagency referral form, indicating that the latter is an important factor in provision of information on transfer of patients from the care of hospital nurses to that of public health nurses (p < 0.001). There were no significant links between providing hospital discharge notification and the number of beds, the existence of a visiting nurse room, the MSW, the examination of nursing assistance methods after discharge, or the notification of hospitalization. These results indicated that the nursing interagency referral form to be important for notification purposes.

Adult↗
PubMed1993

Tuberculosis in the West Midlands, 1990-1991.

In the late 1980s, notifications of tuberculosis stopped their former steady decline. There has been speculation as to why this should be so, with much interest centred on a possible association with the HIV epidemic. Notification rates are higher in persons of Indian subcontinent ethnic origin compared with the indigenous white population. Changes in the size and structure of the former population subgroup may have contributed to the recent increase in notifications in some areas. The absence of data on ethnic group in routinely collected data has led to the recommendation that special surveys should be conducted to clarify the contribution of ethnic minorities to the occurrence of tuberculosis in the UK. One such survey has been carried out in the West Midlands, where notifications increased by 27% between 1987 and 1989. Notification rates were found to vary widely by age, sex, district of residence and ethnic group; the highest notification rates occurring in older females of Indian subcontinent origin. These differences help to explain the increase in the absolute number of notifications and suggest that certain population subgroups warrant special attention.

Adolescent↗