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PubMed1998

[The epidemiology of hepatitis A in the Netherlands, 1957-1998].

OBJECTIVE: To describe the incidence of hepatitis A in the Netherlands, 1957-1997 to find an explanation for the increase in 1998. DESIGN: Descriptive. SETTING: National Institute of Public Health and Environment (RIVM), Bilthoven, the Netherlands. METHOD: Following an increase of the number of hepatitis A notifications in 1998 the national notification data over the period 1957-1997 were examined. The impact of waning natural immunity in the Dutch population and of the annual influx from high-endemic countries on the epidemiology of hepatitis A was studied. RESULTS: The number of notifications declined considerably in the early sixties and stabilised in the seventies at 5-7 notifications per 100,000 inhabitants. The age distribution over time showed that the proportion of cases in children is still the largest, although the proportion of notifications of adult cases increased slightly over time. A seasonal fluctuation was demonstrated by a steep increase in the number of notifications among non-Dutch children in autumn, with the infection acquired abroad, probably in Morocco or Turkey, followed by an increase among children and adults who acquired their infection in the Netherlands. The number of notifications doubled in the early months of 1998 compared with 1997. The present epidemic increase can be explained by increased transmission in subgroups who contributed similarly in the same months in the past 5 years and may result from secondary infections related to the relatively high peak in autumn in 1997. CONCLUSION: In 1975-1997 a stable but low incidence of hepatitis A was observed in the Netherlands; the number of cases among adults did not increase over time. The present epidemic increase underlines the potential risk of epidemics and the role of importation of the virus from high-endemic countries.

Adolescent↗
PubMed2005

A randomized trial of primary care provider prompting to enhance preventive asthma therapy.

BACKGROUND: Guidelines recommend preventive medications for all children with persistent asthma, yet young urban children often receive inadequate therapy. This may occur in part because primary care providers are unaware of the severity of their patients' symptoms. OBJECTIVE: To determine whether systematic school-based asthma screening, coupled with primary care provider notification of asthma severity, will prompt providers to take preventive medication action (prescribe a new preventive medication or change a current dose). DESIGN: Children aged 3 to 7 years with mild persistent to severe persistent asthma were identified at the start of the 2002-2003 school year in Rochester. Children were assigned randomly to a provider notification group (child's primary care provider notified of asthma severity) or a control group (provider not notified of severity). Primary care providers of children in the provider notification group were sent a facsimile indicating the child's symptoms and recommending medication action based on national criteria. Interviewers blinded to the child's group assignment called parents 3 to 6 months later to determine if preventive actions were taken. RESULTS: Of 164 eligible children with mild persistent or more severe asthma, 151 (92.1%) were enrolled. Children in the provider notification group were not more likely to receive a preventive medication action than were children in the control group (21.9% vs 26.0%; P = .57). Additional preventive measures, including encouraging compliance with medications (33.3% vs 31.3%; P = .85), recommending environmental modifications (39.3% vs 42.4%; P = .86), and referrals for specialty care (6.6% vs 6.0%; P > .99), also did not differ between the provider notification and control groups. At the end of the study, 52.4% of children in both groups with no medication changes were still experiencing persistent symptoms. CONCLUSIONS: School-based asthma screening identified many symptomatic children in need of medication modification. Provider notification, however, did not improve preventive care. Findings suggest that more powerful interventions are needed to make systematic asthma screening effective.

Asthma↗
PubMed1994

Tuberculosis trends in eastern Europe and the former USSR.

The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2006

Does smoking explain sex differences in the global tuberculosis epidemic?

To date there has been no satisfactory explanation of the worldwide excess of tuberculosis (TB) notifications among adult males. We investigated the epidemiological basis for sex differences in TB notifications in high-burden countries using available group-level data. Multiple linear regression analysis was used to explore the ecological relationship between smoking and sex differences in TB notifications among high-burden countries. Cigarette consumption was a significant predictor of the sex ratio of TB notifications, and explained 33% of the variance in the sex ratio of TB notifications. Our findings suggest that smoking is an important modifiable factor which has a significant impact on the global epidemiology of TB, and emphasize the importance of tobacco control in countries with a high incidence of TB. This analysis provides support for the interpretation of sex differences in worldwide TB notification rates as indicative of true differences in the epidemiology of TB between males and females.

Adolescent↗
PubMed2002

A review of national legionellosis surveillance in Australia, 1991 to 2000.

A study was undertaken to analyse legionellosis notifications for the period 1991 to 2000 to establish the distribution of legionellosis in Australia with the aim of identifying risk factors amenable to public health intervention. Legionellosis notification rates ranged from 0.6 cases per 100,000 population in 1991 to 2.5 cases per 100,000 population in 2000. Notifications were highest in autumn (March to May). Sixty-nine per cent of cases were males. At-risk population included those aged over 50 years. The upward trend in notification rates of legionellosis indicated that this disease remains a significant public health problem particularly among older people. Seasonal differences in notification rates require further investigation to develop appropriate prevention and control strategies. To have a better understanding of the epidemiology of legionellosis, further information is needed on smoking history, chronic illnesses, whether the notification is outbreak-related and the species of Legionella isolated.

Adolescent↗
PubMed1999

[A quality assessment of notified occupational diseases submitted to the National Occupational Environment Service].

The aim of this study was to assess the quality of a consecutive sample of occupational disease notifications submitted to the National Working Environment Service during 1994. The sample consisted of 860 notifications describing occupational diseases among persons working in companies situated in the county of Vejle. The data information e.g. company name and address, time of employment, harmful exposure and disease, were registered. An overall data quality assessment was performed including evaluation of the etiological connection between described occupational exposure and disease and potential preventive perspectives. The study showed that the notified informations in general were adequate, but doctors need to pay more attention to dose description of the harmful exposure. About 80% of the notifications presented an adequate connection between occupational exposure and disease. Only half of the notifications described preventable and recent (less than five years) harmful exposure. In conclusion, the Danish occupational disease notification system is in general of a high standard, and the National Working Environment Service could make more use of doctors' information provided in these notifications.

Cross-Sectional Studies↗
PubMed2000

Tuberculosis and the role of war in the modern era.

OBJECTIVE: Tuberculosis (TB) remains a major global health problem; historically, major wars have increased TB notifications. This study evaluated whether modern conflicts worldwide affected TB notifications between 1975 and 1995. DESIGN: Dates of conflicts were obtained and matched with national TB notification data reported to the World Health Organization. Overall notification rates were calculated pre and post conflict. Poisson regression analysis was applied to all conflicts with sufficient data for detailed trend analysis. RESULTS: Thirty-six conflicts were identified, for which 3-year population and notification data were obtained. Overall crude TB notification rates were 81.9 and 105.1/100,000 pre and post start of conflict in these countries. Sufficient data existed in 16 countries to apply Poisson regression analysis to model 5-year pre and post start of conflict trends. This analysis indicated that the risk of presenting with TB in any country 2.5 years after the outbreak of conflict relative to 2.5 years before the outbreak was 1.016 (95%CI 0.9435-1.095). CONCLUSION: The modelling suggested that in the modern era war may not significantly damage efforts to control TB in the long term. This might be due to the limited scale of most of these conflicts compared to the large-scale civilian disruption associated with 'world wars'. The management of TB should be considered in planning post-conflict refugee and reconstruction programmes.

Disease Notification↗
PubMed1996

Reasons for under-reporting of notifiable conditions.

OBJECTIVE: To determine the reasons for under-reporting of notifiable conditions by doctors in a tertiary hospital. DESIGN: Questionnaire survey. SETTING: King Edward VIII Hospital, Durban. PARTICIPANTS: A stratified sample of 77 doctors was interviewed. MAIN OUTCOME MEASURES: Doctors' knowledge about notifiable conditions was assessed. Their knowledge was quantified by assigning a score of 1 for each notifiable condition listed. Doctors' opinions of the problems or shortcomings in the reporting system and their suggestions to improve it were also obtained. RESULTS: The overall mean score of correctly listed notifiable conditions was 5.7 (SD 2.6). Only 23.4% of doctors read Epidemiological Comments and 28.6% the table of notifications in the South African Medical Journal. The notification form was considered too complicated by 13% of the doctors and too laborious by 55.8%. Some doctors (19.5%) either did not know the location of a book for notifications, or did not know if one existed. CONCLUSIONS: The overall knowledge of doctors with regard to notifiable conditions was poor. Factors influencing knowledge of notifiable conditions and under-reporting are the accessibility and complexity of the notification form, lack of motivation because of poor feedback on reported cases, and a perception that it is useless to report notifiable conditions. A short, simple and readily accessible form is recommended to improve the reporting rate. Information on the notification process, in particular the importance of notification for disease control and health planning, should be included in undergraduate training and continuing medical education for doctors.

Communicable Diseases↗
PubMed1998

Whooping cough surveillance in the north west of England.

The number of whooping cough notifications has declined in recent years, as vaccine coverage has recovered from the low levels seen in the 1970s and 1980s. Notification of infectious disease is often incomplete, and this study aimed to estimate the extent to which whooping cough is undernotified. We included all cases of whooping cough occurring in the North West Region between 1 April 1994 and 31 December 1996, identified by notification, hospital admission data, or laboratory reports. By combining the three sources, 1239 cases were identified, 69.6% of which were notified. The notification rate was 29.6% (131/442) for cases admitted to hospital and 45.6% (78/170) for laboratory reported cases. Completeness of notification was estimated to be 35.7% (863/2420; 95% confidence interval 30.3-43.4%) using the capture-recapture method. The study confirms that notification of whooping cough is incomplete and suggests that two thirds of cases are not notified.

Age Distribution↗
PubMed1998

Enhanced surveillance for pesticide poisoning in the Western Cape--an elusive target.

AIM: The poor state of reporting of pesticide poisoning is widely recognised as a hindrance to the development of preventive programmes that aim to address this important cause of mortality and morbidity in farm workers. This study aimed to assess the extent to which notification could be improved by enhancing passive surveillance procedures. METHODS: An awareness campaign targeting a range of health care providers was conducted in a rural farming area. This included improving the availability of cholinesterase testing and encouraging all providers to notify on suspicion. Existing reporting forms were supplemented with additional questions, and notification took place through existing channels. The rate of notification in the study area was compared with that in surrounding areas and previous years. RESULTS: Fourteen poisoning events involving 56 people were reported, with 2 events together accounting for 44 cases. All patients were hospitalised. Over 90% of cases occurred on farms, with the farm store being the most common source of pesticide. Only one case was notified by a general practitioner. The rate of notification in the study area was approximately tenfold that of previous years and of the surrounding area for the same year (P < 0.0001). CONCLUSION: Although the enhanced surveillance programme resulted in an increase in notifications, the programme appears to have been ineffective in detecting mild cases of poisoning or in improving notification on suspicion by general practitioners.

Adolescent↗
PubMed2004

[Experiences and difficulties in implementing immunization registries in Saxony-Anhalt].

In the German Federal State of Saxony-Anhalt, the Health Department must be notified of vaccines administered to children <7 years of age including their names. The goal of this mandatory notification is to improve and stabilize the age-appropriate vaccination coverage. However, difficulties have been encountered in implementing mandatory notification. Therefore, the Health Departments of Magdeburg and Halle have launched a model project focusing on analysing and eliminating these problems. Mandatory notification requires parents' approval, endorsement of vaccantors, and availability of human and technicely resources in the Health Department. An enquiry among paediatricians and family doctors in private practice revealed widespread reservations about mandatory notification because of privacy issues related to data and legal protection. Furthermore, family doctors believed that parents disapproved of notification by name. However, a survey among young mothers revealed this not to be the case. Winning young mothers' approval depends largely on the positive attitude of the vaccinators. To implement the mandatory notification of vaccinations to the Health Department, it is necessary to dispel physicians' concerns and to inform young parents about the practical benefits. However, this places high demands on the Health Departments for maintaining immunization registries, communicating with physicians and notifying parents when immunisations are due or late.

Adult↗
PubMed1994

General practice awareness of notifiable infectious diseases.

The Acheson Report concluded that the process of infectious disease notification in England and Wales was unsatisfactory and recommended that it should be reviewed. However, the success of any notification system will depend on the knowledge and motivation of general practitioners, who are responsible for a large proportion of infectious disease notifications. A district-wide telephone survey was conducted in Croydon among general practitioners to assess the level of awareness of which diseases are on the statutory notification list. Respondents' opinions were also sought on the composition of the present list. Results indicated that a generally high level of awareness contrasted with a relative paucity in knowledge of certain of the more common diseases. Differences in knowledge were not associated with the sex, the length of time since the doctor qualified or the number of partners in the particular practice. Motivation may be a particularly important factor underlying the present incompleteness of notifications. A large proportion of doctors stated that legionellosis, AIDS, brucellosis and listeriosis merited statutory notification.

Communicable Disease Control↗
PubMed1989

Assessing the value of different sources of information on meningococcal disease.

Both the true incidence of meningococcal disease and the proportion of cases of meningococcal meningitis notified in England and Wales are not known. A comprehensive search for cases of meningococcal disease within a defined boundary, that of Greater Manchester, was made using various sources of information, for 1985. Sixty-seven per cent of cases of meningococcal meningitis and 63 per cent of meningococcal disease were notified. Fifty-seven percent of cases were referred for further tests to the United Kingdom meningococcal reference laboratory. Only 79 per cent of cases were identifiable on Hospital Activity Analysis (HAA) data. Information was also sought on sources of notification, notification delay, delay in laboratory diagnosis and length of stay. There is considerable potential in reducing notification delay, after comparing dates of laboratory diagnosis and notification. Notification should be more complete. In the absence of this ideal, surveillance of meningococcal disease needs to rely on various sources of information to gain a complete picture of the disease. Management of contacts of cases and of outbreaks is impossible without prompt and complete notification.

Humans↗
PubMed2004

Does ambient temperature affect foodborne disease?

BACKGROUND: Foodborne illness is a significant public health issue in most countries, including Australia. We examined the association between temperature and salmonellosis notifications, and compared these associations for 5 Australian cities. METHODS: Log-linear models describing monthly salmonellosis notifications in terms of calendar time and monthly average temperatures were fitted over the period 1991 to 2001 for each city. We used a negative binomial chance model to accommodate overdispersion in the counts. RESULTS: The long-term trend showed an increase in salmonellosis notifications in each of the 5 cities. There was a positive association between monthly salmonellosis notifications and mean monthly temperature of the previous month in every city. Seasonal patterns in salmonellosis notifications were fully explained by changes in temperature. DISCUSSION: The strength of the association, the consistency across 5 cities, and a plausible biologic pathway suggest that higher ambient temperatures are a cause of higher salmonellosis notifications. The lag of 1 month suggests that temperature might be more influential earlier in the production process rather than at the food preparation stage. This knowledge can help to guide policy on food preparation and distribution. It also suggests a basis for an early warning system for increased risk from salmonellosis, and raises yet another possible health problem with global warming.

Australia↗
PubMed2005

Chlamydia trachomatis testing in the second British national survey of sexual attitudes and lifestyles: respondent uptake and treatment outcomes.

BACKGROUND: Noninvasive molecular tests for bacterial sexually transmitted infections (STIs) provide new opportunities for testing in nonclinical settings. Little information is available on the outcomes when applied to asymptomatic sex survey participants. OBJECTIVE: The objective of this study was to examine patient treatment preferences and partner notification outcomes among Chlamydia trachomatis-positive cases identified in the 2000 national survey of sexual attitudes and lifestyles (Natsal 2000), and factors associated with providing a urine sample. METHODS: The authors conducted a stratified probability sample survey of 11,161 men and women aged 16 to 44 years residing in Britain using computer-assisted self-interviews. Urine testing was performed for C. trachomatis offered to a random half of sexually active respondents aged 18 to 44 using ligase chain reaction. Notification, treatment, and follow up of ligase chain reaction-positive respondents were undertaken. RESULTS: A total of 5105 respondents were invited to provide a urine sample. A total of 3628 (71%) agreed and 3608 samples were successfully tested. Willingness to provide a urine sample was significantly higher among those reporting previous homosexual experience, heterosexual anal sex, and STI diagnosis. Seventy-three respondents (31 men and 42 women) were diagnosed with genital chlamydial infection. Sixty-five (89%) responded to notification of their infection and were recommended for treatment and partner notification. Fifty (77%) respondents preferred to be seen by their general practitioner and 15 (23%) by their local genitourinary medicine clinic. Although physician feedback on treatment and partner notification outcomes was obtained for only half (n = 34) of respondents, follow-up respondent interviews confirmed that a total of 49 (75%) respondents underwent this process. INTERPRETATION: In this community-based survey, the rate of provision of urine samples was high, and those who provided samples were found to be at somewhat greater risk of infection on average. This was accounted for in estimating population chlamydia prevalence. The authors found that treatment and partner notification of newly diagnosed infections can be successfully achieved in STI prevalence studies.

Adolescent↗
PubMed2006

A systematic review of HIV partner counseling and referral services: client and provider attitudes, preferences, practices, and experiences.

OBJECTIVES: The objectives of this study were to understand client and provider attitudes, experiences, and practices regarding HIV partner notification in the United States and to help identify future research and program needs. GOALS: The goals of this study were to synthesize the literature reporting client and provider attitudes, experiences, and practices and to identify potential negative effects of HIV partner notification. STUDY DESIGN: This study consisted of a systematic qualitative review. RESULTS: Clients were willing to self-notify partners and participate in provider notification, and few reported negative effects. The majority of health care providers were in favor of HIV partner notification; however, they did not consistently refer index clients to HIV partner notification programs. CONCLUSION: Considering that clients have positive attitudes toward self- and provider referral, local HIV prevention programs need to ensure that all HIV-positive clients are offered partner notification services. Additional research is needed to assess the potential risks of notifying partners and to identify effective techniques to improve client and provider participation.

Attitude↗
PubMed1994

Surveillance for Bordetella pertussis infection in Victoria.

Our aims were to describe the epidemiology of Bordetella pertussis infection in Victoria during the last decade and to evaluate surveillance of B. pertussis by comparing notifications with laboratory isolations and hospital diagnoses. Whooping cough was once a leading cause of childhood morbidity and mortality but there was a dramatic reduction in the 1940s because of immunisation. During the last two decades, controversy about the vaccine's toxicity has resulted in waning immunisation rates and outbreaks of the disease. The notification system in Victoria has undergone changes which make interpretation of surveillance data difficult. We compared notifications of B. pertussis with laboratory data from the Royal Children's Hospital and hospital separations with B. pertussis from all hospitals in Victoria. The latter sources revealed epidemic years of infection in 1982, 1985 and 1989. This was not apparent from notifications alone and highlights the importance of using multiple sources of surveillance data. We also found a higher rate of notification from Geelong than rural Victoria and metropolitan Melbourne. The fluctuating incidence of B. pertussis infection in the last decade may reflect changing immunisation practices. Unfounded fears that pertussis vaccine causes serious neurological sequelae have inappropriately influenced individual practice and legislation. The increased notification of B. pertussis in the early 1980s may have reflected the omission of the fourth dose of pertussis vaccine from the Australian schedule in 1979. Surveillance data should be used not only for descriptive epidemiology, but for public health action, and efforts should be made to ensure that immunisation rates remain high.

Child↗
PubMed1981

Whooping cough in relation to other childhood infections in 1977-9 in the United Kingdom.

Estimates based upon notifications indicate that there was in the 1977-9 triennium in the United Kingdom the largest outbreak of whooping cough for 20 years or more. During this triennium there was also a sharp increase in other infections diseases of childhood, notably in non-notifiable respiratory infections. Isolates of certain respiratory viruses ran in parallel and collectively outnumbered those of Bordetella pertussis during the period of increase in notifications. There was highly significant positive correlation between isolates of B pertussis and of ECHO viruses, of Mycoplasma pneumoniae and rhinoviruses and, in Scotland only, of Coxsackie virus. Deaths in which whooping cough was certified as the immediate of underlying cause were lower than in previous outbreaks. Only a minority were bacteriologically confirmed. A closer study of the outbreak in Glasgow disclosed considerable variations in notification procedure and lack of correlation with isolates of B pertussis at the peak of the notification period. Attack rates calculated from notification were higher in deprived areas. Birth cohort studies showed a significantly higher proportion of notifications in unvaccinated children aged 1-4 and this was confirmed in family studies of clinical whooping cough in home contacts. But, overall, about 35% of reported cases were children who had received three injections of triple vaccine. Acceptance of pertussis vaccine fell sharply in 1975 but about 95% of unvaccinated children in age groups 0-5, including the 1977 and the 1977 and 1978 birth cohorts, either escaped infection or were not notified.

Adolescent↗