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PubMed2005

Surveillance of Shiga toxigenic Escherichia coli in Australia.

All Australian States and Territories have low rates (< or = 0.32 cases per 100,000 population) of notification for Shiga toxin-producing Escherichia coli (STEC), except for South Australia where the rates are ten-fold higher at 2.58 cases per 100,000 population. To explore possible reasons for the variation in rates we surveyed public health reference laboratories to determine the methods used and number of specimens tested for these organisms. Only five of eight jurisdictions routinely conducted testing for STEC, and polymerase chain based tests were most common. Culture was also common and in one jurisdiction that tests specimens with culture, approximately 1.2 per cent of specimens were positive. The notification rates for different jurisdictions reflected the number of specimens tested, with jurisdiction testing < or = 500 specimens having rates < or = 0.32 cases per 100,000 population. The use of culture as a test method may also influence notification rates. Public health agencies must consider the number of specimens tested in interpreting surveillance data.

Australia↗
PubMed2006

Influenza surveillance in Victoria, 2005.

Influenza activity remained within normal seasonal activity with a well-defined peak at week 29 (beginning 18 July) during the Victorian influenza season from May to September 2005. Surveillance was based on sentinel general practice influenza-like illness (ILI) notifications with laboratory confirmation, medical locum service ILI notifications and laboratory notification of influenza detections. One thousand and eighty-seven consultations for ILI were reported from 38 general practices, while medical practitioners from the locum service reported 317 consultations for ILI. The average weekly rate of ILI from sentinel surveillance was 7.3 per 1,000 consultations. Similar numbers of influenza A subtypes H1N1 and H3N2 were detected; 45 per cent of which were A/California/7/2004-like (H3), 44 per cent were A/New Caledonia/20/99-like (H1) and 11 per cent were A/Wellington/1/2004 (H3). Of the influenza B samples, 67 per cent were B/Hong Kong/330/2001-like and 33 per cent were B/Shanghai/361/2002-like. The influenza vaccine for 2005 contained: A/New Caledonia/20/99(H1N1)-like virus, A/Wellington/ 1/2004(H3N2)-like virus, and B/Shanghai/361/2002-like virus. Although the predominant H3 and B circulating strains were not included in the vaccine, there was reasonable serological cross protection between vaccine and circulating strains.

Adolescent↗
PubMedDate not supplied

[Communicable disease surveillance in Navarre, 2004].

Epidemiological surveillance in Navarre (584,734 inhabitants) covers 34 transmissible diseases, whose notification is compulsory, and epidemic outbreaks of any aetiology. Notification is carried out on a weekly basis by the doctors from paediatrics, primary care and specialised care. In 2004, 75.8% of all the possible notification reports (a weekly report for each doctor) were received, a percentage that has improved in the last five year period. Flu only reached 14.4 cases per 1,000 inhabitants (Epidemic Index, EI: 0.30), due to the advance of the epidemic peak for the 2003-2004 season to the month of November. The rate of respiratory tuberculosis fell to 11.6 cases per 100,000 inhabitants, and the rate of non-respiratory tuberculosis rose to 2.7 per 100,000. Ten cases of tuberculosis (11.9%) were grouped into four outbreaks that affected adolescents and young adults. Thirty percent of the cases were produced in immigrants and 4.8% in persons coinfected with HIV, proportions that are similar to those of the previous year. Eleven cases of meningococcal disease were reported, (1.9 cases per 100,000 inhabitants; EI 0.73), but only in 8 cases was the clinical form sepsis and/or meningitis. Neisseria meningitidis serogroup B was isolated in 8 cases, and serogroup C in 2 cases, the latter 2 were adults and were not vaccinated. The incidence of immunopreventable diseases continues to fall, and for the fifth consecutive year no case of measles has been reported. Legionnaire's disease, which is detected through the systematic determination of the antigen in urine, rose to 5.8 cases per 100,000 inhabitants (EI: 1.42), without any epidemiological relation between them. The incidence of imported diseases rose, with 12 cases of malaria, 8 of shigellosis, 5 of hepatitis A and 2 of legionnaire's disease acquired outside Spain.

Adult↗
PubMedDate not supplied

[The quantification of tuberculous disease in an Italian area and the estimation of underreporting by means of record linkage].

The description and interpretation of tuberculosis spatial and temporal variations in Italy is rather difficult because of well-grounded suspicions of disease underestimation, related with the bad working of the compulsory notification system. In this study, the record-linkage technique was used to estimate the proportion of TB undernotification in an Italian area, in order to give a first quantitative estimate of tuberculosis at a geographical level. The area considered was the Local Health Agency of Florence (population in 1994: 803,588) in 1995. Information for record-linkage was taken from: the Regional TB Archive, Hospital Discharge files, Laboratories, Pathology Departments, the Regional AIDS Registry, the Regional Mortality Registry. The linkage among the different sources was based on first and last name, date and place of birth, or only on first and last name for the laboratories. Prevalent cases and relapses were excluded through comparison with various historical archives. Most cases signalled only in hospital discharges were re-evaluated through original medical records. In such a way, the original sample was reduced from 690 to 182 cases incident in 1995, diagnosed in the area considered, and mostly resident in the same area. Among these cases, 98 (53.8%) were unknown to the compulsory notification system. The most of them come from hospital departments (27 cases) and from laboratories (47 cases). Fourty-nine of the unknown cases concerned pulmonary TB. The notification rate in the area moves then from 10.5/1000 to 22.7/1000.

Disease Notification↗
PubMed1998

Epidemiology of tuberculosis in Europe.

The regular decline in tuberculosis (TB) notification rates observed in several industrialized countries over the past two decades has levelled off or reversed in recent years. The aim of the present study is to review the epidemiological situation in Europe (updated to 1996), focusing on the annual risk of TB infection, mortality, notifications and age distribution of new smear-positive cases. Epidemiological data were obtained from national statistical reports produced by the Ministry of Health, the Global Tuberculosis Programme and Monitoring Project of the World Health Organization and the Euro TB Report on the feasibility study of Surveillance of Tuberculosis in Europe. The increasingly high mortality rates notified by the Baltic States, Romania, the Russian Federation and the countries previously belonging to the USSR and a few countries of the former Yugoslavia have been attributed to late patient detection and low cure rates, compounded, in some cases, with a lack of first-line drugs, resulting in the use of suboptimal regimens. In addition, higher death rates than in the general population have been described in risk groups, including prisoners and exprisoners, alcohol addicts and the unemployed. The analysis of notification rates and trends in Europe indicates that a stabilization in the number of notified cases or even a new decline had been achieved where efficient TB control programmes had been established or revitalized (e.g. in the majority of Western European and in several Central European countries).

Disease Notification↗
PubMed1995

California expands the duty to warn patients exposed to and infected with HIV. Reisner v. Regents of the University of California.

There is still no general definitive guide for hospitals and other health care providers concerning the extent of their duty to warn third parties of a patient's HIV status. However, even in states like California that have statutorily eliminated any duty to directly inform third parties, the Reisner case clearly indicates that liability to third parties may arise indirectly based on a failure to warn HIV-exposed or -infected patients of their status and the risks of communicating the virus to others. Accordingly, health care providers should take several actions: 1. Ascertain, with the assistance of legal counsel, the precise dictates of applicable state statutes and case law regarding (a) a provider's obligation to warn HIV-exposed or -infected individuals of the potential of communicating the virus to others; (b) additional statutory requirements such as notification of public health authorities; and (c) whether notice to third parties at risk of exposure from the patient is required or even permitted. 2. Develop and implement written policies regarding notification and counseling of exposed or infected patients, including counseling patients on the risks of communicating the virus to third parties; and 3. Develop and implement written policies regarding permissive or mandatory notification and counseling of exposed or infected third parties. In this context, providers should be aware that patient confidentiality and privacy laws may prohibit disclosure of the identity of exposed or infected patients to third parties.

California↗
PubMed1999

[Factors for the onset of and the exacerbation of tuberculosis. 6. Recent socio-medical characteristics of tuberculosis and their perspectives in Japan].

In the late 1970s the decline of TB incidence rate has begun to slow down among both elderly population and younger one. This phenomenon mostly owed the reactivation of dormant M. tuberculosis infection among the elderly people and small TB outbreaks in the younger generation. The micro-epidemics among adolescent and young adults have been reported since 1980. The latest data showed the TB incidence in 1997 was 33.9 per 100,000 population, increased from 33.7 per 100,000 in 1996. To explain the situation above, several sociomedical factors were discussed as follow: (1) Age distribution of TB: The highest peak of newly registered TB patients shifted to the elder age cohorts and was the age group between 65 and 74 years in 1997, contrasting small peaks observed in 20-29 years age group remained unchanged. (2) Characteristics of infection route: Overall incidence rates of smear positive TB cases slightly increased in 1980s and leveled off thereafter. However, the number of smear positive cases among persons elder than 70 years old sharply increased, 1,779, 3,744, 5,728, in 1977, 1987 and 1997, respectively. Several papers showed that about one quarter of TB patients was diagnosed as TB while being treated for diseases other than TB. This may have contributed to the current TB infection. (3) Delay in case-finding: Patient's delay in symptomatic smear positive cases, especially among male patients in 30-54 age group, has been increased during last 10 years. This may also contribute to the current TB issue to the younger people. (4) TB problems in the cities: TB incidence rate in a certain area of some big cities was much higher than the other areas and the regional difference became magnificent due to serial socioeconomic problems of vulnerable population there. (5) Notification of TB: One study using mailed questionnaires showed that only 76 percent of medical doctors knew the TB notification system under the TB control law. It concluded that contact tracing would become more important issue in case-finding and the 100 percent of TB notification in medical institutions would be indispensable.

Adolescent↗
PubMed2000

[An outbreak of scarlet fever, impetigo and pharyngitis caused by the same Streptococcus pyogenes type T4M4 in a primary school].

UNLABELLED: EPIDEMIC: Following the notification of an unusual number of scarlet fever cases within the same primary school, the epidemiological and clinical features of the outbreak were investigated. Questionnaire information about the cases was collected from parents and general practitioners per telephone. Throat specimens were taken, before and after treatment, for culturing and specific typing of streptococci was performed to determine transmission. Within a period of one month, 21 schoolchildren in a class of 29 pupils, with a mean age of 5 years, presented with symptoms caused by streptococcal infection (attack rate: 72%). Eight had scarlet fever, 5 suffered from impetigo and 8 had pharyngitis. A further 6 children, outside of this class, had complaints of scarlet fever, impetigo or pharyngitis. For 90% (26/29) of the schoolchildren a throat culture was established. Twelve positive cultures of the same strain of beta-haemolytic group A streptococcus, T4M4 exotoxin C gene positive, were found. The advice given was to treat all positive children for 3 days with azithromycin to prevent complications and further spreading of the disease. After two weeks only one child, that had not taken the antibiotics, still had a positive throat culture. No further cases or complications were reported. DISCUSSION: The pattern of the outbreak was typical of a person-to-person transmission. This was confirmed by typing of the isolates. The results of this study demonstrate the importance of mandatory notification of infectious clusters by institutions, such as schools, as introduced in the new Dutch Infectious Disease Act. On the one hand, the notification gives the municipal health authority the opportunity to analyse source and transmission dynamics and on the other to prevent disease and complications.

Bacterial Typing Techniques↗
PubMed2003

Using a geographical information system to plan a malaria control programme in South Africa.

INTRODUCTION: Sustainable control of malaria in sub-Saharan Africa is jeopardized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (AIDS) epidemic. In Mpumalanga province, South Africa, rational planning has historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdivision of a province). METHODS: To better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented. The introduction of a simplified notification form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographical information system. RESULTS: The geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria risk within those magisterial districts at highest risk, Barberton and Nkomazi. The conspicuous west-to-east gradient, in which the risk rises sharply towards the Mozambican border (relative risk = 4.12, 95% confidence interval = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control. DISCUSSION: The geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown. Matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in Mpumalanga province.

Databases, Factual↗
PubMedDate not supplied

[Epidemiology of human hydatidosis in the IX Region of la Araucania, Chile 1991-1998].

In the region of la Araucania, located in the south of Chile (37 degrees 24'-39 degrees 34' South lat.), the economy is based in cattle raising and agriculture. The cases of human hydatidosis, mortality and notification registered in la Araucania 1991-1998 are reviewed. The rate for hydatid disease is 38.5 per 100,000 population. Liver (47.1%) and lung (40.7%) were the most affected viscera. Days in hospital, 11-20 the 56.1%. Disease in female is 51.1%. The mortality rate is 0.8 per 100,000, the most frequently affected county is Imperial. The age group 15-44 years is the most affected. The notification rate is 8.74 per 100,000 population. The rate for hydatid disease is higher than the rate of notification, then necessarily there exist a subnotification. We think that it is necessary to investigate the serological prevalence of hydatidosis in the population of the IX Region Araucania.

Adolescent↗
PubMed2001

Pyrazinamide use as a method of estimating under-reporting of tuberculosis.

OBJECTIVE: To develop a method of validating the notification of active tuberculosis by physicians in the Netherlands. METHOD: The chemotherapeutic agent pyrazinamide was used as a marker for the occurrence of tuberculosis. On the basis of defined daily doses (DDD) of pyrazinamide dispensed to out-patients, an estimate was made of the number of patients with tuberculosis in the Netherlands in the period 1994-1998. DDD is a technical unit of measurement and does not necessarily reflect the recommended or actual dose used. Usually it is based on the average dosage per day for the main indication in adults with normal organ function. The Dutch Drug Information Project (GIP) of the Health Care Insurance Board (CVZ) provided the DDD data. Based on the notification of tuberculosis patients to the Netherlands Tuberculosis Register (NTR) we calculated how much pyrazinamide (measured in DDDs) these patients would have used depending on their body weight. RESULTS: The number of DDDs prescribed according to the GIP pharmacy records differed by only 8% from the number of DDDs calculated on the basis of notification to the NTR; 6889 patients should have been registered instead of 6349. CONCLUSION: The close correlation between the use of pyrazinamide as measured by the GIP and NTR provides strong evidence that in the Netherlands tuberculosis is reported in conformity with the guidelines for notifiable diseases. The method was simple to apply and may deserve follow-up in other countries.

Adolescent↗
PubMed2002

Mass measles immunization campaign: experience in the Hong Kong Special Administrative Region of China.

After the 1988 measles outbreak, annual notification rates for measles in Hong Kong SAR between 1989 and 1999 were 0.4-4.9 per 100 000, with peaks in 1992, 1994 and 1997. The first half-year incidence rates per 100 000 were 2.3 in 1997, 0.5 in 1995 and 1.2 in 1996. Monthly notification rates increased from a baseline of <10 cases to 59 in May 1997. Serological surveillance showed only 85.5% of children aged 1-19 years had measles antibodies. An epidemic, mainly because of failure of the first dose to produce immunity, seemed imminent in mid-1997. A mass immunization campaign targeted children aged 1-19 from July to November 1997. The overall coverage was 77%. The rate of adverse events was low. After the campaign, measles notification fell to 0.9 per 100 000 in 1998. A two-dose strategy and supplementary campaigns will maintain measles susceptibility at levels low enough to make measles elimination our goal.

Adolescent↗
PubMed1987

Act, 29 April 1987.

This Act amends Sections 36-2152 36-2153 of the Arizona Revised Statutes, which deal with parental notification requirements for abortions performed on minors. It replaces such notification requirements with a requirement that the treating physician receive written consent from one of the minor's parents or the minor's legal guardian before an abortion is performed. It also eliminates an exception to the notification requirement in cases where the parent or legal guardian cannot be located.

Abortion, Induced↗
PubMed2004

From tuberculin to prevalence survey in Cambodia.

OBJECTIVES: To assess the annual risk of tuberculosis infection (ARTI) in urban and rural areas of Cambodia in 1995, and to document the decreasing trend since 1955. To compare tuberculosis (TB) estimates based on ARTI with active case finding activities and tuberculosis notification data. METHODS: Two national representative samples of 3524 and 4407 schoolchildren were tested with 1 TU of tuberculin, PPD RT23/Tween 80. Estimates based on ARTI were compared with the results of both active TB case finding and case notification, using WHO/IUATLD-recommended quarterly reports available country-wide since 1994. FINDINGS: ARTI was estimated to be 0.75% (0.56-0.96%) in Cambodia in 1995 using a 10 mm induration cut-off point. The average ARTI annual decrease was 4.2% per year in Phnom Penh and 4.9% per year in the provincial areas from 1955 to 1995. The estimated TB incidence based on urban ARTI is 2.4 times lower than the TB notification rate in 1995, and 4.3 times lower than the incidence estimated from the screening survey. CONCLUSION: The ARTI has regularly declined over time. Predicting the TB incidence from ARTI should be complemented in Cambodia by ongoing prevalence surveys. More accurate estimates are needed to maintain political support for the National Tuberculosis Programme.

Cambodia↗
PubMed2004

Decreasing tuberculosis case fatality in England and Wales, 1988-2001.

SETTING: Despite declining tuberculosis mortality per head of population, there was little change in tuberculosis case fatality in England and Wales from 1974 to 1987. OBJECTIVE: To determine the trend in tuberculosis case fatality for England and Wales from 1988 to 2001. DESIGN: Annual deaths to notifications ratios (DNRs) for tuberculosis were calculated using published notification and mortality data, and analysed by age group and three disease sites (central nervous system [CNS], respiratory and other). DNRs for seven disease sites (miliary, bone and joint, CNS, respiratory, genitourinary, gastrointestinal and other) were calculated for 1998 and 1999 combined, using additional data from the enhanced tuberculosis surveillance programme. RESULTS: DNR for all ages and disease sites combined fell from 9.26% in 1988 to 5.59% in 2001 (r = -0.90; 95%CI -0.97 - -0.70). DNRs for 1998-1999 combined were 41% for miliary disease, 17% for bone and joint disease, 8% for CNS disease, 7% for respiratory disease, 2% for genitourinary and gastrointestinal disease and 0.6% for other disease. CONCLUSIONS: Some of the decrease in DNRs may be due to improving notification rates. True declines in overall case fatality reflect increases in the proportion of tuberculosis patients in younger age groups and with low mortality extra-pulmonary disease.

Adolescent↗
PubMed2004

Childhood tuberculosis in a low-income Paris suburb: lessons from a resurgence brought under control.

SETTING: Few series of paediatric tuberculosis (TB) have been reported in the last 20 years. OBJECTIVE: To describe diagnostic and treatment practices in children with TB living in Seine-Saint-Denis, a low-income Paris suburb. METHODS: Local TB incidence in 1998 was 34.2/100,000 overall and 10.2/100,000 in children. Between September 1996 and December 1997, the hospitals and prevention units serving the area's paediatric population were sent questionnaires to identify TB cases in children aged under 15 living in Seine-Saint-Denis and treated with at least one anti-tuberculosis drug. RESULTS: Of 92 cases identified, 60 (65%) had been diagnosed during contact tracing; for 52 patients (60%), the index case had been found. The reason for anti-tuberculosis treatment was active TB in 26 (28.3%), latent TB in 46 (50%), and prophylaxis in 20 (21.8%). Forty per cent (37/92) of the patients were aged under 5. Only 15 of the 35 notified cases met the criteria for mandatory notification (at least three anti-tuberculosis drugs). CONCLUSION: TB remains a public health problem in Seine-Saint-Denis. The high proportion of cases identified by contact tracing attests to the efficacy of the local contact-tracing programme. The criteria for mandatory notification in France were too restrictive to ensure effective surveillance of childhood TB. Since 2002, notification has included cases of tuberculous infection in children.

Adolescent↗
PubMed2005

Lack of adherence to the national guidelines on the prevention of rheumatic fever.

OBJECTIVES: To explore the extent to which current practices for the secondary prevention of rheumatic fever (RF) in Cape Town adhere to those outlined in the national guidelines on the primary prevention and prophylaxis of RF and rheumatic heart disease (RHD) for health professionals at primary level. METHODS: A combination of qualitative tools was used to evaluate the four priority issues identified in the guidelines as fundamental elements of a comprehensive programme for the secondary prophylaxis of RF/RHD: (i) health education and promotion; (ii) case detection of RF and RHD; (iii) secondary prophylaxis every 3-4 weeks at primary level; and (iv) notification of acute rheumatic fever (ARF). The qualitative tools included parent/child interviews of cases diagnosed with ARF in the Cape metropole area during the period 1999-2003; a physician questionnaire focused on awareness and adherence to the national guidelines; and a review of the records on acute rheumatic fever notification in the Cape metropole area from 1999 to 2003. RESULTS: The evaluation revealed four key findings. First, patient knowledge on the disease was almost non-existent. Despite this lack of knowledge, adherence to secondary prophylactic treatment was good. Second, the physicians most likely to encounter a case of rheumatic fever were least likely to be aware of and to comply with the national guideline. Third, the guidelines do not clearly state how increased detection of ARF will be achieved. Finally, the RF notification system is dysfunctional, with discrepancies in the reporting of cases at hospital, city and provincial levels. CONCLUSIONS: Since the publication of the national guidelines in 1997, little progress has been made towards achieving the implementation of a comprehensive programme for the secondary prevention of RF/RHD.

Disease Notification↗
PubMed2005

The effect of training on the reporting of notifiable diseases among health workers in Yobe State, Nigeria.

The generation of data through disease surveillance and notification system is critical to appropriate planning and implementation of disease control programmes, outbreak investigation, emergency preparedness and response. Health workers therefore need to be trained, retrained and updated on the principles and practice of disease surveillance and notification. This quasi-experimental study compared a study and control group "before and after" an intervention (training programme) in the study group. The Experimental and control LGA's were selected using a multistage, stratified random sampling technique. Overall, three LGA's were selected and enrolled in each of the groups. In each of the selected LGA's, all functional health facilities and personnel that fulfilled the inclusion criteria were then included in the study. The total number of participants in the experimental and control groups were 73 and 71 respectively at baseline. The proportion of personnel who were aware of the surveillance system increased from 35.6% to 91.9% (p=0.00) and the mean knowledge score increased from 0.85+/-1.38SD to 6.152.64SD (p=0.00) post intervention in the experimental group. The percentage completeness was 2.3% before and 52.0% after (p-0.00), while the percentage timeliness was 0.0% before and 42.9% after (p=0.00) in the experimental group. These statistically significant differences were however not demonstrated in the control group. Training therefore had a positive effect on health personnel knowledge, reporting requirement and the timeliness and completeness of the disease surveillance and notification system.

Adult↗