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PubMed2003

Epidemiology of hepatitis C virus infection in Australia.

BACKGROUND: Since the discovery in 1989 of hepatitis C virus (HCV) as the infectious agent responsible for the vast majority of post-transfusion non-A non-B hepatitis the patterns of transmission and clinical consequences of this highly prevalent flavivirus have been widely studied. OBJECTIVE: This paper reviews available evidence on the epidemiology of HCV infection in Australia, including HCV notification data obtained through public health surveillance systems, HCV seroprevalence surveys among high risk populations, and models for estimating and projecting HCV transmission and long-term consequences of chronic HCV infection. RESULTS: Over the period 1990-2000 approximately 160,000 notifications of HCV infection were received by State and Territory health jurisdictions making it the most commonly notified communicable disease in Australia. Approximately 210,000 people are estimated to be living with HCV infection in Australia, with an estimated 80% having acquired their infection through injecting drug use. Less than 500 cases of newly acquired HCV infection are notified each year, however, an estimated 16,000 new infections occur annually. Despite the widespread introduction of needle and syringe programmes in the late 1980s, HCV transmission continues at high levels among current injecting drug users (IDUs) with incidence and prevalence estimates of 10-20/100 person years and 50-55%, respectively. Levels of HCV transmission are particularly high in both younger and incarcerated IDUs. In contrast to HCV infection, prevalence of HIV among current IDUs has remained below 2% since 1995. Although a small minority of people with chronic HCV infection will develop liver failure or hepatocellular carcinoma, the incidence of these advanced disease complications is estimated to double over the next decade. CONCLUSION: The epidemic of HCV infection continues to escalate in Australia, predominantly through transmission related to injecting drug use. As the population of people with chronic HCV infection and progressive liver disease expands the public health burden of advanced disease complications will be considerable.

Adolescent↗
PubMed2002

Predicting tuberculosis among migrant groups.

In industrialized countries migrants remain a high-risk group for tuberculosis (TB). Multiple linear regression analysis was used to determine the ability of indicators of TB incidence in the country of birth to predict the incidence of TB among migrants in Australia during 1997. World Health Organization total case notifications, new smear-positive case notifications and the estimated incidence of TB by country of birth explained 55, 69 and 87% of the variance in TB incidence in Australia, respectively. Gross national income of the country of birth and unemployment level in Australia were also significant predictors of TB in migrant groups. Indicators of the incidence of TB in the country of birth are the most important group-level predictors of the rate of TB among migrants in Australia.

Australia↗
PubMed1999

Mumps: a current epidemiologic pattern as a necessary background for the choice of a vaccination strategy.

Before the measles mumps rubella (MMR) vaccination was widely offered, the epidemiologic data about mumps (morbidity, immunization level, vaccine coverage) were analyzed in Piedmont region (Italy). The disease had a 3- to 5-year epidemic recurrence with morbidity rate between 40 and 150/100,000; the surveillance conducted by 'sentinel' pediatricians showed that the notifications underestimated the real data by about 5- to 7-fold. The 12-year-old subjects showed an immunization level (reached by the disease or the vaccination) of about 50% and their parents tended to refuse the MMR vaccination. Only 54% of the 3- to 5-year-old children received the MMR vaccine in the second year of life and the frequency of the vaccination failure was about 10%. The strategy of vaccination should take into account this epidemiologic pattern, to program an offer adequate to reach mumps control/elimination; the strategy of our region should include the active offer in the second year of life to reach higher coverage, a second offer at 4-6 and/or 12 years of life, when other vaccinations are given and the choice of a highly efficacious vaccine. The improvement of the notification system could also allow a more sensitive surveillance of epidemiologic patterns.

Adolescent↗
PubMed2002

Neonatal tetanus elimination in Mpumalanga Province, South Africa.

Neonatal tetanus (NNT) is a serious but preventable disease, and the World Health Organization (WHO) wants to eliminate NNT globally by reducing its incidence to <1 case per 1000 live births. South Africa adopted this goal in 1995, but Mpumalanga, a rural province, has consistently reported cases of NNT despite an appropriate vaccination strategy to eliminate the disease. The aim of the study was to investigate the completeness of the passive notification system and to explore reasons for ongoing NNT cases despite implementation of the provincial vaccination strategy. We reviewed all hospital admissions in the province between 1996 and 2000 meeting the case definition for NNT and interviewed mothers of the NNT cases reported in 2000. We identified 26 NNT cases, of which only 14 (54%) were reported through the routine notification system. Most cases occurred as a result of the cultural practice of applying cow dung or rat faeces to the umbilical stump in the neonatal period. Although all districts met the WHO elimination target during the review period, there is scope to prevent unnecessary NNT deaths through culturally acceptable public awareness campaigns aimed at changing harmful practices, and encouraging hygienic births and postnatal cord care.

Disease Notification↗
PubMed2005

[Tuberculosis in Germany in 2001 and 2002].

The implementation of the new law on infectious diseases in 2001 and the resulting notification of more detailed variables has led to a better knowledge about the epidemiology of tuberculosis (TB) in Germany. 7,515 new cases of active tuberculosis were notified to the Robert Koch Institute in 2001, and 7,684 cases in 2002, corresponding to an incidence of 9.1 (2001) and 9.3 (2002) per 100,000 inhabitants (as per 1 October, 2003). The slight increase in new cases in 2002 is most likely due to under-notification in 2001 because of the new system, considering that the previous decline over many consecutive years is continued according to the incidence for 2003 (8.7/100,000; n = 7,184). In 2001 as well as in 2002 42 % of new TB patients were born outside Germany, and those of foreign nationality have a five-fold higher incidence on the average than German citizens. The lung remains the most affected organ (80 %). 4,230 (2001) and 4,267 (2002) were cases of open, i. e., bacteriologically confirmed, pulmonary tuberculosis potentially contagious to their immediate contacts. The resistance rates are stable in the indigenous population, while patients coming from countries with high resistance rates reflect the situation in their countries of origin. Over two thirds of TB patients in Germany are hospitalized at some point during their disease. The treatment results (78 % on the average in 2001) do not reach the WHO target of 85 %. Approximately 7 % of TB patients in Germany still die because of this infectious disease.

Disease Notification↗
PubMed1998

HIV follow-up care at a London teaching hospital.

Counselling around all stages of HIV infection is important for those infected and affected with HIV disease. Partner notification may promote safer sexual practices and increase HIV-related social support which might in turn prompt the psychological adjustment to a terminal illness. This paper describes the counselling service used at the Royal Free Hospital's HIV Unit and explores the notification patterns of an HIV diagnosis to family, partners and significant others. Retrospective data was abstracted from counselling notes for 100 HIV-positive patients attending the unit for the first time between November 1995 and March 1996. The majority of the sample were gay males who tested from 1995 onwards. Most patients tested at the Same Day Testing Clinic (SDTC) were gay males. In contrast, patients who tested elsewhere were more likely to be females. Rates of pre- and post-test counselling were high and the majority (85%) of the patients had notified a family member, partner or significant other. Few significant differences in demographics were found between those who had notified others and those who had not, although patients who had been diagnosed more recently were less likely to have notified other family members. The implication of the results are discussed.

Adolescent↗
PubMed2005

Epidemiology and surveillance of pertussis among infants in Catalonia, Spain, during 1997-2001.

BACKGROUND: Despite high levels of vaccination coverage in Spain and Catalonia (98% in 2002), pertussis is a significant cause of morbidity among infants. The study aim was to estimate the incidence of hospitalizations for pertussis among infants from 1997 through 2001 in Catalonia. METHODS: A retrospective review of records for patients <12 months of age with a diagnosis of pertussis (International Classification of Diseases, 9th revision, code 033) at discharge from 11 Catalonian hospitals was performed. RESULTS: Three hundred forty-six patients were identified, 62 (1997), 28 (1998), 59 (1999), 150 (2000) and 47 (2001), of whom 284 (82%) were <4 months of age. The incidence of hospitalizations because of whooping cough from 1997 through 2001 in Catalonia was estimated at 118 cases per 100,000 inhabitants <12 months of age. Symptoms included paroxysmal cough (95%), cyanosis (67.9%), vomiting (36.7%) and apneic episodes (27.7%). Three infants (0.8%) died, all <2 months of age. Two hundred thirty-four patients (67.6%) were unvaccinated (222 patients were <3 months of age). Six patients (1.7%) were fully vaccinated (3 doses). Considering that only 220 patients <12 months of age were reported through the Catalonian Notification System in 1997-2001, at least 126 hospitalizations (36.4%) for pertussis were not reported to this system (mean difference per year, 32.6%; range, 8.4-56%). CONCLUSIONS: In this study, hospitalizations exceeded the number of notifications by at least 32.6%; therefore, the real incidence is likely to be greatly underestimated. Pertussis incidence remains high among infants, most of whom are <4 months of age and have had no or 1 dose of vaccine.

Bordetella pertussis↗
PubMed1997

A review of Q fever in Australia 1991-1994.

Q fever continues to be an important disease in Australia. Despite the development of an effective vaccine that has been commercially available since 1989, the number of cases notified has continued to increase. This study reviewed national notifications of Q fever between 1991 and 1994, together with demographic, socioeconomic and occupational information, to investigate temporal and spatial disease patterns. Based on notification data, Q fever can be considered primarily a disease of adult males that occurs in eastern Australia: southern Queensland and northern New South Wales have the highest levels of activity. A significant association between Q fever activity of areas and the presence of livestock was found. A strong association with the meat industry was also confirmed. Q fever is conservatively estimated to cost Australia around A$1 million and more than 1700 weeks of work time annually. There is a need to increase awareness of this disease and its prevention. An extension program in rural communities and provision of vaccine to all abattoir workers would appear to be sensible public health approaches.

Adolescent↗
PubMed2002

Meningococcal disease and meteorological conditions in Auckland, New Zealand.

OBJECTIVE: The purpose of the study was to explore and model the relationship between meteorological variables and meningococcal disease notifications in Auckland during an ongoing group B meningococcal disease epidemic. METHODS: An ecological study design was used to investigate the relationship between 1,097 notified cases of meningococcal disease from January 1992 to December 1998 among residents of Auckland's three health districts and various meteorological variables. Descriptive epidemiology and Poisson regression modelling were used to describe this relationship. FINDINGS: The study found that the occurrence of meningococcal disease varied with season, increased with high humidity and cooler temperatures and appeared to decline with prolonged periods of heavy rain. Poisson regression analysis showed a significant relationship between the expected number of cases developing meningococcal disease on a given day and season and temperature. DISCUSSION: The results of the modelling analysis provide the initial work for the future development of a predictive tool to forecast the magnitude and duration of the annual peak in meningococcal disease incidence using routine notification data and meteorological recordings, thus allowing for better management of the public health workload and interventions, and the appropriate timing of media campaigns.

Disease Notification↗
PubMed2005

Results of a hepatitis C general transfusion lookback program for patients who received blood products before July 1992.

BACKGROUND: The Centers for Disease Control and Prevention recommend hepatitis C virus (HCV) antibody (anti-HCV) screening for persons who received blood products before July 1992. A general transfusion lookback program was implemented to identify, counsel, and screen persons who received transfusions at the Alaska Native Medical Center between January 1980 and July 1992. STUDY DESIGN AND METHODS: Hard-copy transfusion records data were entered, and available databases were queried to identify deceased patients and the mailing address of those living. Patients were notified by letter of their HCV risk and encouraged to seek counseling and testing. Serum samples were screened for anti-HCV and HCV RNA, and program costs were estimated. RESULTS: Overall, 3169 transfusion recipients were identified, with 1356 (43%) living and targeted for notification. Of 764 patients notified and screened by this program, 41 (5%) were anti-HCV-positive and 19 (2%) were HCV RNA-positive. There was a higher probability of detecting anti-HCV with each subsequent increase of a transfusion event. Among 298 lookback patients, 33 percent were unaware of having received a blood transfusion. The estimated cost per person sent notification was US$57 and to detect an anti-HCV-positive case it was US$3146. CONCLUSION: This general transfusion lookback program successfully notified and screened patients at a reasonable cost. Further investigation would be helpful in determining the role these programs or other measures could play in promoting HCV screening in persons receiving transfusions before July 1992, especially among those who are unaware of their transfusion history.

Alaska↗
PubMed1995

Influenza in Madrid, Spain, 1991-92: validity of the sentinel network.

OBJECTIVES: The aim was, firstly, to study the validity of the sentinel network data by analysing the correlation between the weekly influenza cases detected by the network and the number of cases notified to the compulsory disease notification system and, secondly, to describe the epidemiology of the period 1991-92 in terms of the sentinel network data. DESIGN: The study design was descriptive. SUBJECTS: The population resident in the city of Madrid. MAIN RESULTS: There was a high correlation between the cases notified to the compulsory disease notification system and those listed by the sentinel network (r = 0.91, p < 0.001, r2 = 0.82). The epidemic activity during the period 1991-92 was centred approximately on week 48 in 1991 and week 6 in 1992 (24 November 1991-8 February 1992). Altogether 913 cases of influenza were notified through the sentinel network. The greatest number of cases occurred in people aged between 20 and 39 years. CONCLUSION: For the epidemiological surveillance of influenza it is necessary to develop systems that can quickly detect epidemic periods and provide information about populations at risk, in addition to systems that isolate and identify seasonal epidemic viruses. Both types of data will help the development of adequate public health policies. Sentinel networks provide these data and offer additional advantages such as lower cost.

Adolescent↗
PubMedDate not supplied

Soft tissue sarcomas in the general population living near a chemical plant in Northern Italy.

BACKGROUND AND OBJECTIVES: After the notification by a general practitioner of a high frequency of soft tissue sarcomas among subjects living close to the industrial area of the city of Mantua (northern Italy), the local Medical Association carried out a formal epidemiologic investigation to corroborate or falsify the hypothesized excess. Several industrial activities of the area were hypothesized to be a source of environmental pollution that might cause soft tissue sarcomas. METHODS: All general practitioners working in the area were requested to report the cases of soft tissue sarcoma diagnosed in the study area. Person-years of observation were computed for all subjects who ever resided in the area between 1984 and 1997. Expected incidence was computed from the cancer registry covering a nearby province (Varese) and from the pool of Italian cancer registries. Peripheral soft tissue sarcoma and visceral sarcomas were included in the analysis. RESULTS AND CONCLUSIONS: Overall, 20 cases were observed in a 13-year period, 8.87 were expected from the Varese province cancer registry and 7.72 from the pool of Italian registries. The corresponding standardized morbidity ratios were 2.25 (95% confidence interval, 1.34-3.47) and 2.6 (95% confidence interval, 1.6-4.0), respectively. A significant excess persisted after excluding 5 cases that had been the object of the original notification. We hypothesize that the soft tissue sarcoma excess may have resulted from environmental pollution by industrial toxic emissions, which likely included 2,3,7,8-tetrachloro-dibenzo-dioxin.

Adult↗
PubMed1995

What are women told about Pap smears that lack endocervical cells?

BACKGROUND: Debate exists about the definition of what constitutes an adequate Pap smear and about the recommended rescreening interval for Pap smears lacking an endocervical component. This study aimed at determining whether women are currently informed about the endocervical status of their Pap smears and what rescreening recommendations are made to women whose smears lack endocervical cells. METHOD: Consecutive Pap smears lacking an endocervical component were identified from pathology records. After obtaining consent from the referring doctor, 165 women were interviewed by telephone. RESULTS: Only 110 (67%) of 165 women received active notification of their Pap test result and only six (4%) were aware that their smear lacked endocervical cells. Thirteen (8%) had been advised to have a repeat smear within three months. Nearly half the women reported that they would like more information about their result. CONCLUSIONS: It seems that current Pap smear notification patterns for women in New South Wales could be improved. One third are not actively informed at all about their results, and few are given detailed information about their Pap test results. Methods of enhancing the level of information women are given about their medical and screening tests need to be improved.

Adult↗
PubMed2003

A proposed architecture and method of operation for improving the protection of privacy and confidentiality in disease registers.

BACKGROUND: Disease registers aim to collect information about all instances of a disease or condition in a defined population of individuals. Traditionally methods of operating disease registers have required that notifications of cases be identified by unique identifiers such as social security number or national identification number, or by ensembles of non-unique identifying data items, such as name, sex and date of birth. However, growing concern over the privacy and confidentiality aspects of disease registers may hinder their future operation. Technical solutions to these legitimate concerns are needed. DISCUSSION: An alternative method of operation is proposed which involves splitting the personal identifiers from the medical details at the source of notification, and separately encrypting each part using asymmetrical (public key) cryptographic methods. The identifying information is sent to a single Population Register, and the medical details to the relevant disease register. The Population Register uses probabilistic record linkage to assign a unique personal identification (UPI) number to each person notified to it, although not necessarily everyone in the entire population. This UPI is shared only with a single trusted third party whose sole function is to translate between this UPI and separate series of personal identification numbers which are specific to each disease register. SUMMARY: The system proposed would significantly improve the protection of privacy and confidentiality, while still allowing the efficient linkage of records between disease registers, under the control and supervision of the trusted third party and independent ethics committees. The proposed architecture could accommodate genetic databases and tissue banks as well as a wide range of other health and social data collections. It is important that proposals such as this are subject to widespread scrutiny by information security experts, researchers and interested members of the general public, alike.

Computer Security↗
PubMed2006

Assessment of routine surveillance data as a tool to investigate measles outbreaks in Mozambique.

BACKGROUND: Measles remains a major public health problem in Mozambique despite significant efforts to control the disease. Currently, health authorities base their outbreak control on data from the routine surveillance system while vaccine coverage and efficacy are calculated based on mathematical projections of the target population. The aim of this work was to assess the quality of the measles reporting system during two outbreaks that occurred in Maputo City (1998) and in Manica Province (2002). METHODS: Retrospectively, we collected data from the routine surveillance system, i.e. register books at health facilities and weekly provincial and national epidemiological reports. To test whether the provinces registered an outbreak, the distribution of measles cases was compared to an endemic level established based on cases reported in previous years. RESULTS: There was a significant under-notification of measles cases from the health facilities to the province and national level. Register books, the primary sources of information for the measles surveillance system, were found to be incomplete for two main variables: "age" and "vaccination status". CONCLUSION: The Mozambican surveillance system is based on poor quality records, receives the notification of only a fraction of the total number of measles in the country and may result in failures do detect epidemics. The measles reporting system does not provide the data needed by Expanded Program on Immunisation managers to make evidence-based decisions, nor does it allow in-depth analysis to monitor measles epidemiology in the country. The progress of Mozambique to the next stage of measles elimination will require an improvement of the routine surveillance system and a stronger Health Information System.

Adolescent↗
PubMed2006

A review of interventions triggered by hepatitis A infected food-handlers in Canada.

BACKGROUND: In countries with low hepatitis A (HA) endemicity, infected food handlers are the source of most reported foodborne outbreaks. In Canada, accessible data repositories of infected food handler incidents are not available. We undertook a systematic review of such incidents to evaluate the extent of viral transmission through food contamination and the scope of post-exposure prophylaxis (PEP) interventions. METHODS: A systematic search of MEDLINE and EMBASE was conducted to identify published reports of incidents in Canada. An expanded search of a news repository (i.e., transcripts from newspapers and newscasts) was also conducted to identify the location and timing of an incident, which was used to retrieve the related report by contacting local public health departments. Data pertaining to case identification, public health risk, PEP interventions, and associated costs was independently abstracted by two reviewers and summarized according to incidents with and without large PEP interventions. RESULTS: A total of 16 incidents were identified from 1998-2004. There were approximately 3 incidents requiring public notification per year. Only 12.5% of incidents were described in published reports, indicating that published data significantly underestimated the number of incidents and PEP interventions. Data pertaining to the remaining incidents was unpublished, sparse and highly dispersed at the local public health level. Six of the 16 incidents required large PEP interventions to immunize on average 5000 potentially exposed individuals. Secondary transmission was low. Characteristics of incidents requiring large PEP interventions included potentially infectious food handlers working with uncooked food for a prolonged duration in high-volume grocery stores in high-density urban areas. CONCLUSION: Infected food handlers with hepatitis A virus (HAV) requiring public notification are not infrequent in Canada. Published data severely underestimated the burden of PEP intervention. Better and consistent reporting at the local and national level as well as a national data repository should be considered for the management of future incidents.

Canada↗
PubMed2003

Hepatitis C in Austria 1993-2000: reporting bias distort HCV epidemiology in Austria.

From 1993 to 2000 in Austria, the notification system registered 2232 cases of hepatitis C whereas 10 607 hospital cases were reported in the hospital discharge register (HDR). These differences can be explained by under-reporting due to lax reporting behaviour and stigma associated with this disease. The distribution of HCV infection varied geographically. The notification data showed the highest incidence rates in Tyrol, while HDR data showed highest hospitalisation rates in Vienna and Lower Austria. This study highlights the urgent need for a clear case definition at the national level and an electronic reporting system.

Austria↗
PubMed2004

European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease: the Italian experience.

In Italy, 35 clusters of travel associated Legionnaires' disease were identified from July 2002, when the European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease have been adopted by the EWGLINET network, to October 2003. Eight per cent (28.6%) would not have been identified without the network. The clusters detected were small, ranging from 2 cases to a maximum of 6. All clusters involved 5 camping sites and 30 hotels/residences, and an overall of 87 patients. The diagnosis was confirmed in 92.0% of the cases and mainly performed by urinary antigen detection (84.7%). A clinical isolate was available only in one case. Following environmental investigations, samples were collected for all the 35 clusters from the water system, and Legionella pneumophila was found in 23 occasions (65.7%). In 15 resorts out of 35, investigations were already in progress at the time of EWGLI cluster notification, since in Italy full environmental investigation is performed even after notification of a single case. Control measures were implemented in all accommodation sites at risk and one hotel only was closed. In all the 35 clusters, reports were completed and sent on time, highlighting that it is possible to comply with the procedures requested by the European Guidelines.

Adult↗