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PubMed2006

Detecting emerging diseases in farm animals through clinical observations.

Predicting emerging diseases is among the most difficult challenges facing researchers and health managers. We present available approaches and tools to detect emerging diseases in animals based on clinical observations of farm animals by veterinarians. Three information systems are described and discussed: Veterinary Practitioner Aided Disease Surveillance in New Zealand, the Rapid Syndrome Validation Project-Animal in the United States, and "émergences" in France. These systems are based on syndromic surveillance with the notification of every case or of specific clinical syndromes or on the notification of atypical clinical cases. Data are entered by field veterinarians into forms available through Internet-accessible devices. Beyond challenges of implementing new information systems, minimizing economic and health effects from emerging diseases in animals requires strong synergies across a group of field partners, in research, and in international animal and public health customs and practices.

Animals↗
PubMed1997

Meningococcal disease in Australia; looking at the past, thinking of the future.

In 1987 an unexpected change in the epidemiology of meningococcal disease began in Australia. The change was accompanied by an outbreak of serogroup A meningococcal disease among Aboriginal central Australians, and was followed by a progressive rise in notifications of disease caused by both serogroup B and C nationwide. Over the last 4 years, the notification rate has plateaued at 2.1-2.3 per 100,000 population. Virulent clonal groups of serogroup A and C meningococci that have caused outbreaks appear to be identical to strains that have caused large outbreaks in other countries. We cannot predict where and when the next outbreak will occur. However, we can plan to respond swiftly when it does. This report presents an overview of the observed trends, the association between the microbiology and epidemiology of meningococcal disease, and the relevance of this association to outbreaks, with recommendations for management.

Australia↗
PubMed2000

Typhoid and paratyphoid fever in south-eastern Sydney, 1992-1997.

Notification records of typhoid and paratyphoid cases among residents of south-eastern Sydney during 1992-1997 were reviewed, with particular attention paid to identifying a source of infection and to completeness of follow up. Notifications comprised 30 cases of Salmonella Typhi, nine of S. Paratyphi A and five of S. Paratyphi B. These 44 cases had a median age of 20 years (range 2-62). Of the 39 cases with known country of birth, 30 were born overseas, predominantly in Asian countries. Of 39 cases with a known travel history, 33 were cases of overseas-acquired acute infection and two cases were asymptomatic chronic carriers. A source was identified in only one of four domestically acquired infections. Of eight household contacts in occupations posing a public health risk (seven food-handlers and one health-care worker), complete follow-up information was available for only five. Most cases were in overseas-born individuals who may have been infected when returning to their country of birth. Explicit follow-up protocols need to cover appropriate clinical management (including treatment of chronic carriage) and monitoring of those cases and contacts who could pose a public health risk.

Adolescent↗
PubMed2004

Trends in potential exposure to Australian bat lyssavirus in South East Queensland, 1996 to 2003.

This study examined trends in notifications of potential exposure to Australian bat lyssavirus reported to the Brisbane Southside Public Health Unit, Australia between 1 November 1996 and 31 January 2003. Notification rates declined among all population groups and potential exposures were notified more promptly. Concern exists regarding possible under-reporting of potential exposure to Australian bat lyssavirus especially among volunteer bat carers.

Adolescent↗
PubMed2004

Foodborne disease investigation across Australia: annual report of the OzFoodNet network, 2003.

In 2003, OzFoodNet conducted enhanced surveillance of foodborne diseases across Australia, which covered all states and territories. During 2003, there were 23,250 notifications of eight potentially foodborne diseases, of which 67 per cent and 30 per cent were due to Campylobacter and Salmonella infections respectively. The most common Salmonella serotype was Typhimurium, as in previous years. Most S. Enteritidis were acquired overseas, except for Queensland where 52 per cent of infections were acquired locally. Locally acquired S. Enteritidis infections in Australia were predominantly due to phage type 26. The most common serotype of Shiga toxin producing E. coli was O157, although for 49 per cent of notified infections serotype was unknown due to the use of polymerase chain reaction based screening tests. There were 12 materno-foetal listeriosis infections in 2003, which was an increase compared to recent years. During 2003, there were 444 outbreaks of gastroenteritis and foodborne disease recorded. Ninety-nine of these were of foodborne origin affecting 1,686 persons, hospitalising 105 and causing six deaths. A wide range of agents and foods caused these outbreaks, with Salmonella Typhimurium being the most common pathogen. Outbreaks associated with fish and seafood dishes, poultry meat, and Asian style and imported foods were common. Four outbreaks with international implications were reported: an outbreak of Salmonella in Montevideo involving contaminated tahini from the Middle East and three outbreaks of norovirus infection associated with imported Japanese oysters. Outbreak data indicated a need to monitor food safety in aged care settings, restaurants and catering. Eighty-nine investigations into clusters of gastrointestinal illness where a source could not be identified were conducted, including multi-state outbreaks of salmonellosis. One multistate investigation of antibiotic resistant Salmonella Paratyphi b Java identified 18 cases who had recent exposure to tropical fish aquariums. Ninety-seven per cent of Salmonella notifications on state and territory surveillance databases have complete information on serotype and phage type. In 2003, OzFoodNet demonstrated the benefits of national collaboration to control food borne disease.

Adolescent↗
PubMed2006

Burden and causes of foodborne disease in Australia: Annual report of the OzFoodNet network, 2005.

In 2005, OzFoodNet sites recorded 25,779 notifications of seven potentially foodborne diseases, which was 12.5 per cent higher than the mean for the previous five years. Diseases with significant increases in 2005, when compared to historical reports include: Shiga toxin-producing Escherichia coli, shigellosis, haemolytic uraemic syndrome, salmonellosis and campylobacteriosis. The most significant increases were those due to Salmonella (13.1%) and Campylobacter (5.1%) because of the frequency of these infections. Reports of listeriosis were lower than previous years and there were only four materno-foetal infections compared to seven in 2004. Sites reported 624 outbreaks of gastroenteritis and foodborne disease in 2005. One hundred and two of these were foodborne and affected 1,926 persons, hospitalised 187 and caused four deaths. Among foodborne outbreaks, Salmonella Typhimurium was the most common pathogen and restaurants were the most common place where food implicated in outbreaks was prepared. Outbreaks associated with fish, poultry meat, and mixed meat dishes were common. There were several large outbreaks of salmonellosis, including one associated with dips at a Turkish restaurant, one with alfalfa sprouts, and two due to egg-based dishes. In addition, there were several multi-state investigations of Salmonella infection during 2005, including one large outbreak of S. Typhimurium 135 implicating poultry meat from retail supermarkets. Sites identified a source of infection for 39 per cent (41/104) of investigations into clusters of salmonellosis. Overall, 97.4 per cent of Salmonella notifications on state and territory surveillance databases recorded complete information about serotype and phage type. This report highlights the considerable burden of disease from food sources in Australia and the need to continue to improve food safety.

Adolescent↗
PubMed1999

Progress in global tuberculosis control 1995-1996, with emphasis on 22 high-incidence countries. Global Monitoring and Surveillance Project.

OBJECTIVE: To review global tuberculosis case notifications and treatment outcomes, and to assess progress in TB control 1995-1996, especially in the 22 countries that carry 80% of all incident cases. DESIGN: Compilation of case notifications; cohort analysis of treatment outcomes in DOTS and non-DOTS programmes. RESULTS: The 181 of 212 countries (85%) that reported data to WHO in 1997 covered 97% of the global population. They reported 3.81 million cases of tuberculosis, of which 1.29 million were smear-positive, representing case detection rates of approximately 39% and 51%, respectively. DOTS programmes diagnosed 67% of new pulmonary cases to be smear-positive (65% expected), compared with 30% in other control programmes. They evaluated a higher fraction of registered cases (94% vs 55%), achieved higher treatment success rates (78% vs 45%), and a higher fraction of patients was shown to be cured by smear conversion (72% vs 23%). Despite the apparent advantages of DOTS, only 12% of all estimated cases, and only 15% of smear-positive cases, were treated in such programmes. CONCLUSION: With the exceptions of Vietnam, Peru and Tanzania, none of the 22 highest-incidence countries achieved WHO targets for TB control. The slow progress is of greatest concern in 16 countries, including India, Indonesia, Nigeria and Pakistan.

Antitubercular Agents↗
PubMed1999

An outbreak of meningococcal meningitis in Gauteng, Spring 1996.

OBJECTIVE: To describe a Neisseria meningitidis outbreak in Gauteng during the period 1 July to 31 December 1996. DESIGN: A descriptive study. SETTING: Patients with meningococcal meningitis in Gauteng who had been diagnosed by laboratory means, or notified during the period 1 July to 31 December 1996. MAIN OUTCOME MEASURES: Data including age, sex, date of admission to hospital, N. meningitidis serogroup and outcome were collected from Gauteng notification lists, South African Institute of Medical Research (SAIMR) records, a linelist compiled by the Gauteng Health Department, and hospital records. RESULTS: A total of 201 patients was studied; of this number 87 (43%) had been notified. Seventy per cent of cases were below 30 years of age and 78% were male. More than half (54%) of the cases were from the West Rand. The case fatality rate for 70 cases of known outcome was 14%. Serotyping of 85 isolates showed that a majority (76%) were serogroup A, with 57% being serogroup A clone I-1. Serogroup A clone III-1 accounted for 14% of the typed isolates. All isolates were sensitive to penicillin with minimum inhibitory concentrations of < 0.05 microgram/ml. CONCLUSION: In 1996 Gauteng experienced an epidemic of serogroup A meningococcal meningitis. The serotype that caused the majority of cases had been recorded in South Africa before, but serogroup A clone III-1, responsible for epidemics spreading across two continents, was recorded in South Africa for the first time. Notification of cases by health workers was inadequate in this epidemic.

Adolescent↗
PubMed1999

Present state of tuberculosis in the Czech Republic and in central European and Baltic countries.

The Central Europe forms a buffer zone between the countries of the European West reporting tuberculosis notification rates lower than 20 per 100,000, the cut-off set between low and high incidence areas, and the Eastern European countries including the republics of the former USSR, Russia and the Baltic States. The Czech Republic holds an intermediate place between these two territories with the total notification rate of tuberculosis cases 18.8, 9.7 bacteriologically verified and 5.7 positive in direct smear per 100,000 in 1996. Data on drug resistance obtained from the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance were available from the Czech Republic, the only Central European country participating in the Project. The prevalence of resistant cases was here low: 2% primary and 13% acquired, and MDR cases were recorded in 1% of untreated and in 6% of repeatedly treated patients. The first microepidemic of MDR cases comprising 21 individuals was characterized by DNA fingerprinting. This outbreak pointed out the MDR tuberculosis as a new, extremely serious phenomenon in the epidemiology of tuberculosis. Corresponding data from Estonia and Latvia showed incomparably higher values in the drug resistance pattern: from 28 to 34% primary and 46 to 74% acquired resistance. MDR strains were reported in 9 to 14% of untreated and in 19 to 54% of repeatedly treated patients.

Adolescent↗
PubMed1999

[How valid is the official data from the Health Department on reported morbidity in Israel? Hepatitis A as an example].

Hepatitis A is one of the most frequently reported notifiable infectious diseases in Israel. The annual incidence as reported is around 70/100,000. The physician or the diagnostic laboratory notifies the district health office of the Ministry of Health. The purpose of this research was to evaluate the sensitivity of passive surveillance of hepatitis A morbidity among adults, 18 years and over. Methods included study of notifications to the Ministry of Health or hospitalizations of cases of hepatitis A and of positive laboratory tests results (IgM) for hepatitis A. We estimated the extent of under-reporting by 2 different methods of extrapolation. Data based on passive surveillance among the adult population, between 1.1.1993-31.12.1994, comprised less than 1/5 of the actual number of cases. Physicians notified about 6.2% of their hepatitis A patients. 5.1% of the notifications to the district health office were sent twice or more, usually both by the physicians and labs. The official data on hepatitis A morbidity, based on passive surveillance, are considerably underestimated. Physicians and public health officials should be aware that such data may not accurately reflect the magnitude of the risk or the amount of disease that can be prevented. Efforts should be made to improve this situation.

Adult↗
PubMed2000

[Diagnosis of tuberculosis in children in provinces of Argentina].

Confirming the diagnosis of pediatric tuberculosis is cumbersome, due to the clinical features (generally paucibacillary forms) of the disease. This national study was undertaken in order to establish: the features of childhood tuberculosis at the time of diagnosis, the criteria on which the pediatricians based the diagnosis, the bacteriologic contribution to the diagnosis and the quality of notifications to the National Programme. Medical and laboratory records were reviewed for children under 15 years of age who were diagnosed with tuberculosis disease or primary infection during 1995. The study included children cared for at health centres from Argentinean provinces (capital city excluded) where pediatricians accepted to participate. Four hundred cases (17% of childhood notifications to the National Programme) and 81 primary infections were studied. The percentage of children studied by means of chest radiology, presence of symptoms, Mantoux test, case contact investigation and bacteriology were 95.3%, 79.6%, 90.1%, 92.7% and 35% for pulmonary cases, respectively, and 87.7%, 100%, 87.7%, 85.9% and 78.9% for extra-pulmonary cases, respectively. Of the evaluated pulmonary cases, 99.1% had abnormal x-rays, 79.0% had a tuberculin test > or = 10 mm, 79.8% had symptoms and 80.2% had a history of close contact. All extra-pulmonary patients had symptoms at the time of diagnosis; 63.0% had abnormal chest radiograph at diagnosis. Bacteriologic confirmation was achieved in 10.7% of the cases (20.8% and 40.0% of the investigated pulmonary and extra-pulmonary cases, respectively). This study would indicate that the diagnosis is made at relatively early stages of the disease. In general, recommendations of the Argentine Society of Pediatrics were followed. A low rate of bacteriological proof of diagnosis was observed, probably due to the scarce bacteriologic investigation and the low yield achieved in culturing pulmonary specimens. The study found under-register of cases and lack of precision in the information reaching the National Programme.

Adolescent↗
PubMed2001

Childhood tuberculosis in the State of Qatar: the effect of a limited expatriate screening programme on the incidence of tuberculosis.

OBJECTIVE: To determine incidence rates and the effectiveness of the expatriate screening programme on paediatric tuberculosis (TB) in the State of Qatar. METHOD: A state-wide, population-based, retrospective analysis of all cases of tuberculosis among children 0-14 years of age reported to the TB Unit of the Division of Public Health during 1983-1996. RESULTS: One hundred and forty-four children with tuberculous disease were identified, with a steadily declining incidence rate (rate of notification) from 11/100000 children (0-14 years) population in 1983 to 7/100000 in 1996. This decrease in the childhood TB case notification rate correlated with foreign-born children, older children and the implementation of expatriate screening in 1986. Diagnosis in 56% of children was made abroad or within 3 months of arrival from vacation and 30% within one year of arrival. Comparison of the three age groups (<5, 5-9 and 10-14 years) showed no significant difference with regard to nationality, sex, type of TB, radiological findings and screening. However older children were more likely to be symptomatic (P < 0.0001) and to have positive tuberculin skin test (TST) reactivity (P = 0.012), culture (P < 0.0001), and gastric aspirates (P = 0.018). CONCLUSION: Although there was a 36% decrease in paediatric TB incidence after the implementation of expatriate screening in 1986, Qatar has a high rate of paediatric tuberculosis. The policy of BCG vaccination at birth should be continued, and screening children at school entry and on return from vacation would be useful for further case identification.

Adolescent↗
PubMed2002

[Selective screening for hepatitis B of pregnant women with previous acute hepatitis B].

INTRODUCTION: The aim of this study was to examine the performance of the selective screening programme for hepatitis B (HB) in pregnancy. MATERIAL AND METHODS: Notifications of women with acute HB in the period 1981-1997 were traced in the National Birth Registry. For children born after the HB event, details of the records on the results of HB testing and other information about the previous HB disease were obtained from the maternity wards. RESULTS: The study group comprised 129 mothers and their 185 deliveries. Of the 185 deliveries, 31% took place without any information about the previous HB disease and 51% without testing for HB. When these results were related to the information on the notification form regarding the mode of transmission, it transpired that the proportion with an unknown mode of transmission was higher in those with no information about previous HB in the maternity records than in those with information (43% vs 18%). Of 18 infants delivered of 13 chronically infected mothers, four did not receive the proper immunoprophylaxis. DISCUSSION: The study shows that a selective screening programme as used in Denmark is not good enough to identify pregnant women at risk of chronic HB infection. The main problems are related to failure to identify risk factors of hepatitis B transmission. Screening and treatment failure in siblings delivered of chronically infected mothers was also found. As in most other western countries a general programme should replace the selective screening programme.

Acute Disease↗
PubMed2002

Audit of suspected meningitis in a district in 1996-1997 and in 1999.

The Public Health Laboratory Service has published guidance outlining appropriate investigations and public health action to control the spread of meningococcal disease. We investigated compliance with this guidance in audits of suspected meningitis cases in our district notified to the public health department between January 1996 and December 1997, and in 1999. The total number of suspected meningitis cases in 1996-7 and in 1999 were 58 and 34 respectively. Meningococcal disease was suspected in 49 and 28 patients respectively, and for 58 (75.3%) of these case notes were found. Rash was more often a presenting sign in 1999. The second audit also showed a non-significant reduction in the proportion of patients given penicillin before hospital admission (22.4% vs. 7.1%, p = 0.12), and in CSF microscopy requests (31% vs. 17.6%, p < 0.5). Requests for meningococcal investigation by blood culture (77.5% vs. 79.4%, p < 0.5) blood PCR (34.5% vs. 64.7%, p < 0.001) and throat swab (25.9% vs. 55.9%, p < 0.005) were increased. Notifications of cases to the public health department within 24 hours of admission were also increased slightly (42.8% vs. 52.9%; p < 0.5). Changes in clinical practice can be achieved through guidelines, audit and feedback. The importance of parenteral penicillin administration prior to hospital admission, appropriate investigations and prompt public health notification should be re-emphasised.

Adolescent↗
PubMed2002

Preventing tuberculosis among health workers in Malawi.

OBJECTIVE: Following the introduction of guidelines for the control of tuberculosis (TB) infection in all hospitals in Malawi, a study was carried out to determine whether the guidelines were being implemented, the time between admission to hospital and the diagnosis of pulmonary TB had been reduced, and the annual case notification rates among health workers had fallen and were comparable to those of primary-school teachers. METHODS: The study involved 40 district and mission hospitals. Staff and patients were interviewed in order to determine whether the guidelines had been adopted. In four hospitals the diagnostic process in patients with smear-positive pulmonary TB was evaluated before and after the introduction of the guidelines, with the aid of case notes and TB registers. In all hospitals the proportion of health workers registered with TB before and after the guidelines were introduced, in 1996 and 1999, respectively, was determined by conducting interviews and consulting staff lists and TB registers. A similar method was used to determine the proportion of primary-school teachers who were registered with TB in 1999. FINDINGS: The guidelines were not uniformly implemented. Only one hospital introduced voluntary counselling and testing for its staff. Most hospitals stated that they used rapid systems to diagnose pulmonary TB. However, there was no significant change in the interval between admission and diagnosis or between admission and treatment of patients with smear-positive pulmonary TB. The TB case notification rate for 2979 health workers in 1999 was 3.2%; this did not differ significantly from the value of 3.7% for 2697 health workers in 1996 but was significantly higher than that of 1.8% for 4367 primary-school teachers in 1999. CONCLUSION: The introduction of guidelines for the control of TB infection is an important intervention for reducing nosocomial transmission of the disease, but rigorous monitoring and follow-up are needed in order to ensure that they are implemented.

Adolescent↗
PubMed2002

Using the two-source capture-recapture method to estimate the incidence of acute flaccid paralysis in Victoria, Australia.

OBJECTIVE: To estimate the incidence and the completeness of ascertainment of acute flaccid paralysis (AFP) in Victoria, Australia, in 1998-2000 and to determine its common causes among children aged under 15 years. METHODS: : The two-source capture-recapture method was used to estimate the incidence of cases of AFP and to evaluate case ascertainment in the routine surveillance system. The primary and secondary data sources were notifications from this system and inpatient hospital records, respectively. FINDINGS: The routine surveillance system indicated that there were 14 cases and the hospital record review identified 19 additional cases. According to the two-source capture-recapture method, there would have been 40 cases during this period (95% confidence interval (CI) = 29-51), representing an average annual incidence of 1.4 per 100000 children aged under 15 years (95% CI = 1.1- 1.7). Thus case ascertainment based on routine surveillance was estimated to be 35% complete. Guillain-Barré syndrome was the commonest single cause of AFP. CONCLUSIONS: Routine surveillance for AFP in Victoria was insensitive. A literature review indicated that the capture-recapture estimates obtained in this study were plausible. The present results help to define a target notification rate for surveillance in settings where poliomyelitis is not endemic.

Acute Disease↗
PubMed2002

[Medical birth registry--an essential resource in perinatal medical research].

Based on compulsory notification and operative since 1967 the Medical Birth Registry of Norway comprises all births in the country after 16 weeks gestation. The notification form is filled in by the midwife and the doctor and contains civil data on mother, father and the newborn as well as medical data on mother's health before and during the pregnancy, on the birth, including complications, and on the newborn, including birth defects and other congenital conditions. All diagnoses recorded before discharge from the hospital are included. From 1998, diagnoses recorded after transfer to a paediatric department and throughout the first year of life are notified as well. The registry data are used for epidemiological surveillance of birth defects and other perinatal health problems, for evaluation of health services and as a basis for perinatal epidemiological research; follow-up studies based on internal and external record linkage are essential.

Birth Certificates↗
PubMedDate not supplied

Estimation of tuberculosis incidence and mortality in Egypt using epidemiological models.

To estimate tuberculosis incidence in Egypt, data were collected from national tuberculosis case notification records, vital registration statistics, tuberculin surveys and treatment outcomes. An important source of information was the national comprehensive tuberculin survey results, which estimated a 55.2% case detection rate and a 65.6% case notification rate. The data suggest that only two-thirds of actual cases are being identified and treated by the national programme. The figures for expected versus reported deaths from tuberculosis in Egypt in 1996 suggest underreporting to be almost 80%.

Adolescent↗