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PubMed1996

The high morbidity associated with a measles outbreak in a west Australian town.

OBJECTIVE: To determine the effectiveness of the measles vaccine and to record the morbidity during a measles outbreak. METHODOLOGY: A retrospective cohort study was carried out. It was a community-based study in Bunbury, Western Australia, between February and May 1994, of 53 cases of measles and their household contacts. RESULTS: Of the 53 cases of measles, 24 were from one high school. Only two cases occurred in the high school class that had received the National Health and Medical Research Council of Australia recommended measles, mumps and rubella (MMR) booster 12 months earlier. Neither had been vaccinated. Vaccine effectiveness was 91% (95% confidence interval 67-97%). Ten cases had complications of measles and a further five were admitted to hospital. Doctors prescribed antibiotics to 29 cases and metoclopramide to five cases. One month elapsed between the day the index case became ill and the first notification to the community health centre. CONCLUSIONS: The low herd immunity that led to this high school outbreak can be attributed to low vaccine coverage. There was a significant morbidity associated with this outbreak that may have been averted if earlier notification had occurred. The MMR booster dose should be offered to all 10-16 year olds to prevent high school outbreaks.

Adolescent↗
PubMed2005

Characteristics of patients with delayed diagnosis of infectious pulmonary tuberculosis.

OBJECTIVE: The aim of this study was to identify patient and disease characteristics associated with delayed diagnosis of infectious pulmonary tuberculosis (TB). METHODOLOGY: A retrospective analysis of 375 adult patients with culture-positive pulmonary TB and cough, treated at the Singapore Tuberculosis Control Unit (TBCU) in 2000, was carried out using data extracted from the TB notification registry and clinical records of the TBCU. Demographic, social, clinical and disease characteristics of patients with reported cough of duration less than, and exceeding, the median duration for the study population were compared. RESULTS: The median duration of cough reported at TB notification was 4 weeks (range, 1-156 weeks). By multivariate analysis, patients with cough > 4 weeks were more likely to be < 65 years old (adjusted odds ratio (OR), 1.8; 95% CI, 1.1-2.9; P = 0.02), of Chinese ethnicity (adjusted OR, 2.0; 95% CI, 1.2-3; P = 0.004), more likely to be sputum acid-fast bacilli smear-positive (adjusted OR, 1.7; 95% CI, 1.1-2.7; P = 0.016), and to have weight loss (adjusted OR, 2.6; 95% CI, 1.7-4; P < 0.01). CONCLUSION: Further studies are needed to identify the possible reasons for delayed diagnosis of TB among those < 65 years old, in the Chinese population in Singapore.

Adolescent↗
PubMed1986

Experience with spinal injuries in New South Wales.

Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty-nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One-man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed2005

Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease.

BACKGROUND: Acute epiglottitis due to infection with Haemophilus influenzae type b (Hib) is much less common in children following the introduction of Hib vaccination; however, adult epiglottitis cases have not decreased. In addition, epiglottitis hospitalizations are consistently more numerous than notifications and the reason for this is not clear. AIMS: To more accurately describe the clinical, aetiological and epidemiological features of epiglottitis and to ascertain the accuracy of hospitalization data in an era of widespread Hib vaccination. METHODS: Medical records in 11 public hospitals in three area health services in New South Wales with a principal or stay diagnosis (International Classification of Diseases (ICD)-9-CM or ICD-10-AM code) of acute epiglottitis between July 1990 and June 1992 (prior to Hib vaccination = pre-vaccine era) and July 1998 and June 2000 (widespread Hib vaccination = vaccine era) were reviewed. Case definitions of epiglottitis were applied. RESULTS: One hundred and forty-two records were identified (114 pre-vaccine era and 28 vaccine era). Incorrect coding was more common in vaccine era records (32 vs 7%). Of correctly coded records, adults over 20 years old comprised the majority in the vaccine era (84 vs 17%). Hib bacteraemia was identified in 62% of cases in the pre-vaccine era compared to no cases in the vaccine era, despite equivalent blood cultures being taken between the two eras (84 vs 74%). Streptococcus pneumoniae was the only other organism isolated. Three deaths were recorded (1 child, 2 adults), all in the pre-vaccine era. CONCLUSIONS: Acute epiglottitis hospitalizations in the current Hib vaccine era are predominantly in adults, and rarely are Hib or other causative organisms identified, although microbiological data are often incomplete. The discrepancy between hospitalization and notification data appears to be due to misclassification of hospitalization records.

Acute Disease↗
PubMed2004

Psychological impact of childhood islet autoantibody testing in families participating in the BABYDIAB study.

AIMS: To determine anxiety in parents of children undergoing testing for islet autoantibodies. SUBJECTS AND METHODS: Children of parents with Type 1 diabetes (T1DM) were tested at birth, age 9 months, 2 years and 5 years for islet autoantibodies. Families were informed about islet autoantibody status in the child after each visit. The psychological impact of islet autoantibody testing was assessed in parents before and after the 5 years visit. Anxiety was measured using a subscale of the State-Trait-Anxiety Inventory (STAI) and structured single-item questions. Four hundred and sixty-three parents were evaluated before blood drawing and 317 parents at notification of islet autoantibody status. RESULTS: Before blood withdrawal, anxiety was increased in mothers and in particular in mothers of islet autoantibody-positive offspring compared with a normative control group. At notification of islet antibody status, anxiety significantly decreased in parents of islet autoantibody-negative offspring, and increased in parents of islet autoantibody-positive offspring. Blood withdrawal was considered a burden for parents and offspring (15% and 48%, respectively). Most parents from islet autoantibody-negative and -positive offspring wished to know the diabetes risk of their child (95% and 100%, respectively) and were glad to be informed about their child's islet antibody status (97% and 87%). CONCLUSIONS: Overall, islet autoantibody testing in early childhood reduces anxiety in T1DM families. The increased anxiety associated with islet autoantibody-positive status suggests, however, that testing should be performed in centres which can provide accurate risk information and counselling if required.

Anxiety↗
PubMed2002

The risk of Ross River and Barmah Forest virus disease in Queensland: implications for New Zealand.

OBJECTIVES: To describe the incidence of Ross River (RR) and Barmah Forest (BF) virus disease in Queensland and determine the risk of importation of RR virus from Queensland into New Zealand (NZ) via viraemic travellers. METHODS: Based on routine RR and BF virus notification data of seven major urban tropical and subtropical Queensland populations, incidence rates adjusted for age, sex, season and a baseline level of immunity were used to examine the annual and seasonal risk of disease in the specific populations and selected subgroups. The risk for NZ was determined by estimating the number of infections among major visitor groups travelling from Queensland to NZ, using seroconversion rates. RESULTS: In Queensland, annual rates of RR and BF virus disease ranged between 31.5-288.3 and 3.4-37.4/100,000 person years respectively and increased to between 48.4-423.5 and 3.8-40.4/100,000 person years at risk when adjusted for immunity. Our estimates indicate that more than 100 viraemic travellers may enter NZ from Queensland each year. Estimates were greatest among New Zealanders returning home. CONCLUSIONS AND IMPLICATIONS: Usefulness of notification data could be maximised by presenting more detailed information to the local governments responsible for the control and public health awareness of these pathogens. Given the high number of viraemic persons entering NZ, the abundance of possums and the emergence of Oc. camptorhynchus, transmission of RR virus within NZ is probable. Health authorities should prepare for a virgin soil epidemic of RR virus by initiating serological and clinical surveillance in key areas, enhance public and professional awareness and elevate national resources necessary to invoke emergency vector control and case management.

Adolescent↗
PubMed2003

Immunisation coverage in Australia corrected for under-reporting to the Australian Childhood Immunisation Register.

OBJECTIVE: To assess the level of under-reporting to the Australian Childhood Immunisation Register (ACIR) and the resulting underestimation of national immunisation coverage using ACIR data, and to correct national immunisation estimates for under-reporting. METHODS: A national population-based telephone survey was conducted in May-July 2001 of two random samples of children born in 1998 and 1999 who were recorded on the ACIR as incompletely immunised at either 12 months or 24 months of age. Parents were asked whether and when their child had received the vaccinations required to qualify as fully immunised. Survey data were then used to correct ACIR-derived coverage estimates at 12 and 24 months of age. RESULTS: Of 640 surveyed children in the 12-month group, 258 (40%) met the study definition of 'definitely immunised'. This adjusted the ACIR coverage estimate upwards by 2.7% to 94% (95% CI 93.6-94.1). Of 698 surveyed children in the 24-month group, 387 (55%) met the study definition of 'definitely immunised' at the second birthday. Adjusted coverage for doses due by 24 months was 89.8% (95% CI 89.6-90.1), 5% higher than recorded on the ACIR. CONCLUSIONS: Immunisation coverage in Australia for all scheduled vaccines due by 12 months of age is 94% and for all vaccines due by two years of age is almost 90%. The ACIR underestimates coverage by up to 5%. As the ACIR database relies on provider notification, published estimates of immunisation coverage are unlikely to rise significantly above current levels, unless mechanisms are put in place to further improve notification to the ACIR.

Australia↗
PubMed2004

Women's experiences of cervical cellular changes: an unintentional transition from health to liminality?

Cervical cancer screening is a preventive intervention directed towards women to both detect cervical cancer and identify those at risk for developing this disease. It has been argued that participation in screening programmes and early detection situations may lead to new kinds of sickness experiences. This article is based on qualitative phenomenological hermeneutical analysis of interviews with women who have received abnormal Pap smear test results through a population-based outreach screening programme in urban Sweden. The aim of this article is to illuminate the meaning, for the participating women, of the lived experience of receiving notification about an abnormal Pap smear result. The data are presented in terms of two themes: Pap smear for routine and recurrent confirmation of health and unexpected and ambiguous communication about Pap smear results. The findings are discussed as an unintentional transition from confirmation of health to liminality. Whereas medical diagnosis has been discussed as structuring the inchoate, an abnormal Pap smear did not create order for the interviewed women. On the contrary, the notification of an abnormal Pap smear created disorder as the women had expected to be confirmed as healthy but instead neither health nor disease were confirmed or excluded. Even 'simple' technology is shown to have an ontological dimension, with the ability to transform daily taken-for-grantedness of ourselves as primarily healthy to (potentially) unhealthy.

Cervix Uteri↗
PubMed1976

Major central nervous system malformations notified in Northern Ireland, 1969 to 1973.

In Northern Ireland, during the years 1969 to 1973, there were 485 notifications of anencephalus, 525 of spina bifida and 328 of hydrocephalus in a population of 157,725 (live and still) births. The data were based on the voluntary notification system for congenital malformations which has been operating in Northern Ireland and in England and Wales sine 1964. The malformation rates per 1000 (live and still) births were 3-1 for anencephalus, 3-3 for spina bifida and 2-1 for hydrocephalus. Secular trends in these data indicate a decrease in the incidence of all three major central nervous system malformations, but this is significant only in relation to anencephalus. Spina bifida was more common in female births than in male births, and 79 per cent of affected infants were liveborn. Indirect evidence suggests that some 40 per cent of the total number of live and stillborn infants having spina bifida at birth will survive to one year of age.

Anencephaly↗
PubMed1989

Gestational trophoblastic disease in New Zealand, 1980-1986.

During the period 1980 to 1986, inclusive, 350 cases of gestational trophoblastic disease were recorded within New Zealand; of these cases nearly 70% were reported to a Register established to obtain epidemiological information. Clinical information obtained with the notifications revealed no difference in incidence of gestational trophoblastic disease among the 3 main ethnic groups which make up the New Zealand population; the uterine fundus was recorded as being large for dates in only 26%; the most common clinical presentation was as a threatened abortion; 7% of the cases were diagnosed at either routine ultrasound examination or at termination of pregnancy, there having been no suspicions prior to that procedure. A review of histological material obtained following notification suggested that the histological diagnosis of trophoblastic disease could not be substantiated in 14.7% of cases. During the period under review, therefore, there were 299 cases of trophoblastic disease (all but 2 of which were hydatidiform mole) and 447,667 pregnancies giving an incidence of 1 case of trophoblastic disease per 1,497 pregnancies.

Adult↗
PubMed2006

Integration of nucleic acid amplification test results into hepatitis C virus supplemental serologic testing algorithms: implications for donor counseling and revision of existing algorithms.

BACKGROUND: The routine use of hepatitis C virus (HCV) nucleic acid amplification testing (NAT) donor screening assays has provided an opportunity for revision of the current HCV supplemental testing algorithm, which requires that recombinant immunoblot assay (RIBA) be performed on every HCV enzyme immunoassay (EIA)-repeat-reactive donation. The FDA has approved variance requests to use a new algorithm that eliminates the need to perform RIBA when HCV NAT results are reactive. Data are provided in support of this new algorithm. STUDY DESIGN AND METHODS: HCV EIA (including signal-to-cutoff optical density ratio), RIBA, and NAT data were compiled from 33.2 million donations screened over an approximately 4-year period by the American Red Cross and Blood Systems Laboratories. Further, donations having specific combinations of HCV EIA, RIBA, and minipool (MP) NAT results were evaluated, with more sensitive individual-donation (ID) NAT, to construct improved counseling messages for donors. RESULTS: Of 47,041 EIA-repeat-reactive donations, 49.3 percent were RIBA-positive, 17.1 percent RIBA-indeterminate, and 33.5 percent RIBA-negative. NAT-reactive rates were 79.2, 2.5, and 0.18 percent for RIBA-positive, -indeterminate, and -negative donations, respectively. The new algorithm classified an additional 1 percent of donations as HCV-infected while at the same time detecting all infections classified as HCV-infected under the current algorithm. An additional 2.4 percent of RIBA-positive, MP NAT-nonreactive donations were reactive when a frozen-thawed aliquot was retested by ID NAT. CONCLUSION: Integrating HCV NAT results with RIBA results for purposes of donor notification allows more appropriate counseling messages to be given to EIA-repeat-reactive donors. The new HCV supplemental algorithm is an acceptable alternative to the current algorithm because it provides equivalent or superior accuracy in formulating donor counseling messages and may also result in reduced costs and more timely notification of infected donors.

Algorithms↗
PubMed1992

Risk of deliberate self-harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection.

The study was aimed at evaluating the risk of deliberate self-harm (DSH) and factors associated with suicidal behaviour in 213 asymptomatic individuals with human immunodeficiency virus (HIV) infection in 3 transmission categories (68 gay men, 123 intravenous drug users and 22 heterosexuals). The results showed that 12 HIV-seropositive (HIV+) subjects were involved in DSH after the notification of a positive HIV test result, of which 8 occurred within 6 months and 4 between 6 months and 3 years. HIV+ subjects with a past psychiatric history showed a 7.7-fold increase in the relative risk of DSH, and HIV+ subjects with a history of DSH showed a 5-fold increase in the relative risk of DSH compared with HIV+ individuals without a past psychiatric history and a history of DSH. Professionals involved in the care of HIV+ individuals need to be aware of this risk, especially in the first few months after notification of HIV status and also at later stages of acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Notifying women of the results of their cervical smear tests by mail: does it result in a decreased loss to follow-up of abnormal smears?

We undertook a prospective randomised intervention study of the proportions of women with abnormal cytology results who were lost to follow-up in 42 general practices in urban and rural Queensland over 26 weeks. Practices in the intervention group were provided with a redesigned cervical smear request form that allowed patients to provide an address for direct notification from the laboratory by mail. Satisfaction questionnaires sent to the general practitioners in the intervention group showed that most made at least some use of direct notification, and most felt it was worthwhile. For women with an initial result of cervical intraepithelial neoplasia (CIN), there was a loss to follow-up of 23 per cent (95 per cent confidence interval (CI) 11 to 39) among the control group compared to none in the intervention group (upper CI 7 per cent), a highly significant difference (P < 0.001). Mailing cervical screening results to women may reduce the loss to follow-up of those with CIN findings.

Continuity of Patient Care↗
PubMed2026

Ross River virus transmission, infection, and disease: two and a half decades of research progress-an updated cross-disciplinary review.

SUMMARYRoss River virus (RRV) causes the most mosquito-borne disease notifications in Australia and a considerable burden of non-fatal, yet frequently prolonged rheumatic illness across the Australia-Pacific region, reflected in thousands of notifications each year and notable economic and quality-of-life losses. Research on RRV spans multiple disciplines, encompassing viral genomics, immunopathology, transmission ecology, epidemiology, entomology, and environmental science. This review synthesizes two decades of cross-disciplinary investigations to present an integrated perspective on the biological, clinical, ecological, and environmental dimensions of RRV infection. By consolidating findings from diverse fields, the review enhances understanding of the complex factors influencing RRV transmission and disease outcomes throughout its endemic range.

Humans↗
PubMed1991

Immunologic function in a cohort of human immunodeficiency virus type 1-seropositive and -negative healthy homosexual men.

The study objectives were to determine the early effects of human immunodeficiency virus type 1 (HIV-1) infection on both phenotypic and functional immunologic markers in healthy homosexual men, to ascertain the relationships of these markers to each other, and to discover which markers were affected by enrollment in an AIDS study in which HIV-1 serostatus would be determined. The major findings were as follows. (i) The CD4/CD8 ratio and lymphocyte proliferative response to pokeweed mitogen were the characteristics most affected by early HIV-1 infection. (ii) The loss in CD4 cells observed in the HIV-1-positive homosexual men was entirely due to diminished numbers of the memory subset. CD4+ CD29+. The reciprocal subset of CD4, CD4+ CD45RA+, did not differ in the two groups of homosexual men at either time point or in the controls. (iii) Prior to learning their HIV-1 serostatus, HIV-1 antibody-negative risk-group males had lower phytohemagglutinin (PHA) responses than the controls did. In the assays following notification of their seronegativity, however, these men had PHA values which were not different from those of the controls. In the HIV-1-positive group, the responses to both PHA and pokeweed mitogen were below those of both HIV-1-negative groups and did not change after serostatus notification. (iv) The activity of natural killer cells was lower in the risk-group men than in the controls at both pre- and postdiagnosis but was not related to HIV-1 serostatus. (v) In this cohort of homosexual men, the CD4/CD8 ratio correlated significantly with the functional measures of immunologic status in the HIV-1-positive men, but not in the HIV-1-negative men.

Adolescent↗
PubMed1997

Audit of screening programme for congenital hypothyroidism in Scotland 1979-93.

OBJECTIVE: To evaluate the efficiency of the screening programme for congenital hypothyroidism in Scotland and to determine the outcome in the cohort of children with positive testing for thyroid stimulating hormone (TSH). DESIGN: Establishment of comprehensive database for all Scottish infants with high TSH, detected on Guthrie screening. SUBJECTS: 344 infants born between August 1979 and December 1993 with TSH greater than 40 mU/l on initial Guthrie, or 15-40 mU/l on repeat Guthrie. MAIN OUTCOME MEASURES: Ages at time of: (a) Guthrie collection, (b) notification of positive result by laboratory, and (c) start of treatment; audit of late diagnosis/missed cases; categorisation of positive cases into definite and probable congenital hypothyroidism, transient TSH elevation, and uncertain status; educational status of children with definite and probable congenital hypothyroidism. RESULTS: 344 positive cases were categorised as having definite (224) and probable (11) congenital hypothyroidism, transient TSH elevation (88), and status uncertain (21). The overall incidence of definite/probable congenital hypothyroidism was 1 in 4400 live births. For the definite/probable groups median age of Guthrie collection was consistently between 6 and 7 days from 1983 onwards but for the whole cohort was later than 10 days in 10.5%. Median age of notification fell from 14 days in 1980 to 11 days in 1993. Median age of starting treatment ranged between 11 and 15 days from 1983 onwards. Treatment was delayed in four cases, three due to failed or late Guthrie card submission. Of 149 children with definite/ probable congenital hypothyroidism who were of school age, educational status was ascertained in 139 (93%). Only two children (1.4%) were attending special school, one of whom was known to have mild hypothyroidism. Sixteen children (11.5%) were receiving extra help in mainstream education compared with 18% of control children in the Scottish very low birth weight study. CONCLUSION: The current screening programme is working well, but efficiency could be increased by earlier and more reliable Guthrie collection. A substantial proportion of children picked up on the screening programme have a transient rise in TSH rather than true congenital hypothyroidism. The incidence of special education and learning support in Scottish children with congenital hypothyroidism appears to be no different to that of the general population.

Age Factors↗
PubMed1999

Epidemiology of pyridoxine dependent and pyridoxine responsive seizures in the UK.

OBJECTIVE: To study the epidemiology of pyridoxine dependent seizures and other forms of pyridoxine responsive seizures. DESIGN: Monthly notifications to the British Paediatric Surveillance Unit over two years. Questionnaire follow up. SETTING: UK and the Republic of Ireland. PATIENTS: Children aged 15 years or younger whose seizures respond to pyridoxine. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Numbers of children with definite, probable, and possible pyridoxine dependent seizures or other seizures responsive to pyridoxine. RESULTS: Point prevalence and birth incidence: 1/687 000 and 1/783 000, respectively (definite and probable cases); 1/317 000 and 1/157 000, respectively (all types of pyridoxine responsiveness). NOTIFICATIONS: Pyridoxine dependency: 14 definite, 9 probable, and 10 possible cases; neonatal seizures not meeting case definitions: 7; infantile spasms: 5. Eight of 18 families of definite/probable cases had 2 affected siblings. Just over a third had atypical presentations and just under a third had features and/or initial diagnoses of birth asphyxia and neonatal hypoxic ischaemic encephalopathy. CONCLUSIONS: Pyridoxine dependency is rare. Atypical presentations are relatively frequent. A trial of pyridoxine is justified in all cases of early onset intractable seizures or status epilepticus, whatever the suspected cause.

Adolescent↗
PubMed2001

Ascertainment of children with congenital cataract through the National Congenital Anomaly System in England and Wales.

BACKGROUND/AIMS: Congenital ocular anomalies contribute significantly to childhood visual morbidity, with congenital cataract being a major cause of visual impairment throughout the world. As in many other countries, a National Congenital Anomaly System (NCAS) exists in England and Wales to monitor the frequency of ocular and other anomalies in order to identify new public health hazards and inform aetiological research. The aim of this study was to assess level of ascertainment by the NCAS of children with congenital cataract. METHODS: Using independent ophthalmic and paediatric national active surveillance schemes, all infants (< or =1 year) newly diagnosed with congenital and infantile cataract in England and Wales in 1 year from September 1995 were identified. These notifications were compared with those made independently to the NCAS during the same period. The proportion of cases identified by the active surveillance schemes and also notified to the NCAS was determined. RESULTS: 10% (15/149) of eligible children with newly diagnosed congenital or infantile cataract were actually notified to the NCAS. A higher proportion of those diagnosed as neonates (16%, 14/85) than in later infancy (2%, 1/64) was ascertained through the NCAS. There is a need for better verification of notifications and reported information in the NCAS. CONCLUSION: Currently, ascertainment of congenital cataract through the NCAS is low and the system is likely to be insensitive to small but important changes in risk factors for this disorder. This limits its use for monitoring secular and other trends in ocular anomalies. Strategies to improve its future use are discussed, including enhancing the awareness and participation of ophthalmic professionals involved in managing children with anomalies.

Cataract↗