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At least 19 recordsLinked to original sources
PubMed2000

Tuberculosis in the elderly.

Tuberculosis (TB) today remains one of the world's most lethal infectious diseases. An estimated one-third of the world's population is infected with the tubercle bacillus-Mycobacterium tuberculosis (Mtb), and 7 to 8 million people develop TB disease each year (27). For purpose of clarity, TB infection (latent TB) is defined as harboring Mtb without evidence of active infection, and TB disease is active infection without Mtb based on clinical and laboratory findings. Recognizing that TB has been one of the most neglected international health problems and that the TB epidemic is rampant in many parts of the world, the World Health Organization (WHO) declared TB to be a global health emergency in 1993 (23). Despite the steady decline in TB cases since this time resulting from the overall implementation of more effective infection control practices, directly observed therapy (DOT), and efforts to control the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) epidemic, preventive and control strategies among other high-risk populations such as the elderly evidently remain a clinical and epidemiological challenge. The geriatric population among all ethnic groups and both genders, represent the largest reservoir of TB infection, particularly in developed nations (9). Clinical features of TB in older adults may be atypical, non-specific, and confused with concomitant age-related diseases (28). Underlying acute or chronic diseases, malnutrition, and the biological changes with aging, can disrupt integumental barriers, impair microbial clearance mechanisms, and contribute to the expected age-associated decline in cellular immune responses to infecting agents such as Mtb. Diagnosis of TB can be difficult and consequently overlooked; this treatable infection may unfortunately be recognized only at autopsy. Furthermore, therapy of TB in the elderly is challenging because of the increased incidence of adverse drug reactions. Optimal treatment of associated chronic diseases, minimization of invasive procedures, limitation of polypharmacy, and adequate nutritional support are essential for this vulnerable population. The institutionalized elderly in addition are especially at high risk for reactivation of latent TB as well as susceptible to new TB infection. This article will discuss the global epidemiology, pathogenesis and immunologic aspects, unique clinical consideration, treatment and prevention of TB, briefly inclusive of the recent published guidelines for targeted tuberculin testing and treatment of latent TB infection as it pertains to the elderly.

Aged↗
PubMed2000

Forecasting disease risk for increased epidemic preparedness in public health.

Emerging infectious diseases pose a growing threat to human populations. Many of the world's epidemic diseases (particularly those transmitted by intermediate hosts) are known to be highly sensitive to long-term changes in climate and short-term fluctuations in the weather. The application of environmental data to the study of disease offers the capability to demonstrate vector-environment relationships and potentially forecast the risk of disease outbreaks or epidemics. Accurate disease forecasting models would markedly improve epidemic prevention and control capabilities. This chapter examines the potential for epidemic forecasting and discusses the issues associated with the development of global networks for surveillance and prediction. Existing global systems for epidemic preparedness focus on disease surveillance using either expert knowledge or statistical modelling of disease activity and thresholds to identify times and areas of risk. Predictive health information systems would use monitored environmental variables, linked to a disease system, to be observed and provide prior information of outbreaks. The components and varieties of forecasting systems are discussed with selected examples, along with issues relating to further development.

Communicable Diseases↗
PubMed1999

Prevention and control of malaria epidemics.

Malaria epidemics have recently occurred in many areas of the world, particularly in the irregular fringe, along the limits of distribution of malaria endemicity, whether the limiting factors are temperature (latitude or altitude) or relative humidity (deserts), which were the scene of the major epidemics of the past. A review is made of the current approaches to epidemic prevention and control in line with the global malaria control strategy, of which it constitutes an essential element. The different components are discussed, including the identification and study of epidemic prone areas, the search for indicators of epidemic risk, their monitoring, and the early detection and control of actual epidemics. The potential implementation of preventive and control activities depends, nevertheless, on the degree of preparedness of the health services to detect alarm signals, the real time left for action and their capacity of implementation within that time. Recent developments in geographical information systems (GIS) and satellite derived meteorological information offer most useful tools for precise and timely epidemic forecasting, although it should be recognised that such information is only useful if based on a real understanding of their local significance. There remains an urgent need to develop and support local capabilities for the ground truthing of satellite information and for translating it into preventive and control actions.

Disease Outbreaks↗
PubMedDate not supplied

[The malaria situation in the WHO European region].

The number of indigenous malaria cases in European region peaked in 1997, when 77,985 cases were officially reported. These were caused almost exclusively by P. vivax, P. falciparum being restricted to a rather limited number of cases in Tajikistan only. Another important problem in the European Region is the importation of malaria associated with a high fatality rate from tropical endemic countries. There were 841 cases of malaria in Armenia, 567 of which were locally transmitted, 30 out of 81 districts recorded malaria cases. 89% of the indigenous cases were registered in Masis district, in the Ararat valley. In 1998, total number of cases increased to 1156. Of the 542 indigenous cases registered, 376 were in Masis district. 9911 cases were officially reported in 1997 in Azerbaijan and 5175 cases in 1998. Approximately half of malaria cases were reported from seven districts: Nakhichivan (10.4%), Imishli (14.6%), Fizuli (8.1%), Sabirabad (6.8%), Saatly (6%), Bejlagan (5.6%) and Bilasuvar (4.8%). Local transmission is also reported from the periurban areas of Baku, where many displaced people are living in temporary shelters. In 1997, a total of 30,054 malaria cases were officially registered in Tajikistan, of which 85.3% occurred in the Khatlon region, 10.5% in Dushanbe region, 3.5% in Gorno-Badakhshan region and 0.7% in Leninabad region. Following implementation of malaria control activities with WHO assistance, the number of malaria cases officially registered in 1998 dropped to 19,361 (187 were cases of falciparum malaria). A dramatic change occurred in malaria situation in Turkmenistan in 1998, when 115 indigenous cases were registered. The majority of malaria cases (104) were registered in the Kushka district, in south-east of Turkmenistan, among military service personnel. In recent years, the Government of Turkey has renewed its efforts to fight malaria, incorporating them into GAP with support from UNDP and WHO. In 1998, 36,451 cases were reported, 87.1% from southeastern Anatolia, 8.7% from Adana area and 4.2% from other areas of Turkey. The epidemics in Armenia, Azerbaijan, Tajikistan and Turkey are having a considerable impact on the malaria situation in neighbouring countries of the European Region. Malaria cases have been imported from Turkey mainly to western Europe; from Azerbaijan to the Russian Federation, Georgia, and the Republic of Moldova; and from Tajikistan to the central Asian republics and to the Russian Federation. WHO made all possible efforts to mobilize and coordinate assistance from international community. WHO/EURO organized missions to those NIS where there is a risk of malaria epidemics. Most of the very limited funds reserved for epidemic prevention and control were immediatelly used to provide a limited stock of antimalarial drugs and to help the national institutions in Kazakhstan and Uzbekistan implement antimalarial activities. In 1997, with the financial support of the Italian Government and the technical assistance of the Instituto Superiore di Sanità in Rome (WHO collaborating centre for research and training in planning tropical disease control) and of the Martsinovsky Institute of Medical Parasitology and Tropical Medicine in Moscow (WHO collaborating centre on vivax malaria), the training of health personnel in the field of malaria diagnosis, treatment and control was initiated in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. In 1996-1997, Japan provided financial support for a large malaria control project in Tajikistan, and Norway supported activities carried out in 1997 to tackle the malaria outbreak in Armenia. In 1997-1998, Italy supported malaria prevention activities in Kazakhstan, Kyrgyzstan and Uzbekistan, and some of the malaria activities carried out in Tajikistan under the integrated Management of Childhood Illness initiative. Several training courses and seminars were carried out in Turkey in 1998 by the national malaria contro

Disease Outbreaks↗
PubMed1995

Modelling AIDS reduction strategies.

BACKGROUND: Mathematical models of the AIDS epidemic have not been able to give accurate predictions about the size of the epidemic because it is not possible to obtain sufficiently accurate measurements of the factors that enable HIV transmission. The uncertainties inherent in models of the AIDS epidemic appear to limit their relevance to epidemiologists. However, it is shown here that the uncertainties need not prevent models being used to make reliable decisions about which preventive strategy will be most effective. METHOD: A range of strategies are simulated in a model of the AIDS epidemic. The simulations are repeated as the value of what seems to be the most important uncertain factor, is varied. The effect of this variation on the effectiveness of each strategy is noted. In principle, the process could be repeated whilst all other uncertain factors are varied as well. RESULTS: Although varying one uncertain factor created enormous variation in the size of the epidemic, it is remarkable that for most preventive strategies the relative effectiveness of the strategies was barely altered. Hence for the most part the ranking of strategies in order of effectiveness is not affected by the area of uncertainty explored here. The results also highlight the potential effectiveness not only of general condom promotion, but also the use of circumcision and spermicides and general screening or targetted screening in sexually transmitted disease clinics. CONCLUSIONS: Epidemiological modelling may accurately rank the effectiveness of interventions although it may fail to predict the size of the epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2000

The emerging AIDS crisis in Russia: review of enabling factors and prevention needs.

Eastern Europe is experiencing increased rates of HIV/AIDS, and the Russian Federation is among the countries with the most alarming case rate increases. Behavioural and biological studies demonstrate that the transmission of HIV in Russia is occurring as a result of injection drug use, homosexual, and heterosexual risk behaviours. Factors that promote risk and therefore enable HIV transmission in Russia parallel those found in other countries, including epidemics of other sexually transmitted infections, economic instability, poverty, and social factors such as gender roles. Research is urgently needed to better understand and forecast the HIV epidemic in Russia, as well as to develop effective interventions to prevent a Russian AIDS crisis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The road to health.

This article is published as a tribute to Professor Thomas McKeown, the eminent epidemiologist, who died in 1988 aged 75. In it the author urges that the spread of services comprising primary health care be arranged in strict order of priority. Since improvements in nutrition have a particularly profound effect on health they should be the primary aim of developing countries.

Communicable Disease Control↗
PubMed1994

Epidemics: models and data.

"The problems of understanding and controlling disease raise a range of challenging mathematical and statistical research topics, from broad theoretical issues to specific practical ones. In particular, recent interest in acquired immune deficiency syndrome has stimulated much progress in diverse areas of epidemic modelling, particularly with regard to the treatment of heterogeneity, both between individuals and in mixing of subgroups of the population. At the same time better data and data analysis techniques have become available, and there have been exciting developments in relevant theory.... This progress in specific areas is now being matched by interdisciplinary cooperation aimed at elucidating relationships between the widely varying types of model that have been found useful, to determine their strengths and limitations in relation to basic aims such as understanding, prediction, and evaluation and implementation of control strategies."

Acquired Immunodeficiency Syndrome↗
PubMed1988

Seroepidemiology of human immunodeficiency viruses in Africa.

The first generation of serological tests for anti-HIV-1 gave so many false positives with African sera that it was wrongly postulated that the virus was endemic in Africa. As there is no simian or other virus sufficiently closely related to HIV-1 as to suggest a recent common ancestor, the evolution of HIV-1 is obscure and there is no current evidence to support the hypothesis of an African origin. However, the similarity of HIV-2 to SIV and its geographical distribution do suggest an evolution of this virus in west Africa. The earliest anti-HIV-1 positive serum was from a subject in Kinshasa in 1959. Seroprevalence rose in pregnant women in Kinshasa from 0.25% in 1970, to 3.0% in 1980 and 5.7% in 1986. When two sexually promiscuous groups are compared, seropositivity rose sharply in female prostitutes in Nairobi from 4% in 1981, to 59% in 1984 and 64% in 1986, a curve which is approximately parallel to, but three years later than that of homosexual males in San Francisco. In central and east Africa, HIV-1 is now epidemic from Congo to Kenya and from Uganda to Zimbabwe. In west Africa, both HIV-2 and HIV-1 are epidemic: seroprevalence of HIV-2 is highest in southern Senegal, Guinea-Bissau and Côte d'Ivoire: HIV-1 has the highest frequency in Côte d'Ivoire and Ghana. HIV-2 has not been reported, and HIV-1 is pre-epidemic in Africa north of the Sahara, Nigeria, Angola, Mozambique and southern Africa, being found at significant frequency only in female prostitutes, patients with STD, or, in Morocco and South Africa only, in male homosexuals. Seroprevalence is greatest in female prostitutes and patients with STD: infection is more frequent in urban than in rural populations, except in Uganda. The peak frequency is at 30-34 yr in males and 20-24 yr in females. Other groups at risk are infants born to infected mothers, and those requiring blood transfusions, especially pre-school children, patients with sickle-cell disease and pregnant women. The doubling time for seropositivity is about one year in the sexually active age range in some populations. Even at existing seroprevalence, decimation or worse of the most productive age groups is inevitable during the next few years in certain countries.(ABSTRACT TRUNCATED AT 400 WORDS)

AIDS Serodiagnosis↗
PubMedDate not supplied

Hepatitis in day care centers: epidemiology and prevention.

Hepatitis A is a significant health problem in day care centers, causing outbreaks that average 12 cases in size and three months in duration. These outbreaks have three characteristic features: children have mild or asymptomatic infections; adults (primarily parents) are the major group with clinical hepatitis; and persons having contact with one- or two-year-old children run the highest risk of infection. Outbreaks are commonest in centers that are large, have long operating hours, and enroll children younger than the age of two years (i.e., those in diapers). The presence of such children is necessary for the rapid spread of the disease. Nationally, outbreaks occur primarily in areas with many infant/toddler centers, which often form the focus for epidemics. Prevention relies on hygiene, especially hand washing. Disease control depends on early detection of outbreaks and aggressive use of immunoglobulin. The spread of hepatitis B has not been documented in day care centers; however, when a child carrying hepatitis B virus enrolls in a center, a low risk of transmission may exist and precautions are recommended, with a focus on personal hygiene.

Adult↗
PubMed2002

Community interventions and the epidemic prevention potential.

Evaluation of community-level effects of intervention programs in infectious diseases is receiving increased attention. In this paper, we consider evaluation of the community-level effectiveness measures on the example of vaccination of children against influenza. We introduce the concept of the epidemic prevention potential (EPP) as a measure of the ability of an intervention to either prevent transmission or at least to keep it below a pre-defined limit. As a concept to describe the general ability of an intervention to limit outbreaks to a certain defined size, the term EPP fills a void. We constructed a stochastic simulation model of influenza transmission and vaccination in a structured community to illustrate the effectiveness measures of interest and the epidemic prevention potential. The concepts are general and could be applied to other interventions, such as antivirals and quarantine.

Adult↗
PubMedDate not supplied

AIDS: has the problem been adequately assessed?

Epidemiologic inferences about the epidemic of acquired immunodeficiency syndrome (AIDS) are developed from three different sources: case-control studies, cohort studies, and national data on prevalence and incidence. Together these data imply that reducing the number of sexual partners may in itself provide little protection. Shifting to a "lower-risk" behavior will only be helpful if the cumulative risk of transmitting the virus can be reduced nearly to zero. However, if all members of a minimally affected population made such a shift, the benefit to that population could be dramatic. The emerging realization that latency periods are longer than was first thought implies that the epidemic could be much more severe than has been anticipated. Regional trends give no assurance that it has reached a peak, even in areas of highest prevalence. Much more work needs to be done to establish the actual role of saliva in transmitting HTLV-III because oral contagion has the greatest potential to spread the disease. Efforts to determine the latency period are crucial to predicting the future of the epidemic. Preventive measures--behavior modification and education--hold some hope of retarding spread of the epidemic pending development of effective therapy or a vaccine.

Acquired Immunodeficiency Syndrome↗
PubMed2001

The Serostatus Approach to Fighting the HIV Epidemic: prevention strategies for infected individuals.

In the United States, HIV prevention programs have historically tailored activities for specific groups primarily on the basis of behavioral risk factors and demographic characteristics. Through the Serostatus Approach to Fighting the Epidemic (SAFE), the Centers for Disease Control and Prevention is now expanding prevention programs, especially for individuals with HIV, to reduce the risk of transmission as a supplement to current programs that primarily focus on reducing the risk of acquisition of the virus. For individuals with HIV, SAFE comprises action steps that focus on diagnosing all HIV-infected persons, linking them to appropriate high-quality care and prevention services, helping them adhere to treatment regimens, and supporting them in adopting and sustaining HIV risk reduction behavior. SAFE couple a traditional infectious disease control focus on the infected person with behavioral interventions that have been standard for HIV prevention programs.

AIDS Serodiagnosis↗
PubMedDate not supplied

[Current malaria situation in the Republic of Uzbekistan].

Malaria was once one of the most common diseases in Uzbekistan. There were massive epidemics with high mortality rates, wherein 140,000 to 700,000 cases of malaria were recorded. Following large-scale malaria control measures, the disease was eradicated in Uzbekistan in 1961 and the epidemiological situation is still favorable. The natural and climatic conditions that prevail in the Republic of Uzbekistan mean that the country is very susceptible to malaria. There are large water areas varying in type and origin, which provide a habitat for a number of epidemiologically dangerous species of malaria-transmitting mosquitoes in a single area. These are Anopheles maculipennis, An. pulcherrimus and An. superpictus. The prevailing temperatures promote rapid growth of vector mosquitoes and parasites and the malaria transmission season is over 5 months long. Seven malaria-transmitting mosquito species have been recently recorded in the Republic. DDT resistance has been so far noted in Anopheles maculipennis, An. hyrcanus and An. bifurcatus. An. superpictus is sensitive to all insecticides used in clinical practice (organophosphorus and organochlorine compounds, HOS, carbamates, pyrethroids). The most dangerous areas for transmitting malaria by importation are the flood plains of the country's main rivers, such as Syrdarya, Amudarya, Chirchik, Surkhana, etc., and rice-growing areas (an area of about 150,000 ha was under rice cultivation in 1999). The Republic is still very subjected to large-scale importations of malaria particularly in the towns and areas along the border with Tajikistan. There has been recently an increase in the incidence of infections imported into the Republic: 27 cases in 1995, 51 in 1996, 52 in 1997, 74 in 1998, and 78 in 1999. Eight regions of Uzbekistan border Tajikistan, their population is over 5.6 million people. In addition, close family ties between the populations of the frontier towns and regions further increase the risk for malaria to be imported and passed on. Noteworthy is the Surkhandaryin region that accounted for 60% of the cases recorded in 1999. The number of towns and villages where malaria occurs for the first time increased (49 and 46 cases in 1999 and 1998, respectively). The number of cases imported into rural areas also increased (70 (83%) cases in 1999 versus 48 (65%) cases in 1998); due to the large populations of malaria mosquitoes, there is a real danger that the disease may spread. In 1999, most cases of malaria were imported from Tajikistan (65 cases or 76% of all cases). There was a case from each of the following countries: Afghanistan, Pakistan, and Kazakhstan and 5 cases from Azerbaijan and Kyrgyzstan. The recorded cases included slighly more men than women (54% vs 46%). There were 10 infected children under 14 years, which was 23.5% of all notified cases. Analyzing various populations showed that 67.1% of the patients visited their relatives in malaria-endemic countries (mostly Tajikistan) and 25.8% migrated from Tajikistan. All the detected cases were confirmed by laboratory tests. As in the past, most cases were tertian (P. vivax) malaria (n = 82 or 96.4% of all cases). Tropical (P. falciparum) malaria was confirmed in 3 (3.5%) cases. These cases had been imported from Tajikistan into the Surkhandaryin region. Seventy seven (91%) cases were detected in the epidemical season. Of them 58 (68.2%) cases were detected during a malaria transmission season. Seven cases who contacted the patients with imported malaria and were infected were recorded in 1999. They included 4 and 3 cases in the Surkhandaryin and Kashkadaryin Regions, respectively. In 1999, there was a decline in the number of malaria patients who needed health care and in the diagnosed malaria cases in therapeutical and prophylactic institutions. Throughout the country, 34 (40%) of the 85 detected cases presented within 3 days of malaria outbreak (68.9% in 1998). Malaria was immediate diagnosed in 43.5% of cases (64.9% in 1998). The remaining cases were diagnosed as having acute respiratory viral infections, tropical and parasitic diseases, viral hepatitis, or influenza. Early diagnosis of malaria was made in 60% of cases (77% in 1998). Three cases of imported tertian malaria were recorded in the Tashkent Region in the first quarter of 2000. They were imported from Tajikistan into rural areas and the patients had been infected during the 1999 season. Epidemiological surveillance of malaria in Uzbekistan is regularly carried out by the general network of health facilities and by the departments of parasitology of state epidemiological surveillance centers in collaboration with medical administrative departments, the Ministry of Agriculture and Fisheries, the L.M. Isayev Research Institute of Medical Parasitology, and other agencies. Active links are maintained with WHO under the Roll Back Malaria programme. Great emphasis is laid on medical staff training at all levels. During the 1999 epidemiological survey, 672,536 laboratory tests were performed on blood samples from suspected malaria patients and individuals who had visited malaria-endemic countries, 55% of them suffering from fever. A total area of 17 million m2 of dwelling and nondwelling buildings 20 ha of water areas were treated against mosquitoes and the larvivorous fish Gambusia was put into the water areas occupying 6,500 ha. In all cases of malaria, the focus of infection was epidemiologically surveyed and required epidemic preventive measures were implemented. All malaria patients received a full course of radical therapy and recovered completely. The epidemiological surveillance system for malaria is affected by staff shortages at the parasitology departments of state epidemiological surveillance centers and by shortages of microscopes, reagents, sterilizing equipment, insecticides, etc. There are still difficulties in obtaining supplies of primaquine although a small stock is locally available as due to WHO humanitarian assistance. The Epidemiological Malaria Surveillance Programme for the Republic of Uzbekistan for 2000-2004, intended to strengthen the epidemic control capacity of health care facilities, Ministry of Health, is under adoption. The following activities are scheduled for 2000: to plan malaria control activities, including the zoning of the country by the risk of malaria transmission in accordance with republic-leveled directives, instructions, and methodology and WHO recommendations: adjustments to these plans to be made as necessary; to fill vacant posts in the parasitology departments of state epidemiological surveillance centers; to procure stocks of antimalarial drugs, reagents, insecticides, sterilizing equipment, etc., to be paid for from epidemiological service resources; to include malaria issues into certifying tests for physicians, as appropriate for the posts to be occupied and their level of qualifications; to publish posters, brochures, and leaflets about malaria prevention before the malaria transmission season for health education; to hold seminars and meetings for health workers on the etiology of malaria, its clinical features, diagnosis, treatment, and prevention.

Adolescent↗