Communicable disease and public health最新文献

Group A streptococci cause a wide range of illnesses from non-invasive disease such as pharyngitis to more severe invasive infections such as necrotising fasciitis. There remains uncertainty about the risk of invasive disease among close contacts of an index case of invasive disease and whether this risk warrants antibiotic prophylaxis. A 19-200 fold increased risk among household contacts has been reported in the literature. Recommendations for antibiotic prophylaxis regimens vary by country. A comprehensive literature review together with preliminary analysis of 2003 United Kingdom data from the strep-EURO programme informed the interim recommendations of an expert working group. The evidence base to formulate definitive guidance is weak. Risk calculations based on provisional UK data estimated that over 2,000 contacts would need to receive antibiotic prophylaxis to prevent a subsequent case of invasive group A streptococcal disease. The Working Group considered that currently available evidence did not warrant the routine administration of chemoprophylaxis to all close community contacts. More robust risk estimates will be derived from ongoing UK surveillance data to inform a review of this guidance in 2005.

In June 2003 a questionnaire on immunisation training was sent to the 302 primary care trusts (PCTs) in England to ascertain the frequency and content of immunisation training being offered to healthcare professionals. Fifty-four per cent of the 227 trusts (75%) who replied were concerned about their ability to deliver an immunisation programme. Contributing factors included the lack of a designated training lead, shortage of specialist input, available time, and funding. Of PCTs, 33/219 (15%) were not providing immunisation training sessions for practice nurses, 28/219 (13%) for health visitors, and 30/219 (14%) for school nurses; 67/219 (31%) had no sessions organised for general practitioners. Most 138/175 (79%) PCTs would welcome the introduction of some national minimum standards for immunisation training to assist them in setting up and maintaining a programme, and allocating sufficient resources to it.

Current UK policy on immunisation for tetanus has changed in the light of evidence that five doses of vaccine probably provides sufficient protection as long as high-risk wounds are managed with tetanus immunoglobulin. This paper reviews the evidence base for tetanus immunisation policy in England and Wales: the epidemiology of tetanus, vaccination coverage and response to tetanus toxoid, and population immunity to tetanus. The paper highlights gaps in our current knowledge of tetanus vaccination and policy implementation, and makes recommendations for further investigations.

A man who had recently started work as a packer in a chicken factory developed campylobacteriosis with severe complications. This prompted a qualitative assessment of the occupational infection risk. It is likely that his infection occurred by droplet transmission via the mouth. Serological studies have shown increased risk of infection to poultry workers, particularly in the first weeks of employment. Previous reports have identified the risks of airborne pathogen transmission, and these papers are reviewed here. Epidemiological evidence from the plant indicated that workers were three times more likely than the general population to suffer campylobacteriosis, and occupational health reporting confirms the risk to poultry workers. Employers should offer face masks to their workers for protection from airborne infection.

London has relatively high rates of HIV, hepatitis B and syphilis, and has the potential for undiagnosed infection in pregnancy. As part of a drive to improve HIV testing in pregnancy, surveillance of a number of antenatal infections has been carried out in London's 30 maternity units since 2000. Infection screening rates rose from 89% in 2000 to 94% in 2002, and HIV screening rates increased from 66% to 86%. During 2002, 115,230 women booked for antenatal care; 998 were HBsAg positive (about ten in 1000), 452 were HIV positive (five in 1,000), 412 tested positive for syphilis (four in 1000), and 3,929 were susceptible to rubella (36 in 1000). The main burden of infection was concentrated in a few geographic areas. Worryingly the majority of women found to be HIV positive were diagnosed by antenatal screening and not before.

Drug misuse is increasingly being managed in general practice. It has been proposed that better use could be made of this contact to identify people with bloodborne virus (BBV) morbidity and to deliver prevention strategies. The Hepatitis B and C Prevention Project was designed to enhance the work of primary healthcare teams in preventing transmission of BBVs in people known to have a history of problem drug use. As part of this work a baseline audit of current provision was undertaken and the results are reported here. Primary care records of 1278 people with a history of illicit drug use were audited to establish the levels of hepatitis B immunisation and testing for BBVs and to determine whether there was a record of any professional discussion of BBV issues with the patient. Records were drawn from rural and city-based general practices. Audit feedback, training, and advice were offered to raise awareness and discussion of how this work was currently being undertaken, and how it might be improved. This baseline audit showed that 90% (n = 1153) of the patients had been questioned about injecting drug use and of these 50% (579/1153) reported injecting at some point in the past. Only 4% (54/1278) had completed a course of hepatitis B immunisation and of these three quarters gave a history of injecting drug use. Another 6% (74/1278) of patients tested for hepatitis B virus (HBV) showed markers of natural immunity. Up to 90% of this group therefore remained vulnerable to this preventable disease. A discussion of BBV issues with a professional was recorded in41% (523/1278) of cases, and was more likely to have occurred in those with a known history of injecting. Individuals were less likely to have been tested for hepatitis C virus (HCV) than for HIV or HBV despite its high prevalence in this group. Only 28% (354/1278) were tested for HCV compared with 33% (416/1278) tested for HBV and 36% (454/1278) tested for HIV. Prevalence of anti-HCV for people with a history of injecting was 51% (137/268) compared to 11% (9/83) in those with no history of injecting. Prevalence of anti-HIV in those with a history of injecting was 10% (29/294) compared 0.7% (1/137) in those with no history of injecting. Prevalence of HBV markers in those with a history of injecting was 23% (65/279) compared with 7% (8/114) in those with no history of injecting. Of the 530 patients with test results, only 52% (275/530) had been tested for all three viruses despite the common transmission routes.

Pregnant women from countries with high prevalence rates of hepatitis B virus (HBV) infection may have significant HBV DNA levels despite being hepatitis B e antigen (HBeAg) negative and having antibody to HBeAg (anti-HBe positive). It is suggested that their babies, following delivery, should be given hepatitis B specific immunoglobulin (HBIG) in addition to hepatitis B vaccine in order to ensure their protection against infection.

In December 2001, an increase in cases of hepatitis A was observed in South Yorkshire. Cases were predominantly young males who reported injecting drug use. A community-based vaccination programme was introduced in November 2002, but new cases continued to occur. In March 2003, a vaccination campaign was implemented in the local prison for a four-week period. One thousand two hundred and thirty-six (91%) prisoners were vaccinated. Two thirds (895/1,363) of the prisoners came from the area affected by the outbreak and 52% (465/895) reported injecting drugs. The median age of injectors was 25 years. Notifications of cases of hepatitis A from South Yorkshire ceased in August 2003. Although on this occasion the prison vaccination campaign was probably implemented too late to have had a significant impact on the local outbreak, a large number of young male injectors from the local area were successfully vaccinated. This suggests that a prison-based intervention offers a potentially effective way of immunising the IDU population and interrupting a community-based outbreak.

The objectives of this study were to determine the number of discarded syringes found in four parks in Southwark, South London, over a specific time period and to test their contents for the presence of hepatitis B virus (HBV) and hepatitis C virus (HCV). Of 106 syringes collected over a four-month period, evidence of HBV was detected in 4.7% (5/106) and HCV in 4.7% (5/106). Urban children, park users and workers are at risk of contact with sharps which may be contaminated with both viruses. Park users need more information on what to do in the event of an injury, and park workers should be immunised against HBV and educated on safe disposal of sharps.

Effective public health control of meningococcal disease (meningococcal meningitis and septicaemia) is dependent on complete, accurate and speedy notification. Using capture-recapture techniques this study assesses the completeness, accuracy and timeliness of meningococcal notification in a health authority. The completeness of meningococcal disease notification was 94.8% (95% confidence interval 93.2% to 96.2%); 91.2% of cases in 2001 were notified within 24 hours of diagnosis, but 28.0% of notifications in 2001 were false positives. Clinical staff need to be aware of the public health implications of a notification of meningococcal disease, and of failure of, or delay in notification. Incomplete or delayed notification not only leads to inaccurate data collection but also means that important public health measures may not be taken. A clinical diagnosis of meningococcal disease should be carefully considered between the clinician and the consultant in communicable disease control (CCDC). Otherwise, prophylaxis may be given unnecessarily, disease incidence inflated, and the benefits of control measures underestimated. Consultants in communicable disease control (CCDCs), in conjunction with clinical staff, should de-notify meningococcal disease if the diagnosis changes.