Communicable disease and public health最新文献

Human T-cell lymphotropic virus (HTLV) is a retrovirus transmitted through breastfeeding, sexual contact, blood transfusion and injecting drug use. HTLV is endemic in the Caribbean and parts of Africa, Japan and South America, with isolated foci in other areas. Infection is life-long. Less than 5% of those infected progress to one of the HTLV-related diseases, but these are debilitating and often fatal. Laboratory reports of new HTLV diagnoses are followed up through clinicians to establish information such as probable country of infection, country of birth, clinical details and reason for test. Clinician reports are also received for HTLV-infected blood donors identified by the National Blood Service. Seventy-seven individuals newly diagnosed with HTLV infection in 2002 were reported to the Communicable Disease Surveillance Centre (CDSC) by June 2003. Thirty-three (43%) were male, and 44 (57%) female, with median ages at diagnosis of 58.5 and 50.1 years respectively. Seventy-three (95%) individuals were HTLV-I positive and three HTLV-II positive, with one remaining untyped. For 52 of the 77 infections, clinician reports were received. Where ethnicity was reported (48), 30 (63%) were Black Caribbean, 12 (25%) White, and the remainder (6) of other ethnicities. Probable route of infection was reported for 31 individuals: nine (29%) were probably infected heterosexually, seven (23%) through mother-to-child transmission, 12 (40%) through either route, two through blood transfusion, and one through injecting drug use (HTLV-II positive). Where probable country of infection was reported (31), 14 (45%) were probably infected in the UK, 13 (42%) in the Caribbean, and four elsewhere. Where reported (50), reason for test was: symptoms for 19 (38%) individuals, blood donation for 21 (42%), and the remainder for other reasons. Numbers of new HTLV diagnoses were relatively high in 2002, and the characteristics of patients and clinical presentations differed from previous years, mainly due to the introduction of blood donor testing for anti-HTLV. Beyond 2004, the number of HTLV-infected individuals detected through blood donation is expected to decline. While numbers of individuals affected are small compared to many other diseases, the infection is chronic and untreatable, and it is important that adequate standards of diagnosis, prevention, care and support are provided, and surveillance maintained.

Most adults are not susceptible to chickenpox. We present a report of an outbreak of chickenpox among institutionalised adults with learning difficulties. An inventory of exposed and possible affected residents was done after three adult males were diagnosed with chickenpox following a case of zoster. Individuals with a recent history of chickenpox rash or herpes zoster were included as cases. Medical files were used to derive background information. Serum samples of the first two patients were tested for IgM varicella-zoster virus (VZV) antibodies. Eventually ten cases of chickenpox (eight residents and one group leader and her partner) and two residents with herpes zoster were registered over a period of four months in 2001. The first two patients tested positive in serum. One resident with chickenpox died. This outbreak suggests a higher risk from chickenpox for institutionalised adults with learning difficulties in comparison with the general Dutch population, probably due to limited contacts with the general population. Further research into varicella-zoster seroprevalence, preferably with low-invasive diagnostic methods, is necessary to determine if this potential risk is present elsewhere, since the risk of life-threatening chickenpox in adults could be reduced by the now available live attenuated VZV vaccine.

An outbreak of an upper respiratory tract illness at a secondary school, which led to the hospitalisation of 23 cases, occurred in Ireland at the beginning of September 2003. Medical and laboratory examinations, initially for suspected meningitis, were carried out on the hospitalised cases and bacterial meningitis was ruled out. One hundred and seventy-nine students and teachers were interviewed and a retrospective cohort study was conducted among the sixth year students. One hundred and seven respondents met the case definition, but no associations were found between the environmental exposures investigated and illness. As it was before the expected influenza season, initial samples were not tested for influenza, but one month later the new influenza A/Fujian/411/2002 (H3N2)-like strain was confirmed and implicated in the outbreak. It was the first reported outbreak of influenza in Europe in the 2003 'winter' season and it demonstrated the need for vigilance for early and unexpected occurrence of influenza. It also provided valuable lessons for laboratory and epidemiological investigation and management of pre-season influenza.

An outbreak of chickenpox occurred in a Scottish prison in April 2003. Three clinical cases (one virologically confirmed) were identified, two prisoners and one staff member. All were male and aged between 30 and 45 years. A further six possible cases were identified. The source of the outbreak was likely to have been a prisoner's child who visited the prison with a chickenpox rash. The outbreak was point source in nature, and no secondary spread of infection occurred within the prison despite the crowded conditions, possibly reflecting high levels of natural immunity. The outbreak serves as a reminder of the prison environment and the vulnerability of the prison population to infectious disease, both because of the prison environment and the clinical characteristics of the prison population.

Prompt reporting of meningococcal disease improves the management of contacts. We looked at cases from five major local hospitals over a two-year period to ascertain the time taken to report and reasons for delays. Over 80% of cases were reported in the first 24 hours. Transfer to another unit was a frequent reason for a report being delayed. Nearly half the delayed cases were reported by the microbiology laboratory rather than the clinical team. We stress the need to emphasise timely reporting in the training of frontline medical staff, and the need to designate an individual in accident and emergency as responsible for reporting cases.

This study was conducted to determine the extent to which genitourinary medicine clinics in the East of England region are monitoring the uptake of HIV testing. Ninety-four per cent of GUM clinics in the region offer HIV testing to all new patients. The uptake varied around the region, but all clinics are able to monitor uptake and the majority of clinics can audit uptake. The overall regional uptake has already exceeded the target for 2004.

Employees may be found working alone in a wide range of occupations. Technological advance, rationalisation and automation mean that more and more frequently. one single person is in charge of several machines, pieces of equipment or different work activities. Employees will be found working alone during work carried out as 'overtime', as part of flexible working hours, on Saturdays, Sundays, Bank Holidays and other statutory leave days, or in situations where their work takes them away from a fixed base (mobile workers). A person may be considered to be 'working alone' whenever it is not possible to offer immediate assistance following an accident or in another critical situation. This article looks at the legal background to lone working and what an employer must do to ensure lone workers are at no greater risk to their health and safety than any other members of the workforce.

A study of ready-to-eat pre-cut fruit, sprouted seeds, and unpasteurised fruit and vegetable juices from retail and production premises was undertaken in the UK to determine the microbiological quality of these products, and to verify the application of hazard analysis and critical control points (HACCP) procedures by food operators. Almost all (99%; 2,075/2,096) samples were of satisfactory/acceptable microbiological quality. Two (0.1%) samples (melon, beansprouts) were of unacceptable quality due to the presence of Listeria monocytogenes at 102 cfu/g or more while a further 19 (0.9%) were unsatisfactory due to Escherichia coli levels in the range of 102 to 106 cfu/g. Neither Salmonella spp. nor E. coli O157 were detected in samples examined. A hazard analysis system was in place in most (85%) premises visited, and in 80% it was documented. Most managers (83%) had received some form of food hygiene training. Minimally processed produce is exposed to a range of conditions during production and distribution, and this may increase the potential for microbial contamination, highlighting the need of applying good hygiene practices from farm to fork to prevent contamination and/or bacterial growth. Such products should be stored and displayed at or below 8 degrees C.