Communicable disease and public health最新文献

A female nurse, recruited from the Philippines five months previously, developed meningo-encephalitis and was hospitalised. She was later transferred to a hospital in a neighbouring region for specialist treatment. Rabies was part of a differential diagnosis and decisions on public health intervention had to be made in the absence of a firm diagnosis or clinical history. These decisions centred on what infection control measures should be put into effect and when. Issues included the leadership and composition of the incident management team, the coordination of consistent approaches between the health regions and organisations involved, the different priorities of those forming the team and, in particular, contacts with the media and meeting public anxieties.

The uncertainty about the extent of proliferation of smallpox virus holdings since the early 1990s, and particularly whether terrorist groups or so-called rogue states might now hold the virus, confronts potential target countries with a continuing dilemma. An increasingly large majority of their populations have never been vaccinated, and those who have been vaccinated may have become susceptible to smallpox again. Yet recent attempts by the United States and other governments to persuade large numbers of key personnel and others to accept vaccination have at least partially failed and a different long-term strategy is needed. This strategy should be based on surveillance of rash illnesses, improved public education, more refined contingency planning and a new approach to smallpox vaccination. The last should if possible be based on cell-grown, less reactogenic vaccines, even though it may be some years before these can become available. Meanwhile this article examines other expedients including the use of existing lymph vaccines.

Seroprevalence data among ethnic minority groups within England and Wales are rare. An opportunistic approach was taken to test residual oral fluid, collected from pre-adolescent school children from an ethnically diverse region of northwest England, for anti-hepatitis A virus (HAV) IgG. Individual data on ethnicity and country of birth were also available. Of the 257 children who consented to participate, 62% were of South Asian ethnic origin. The overall seroprevalence was 18.8%, higher than 13.1% reported from a recent population-based survey in England and Wales among a mainly Caucasian population of the same age. The only factor significantly associated with HAV seropositivity in a multivariable logistic regression model was birth of the child abroad. Association with the place of birth of the child, but not that of the parent indicates that infection within this group occurs mainly abroad. Larger studies among ethnic minority groups are needed to investigate this claim further.

The effects of the policy change in X-ray follow-up of adult tuberculin-positive close contacts of sputum microscopy positive pulmonary tuberculosis made by the Joint Tuberculosis Committee of the British Thoracic Society in 2000 were monitored prospectively from late 2000 until the end of 2003. No cases in contacts that could have been detected by interval X-rays at three and 12 months were found. The data, on 291 cases, support the abandonment of X-ray follow-up in favour of an 'inform and advise' strategy after an initial normal chest X-ray in this category of tuberculosis contact.

The aim of this audit was to provide baseline measurement of antenatal hepatitis B virus (HBV) screening uptake, coverage of HBV vaccination in infants born to high- and low-risk HBsAg carrier mothers, completion of post-vaccination serological testing, outcome for vaccinated infants, and an assessment of the factors that influenced the effectiveness of the whole programme. Methods included identifying HBV positive pregnancies by laboratory results, and follow up of at-risk infants by a GP survey. Uptake of antenatal HBV screening was 99.9%. Thirty-one HBV positive pregnancies were identified, and twenty-nine infants were followed up. The overall HBV vaccination completion rate was 93%. Fifty per cent of eligible infants were tested for hepatitis carriage, the majority of whom were high-risk infants. None had acquired HBV infection and all had gained adequate immunity. We conclude that, although the local screening programme has been implemented effectively, there is inconsistency in the follow up of infants at high and low risk of acquiring HBV.

We report a case of falciparum malaria in a renal transplant patient with no history of foreign travel. Three weeks previously she had been a hospital inpatient with cellulitis and had stayed on the same ward as a man with falciparum malaria acquired in Nigeria. There were no cases of malaria in other patients on the ward at the same time. The parasites from the two cases were genotypically indistinguishable. Despite a thorough investigation, reviewed by an expert external panel, no clear route of infection between the cases was identified. Patients with malaria should be considered highly infectious by the parenteral route. They should be managed with the infection control precautions used for patients with bloodborne virus infections. Our case reinforces the need for high levels of compliance with universal infection control procedures.