Communicable disease and public health最新文献

Threats from bioterrorism are of national and international concern. We outline a system of disease surveillance covering a selection of diseases linked to potential bioterrorist threats, based on the weekly returns service of the Royal College of General Practitioners and covering a surveillance population of 650,000 in England and Wales. Practices record working diagnoses and the episode type (distinguishing new episodes of illness from ongoing consultations) on patients' computerised medical records. These are interrogated twice weekly by using automated routines. The registered population and persons consulting for each Read code (group of codes) are counted in sex and age specific groups and the data forwarded electronically to the Research Unit, where the results are consolidated by region (North, Central, South). Weekly incidence rates between October 2001 and September 2002 were compared with the weekly average over the past seven years for 13 selected conditions. Detailed data are presented for three conditions (asthma, infections of the skin, disorders of the peripheral nervous system). For asthma increased incidence was reported in weeks 31 and 32 of 2002, predominantly in the Central region. For the other two conditions no unusual peaks of incidence were observed in any region. Operational research based on disciplined recording of morbidity in general practice can deliver timely surveillance data on bioterrorist threats.

After a second meningitis case occurred in a school, we undertook mass prophylaxis of 2095 pupils and staff of three institutions on the site. This incident, early in the life of the new primary care organisations, presented several challenges and provided opportunities to learn about successful co-management of future major incidents. This paper aims to identify and address problems in planning such prophylaxis, with particular reference to the new NHS arrangements. It also provides a practical checklist, with commentary on potential issues based on our local experience. This may help other health protection units facing similar incidents, and contribute to the development of more general guidance.

We describe the epidemiology of HIV among young people (15-24 years) in England, Wales and Northern Ireland (E, W&NI) between 1997 and 2001 inclusive. Rising rates of sexually transmitted infections (STIs) and 'risk' behaviours suggest that they are at increased risk of acquiring HIV. Data from three national surveillance systems are reviewed. Over the period, 1,624 young people were diagnosed with HIV (10% of all new diagnoses). In 1997 there were 254 new diagnoses, rising to 493 in 2001, a 1.9-fold increase. Of the total, 890 (55%) were heterosexually infected (81% female), 631 through sex between men, and the remainder via other routes. Where probable country of infection was reported (1,139), 618 (54%) were infected in Africa and 362 (32%) in the UK. In 1997, 675 young people accessed HIV-related services, rising to 975 in 2001: an increase of 1.4 fold. In 2001, for 34 of those accessing services the likely route of infection was perinatal. Between 1997 and 2001 inclusive, HIV prevalence among young heterosexual genitourinary medicine (GUM) clinic attendees was 0.17% (193/116,443), and for young homo/bisexual males, 3.4% (174/5,086). Sixty-five percent (104/159) of previously undiagnosed HIV-infected heterosexuals and 47% (51/108) of previously undiagnosed HIV-infected homo/bisexual males left the clinic unaware of their infection. In 2000 and 2001, overall prevalence was 0.11% (77/70,455) among young women giving birth. HIV diagnoses in young people have increased in recent years, while HIV prevalence among young people attending GUM clinics and giving birth has remained low. However, with dramatic increases in chlamydia rates among young women over the past decade, and the highest rates of gonorrhoea and concurrent partnerships among young people, concern about the potential for HIV transmission remains.

HIV-1 drug susceptibility testing by genotypic methods is now widespread in the UK and it is thus important to determine the reproducibility of such investigations. A pilot study was carried out to determine the reproducibility between laboratories of genotypic testing by nucleotide sequencing of patient samples, and to compare the interpretations of the results provided to the clinicians. Samples were distributed between the participating laboratories. Eight laboratories, using three different methods, sequenced four samples. Nucleotide sequence and reports were collated and compared by one laboratory. Where sequencing data were obtained > 99% concordance was observed for nucleotide designations. No discordances in nucleotide sequencing were found in positions associated with drug resistance. However, there were considerable differences between the laboratories in the interpretation of some of the mutations with respect to their effect on drug susceptibility. This study emphasises the variability in the available interpretation systems, and the importance of joint laboratory-clinical discussion in making decisions about treatment options.

Between 7 and 20 August 1999 a Public Health Department was notified of seven cases of Escherichia coli O157 infection. Phage typing demonstrated that four were related and three unrelated. The investigation centred around the three cases of E. coli O157 phage type 21/28 who visited the same beach during the last week of July. The fourth related infection was identified as a result of the investigation. Although the investigation failed to identify a source of infection, interviews with the families of the four related cases suggested that they had occupied the same part of the beach on the same day and so it is possible that a contaminated area of beach was the source. We believe this to be the first outbreak of E. coli O157 to be associated with a bathing beach.

The objectives were to study knowledge, attitudes, and practices (KAP) regarding tuberculosis (TB) among Somalian subjects in inner London. We administered structured, fixed response KAP questionnaires to 23 patients (culture proved TB), and two groups of controls: 25 contacts (family members) and 27 lay controls (general Somali immigrant population). Responses were summed on a five-point scale. Most were aware of the infectious nature of TB but uncertain of other risk factors. Many were uncertain about coping with the disease and its effect on lifestyle. Belief in biomedicine for TB was unequivocal with men having a significantly higher belief score than women (p = 0.02); the need to comply with TB medication was unambiguously understood. Somalians interviewed were educated, multilingual, and aware of important health issues. Uncertainties in core TB knowledge need to be addressed with direct educational input, especially in women and recent entrants into the country. Volunteers from the established Somalian community could play a valuable part as links in the community to fight TB.