Communicable disease and public health最新文献

In order to derive more accurate estimates of HIV infection among the general population in Great Britain from unlinked anonymous neonatal seroprevalence data, the differential HIV and fertility patterns amongst groups of women were explored. The HIV risk in women was estimated using neonatal seroprevalence data and reports of diagnoses of HIV infection in pregnant women. Live birth rates were estimated using population data and these were supplemented using data from a prospective European cohort of HIV-infected pregnant women. HIV prevalence was higher in women born in sub-Saharan Africa (SSA) and injecting drug users (IDUs) (2.50% and 0.29% respectively in London) compared to other women (0.068%). Fertility was also higher in women born in SSA (OR 1.33 using population data), whilst IDUs were more likely to have had a previous termination (OR 1.48 using the European cohort of HIV-infected pregnant women data). We conclude that when unlinked anonymous neonatal seroprevalence data is used to estimate general population prevalence, adjustments need to be made for fertility differentials in population subgroups at varying risk of HIV.

Severe flooding may become more frequent due to global warming. A historical cohort study was conducted by telephone interview for new episodes of illness in all age groups, and for psychological distress in adults, following severe river flooding on 12 October 2000 in the town of Lewes in Southern England. Two hundred and twenty-seven residents of 103 flooded households and 240 residents of 104 non-flooded households in the same postal district were recruited by random selection of addresses from a post flooding survey and a commercial database respectively. Having been flooded was associated with earache (RR 2.2 [1.1,4.1] p = 0.02), and a significant increase in risk of gastroenteritis with depth of flooding (RR 1.7 [0.9,3.0] p = 0.09, p for trend by flood depth = 0.04). Adults had a four-times higher risk of psychological distress defined as a score of > or = 4 in response to the 12-item General Health Questionnaire (GHQ-12) (RR 4.1 [2.6, 6.4] p < 0.0005, p for trend by flood depth = 0.01). Associations between flooding and new episodes of physical illness in adults diminished after adjustment for psychological distress. Flooding remained highly significantly associated with psychological distress after adjustment for physical illnesses. Psychological distress may explain some of the excess physical illness reported by flooded adults and possibly by children as well. Policies to promote population resilience to flooding where flood prevention has failed must include practical support for flood victims and provision of appropriate psychological support. Associations with physical illnesses affirm the need for advice and assistance with individual, household and environmental hygiene and access to medical services.

In January 2002 the Communicable Disease Surveillance Centre (CDSC) introduced outcome reporting for tuberculosis 12 months after start of treatment. To determine whether outcome could change with longer and more detailed follow up, we examined this at 12 months and two years for a cohort notified in 2000 at a central London hospital. At 12 months 61/94 (65%) notified patients had completed treatment, 10 (16%) had died, 11 (12%) were lost to follow up, six (6%) were transferred to another service in the UK, four (4%) were still on treatment, and treatment for one (1%) patient had been stopped. After a mean follow up of two years, 65 (69%) had completed treatment. In this London service with a high prevalence of HIV infection (at least 23%), low treatment success was due to deaths, transfers and losses to follow up. The last of these was often due to patients returning to their country of origin (7 of 11). Tuberculosis was the primary or contributing cause of death in at least 4/94 (4%) cases. Completion rates need to be interpreted with caution particularly in specialist units with highly mobile populations. This has implications for national targets as well as for models of care.

Between the beginning of December 2002 and the end of March 2003, eight cases of infectious syphilis were diagnosed in Walsall. Two unrelated clusters were identified. The first consisted of three cases, two heterosexual patients and a baby with congenital syphilis. The infant had no congenital stigmata of syphilis, which is consistent with recent infection. The second cluster consisted of five cases in men who have sex with men (MSM) who attended a local sauna that attracts men from the Midlands and north west England. One infection was detected in an outreach screening initiative of 60 MSM. Both clusters illustrate the problems of case ascertainment and the need for continued vigilance to the potential of syphilis infection in high risk groups. Vigorous public health efforts are required to promote safer sex and awareness to infection with syphilis and human immunodeficiency virus, reinforced by targeted case finding in clinic and community settings.

Most people with acute gastroenteritis do not seek medical care and are therefore not captured by routine surveillance. For this reason, population-based studies are needed to measure the burden of illness. A study of acute gastroenteritis in Northern Ireland and the Republic of Ireland surveyed 9,903 people by telephone over the 12-month period from December 2000 to November 2001. The rate of acute gastroenteritis was 0.60 episodes per person per year. A general practitioner was consulted by 29.2% of those reporting illness, and 2.0% submitted a stool sample. The use of antibiotics was reported by 7.4% of ill respondents and 14.8% took anti-diarrhoeals. Taking days off work due to illness, was reported by 17.4% of respondents. Acute gastroenteritis causes a large amount of illness in the community. There are established and effective measures to prevent this condition and the challenge is to find new ways of promoting these precautions.

Laboratory recognition of recent infection allows HIV incidence to be monitored. We have determined HIV incidence in homo/bisexual men attending 15 genitourinary medicine clinics (GUM) across England, Wales and Northern Ireland (EW&NI). The estimated HIV incidence for 2002 was 3.5%, an increase from the 2.5% incidence seen in 2000 and 2001. Incidence was higher in London than outside, though outside London the overall incidence has recently increased over two-fold from 1% in 2001 to 2.5% in 2002. Throughout the UK HIV incidence may have risen in homo/bisexual men attending GUM clinics.

Clusters of meningococcal disease in school and pre-school settings generate high levels of public anxiety. Thus, cluster detection and reporting is crucial to trigger prompt public health measures, and detailed study is essential to shape future public health policy. In 2001/02, most clusters were of group B meningococcal disease and most occurred in pre-school or secondary school settings. No clusters of group C meningococcal disease occurred in this time period.

Malaria in south east London is under-notified, and a previous local study has described how available data can underestimate the incidence. An active surveillance system was established and data on malaria cases diagnosed between the 1st January and 31st December 2000 were gathered from local laboratories, the Malaria Reference Laboratory (MRL) and a neighbouring health authority. In total 320 cases were identified in local residents (42.33 per 100,000). Of these 320, 293 were laboratory confirmed (38.75 per 100,000) and there were 47 notifications on clinical suspicion. Only 6.8% (20) laboratory-confirmed cases were formally notified. Males of African descent aged 25-39 years who travelled to West Africa were most affected, and 92.5% of the cases were of P. falciparum infection. The surveillance programme confirmed that formal malaria notifications are unreliable. The most important group of residents for targeted health intervention are members of ethnic minority groups, born in endemic areas and travelling to their countries of origin to visit family or friends.