NIPH annals最新文献

One case of meningococcal conjunctivitis followed by meningitis and septicemia with fatal outcome is described. Primary meningococcal conjunctivitis is rare, but 10% of the published cases are complicated by systemic infection. It is recommended that these patients be given both local and parenteral treatment. The value of culturing the purulent exudate from the conjunctival sac to reach an etiological diagnosis is pointed out.

In whole cell preparations of 27 nonmucoid strains of Moraxella nonliquefaciens neuraminic acid was detected by gas chromatography (GC) in 16 (59%) of the strains. Seven neuraminic-acid-containing strains were tested for agglutination with diagnostic group-specific meningococcal antisera produced in rabbits, and all were positive with group B serum. Counter-immunoelectrophoresis of bacterial suspensions of the three strains with the strongest reaction with such anti-group B serum gave distinct precipitation lines. When tested by double immunodiffusion in agarose with monoclonal antibody to meningococcal group B polysaccharide, suspension of a strain of M nonliquefaciens gave identity reaction with a strain of Neisseria meningitidis, and reacted even more strongly than the latter. Phenol extracts of M nonliquefaciens strains generally contained higher amounts of neuraminic acid than N meningitidis group B strains. Neuraminic-acid-containing polysaccharides of M nonliquefaciens strains sedimented more slowly by ultra-centrifugation than the group-specific B polysaccharide of N meningitidis strains. They also reacted more strongly with a monoclonal anti-group B antiserum than did N meningitidis group B capsular polysaccharide in an antibody binding inhibition test (solid phase radioimmunoassay). Immunological reactivity of the polysaccharides of both species was lost if extraction was performed with unbuffered phenol at 68 degrees C, instead of with neutral phenol at 4 degrees C. The results show that several strains of M nonliquefaciens, often inhabiting the human nose, have high levels of a surface polysaccharide chemically and immunologically closely similar to N meningitidis group B capsular polysaccharide. The cross-reactivity may have immunological implications for meningococcal disease.

Characteristics of 67 strains of Neisseria meningitidis causing systemic disease in Norway during the winter 1981-82 are reported and related to clinical manifestations. Included in the study were also pharyngeal isolates of meningococci collected in the same period from 35 healthy military recruits. The strains were examined for serogroup, serotype as determined with monoclonal antisera (against antigens 2a, 2b, 12, 15 and 16), and sulfonamide susceptibility. Predominating in the systemic disease material were serogroup B, serotype 15, 16 (or 15), and sulfonamide-resistant strains. This complex of characteristics also appeared to be associated with the severity of manifestations (septicemia and death). The material of meningococci from healthy carriers unassociated with cases of disease was clearly different; these strains were typically non-groupable, non-typable and sulfonamide-sensitive. The full combination of traits usually seen in strains causing systemic disease was rare in carrier isolates. The results are discussed in relation to the epidemiological development of meningococcal disease in Norway.

As part of a greater project (MenOPP), the type, distribution and frequency of sequelae after meningococcal disease (MCd) were estimated on the basis of examinations carried out about six weeks after hospital admission. Well documented sequelae were found in about 18% of 102 MCd cases compared to about 3% in 61 control patients. In 18 control patients with meningitis/septicemia due to other bacteria, the sequelae frequency was 11%. Our MCd sequelae results correspond with many of those published during the last few years. The frequency of uncertain sequelae was about the same (16%) in the MCd and the control group patients. A routine examination six weeks and one year after a MCd episode seems to be useful for the individual patient and for the research on better prophylaxis and improved treatment.

The Norwegian offshore oil industry is rapidly expanding. The health services for this industry have also developed quickly. An EDB-based medical registration system for the Norwegian continental shelf (MICS) has been planned in support of health services, health authorities and researchers. This information system will consist of an injury/disease register and a register of the population on the Norwegian continental shelf. The injury/disease register will comprise inter alia reported cases of occupational injury, occupational disease, notifiable infectious disease and summary data about rate of utilisation of ambulance transport and health services offshore. The system will be administered by the Norwegian Directorate of Health in cooperation with the Norwegian Oil Directorate. MICS will provide new possibilities for epidemiological studies of health and disease among the employees in the oil industry.

The acquired immunodeficiency syndrome (AIDS) is a new, serious condition of major public health concern. It is most prevalent among young homosexuals and may be present with Kaposi's sarcoma and serious opportunistic infections. Physicians dealing with male homosexuals should be aware of this diagnostic possibility in any patient with unusual skin lesions or unusual clinical findings indicating infection. AIDS may be preceded by persistent generalized lymphadenopathy which may be accompanied by fatigue, low grade fever, night sweats and weight loss. The prognosis is poor with high mortality rates and no indication of spontaneous recovery of cellular immunocompetence.

The secular trends of NTDs by subgroups were investigated using data from the population-based Medical Birth Registry of Norway. During 1967-81, rates of total congenital malformations significantly increased by 4.1% annually. In contrast, there was an average annual decline of 1.6% in anencephaly rates and 0.4% in spina bifida rates. Annual rates of NTDs among twins decreased more (3.8%) than among singletons (1.6%). Females had an annual decline in rates (2.2%) that was greater than in males (0.7%). Separation of NTDs into two sub-groups based on the presence of multiple major malformations, revealed a significant decline of 2.1% annually in singles, whereas rates in multiples showed an increase of 3.3% annually. The different prevalence patterns revealed in various subgroups strongly suggest different etiologic entities. These should be further refined for elucidating etiologic factors. Furthermore, in prediction of current cases and evaluation of the effects of health services, the proportion of the various subgroups present should be considered.

Vaccination against rubella was introduced in Norway in 1978. Without any vaccination policy the frequency of congenital rubella is estimated at 0.4 per 1000 births. In this paper the consequences and effectiveness of the various vaccination programmes are evaluated by applying a cost benefit model. Economically, all strategies to prevent congenital rubella turn out to be cost effective. However, based on the benefit/cost ratios and the net benefit the following recommendation can be made: vaccination, preferentially with the polyvalent vaccine, should be offered to all girls in puberty as a permanent running programme. In addition, this policy should be supplemented for one or two decades with a programme offering vaccination to non-immunized women after delivery and to women especially at risk of exposure. However, if the participation and acceptance rate of the vaccination is less than 100%, permanent vaccination offered at two different ages (i e in childhood and in puberty) gives the best results in the prevention of congenital cases.

1137 newborn infants in the towns of Harstad and Tromsø were examined for Staphylococcus aureus. The children were followed for two months after birth, and 10% showed signs of infection. The first symptom occurred on the average on the ninth day of life, while the average stay in the maternity ward was six days. 85% of those being regarded on clinical grounds as infected with S aureus showed growth of this bacterium on cultivation of the specimens taken. Over 80% of the strains were resistant to penicillin G/V and approximately 11% resistant to fucidic acid. Resistance to other antibiotics was not found to present any problem. A survey of staphylococcal infections among the newborn should include both the stay in the maternity ward and the first week at home.

The prevalence rates of infections among hospitalized patients in 15 Norwegian hospitals on 28 November 1979 is reported. A total of 7833 patients were included in the study, representing approximately 35 per cent of patients in somatic hospitals in Norway on that day. The prevalence rate of all infections was 17 per cent and for hospital infections 9 per cent. Hospital infections were most frequent in haematology and intensive care departments (23 and 22 per cent respectively) while the lowest rates were found in ophtalmology and psychiatry (2 per cent). Urinary tract infections played a major role both overall (33.5 per cent) and in hospital infections (41.9 per cent). In community acquired infections alone lower respiratory tract infections were slightly more common than urinary tract infections (26.6 per cent of infections versus 24.1 per cent). The study also comprises data on frequency of bacteriological examination in infected patients and on usage of indwelling urinary catheters in patients with urinary tract infections. The rates are compared to studies in other countries. We found the prevalence survey method to be an acceptable way of assessing infection rates among hospitalized patients in Norway. The greatest benefit of the survey is believed to be the ability to increase the awareness of infection problems in hospitals among health personnel.