Communicable disease report. CDR review最新文献

The aim of this study was to determine associations between indicators of social deprivation and the uptake of primary immunisation in London. Correlation coefficients were calculated between immunisation coverage in London for each of the 28 inner and outer London district health authorities in November 1991 and a range of possible explanatory variables from small area statistics data from the November 1991 census. The proportions of children under 5 years of age, lone parent families, unemployed members of the workforce, domestic overcrowding, ethnic minorities, and unskilled workforce were correlated significantly with the coverage of primary immunisation for third dose diphtheria (D3) and pertussis (P3) at 12 months. A significant correlation with measles, mumps, and rubella (MMR) at 24 months existed only for lone parent families. Multiple linear regression weighted by population size was used to identify independent predictors of variation in immunisation cover. The proportion of lone parent families in each district health authority was the only significant independent risk factor consistently associated with variation in immunisation coverage for D3, P3, and MMR. The proportion of lone parent families explained 42% of the variation in coverage for D3 in November 1991. This study has identified lone parenthood as an important independent risk factor in London for failure to complete immunisation.

Surveillance of prevalent serogroups/types of Streptococcus pneumoniae and their susceptibility to antimicrobial agents is important for understanding the epidemiology of pneumococcal infections and for guiding empirical treatment. Current vaccines for prevention of pneumococcal infection utilise serotype specific antigens, so knowledge of the prevalence of particular serotypes is relevant to vaccine use and development. Five thousand seven hundred and ninety-six isolates of S. pneumoniae from separate patients were serogrouped or serotyped by the Streptococcus and Diphtheria Reference Unit between 1993 and 1995. Antibiotic susceptibility testing was carried out by the Antibiotic Reference Unit on 3821 (65.9%) of these isolates. A total of 40 distinct serogroups/types, together with a small number of non-typable isolates, were noted over the three year period. The same five serogroups/types (6, 9, 14, 19, and 23) occurred most commonly in each year of the study, not only in the total population of isolates studied, but also in isolates obtained from blood or cerebrospinal fluid, and among isolates with antibiotic resistance. Ninety-six per cent of the isolates belonged to serogroups/types included in the currently available 23-valent capsular polysaccharide pneumococcal vaccine; the conjugate petna-, hepta-, and nonavalent vaccines covered 51%, 75%, and 80% of isolates respectively. The nonavalent vaccine offers the most promise as 74% of all blood and cerebrospinal fluid isolates and 90% of antibiotic resistant isolates belonged to serogroups or types included in this formulation.

These guidelines on malaria prevention are an aid to health care workers who advise travellers, particularly those who will be overseas for less than a year. They represent a virtual consensus of the views of 44 doctors, nurses, and pharmacists with special expertise in malariology or travel medicine who met to develop them in 1996 (see list on R152). The guidelines are in three parts. The first part is a summary that emphasises modifications to the advice given in the last set of guidelines, published in 1995. The second part discusses the issues addressed in formulating the guidelines. Doctors, practice nurses, and pharmacists are asked to read this section to avoid doing harm by giving chemoprophylaxis without due attention to the traveller's history or destination and by using oversimplified lists of recommendations by country. The second part also addresses the health care worker's consultation with prospective travellers. The third part gives specific recommendations for travellers to specific destinations and some details of individual drugs. Fuller information on some points was given in earlier versions of the guidelines, which should not be discarded. Meetings of the sort described above have been held since 1980 and the group's membership has included people with varied views and experience. The views expressed in these guidelines reflect experienced professional opinion, since data are inadequate for unequivocal views to be given on several issues. There is often a range of acceptable options, but to meet the requests of general practitioners the guidelines try to give one recommended option and state alternatives, suggesting when and how different regimens can be used to good effect. Decisions on the terms under which different drugs are licensed for use are the responsibility of the Licensing Authority, advised by the Committee on Safety of Medicines (not of these guidelines). The guidelines should be read as a supplement to and not as a substitute for the relevant data sheets. Chemoprophylaxis lies somewhere between vaccination (for which people expect governments to lay down schedules) and treatment of ill people (for which each physician does what seems most appropriate) in concept and practice. The risks of malaria need to be balanced against the risks of the preventive measures, on the basis of the data available. Travellers may ask for an explanation of these risks and doctors and practice nurses need to be well informed and able to present their knowledge to travellers. The second part of these guidelines may be of use to prospective travellers who wish to read about the options themselves. All readers are recommended to read part two in its entirety to get a balanced picture.