Communicable disease report. CDR review最新文献

A questionnaire on the services provided and the methods used for the diagnosis of fungal infections and for the support of antifungal chemotherapy was sent to members of the British Society for Medical Mycology (BSMM) and the British Society for Antimicrobial Chemotherapy (BSAC). Ninety-five responses from general microbiology laboratories in the United Kingdom were analysed, and we compared services provided by laboratories that serve a transplant unit with those offered by other laboratories. We estimate that about 150 cases of cryptococcosis, 500 to 600 of candidaemia, and 300 to 400 of invasive aspergillosis are identified by laboratories in the United Kingdom (UK) each year. The clinical laboratories are aware of the importance of fungal infection, but rely heavily on reference services. In some laboratories, however, the degree of investigation of specimens and the procedures in use are inadequate for diagnosing systemic mycoses and determining the susceptibility of isolates to antifungal agents. The balance between reference and local services requires attention and external quality assurance needs to be applied effectively. In addition, effective methods for the diagnosis of systemic mycoses, and reliable and practicable methods for determining the susceptibility of isolates to antifungal agents, are needed urgently.

We surveyed consultants in communicable disease control (CCDCs) for their views on the current and potential value of Statutory Incident Reports--Salmonella in Animals, Birds and their Products received from the Ministry of Agriculture Fisheries and Food (MAFF), in the surveillance, prevention, and control of Salmonella typhimurium infections in humans. CCDCs from 103 (83%) of 124 district health authorities responded. Most CCDCs in rural areas used the reports either to cross reference information about animal and human isolates or to discuss with environmental health officers. Many believed that the reports' relevance to human infection could be improved if they were sent more quickly. Some CCDCs suggested that it would be useful to cross reference laboratory reports of animal and human infection at regional level and to have personal contact with local veterinary officers of MAFF. Close cooperation between public health doctors and MAFF and a coordinated approach is needed to prevent and control associations between animal and human zoonotic infections.

A prospective survey was carried out in Northern Ireland between February and August 1994 to assess the current levels of salmonella in retail chickens, and to determine whether contamination rates differed between chickens sold in supermarkets and by butchers. One hundred and forty chilled and frozen raw chickens were sampled from retail display and examined for the presence of salmonella using an approved method. Contamination was commoner in chickens that were chilled, sold from smaller premises, and reared or slaughtered outside Northern Ireland. Salmonella enteritidis phage type 4 was the most commonly isolated type. The contamination rate of about 7% is considerably lower than in Great Britain and this may partially explain the lower rate of human salmonella infections in Northern Ireland. This finding supports the recommendations made in the Advisory Committee on the Microbiological Standards of Food's report on poultry meat, since many of the improvements proposed are already in operation in areas of the Northern Ireland poultry industry.

Data from the surveillance scheme of general outbreaks of infectious intestinal disease in England and Wales, reported to the PHLS Communicable Disease Surveillance Centre (CDSC), were used to review 1280 of the 1594 outbreaks identified between 1 January 1992 and 31 December 1994 for which a minimum data set was captured. The number of outbreaks reported in each regional health authority ranged from 31 in Mersey to 221 in Yorkshire. The commonest pathogens reported were salmonellas in 32% (412) of outbreaks, small round structured virus (SRSV) in 27% (342), Clostridium perfringens in 7% (90), and Shigella sonnei in 4% (46). The main mode of transmission was described as foodborne in 50% (642), over half of which were caused by salmonellas, and person to person in 39% (496), over half of which were caused by SRSV. Most outbreaks transmitted from person to person occurred in hospitals and in residential institutions for elderly people. Outbreaks lasted from one to 217 days (median five days) and their duration varied with the pathogen. The median attack rate was 37%. Illness was reported in 34,158 people, 751 of whom (2%) were admitted to hospital. There were 55 deaths, 28 of which were associated with salmonella and 12 with SRSV. Most of the outbreaks reported and the associated morbidity and mortality could have been prevented by following standard food hygiene practices, implementing infection control policies, and ensuring that food entering kitchens was of the highest microbiological quality possible.

In order to study selected factors affecting the uptake of Haemophilus influenzae type b (Hib) vaccine a case control study was undertaken in residents of the Southern Health and Social Services Board in Northern Ireland. Standard data from the child health computer system were used. Residents in the catchment area of the health board born between 1 January and 30 June 1993 were defined as cases (unvaccinated) and controls (vaccinated). The uptake of Hib vaccination and odds ratios for factors associated with non-completion of vaccination were calculated. Overall uptake of Hib vaccination exceeded 97%. Children of mothers who smoked or children who had two or more younger siblings were less likely to have been vaccinated.

In April 1995 an outbreak of cryptosporidiosis occurred among 43 schoolchildren and four staff after a week's holiday at a rural farm. A retrospective cohort study found illness to be 3.8 times more likely in those who handled calves and 1.5 times more likely in those who habitually bit their nails or sucked their thumbs. Cryptosporidium oocysts were detected in faecal specimens from six of the 29 pupils and one of the four staff who were ill. Infection occurred in children despite supervised handwashing. The infection hazards of farm visits need more publicity, and further study on the risks of cryptosporidiosis transmission in the farm environment is required to guide preventive measures.

Herpes simplex virus (HSV) type 2 is the main cause of genital herpes infections. Conventional serological techniques cannot discriminate between antibodies specific to HSV types 1 and 2, so these methods cannot be used in the seroepidemiological investigation of genital herpes infections. The discovery of type specific antigens in HSV-1 and HSV-2, most notably glycoprotein G (gG), has been successfully exploited to develop assays for the detection of type specific HSV antibody. The presence of type specific antibodies provides evidence for infection with HSV-1, HSV-2, or both. Tests which detect humoral responses to HSV-2 have been used during the past decade to investigate populations in various countries. Most surveys of general adult populations in the developed world have found a relatively low seroprevalence of HSV-2, although this does differ between countries. Studies of HSV-2 antibody in developing countries have revealed higher rates of infection in adults. People attending sexually transmitted diseases (STD) clinics have higher rates of HSV-2 infection than general populations sampled in the same country. Assays of HSV type specific antibodies have been used in seroepidemiological surveys that include information about demography and sexual behaviour to identify risk factors for HSV-2 infection. The surveys show that people with a large number of sexual partners are at increased risk of acquiring HSV-2 infection and that a high proportion of HSV-2 infections are asymptomatic. Assays of HSV type specific antibody have been used to show that the presence of pre-existing HSV-1 antibody may reduce the severity of genital HSV-2 infection. Such assays have also been used in studies of the transmission of genital herpes. Proposed interventions to counter the spread of genital herpes include targeted education and vaccination programmes. Assays of HSV type specific antibodies may be used to monitor the effectiveness of such policies.

Fear of wild rats as carriers of disease is embedded within our culture. Surprisingly little is actually known about parasites in wild rat populations. In recent studies aimed to rectify this omission, farms in England and Wales were surveyed to identify parasite species present in the rat populations. Rats were found to be infected with numerous zoonotic parasites, including cryptosporidium, pasteurella [correction of pasturella], listeria, yersinia, coxiella, and hantavirus. These findings suggest that wild brown rats represent a potential risk to the health of humans and domestic animals.