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Biomedical subjects

A Tegnell

Publications and source records attributed to A Tegnell.

16 recordsLinked to original sources
PubMed2006

Coverage of hepatitis B vaccination in Swedish healthcare workers.

The aim of this study was to assess how well the guidelines on vaccination against hepatitis B had been implemented among healthcare workers (HCWs) at risk for blood exposure. A point-prevalence survey was conducted in six departments of a university hospital in Sweden: the emergency room, intensive care unit, postoperative unit, surgical theatre, department of anaesthesiology and the laboratory for blood chemistry. All HCWs who worked in these departments during the 24h of the survey were asked to complete a questionnaire. In total, 369 questionnaires were analysed. Seventy-nine percent (293/369) of HCWs had received at least one dose of vaccine, but only 40% (147/369) reported that they were fully vaccinated and 21% (76/369) had not been vaccinated at all. The majority of unvaccinated HCWs (72/76, 95%) stated that they would accept vaccination if offered. The main barrier to better compliance with the guidelines is not lack of acceptance among the employees but the failure of the employer to ensure that policies are implemented.

Adult↗
PubMed2006

Development of a matrix to evaluate the threat of biological agents used for bioterrorism.

Adequate public health preparedness for bioterrorism includes the elaboration of an agreed list of biological and chemical agents that might be used in an attack or as threats of deliberate release. In the absence of counterterrorism intelligence information, public health authorities can also base their preparedness on the agents for which the national health structures would be most vulnerable. This article aims to describe a logical method and the characteristics of the variables to be brought in a weighing process to reach a priority list for preparedness. The European Union, in the aftermath of the anthrax events of October 2001 in the United States, set up a task force of experts from multiple member states to elaborate and implement a health security programme. One of the first tasks of this task force was to come up with a list of priority threats. The model, presented here, allows Web-based updates for newly identified agents and for the changes occurring in preventive measures for agents already listed. The same model also allows the identification of priority protection action areas.

Bioterrorism↗
PubMed2004

Basic Surveillance Network, a European database for surveillance data on infectious diseases.

The Basic Surveillance Network was started in 2000 and is one of the networks on infectious diseases funded by the European Commission. The network collects and makes readily available basic surveillance data on infectious diseases from all the 'old' (pre-2004) European Union member states. The aim is to provide easy access to descriptive data that already exist in national databases, so that it is possible to monitor and compare incidence trends for infectious diseases in the EU member states. The list of diseases covered by the network has recently been expanded from 10 initial 'pilot' diseases to over 40 diseases listed by the EU to be under surveillance. In the near future, the new member states will be invited to participate in the network. Data are case-based and comprise date of onset of disease, age and sex. Only a very short list of disease specific additional variables, such as country of infection or immunisation status, is collected. Classification of cases (possible, probable, confirmed) is specified according to EU case definitions. The participants of the network have access to an internal web site were all the data is presented in tables and graphs. An open website is available for the public at https://www.eubsn.org./BSN/

Communicable Diseases↗
PubMed2002

Biological weapons and bioterrorism preparedness: importance of public-health awareness and international cooperation.

Biological weapons and biological terrorism have recently come into focus due to the deliberate release of Bacillus anthracis via mail delivered in the USA. Since the 1930s, biological weapons have been developed in a number of countries. In 1975, the Biological and Toxin Weapons Convention entered into force; this prohibits the use of these weapons and has been signed by a large majority of countries (144). Unfortunately, several countries failed to respect this treaty. The Soviet Union continued and expanded its biological weapons program, and after the Gulf War it was revealed that Iraq also had an extensive biological weapons program. Large-scale deliberate release of, Bacillus anthracis, for example, or an epidemic following a release of smallpox virus, would have a devastating effect. This has motivated the world community to strengthen the Biological and Toxin Weapons Convention with a control mechanism which has, as yet, not been successful. Sweden, like other countries, is enhancing its preparedness with regard to stocks of antibiotics and vaccines, related to these improving the diagnostics these and similar agents, and is setting up an epidemiologic task force that can be used in infectious disease emergencies such as the deliberate release of biological warfare agents. International cooperation in this area has to be enhanced, not least in the European Union.

Biological Warfare↗
PubMed2002

Biological warfare in a historical perspective.

There are some early examples of biological warfare (BW), but in modern times it was used first for sabotage by Germany during WWI. Development of biological weapons on a military significant scale was initiated in several countries in the period between the world wars. During WWII, several countries had active programs such as the USA, UK, Canada, Germany, Japan and the Soviet Union. It was only Japan that on a fairly large scale used BW. The US program continued until 1969, when President Nixon took a decision to end it in connection with signing the BTWC. The Soviet Union had also continued its program after the war, and this was enhanced after signing the BTWC: in the 1980s the program consisted of around fifty facilities and involved around 60,000 people. The Soviet Union produced and maintained a large stockpile of BW-agents. After the collapse of the Soviet Union, and due to pressure from USA and UK, President Yeltsin issued a decree in 1992 banning continued offensive BW activity. However, there are still concerns of residual activity in Russia. Another program of concern is the Iraqi BW-program. After 10 years of UN inspections that were stopped in 1998, there are still many unanswered questions concerning the BW program. There was also a covert BW-program in South Africa that was terminated around 1993. There have also been a number of allegations of alleged use or possession. In addition, there are indications that 10-12 states are now trying to acquire BW, and this assessment is based on intelligence information, mainly from the USA. For example Iraq, North Korea, Iran, Syria, Sudan and Libya. Another aspect is the strong driving force of technology developments to promote this type of program, opening new risks for future potential military misuse.

Animals↗
PubMed2002

Smallpox--eradicated, but a growing terror threat.

Smallpox is a disease that followed humanity for thousands of years up until 30 years ago. It was possible to eradicate, because an effective live vaccine from crossreacting vaccinia could be developed. Twenty years have passed since vaccinations stopped and very few people are protected against the disease today. Variola today has become an object of discussion due to the possibility that it can be used as a bioweapon. Due to the number of complications that can be expected a general vaccination is probably not possible. Research is ongoing to develop new vaccines. Many countries are improving their capabilities to respond to a renewed threat of a smallpox epidemic.

Antiviral Agents↗
PubMed2002

Changes in the appearance and treatment of deep sternal infections.

The Department of Thoracic Surgery at the University Hospital, Linköping, Sweden, has actively followed up infectious complications of cardiac surgery since 1989. The aim of this study was to investigate whether changes occurred during the 1990s in the appearance and the management of deep infections. This was done by studying patients undergoing surgical revision of infected wounds. We studied 42 patients during 1990-94 and 49 during 1997-98 (total number of operations in these periods, 3075 and 1646, respectively). Pre-operative and intra-operative variables were recorded for the two patient populations. The proportion of cardiac surgery procedures followed by a surgical revision for an infection in the sternal wound increased between the two periods (1.4% vs. 3.0%). Variables associated with the surgical procedures preceding the infection remained unchanged. In the later period, treatment was started earlier (64 vs. 24 days), and the length of antibiotic treatment was decreased (115 vs. 72 days). The incidence of osteomyelitis of the sternal bone was lower (61% vs. 27%). It appears that as the proportion of patients undergoing surgical revision increased, management of the infections became more effective, with aggressive surgical and antibiotic treatment policies and shorter treatment periods. This indicates that in order to evaluate the overall impact of measures designed to reduce infections after cardiac surgery, not only the incidence of infection needs to be followed up but other factors also need to be taken into account.

Aged↗
PubMed2002

A clone of coagulase-negative staphylococci among patients with post-cardiac surgery infections.

Coagulase-negative staphylococci (CoNS) are important causes of hospital-acquired infections such as infections after cardiac surgery. Efforts to reduce these infections are hampered by the lack of knowledge concerning the epidemiology of CoNS in this setting. Forty strains of CoNS collected during the surgical revision of 27 patients operated on between 1997 and 2000 were analysed. Strains were also collected from the ambient air in the operating suite. Their pulsed-field gel electrophoresis (PFGE) characteristics and antibiotic resistance were analysed. Using PFGE 19 of 40 strains from 15 of 27 patients were shown to belong to one clone, and strains from this clone were also isolated from the ambient air. This clone had caused infections throughout the period. Antibiotic resistance did not correlate with PFGE patterns. Using PFGE one clone could be identified that caused 56% of the CoNS infections during this period. A strain from this clone was also found in the air of the operating suite suggesting the origin of the CoNS causing infections was the hospital environment.

Aged↗
PubMed2001

[Anthrax--the Swedish perspective].

The recent occurrence in the USA of deliberate release of virulent Bacillus anthracis in letters sent to three media corporations and to the American senate has led to a great anxiety in Sweden and elsewhere in Europe. Numerous letters have been suspected to contain B. anthracis spores and several have contained powder of different types. In none of the tested letters collected by the Swedish police have we been able to detect anthrax bacilli. Powder containing letters have been tested with either bacterial isolation and/or B. anthracis specific PCR. Anthrax is a disease found naturally in herbivores and is occasionally spread to humans. It is caused by the gram-positive rod B. anthracis that was discovered by Robert Koch in 1876. Beginning in the 1930s many states have developed B. anthracis for use as a weapon. A few releases of the bacteria have been reported before October 2001. B. anthracis causes three forms of disease, cutaneous, pulmonary and gastro-intestinal. The pulmonary form is the most dangerous and may lead to death merely one to two days after onset of severe symptoms. This is due to the rapid growth and release of several potent toxins that engage the immune system and promote tissue destruction. B. anthracis infection can be treated with several antibiotics, among which quinolones and tetracyclins have been recommended. Diagnosis can readily be achieved by microscopy, bacterial isolation and PCR at the Swedish Institute for Infectious Disease Control and the Swedish Defence Research Agency. Antibiotics relevant for treatment of B. anthracis infections are already stockpilled in our country. Further actions to strengthen our capability to deal with bioterrorism are ongoing.

Anthrax↗
PubMed2001

[Update on biological weapons and bioterrorism. Important that health services pay attention to unusual events].

Biological weapons and biological terrorism have recently been in focus due to the deliberate release of Bacillus anthracis via mail delivered in the USA. Since the 1930s biological weapons have been developed in a number of countries. In 1975 a biological and toxin weapons convention prohibiting the use of these weapons were signed by a large majority of world countries. Unfortunately, a number of countries have failed to respect this treaty. The Soviet union continued and expanded its biological weapons program and after the Gulf war it was revealed that Iraq also had an extensive bio-weapons program. Large scale deliberate release of for example B. anthracis or an epidemic following a release of smallpox virus would have a devastating effect. This has urged the world community to strengthen the biological and toxin weapons convention with a control function which as of yet has not been successful. Furthermore, many countries including Sweden, increase stocks of antibiotics and smallpox vaccines. Sweden is also increasing preparedness regarding diagnostics of these and similar agents and is setting up an epidemiological task force that can be used in infectious disease emergencies such as the deliberate release of a biological weapon.

Anthrax↗
PubMed2001

A whirlpool associated outbreak of Pontiac fever at a hotel in Northern Sweden.

In April 1999, an outbreak of Pontiac fever occurred at a hotel in Northern Sweden. A retrospective cohort study to find the source and define the extent of the outbreak was carried out among 530 Swedish and Norwegian guests. Twenty-nine epidemiological cases (8% of 378 responders) aged 21-57 years were identified. Antibodies against Legionella micdadei were detected in 17 of 27 tested cases and 3 other symptomatic persons. Visiting the whirlpool area was identified as the sole risk factor (RR 86; 95% CI 21-352) and infected cases were confined to visitors to this area over three successive days. The attack rate was 71% (27/38) and 24 cases (83%) used the whirlpool. Environmental sampling was negative for Legionella sp. But epidemiological investigation strongly suggests that the whirlpool was the source of the outbreak. The possibility of serious legionella infections underlines the importance of strict maintenance practices to maintain hygiene of whirlpools.

Adult↗
PubMed2000

Coagulase-negative staphylococci and sternal infections after cardiac operation.

BACKGROUND: Coagulase negative staphylococci (CoNS) have been recognized as important pathogens in nosocomial infections, especially in connection with implanted foreign materials. In cardiac operation they are among the most common pathogens isolated from infected sternal wounds. The definition of the infection is very important. In this study we focus on deep postoperative chest infections. METHODS: By studying 33 infected patients retrospectively and comparing them to 33 matched uninfected controls, we studied the characteristics and costs of the infections. RESULTS: Typical for these infections is the late and insidious onset, and that the infections initially give only minor symptoms such as pain, redness, and serous secretion. We found the following risk factors for infection: number of preoperative days in a hospital, the total length of the operation, and if the patient had undergone an early reoperation due to causes other than infection. This kind of infection more than doubled the hospital costs for the patients affected. CONCLUSIONS: Coagulase negative staphylococci are the most important pathogens in deep postoperative infections in this material. They cause infections that are difficult to recognize since they give only discrete symptoms and start well after the patients leave the hospital. The risk factors for patients with CoNS infections are mostly associated with a long exposure to the hospital environment. The treatment is often difficult and costly because of multiresistant bacteria and frequent need for repeated surgical revisions.

Cardiac Surgical Procedures↗
PubMed1995

Intrathecal production of specific IgA antibodies in CNS infections.

Cerebrospinal fluid (CSF) and serum from subjects with herpes simplex encephalitis, herpes zoster, mumps meningitis and neuroborreliosis were analysed for the presence of immunoglobulin A (IgA) and G (IgG) antibodies to the corresponding four antigens. Specific intrathecal IgA antibody synthesis as manifested by an elevated index was a frequent finding. Higher IgA index values than the corresponding IgG was seen in one third of the samples from subjects with herpes simplex encephalitis and herpes zoster. Correlation between specific IgG and IgA index was most pronounced for varicella-zoster virus (r = 0.66, P < 0.001). In subjects with mumps meningitis a strong intrathecal IgA and IgG antibody response to Borrelia burgdorferi was demonstrated. Specific herpes simplex and varicella-zoster virus IgA was not found to contain secretory component, thus contradicting an active secretion into the CNS compartment. In conclusion, our data indicate that specific IgA is intrathecally produced in herpes simplex encephalitis, herpes zoster and mumps meningitis but is a rare finding in neuroborreliosis.

Adult↗