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Biomedical subjects

Kåre Mølbak

Publications and source records attributed to Kåre Mølbak.

At least 19 recordsLinked to original sources
PubMed2007

Incidence of and risk factors for skin ailments among farmers working with wastewater-fed agriculture in Hanoi, Vietnam.

The use of wastewater in agriculture and aquaculture is widespread in many developing countries, but limited information is available about the health hazards associated with this practice. To study the occurrence of skin ailments in relation to wastewater use in agriculture and aquaculture, an open cohort of 636 adults aged 15-70 years living in a wastewater-irrigated area in Hanoi, Vietnam, was followed by weekly visits for 12 months. A nested case-control study with 108 case/control pairs was conducted to investigate possible risk factors for skin ailments. The incidence rate of skin ailments was 32.5 episodes per 100 person-years at risk. Independent determinants of skin ailments included wastewater contact in the past 7 days (odds ratio (OR=2.74, 95% confidence interval (CI) 1.29-5.82), female gender (OR=2.48, 95% CI 1.06-5.76), fish farming-related jobs (OR=3.47, 95% CI 1.27-9.50) and lack of protective measures (OR=2.24, 95% CI 1.21-4.12). It is likely that effective promotion of personal protective measures and improved hygiene practices amongst wastewater users will mitigate the risk of dermatological problems and will thus be of benefit to public health in communities that rely on the use of wastewater for agricultural and aquacultural productions.

Adolescent↗
PubMed2006

Community cohort study of rotavirus and other enteropathogens: are routine vaccinations associated with sex-differential incidence rates?

OBJECTIVE: Community studies in West Africa have demonstrated that routine vaccinations may have non-targeted effects, the female-male mortality ratio being reduced after administration of BCG and increased after diphtheria-tetanus-pertussis (DTP). We examined whether immunisation status was associated with infection with rotavirus and other enteropathogens. METHODS: We recruited 200 children shortly after birth and followed them until 2 years of age with weekly morbidity interviews and stool sampling. Vaccination status for each child was classified according to the most recent vaccination as documented by vaccination card. MAIN OUTCOME MEASURES: The female-male incidence rate ratios (IRR) of infection with an enteropathogen and of enteropathogen-associated diarrhoea were estimated for children according to whether they had received BCG or DTP as their last vaccination. RESULTS: For children who received BCG as their last vaccine, the adjusted female-male IRRs for primary rotavirus-infection and diarrhoea were 1.05 (95% CI: 0.21-5.28) and 0.0 (95% CI: 0-3.02), respectively. For children who received DTP as their last vaccine, the adjusted female-male IRRs were 1.93 (0.89-4.21) and 1.92 (0.70-5.32), respectively, for rotavirus-associated infection and diarrhoea. Restricted to the rotavirus season, the female-male IRRs for rotavirus infection and diarrhoea were 2.56 (1.17-5.63) and 2.63 (0.94-7.34), respectively. The female-male IRR for rotavirus-associated diarrhoea differed significantly among BCG and DTP recipients (p=0.02). Infections with enteropathogens not associated with diarrhoea were associated with lower female-male IRRs after BCG of 0.82 (0.55-1.23) and higher female-male IRRs after DTP vaccination of 1.32 (1.03-1.70) for primary infection (p=0.05). Though there were few infections with other diarrhoea-causing enteropathogens, these were also associated with a lower female-male IRR after BCG of 0.62 (0.26-1.52) and a higher female-male IRR after DTP vaccination of 1.51 (1.04-2.20) for all infection. CONCLUSION: Routine immunisations may affect morbidity for non-targeted infections. As in studies of infant mortality, BCG is associated with lower risk for girls, whereas, DTP is associated with higher risk for girls relative to boys.

BCG Vaccine↗
PubMed2006

Community cohort study of Cryptosporidium parvum infections: sex-differential incidences associated with BCG and diphtheria-tetanus-pertussis vaccinations.

OBJECTIVE: Community studies in West Africa have suggested that routine vaccinations may have sex-differential non-targeted effects, the female-male mortality ratios being increased after receiving diphtheria-tetanus-pertussis (DTP) vaccination and reduced after administration of BCG or measles vaccine (MV). Using an existing data set, we examined whether vaccinations were associated with gender-differential incidences of Cryptosporidium parvum infection. METHODS: Two hundred children had been recruited shortly after birth and followed until 2 years of age or until follow-up was interrupted by a war. We performed weekly morbidity interviews and collected stool specimens, irrespective of whether the children had diarrhoea. Vaccination status for each child was classified according to the most recent vaccination with BCG, DTP, or MV. FINDINGS: The female-male incidence rate ratio (IRR) for Cryptosporidium infection among children who had received BCG as their last vaccine was 0.0 (95% CI: 0-3.49). However, among those who had received DTP as their last vaccine, the female-male IRR was 6.25 (2.06-18.9) for Cryptosporidium infection and 3.60 (0.91-14.2) for Cryptosporidium-associated diarrhoea. The female-male IRRs for Cryptosporidium infection differed significantly among BCG and DTP recipients (p=0.01). Among children who had received measles as their last routine vaccine, the female-male IRR was 1.57 (0.60-4.11) for Cryptosporidium infection and 0.98 (0.28-3.52) for Cryptosporidium-associated diarrhoea. The female-male IRRs for Cryptosporidium infection differed among DTP and MV recipients (p=0.02). For girls, early DTP vaccination compared with late or no DTP vaccination was associated with increased incidence rate of Cryptosporidium infection (IRR=4.23 (1.04-17.2)). For girls, the incidence rate decreased when they received MV. INTERPRETATION: Routine immunisations may affect morbidity for non-targeted infections. As in studies of infant mortality, BCG is associated with a low risk for girls relative to boys, whereas DTP is associated with a high female-male IRR of C. parvum infection.

Animals↗
PubMed2006

Foodborne bacterial infection and hospitalization: a registry-based study.

BACKGROUND: Foodborne bacterial gastrointestinal infections are important causes of morbidity and mortality worldwide, and despite successful control programs in some developed countries, these infections continue to have a major impact on public health and economy. METHODS: On the basis of data from 3 national registries, we determined short- and long-term risks of hospitalization due to gastroenteritis, short-term complications, and long-term sequelae after infections with nontyphoid Salmonella enterica, Campylobacter species, Yersinia enterocolitica, diarrheagenic Escherichia coli, and Shigella species. RESULTS: Among 52,121 patients, 7524 (14.4%) were hospitalized with a diagnosis of gastroenteritis within 90 days after microbiological diagnosis. A total of 4941 patients (17.7%) with infections due to S. enterica and 1937 (10.8%) with infections due to Campylobacter species were admitted to the hospital. Complications, such as gastrointestinal perforation and invasive illness, occurred in 647 patients (1.2%). The risk of invasive illness was > 6-fold higher in patients with infections due to S. enterica (odds ratio [OR] compared with the general population, 30.3; 95% confidence interval [CI], 26.2-35.1) than in those with infections due to Campylobacter species (OR, 4.9; 95% CI, 3.5-6.8) (P < .001). Long-term sequelae were seen in 865 patients (1.7%). Among 1000 patients with infections due to S. enterica, 1820 days of hospital stay were attributable to gastroenteritis, complications, and long-term sequelae. The corresponding figure for Campylobacter infections was 714 days. CONCLUSIONS: Infections with bacteria that are usually foodborne cause considerable morbidity, in terms of severe gastroenteritis that requires admission to hospital, as well as complications and long-term sequelae. The risk of complications and sequelae depends on bacterial species, and nontyphoid Salmonella is particularly associated with a burden of severe morbidity.

Adolescent↗
PubMed2006

[The three types of influenza].

The unprecedented spread of the highly pathogenic avian influenza type A H5N1 is a threat to veterinary public health. However, the virus does not in its present form constitute a major threat to human public health. Only if the virus mutates to spread effectively from person to person will there be a risk of a new pandemic. It is not possible to predict if this will happen, when it may happen or how serious it may be. At present, seasonal influenza represents the greatest burden of illness among the three types of influenza A illness: seasonal, avian, and pandemic influenza.

Animals↗
PubMed2006

[Salmonella infections acquired from exotic pets].

The majority of non-typhoidal Salmonella infections are foodborne, with undercooked eggs, chicken and red meat being the most important sources. Transmission from exotic pets, reptiles in particular, may account for 3-5% of human Salmonella cases. We describe a case of S. Saintpaul infection in an eight-month-old infant. A food source was unlikely because the infant was fed from a percutaneous endoscopic gastrostomy tube and the food tested negative for Salmonella. The family kept pet turtles, and S. Saintpaul with indistinguishable pulsed field gel electrophoresis patterns was isolated from the turtle water. The infant's older sister, who had contact with the turtles, had had gastroenteritis and may have served as the vehicle of transmission.

Animals↗
PubMed2006

Risk factors for diarrhea among children in an industrialized country.

BACKGROUND: Risk factors for childhood diarrhea in industrialized countries are not well characterized, although diarrhea remains an important cause of morbidity. METHODS: We conducted a case-control study of 422 cases and 866 controls over 22 months in Denmark. We selected cases among children under 5 years of age with diarrhea. Age-matched healthy controls were selected from the background population using a population register. Parents were interviewed about possible exposures and underlying conditions. In addition, stool samples from both cases and controls were analyzed for viruses, parasites, and bacteria. We analyzed risk factors for diarrhea in general and for diarrhea of a viral, bacterial, or "unknown" etiology using logistic regression. RESULTS: The following factors were independently associated with an increased risk of diarrhea: recent foreign travel, contact with symptomatic persons (particularly in daycare centers), hospitalization, contact with a dog with diarrhea, private daycare, consumption of products containing formula milk, unemployment and low educational status of parents, and prior diagnosis of several types of atopic diseases. In a pathogenic-specific analysis of diarrhea of bacterial (73 patients), viral (88), or "unknown" (222) etiology, the major risk factor for viral diarrhea was contact with symptomatic persons. For bacterial diarrhea, foreign travel and socioeconomic factors were the main risk factors. CONCLUSIONS: Viral diarrhea appears to be transmitted predominantly from person to person, whereas bacterial diarrhea appears to be primarily foodborne. A substantial portion of the diarrheal episodes may be of noninfectious etiology. Limiting child-to-child transmission of disease in daycare centers may substantially reduce the disease burden.

Animals↗
PubMed2006

Breast milk reduces the risk of illness in children of mothers with cholera: observations from an epidemic of cholera in Guinea-Bissau.

BACKGROUND: A protective effect of breastfeeding against cholera has been demonstrated in areas endemic of cholera. To assess the protection offered by breast milk from mothers living in an area that had been free from cholera for 7 years, we investigated mothers with cholera and their children during an epidemic with Vibrio cholerae El Tor in the capital of Guinea-Bissau. METHODS: Eighty mothers with clinical cholera and their children were identified, and interviewed. Blood samples for vibriocidal and antitoxin antibodies were collected from mother-and-child pairs. Breast milk samples were collected from lactating mothers. Cholera was defined as acute watery diarrhea during the epidemic and a vibriocidal reciprocal titer of 20 or above. RESULTS: Three (7%) of 42 breastfed children had cholera as defined above compared with 9 (24%) of 38 nonbreastfed children (RR for breastfed children, 0.19; 95% CI, 0.04-0.91, adjusted for age). The 3 breastfed children who developed cholera received milk containing lower concentrations of anticholera toxin IgA/total IgA (median, 2.0 units/mL) than 14 children who had serologic signs of colonization but did not develop the disease (median, 17.4 units/mL). CONCLUSIONS: The protective effect of breast milk against cholera is not confined to endemic areas. Lactating mothers with cholera should receive supportive care to continue breastfeeding.

Adolescent↗
PubMed2006

Fresh chicken as main risk factor for campylobacteriosis, Denmark.

We report the findings of a case-control study of risk factors for sporadic cases of human campylobacteriosis in Denmark. In 3 different analytical models, the main domestic risk factor identified was eating fresh, unfrozen chicken. Specifically, 28 of 74 domestically acquired case-patients were exposed to fresh chicken compared with 21 of 114 controls (multivariate matched odds ratio 5.8; 95% confidence interval 2.1-15.9). In contrast, a risk from eating other poultry, including previously frozen chicken, was only indicated from borderline significant 2-factor interactions. The marked increase in consumption of fresh, unfrozen poultry in Denmark during the 1990s likely contributed substantially to the increasing incidence of human campylobacteriosis in this period.

Animals↗
PubMed2005

A large, multiple-restaurant outbreak of infection with Shigella flexneri serotype 2a traced to tomatoes.

BACKGROUND: Foodborne outbreaks of Shigella infection are uncommon and tomatoes are an unusual vehicle. We describe a large, multiple-restaurant outbreak of Shigella flexneri serotype 2a infection that was associated with tomatoes. METHODS: We conducted nationwide surveillance and a case-control study, collected fecal specimens for culture, and measured the survival of the outbreak strain of S. flexneri in tomatoes. RESULTS: We interviewed 306 of 886 ill restaurant patrons and 167 control subjects. Matched univariate analysis showed that several food items were associated with illness, but only tomatoes remained significant in multivariate models. Illness peaked at each restaurant within 24 h after the arrival of hand-sorted bruised and overripe tomatoes from a new distributor; all patient isolates that were tested were indistinguishable by PFGE. Sliced tomatoes from the distributor were inoculated with the outbreak strain, and viable S. flexneri were recovered for 72 h. CONCLUSION: To prevent such outbreaks, persons with shigellosis should be excluded from handling food at all points along the distribution chain.

Adult↗
PubMed2005

[Imported diseases].

In Denmark, about one third of notifiable diseases are imported, but these have had only a limited spread within the Danish community. For example, imported strains of Mycobacterium tuberculosis remain confined to the immigrant population, and the high prevalence of chronic hepatitis B among certain groups of immigrants has not resulted in a general increase in the incidence of hepatitis B. Exceptions are imported cases of hepatitis A in children, which have resulted in outbreaks in the indigenous Danish population, and the import of drug-resistant bacteria, which often pose a serious challenge to hospital hygiene.

Adult↗
PubMed2005

Human health consequences of antimicrobial drug-resistant Salmonella and other foodborne pathogens.

There are several clinical and public health consequences associated with antimicrobial drug resistance in non-Typhi Salmonella species and other foodborne pathogens. If bacteria acquire resistance to clinically important antimicrobial drugs, early empirical treatment may fail, and there will be limitations in the choices of treatment after the establishment of microbial diagnosis. Drug-resistant gastrointestinal pathogens preferentially cause illness in persons receiving antimicrobial drugs for any medical condition. Consequently, emerging resistance in foodborne pathogens may result in increased burdens of illness and outbreaks in settings where patients are treated with antimicrobial drugs. Finally, resistance may be associated with increased virulence, and several epidemiological studies have demonstrated that infections with drug-resistant non-Typhi Salmonella serotypes and Campylobacter species are associated with excess mortality and morbidity. Mitigation of drug resistance in foodborne bacteria is likely to be of benefit for human health.

Anti-Bacterial Agents↗
PubMed2005

Spatial distribution and registry-based case-control analysis of Campylobacter infections in Denmark, 1991-2001.

Using data from an 11-year period (1991-2001), the authors analyzed available information on location of residence for all registered, laboratory-confirmed, domestically acquired cases of campylobacteriosis in Denmark. Patient data were merged with data from a national register on housing and addresses, and a population density index was constructed using the Danish population register. The study was performed as a register-based case-control study; 15 age-matched controls for each case were selected from the national population register. A total of 22,066 cases were compared with 318,958 controls in logistic regression analysis. Living in types of housing found in rural areas and living in areas with a low population density were both associated with an increased risk of infection. This relation concerned children in particular and explained one third of cases among children in the countryside. Furthermore, in some counties there was an association between infection and type of drinking-water company serving the home. This study indicated that contact with animals or the environment is the source of a substantial proportion of sporadic Campylobacter infections in the Danish countryside, particularly among children.

Adolescent↗
PubMed2005

Rapid decay of Salmonella flagella antibodies during human gastroenteritis: a follow up study.

An indirect enzyme-linked immunosorbent assay (ELISA) based on Salmonella re-polymerized flagella was employed to measure levels of immunoglobulin (Ig) G, IgM and IgA antibodies in sera from 303 Danish patients diagnosed with either Salmonella enteritidis or Salmonella typhimurium. The antibody-levels were assessed at one, three and six months after onset of salmonellosis, and sera from a control-group of 170 healthy blood donors were additionally analysed in order to establish cut-off values for the analysis. Cross-reactions to other Salmonella serotypes, as well as to Escherichia coli, Yersinia enterocolitica, Campylobacter jejuni, Campylobacter coli and Helicobacter pylori were observed. At one month after onset of symptoms, 70% of the patients recovering from a S. enteritidis infection carried detectable levels of anti-flagella antibodies, as did 77% of the patients recovering from S. typhimurium infection. Three months after onset of symptoms these detection rates had decreased to 46% and 40%; and six months after onset of symptoms the detection rates were 34% and 38%. This rapid decrease in the serum levels of flagella antibodies is in conflict with the "common knowledge" statement of a long-lasting anti-flagella immunoresponse. The present study suggests that such a tenacious statement is (or may be) inaccurate.

Adolescent↗