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PubMed2002

[Premature death from infectious diseases in Spain, 1908-1995].

OBJECTIVES: Infectious diseases have traditionally been one of the leading causes of death in developed countries. The objectives of this research were to: 1) quantify the importance of infectious diseases as a cause of premature mortality in Spain between 1908 and 1995, and 2) determine the frequency and distribution of the infectious diseases with the greatest impact on premature death. METHODS: The study was carried out based on data on mortality from infectious causes published by the National Institute of Statistics in the Movimiento natural de la población (Natural Movement of the Population) for the study period. Three indicators of premature mortality were used: the potential years of life lost (PYLL), the crude rate of PYLL per 1 000 population, and the percentage and the average of PYLL. RESULTS: Between 1908 and 1995, the number and the rate of PYLL from infectious causes clearly declined. The decrease was more prominent starting in the 1950s, and it was seen in all age groups. Tuberculosis was the leading cause of premature death from the beginning of the century until the 1970s, but after that, the leading causes became pneumonia and AIDS. CONCLUSIONS: The impact of infectious diseases as determinants of premature death in Spain declined during the 20th century, especially starting in the 1970s.

Adolescent↗

PubMed2005

[Present situation and control on emerging respiratory infectious diseases such as SARS and avian influenza].

Infectious diseases have been recognized again due to appearing of emerging and re-emerging infectious diseases in the world. Most of them occur not only in developing countries but also in developed countries, and in Asian region. The pathogen is mainly virus and most of them are suspected zoonotic origin. SARS emerged in the world abruptly and disappeared in 2003. We have had many lessons and learn on control measures, public health, economic impacts, human rights, international cooperation and infectious diseases. The outbreaks of avian influenza among fowls have been occurred since 2004, and some fatal human cases infected with avian influenza virus are detected in Viet Nam, Thailand, Cambodia and Indonesia. Although the total number of human cases are still limited and human to human transmission mode is not yet detected, it has been concerned the possibility to shift new types of influenza for human as pandemic. It is necessary to recognize correctly on existing of infectious diseases, to enhance surveillance, to call partnerships among several sectors such as medical institutes, medical education institutes, research institutes and public health departments. Further, infectious disease control should tackle in global level.

Animals↗

PubMed1997

[Seasonal patterns of infectious disease: similarity and differences].

BACKGROUND: Most infectious diseases in template climates have seasonal pattern, that can be influenced by climatic, social and host factors. AIM: To study the seasonal patterns of seven human infectious diseases in Chile. MATERIAL AND METHODS: Series of monthly cases of measles, whooping cough, scarlet fever, meningitis, diphtheria, typhoid fever and poliomyelitis were obtained from yearly reports of infectious disease of the Ministry of Health. Descriptive statistical parameters and multivariate methods were used to analyze data. RESULTS: Diseases that have an enteric mode of transmission predominate in summer, independent of the type of agent (viral or bacterial) or presence of carriers. Diseases with a respiratory mode of transmission have two different patterns. Those without carriers (measles and whooping cough) predominate in spring and those with carriers (scarlet fever, diphtheria and meningitis) have a winter predominance. CONCLUSIONS: This work confirms the seasonal variation of enteric and respiratory infectious diseases and defines patterns that can be useful for future studies.

Chile↗

PubMed2004

Impact of infectious diseases on war.

Wartime epidemics of infectious diseases have decimated the fighting strength of armies, caused the suspension and cancellation of military operations, and brought havoc to the civil populations of belligerent and nonbelligerent states. This article summarizes the principal factors that have contributed to the spread of infectious diseases in past wars and reviews the associated demographic losses in military and civil populations. Drawing on the detailed epidemiologic records for the United States Army, case studies of the spread of infectious diseases in relation to military mobilization are presented for the American Civil War, Spanish-American War,and World War I. The article concludes with a brief overview of infectious disease activity in high- and low-intensity conflicts of the late twentieth and early twenty-first centuries.

Communicable Diseases↗

PubMed2000

Interleukin-18 (IL-18) and infectious diseases, with special emphasis on diseases induced by intracellular pathogens.

Interleukin-18 (IL-18) is a novel cytokine mainly produced by activated macrophages. IL-18 was originally called interferon-gamma inducing factor, due to its action in inducing IFN-gamma secretion from Th1 cells, NK cells and NKT cells. It has been reported that IL-18 may play important roles in various diseases including cancer and infectious diseases. This review deals with the roles of IL-18 in infectious diseases, with special emphasis on IL-18 in infectious diseases caused by intracellular pathogens including Mycobacterium tuberculosis, Mycobacterium leprae, Listeria monocytogenes and Salmonella typhimurium.

Animals↗

PubMed2004

Role of infectious diseases consultants in management of antimicrobial use in hospitals.

The Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members to characterize antimicrobial restriction policies in their hospitals and the involvement of infectious diseases consultants in this process. Of the 502 respondents (73%), 250 (50%) indicated that their hospital pharmacies would not dispense certain antimicrobials without approval of infectious diseases consultants. Moreover, 89% agreed that infectious diseases consultants need to be directly involved in the approval process. At hospitals with control policies, commonly restricted agents included lipid formulations of amphotericin B, carbapenems, fluoroquinolones, piperacillin-tazobactam, and vancomycin. Only 46 EIN members (18%) reported remuneration of infectious diseases consultants for participation in the approval process. Pediatric infectious diseases consultants were more likely to practice in hospitals with restriction policies than were adult infectious diseases consultants (64% vs. 45%; P<.001). Similarly, teaching hospitals were more likely to have antimicrobial-control policies than were nonteaching facilities (60% vs. 17%; P<.001).

Anti-Infective Agents↗

PubMed1998

Trends in infectious disease mortality in Australia, 1979-1994.

OBJECTIVE: To examine trends in infectious disease mortality in Australia over the period 1979-1994. DESIGN: Descriptive study based on Australian Bureau of Statistics data. PARTICIPANTS AND SETTING: All persons who died in Australia during 1979-1994. OUTCOME MEASURES: Infectious diseases as the underlying cause of death by International Classification of Diseases, Ninth Revision codes. RESULTS: Overall mortality from infectious diseases declined from 29.2/100,000 population in 1979-1981 to 24.1/100,000 in 1992-1994 (P = 0.02). Respiratory infection was the major category of infectious disease mortality, declining from 15.8/100,000 in 1979-1981 to 10.6/100,000 in 1992-1994. HIV infection (increasing from 0 to 2.9/100,000) replaced kidney/urinary tract infection (3.3 to 1.5/100,000) as the second most common category of infectious disease mortality. There were also significant increases in mortality from septicaemia (1.0 to 2.6/100,000), and viral hepatitis (0.2 to 0.5/100,000). The only group in which infectious disease mortality increased was men aged 25-44 years (3.4 to 15.1/100,000). The Northern Territory had the highest mortality rate from infectious disease, but showed a substantial decline (162 to 76/100,000) over the study period. There were also significant declines in Victoria, Queensland, and Western Australia. CONCLUSIONS: Mortality from infectious disease in Australia declined overall between 1979 and 1994. The substantial decline in the Northern Territory suggests a decline among indigenous Australians. HIV infection has become a leading cause of infectious disease mortality, particularly among adult males.

Adolescent↗

PubMed2000

[Is there a role for infectious disease specialists in private practice?].

For the last 20 years infectious diseases have gained increasing importance for hospital medicine. As a specialty, infectious diseases have been recognized only recently by the Swiss medical association. However, the precise role of infectious disease specialist operating in private practice remain to be defined. The medical community faces many challenges for which infectious disease specialist must provide answers. Knowledge in microbiology has progressed enormously and many very sophisticated and, partly, expensive diagnostic techniques are widely available. New treatment options are introduced while numerous microbial species demonstrate increasing resistance to antimicrobial agents. The intervention of infectious disease specialist could thus contribute to optimize treatment and limit the use of economic resources. Infectious disease specialist in private practice are also facing new activities such as parenteral outpatient treatment for severe infections and HIV infection, which clearly require a specialized professional approach. Infectious disease specialist in private practice will need great care to find a responsible equilibrium between clinical consultation and telephone consultation.

Communicable Diseases↗

PubMed2003

Emerging trends in international law concerning global infectious disease control.

International cooperation has become critical in controlling infectious diseases. In this article, I examine emerging trends in international law concerning global infectious disease control. The role of international law in horizontal and vertical governance responses to infectious disease control is conceptualized; the historical development of international law regarding infectious diseases is described; and important shifts in how states, international institutions, and nonstate organizations use international law in the context of infectious disease control today are analyzed. The growing importance of international trade law and the development of global governance mechanisms, most prominently in connection with increasing access to drugs and other medicines in unindustrialized countries, are emphasized. Traditional international legal approaches to infectious disease control--embodied in the International Health Regulations--may be moribund.

Communicable Disease Control↗

PubMed1999

Outpatient visits for infectious diseases in the United States, 1980 through 1996.

BACKGROUND: Recent studies have documented increases in infectious disease mortality and in the proportion of hospitalizations attributable to infectious diseases. To further evaluate trends in the burden of infectious diseases in the United States, we analyzed data from the National Ambulatory Medical Care Survey from 1980 through 1996. OBJECTIVE: To examine the epidemiology of and recent trends in outpatient visits for infectious diseases. METHODS: Data were from a national probability sample of patient visits to office-based physicians. Diagnoses reported by the surveyed physicians were coded to indicate whether they were infectious or noninfectious. Infectious diseases were placed into 11 mutually exclusive categories. RESULTS: During the course of the survey, infectious diseases accounted for 19.0% of visits to physicians, or an average of 129 million visits per year. The infectious disease visit rate was higher in females than in males (587 vs 461 per 1000 persons per year) and higher in non-Hispanic whites than in non-Hispanic blacks or Hispanics (538 vs 407 vs 485 per 1000 persons per year). The visit rate for infectious diseases was greatest in 0- to 4-year-olds. Upper respiratory tract infections accounted for the largest proportion of visits (38.0% of infectious disease visits), followed by otitis (15.1%) and lower respiratory tract infections (14.1%). The age-adjusted visit rate for infectious diseases increased from 462 visits per 1000 persons (17.5% of all visits) in 1980 to 575 (20.2%) in 1990. From 1990 to 1996, this rate declined to 483 per 1000 (18.1%). CONCLUSIONS: Infectious diseases are responsible for a substantial proportion of outpatient visits to physicians in the United States. Upper respiratory tract infections account for the largest proportion of these visits.

Adolescent↗

PubMed2006

Joint spatial analysis of gastrointestinal infectious diseases.

A major obstacle in the spatial analysis of infectious disease surveillance data is the problem of under-reporting. This article investigates the possibility of inferring reporting rates through joint statistical modelling of several infectious diseases with different aetiologies. Once variation in under-reporting can be estimated, geographic risk patterns for infections associated with specific food vehicles may be discerned. We adopt the shared component model, proposed by Knorr-Held and Best for two chronic diseases and further extended by (Held L, Natario I, Fenton S, Rue H, Becker N. Towards joint disease mapping. Statistical Methods in Medical Research 2005b; 14: 61-82) for more than two chronic diseases to the infectious disease setting. Our goal is to estimate a shared component, common to all diseases, which may be interpreted as representing the spatial variation in reporting rates. Additional components are introduced to describe the real spatial variation of the different diseases. Of course, this interpretation is only allowed under specific assumptions, in particular, the geographical variation in under-reporting should be similar for the diseases considered. In addition, it is vital that the data do not contain large local outbreaks, so adjustment based on a time series method recently proposed by (Held L, Höhle M, Hofmann M. A statistical framework for the analysis of multivariate infectious disease surveillance data. Statistical Modelling 2005a; 5: 187-99) is made at a preliminary stage. We will illustrate our approach through the analysis of gastrointestinal diseases notification data obtained from the German infectious disease surveillance system, administered by the Robert Koch Institute in Berlin.

Adolescent↗

PubMed1999

The risk of occupational exposure and infection with infectious disease.

The diversity of potentially infectious agents that frequent the health care environment continues to increase. As a result, healthcare workers are at some degree of risk, for exposure to, and infection by, a variety of infectious diseases or conditions. This article is devoted to the epidemiology of major infectious diseases and conditions known to be transmitted in health care settings. In addition, the relative risk of occupational exposure to and infection by these diseases is also discussed as are general preventive measures associated with Standard and Transmission-based Precautions.

Blood-Borne Pathogens↗

PubMed1999

Trends in infectious disease mortality in the United States during the 20th century.

CONTEXT: Recent increases in infectious disease mortality and concern about emerging infections warrant an examination of longer-term trends. OBJECTIVE: To describe trends in infectious disease mortality in the United States during the 20th century. DESIGN AND SETTING: Descriptive study of infectious disease mortality in the United States. Deaths due to infectious diseases from 1900 to 1996 were tallied by using mortality tables. Trends in age-specific infectious disease mortality were examined by using age-specific death rates for 9 common infectious causes of death. SUBJECTS: Persons who died in the United States between 1900 and 1996. MAIN OUTCOME MEASURES: Crude and age-adjusted mortality rates. RESULTS: Infectious disease mortality declined during the first 8 decades of the 20th century from 797 deaths per 100000 in 1900 to 36 deaths per 100000 in 1980. From 1981 to 1995, the mortality rate increased to a peak of 63 deaths per 100000 in 1995 and declined to 59 deaths per 100000 in 1996. The decline was interrupted by a sharp spike in mortality caused by the 1918 influenza epidemic. From 1938 to 1952, the decline was particularly rapid, with mortality decreasing 8.2% per year. Pneumonia and influenza were responsible for the largest number of infectious disease deaths throughout the century. Tuberculosis caused almost as many deaths as pneumonia and influenza early in the century, but tuberculosis mortality dropped off sharply after 1945. Infectious disease mortality increased in the 1980s and early 1990s in persons aged 25 years and older and was mainly due to the emergence of the acquired immunodeficiency syndrome (AIDS) in 25- to 64-year-olds and, to a lesser degree, to increases in pneumonia and influenza deaths among persons aged 65 years and older. There was considerable year-to-year variability in infectious disease mortality, especially for the youngest and oldest age groups. CONCLUSIONS: Although most of the 20th century has been marked by declining infectious disease mortality, substantial year-to-year variation as well as recent increases emphasize the dynamic nature of infectious diseases and the need for preparedness to address them.

Adolescent↗

PubMed2005

Herd-level risk factors for infectious diseases in Swedish dairy calves aged 0-90 days.

The effect of environmental factors and management routines on the risk of diarrhoea, respiratory disease and other infectious diseases was investigated in 3081 heifer calves 0-90 days old in 122 Swedish dairy herds. The farmers kept records on cases of diseases in their heifer calves and in addition, project veterinarians clinically examined all calves every 2-3 months. At each visit, the veterinarians also measured the ammonia concentration and relative air humidity in the housing facilities for the calves. The cleanliness of the animals and their environment was recorded as a measure of the hygienic status of the farm. The presence or absence of draught (i.e. wind velocity>0.5 m/s) was recorded twice during the study period. The effect of these factors, as well as the placing of the calf pens, the nature of the pen walls, air volume per animal, management factors (such as the status of the caretaker and feeding routines) and presence or absence of a bovine viral diarrhoea virus (BVDV) infection in the herd, was evaluated by means of a two-level variance component logistic model. The placing of calf pens along an outer wall was significantly associated with the risk of diarrhoea (odds ratio (OR): 1.92, P<0.01). The risk for respiratory disease was significantly associated with an ammonia concentration below 6 ppm (OR: 0.42, P<0.05) while the odds ratio for moderately to severely increased respiratory sounds was significantly associated with a BVDV infection in the herd (OR: 2.39, P<0.05) and draught (OR: 3.7, P<0.02). Absence of draught was significantly associated with the risk for infectious diseases other than diarrhoea and respiratory disease (OR: 0.42, P<0.01).

Animal Husbandry↗

PubMed1996

Do surgeons have a role as infectious disease consultants?

BACKGROUND: Antibiotic drug restriction policies have become widespread in North America hospitals mandating medical infectious disease consultation for use of routine antimicrobial agents. OBJECTIVE: To determine physician and institutional attitudes regarding the credibility of surgeons in the area of infectious disease. DESIGN: A survey of the Surgical Infectious Disease Society (SIS) membership. PARTICIPANTS: Members of the SIS practicing in the United States and Canada (n = 464) were sent a simple opinion poll regarding surgical infectious disease specialists. After receiving the survey, the SIS members were given approximately 4 weeks to anonymously complete the questionnaire and return it to our office. RESULTS: Responses were received from 198 SIS members (43%). Most were from large (> 400 bed) institutions (63%), and the majority of them were from university centers (76%). Predictably, 86% of the respondents were in full-time academic practice. Some SIS respondents (21%) had undergone special training in infectious disease, and of these, 63% actually had completed a formal surgical infectious disease fellowship. Antibiotic restriction policies were nearly universal and required in 87% of institutions. Only 44% of surgeons in these hospitals, however, were privileged to release antibiotic drugs. Medical infectious disease physicians recognized surgical expertise in infectious disease in few instances (32%). The great majority of responding SIS members (81%) believed that an examination or certification in infectious disease for surgeons was not warranted. CONCLUSIONS: Antibiotic drug restriction is prevalent in North America, and medical infectious disease specialists do not generally recognize surgical expertise in the area of infectious disease. Despite this environment, responding SIS members believe that special credentialing of surgeons in the area of infectious disease is unnecessary.

Communicable Diseases↗

PubMed2002

Surveillance for early detection and monitoring of infectious disease outbreaks associated with bioterrorism.

The appearance of "new" infectious diseases, the reemergence of "old" infectious diseases, and the deliberate introduction of infectious diseases through bioterrorism has highlighted the need for improved and innovative infectious disease surveillance systems. Traditional current surveillance systems are generally based on the recognition of a clear increase in diagnosed cases before an outbreak can be identified. For early detection of bioterrorist-initiated outbreaks, the sensitivity and timeliness of the systems need to be improved. Systems based on syndromic surveillance are being developed using technologies such as electronic reporting and the internet. The reporting sources include community physicians, public health laboratories, emergency departments, intensive care units, district health offices, and hospital admission and discharge systems. The acid test of any system will be the ability to provide analyses and interpretations of the data that will serve the goals of the system. Such analytical methods are still in the early stages of development.

Bioterrorism↗

PubMed2005

The European Union of Medical Specialties core training curriculum in infectious diseases: overview of national systems and distribution of specialists.

The European Union of Medical Specialities (UEMS) Section of Infectious Diseases agreed on an infectious disease training programme in 1999, which was updated in 2002. Although the provision of infection services throughout Europe is not uniform, with variation in the roles of infectious disease physicians and microbiologists, there are, nonetheless, physicians with a predominant responsibility for clinical infectious diseases (and tropical medicine) in most countries. However, infectious diseases is formally recognised as a specific discipline by most, but not yet all, European countries. There has been consensus from national representatives to the UEMS on the content of the published curriculum. There are clear areas of overlap in training between different infection disciplines, and exploration of possible areas for closer liaison and collaboration between them has been initiated. The increased movement of medical staff within Europe will place greater demands on those responsible for training, monitoring and quality assurance. The Board and Section of Infectious Diseases have established core training programmes with a generic logbook to assist those countries without a written curriculum or record book and facilitate the development of common standards of training. The duration of training varies across Europe; 4 years is the UEMS standard, or longer if the training is combined with general internal medicine. The numbers of infection specialists (infectious diseases and microbiology) per million population show considerable variation. The UEMS Sections have recognised the importance of working closely with European specialist societies involved with training. The Section for Infectious Diseases has, in partnership with the ESCMID, established a Board for the accreditation of continuing medical education/continuing professional development.

Communicable Disease Control↗

PubMedDate not supplied

Infectious diseases as a Canadian subspecialty, with projections to the year 2000.

Infectious diseases is a relatively new subspecialty in Canada. During the past decade, however, important advances have been made. These include the formation of the Canadian Infectious Diseases Society and the development of the first Royal College of Physicians and Surgeons examinations in the subspecialty of infectious diseases. The majority of Canadians training for practice in the field of infectious diseases are now enrolled in programs in Canada. Despite predictions in the United States of an excess of physicians who specialize in infectious diseases, such a situation has not occurred in Canada. More physicians with training in infectious diseases will be required in Canada in the next decade to fill positions in patient care, microbiology (for individuals with both clinical and laboratory training), research, epidemiology and infection control, programs related to human immunodeficiency virus infections, geographic and international medicine, the pharmaceutical industry, and education and administration. In Canada, the extent to which infectious diseases physicians are involved in these areas varies from that in the United States. This review suggests a continued need for physicians with appropriate training in infectious diseases.

Canada↗