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PubMed1992

The male predominance in the incidence of infectious diseases in children: a postulated explanation for disparities in the literature.

In children, a male predominance in the incidence of symptomatic disease has been reported for some infectious agents and not for others. Not only are the factors underlying these sex differences poorly understood, but it is also not clear why the differences are described only for selected infectious diseases. In this study of sex- and age-specific incidence of infectious diseases in children, a possible explanation for the inconsistencies in the literature was explored. The sex ratio in reported disease incidence in Israel during a period of about 20 years was examined for various viral and bacterial infections. In addition, an hypothetical mathematical model was developed which assumes increased susceptibility to infectious disease (such as in relative immune deficiency) in a proportion of males. In children aged under 4 years, a higher incidence among males was consistently observed for all diseases, and the sex ratio varied between 1.16 (95% confidence interval (CI): 1.13-1.18) for shigellosis to 1.98 (95% CI: 1.79-2.17) for viral meningitis. The highest ratios were associated with the diseases which tend to present asymptomatically most often, which is consistent with the predictions of the model. The male excess in symptomatic disease appears to be present for most infectious diseases and this should be taken into account in studies comparing observed disease incidence between groups with different sex ratios. The inconsistencies in reports on the excess male morbidity for infectious diseases may be due to variations in symptomatic to asymptomatic infection ratios.

Adolescent↗

PubMed2006

[Combating infectious disease using mathematical modelling].

When determining interventions against threatening infectious diseases such as HIV-infection, severe acute respiratory syndrome (SARS), smallpox and pandemic influenza, the use of mathematical models of the spread of infectious diseases is becoming increasingly popular. These models contribute to the structuring of the knowledge already available in various disciplines, to finding epidemiological connnections, to demonstrating lacunas within the pool of knowledge and to the comparison of the expected effects and costs of preventative and intervention measures. The use of models leads to a 'made-to-measure' analysis ofthe effects and costs of preventative and intervention measures which takes account of the specific characteristics of infectious diseases. The integration of knowledge from various disciplines can be supported by more research into the theoretical epidemiology of infectious disease and by better integration of mathematical models into policy development. The resulting and better foundations of this policy that are achieved by means of infectious disease modelling translate into more effective combating of infectious disease.

Cost-Benefit Analysis↗

PubMed1998

Trends in infectious disease hospitalizations in the United States, 1980-1994.

BACKGROUND: A recent study concluded that between 1980 and 1992, deaths from infectious diseases increased 58%. This article explores trends in infectious diseases as a cause of hospitalization. METHODS: We analyzed data from the National Hospitalization Discharge Survey for 1980 through 1994 using a previously developed approach to evaluate infectious diseases in data coded according to the International Classification of Diseases, Ninth Revision. RESULTS: Between 1980 and 1994, the rate of hospitalizations in the United States declined approximately 33%; hospitalizations occurred at a rate of 133+/-5 per 1000 US population (35 million+/-1 million discharges) in 1994. The rate of hospitalization for infectious diseases declined less steeply--12% during this interval--resulting in an increased proportion of hospitalizations because of infectious diseases. In 1994, the rate of hospitalizations for infectious diseases was 15.4+/-0.7 per 1000 US population (4.0 million+/-0.2 million discharges). The fatality rate associated with hospitalizations for infectious diseases increased from 1.9%+/-0.1% to 4.0%+/-0.3%, attributable to increased hospitalizations of elderly persons and an increased fatality rate among those younger than 65 years. Among selected categories, hospitalizations for human immunodeficiency virus infections and acquired immunodeficiency syndrome, prosthetic device infections, sepsis, and mycosis increased substantially, and hospitalizations for upper respiratory tract infections, pelvic inflammatory disease, and oral infections declined sharply. Hospitalizations for lower respiratory tract infections constituted 37% of all infectious disease hospitalizations in 1994. CONCLUSIONS: Considering hospitalizations as a dimension of the burden of infectious diseases involves an array of factors: secular trends in hospitalization, changing case management practices, demographic changes, and trends in the variety of infectious diseases themselves. Increases in the proportions of hospitalizations because of infectious diseases during years when hospitalizations for all causes were decreasing reflect an increasing burden of infectious diseases in the United States between 1989 and the mid-1990s.

Communicable Diseases↗

PubMed1999

Influence of Immunology Advances on the Conjuncture and Evolution of Infectious Diseases.

The main purpose of immunology in the field of infectious pathology is to artificially create collective insusceptibility of people to pathogens of infectious diseases. As immunology, knowledge of humoral and cellular mechanisms of protection, conditions affecting the effectiveness of the functioning and control of the immune system when exogenous and endogenous antigen substances act thereon developed, vaccinology and then immunobiotechnology also developed, i.e. those branches of immunology which are occupied with the development of measures and methods for specific prophylaxis of infectious and non-infectious diseases, methods of constructing and producing immunobiological preparations, their practical use in the prophylaxis and treatment of infectious and non-infectious diseases. Vaccinoprophylaxis is one of the most effective and economical methods for protection against infectious diseases. It should especially be underlined that only vaccinoprophylaxis makes it possible to completely liquidate an infectious disease as a nosologic unit. Unfortunately, this only relates to the so-called controllable infections, against which effective vaccines have already been developed. Vaccines have not been developed at all against many widespread infectious diseases, whose prevention can't be made by epidemiological measures. Therefore, in the next few years immunology should, on the basis of fundamental research into the mechanisms of anti-infectious immunity, find new principles of creating and using immunogenic vaccines (and these principles have already been mapped out and were mentioned above), solve the problem of reducing and liquidating in the first place emerging infectious diseases and those among them which bring uncountable harm and suffering to mankind, cause economical losses, and have an effect on the genetic structure of the human population as a whole.

Journal Article↗

PubMed2002

[Laboratory tests for infectious diseases and medical reimbursement].

Emerging and reemerging infectious diseases, drug-resistant bacteria and nosocomial infection are becoming increasingly serious social problems. To control infectious diseases, it is important to develop effective therapies and to achieve complete prevention of pathogen transmission. For these purposes, rapid detection of pathogenic microorganisms is essential. Recent development and technical innovation in laboratory tests and diagnosis for infectious diseases are remarkable. New techniques such as antigen detection and genetic diagnosis, neither of which require conventional culture, have been intensively developed and introduced into clinical practice. These methods are now widely accepted as effective diagnostic tools because of their high specificity, high sensitivity and rapidity. In this article, we describe the burden of medical expenses under the law on novel infectious diseases and medical reimbursement for diagnostic tests for these diseases.

Clinical Laboratory Techniques↗

PubMed2006

Early detection and surveillance for biopreparedness and emerging infectious diseases.

Biological weapons and emerging infectious diseases pose a significant risk to public health. A timely response is needed to effectively treat and contain a potential infectious disease outbreak. Detection and surveillance of biological agents needs to be sensitive and specific to allow providers to quickly and accurately identify the disease process and begin the necessary response procedures. This article addresses the importance of early detection and surveillance of both intentional and unintentional biological events. Challenges of bioterrorism and the nursing role in response are discussed. Epidemiological considerations, such as route of transmission and personal protective equipment, are presented. An overview of the major surveillance systems, including advances in computer-based technology, is provided to help health care providers become aware of current surveillance systems and clinical decision support tools designed to help diminish the impact of biological threats.

Bioterrorism↗

PubMed2004

From Pasteur to genomics: progress and challenges in infectious diseases.

Over the past decade, microbiology and infectious disease research have undergone the most profound revolution since the times of Pasteur. Genomic sequencing has revealed the much-awaited blueprint of most pathogens. Screening blood for the nucleic acids of infectious agents has blunted the spread of pathogens by transfusion, the field of antiviral therapeutics has exploded and technologies for the development of novel and safer vaccines have become available. The quantum jump in our ability to detect, prevent and treat infectious diseases resulting from improved technologies and genomics was moderated during this period by the greatest emergence of new infectious agents ever recorded and a worrisome increase in resistance to existing therapies. Dozens of new infectious diseases are expected to emerge in the coming decades. Controlling these diseases will require a better understanding of the worldwide threat and economic burden of infectious diseases and a global agenda.

Antiviral Agents↗

PubMed2004

Infectious diseases in ancient Egypt.

Techniques for studying infectious disease in the ancient world are discussed. A brief survey of infectious diseases, such as schistosomiasis and malaria, in ancient Egypt is presented, and the physical traces of these diseases are examined. A discussion of the ancient Egyptian physician's response to infectious disease is included. There are two substantial sources of evidence for infectious diseases-physical remains and descriptions in Egyptian medical papyri. This preliminary survey suggests that ancient Egypt was far from the idyllic paradise on the Nile that some historians would like to imagine.

Bacterial Infections↗

PubMed2003

[Cardiopathy in infectious diseases: clinical and pathogenetic aspects of diagnosis].

The disease of cardiovascular system is one of the causes of invalidity and unfavorable outcomes. Together with such common diseases as rheumatism, hypertension, atherosclerosis that cause the development of cardiovascular insufficiency there are many other diseases including the infectious one that have rather unfavorable influence on the myocardium and vascular system. The disorders in cardiovascular functions at acute infectious diseases are noted frequently (80%) and closely connected with total pathogenesis of the disease. They influence the clinical course and outcomes of infectious process. Follow-up of the infectious patients and conduction of rational and especially intensive therapy require the wide functional control of cardiovascular state at different stages of the disease. The work shows our great experience in development of the problem of clinical-and-electrocardiographic investigations in infectious patients. The critical analysis of the problem condition today according to the literature data is presented. The material is based on the investigation of about 25 thousand patients treated in the clinic of infectious diseases of the Military Medical Academy for the last 30 years.

Acute Disease↗

PubMed2006

Automated detection of infectious disease outbreaks: hierarchical time series models.

The purpose of infectious disease surveillance is to inform the public health policy makers on the incidence and trends of infectious diseases and to trigger appropriate actions to control infectious disease outbreaks. The enormous amount of data collected with automated laboratory-based surveillance systems require automated algorithms for detecting unexpected aberrations that may signal infectious disease outbreaks. In this paper, we explore the potential of hierarchical time series models to detect deviations from expected incidence. As these count data are extremely noisy it can be expected that these models are suitable to detect signal from noise and accommodate for possible autocorrelation. The proposed procedure consists of three steps; (1) the model parameters are estimated by empirical Bayes on a training period of, e.g. a year; (2) the expected values are updated for small time steps (e.g. daily) as new data arrive; (3) threshold levels are updated conditionally on the past expected values and an alarm is triggered when the threshold level is exceeded. To test the potential of the models we estimated sensitivity, specificity and timeliness on simulated time series and compared the results with an alternative approach of a linear regression model adjusted for trends and season. We also used two observed series for Rubella notifications and Salmonella infections and compared our findings with the expert opinions on these series. The hierarchical time series models approach shows high sensitivity and specificity and correctly identifies outbreaks at an early stage. This, in our opinion, makes the proposed model a reliable tool for adequate automated detection of infectious disease outbreaks.

Algorithms↗

PubMed2006

Use of the internet to enhance infectious disease surveillance and outbreak investigation.

Modernization of electronic communication systems to facilitate infectious disease surveillance and outbreak investigation became a priority after the 2001 anthrax attacks. However, the extent to which communicable disease investigators are using web-based information resources, e-mail notifications, or secure information exchange systems to facilitate surveillance is unknown. To address this question, we conducted a survey in 2004 of state and local communicable disease investigators responsible for infectious disease surveillance and outbreak investigation in three states. The majority (70.7%) of the 297 respondents accessed the Internet for information regarding infectious disease surveillance and outbreaks at least weekly. Most (74%) respondents who searched for information from the Centers for Disease Control and Prevention (CDC) website reported that they found what they were looking for 75-100% of the time, compared with 54% who found the information from their state health department websites 75-100% of the time. One-third of respondents read e-mail notifications regarding outbreaks under investigation in their state less frequently than monthly; 34% of those enrolled in CDC's Epidemic Information Exchange (Epi-X) read e-mail notifications of new reports less frequently than monthly. Forty-seven (18%) respondents read ProMED-mail at least monthly, while 46% indicated they had never consulted MEDLINE/PubMed. Some progress has been made in use of the Internet to facilitate communication in infectious disease surveillance and outbreak investigation. Addressing barriers to access and usability of new information systems in conjunction with training and technical support could enhance infectious disease surveillance and timely investigation of outbreaks and bioterrorism events.

Centers for Disease Control and Prevention, U.S.↗

PubMed1998

Global progress in infectious disease control.

There is both good news and bad news concerning infectious disease control globally. The good news is that smallpox has been eradicated, eradication of poliomyelitis and guinea worm disease is on track, and many infectious diseases are under effective control in much of the world. The advances are primarily the result of improved sanitation, effective use of vaccines, and introduction and use of specific therapies (whose impact has primarily been on mortality, rather than incidence). The bad news is that infectious diseases are still the leading cause of death world-wide, new diseases are emerging, old diseases are re-emerging, there are ominous interactions between diseases, and antibiotic resistance is emerging as a major problem. There are many promising developments for the future, including new and improved vaccines, new specific therapies, and new strategies to deal with infectious disease. However, unless eradicated, infectious diseases remain a threat and require continuous efforts to be kept under control. Given the ability of infectious agents to evolve, it is certain that the future will also hold new problems and new diseases.

Bacterial Infections↗

PubMedDate not supplied

[Time trends in infectious disease mortality in Italy: 1969-1999].

OBJECTIVE: To describe the global impact of infectious diseases on mortality in Italy from 1969 to 1999. DESIGN: Statistical analysis of routinely collected mortality data, using a revised definition of infectious causes of death based on target organs. SETTING: The present paper summarizes time trends of infectious disease mortality widely discussed in the Atlas "30 Anni di Malattie Infettive in Italia: Atlante di Mortalità". MAIN OUTCOME MEASURES: Age standardized mortality rates (/100,000); standardized mortality ratios (SMR); percentage of deaths attributable to infectious diseases. RESULTS: Apart from HIV infection and AIDS, infectious diseases were responsible of 1.7% of the overall mortality that occurred in Italy in the study period: 57.5% of such deaths were not included in the ICD8 and ICD9 codes for infectious diseases. The mortality for all infectious diseases showed a very strong downward trend up to 1994, (with a 6-fold decline). Thereafter, a slight increase in deaths for septicaemias, heart infections and hepatitis was recorded. Over time, an increasing proportions of deaths due to infections occurred in the elderly (i. e., > or = 65 years of age), from 48.1% in 1969-1979 to 77.3% in 1990-1999. Mortality rates were consistently higher in men than in women, and showed a substantial geographic heterogeneity. In newborns, from 1969 thru 1999 mortality rates declined 10-fold all over the country, but an inverse north-south geographic gradient persisted during the whole study period. The spread of HIV infection and AIDS epidemic in the first '80s dramatically interrupted the downward trend in infectious disease mortality outlined above. Between 1993 and 1996, HIV/AIDS was the main cause of death among Italian men aged 30 to 39 years. CONCLUSIONS: This statistical analysis allowed to better quantify the impact of infectious diseases on overall mortality in Italy. Observed time trends were in accordance to the picture recorded in other western Countries, whereas the higher newborn mortality in southern Italy reflects the persistence of geographical inequalities in the health care organization.

Adult↗

PubMed1996

The relationship between serum levels of interleukin-6 and thyroid hormone during the follow-up study in children with nonthyroidal illness: marked inverse correlation in Kawasaki and infectious disease.

Our previous study demonstrated that the serum IL-6 correlated inversely with serum T3 and the T3/T4 ratio in children with acute respiratory infection during the acute phase of illness. To investigate whether serum IL-6 inversely correlates with serum thyroid hormone during not only the active stage of the disease but also in the follow-up period in nonthyroidal illness, we measured serum levels of IL-6, T3 and T4 in 31 children from the acute to the convalescent phase. They were divided into 3 groups; 7 patients with Kawasaki disease, 16 patients with infectious disease and 8 patients with non-inflammatory disease. In the follow-up of patients with Kawasaki disease, a marked inverse relationship was observed between serum IL-6 and T3 (r = -0.844, P < 0.001) or the T3/T4 ratio (r = -0.863, P < 0.001). Serum T4 showed a weak but significant negative correlation with serum IL-6 (r = -0.474, P = 0.035) only in this situation. There was also a significant negative correlation between serum IL-6 and T3 (r = -0.582, P < 0.001) or the T3/T4 ratio (r = -0.660, P < 0.001) during the follow-up of children with infectious disease. In the follow-up study of patients with non-inflammatory disease, however, no significant relationships were observed between serum thyroid hormones and IL-6. IL-6 may be one important factor involved in the decrease in the serum T3 level and the T3/T4 ratio in patients with nonthyroidal illness particularly characterized by strong inflammation and activation of the immune system as observed in Kawasaki and infectious disease.

Adolescent↗

PubMed2003

[Infectious diseases in Poland in 2001].

In 2001 surveillance system of infectious diseases in Poland remained unchanged. New cases of infectious diseases were recorded in 103 positions including intoxications. Tuberculosis and sexually transmitted infections were registered in separate systems. Influenza was the most frequently reported infectious disease with 576,449 cases, 63.9% less then in the previous year. The next most numerous were foodborne infections, which were reported in 24,393 cases, including 19,788 cases of infections caused by Salmonella sp. An increase in incidence was observed in the following diseases: viral hepatitis type A, rubella, measles and pertussis. Also the number of recorded cases of Lyme boreliosis and tickborne encephalitis were higher then in 2000. Incidence of AIDS remained within the range recorded during the last few years. In 2001 further drop in incidence of viral hepatitis type B was observed reaching the level of 6.2 per 100,000. It was the result of implemented comprehensive program of prophylactic measures, which brought incidence of this disease from the highest in Europe down to the level close to European average. Infectious diseases contributed to 0.75% of deaths. The most frequent cause of death among infectious diseases was tuberculosis and its sequels (1,061 cases). 13 cases of death due to tuberculosis occurred in people below 30 years of age.

Adolescent↗

PubMed1996

Application of the polymerase chain reaction to the diagnosis and management of neonatal herpes simplex virus disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.

Cerebrospinal fluid (CSF) specimens from 77 neonates with herpes simplex virus (HSV) disease were evaluated retrospectively by polymerase chain reaction (PCR). Samples were collected from 202 infants enrolled in a National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group trial that compared vidarabine with acyclovir for the treatment of neonatal HSV infection. HSV DNA was detected in the CSF of 26 (76%) of 34 infants with CNS disease, in 13 (93%) of 14 infants with disseminated infection, and in 7 (24%) of 29 with skin, eye, or mouth (SEM) involvement. One of the 7 PCR-positive SEM patients subsequently developed severe neurologic impairment. Eighteen (95%) of 19 infants with positive CSF PCR results after the completion of 10 days of antiviral therapy experienced significant morbidity or mortality. Application of PCR to neonatal HSV disease may provide additional information on which clinical decisions may be based, although its diagnostic utility outside the research setting is unproven.

Brain↗

PubMedDate not supplied

Surveillance and control of infectious diseases: progress toward the 1990 objectives.

Great progress has been made in the United States in reducing infectious disease mortality. However, infectious diseases remain the greatest cause of morbidity in this country. Newer infectious diseases or agents have been recognized, but newer tools for surveillance and control have also been made available. Specific objectives for the reduction of infectious diseases by 1990 have been set by the Public Health Service. The opportunities appear to be good for achieving by 1990 objectives for nosocomial infections, Legionnaires' disease, tuberculosis, and surveillance and control of infectious diseases. Achievement of the 1990 objectives for hepatitis B, pneumococcal pneumonia, and bacterial meningitis, however, will require both scientific advances and additional resources.

Bacterial Infections↗

PubMed2004

Are there characteristics of infectious diseases that raise special ethical issues?

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community.

Acquired Immunodeficiency Syndrome↗