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PubMed2003

[Epidemiology of occupational infectious diseases in health care workers].

BACKGROUND: Despite continuous progress in medicine and improvement of quality of work, occupational diseases are still a serious problem. During the last few years, 5000 to 12,000 cases of occupational diseases were annually registered in Poland. Among them, infectious diseases still occupy the third place. The aim of the study was to carry out an epidemiological analysis of occupational infectious diseases identified in health care workers of the Wrocław region in 1990-2002. MATERIALS AND METHODS: Information included in occupational disease identification cards was used as a basis for the study group selection. The form provided data on workplaces with exposure to agents responsible for generation of occupational diseases. Decisions on identification of occupational diseases in workers employed in EKD sections (code 85) were also taken into account. RESULTS: During last years, 136-300 cases of occupational diseases in health care workers were annually diagnosed in the Wrocław region, and infectious diseases made 10-30% of this number. In this group of diseases, viral hepatitis and tuberculosis were most frequent (45-82%). In 1990-2000, viral hepatitis was identified as an occupational disease in 323 health care workers; nurses formed the major group (195) followed by doctors (39) and lab workers (30). Recently, epidemiological situation of occupational infectious diseases has improved. From 1989, the incidence of occupational viral hepatitis in health care workers is on the systematic decrease (only 17 cases in 1994). Undoubtedly, the introduction of obligatory vaccination against HBV among health care workers has greatly contributed to this improvement. CONCLUSIONS: It is found that hepatitis B virus (HBV) is the major factor responsible for infections in professional health care workers. The decrease in HBV infections correlates with a growing proportion of the vaccinated personnel. It should be stressed that infections with HCV are on the increase in this occupational group.

Communicable Diseases↗

PubMed2001

Role of clinical microbiology laboratories in the management and control of infectious diseases and the delivery of health care.

Modern medicine has led to dramatic changes in infectious diseases practice. Vaccination and antibiotic therapy have benefited millions of persons. However, constrained resources now threaten our ability to adequately manage threats of infectious diseases by placing clinical microbiology services and expertise distant from the patient and their infectious diseases physician. Continuing in such a direction threatens quality of laboratory results, timeliness of diagnosis, appropriateness of treatment, effective communication, reduction of health care-associated infections, advances in infectious diseases practice, and training of future practitioners. Microbiology laboratories are the first lines of defense for detection of new antibiotic resistance, outbreaks of foodborne infection, and a possible bioterrorism event. Maintaining high-quality clinical microbiology laboratories on the site of the institution that they serve is the current best approach for managing today's problems of emerging infectious diseases and antimicrobial agent resistance by providing good patient care outcomes that actually save money.

Communicable Disease Control↗

PubMed1999

[Determination of the numbers of monitoring medical institutions necessary for estimating incidence rates in the surveillance of infectious diseases in Japan].

Our purpose was to determine the number of monitoring stations (medical institutions) necessary for estimating incidence rates in the surveillance system of infectious diseases in Japan. Infectious diseases were selected by the type of monitoring stations: 15 diseases in pediatrics stations, influenza in influenza stations, 3 diseases in ophthalmology stations and 5 diseases in the stations of sexually transmitted diseases (STD). For each type of monitoring station, 5 cases of the number of monitoring stations in each health center, including the number determined from presently established standards and the actual number in 1997, were given. It was assumed that monitoring stations were randomly selected among medical institutions in health centers. For each infectious disease, each case and each type of monitoring station, standard error rates of estimated numbers of incidence cases in the whole country were calculated in 1993-1997 using the data of the surveillance of infectious diseases. Among 5 cases of monitoring stations, the case satisfied the condition that those standard error rates were lower than the critical values, was selected. The critical values were 5% in pediatrics and influenza stations, and 10% in ophthalmology and STD stations. The numbers of monitoring stations in the selected cases were 3,000 in pediatrics stations, 5,000 in influenza stations (including all pediatrics stations), 605 in ophthalmology stations and 900 in STD stations.

Child↗

PubMed1998

The immunogenetics of human infectious diseases.

Twin and adoptee studies have indicated that host genetic factors are major determinants of susceptibility to infectious disease in humans. Twin studies have also found high heritabilities for many humoral and cellular immune responses to pathogen antigens, with most of the genetic component mapping outside of the major histocompatibility complex. Candidate gene studies have implicated several immunogenetic polymorphisms in human infectious diseases. HLA variation has been associated with susceptibility or resistance to malaria, tuberculosis, leprosy, AIDS, and hepatitis virus persistence. Variation in the tumor necrosis factor gene promoter has also been associated with several infectious diseases. Chemokine receptor polymorphism affects both susceptibility ot HIV-1 infection and the rate of progression to AIDS. Inactivating mutations of the gamma-interferon receptor lead to increased susceptibility to typical mycobacteria and disseminated BCG infection in homozygous children. The active form of vitamin D has immunomodulatory effects, and allelic variants of the vitamin D receptor appear to be associated with differential susceptibility to several infectious diseases. NRAMP1, a macrophage gene identified by positional cloning of its murine homologue, has been implicated in susceptibility to tuberculosis in Africans. Whole genome linkage analysis of multi-case families is now being used to map and identify new loci affecting susceptibility to infectious diseases. It is likely that susceptibility to most microorganisms is determined by a large number of polymorphic genes, and identification of these should provide insights into protective and pathogenic mechanisms in infectious diseases.

Animals↗

PubMed2002

Pharmacogenomics and infectious diseases: impact on drug response and applications to disease management.

The impact of pharmacogenomics on the prevention, diagnosis, and treatment of infectious diseases is discussed. The application of pharmacogenomics to infectious diseases requires consideration of the genomes of both the pathogen and the host. The pathogen's genome may be used for antigen identification, to identify infecting organisms, and to determine antimicrobial resistance. Diagnostic tool development and vaccine design can be aided by knowing which portions of a pathogen are important antigenic determinants. The unique genetic makeup of a pathogen can facilitate its identification as an augmentation to the traditional culture. Important genes conferring resistance to antibiotics can be detected, and this information can be used to choose appropriate antibiotic therapy. The genome of the host may reveal susceptibility genes and new drug targets that may be used in the treatment of infectious diseases. Thus far, polymorphisms in genes of the host immune system have been associated with susceptibility to infections and response to treatment. Examples of these findings will be described. Pharmacogenomics has the potential to revolutionize the prevention, diagnosis, and treatment of infectious diseases.

Adolescent↗

PubMedDate not supplied

Cryoglobulins and infectious diseases.

The relationship between infectious diseases due to various pathogenetic factors and cryoglobulin production mechanisms has been investigated. Cryoglobulins have been evidenced in infections caused by very heterogeneous pathogens, i.e. leptospirosis, psittacosis, Mediterranean tick typhus, brucellosis, gram-negative bacterial septicemias, in which they had never been previously reported. In type A hepatitis a high cryoglobulin prevalence (91%) has been confirmed during the acute phase, with a rapid decrease both in prevalence and concentration in the subsequent stages of the disease. Cryoglobulins were all of type III and were mainly represented by IgM; anti-HAV-IgM antibodies have been evidenced in all but one cryoprecipitates. In non-A, non-B hepatitis a lower cryoglobulin prevalence (44.7%) was shown during the acute phase and the same fast decrease has been noted in the subsequent stages. Cryoglobulins were all of type III and in some cases polyclonal IgG was the only Ig class present in cryoprecipitates. The cryoglobulin prevalence in the acute phase of HBsAg-positive hepatitis amounted to 73.4%; all the cryoprecipitates were of type III. No correlation between the presence of cryoglobulins and HBeAg positivity or between cryoglobulins and delta agent infections was found. In all the cases studied the presence of cryoglobulins was related to the persistence of liver damage. Cryoglobulins were not found in HBsAg chronic carriers, while they have been evidenced, by a preliminary study, in 41.6% of HTLV-III antibody-positive subjects complaining of a persistent generalized lymphadenopathy without clinical or laboratory signs of liver impairment. No HTLV-III antibodies were found by ELISA method in the type III cryoprecipitates.

AIDS-Related Complex↗

PubMed2001

Climate change and emerging infectious diseases.

The ranges of infectious diseases and vectors are changing in altitude, along with shifts in plant communities and the retreat of alpine glaciers. Additionally, extreme weather events create conditions conducive to clusters of insect-, rodent- and water-borne diseases. Accelerating climate change carries profound threats for public health and society.

Animals↗

PubMed1982

The role of microbial interactions in infectious disease.

The occurrence of infectious disease is affected by interaction between microorganisms in three ways. The indigenous flora (commensal microorganisms) of some mucous surfaces provide one of the main protective mechanisms against infection by pathogens (disease-producing microbes). The commensal populations interfere with the establishment of pathogens on mucous membranes by evoking anaerobic conditions, by competing for space and nutrients and by producing inhibitors. How, at the beginning of successful infection, pathogens in relatively small numbers overcome this protective activity of the commensal population is unknown. Although not a general phenomenon, some pathogens exacerbate the effects of others. The best examples are the potentiation of bacterial infections by existing viral infections: mucosal adherence and penetration by bacteria are enhanced and phagocytic defences against them weakened. Some microorganisms that are unable to produce significant disease on their own may combine with others to cause serious sickness. The harmful effects of these combinations of microorganisms can be explained by the multifactorial nature of pathogenicity (virulence), i.e. the capacity to produce disease. Although each member of the mixed population cannot alone produce the full complement of factors needed for disease production, the complement can be attained by combining contributions from different members.

Bacteria↗

PubMed1990

Regulation of hepatic cytochrome P-450 during infectious disease.

During episodes of infectious disease the mixed function oxidase system is depressed and the capacity of the liver to metabolize drugs can be compromised in both animals and humans. The depression that occurs during viral infections is mediated via the production of interferon. This action of interferon requires the synthesis of an intermediate protein(s) yet to be identified. Using an oligonucleotide probe for a unique sequence in cytochrome P-450LA omega we have now shown that the mRNA for this isozyme is depressed following the administration of interferon inducers. The magnitude in the loss of mRNA corresponds to the magnitude of the loss in the levels of this isozyme. This depression is observed within 6 h of interferon exposure. It is concluded that the decrease in drug metabolism during viral infections is caused by an interferon-mediated loss in mRNA and subsequent cytochrome P-450 synthesis in the liver.

Cytochrome P-450 Enzyme System↗

PubMed1990

Perspectives and limits in the eradication of infectious diseases.

Eradication of an infectious disease on a global scale means that transmission of the disease has been completely vanished and the disease caused by the infection has totally disappeared. Regional eradication represents disappearance of an infection from a certain area or region whereas elsewhere it continues to be transmitted. Smallpox which was finally eradicated in 1977 had been progressively eliminated from one continent after another in the preceding years. At the present time regional elimination of paralytic poliomyelitis has almost succeeded in the USA, the United Kingdom, Europe and Asia through routine use of Sabin live oral vaccine. Paralysis associated with the use of this vaccine has continued with an extremely low incidence-rate. Contact-infection and spread of virus excreted by recently-vaccinated persons occur to a significant extent and fortunately with polioviruses mostly unchanged in virulence. The second disease with attempted regional elimination is measles. In the USA county-wide elimination was successful in 1985 in all but a minority of counties. There followed two years with many more cases before a decline in incidence resumed once again. Elsewhere the general sponsoring of immunization under the expanded programme (EPI) of WHO is slowly taking effect.

Child, Preschool↗

PubMed1994

Addressing emerging infectious disease threats: a prevention strategy for the United States. Executive summary.

The spectrum of infectious disease is changing rapidly in conjunction with dramatic societal and environmental changes. Worldwide, explosive population growth with expanding poverty and urban migration is occurring; international travel and commerce are increasing; and technology is rapidly changing-all of which affect the risk of exposure to infectious agents. Recent examples of important emerging infectious diseases include prolonged diarrheal illness due to waterborne cryptosporidium, hemorrhagic colitis and renal failure from foodborne Escherichia coli O157:H7, pneumonia and middle-ear infections caused by drug-resistant pneumococci, and rodentborne hantavirus pulmonary syndrome. These diseases as well as resurgent diseases (e.g., tuberculosis and cholera) illustrate human vulnerability to microorganisms in the environment. Three recent reports by the Institute of Medicine document the need to address emerging infectious disease threats. In partnership with representatives from health departments, other federal agencies, medical and public health professional associations, and international organizations, CDC has developed a strategic plan to address emerging infectious disease threats. The plain contains four goals that emphasize surveillance, applied research, prevention and control, and public health infrastructure. To ensure sustainability, plan implementation will be approached in stages, as a long-term endeavor with emphasis on extramural programs. As health-care reform proceeds, priority should be given to strengthening partnerships between health-care providers, microbiologists, and public health professionals to detect and control emerging infectious diseases.

Communicable Disease Control↗

PubMed1999

Infectious disease policy: towards the production of health.

This paper reflects on current infectious disease control methods, their biomedical history and the management structures they are driven by. It asks whether a broader concept of 'infectious disease policy', with an emphasis on 'process' rather than outcomes, will help to re-frame the control discourse to ensure that infectious disease control is not only a method for preventing and treating infectious diseases, but is also a path for the creation of healthy communities.

Communicable Disease Control↗

PubMed2005

Skeletal evidence for the emergence of infectious disease in bronze and iron age northern Vietnam.

Human skeletal evidence for the emergence of chronic infectious disease in northern Vietnam is examined. The sample includes the remains of 192 individuals representing the Mid-Holocene and Bronze to Iron Ages. The objective is to see if the transition from sedentary, foraging, coastally oriented economies to centralized chiefdoms with attendant development and intensification of agriculture, trade, metal technologies, warfare, and population increase was accompanied by an emergence of and/or increase in infectious disease. It was found that skeletal evidence for infectious disease was absent in the Mid-Holocene, while over 10% of the Metal period sample exhibited lesions consistent with either infectious disease or immune system disorders. Factors potentially contributing to the emergence of infectious disease in northern Vietnam in the Metal period include: increased contact with bacterial or fungal pathogens either directly or by way of vertebrate and/or arthropod vectors; higher levels of debilitation and/or decreased levels of immunocompetence in the Metal period; and evolution of pathogens present in Mid-Holocene human hosts into more virulent forms in the Metal period. The first two factors may be related to historically and archaeologically documented major demographic (Han colonizing efforts) and economic (agricultural intensification) changes in the region during the Metal period.

Adolescent↗

PubMed1991

Policy for managing a community infectious disease outbreak.

OBJECTIVE: To identify guidelines for the management of an infectious disease emergency. SETTING: In February 1990, the discovery of hepatitis A in three foodhandlers prompted city and state health officials to offer mass immunization to residents of several counties in eastern Pennsylvania. In an attempt to facilitate the immunization effort, local hospitals were asked to establish and staff clinics to supplement the efforts of the health bureaus. RESULTS: Over a four-week period, combined efforts resulted in approximately 10,000 people receiving immunization with immune serum globulin (IgG). CONCLUSIONS: This was one of several infectious disease emergencies the community has faced in the recent past. Recognizing that future incidents of this nature are likely to occur, one 435-bed community teaching hospital devised an infectious disease emergency policy that allows for rapid deployment of personnel and services in the event of an infectious disease outbreak.

Clinical Protocols↗

PubMed1996

Fight against infectious diseases.

During early Meiji era in Japan, there were frequent epidemics of fatal acute communicable diseases such as cholera, dysentery and smallpox, and preventive measures and preparations for acute infectious diseases were urgently needed. Together with improvement of scientific preparations, the Communicable Disease Prevention Law was promulgated in 1897. Then gradually until 1940's, the focus of preventive measures have been shifted from acute infectious diseases to chronic ones, particularly tuberculosis. After the World War II, except the short period of social confusion, major legally-defined communicable diseases had been decreasing rapidly mainly due to the use of antibiotics and improvement of environmental sanitation. At the same time, the introduction of preventive vaccination marked a new era for the prevention of infectious diseases and was largely responsible for the remarkable decrease of infant mortality in Japan. Recently the concept of defense by vaccination against infectious diseases has evolved from group-oriented to individual-oriented, so that the Preventive Vaccination Law was drastically revised in 1994. Currently, effective counter-measures against newly emerged infectious diseases, as viral hepatitis, institution-acquired infection, viral hemorrhagic fever etc., have been implemented. For the future, improvement of infections disease surveillance, vaccine development and expansion of vaccination coverage along with monitoring side-effects, preventive health education on AIDS/STDs, addressing the special needs of foreigners living in Japan and international collaboration for disease control abroad are all vital to the success of protection of the public's health from infectious diseases in Japan.

Communicable Disease Control↗

PubMed2004

Limited access to hospitalization in an Italian infectious disease ward.

OBJECTIVE AND METHODS: A four-year retrospective survey was carried out in our Infectious Disease ward, to point out discrepancies between immediately hospitalized patients, and those referred to us for admission, but needing transferal elsewhere, due to lack of a suitable hospital room. RESULTS: Since the year 2000, 439 patients out of 1,979 needing hospitalization (28.5%), could not be admitted to our ward. After increasing the number of rooms in our Ward (June 2002, 16 to 35 beds), the described phenomenon decreased sharply, but a subsequent stabilization followed until July 2003, with around 13% of Infectious Disease patients sent elsewhere for hospitalization. Patients with severe, transmissible diseases were of particular concern, when the accepting Infectious Disease unit is located 40-120 Km far from our city. This was the case for nearly 25% of patients refused by our Hospital, since the year 2000. CONCLUSIONS: Infectious Disease wards need a continuous fitting to economic, technical, human, and professional health care resources, on the ground of ever-changing predominant diseases and/or problems. A strict monitoring of hospital admission needs in the Infectious Disease setting is strongly needed, to improve care of managed patients in the Bologna metropolitan area in the future.

Communicable Diseases↗

PubMed2000

[The new law concerning the prevention of infectious diseases and medical care for patients of infections].

A new law concerning the prevention of infectious diseases and medical care for patients with infectious diseases was enacted on Oct 2, 1998 and became effective on April 1, 1999. In the new infection control law, all infectious diseases are included as the targets of national epidemiological surveillance and are classified into new categories 1 through 4, depending on their contagiousness and severity. Under this new law, the national epidemiological surveillance of infectious diseases is defined as one of the main objects. This new law also specified the provision of a medical care supply system including assigned hospitals and medical fees.

Communicable Disease Control↗

PubMed1985

[Prevalence of infectious diseases at the Vaud University Hospital Center].

The prevalence of infectious diseases at our hospital (Centre hospitalier universitaire vaudois, Lausanne [CHUV], 900 beds) was studied retrospectively over a two years period (1980-1981). The medical diagnosis of 30203 patients recorded in the computerized medical archives, representing 93% of the patients admitted during the period of observation, was reviewed. To assess the reliability of the computerized data, quality control was carried out through detailed analysis of all the histologically proven appendicitis recorded during 1981. 88% of the histologically proven appendicitis were registered in the computer and the diagnosis was specific in 87% of cases. An infectious disease was the primary reason for admission in 12.8% of the patients (3873) during the study period. Altogether, 20.2% of patients presented with an infection during their hospital stay. Because of the retrospective nature of the study it was not possible to determine whether these additional infections were nosocomially acquired. The organ systems most frequently infected were the respiratory tract (28.5% of all infections), the digestive tract (20.5%), the skin and osteoarticular system (16%) and the urogenital tract (11.6%). An infection was the primary reason for admission of 40.2% of the patients hospitalized in the dermatology service, of 19.7% of patients admitted in internal medicine, of 15-17% of the patients admitted in pediatrics, ENT and general surgery, and of 1-2% of the patients admitted in neurosurgery and radiotherapy. These observations highlight the continuing importance of infectious diseases in a modern hospital, in spite of high socio-economic levels, stringent hygiene and epidemiologic measures, and modern antibiotic availability.

Appendicitis↗