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PubMed2005

Childhood vaccination and nontargeted infectious disease hospitalization.

CONTEXT: It has been hypothesized that multiple-antigen vaccines, such as measles-mumps-rubella vaccine, or aggregated vaccine exposure could lead to immune dysfunction, resulting in nontargeted infectious diseases as a result of an "overload" mechanism. OBJECTIVE: To evaluate the relationship between routinely administered childhood vaccines (Haemophilus influenzae type b; diphtheria-tetanus-inactivated poliovirus; diphtheria-tetanus-acellular pertussis-inactivated poliovirus; whole-cell pertussis; measles-mumps-rubella; oral poliovirus) and hospitalization for nontargeted infectious diseases. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort comprising all children born in Denmark from 1990 through 2001 (N = 805 206). Longitudinal information was collected on type and number of vaccine doses received and hospitalization with infectious diseases, specifically acute upper respiratory tract infection, viral and bacterial pneumonia, septicemia, viral central nervous system infection, bacterial meningitis, and diarrhea. MAIN OUTCOME MEASURES: Rate ratios for each type of infectious disease according to vaccination status. RESULTS: During 2,900,463 person-years of follow-up, 84,317 cases of infectious disease hospitalization were identified. Out of 42 possible associations (6 vaccines and 7 infectious disease categories), the only adverse association was for Haemophilus influenzae type b vaccine and acute upper respiratory tract infection (rate ratio, 1.05; 95% confidence interval, 1.01-1.08 comparing vaccinated participants with unvaccinated participants). This one adverse association of 42 possible outcomes was within the limits of what would be expected by chance alone and the effect was not temporal or dose-response. When considering aggregated vaccine exposure, we found no adverse associations between an increasing number of vaccinations and infectious diseases. CONCLUSION: These results do not support the hypotheses that multiple-antigen vaccines or aggregated vaccine exposure increase the risk of nontargeted infectious disease hospitalization.

Child↗

PubMed1987

Infectious diseases: preventable causes of infant mortality.

After almost a century of improvement, the rate of decrease in US infant mortality rates began to level off during the period of 1982 to 1984. Rates actually increased in some states. Because much of the decline in infant mortality in this century can be attributed to advances in infectious disease treatment and prevention programs, we evaluated the current impact of infectious diseases on infant mortality. The National Center for Health Statistics mortality data for 1980 contains information on as many as 20 causes of death for a given individual. Using these data, we found that infectious diseases contributed to 12.5% of all infant deaths and to almost 400,000 years of potential life lost because of infant deaths. Infectious diseases contributed to 9% of deaths of low birth weight infants and to more than 18% of all deaths in the postneonatal period. Compared with white infants, a higher proportion of nonwhite infants died of causes related to infectious diseases. For black infants, the mortality rate related to infectious diseases was twice that for white infants. These data indicate that infectious diseases still are a major contributor to infant mortality, one of the 15 areas targeted for prevention by the federal government, and the data suggest that programs for reducing infant mortality should place increased emphasis on preventing infectious diseases.

Communicable Diseases↗

PubMed1997

Uses of the EM algorithm in the analysis of data on HIV/AIDS and other infectious diseases.

The analysis of data on infectious diseases is a natural setting for applications of the EM algorithm, because the infection process is only partially observable. Difficulties in determining the expectation at the E step have been side-stepped by adopting pragmatic models which reflect only part of the mechanism that generates the data. In the HIV/AIDS context the EM algorithm has helped in the reconstruction of the unobserved HIV infection curve, the so-called backprojection problem, as well as in the estimation of the distribution for the incubation period until AIDS, in estimating the infectivity of HIV in partnerships and in estimating parameters describing the decline in the immune system. There is a need for smooth estimates of functions in these applications, suggesting the use of the EMS algorithm or use of the EM algorithm to maximize a penalized likelihood. For data on other infectious diseases the application of the EM algorithm has so far been restricted to analyses of data on the size of outbreaks in a sample of households.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Results of a survey of infectious disease testing practices by organ procurement organizations in the United States.

BACKGROUND: Information related to infectious disease testing policies and practices of organ procurement organizations in the United States does not currently exist. METHODS: A total of 63 organ procurement organizations in the United States were surveyed during May 1996. Participants responded to a detailed questionnaire concerning infectious disease tests performed for tissue and solid organ donors and policies related to the reporting and notification of positive test results. RESULTS: The response rate was 77.8%. The majority of testing is performed by hospital laboratories with an expected turnaround time of 5 hr or less by 71% of organ procurement organizations. Almost all routinely perform screening tests for human immunodeficiency virus, hepatitis C virus, cytomegalovirus, syphilis, human T lymphocyte virus I, and hepatitis B surface antigen. Other tests are performed with greater variability. Although the majority of organ procurement organizations perform confirmatory tests when screening tests are positive, 35% do not perform confirmatory testing or do so only sporadically. There are a wide range of policies concerning the subsequent reporting of positive infectious disease tests and to whom results should be reported. CONCLUSIONS: Infectious disease testing policies of organ procurement organizations, particularly for solid organs, demonstrate variability in interpretation and perceived significance of positive test results, the initiation or need for reflex and confirmatory testing, the reporting of positive results, and to whom positive test results should be reported. There is a need for a consistent national policy for appropriate infectious disease testing and reporting of results.

AIDS Serodiagnosis↗

PubMedDate not supplied

Determinants of emerging and re-emerging infectious diseases.

In the 1960s and 1970s, many public health experts assumed that infectious diseases could at long last be conquered as had occurred with smallpox. In the last two decades, reports warned that infectious diseases were clearly not a problem of the past. They could not be considered as a unique or isolated event of wild and faraway regions, but penetrated every corner of the globe. Emerging infectious diseases have been recently described as clinically distinct conditions whose incidence in humans has increased regionally or worldwide within the past two decades. Emergence may be due to the introduction of new agents to or the recognition of an existing disease that has gone undetected, and re-emergence may describe the re-appearance of known diseases after a decline in incidence. In this article a global, multidisciplinary and integrated approach in different fields of demography, epidemiology, economy, ecology, anthropology and environment at science has been considered to describe the different determinants responsible for the emergence and re-emergence of infectious diseases.

Biological Evolution↗

PubMed1994

[Gene level diagnostics of infectious diseases].

Recent developments in medical technology have caused a great change in infectious diseases, as characterized by epidemics of antibiotics-resistant bacteria, opportunistic infection in compromised hosts, and blood-borne viral infections such as hepatitis virus and human immunodeficiency virus. In the diagnosis of such new aspects of infectious diseases, conventional immunological, culture, and microscopical techniques are not always practical. By contrast, evaluation of infectious agents using molecular biological technology frequently offers the rapid, most accurate and sensitive method of diagnosis. Amplification methods are particularly attractive for the detection of small numbers of microorganisms, as in latent conditions, or for the fastest identification of the pathogen without laborious isolation. For introduction of the tests into routine procedures, their standardization as well as simplicity and low cost are required. Gene level diagnostics should be applied appropriately to management of infectious diseases along with the conventional techniques, while further roles of the tests must be determined, on the basis of the molecular elucidation of infectious diseases.

DNA, Bacterial↗

PubMed2005

Evolutionary nursing: the case of infectious diseases.

AIM: The aim of this paper is to examine the effect of evolution on infectious diseases nursing, and propose a model that may help to increase understanding of how hosts and microorganisms co-exist and how humans can alter the delicate balance between them. BACKGROUND AND RATIONALE: Infectious diseases occur as the result of interactions between hosts and microorganisms. There is an increasing acceptance that the evolution of host and parasite is important in the development of infectious diseases. However, such views have made little impact in nursing, and the use of evolutionary interventions remains controversial. METHOD: The Medline database was searched from 1966 to present using the terms pathogen$, virulen$, evolution, bacteria, and all combinations of these. Additionally reference lists of text books and papers were hand searched for relevant papers. Papers were selected from a variety of disciplines, including infectious diseases, microbiology, evolutionary biology, and ecology. Recurrent themes from these papers were identified and a model of evolutionary nursing constructed. RESULTS: Microorganisms are plentiful, ubiquitous, and rapidly evolving by comparison with humans and other animals. As a result of this, attempts to 'outwit' them have been, and are, doomed to failure. However, through careful management of public and personal health, a balance encouraging co-existence may be possible. A number of specific interventions is proposed. CONCLUSIONS: There are a number of key interventions that may reduce the virulence of microorganisms. With an increasing world population, antibiotic resistance and international travel, such an approach may be one way of reducing the morbidity associated with infectious diseases.

Biological Evolution↗

PubMed2003

Infectious diseases detected at autopsy at an urban public hospital, 1996-2001.

Previous studies have demonstrated significant discrepancy rates between clinical and autopsy diagnoses. However, infectious diseases have not received emphasis in these studies. We conducted a study to determine whether the clinical and autopsy diagnoses of infectious diseases are concordant or discrepant and to determine discrepancy rates. Retrospective reviews of the records of 276 patients (adults, 182; fetuses and neonates, 94) who underwent autopsy during the years 1996 through 2001 were performed. Comparison of clinical and autopsy diagnoses was performed using the Goldman classification scheme. Of 182 adult patients, 137 (75.3%) had an infectious disease at autopsy. In 59 (43.1%) of 137 patients, the infectious disease diagnoses were unknown clinically. Of 94 fetuses and neonates, 45 (48%) had an infectious disease at autopsy. In 26 (58%) of 45 patients, the infectious disease diagnoses were unknown before death. There are substantial discrepancies between clinical and autopsy diagnoses of infectious diseases. In adults, acute bronchopneumonia is the infectious disease most often missed clinically; in fetuses and neonates, it is acute chorioamnionitis.

Adult↗

PubMed1997

The contribution of infectious diseases to infant mortality in Alaska.

BACKGROUND: Based on death certificates to determine cause of death, current research suggests that infectious diseases are less important causes of infant mortality than in the past. METHODS: To determine the contribution of infectious diseases to infant mortality and the sensitivity of death certificates for identifying infectious disease causes of death, we examined information from multiple sources for a population-based sample of infant deaths that occurred in Alaska during 1992 through 1994. RESULTS: We collected information for 181 of 272 reported infant deaths and identified 48 infants for whom an infection was a primary (n = 15), contributing (n = 12) or suspected (n = 21) cause of death (infectious disease-related infant mortality rate, 2.2/1000 live births). Of these 48 deaths 27 were associated with a maternal peripartum infection and 15 were associated with a postneonatal respiratory tract infection. A specific organism was identified for 15 of 29 infants who died during the neonatal period and for 5 of 19 infants who died during the postneonatal period (including 2 with coagulase-negative Staphylococcus and the rest with a variety of other organisms). Death certificates identified an infectious disease as a primary or contributing cause of death for 19 infants (sensitivity, 40%) and reported a specific organism for 4 infants. CONCLUSIONS: Infectious diseases caused or contributed to a high proportion of infant mortality in Alaska during 1992 through 1994. Death certificates had poor sensitivity for identifying infectious disease-related infant deaths.

Alaska↗

PubMedDate not supplied

The increasing burden of infectious diseases on hospital services at St Mary's Hospital Lacor, Gulu, Uganda.

To evaluate the impact of infectious diseases on hospital services in Northern Uganda, a retrospective analysis of discharge records concerning 70,304 inpatients admitted to the Lacor Hospital (Gulu, Uganda) during the period 1992-1997 was performed. Children less than five years old represented 46.5% of the admissions, and the burden of infectious diseases on pediatric admissions increased over time, especially due to malaria and measles. Infectious diseases accounted for 7 of the 10 leading causes of admission. The most frequent cause was malaria (21.8% of total). The second leading infectious disease resulting in admission was respiratory tuberculosis (6.2%); given the long hospital stay, this is the most important disease in terms of hospital bed days (24.6%). Infectious diseases have represented a progressively heavy burden on hospital services, mostly due to pediatric admissions. Respiratory tuberculosis and malaria represent nearly one-third of the overall burden in terms of hospital bed days.

Adolescent↗

PubMed1998

The principle of diagnostic method and diagnostic imaging for infectious diseases.

Rapid progress of diagnostic examination or technique for infectious diseases has been observed in recent several years. Diagnostic imaging also developed remarkably through introductions of new technology, and made the diagnosis of infectious diseases much more easier than before. However, the most important point is the perfect collection of patients' or disease information and their appropriate evaluation by medical doctors to make full use of the latest technology. This fundamental ability of medical doctors is indispensable for rapid and certain diagnosis of infectious diseases.

Adult↗

PubMed2004

The infectious disease profile of Texas prison inmates.

PURPOSE: Prison inmates present with higher rates of disease morbidity and mortality than the general population. The rates of certain infectious diseases such as hepatitis C, HIV/AIDS, and tuberculosis are reported to be particularly elevated in prison systems. Scarce information, however, exists on the overall infectious disease profile of inmate populations. The present study examined the prevalence of major infectious diseases in one of the nation's largest prison populations. METHODS: The study population consisted of 336,668 Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions, sentencing factors, and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Latent tuberculosis infection constituted the most prevalent infectious disease reported among inmates. This was followed in frequency by hepatitis C, HIV/AIDS, and syphilis. Prevalence estimates for most of the infectious diseases under study exhibited substantial differences across gender, age, and ethnicity. CONCLUSION: The present study shows that the prison population had prevalence rates that were substantially higher for latent TB, HIV/AIDS, and hepatitis C than those reported for the general population and some incarcerated populations. The rate of active TB among TDCJ inmates, however, was comparable to that of the general population and other incarcerated populations.

Adolescent↗

PubMed1996

Common infectious diseases.

Many of the common infectious diseases of humans are highly transmissible, and there is ample opportunity within the dental office for spread of these infections between patients and staff. Adherence to universal infection control procedures, however, introduced to deal with the threat posed by unknown carriers of bloodborne viruses, also greatly limits spread of the more common infectious agents described in this article.

Adult↗

PubMed2005

[The role of public health service in prevention and control of infectious diseases in the Federal Republic of Germany. Tasks, structures and responsibilities--an overview].

The goal is to describe the structure of administration for the control of infectious diseases in the German states. Internationally there is an increasing risk of potentially global transmission of infectious diseases and therefore increasing need for improved control mechanisms which are viable locally, regionally and internationally. The international public health community must ensure that responses to infectious disease with a potential impact on more than one county entail concerted action, clear communication and decision making by diverse administration agencies. Given Germany's federal structure, the 16 states have differing protocols delineating responsibilities for infection control systems. This paper provides an overview, going into detail only with regard to the administration structure in Hesse. In 2001, the German law governing infectious disease control was amended and significantly expanded. With regard to protection of humans from infectious disease, each state must define its schedule of responsibilities on the resulting scope of duties. Each state in Germany has entrusted the local public health service at the county level with the responsibility for infection prevention and control. As a rule, at the state level both an expert agency and one or more district administration agencies have been installed; these work directly with the Ministry of Health at the state level. In addition to this, Hesse has established a "centre of competence for highly contagious diseases." In the event of an infectious emergency, this network provides special treatment of highly infectious patients and expertise for public health services and the Ministry of Health on a 24-h shift basis. In times of ongoing structural transformation, it is important to emphasize that expertise at the state level is not an alternative to maintaining enough specialised personnel in the public health services themselves. Specialized practitioners are needed to ensure professional and fast-acting responses, both for the prevention and control of infectious diseases.

Communicable Disease Control↗

PubMed2006

Infectious diseases in children admitted from a residential child care centre.

OBJECTIVES: To describe the pattern of infectious diseases among children admitted from a residential child care centre and to identify any unusual clusters of admissions. DESIGN: Retrospective case review. SETTING: Regional hospital, Hong Kong. PATIENTS: All children from a residential child care centre aged over 28 days who were admitted from the Accident and Emergency Department to paediatric wards for infections from 1 January 1999 to 31 December 2003. MAIN OUTCOME MEASURES: Demographic data, clinical diagnoses, infectious diseases identified, and incidence and seasonal pattern of various infections. RESULTS: Of 267 children admitted to the hospital over the 5-year period, 221 had infectious diseases. Respiratory tract infections, viral exanthema, and gastroenteritis were present in 83.7%, 7.2%, and 5.9%, respectively. Among those with a respiratory tract infection, 22.7%, 9.2%, and 8.6% had respiratory syncytial virus, parainfluenza virus, and influenza A or B viruses, respectively. Two unusual clusters of respiratory syncytial virus and parainfluenza virus were recognised in late 2003. CONCLUSION: Children in this residential child care centre were at risk of infectious diseases. Respiratory tract infection is the most common infectious disease in this centre. An outbreak of respiratory tract infection was recognised. Further efforts may be necessary to improve infection control measures in this setting.

Adolescent↗

PubMed2001

Black-white differences in infectious disease mortality in the United States.

OBJECTIVES: This study determined the degree to which Black-White differences in infectious disease mortality are explained by income and education and the extent to which infectious diseases contribute to Black-White differences in all-cause mortality. METHODS: A sample population of the National Longitudinal Mortality Study from 1979 through 1981 was analyzed and followed up through 1989. RESULTS: Infectious disease mortality among Blacks was higher than among Whites, with a relative risk of 1.53 after adjustment for age and sex and 1.34 after further adjustment for income and education. Death from infectious diseases contributed to 9.3% of the difference in all-cause mortality. CONCLUSIONS: In the United States, infectious diseases account for nearly 10% of the excess all-cause mortality rates in Blacks compared with Whites.

Adult↗

PubMed2006

Genetic susceptibility to infectious disease: lessons from mouse models of leishmaniasis.

Susceptibility to infectious disease is influenced by multiple host genes, most of which are low penetrance QTLs that are difficult to map in humans. Leishmaniasis is a well-studied infectious disease with a variety of symptoms and well-defined immunological features. Mouse models of this disease have revealed more than 20 QTLs as being susceptibility genes, studies of which have made important contributions to our understanding of the host response to infection. The functional effects of individual QTLs differ widely, indicating a networked regulation of these effects. Several of these QTLs probably also influence susceptibility to other infections, indicating that their characterization will contribute to our understanding of susceptibility to infectious disease in general.

Animals↗

PubMed2001

Infectious diseases journals on the World Wide Web: attractions and limitations.

Online infectious diseases (ID) journals are an increasingly common Web phenomenon. We performed a study of practices in this evolving area that make these sites more usable and useful from the perspective of ID physicians. The Web sites of 18 journals pertaining to general ID and infection control and hospital epidemiology were evaluated for a set of 24 Web interface characteristics and online features. Journals hosted by the High Wire Press (Antimicrobial Agents and Chemotherapy, Infection and Immunity, and the Journal of Antimicrobial Chemotherapy) and the University of Chicago Press (The Journal of Infectious Diseases and Clinical Infectious Diseases) best fulfilled our criteria. Electronic reference linking, archives, e-mail alerts, and links to external resources are some of the features of electronic journals that users in the ID specialty may find especially useful.

Communicable Diseases↗