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PubMed2005

[Recognition of the threats caused by infectious diseases in The Netherlands in 2002 and 2003 by the weekly meetings of the early warning committee].

OBJECTIVE: To establish whether the meetings of the so-called 'early warning committee' recognise all the threats to the public health in the Netherlands caused by infectious diseases. DESIGN: Retrospective and descriptive evaluation. METHOD: The information about the outbreaks of infectious diseases in the Netherlands and about events in the area of infectious diseases in foreign countries was compared with the domestic and foreign reports discussed in the regular weekly meetings of the Dutch early warning committee. For this purpose, the authors summarized the outbreaks of infectious diseases in the Netherlands in 2002 and 2003 as reported in articles in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine). This summary was then compared with the domestic reports discussed in the meetings of the early warning committee. If an outbreak was not mentioned in the meetings of the early warning committee, the cause for this was established. For the same period, a summary was made of the foreign events in the area of infectious diseases and this was also compared with the foreign reports mentioned in the meetings of the early warning committee. When an event had not been discussed in the meetings of the early warning committee, it was established on the basis of criteria whether the event could have been a threat to public health in the Netherlands. RESULTS: All outbreaks of infectious diseases in the Netherlands had been discussed in the early warning committee. Of the foreign events in 2002, 3 had not been discussed in the committee although they should have been, based on the criteria for a potential threat to the Netherlands: the outbreak of avian influenza A/H5NI in domestic fowl in Hong Kong, the increase among hospitalised patients of carriers of extended-spectrum 3-lactamase producing micro-organisms in Scotland, and outbreaks of measles in several countries. In 2003, all foreign events that could have been a threat to the Netherlands were discussed in the early warning committee. CONCLUSION: In 2002 and 2003, the meetings of the early warning committee recognised practically all the outbreaks of and threats due to infectious diseases.

Communicable Disease Control↗

PubMed2004

[Analysis of the intestinal infectious diseases occurring in the past ten years in a military unit].

OBJECTIVE: To identify the causes of intestinal infectious diseases in a military unit in the past 10 years. METHODS: The data of these diseases were acquired from a disease control and prevention center of a military command, including the epidemic cards, the first pages of medical record and investigation reports of the infectious diseases. Statistical analysis was performed after summarization of the data. RESULT: From 1992 to 2001, 3 612 cases of intestinal infectious diseases were reported in the military unit, most of which were bacillary dysentery (32.40%), hepatitis A (26.80%), typhoid (14.34%) and infectious diarrhea (7.34%), and 40.13% of them were intestinal infectious diseases. Fifteen epidemic outbreaks were documented from 1988 to 2002, including 9 arising from water and 6 from food contamination. CONCLUSION: Intestinal infectious diseases are seasonal and strict food and water hygiene should be maintained.

Adult↗

PubMed2001

Surveillance of infectious diseases in the Italian military as pre-requisite for tailored vaccination programme.

Surveillance and control of infectious diseases in the Italian military include prompt reporting of all occurring cases and prophylaxis through compulsory vaccination practices. The last mandatory immunisation programme in the Italian military was launched in 1998 (more than 10 years after the previous programme was introduced in 1986-1987) and it was planned according to the epidemiological data herein reported. The incidence rates (number of cases x 100000 subjects) of infectious diseases notified during the period 1976-1980 were compared with the corresponding figures notified 15 years later (1991-1995). An increase of three airborne-transmitted viral diseases--varicella, rubella and measles--counterbalanced by a decrease of other infectious diseases, such as mumps, typhoid fever, tuberculosis, viral hepatitis, scabies, syphilis and gonorrhea, was observed. This may be related to improvements in the general hygienic conditions and more responsible sexual behaviour among Italian military recruits. Moreover, incidence rates of cases notified in the military were compared with those notified in the general population of the same sex- and similar age-range (15-24 years) over a 12-year period (1986-1997), to monitor the epidemiological situation in relation to (a) potential risk factors specifically linked to military life and (b) protective effects induced by specific vaccinations. Airborne-transmitted viral diseases, such as varicella, rubella, measles and mumps--which are usually underreported among civilians--show higher incidence rates in the military. Meningococcal meningitis shows higher incidence rates in the military in 1986 and 1987 (before the introduction of mandatory specific vaccination) as well as in 1995-1997 (main etiologic agent N. meningitidis serogroup B); similar rates were instead observed in the other years. Incidence rates for typhoid fever are generally lower in the military, despite the community life, probably reflecting the protective efficacy of specific vaccine. Hepatitis A and B show similar rates between military and civilian population. Finally, pulmonary tuberculosis generally shows higher rates in the military. These data therefore allow the conclusion that the only infectious diseases, for which possible risk factors in the military life may be hypothesised, seem to be meningococcal meningitis and perhaps pulmonary tuberculosis. Epidemiological surveillance of infectious diseases in the military as a pre-requisite for appropriate public health intervention strategy represents a good model to be followed also in larger contexts.

Adolescent↗

PubMed1996

Child-care practices: effects of social change on the epidemiology of infectious diseases and antibiotic resistance.

The increasing number of mothers of young children in the work force and the resultant escalated use of child-care facilities has had a marked effect on the epidemiology of infectious diseases in young children. Children attending child care are at high risk for respiratory and gastrointestinal tract illnesses. The high prevalence of infectious diseases in the child-care setting is accompanied by high usage of antibiotics, which in turn has resulted in spread of antibiotic-resistant organisms. The infectious disease standards of the American Public Health Association/American Academy of Pediatrics guidelines were developed to prevent and limit transmission of infectious diseases in the child-care setting. Adherence to these standards is essential but will not completely eliminate the increased risk of infectious diseases in child-care settings. New challenges need to be addressed to assure that optimal health promotion and disease prevention is practiced in child-care settings. We approach the 21st century with a vast amount of medical knowledge, molecular technology, highly effective vaccines, and powerful antimicrobial agents. However, at the same time we face many unsolved serious problems, such as preventing or controlling the emergence and spread of antibiotic-resistant organisms that adversely affect our ability to treat infectious diseases. Further research is needed concerning the relations between child care, the use of antibiotics, and transmission of antibiotic-resistant organisms in order to design and implement the most effective strategies for preventing or controlling antibiotic resistance. The potential risk for transmission of HIV in the child-care setting also needs to be recognized, and procedures to prevent transmission of blood-borne pathogens need to be followed. Monitoring compliance with national standards for child-care facilities, dissemination of information concerning infectious diseases and use of antibiotics, and development and use of new vaccines are strategies which should be used to help protect the health of children in child-care environments.

Anti-Bacterial Agents↗

PubMed2004

Cohort study of sibling effect, infectious diseases, and risk of atopic dermatitis during first 18 months of life.

OBJECTIVES: To determine whether early infectious diseases could explain the association between number of siblings and other markers of microbial exposure and the development of atopic dermatitis before the age of 18 months. DESIGN: Cohort study. Information on atopic dermatitis, infectious diseases occurring before 6 months of age, number of siblings, early day care, pet keeping, farm residence, and background factors was collected in telephone interviews. SETTING: Danish national birth cohort. PARTICIPANTS: 24,341 mother-child pairs. MAIN OUTCOME MEASURES: Incidence rate ratios of atopic dermatitis. RESULTS: 13,070 children (54%) had at least one clinically apparent infectious disease before 6 months of age. At age 18 months, 2638 (10.8%) of the children had had atopic dermatitis. The risk of atopic dermatitis increased with each infectious disease before 6 months of age (incidence rate ratio 1.08, 95% confidence interval 1.04 to 1.13). The risk of atopic dermatitis decreased with each additional exposure to three or more siblings, day care, pet ownership, and farm residence (0.86, 0.81 to 0.93). CONCLUSIONS: Early infections do not seem to protect against allergic diseases. The protective effect of number of siblings, day care, pet ownership, and farm residence remained after adjustment for clinically apparent infectious diseases, suggesting that the effect is established independently early in life.

Age Distribution↗

PubMed1998

Preventing Emerging Infectious Diseases: A Strategy for the 21st Century. Overview of the Updated CDC plan.

Societal, technological, and environmental factors continue to have a dramatic effect on infectious diseases worldwide, facilitating the emergence of new diseases and the reemergence of old ones, sometimes in drug-resistant forms. Modern demographic and ecologic conditions that favor the spread of infectious diseases include rapid population growth; increasing poverty and urban migration; more frequent movement across international boundaries by tourists, workers, immigrants, and refugees; alterations in the habitats of animals and arthropods that transmit disease; increasing numbers of persons with impaired host defenses; and changes in the way that food is processed and distributed. Several recent health events underscore the need for a public health system ready to address whatever disease problems that might arise. For example, in 1997, an avian strain of influenza that had never before infected humans began to kill previously healthy persons in Hong Kong, and strains of Sta phylococcus aureus with diminished susceptibility to the antibiotic vancomycin were reported in Japan and the United States. In addition, researchers recently discovered that a strain of the virus that causes acquired immunodeficiency syndrome (AIDS) had been infecting humans for at least 20 years before AIDS emerged as a worldwide epidemic. Preventing Emerging Infectious Diseases: A Strategy for the 21st Century describes CDC's plan to combat today's infectious diseases and prevent those of tomorrow. It represents the second phase of the effort launched in 1994 with the publication of CDC's Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States. This overview of the updated plan outlines specific objectives under four major goals: a) surveillance and response, b) applied research, c) infrastructure and training, and d) prevention and control. Achieving these objectives will enhance understanding of infectious diseases and bolster their detection, control, and prevention. The plan also targets nine categories of problems that cause human suffering and place a burden on society. The aim of this plan is to build a stronger, more flexible U.S. public health system that is well-prepared to respond to known disease problems, as well as to address the unexpected, whether it be an influenza pandemic, a disease caused by an unknown organism, or a bioterrorist attack. The implementation of this plan will require the dedicated efforts of many partners, including state and local health departments, other federal agencies, professional societies, universities, research institutes, health-care providers and organizations, the World Health Organization, and many other domestic and international organizations and groups.

Communicable Disease Control↗

PubMed2002

Psychiatric presentations of non-HIV infectious diseases. Neurocysticercosis, Lyme disease, and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection.

Infectious diseases can cause an array of symptoms, including psychiatric symptoms. Psychiatrists serving the medically ill need to be aware not only of classic infectious diseases (e.g., neurosyphilis and HIV), but also of less commonly discussed infectious diseases (e.g., NCC, PANDAS, and Lyme disease). These examples represent an internationally endemic disease (e.g., NCC), a probable immunogenetic disease (e.g., PANDAS), and a frequently overdiagnosed and overtreated disease (Lyme disease).

Adult↗

PubMed2004

Combating tropical infectious diseases: report of the Disease Control Priorities in Developing Countries Project.

Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

Biomedical Research↗

PubMed2003

Quantifying the risk of infectious diseases for people with diabetes.

OBJECTIVE: In vitro evidence shows that immune function is compromised in people with diabetes. Although certain rare infections are more common and infection-related mortality is higher, the risk of acquiring an infectious disease for diabetic patients has never been quantified. RESEARCH DESIGN AND METHODS: A retrospective cohort study using administrative data compared all people with diabetes in Ontario, Canada, on 1 April 1999 to matched nondiabetic people (n = 513,749 in each group). The risk ratios of having an infectious disease and of death attributable to infectious disease between those with and without diabetes were calculated. Secondary analysis individually examined common infectious diseases. The study was repeated using a second pair of cohorts defined in 1996 to confirm stability of the estimates. RESULTS: Nearly half of all people with diabetes had at least one hospitalization or physician claim for an infectious disease in each cohort year. The risk ratio for diabetic versus nondiabetic people was 1.21 (99% CI 1.20-1.22) in both cohort years. The risk ratio for infectious disease-related hospitalization was up to 2.17 (99% CI 2.10-2.23). The risk ratio for death attributable to infection was up to 1.92 (1.79-2.05). Many individual infections were more common in people with diabetes, especially serious bacterial infections. CONCLUSIONS: Diabetes confers an increased risk of developing and dying from an infectious disease, corroborating both in vitro evidence and commonly held clinical belief. In addition to microvascular and macrovascular sequelae, clinicians should consider infection a complication of diabetes.

Aged↗

PubMedDate not supplied

Community perceptions about infectious disease risk posed by new arrivals: A qualitative study.

OBJECTIVE: To report on perceptions about the risk of infectious diseases from new arrivals to Australia arising from a wider study of mothers' attitudes to childhood vaccination. DESIGN, PARTICIPANTS AND SETTING: Six focus groups on perceptions about the benefits and risks of vaccination with 37 mothers of children aged 5 weeks to 18 years, mostly conducted in middle-class areas of Sydney between 6 October and 15 December 1999. MAIN OUTCOME MEASURES: Mothers' views about infectious disease risk posed by immigration as a major reason to favour immunising children. RESULTS: The idea of immigration being the primary source of infectious diseases was striking, and arose among a number of participants in every group conversation. Mothers expressed their dread of new diseases "from overseas", and a sense that there are "more germs nowadays", mostly from increased immigration to Australia and international travel. Some perceived people coming from other countries as having more disease because of an innate susceptibility or through cultural practices. CONCLUSION: Recent media coverage about infectious diseases importation by African refugees not only feeds, but reflects, community concerns about new arrivals as a source of allegedly rampant infection threatening Australians. These concerns have little evidence base. Public health advocates need to be proactive with the media to provide sophisticated counter-messages that expose the underlying subtexts and educate the community about the true risks of infectious diseases.

Adolescent↗

PubMed2005

[Surveillance of infectious diseases: principles and organisation in France in 2005].

Surveillance is a continuous and systematic process of collection, analysis, and diffusion of health data to all those who contributed to the collection and all those who need this data in order to take action. Surveillance activities first target health problems for which effective prevention or control measures are available. Surveillance objectives include the following-up of trends and changes in disease characteristics, evaluation of public health actions, and early detection of infectious diseases threats and epidemic and their investigation. The data produced by surveillance systems allow prioritizing public health actions and defining the objectives of infectious diseases control or prevention. The surveillance of infectious diseases relies on a large number of partners grouped in a public health network in which clinicians and microbiologists have a prominent role. In France, the surveillance of infectious diseases is based on mandatory notification of some diseases, national reference centers, networks of voluntary health professionals or services, and repeated surveys. The national surveillance is coordinated by a public health institute, "l'Institut de Veille Sanitaire", the missions of which are public health surveillance of the population, alerting health authorities in case of health threats, and identifying the determinants of changes in the population's health status.

Communicable Diseases↗

PubMed2004

Infectious disease screening for refugees resettled in the United States.

Refugees resettling in the United States carry a significant burden of infectious diseases as a result of exposures in their countries of origin and the circumstances of their migration. Overseas screening is required before entry, but it incompletely assesses infectious diseases in refugees. Domestic health assessment has the potential to provide more comprehensive assessment for infectious diseases. Screening protocols ideally should test for tuberculosis, hepatitis B, and intestinal and other parasites and should include mechanisms for providing or updating immunizations. Testing for other infectious diseases, including malaria, hepatitis C, human immunodeficiency virus, and sexually transmitted diseases, can be performed on the basis of clinical signs and symptoms. This article reviews the current status of overseas and domestic health screening for refugees, infectious disease burdens, and future goals for health assessment of refugees and other immigrants.

Communicable Disease Control↗

PubMed2005

Anemia as a risk factor for infectious diseases in infants and toddlers: results from a prospective study.

Anemia due to iron deficiency is the most prevalent form of micronutrient malnutrition in the world, however, the causal relationship between anemia and infection remains unclear. We examined prospectively, the association between anemia and infection among Bedouin infants. We recruited 293 families and newborns from the Bedouin population, which is ongoing major lifestyle changes, during the periods of 1989-1992 and 1994-1997 and followed them to age 18 months. The number of diarrhea and respiratory disease episodes as well as total days of diarrhea were ascertained weekly. Hemoglobin levels were obtained at age 6 months. Additional data on feeding practices, environmental, household and demographic characteristics were obtained throughout the 18 months. Diarrhea before 6 months of age was found to be a risk factor for diarrhea after that age. After controlling for early morbidity < 6 months, anemia (Hb < 11 g/dl) at 6 months was an independent risk factor for diarrhea and respiratory illness from 7 to 18 months of age. This associations remained significant even after controlling, in addition, for environmental and socio-economic factors. In the multivariable models, anemia at age 6 months increased the risk for diarrhea after that age by 2.9-fold (95% confidence interval 1.6 - 5.3; p = 0.001) and that of respiratory disease by 2-fold (1.1 - 3.7; p = 0.03). Our findings suggest that anemia may increase the rates of infections in toddlers. The possibility that reducing anemia in infants may be a preventive measure to lower disease burden from infectious disease in this and other vulnerable populations should be tested in further studies.

Anemia↗

PubMed1998

In vitro assessment of the antimicrobial activity of a local sustained release device containing amine fluoride for the treatment of oral infectious diseases.

Dental caries and periodontal diseases are chronic infectious diseases caused by oral bacteria. Local sustained release delivery systems extend the time in which the drug is present in the oral cavity, thus enhancing its therapeutic potential while reducing its side effects. Amine-fluorides (AmF) are known anticaries agents and have recently been found to have an antibacterial effect against periodontal pathogens and caries-associated bacteria. The purpose of this in vitro study was to assess the antimicrobial activity of a local sustained release device (LSRD) containing AmF on Streptococcus sobrinus 6715. LSRD was prepared from an ethylcellulose matrix containing AmF. Release kinetics of AmF from the LSRD was measured simultaneously with its antimicrobial activity. The organic amine and the fluoride were released in different kinetics profiles: The fluoride was released faster than the organic amine. The antimicrobial activity of AmF was measured on planktonic bacteria in solution and on bacteria as part of experimental dental plaque. During a 10-day period, the concentration of the released AmF was above its MIC and no bacterial growth was observed. Bacterial counts in the dental plaque were reduced by 1 to 2 log units. Hence, the LSRD containing AmF has the potential to serve as a medicament in prevention and treatment of dental caries and periodontal diseases.

Anti-Infective Agents, Local↗

PubMed2002

HIV-1/AIDS and the control of other infectious diseases in Africa.

The effect of HIV-1 on other infectious diseases in Africa is an increasing public health concern. In this review, we describe the role that three major infectious diseases--malaria, sexually transmitted diseases (STDs), and tuberculosis--have had in the HIV-1 epidemic. The high prevalence of untreated STD infections has been a major factor facilitating the spread of HIV-1 in Africa; with the synergistic interaction between HIV-1 transmission and genital herpes being of special concern for control of both diseases. Increased susceptibility to tuberculosis after infection with HIV-1 has led to a rising incidence and threat of increased transmission of tuberculosis. Clinical malaria occurs with an increased frequency and severity in HIV-1-infected individuals, especially during pregnancy. As with tuberculosis, STDs, and other communicable HIV-1-associated diseases, the net effect of HIV-1 might include increased rates of malaria transmission across communities. In addition to enhancing access to HIV-1 prevention and care, public health surveillance and control programmes should be greatly intensified to cope with the new realities of infectious disease control in Africa.

AIDS-Related Opportunistic Infections↗

PubMed2005

The -308G/A polymorphism of TNF-alpha influences immunological parameters in old subjects affected by infectious diseases.

Abnormal increments of pro-inflammatory cytokines (IL-6 and TNF-alpha) characterize the outbreak of infectious diseases, which are the major cause of death in the elderly. A counterbalance to the inflammation is exerted by IL-10 with an inhibitory role on TNF-alpha production. As is well known, some cytokine gene polymorphisms influence the cytokine production, playing a role as susceptibility or resistance factors against immune-mediated and infectious disease. Genetic variations in the -308A/G locus for TNF-alpha seems to affect the clinical outcome of some infectious diseases. In fact, the -308A allele is associated with severe septic shock and death. On this basis, we have screened healthy old subjects, nonagenarians and old patients affected by the acute phase of chronic obstructive bronchitis and bronchopneumonia of bacteria origin for the -308G/A locus (PCR-RFLP). Subjects are grouped in A+ (AG, AA genotypes) and A- (GG genotype) and data on IL-6, TNF-alpha, IL-10, NK cell cytotoxicity, zinc and metallothioneins (MTs) gene expression (RT-PCR) were stratified according to different TNF-alpha genotypes. The frequency of the A allele was increased in infected patients in comparison with healthy old controls. No differences existed between A+ and A- young adult, old and nonagenarian controls in tested parameters. Conversely, A+-infected patients displayed elevated IL-6, TNF-alpha and MTmRNA, low IL-10 coupled with impaired NK cell cytotoxicity and lower zinc ion than A- patients. However, the data reported are gender independent. Therefore, the -308A polymorphism at the locus of TNF-alpha may be one of the susceptibility factor for infectious diseases in old persons, particularly considering its association to the increased release of pro-inflammatory cytokines and to the reduction of zinc release and MTs synthesis involved in the control of the inflammatory response. These data strongly suggest that the genetic screening of the -308G/A polymorphism may be a valid tool for identification of subjects needing a more appropriate therapy when affected by acute and/or recurrent infectious diseases.

Adult↗

PubMed2005

[The control of infectious diseases in The Netherlands].

Municipal health services (MHSs) carry out the control and prevention of communicable diseases, under the authority of the municipal councils. Mayors have the authority to enforce measures aimed at individuals, such as isolation and quarantine. The mandatory notification of infectious diseases by physicians, as required by the Infectious Diseases Act, is an essential part of infectious disease control. By collecting these notifications, MHSs obtain a much better picture than the individual physician of the mutual relationships between the reported cases. MHSs monitor current regional developments, while the National Institute for Public Health and the Environment (RIVM) does this for the entire country and elsewhere in the world. By means of electronic message service, the information can be disseminated immediately, if necessary, to health professionals everywhere in The Netherlands. In case of national threats or epidemics, the National Coordination of Infectious Disease Control (LCI) can request expert advice from the Outbreak Management Team and can advise the Minister of Public Health, Welfare and Sport (VWS) as to the best control measures. The Minister is chairman of a board of administrators, defines the policy and bears the final responsibility. The Ministry of VWS creates the necessary conditions. The Minister of VWS has noted structural errors in the organisation of the prevention of infectious diseases and will implement an improved organisational structure in the beginning of 2005. The assignments of the new centre are not only research and advising, but also the overall management of the prevention.

Communicable Disease Control↗

PubMed2000

International health and emerging infectious diseases.

This article explored the role of international health in reducing the impact of infectious diseases by espousing the monumental application of global electronic communication and socioeconomic development initiatives. The interaction between the society and environmental changes have dramatic effects on the frequency of infectious diseases worldwide. Development of dams, human population expansion, migration patterns, urbanization and the invasion of hitherto virgin forests, and global warming enhance the proliferation of vectors of infectious diseases. Sustainable development and emphasis on primary prevention initiatives, coupled with the application of technology to improve farming, provision of safe water and electrification of rural communities, are significant steps in infectious disease control.

Attitude to Health↗