Some often neglected factors in the control and prevention of communicable diseases.
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Measles is a rare communicable disease which may be fatal in renal transplant patients. Herein we present a patient with renal transplantation who had measles and who subsequently developed subacute measles encephalitis 4 months later. We recommend all children with chronic renal failure be vaccinated against measles before transplantation.
The non-communicable diseases, which include hypertension, diabetes (adult onset type), coronary heart disease, chronic bronchitis and certain cancers (especially those of the lung and bowel) are major public health problems in the adult populations of many Pacific nations undergoing "modernization" of their way of life. Programmes for the prevention and control of these conditions have become more feasible in the Pacific in recent years because of increased awareness of the magnitude and the nature of the problem, and because of important conceptual breakthroughs. Primary prevention will play a cardinal role in such programmes. Secondary prevention, using a conventional therapeutic approach through the primary care system, will also be used, especially for hypertension. Prevention and control programmes against these diseases in the Pacific are in the process of development, and the prospects and constraints in each country will have to be individually and carefully assessed.
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Billing records from the outpatient clinics of the University of Arizona were compared to case reports of communicable diseases received by the local health department. Of 286 cases of reportable diseases found, 183 (64 percent) were reported to the local health department. Sexually transmitted diseases were more likely to be reported than other diseases [risk ratio (RR) = 1.97; 95 percent confidence interval (CI), 1.62-2.39]. Diseases of residents of Pima County were more likely to be reported than those of residents of other Arizona counties (RR = 1.40; 95 percent CI, 1.11-1.77), and diseases in Arizona residents were more likely to be reported than those of residents of other States (RR = 2.37; 95 percent CI, 1.35-4.15). Diseases of citizens of other countries were never reported. The only significant difference found among the specialty clinics of the medical center was that pediatricians reported less frequently than others (RR = 0.75; 95 percent CI, 0.58-0.98).
Inserm has developed, since 1984, an information system based on a computer network of physicians in France. It allows for constitution of large databases on diseases, with individual description of cases, and to explore some aspects of the mathematical theory of communicable diseases. We developed user-friendly interfaces for remote data entry and GIS tools providing real-time atlas of the epidemiologic situation in any location. The continuous and ongoing surveillance network is constituted of about 1200 sentinel voluntary and unpaid investigators. We studied their motivation, reasons for either withdrawal or compliance using survival analyses. We implemented early warning systems for outbreak detection and for time-space forecasting. We conducted epidemiological surveys for investigating outbreaks. Large available time and space series allowed us to calibrate and explore synchronism of influenza epidemics, to test the assumption of panmixing in susceptibles-infectious-removed type models and to study the role of closing school in influenza morbidity and mortality in elderly. More than 250 000 cases of influenza, 150 000 cases of acute diarrheas, 35,000 patients for whom HIV tests have been prescribed by general practitioners and 25,000 cases of chickenpox have been collected. Detection of regional influenza or acute diarrhea outbreaks and forecasting of epidemic trends three weeks ahead are currently broadcasted to the French media and published on Sentiweb on a weekly basis. Age-cohort-period models assessed field effectiveness of mass immunization strategies against measles and influenza in the country. Case-control studies with more than 1200 sets of cases of acute diarrheas and their matched controls showed the role of calicivirus and rotavirus as probable major causes of gastroenteritis during recurrent widespread outbreaks in winter in France. An age-specific model for chickenpox showed the probable role of children in disease transmission to their susceptible parents or grandparents. High level of synchronism between influenza epidemics has been demonstrated, either at a regional level (in France) or between France and the USA. The designation of our lab as a WHO collaborating center for electronic disease surveillance stimulates the development of global monitoring of diseases. We developed operational systems that are now available for the global monitoring of influenza (FluNet), and human and animal rabies (RABNET). Extension of electronic syndromic surveillance is needed in the world for improving surveillance capacities and real-time response against emerging diseases.
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The Mortality and Use of Health Services surveys were designed to measure the mortality impact of the Combatting Childhood Communicable Diseases programmes which are based on childhood vaccinations, prenatal immunization against tetanus, home-based use of oral rehydration therapy, and presumptive treatment of malaria. The survey design includes pretest and post-test surveys in programme and non-programme areas. The questionnaires are designed to collect information on use of health services and on pregnancy histories to provide retrospective reporting of child mortality. When combined with data from surveillance systems (particularly information on cases of measles cases seen at clinics and health centres), these data should provide reasonable estimates of programme impact.
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