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PubMed1998

The risk of occupational exposure and infection with infectious diseases (Part I).

The variety of potentially infectious agents that frequent the health care environment is indeed large. As a result, health care workers are at some degree of risk for exposure to a variety of infectious diseases. However, as healthy individuals, we can protect ourselves quite successfully by following the guidelines that govern personal hygiene and immunization and adhering to accepted infection control standards of patient care, disinfection, antisepsis, and disease isolation. A clear understanding of the mechanisms of disease transmission is also important in this regard.

Community Health Nursing↗

PubMed1999

Mortality from infectious diseases in Israel, 1979-1992, based on revised ICD-9 codes: implications for international comparisons.

OBJECTIVES: This study examined trends in infectious disease mortality rates in Israel between 1979 and 1992, using a traditional and a revised set of International Classification of Diseases, Ninth Revision (ICD-9) codes. METHODS: A revised scheme of ICD-9 codes was used to compute mortality rates from infectious diseases for the period 1979 through 1992 by sex and for different age categories. RESULTS: Age-adjusted infectious disease mortality rates based on the revised ICD-9 codes were 3 times higher than those based on traditional codes. Between 1979 and 1992, age-adjusted mortality rates declined more under the revised method than under the traditional method (20% vs 1.7%). CONCLUSIONS: The revised set of ICD-9 codes allows a more comprehensive view of the burden of infectious diseases on public health.

Adolescent↗

PubMed2002

[Nutritional status on admission and hospital mortality of under-five year old children with infectious diseases in Ouagadougou, Burkina Faso].

BACKGROUND: It is known that malnutrition in childhood interacting with infectious diseases contributes to increase mortality. In Burkina Faso, infectious pathologies and malnutrition are public health problems. We examined the impact of malnutrition status, using the Weight-for-age (WA) index, on mortality of children hospitalized for infectious diseases. METHODS: This retrospective study uses a systematic sample derived from the year 1999 hospital register. In total data of 1573 children from 0 to 59 months were analyzed. The association between mortality and dependent variables was measured by relative risks (RR) in univariate analysis. A logistic regression was realized and attributable risk percent (etiologic fraction among exposed) of death was calculated. RESULTS: The total intra-hospital lethality amounted to 15.3%. Age, diagnosis, type of care recourse and malnutrition (low WA index) on admission were associated to mortality. The logistic regression model confirmed the high risks of deaths for young children (0-11m), children in malnutrition (low WA index) and those with severe malaria. The attributable risk percent of death indicates that, 87% of deaths are statically attributable to severe malnutrition (WA Z-score<=-3) and 64.3% of deaths are statically attributable to moderate malnutrition (WA Z-score]-3, -2]). CONCLUSION: Nutritional status evaluation would allow to select children at risk and reduce mortality by including nutritional intervention in standard treatment of children hospitalized for infectious diseases.

Academic Medical Centers↗

PubMedDate not supplied

Perception and knowledge about some infectious diseases among travelers from Québec, Canada.

BACKGROUND: Many travelers from Québec visit tourist destinations, thereby becoming at risk of infectious diseases. Within a study of predictors of utilization of travel health consultation by travelers, knowledge about transmission and perception of risk and severity of some infectious diseases was measured. METHODS: A cross-sectional survey was conducted during winter 1999 on travelers 16 years of age and over going to Mexico and the Dominican Republic. A 34-item self-administered bilingual questionnaire was distributed to travelers during seven flights departing from Montréal Airport. RESULTS: The questionnaires were completed by 1,724 passengers (response rate: 75%). The majority (81%) of the 1,416 travelers from the province of Québec considered themselves at greater risk of diarrhea abroad. Risk perception was less important for hepatitis A and B (44% and 41%, respectively). Most travelers considered diarrhea as slightly or not severe, and hepatitis as severe illnesses. A majority had adequate knowledge about transmission of diarrhea but knowledge concerning hepatitis was less accurate. In the multivariate analysis, the most important associations were noted between perception of risk of diarrhea and knowledge about transmission of diarrhea (odds ratio [OR] 3.2); and between perception of risk of hepatitis and perception of severity of hepatitis (hepatitis A: OR 3.9; hepatitis B: OR 5.9). Consultation in a travel clinic before departure was associated with perception of higher risk of hepatitis A and of infectious diseases in general (OR 2.1). CONCLUSION: Despite its limitations, this study indicates that travelers from Québec, going to sun destinations, seem to underestimate their risk of hepatitis related to travel. Knowledge about transmission of hepatitis seems poor. Education of travelers about risks and modes of transmission of infectious diseases should be reinforced. Travel health consultation before departure or for a previous trip appeared to be associated with higher risk perception.

Adolescent↗

PubMed2004

Topography as a contextual variable in infectious disease transmission.

OBJECTIVE: This paper examines whether or not topography is a contextual variable that indirectly influences the transmission of infectious diseases. Age, gender, race/ethnicity, education level, economic status, injection drug use, and high-risk sexual behavior are known to influence infectious diseases transmission, but the effects of topography are often overlooked. DESIGN: A sample of 395 drug users were chosen from census tracts based upon a target profile of drug use behavior and demographics for the city of Houston. HIV was chosen as the infectious disease used to test this hypothesis. SETTING: Residents of 16 census tracts in Houston, Texas participated in this study. RESULTS: The findings revealed that census tracts that were 'isolated' by topographic barriers, such as bayous, parks, railroad tracks, railway yards, major thoroughfares, freeways, and unique street grids had fewer cases of HIV than census tracks that were more accessible to thru-traffic. CONCLUSION: The research findings suggest that future research studies should consider topography as being contextually related to infectious disease transmission.

Adolescent↗

PubMed2000

Transfusion-transmitted infectious diseases in Argentina, 1995 through 1997.

BACKGROUND: Assessment of the safety of the blood supply, the quality of screening procedures, and the risk of transfusion transmission of infectious diseases in any country can be estimated by reviewing the records of blood donations and screening procedures and the prevalence of serologic markers of infectious diseases. STUDY DESIGN AND METHODS: Information on blood donors, particularly the number of screened donors, and on the prevalence of serologic markers of infectious diseases was available from Argentina for 1995 through 1997. This information permitted the estimation of the risks and costs of preventing transfusion transmission of infectious diseases within the country during this period. RESULTS: Screening coverage was higher in the private sector. The proportion of donors screened for HIV increased from 84.52 percent in 1995 to 97.97 percent in 1997; in the same period, serologic screening for HbsAg increased from 83.71 percent to 98.48 percent; that for HCV from 69. 92 percent to 97.83 percent; and that for syphilis from 87.94 percent to 98.71 percent. One hundred percent of donors were screened for Trypanosoma cruzi throughout the period. The overall prevalence of HIV per year varied from 2.42 to 3.36 per 1,000 donors; that of HBV, from 5.80 to 9.76 per 1,000; of HCV, from 7.39 to 16.61 per 1,000; and of syphilis, from 5.25 to 7.65 per 1,000. The overall prevalence of antibodies to T. cruzi ranged from 36.53 to 49.20 per 1,000 donors. The overall index of the spread of infectious viral disease through blood transfusion decreased from 47. 74 per 10,000 donations in 1995 to 4.75 per 10,000 in 1997. The ratio of acquired infections to donations improved from 1:209 to 1:2, 102 during the same period. The risk of T. cruzi infection from 1995 through 1997 was, in theory, nil, given the 100-percent screening. The greatest threat to the quality of the blood supply throughout the period studied was HCV. CONCLUSION: The status of the blood supply in Argentina improved steadily from 1995 to 1997, as shown by the increase in screening coverage.

Animals↗

PubMed1985

The responsibility of the infectious disease community for the optimal use of antimicrobial agents.

Antimicrobial agents are a critical element of the therapeutic armamentarium of modern medicine. How well they are used reflects our ability to treat and prevent infectious diseases. The major consideration for proper usage is to select the optimal agent at the proper dosage. Secondary, but important concerns are to minimize the emergence of resistance and to provide health services at a reasonable cost. The infectious disease community must work in concert with the pharmaceutical industry to achieve these goals. The relations of infectious disease physicians with the industry have been remarkably effective in evaluating and introducing new drugs, however, it is natural that conflicts should arise. Although the overall accomplishments have been outstanding, there is considerable evidence that antimicrobial agents are often abused and used excessively. This paper outlines some of the issues of marketing and the problems inherent in industry-sponsored trials. As specialties other than infectious diseases have encountered major difficulties, it is timely that this society adopts a code of ethical conduct for its work with industrial sponsors and takes the initiative in developing programs for education of other physicians in the field of infectious diseases and antimicrobial therapy both in this country and in developing nations.

Anti-Bacterial Agents↗

PubMed1996

[Current aspects of infectious diseases in industrialized countries: development or history?].

Man's conception of nature is a historically dated phenomenon. Thus the recent development of infectious diseases in industrialized countries could either be a real phenomenon or simply an artifact related to our current conception of medical progress and research. Is the return of infectious disease a natural process or has modern civilization been less prudent than its predecessors? What are the characteristic features of modern pathogenesis? Are these "changes" the result of some natural dynamics or an evolution in our means of investigation? Modern civilization has not invented technological deviation or diseases of civilization, phenomena well know in the past, but what is new is the fact that science today, with an ever growing amount of information on molecular epidemiology, is still raising questions about infection, recognized new unsuspected forms of the living world which do not fit into our well-knitted outline of infectious agents. We have applied our simplistic and mechanistic schemas designed for the timespan of human life to the evolutionary processes. The effects of evolution and history are thus combined today in a novel way composing a new future for infectious diseases. This new way of looking at infectious diseases is not totally natural nor totally historical. It is perhaps an epistemological revolution going on within epidemiology. The return of infections disease would appear to have a direct effect on magnifying the knowledge and the delinquency of our culture.

Communicable Diseases↗

PubMed2000

[What do medical students know about the epidemiology of tetanus and tuberculosis in Germany?--A comparison of epidemiologic knowledge regarding a rare and a prevalent infectious disease].

A Comparison of Epidemiological Knowledge About a Rare and a Common Infectious Disease: Tetanus and tuberculosis are still worldwide health problems. Due to an increasing number of insufficiently vaccinated persons, mainly in adults, tetanus in Germany requires more and more medical attention. At the same time, due to global migration and an increasing number of immunocompromised patients, the probability of getting infected with tuberculosis is on the increase. For preventing infectious diseases it is necessary to analyse to what extent medical students are informed about the epidemiology of tetanus and tuberculosis in Germany. This knowledge is a mainstay for later differential diagnosis. After completing medical training it is expected that they are capable of diagnosing both diseases properly and that they are trained to inform the population about necessary vaccinations. The following study analysed the incidence estimation of medical students (n = 472) on tetanus and tuberculosis morbidity in Germany. It is obvious that medical students still have gaps in their knowledge about the epidemiology of tetanus and tuberculosis. They overestimated the incidence of tetanus cases per year around 10-1,000 times. In comparison, they underestimated the incidence of tuberculosis. The study shows a distorted assessment of importance of medical problems by the students of medicine. Medical education should consider this and focus more on epidemiology of infectious diseases including tetanus and tuberculosis.

Adult↗

PubMed2003

Conceptual foundations for infectious disease surveillance.

The purpose of this report is to offer concepts for consideration in developing infectious disease surveillance systems, defined here as active, formal, and systematic processes intentionally directed to rapidly seek out and identify infectious disease agents or disease. Performance of surveillance systems can be judged by their accuracy (sensitivity and specificity), precision (repeatability), timeliness, multiple utility, and value. Surveillance system operation and function necessary to achieve high performance are defined in part by characteristics of the specific infectious disease, including disease transition state dynamics, that define probabilities of being in the latent, infectious, or clinical phase of disease. Two key components of surveillance are the sampling scheme, which is intended to maximize the probability of capturing an infected animal or specimen as soon as possible after the herd has been exposed, and the diagnostic assays, which should maximize the probability of detecting the agent, or evidence of the agent, if it is present in the specimen, while minimizing the likelihood of a false-positive result. Proportional risk sampling, targeted sampling, and repeated sampling are strategies that can improve overall surveillance system accuracy and particularly the temporal sensitivity related to early detection. Hierarchical sampling schemes and multiplexed assays can maximize efficiency and improve utility by serving multiple surveillance systems and purposes. Development of the surveillance systems needed to address emerging and foreign animal diseases will necessarily require design and architecture that are highly probability-driven to maximize surveillance sensitivity and specificity and to minimize cost.

Animal Diseases↗

PubMedDate not supplied

A critical review of the infectious diseases surveillance system in the Gaza Strip.

The development and strengthening of national surveillance systems is a key part of communicable disease control. This review article describes and evaluates the Palestinian surveillance system and discusses the role of the epidemiology departments and other health providers in Gaza Strip in reporting infectious diseases, considers the use of the data collected, and makes recommendations for strengthening infectious diseases surveillance. Underreporting of infectious diseases remains a major problem in communicable diseases surveillance. Recommendations include the unification of the reporting forms between different health providers, increased involvement of health providers in reporting of infectious diseases, and complete separation of surveillance and clinical activities in epidemiology departments.

Bias↗

PubMed1984

Curbside consultation in infectious diseases: a prospective study.

This study prospectively evaluates curbside (unofficial, informal) consultation (CSC) directed to the hospital-based Infectious Disease Consultation Service (IDCS) in a 1,000-bed university-affiliated, general teaching hospital. Official consultation (OC) was neither solicited nor discouraged. During a one-year period, the IDCS was consulted officially about 532 patients (503 inpatients, 29 outpatients) and unofficially about 269 patients. Only 31 (11.5%) of the 269 CSCs subsequently resulted in OCs. Problems discussed during a CSC ranged from simple to complicated and life threatening, with pneumonia, hepatitis, and syphilis being the illnesses most frequently discussed. Forty-two percent of the CSCs were sought by the internal medicine housestaff, whereas approximately 29% were sought by internal medicine staff physicians. It may be concluded that a CSC in infectious diseases is common, that it sometimes involves complicated and/or life-threatening illnesses but usually does not result in a subsequent OC, and that it requires a considerable expenditure of time by the Infectious Disease Service. A CSC may also involve the exchange of inaccurate or insufficient information between inquiring physicians and the Infectious Disease Service.

Humans↗

PubMedDate not supplied

Timeliness of notification in infectious disease cases.

Records of notification in cases of eight infectious diseases in the "Servei Territorial de Salut Publica" of the Province of Barcelona, Spain, between 1982 and 1986 were reviewed. Time from onset of symptoms to notification, time from notification to completion of data collection, and time from onset to completion of the case investigation were analyzed. For the period from onset to notification, the shortest mean was registered for meningococcal infection (6.31 days) and the longest was for pulmonary tuberculosis (54.79 days). For time from notification to complete investigation, the shortest value was for pulmonary tuberculosis (12.20 days) and the longest for rickettsioses (35.79 days). Time from onset to completion of data collection was 22.87 days for meningococcal infection and 72.34 days for tuberculosis of other organs (probably because of the long period of time that elapses between the onset of the first symptoms and notification). It would appear that both physicians and the general population must be educated so that lay-men can identify early signs and symptoms of disease and physicians can realize that statutory notification of infectious diseases is strongly linked to community health care.

Communicable Disease Control↗

PubMed2001

PHLS primary care consultation--infectious disease and primary care research and service development priorities.

In 1999 for the first time the PHLS undertook a questionnaire survey of general practitioners' views of the burden of infectious disease and the priorities for research and development of infectious disease services within the PHLS. Three hundred and seventy-one (38%) of 979 questionnaires mailed to chairs of primary care groups in England, and general practitioners in research networks, were returned. Service areas: computer transfer of laboratory results was considered of greatest priority. Guidance on antibiotic usage, guidance on infectious diseases and education for general practitioners were ranked two, three and four. Burden of infectious disease in primary care: upper respiratory tract infections, tonsillitis/pharyngitis, otitis media/externa and acute cough were placed one, three, four and seven respectively. Urinary tract infections were ranked second and dyspepsia/Helicobacter pylori fifth. Leg ulcers, diarrhoea, genital chlamydia infection and vaginal discharge were other diseases considered to cause a large burden of ill-health. Genital chlamydia, tuberculosis, Helicobacter pylori and meningococci were ranked one, two, three, and five in the NHS opportunity to affect the burden of ill-health. Priorities for improvements to diagnostic tests, evidence on which to base treatment and guidance: chronic fatigue/ME was ranked top in these areas. The other top ten syndromes ranked in order were genital chlamydia infections, antibiotic resistance surveillance, vaginal discharge, leg ulcers, sinusitis, otitis media/externa, dyspepsia/Helicobacter pylori, Creutzfeld Jacob Disease, and tonsillitis. This consultation exercise has highlighted broad areas for future PHLS involvement in primary care. In order to make progress, further consultation is needed with groups of GPs, and other relevant bodies. Particularly for the areas ranked in the top ten, the type of further PHLS involvement needs to be defined. For some syndromes (chronic fatigue and leg ulcers) this may be writing guidance and for others (respiratory tract infections) more treatment trials are required. The purposes and possible methods of communicable disease surveillance in general practice should be the subject of additional consultation.

Attitude of Health Personnel↗

PubMed1989

[Infectious diseases in kidney transplant recipients treated with cyclosporin].

Cyclosporin (CYA) is now recognized as an effective immunosuppressant to lead to a marked improvement in graft survival in organ transplant recipients. Although the incidence of infection in the CYA group has been decreased compared with that in the azathioprine group, infectious diseases in 400 kidney transplant recipients treated with CYA were noted in our single center. Treatment strategy for infectious diseases: Antibiotics and/or gamma-Globulin were administered to all recipients with bacterial infections. Aciclovir was added in recipients with herpes simplex virus (HSV) infection or varicella zoster virus (VZV) infection. Human interferon-beta (HuIFN-beta) was used in recipients who had life-threatening viral infection, especially cytomegalovirus (CMV) pneumonitis. Glycyrrhizin was used for acute hemorrhagic cystitis and nephropathy due to adenovirus (AV). Trimethoprim sulfamethoxazole and/or pentamidine were added in recipients complicated with Pneumocystis carinii (Pc) pneumonitis or in order to prevent Pc pneumonitis. Infectious diseases: One hundred and six recipients had infectious diseases 129 times in this series, seventy-six percent of all infections occurred during the first 4 months after the transplantation. Urinary tract infection (UTI), herpes zoster and pulmonary infection were the most common infectious diseases, occurring in 28.7%, 24.0% and 23.2%, respectively. Septicemia or bacteremia developed in 9 recipients, secondary to UTI in 8 and to surgical wound infection in one. Sixty-one symptomatic viral infections occurred in 57 recipients. A total of 5 recipients (1.3%) died of interstitial pneumonitis. Infectious organisms: Viral and bacterial infections were most common, occurring in 47.3% and 41.9%, respectively. Viral species detected in these recipients with the frequency were HSV 14 times, CMV 9 times, VZV 31 times and AV 7 times. 1) The incidence of viral infections in kidney transplant recipients treated with CYA is relatively high compared to bacterial infections. 2) HuIFN-beta therapy is effective in the treatment of serious opportunistic herpes virus infections, especially CMV pneumonitis. 3) Glycyrrhizin therapy is effective in the treatment of acute hemorrhagic cystitis and nephropathy due to AV and hepatic dysfunction. 4) Aerosolised pentamidine therapy is very useful for prophylaxis of Pc pneumonitis.

Adolescent↗

PubMedDate not supplied

The prevalence of hypokalemia in hospitalized patients with infectious diseases problem at Cipto Mangunkusumo Hospital, Jakarta.

AIM: to know the prevalence of hypokalemia that occurs in hospitalized patients with infectious diseases. METHODS: a cross sectional study was carried out in the internal ward Cipto Mangunkusumo General Hospital in Jakarta from December 2005 until June 2006. All hospitalized patients with infectious diseases receiving "replacement solution" were included in this study. We collected the blood sample to perform the serum potassium level at the time of admission and discharge. RESULTS: one hundred and five patients were enrolled in this study; consisting of 44 males and 61 females. The age ranged from 14 to 70 years old. The most common infectious diseases were dengue fever, while the underlying diseases were hepatobiliary disorders. "Replacement solutions" which were given, were ringer's lactate 91%, normal saline 8%, and ringer's acetate 1%. Prevalence of hypokalemia among the hospitalized patients, on admission was 24 patients (23%) and during hospitalization was 39 patients (37%). The mean level of hypokalemia on admission was 3.11 + SD 0.37 mEq/L (range from 1.7 to 3.4 mEq/L) and during hospitalization was 3.13 + SD 0.25 mEq/L (range from 2.5 to 3.4 mEq/L). On admission, the ratio of mild : moderate : severe hypokalemia is 22 : 2 : 1. And at discharge the ratio of mild to moderate hypokalemia becomes 19 : 6. CONCLUSION: the prevalence of hypokalemia in hospitalized patients with infectious disease in Cipto Mangkunkusumo's Hospital, Jakarta is 23%. Further studies are needed to know the contributing factors including the usage of 'intravenous fluid' in relations to hypokalemic state during hospitalization.

Adolescent↗

PubMed1982

Longitudinal studies of infectious diseases and physical growth of children in rural Bangladesh. I. Patterns of morbidity.

Longitudinal studies were done in two villages in rural Bangladesh to learn more about the interactions between infectious diseases and the nutritional status of children. An intensive system of surveillance was used to determine the occurrence and frequency of infectious diseases in a cohort of 197 children aged 2-60 months in 1978-1979. This surveillance revealed that illnesses of the upper respiratory tract, such as purulent rhinitis and pharyngitis, had the highest prevalence. Diarrheas were the second most common illnesses, with a peak prevalence rate in children 6-11 months of age. Diarrhea was also the most frequent reason for hospitalization of study children. The overall prevalence of infectious diseases was high: at least one and often several concurrent illnesses were noted on 75% of all days of observation. Compared with children in the surrounding area, children in this study had a low mortality rate, perhaps because of medical services provided during the study. Nevertheless, the extensive morbidity from infectious diseases may have had adverse effects on the growth and development of the children.

Bangladesh↗

PubMed2006

Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management.

With increased globalisation comes the likelihood that infectious disease appearing in one country will spread rapidly to another, severe acute respiratory syndrome (SARS) being a recent example. However, although SARS infected some 10,000 individuals, killing around 1000, it did not lead to the devastating health impact that many feared, but a rather disproportionate economic impact. The disproportionate scale and nature of this impact has caused concern that outbreaks of more serious disease could cause catastrophic impacts on the global economy. Understanding factors that led to the impact of SARS might help to deal with the possible impact and management of such other infectious disease outbreaks. In this respect, the role of risk--its perception, communication and management--is critical. This paper looks at the role that risk, and especially the perception of risk, its communication and management, played in driving the economic impact of SARS. It considers the public and public health response to SARS, the role of the media and official organisations, and proposes policy and research priorities for establishing a system to better deal with the next global infectious disease outbreak. It is concluded that the potential for the rapid spread of infectious disease is not necessarily a greater threat than it has always been, but the effect that an outbreak can have on the economy is, which requires further research and policy development.

Communicable Diseases↗