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An economic model for on-farm decision support of management to prevent infectious disease introduction into dairy farms.

A more-closed farming system can be a good starting point for eradication of infectious diseases from within a herd. The economic implications of a more-closed farming system will not always be obvious to farmers. The management decisions are related to different parts of the farm and are farm-specific. To support these decisions, a model was developed of the economic consequences of a more-closed system (a simple static and deterministic design was used). The risk factors in the model were based solely on bovine herpesvirus type 1 (BHV1) but losses due to introduction of BVDV, L. hardjo, and S. dublin were added to the model. The model was verified and partly validated and a sensitivity analysis was done. The cost to one 55-cow dairy farm that refrained from purchasing cattle, provided protective clothing to professional visitors and a temporary employee, and built and maintained a double fence around 6 ha of land to prevent over-the-fence contacts was Dfl. 4495 over 5 years. The probability of disease introduction was decreased by 74%. The prevented losses for disease introduction amounted to Dfl. 7033 over 5 years (net benefits of Dfl. 2538 over 5 years).A more-closed system would be still beneficial when a sanitary barrier was used instead of just protective clothing, when the probability of introduction of infectious diseases was decreased, and when odds ratios in the model were replaced by more-conservative relative risks. The benefits became negative when a farm had to build and maintain a double fence around 12 ha instead of 6 ha, when the probability of introduction of all diseases was decreased by 50%, and when the estimations were based solely on BHV1.

Animal Husbandry↗

Recent advances in the study, prevention, and treatment of infectious diseases.

Along with the rapid progress in molecular biology and computer technology, many changes have occurred in the diagnosis, treatment, prevention, and understanding of infectious diseases. Molecular techniques are taking a more important role both in the diagnosis and in the discovery of etiologic agents. The associations of Helicobacter pylori with gastroduodenal disorders and Chlamydia pneumoniae with atherogenesis have revised contemporary thinking about the pathogenesis of chronic organ and tissue diseases. Vaccination, once a privilege of children, is now being used in adults and is also being tried as a therapeutic modality for chronic diseases. Acquired immunodeficiency syndrome (AIDS) has become pandemic and its toll is devastating. The study of AIDS has not only benefited patients living with human immunodeficiency virus (HIV) infection, but has also delivered a strong boost to antiviral research. Structure-based drug design was proven useful through the successful development of HIV protease inhibitors and an influenza neuraminidase inhibitor. In the future, the integration of structure-based drug design and combinatorial chemistry should expedite the pace of new drug development. Finally, dissection of human genes related to susceptibility to infectious diseases is a task to be completed in our fight against infectious microorganisms.

Acquired Immunodeficiency Syndrome↗

Completeness of notifiable infectious disease reporting in the United States: an analytical literature review.

Despite state and local laws requiring medical providers to report notifiable infectious diseases to public health authorities, reporting is believed to be incomplete. Through means of an analytical literature review, the authors synthesize current knowledge on the completeness of disease reporting and identify factors associated with reporting completeness. The review was limited to published studies, conducted in the United States between 1970 and 1999, that quantitatively assessed infectious disease reporting completeness. Thirty-three studies met the inclusion criteria. Reporting completeness, expressed between 0% and 100%, was treated as the dependent outcome variable in statistical analysis; disease, study location, time period, study design, and study size were treated as independent variables. Fifty-six distinct measures of reporting completeness were identified for 21 diseases. Reporting completeness varied from 9% to 99% and was most strongly associated with the disease being reported. The mean reporting completeness for acquired immunodeficiency syndrome, sexually transmitted diseases, and tuberculosis as a group was significantly higher (79%) than for all other diseases combined (49%) (p < 0.01).

Communicable Disease Control↗

Infectious diseases in Rome during the Millennium Year.

During 2000, the millennium year, 26 million people visited Rome. An improved surveillance system for infectious diseases, especially for foodborne disease outbreaks (FBDO), meningitis, and legionnaires' disease was introduced in 1997. This rapid alert network links public health services with the principal sources of diagnosis and laboratory based surveillance. For travel related legionnaires' disease, international surveillance was implemented. Specific control measures for FBDOs were adopted. No increase in the overall incidence of these diseases was observed, and no atypical pathogens in FBDOs or meningitis were isolated in 2000 relating to 1998-99. Cases of legionnaires' disease and FBDOs involving foreign tourists increased (10/4 and 7/2 observed/expected respectively). Three out of six FBDOs involving pilgrims occurred in religious guesthouses. While an increase in cases of legionnaires' disease and FBDOs among foreign tourists was observed by the surveillance system, the millennium year did not influence the epidemiology of infectious diseases in the residential population of Lazio.

Communicable Diseases↗

Analysis and impact of infectious disease consultations in a general hospital.

During an 18-month period, data from all patients in whose care our infectious diseases (ID) service was involved, were recorded in a computerized database. A total of 4184 new consultations was recorded. The consultations were solicited by the patients' physicians in 3326 cases (80%) and initiated by the ID service in the remainder. The purpose of the consultations was diagnosis (14%), therapy (39%), both diagnosis and therapy (40%), and prophylaxis (6%). Two thousand and ninety-four consultations (50%) were performed at the bedside, and the others by personal or telephone discussion. ID consultation was given in more than 10% of admitted patients in six departments, 46% of the admissions in the ICU, and 6.9/100 hospitalized patients. Recommendations included: antibiotic manipulation (i.e., initiation, change or discontinuation of antibiotic treatment) (51%); performance of tests (13%); performance of diagnostic or therapeutic procedures (5%); prophylaxis (4%) or no change in management (26%). Analysis of the solicited vs unsolicited consultations and of the bedside vs telephone consultations revealed that sub-groups of consultations differ significantly from each other in many aspects. Recording of consultations enables the ID service to evaluate its activity and to direct efforts to departments with high rates of infectious diseases and/or antimicrobial usage.

Communicable Diseases↗

Frequency and outcome of infectious disease admissions to a pediatric intensive care unit.

This prospective clinical study was designed to assess patients with primary infectious disease (ID) necessitating admission to a pediatric intensive care unit (PICU), to identify morbidity and mortality risk factors, and to better define this subpopulation of critically ill children and compare them with patients who had a noninfectious disease (NID). All patients (N = 1,151) admitted to a multidisciplinary, university-affiliated, 20-bed PICU from January through December 1988 were studied. The patients were classified as having either ID or NID as the primary indication for PICU admission. Other variables assessed included age, sex, requirement for mechanical ventilatory support, and severity of illness at admission as determined by Pediatric Risk of Mortality (PRISM) score. Of the 1,151 patients admitted, 187 (16%) had ID. Patients with ID had significantly higher PRISM scores than NID patients, but mortality rates were not significantly different between the NID group (9%) and the ID group (11%). The ID and NID groups showed no significant difference with regard to sex, number of days in the ICU, or number of days of mechanical ventilatory support. Patients with ID were significantly younger than those without. Although the highest mortality overall was in neonates, there was no difference in mortality rate for this age group between ID and NID. Fifty-five (30%) of the 187 ID patients had a diagnosis of sepsis syndrome on admission, and had significantly higher PRISM scores and mortality than patients with other ID. We concluded that patients admitted to our PICU with a diagnosis of infectious disease were significantly younger and had higher severity of illness scores than patients admitted with a diagnosis of noninfectious disease. The most frequent cause of death in both groups was multisystem organ failure. Patients with sepsis syndrome showed showed no significant difference in overall mortality, but their PRISM scores and mortality rate were significantly greater than those of the other ID patients.

Bacteria↗

Infectious diseases physicians' preferences for continuing medical education on antimicrobial resistance and other general topics.

A 19-item survey instrument was designed and mailed by the Infectious Diseases Society of America to its membership to determine the media preferred by infectious diseases physicians for continuing medical education on general topics and on antimicrobial resistance. The objective of the survey was to offer the developers of educational programs knowledge on which to base more-effective ways to deliver educational materials to physicians in this specialty.

Attitude of Health Personnel↗

Notification of infectious diseases by general practitioners in New South Wales. Survey before and after the introduction of the Public Health Act 1991 (NSW)

OBJECTIVE: To evaluate attitudes and knowledge about infectious disease notification and the self-reported notifying practices of general practitioners in New South Wales before and after the introduction of the Public Health Act 1991 (NSW). DESIGN: A survey of a random sample of general practitioners in NSW before and after the introduction of the Act. RESULTS: The percentage of doctors who considered notification to be very important increased (57% "before" v. 67% "after"; P = 0.02), as did the percentage who believed that notification usually leads to preventive action (41% v. 54%; P = 0.04). There was no increase in self-reported notification (50% v. 54% who reported notifying cases of notifiable diseases "always, or almost always"; P = 0.42). CONCLUSIONS: Notification of infectious disease by doctors remains suboptimal, but may improve over time as the impact of the new Act is felt. Feedback to doctors showing that preventive action is taken as a result of their notifications may be the most effective way to improve notification practices.

Attitude of Health Personnel↗

Prevalence of HIV infections in hospitalised immigrants in Clinics of Infectious Diseases in Italy: a multicentric survey.

Our aim was to evaluate the prevalence of HIV infection in immigrants hospitalised in infectious disease settings in Italy during 2002. Each participating centre filled in a CRF which regarded the number of immigrants hospitalised in ordinary regime or in day-hospital during 2002 and, for HIV-positive patients only, some demographic (age, sex, origin) and clinical features (only HIV positivity or AIDS, new diagnosis or not, diagnosis of opportunistic infections). A total of 46 Infectious Diseases Units participated in the study and a total number of 2255 patients were tested for anti-HIV, irrespective of the cause of hospitalization, with 378 (16%) cases of positivity. Women accounted for 47.9%; the mean age of the population was 34.5 years. African patients showed a higher prevalence of HIV infections than subjects from other geographical areas (61.9% of all cases). Most HIV-infected patients were unaware of their positivity. In conclusion, HIV infection represents one of the main health problems among immigrants, particularly of African origin.

Adult↗

Infectious diseases on the 21st century doorstep.

Accelerating change can be expected to occur in the fields of Clinical Microbiology and Infectious Diseases. New pathogens, new diseases, new technologies, new vaccines and new treatment modalities will descend on us with increasing frequency in the decade ahead. In order to cope with and even appreciate change, we need to increase our commitment to training, recruiting and retaining health professionals in these disciplines, enhance our research programs, and remain enthusiastic about the benefits offered by skilled, knowledgeable practitioners to our patients. Infectious disease deaths have been increasing during the '90's in most societies. We must reverse this!

Communicable Diseases↗

Acute renal failure related to infectious disease in infancy and childhood.

In this prospective study done between 1983 and 1989, of 109 children with acute renal failure in Sivas, Turkey, infectious disease was found in 94. This was related mainly to preventable disease such as acute gastro-enteritis, sepsis and post-streptococcal acute glomerulonephritis. Within this infectious disease group, the highest incidence rate was found in sepsis.

Acute Kidney Injury↗

The burden of infectious disease among inmates of and releasees from US correctional facilities, 1997.

OBJECTIVES: This study developed national estimates of the burden of selected infectious diseases among correctional inmates and releases during 1997. METHODS: Data from surveys, surveillance, and other reports were synthesized to develop these estimates. RESULTS: During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility. CONCLUSIONS: Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.

Acquired Immunodeficiency Syndrome↗

A farming systems study of abortion in dairy cattle on the Atherton Tableland. 2. The pattern of infectious diseases.

The role of infectious agents on dairy farms on the Atherton Tableland in tropical north Queensland was studied as part of a comprehensive investigation into the causes of bovine abortion. The prevalence of antibody in serums collected from 7 herds whose annual abortion rates ranged from 3% to 21% were as follows: Leptospira hardjo 49.9% (426/853), L. pomona 0.4% (3/851), bovine virus diarrhoea (BVD) 33.7% (35/104). Infectious bovine rhinotracheitis virus (IBR) 11.5% (12/105), Akabane virus 92.2% (95/103), Aino virus 62.1% (64/103), Chlamydia psittaci 3.1% (37/1004), Brucella abortus 0% (0/851), and Toxoplasma gondii 0% (0/105). Testing of serums against a wide range of leptospiral serotypes indicated that reactions occurring in the Hebdomadis and Sejroe serogroups were probably cross reactions with L. hardjo. Infection with L. hardjo and Akabane virus occurred prior to first mating and contact with Aino virus occurred during first pregnancy. Infection with BVD and IBR viruses was sporadic. The pathology and microbiology of 32 aborted foetuses from 24 Tableland herds (10 from the group of 19 farms under more intense study) were performed. Lesions associated with a Sarcocystis-like agent were present in 6, leptospires in 1, suspected toxic hepatosis in 2 and purulent bronchopneumonia (Staphylococcus aureus) in 1 foetus. No diagnoses were made in the remaining 22 foetuses (69%). Evidence for a common infectious cause of abortion in the population was inconclusive.

Abortion, Veterinary↗

Emerging infectious diseases.

Human population growth, technological advances, and changing social behaviors lead to the selection of new microbial pathogens. Antimicrobial drugs, vaccines, diagnostics, and treatments for emerging infectious diseases must be developed. The selective forces that drive the emergence of new infectious diseases, and the implications for our survival, are just beginning to be understood.

Communicable Diseases, Emerging↗

[Asepsis and vigorous antisepsis against infectious disease transmission in the dental office].

Therapeutic acts often surgically practised in the dental office can lead to the transmission of infectious diseases such as A.I.D.S. To prevent this, the authors propose guideline base acts for antisepsis and asepsis. In conclusion, the authors exhort for an integration of these antiseptic acts in the efficient working of the dental office for an effective prevention of these infectious diseases in the area.

Acquired Immunodeficiency Syndrome↗

The importance of bactericidal drugs: future directions in infectious disease.

BACKGROUND: Although a considerable amount of research has gone into the study of the role of bactericidal versus bacteriostatic antimicrobial agents in the treatment of different infectious diseases, there is no accepted standard of practice. METHODS: A panel of infectious diseases specialists reviewed the available literature to try to define specific recommendations for clinical practice. RESULTS: In infections of the central nervous system, the rapidity with which the organism is killed may be an important determinant, because of the serious damage that may occur during these clinical situations. The failure of bacteriostatic antibiotics to adequately treat endocarditis is well documented, both in human studies and in animal models. CONCLUSION: The bulk of the evidence supports the concept that, in treating endocarditis and meningitis, it is important to use antibacterial agents with in vitro bactericidal activity. This conclusion is based on both human and animal data. The data to support bactericidal drugs' superiority to bacteriostatic drugs do not exist for most other clinical situations, and animal models do not support this concept in some situations. Clinicians should be aware that drugs that are bacteriostatic for one organism may in fact be bactericidal for another organism or another strain of the same organism.

Animals↗

[Clinical study of SM-4300 in infectious diseases of pediatrics].

SM-4300, a new developed immunoglobulin preparation with ion-exchange treatment, was used intravenously for 12 infectious diseases. These 12 cases (under 10 years old) were including 4 sepsises, 3 pneumonias, 1 pyothorax, 1 ventriculitis, 1 purulent meningitis, 1 aseptic meningitis and 1 cellulitis. To evaluate the effect of SM-4300, 2 cases were excluded from evaluation because of blood transfusion or immediately death. Since antibiotics were used at the same time, it was surely difficult to evaluate the effect of SM-4300. In 10 cases, 2 cases were excellent effective, 4 cases were fairly effective and others were not effective. Including fairly effective cases, the rate of efficacy was 60%. In all cases, there were no significant side effects regarding clinical findings and laboratory examinations. SM-4300 may be available for severe infectious diseases with antibiotics therapy.

Anti-Bacterial Agents↗

A code of practice on dealing with infectious diseases on aircraft.

Increasing numbers of people are travelling to and from more distant destinations with the possibility of exposure to common as well as exotic disease. At the present time there are no readily accessible rules or guidance for dealing with possible cases of infectious disease occurring during international flights. A 'Code of Practice on dealing with infectious disease on aircraft' is proposed as a ready means of dealing with the problem without excessive action or expense.

Aircraft↗