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PubMed1994

Investigating a single case of Legionnaires' disease: guidance for consultants in communicable disease control.

When a single case of legionnaires' disease is reported, it should be investigated to check whether or not it is linked to other cases or part of an outbreak. The investigation includes confirmation of the diagnosis, tracing the patient's movements during the incubation period, and reporting the case to the National Surveillance Scheme for Legionnaires' Disease at the PHLS Communicable Disease Surveillance Centre. If no common factors are identified between the cases and other cases reported previously, no further action is usually required, unless it is suspected that the infection was acquired in hospital. In these circumstances, the individual case and the hospital's water maintenance programme should be reviewed, and a search made for associated cases, because hospital patients are particularly susceptible to infection. Further steps may be necessary if the link with the hospital is confirmed.

Communicable Disease Control↗
PubMedDate not supplied

Chronic non-communicable diseases.

Chronic non-communicable diseases (NCD) account for almost 60% of global mortality, and 80% of deaths from NCD occur in low- and middle-income countries. One quarter of these deaths--almost 9 million in 2005--are in men and women aged <60 years. Taken together, NCD represent globally the single largest cause of mortality in people of working age, and their incidences in younger adults are substantially higher in the poor countries of the world than in the rich. The major causes of NCD-attributable mortality are cardiovascular disease (30% of total global mortality), cancers (13%), chronic respiratory disease (7%) and diabetes (2%). These conditions share a small number of behavioural risk factors, which include a diet high in saturated fat and low in fresh fruit and vegetables, physical inactivity, tobacco smoking, and alcohol excess. In low- and middle-income countries such risk factors tend to be concentrated in urban areas and their prevalences are increasing as a result of rapid urbanization and the increasing globalisation of the food, tobacco and alcohol industries. Because NCD have a major impact on men and women of working age and their elderly dependents, they result in lost income, lost opportunities for investment, and overall lower levels of economic development. Reductions in the incidences of many NCD and their complications are, however, already possible. Up to 80% of all cases of cardiovascular disease or type-2 diabetes and 40% of all cases of cancer, for example, are probably preventable based on current knowledge. In addition, highly cost-effective measures exist for the prevention of some of the complications of established cardiovascular disease and diabetes. Achieving these gains will require a broad range of integrated, population-based interventions as well as measures focused on the individuals at high risk. At present, the international-assistance community provides scant resources for the control of NCD in poor countries, partly, at least, because NCD continue to be wrongly perceived as predominantly diseases of the better off. As urbanization continues apace and populations age, investment in the prevention and control of NCD in low-and middle-income countries can no longer be ignored.

Adolescent↗
PubMed1986

Statistical analysis of case-control studies of communicable diseases.

At the Communicable Disease Surveillance Centre most outbreak investigations are carried out by questioning cases and unaffected 'controls' to look for associations with possible sources of infection. Illness rates are compared in those exposed with those not exposed to a possible risk factor, using statistical techniques appropriate to the survey design. Significance testing to obtain evidence of the source of transmission is made as quickly as possible so that action may be taken. Microbiological corroboration is sought wherever possible. Unlike chronic disease epidemiology the estimation of odds ratios and relative risk is seldom of primary importance. Examples are given of the analysis of three types of study. Firstly where the whole population is interviewed and then where cases are matched 1:1 and 1:M with controls, including an example with missing data, ie variable numbers of controls.

Adult↗
PubMed1984

A hospital contingency plan for exotic communicable diseases.

The exotic communicable diseases are highly virulent, transmissible, conditions which occur most often in tropical areas. Since the late 1960s, there have been occasions when these diseases have been exported to the US and Canada. Advance planning will facilitate the care of patients infected with these diseases in health care facilities. Hospitals should develop a contingency plan which addresses the management of patients that present themselves to the emergency department as well as patients diagnosed after admission. The plan should address such topics as the isolation room, protective clothing, disinfection of the environment and equipment as well as the management of waste and handling of corpses. A well thought out plan will prevent subsequent transmission of infection to attending personnel, other patients and the surrounding community.

Communicable Disease Control↗
PubMed2003

Communicable diseases surveillance. Highlights for 4th quarter, 2002.

Communicable disease surveillance highlights report on data from various sources, including the National Notifiable Diseases Surveillance System (NNDSS) and several disease specific surveillance systems that provide regular reports to Communicable Diseases Intelligence. These national data collections are complemented by intelligence provided by State and Territory communicable disease epidemiologists and/or data managers. This additional information has enabled the reporting of more informative highlights each quarter. The NNDSS is conducted under the auspices of the Communicable Diseases Network Australia. NNDSS collates data on notifiable communicable diseases from State or Territory health departments. The Virology and Serology Laboratory Reporting Scheme (LabVISE) is a sentinel surveillance scheme which collates information on laboratory diagnosis of communicable diseases. In this report, data from the NNDSS are referred to as 'notifications' or 'cases', and those from ASPREN are referred to as 'consultations' or 'encounters' while data from the LabVISE scheme are referred to as 'laboratory reports'.

Australia↗
PubMed2006

Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: rationale and design of the HAPIEE study.

BACKGROUND: Over the last five decades, a wide gap in mortality opened between western and eastern Europe; this gap increased further after the dramatic fluctuations in mortality in the former Soviet Union (FSU) in the 1990s. Recent rapid increases in mortality among lower socioeconomic groups in eastern Europe suggests that socioeconomic factors are powerful determinants of mortality in these populations but the more proximal factors linking the social conditions with health remain unclear. The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study is a prospective cohort study designed to investigate the effect of classical and non-conventional risk factors and social and psychosocial factors on cardiovascular and other non-communicable diseases in eastern Europe and the FSU. The main hypotheses of the HAPIEE study relate to the role of alcohol, nutrition and psychosocial factors. METHODS AND DESIGN: The HAPIEE study comprises four cohorts in Russia, Poland, the Czech Republic and Lithuania; each consists of a random sample of men and women aged 45-69 years old at baseline, stratified by gender and 5 year age groups, and selected from population registers. The total planned sample size is 36,500 individuals. Baseline information from the Czech Republic, Russia and Poland was collected in 2002-2005 and includes data on health, lifestyle, diet (food frequency), socioeconomic circumstances and psychosocial factors. A short examination included measurement of anthropometric parameters, blood pressure, lung function and cognitive function, and a fasting venous blood sample. Re-examination of the cohorts in 2006-2008 focuses on healthy ageing and economic well-being using face-to-face computer assisted personal interviews. Recruitment of the Lithuanian cohort is ongoing, with baseline and re-examination data being collected simultaneously. All cohorts are being followed up for mortality and non-fatal cardiovascular events. DISCUSSION: The HAPIEE study will provide important new insights into social, behavioural and biological factors influencing mortality and cardiovascular risk in the region.

Aged↗
PubMed2004

A report from the Communicable Diseases Network Australia, July to September 2004.

The Communicable Diseases Network Australia (CDNA) consists of communicable disease authorities from various Australian Government agencies and state and territory health authorities, in addition to expert bodies and individuals in the specific areas of communicable disease epidemiology, clinical management, disease control and laboratory diagnosis. The CDNA provides national public health leadership and co-ordination on communicable disease surveillance, prevention and control, and offers strategic advice to governments and other key bodies on public health actions to minimise the impact of communicable diseases in Australia and the region.

Australia↗
PubMed2006

Benchmarking national surveillance systems: a new tool for the comparison of communicable disease surveillance and control in Europe.

BACKGROUND: Communicable diseases do not respect national boundaries and are important challenges to health internationally. Considerable variation exists in the structure and performance of surveillance systems for communicable disease prevention and control. European Union (EU) countries should share ideas to improve the quality of surveillance systems. The study aims to support the improvement and integration of surveillance systems of communicable diseases in Europe while using benchmarking for the comparison of national surveillance systems. METHODS: Surveillance systems from England and Wales, Finland, France, Germany, Hungary, and The Netherlands were described and analysed. After comprehensive data collection and validation by several European public health (PH) experts, a descriptive data analysis was carried out. Benchmarking processes were performed with selected criteria (e.g. case definitions, early warning applications, and outbreak investigations). After the description of benchmarks, best practices were identified and described. RESULTS: Benchmarking of national surveillance systems is applicable as a new tool for the comparison of communicable disease control in Europe. The countries included in the study have in general well-functioning communicable disease control and prevention systems. Nevertheless, there are different strengths and weaknesses in various countries. Practical examples from the various surveillance systems were demonstrated and recommendations were given to policy makers. CONCLUSION: A gold standard of surveillance systems in various European countries is very difficult to achieve because of heterogeneity (e.g. in disease burden, personal, and financial resources). However, to improve the quality of surveillance systems across Europe, it will be useful to benchmark the surveillance systems of all EU member states.

Benchmarking↗
PubMed2006

Estimating in real time the efficacy of measures to control emerging communicable diseases.

Controlling an emerging communicable disease requires prompt adoption of measures such as quarantine. Assessment of the efficacy of these measures must be rapid as well. In this paper, the authors present a framework to monitor the efficacy of control measures in real time. Bayesian estimation of the reproduction number R (mean number of cases generated by a single infectious person) during an outbreak allows them to judge rapidly whether the epidemic is under control (R < 1). Only counts and time of onset of symptoms, plus tracing information from a subset of cases, are required. Markov chain Monte Carlo and Monte Carlo sampling are used to infer the temporal pattern of R up to the last observation. The operating characteristics of the method are investigated in a simulation study of severe acute respiratory syndrome-like outbreaks. In this particular setting, control measures lacking efficacy (R > or = 1.1) could be detected after 2 weeks in at least 70% of the epidemics, with less than a 5% probability of a wrong conclusion. When control measures are efficacious (R = 0.5), this situation may be evidenced in 68% of the epidemics after 2 weeks and 92% of the epidemics after 3 weeks, with less than a 5% probability of a wrong conclusion.

Animals↗