Hand, foot, and mouth disease outbreak reported in Singapore.
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A GIS based information management system has been developed to help Urban Malaria Control in India. The basic objective is to develop a model to assist planning and implementation of a suitable control measure. The system can help in: (i) identifying high receptive areas in time and space domain; (ii) identifying risk factors for high receptivity; (iii) monitoring and evaluating control measures. To demonstrate this system, information on 33 parameters and malaria cases has been attached to a digitised map of Dindigul, an urban town in Tamil Nadu. Functionalities of the system and its utility are described in this paper. A GIS based information management system ensures that if a localised spurt of the disease occurs, it can be associated rapidly with a likely cause, a specific vector, and a probable human source, so that appropriate preventive action can be taken to arrest any rising trend.
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Examples of equine disease surveillance at the local, regional, national and international level are discussed in this article. Reporting systems at each level are also considered, and the increasing importance of laboratory confirmed diagnoses is emphasized. The need to develop national disease reporting systems is addressed, particularly with respect to conforming to international trading standards.
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Document search is generally based on individual terms in the document. However, for collections within limited domains it is possible to provide more powerful access tools. This paper describes a system designed for collections of reports of infectious disease outbreaks. The system, Proteus-BIO, automatically creates a table of outbreaks, with each table entry linked to the document describing that outbreak; this makes it possible to use database operations such as selection and sorting to find relevant documents. Proteus-BIO consists of a Web crawler which gathers relevant documents; an information extraction engine which converts the individual outbreak events to a tabular database; and a database browser which provides access to the events and, through them, to the documents. The information extraction engine uses sets of patterns and word classes to extract the information about each event. Preparing these patterns and word classes has been a time-consuming manual operation in the past, but automated discovery tools now make this task significantly easier. A small study comparing the effectiveness of the tabular index with conventional Web search tools demonstrated that users can find substantially more documents in a given time period with Proteus-BIO.
We analysed nation-wide reported measles cases during the 1988-9 epidemic and found that longer duration and wider spread were two major characteristics of the outbreak. All the 22 county/city index cases were reported with a delay of > 4 days and 64% were aged 5-14 years. This epidemic occurred mainly among 5-14-year-old school-children (59%), infants under 1 year (19%), and pre-school children (18%). The overall attack rate was 0.63 cases per 10,000 population, with the highest attack rate (7.4 cases per 10,000 population) occurring in infants. Among 280 confirmed cases < 15 months of age, 9-month-old infants (42 cases) had a higher risk of measles and peaked at 10 months (49 cases). This epidemic started in March 1988 among 5-9-year-old children in the northern suburban area, then spread to Taipei City and neighbouring counties or cities. It continued to spread from the northern to southern and western areas during the summer vacation and New Year holidays. Multiple logistic regression analysis showed that the delay of measles reporting was strongly associated with the cases infected early in the epidemic (OR = 6.9, P < 0.001) and reported from teaching hospitals (OR = 2.6, P < 0.001). The reappearance of high attack rates among 5-9-year-old children in the 1985 and 1988-9 measles epidemics in Taiwan indicated the persistence of pockets of susceptible individuals even after mass immunization.
The emergence of dengue haemorrhagic fever is a public health problem in Latin America and the Caribbean. This study, carried out in French Guiana where malaria is endemic, evaluated the value and the limitations of a non-specific alert system including all patients admitted to the emergency department of Cayenne Hospital, between 1 January 1996 and June 2001. Four indices were studied on a weekly basis: the emergency malaria negative index (EMN), the EMN thrombocytopenia index (EMNT), the dengue suspected index: EMNT/EMN ratio; and the number of hospitalized patients with dengue fever according to the Department of Medical Information. These indices were retrospectively compared with data from the Arbovirus Reference Centre at the Pasteur Institute in French Guiana. Using the non-specific indices, we were able to identify four clear epidemics, two of which were shown to be linked to dengue. Variations in the incidence of malaria had no marked effect on this alert system. We propose that this simple, cheap, sensitive and reactive alert system be used to improve the serological and virological monitoring of dengue and to facilitate adequate and timely vector control measures. It could be used in all regions at risk of dengue and malaria.
The free movement of people and foodstuffs between countries are effective ways of distributing disease internationally. There is a requirement for a mechanism whereby data and information on potential outbreaks of foodborne pathogens can be disseminated rapidly to those who need to know. The Enter-net dedicated surveillance network provides this mechanism, complemented by the Salm-gene molecular typing network. Data on epidemiological and microbiological features on current cases, as well as background levels of infections are immediately available within the Enter-net databases. The Salm-gene network with its database of harmonized salmonella PFGE patterns from the participating European countries provides immediate, and electronically exchangeable, DNA fingerprints of outbreak strains. This prompt electronic dissemination of information regarding unusual events with international implications ensures that public health interventions can be implemented and cases of foodborne disease prevented.
Underreporting of hepatitis A infection in England may be high and a number of outbreaks have occurred undetected by routine surveillance. We evaluated surveillance of hepatitis A cases by employing capture-recapture analysis on data from two distinct outbreaks of hepatitis A. The overall reporting of cases of hepatitis A was 81.7% (95% CI 55.3-95) in the first outbreak in North East England and reporting through Lab Base was 65.7% (95% CI 42.8-76.4). In the second outbreak in the East Midlands the overall reporting of hepatitis A cases was 27.8% (95% CI 19-38.7) and through Lab Base 16.6% (95% CI 11.4-23.1). Underreporting of hepatitis A cases is high. Public health interventions exist to prevent and control outbreaks of hepatitis A. The lack of reliable data on incidence and prevalence hampers effective public health management of this disease.
In March 1997, an outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC) infection occurred amongst holidaymakers returning from Fuerteventura, Canary Islands. For the investigation, a confirmed case was an individual staying in Fuerteventura during March 1997, with either E. coli O157 VTEC isolated in stool, HUS or serological evidence of recent infection; a probable case was an individual with bloody diarrhoea without laboratory confirmation. Local and Europe-wide active case finding was undertaken through national centres, Salm-Net and the European Programme of Intervention Epidemiology, followed by a case-control study. Fourteen confirmed and one probable case were identified from England (7), Finland (5), Wales (1), Sweden (1) and Denmark (1) staying in four hotels. Three of the four hotels were supplied with water from a private well which appeared to be the probable vehicle of transmission. The case-control study showed illness was associated with consumption of raw vegetables (OR 8.4, 95% CI 1-5-48.2) which may have been washed in well water. This investigation shows the importance of international collaboration in the detection and investigation of clusters of enteric infection.
This is a summary of the presentations and discussion of Surveillance, Early Warning Alert and Response at the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to the surveillance, early warning alert, and response to communicable and vector-borne diseases as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) needs assessment; (3) coordination; (4) gap filling; and (5) capacity building. The key questions section is presented in six sub-sections: (1) communicable diseases; (2) early warning; (3) laboratory capacity and referral networking; (4) coordination of disease surveillance, early warning, and response; (5) health infrastructure rebuilding; and (6) using existing national surveillance plans to enhance disease surveillance and early warning systems.
In many industrialized countries, infection with the human immunodeficiency virus (HIV) is one of the leading causes of mortality in adult persons below age 45. The incidence of the acquired immunodeficiency syndrome (AIDS) from surveillance systems is the most common indicator to compare the situation of the HIV-epidemic in different geographic regions or countries. Due to reporting delays, AIDS diagnoses in recent years are incompletely reported and need to be estimated. In this study, we analyze reporting delays in Switzerland and Spain for the period from 1988 to mid-1995 and estimate the number of AIDS diagnoses per year. A descriptive analysis for Switzerland shows increasing reporting delays in recent years. Then, a Bayesian generalized linear model on reverse-time hazards is used to model time trends of the reporting delay distribution. The model shows that in recent years (i) for Switzerland reporting delays became longer and yearly AIDS incidence might continue to increase, and (ii) for Spain, reporting delays became considerably shorter resulting in too large estimates of yearly AIDS incidence if stationarity of reporting delays is assumed. Critical issues of modeling non-stationarity of the reporting system are discussed and it is emphasized that estimates of recent AIDS incidence can be biased significantly if time trends of reporting are ignored-as in the example of Switzerland and Spain, this may severely distort comparisons of the AIDS epidemic in different countries.
Techniques of time series analysis were used to examine historical records of the incidence of diphtheria, pertussis, and measles, and of deaths by measles in Portugal during the twentieth century. There are statistically significant seasonal and longterm oscillations in the incidence of these diseases. Seasonal oscillations appear to be in close association with the resumption of school classes in the fall in the case of diphtheria, but not in pertussis and measles. Long-term oscillations in pertussis (3.5-4 year period) and measles (3-year period), before vaccination, corroborate theoretical predictions about the dynamics of these diseases, whereas absence of long-term oscillations in diphtheria is probably due to the influential presence of carriers upon the dynamics of the disease. Mass vaccination strongly suppressed disease incidence, did not eliminate seasonal oscillations, and appeared to have acted to lengthen long-term periodicity in pertussis and measles.
What justified the Center for Disease Control's 1999 determination to require HIV case reporting? Why were names necessary? Why did opponents view the reporting of names with such alarm? This paper retells the history of the encounters over HIV reporting that had occurred since the mid 1980s. In placing HIV reporting within a larger context, however, we understand the clash between privacy and public health necessity as a complex issue, both in historical and contemporary practice. By underscoring the similarities and differences with the histories of surveillance for other infectious diseases, vaccination, occupational diseases, cancer, and birth defects, and HIV reporting internationally, we can better understand the implications of the HIV debate for an ethics of surveillance more generally.
BACKGROUND: More thorough information about risks, exposures and vehicles of food borne diseases can be obtained from epidemiological field investigations than from infectious disease reports or laboratory data. METHODS: We analysed the results of 410 field investigations of food borne disease outbreaks reported from 1996 to 2000 and conducted as cohort studies. RESULTS: The incidence of food borne outbreaks increased from 0.8/100,000 in 1996 to 2.0 in 1999, as did the incidence of salmonellosis (from 16/100,000 to 21 in the same period) and diarrhoea episodes reported by laboratories (from 12/100,000 in 1997 to 29 in 1999). Of the food borne disease outbreaks, 264 (64.4%) occurred in private homes; 5 (1.2%) in hospitals; 31 (7.6%) in canteens and refectories, 84 (20.5%) in restaurants, 41 of which occurred during special functions. The home outbreaks exposed few people (average of 7), had high attack rates (61.7% average) and a high proportion of known aetiology (66%), while food borne disease outbreaks in canteens and restaurants (during special functions) exposed many people (300 and 81, respectively), had medium attack rates (19.7 and 34.5%, respectively) and a higher proportion of confirmed vehicles (50 and 49%, respectively), compared to those occurring at home (21%). Salmonella spp. was the most frequent agent detected in each setting (67% of confirmed cases). The most frequent vehicles at home were mushrooms and sweets containing eggs and cream; in canteens, meat and vegetables and in restaurants, shellfish. CONCLUSIONS: Outbreak characteristics varied according to the setting. This implies the need for a different approach of field investigations, and different preventive measures.