Invasive group A streptococcal disease and association with varicella in Germany, 1996-2009

A nationwide laboratory-based surveillance study was conducted to analyse the epidemiology of varicella-associated invasive group A streptococcal (iGAS) infections in Germany. A total of 1342 iGAS samples were collected between 1 January 1996 and 22 September 2009. For 21 of these isolates, an association with varicella was observed. The median age of this subgroup was 4.2 years (mean 12.1). Most of these patients presented with sepsis (42.9%), streptococcal toxic shock syndrome (23.8%) and necrotizing fasciitis (19.0%). The most common complications among patients with underlying varicella were hypotensive shock and soft-tissue necrosis (38.1% each), disseminated intravascular coagulopathy (33.3%) and renal impairment (28.6%). The overall rate of complications was higher among the patients with underlying varicella than among those without. In the varicella-positive group, emm types 1 (38.1%), 12 (19.0%) and 4 (14.3%) were predominant, while among the varicella-negative isolates, emm types 1 (32.5%), 28 (14.0%) and 3 (8.3%) were found most often. Among the varicella-positive group, the rate of ssa-positive isolates was considerably higher than that among the varicella-negative group (28.6% vs. 12.6%), as well as the coexistence of speC and ssa (14.3% vs. 3.6%).     

Influenza 2009 pandemic: Cellular immunemediated surveillance modulated by TH17 & Tregs

Influenza A virus is a serious public health threat. Most recently the 2009/H1N1 pandemic virus had an inherent ability to evade the host's immune surveillance through genetic drift, shift, and genomic reassortment. Immune characterization of 2009/H1N1 utilized monoclonal antibodies, neutralizing sera, and proteomics. Increased age may have provided some degree of immunity, but vaccines against seasonal influenza viruses seldom yield cross-reactive immunity, exemplified by 2009/H1N1. Nonetheless, about 33% of individuals, over the age of 60, had cross-reactive neutralizing antibodies against 2009/H1N1, whereas only 6-9% young adults had these antibodies. Children characteristically had no detectable immunity against 2009/H1N1. Taken together, these observations suggest some degree of immune transference with at least certain strains of virus that have afflicted the human population in past decades. Because internal influenza proteins may exhibit less antigenic variation, it is possible that prior exposure to diverse strains of influenza virus provide some immunity to novel strains, including the recent pandemic strain (swine-avian A/H1N1). Current trends in immunological studies - specifically the modulation of cellular immune surveillance provided by TH17 and Tregs - also support the need for additional proteomic research for characterizing novel translational evidence-based treatment interventions based on cytokine function to help defeat the virus. Timely and critical research must characterize the impact of genetics and epigenetics of oral and systemic host immune surveillance responses to influenza A virus. The continued development and application of proteomics and gene expression across viral strains and human tissues increases our ability to combat the spread of influenza epidemics and pandemics.     

Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006

Objective: Little is known about the prevalence and patterns of weight discrimination in the United States. This study examined the trends in perceived weight/height discrimination among a nationally representative sample of adults aged 35–74 years, comparing experiences of discrimination based on race, age, and gender. Methods and Procedures: Data were from the two waves of the National Survey of Midlife Developmentin the United States (MIDUS), a survey of community‐based English‐speaking adults initially in 1995–1996 and a follow‐up in 2004– 2006. Reported experiences of weight/height discrimination included a variety of settings in major lifetime events and interpersonal relationships. Results: The prevalence of weight/height discrimination increased from 7% in 1995–1996 to 12% in 2004–2006, affecting all population groups but the elderly. This growth is unlikely to be explained by changes in obesity rates. Discussion: Weight/height discrimination is highly prevalent in American society and increasing at disturbing rates. Its prevalence is relatively close to reported rates of race and age discrimination, but virtually no legal or social sanctions against weight discrimination exist.     

Description and mission evaluation of the Hungarian case-control surveillance of congenital abnormalities, 1980-1996

BACKGROUND: The Hungarian Case-Control Surveillance of Congenital Abnormalities was established in 1980. This article describes how the Hungarian Case-Control Surveillance of Congenital Abnormalities was first organized and is currently maintained. The baseline statistics are provided and potential venues of postmarketing surveillance of drug teratogenicity and other public health tasks and research are proposed. METHODS: Cases with congenital abnormalities and patient controls with Down syndrome were selected from the Hungarian Congenital Abnormality Registry. Population controls without congenital abnormalities were selected from the National Birth Registry on the basis of three matching criteria: sex, week of birth, and district of parent's residence. Three sources of information concerning drug exposures, maternal disorders, and pregnancy complications, among others, were used: (1) prospective and medically recorded data from antenatal care logbooks and discharge summaries; (2) retrospective maternal self-reported data obtained with a structured questionnaire in all the three study groups; and (3) data collected by regional nurse in house visits to nonrespondent cases and patient controls. Twenty-five congenital abnormality groups were evaluated. During the 17-year period of data collection, 22,843 cases, 38,151 population controls, and 834 patient controls were incorporated into the data set, constituting the largest population-based case-control data set of congenital abnormalities to date. RESULTS: Demographic features of pregnant women and informative offspring are presented along with the distribution of 25 main groups of congenital abnormalities. CONCLUSIONS: This system is appropriate for postmarketing the surveillance of drug teratogenicity, for the improvement of congenital abnormality diagnosis, to get informed consent, to have a communication with parents and to provide material for research.     

Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

Introduction

Pregnant women have been identified as a high risk group for severe illness with 2009 pandemic influenza A(H1N1) virus infection (pH1N1). Obesity has also been identified as a risk factor for severe illness, though this has not been thoroughly assessed among pregnant women. The objectives of this study were to provide risk estimates for adverse maternal and neonatal outcomes associated with pH1N1 illness during pregnancy and to assess the role of obesity in these outcomes.

Methods

We established a retrospective population-based cohort of all live births occurring in Florida during the first 15 months of the pandemic. Illness with pH1N1 during pregnancy was ascertained through record linkage with the Florida state notifiable disease surveillance database. Data from the birth record, including pre-pregnancy body mass index, were analyzed to assess risk of adverse outcomes associated with pH1N1 illness.

Results

A total of 194 women were identified through surveillance with pH1N1 illness during pregnancy. Children born to women with pH1N1 illness during pregnancy were at increased risk for low birth weight [OR (95%CI): 1.78 (1.11-2.860)], premature birth [2.21 (1.47-3.330)], and infant death [4.46 (1.80-11.00)], after adjusting for other factors. Women with pH1N1 illness during pregnancy were at increased risk for severe outcomes including admission to an intensive care unit. Obesity was an observed risk factor, both for the more severe pH1N1 illness detected through surveillance, and for severe maternal outcomes.

Conclusions

Case-patients in this analysis likely represent the most severely ill subset of all women infected with pH1N1 during pregnancy, limiting the generalizability of these findings to more severely ill patients rather than influenza infection in general. Nevertheless, these results suggest that more severe pH1N1 illness during pregnancy is associated with adverse neonatal outcomes and that pregnant women should continue to be targeted for appropriate prophylaxis and early treatment.     

Differing Epidemiological Dynamics of Influenza B Virus Lineages in Guangzhou,Southern China, 2009-2010

The epidemiological and evolutionary dynamics of the two cocirculating lineages of influenza B virus, Victoria and Yamagata, are poorly understood, especially in tropical or subtropical areas of Southeast Asia. We performed a phylogenetic analysis of the hemagglutinin (HA) and neuraminidase (NA) sequences of influenza B viruses isolated in Guangzhou, a southern Chinese city, during 2009 to 2010 and compared the demographic and clinical features of infected patients. We identified multiple viral introductions of Victoria strains from both Chinese and international sources, which formed two phylogenetically and antigenically distinct clades (Victoria 1 and 2), some of which persisted between seasons. We identified one dominant Yamagata introduction from outside China during 2009. Our phylogenetic analysis reveals the occurrence of reassortment events among the Victoria and Yamagata lineages and also within the Victoria lineage. We found no significant difference in clinical severity by influenza B lineage, with the exceptions that (i) the Yamagata lineage infected older people than either Victoria lineage and (ii) fewer upper respiratory tract infections were caused by the Victoria 2 than the Victoria 1 clade. Overall, our study reveals the complex epidemiological dynamics of different influenza B lineages within a single geographic locality and has implications for vaccination policy in southern China.     

广东地区1996年流感暴发的分子变异基础

1996年广东地区流感毒株发生明显的血清学抗原漂移;引起广东地区流感暴发的分子基础是流感毒株HA基因编码的A、B、C、D和E五个抗原决定簇位点变异,尤其是A、C、E位点发生氨基酸改变;而受体结合位点的氨基酸改变对此流感流行未发挥明显影响。HA基因编码氨基酸的第145号和第193号位点变异导致流行毒株的生物学特性改变,即分离毒株适应于MDCK细胞株生长,而难以适应鸡胚生长环境。     

广东地区1996年流感暴发的分子变异基础

1996年广东地区流感毒株发生明显的血清学抗原漂移;引起广东地区流感暴发的分子基础是流感毒株HA基因编码的A、B、C、D和E五个抗原决定簇位点变异,尤其是A、C、E位点发生氨基酸改变;而受体结合位点的氨基酸改变对此流感流行未发挥明显影响。HA基因编码氨基酸的第145号和第193号位点变异导致流行毒株的生物学特性改变,即分离毒株适应于MDCK细胞株生长,而难以适应鸡胚生长环境。     

Metallo-beta-lactamase-producing gram-negative rods isolated from inpatients and outpatients, detected using Etest MBL

The aim of presented study was to detect MBL-positive strains in a group of clinical carbapenem-resistant strains isolated from inpatients and outpatients during last four years. From the beginning of November 2001 to the end of October 2005, one hundred and four strains resistant to carbapenem antibiotics--imipenem and meropenem were cultured from clinical samples obtained from patients of the Infant Jesus Clinical Hospital Centre for Trauma Treatment in Warsaw and from patients of outpatient clinics. Strains were identified and their susceptibility to antibacterial agents was determined in the automatic ATB Expression system (bioMérieux). Resistance to imipenem and meropenem was confirmed with a disc diffusion method. Production of metallo-beta-lactamases (MBL) was examined with the use of Etest MBL (AB Biodisk, Sweden), and extended-spectrum beta-lactamases (ESBL) by means of following procedures: DDST and / or DD (four variants) (Oxoid Ltd., England). MBL-positive strains (36) were cultured in cases of infections in adult patients (35 strains) and in a child (1 strain). Majority of strains belonged to the species P. aeruginosa (27), several strains - to the species P. putida (6) and remaining strains--to P. stutzeri, A. xylosoxidans, and E. cloacae (1 strain of each species). Four strains were producers of MBL-type and ESBL-type beta-lactamases. According to our knowledge and accessible literature described strains (except one paediatric strain) are the first MBL-positive strains isolated from adult hospitalized patients and adult ambulatory patients in Poland. Additionally, MBL-positive E. cloacae strain is probably the first MBL producer isolated in Poland, which belongs to the group of enteric rods. MBL-producing strains of Gram-negative rods, detected by phenotypic Etest MBL method, will be verified with genetic procedures.     

2009至2015年度辽宁省锦州市流感样病例和病原学特征分析

了解辽宁省锦州市2009至2015年度流感流行特征及优势毒株的分布情况,为流感的预警和防治提供依据。统计锦州市2009至2015年度流感样病例(ILI)监测数据及病原学结果,分析ILI百分比(ILI%)、病毒分离率及各亚型的变化规律。共监测ILI 51 277例,ILI%为2.28%,主要集中于0～15岁年龄段,占56.72%;采集8 254份ILI咽拭子标本,其中阳性467份,病毒分离率为5.66%,其中新甲型H1N1型192份、季节性H3型186份、B型Yamagata系37份、B 型Victoria系52份。2009年和2013年以新甲型H1N1(55.73%,83.33%)为主,2011年以BY (74.42%)为主,其他年份以季节性H3型为流感优势毒株,BV在人群中流行趋势减弱,新甲型H1N1、BY在人群中偶有检出。2010至2015年各月份ILI%均显著低于2009年,提示2009年后流感病毒活动相对稳定;ILI%与病毒分离率呈正相关(r_s＝0.347;P＝0.039),ILI%的变化能够较好地反映当地流感病毒的活动情况。新甲型H1N1型、季节性H3型、B型混合存在,季节性H1型消失。     

Antiviral Treatment among Older Adults Hospitalized with Influenza, 2006-2012

Objective

To describe antiviral use among older, hospitalized adults during six influenza seasons (2006—2012) in Davidson County, Tennessee, USA.

Methods

Among adults ≥50 years old hospitalized with symptoms of respiratory illness or non-localizing fever, we collected information on provider-initiated influenza testing and nasal/throat swabs for influenza by RT-PCR in a research laboratory, and calculated the proportion treated with antivirals.

Results

We enrolled 1753 adults hospitalized with acute respiratory illness. Only 26% (457/1753) of enrolled patients had provider-initiated influenza testing. Thirty-eight patients had a positive clinical laboratory test, representing 2.2% of total patients and 8.3% of tested patients. Among the 38 subjects with clinical laboratory-confirmed influenza, 26.3% received antivirals compared to only 4.5% of those with negative clinical influenza tests and 0.7% of those not tested (p<0.001). There were 125 (7.1%) patients who tested positive for influenza in the research laboratory. Of those with research laboratory-confirmed influenza, 0.9%, 2.7%, and 2.8% received antivirals (p=.046) during pre-pandemic, pandemic, and post-pandemic influenza seasons, respectively. Both research laboratory-confirmed influenza (adjusted odds ratio [AOR] 3.04 95%CI 1.26-7.35) and clinical laboratory-confirmed influenza (AOR 3.05, 95%CI 1.07-8.71) were independently associated with antiviral treatment. Severity of disease, presence of a high-risk condition, and symptom duration were not associated with antiviral use.

Conclusions

In urban Tennessee, antiviral use was low in patients recognized to have influenza by the provider as well as those unrecognized to have influenza. The use of antivirals remained low despite recommendations to treat all hospitalized patients with confirmed or suspected influenza.     

Influenza surveillance in Rio de Janeiro between 1980-1981: a virological and serological study

Laboratory surveillance of Influenza has shown a low virus activity in Rio de Janeiro during 1980 and 1981. A few influenza A (H3N2) viruses were isolated in both years during the winter months. Serological investigations showed that this subtype has circulated mostly among children under 10 years of age. No H1N1 virus was isolated but an increase in the proportion of adults with antibody to this virus was noted in sera collected in 1981. Influenza B virus was isolated from children in the spring of 1981 and again an increase was noted in the proportion of adults with antibody to this virus.     

宁波市2002-2009年O～14岁儿童伤害死亡流行病学分析

目的 了解宁波市0～14岁儿童伤害死亡的流行病学特征,为开展儿童伤害的预防工作提供科学依据.方法 利用描述性流行病学的方法对宁波市2002-2009年死亡登记资料进行统计分析.结果 2002-2009年宁波市0～14岁儿童伤害死亡率为21.10/10万,占儿童死亡的31.59％,其中伤害占婴儿死亡的8.27％.农村儿童伤害死亡率(24.05/10万)高于城市儿童(15.89/10万),男童伤害死亡率(27.90/10万)高于女童(14.18/10万),儿童伤害死亡率随着年龄的增加呈下降趋势(P＜0.05).意外机械性窒息是婴儿死亡的首位原因,占婴儿伤害死亡的46.20％.淹溺和机动车辆交通事故是1～14岁儿童伤害死亡的前2位原因,所占比例分别为59.30％和19.23％.儿童伤害YPLL标化率为79.91‰.结论 伤害已成为宁波市0～14岁儿童死亡的首位原因,尤其是淹溺、机动车辆交通事故对儿童的生命健康危害更大,亟待开展预防控制工作.     

Seasonal variation of intestinal protozoa infections in outpatients of the north section of Santiago, Chile. 1995-1996]

Formalin preserved fecal samples from 6,058 and 5,863 outpatients were examined for intestinal parasites during 1995 and 1996 respectively. Prevalence rates of infections by intestinal protozoa in both years were similar. By age group (0-9, 10-19 and > 20 years old) Blastocystis hominis was observed in 18.6-19.3, 37.0-31.1 and 25.3-25.4% in 1995-1996 respectively. Prevalence of Giardia intestinalis infections decreased from 16.6-17.4% in the 0-9 year-old children group to 4.1-4.5% in patients over 20 years. Overall percentages of infection by Entamoeba histolytica varied between 4.2 and 10.9. Rates of infections by G. intestinalis, E. histolytica, and Entamoeba coli observed during rainy-cold months (april-september) of the year versus drywarmy period (october-march) were the same. On the contrary, more cases of B. hominis infection 25.8% versus 18.2% (this difference being statistically significant, p > 0.001) were observed during rainy-cold months of the year.     

Maternal Mortality in Henan Province,China: Changes between 1996 and 2009

Background

Maternal deaths occur mostly in developing countries and the majority of them are preventable. This study analyzes changes in maternal mortality and related causes in Henan Province, China, between 1996 and 2009, in an attempt to provide a reliable basis for introducing effective interventions to reduce the maternal mortality ratio (MMR), part of the fifth Millennium Development Goal.

Methods and Findings

This population-based maternal mortality survey in Henan Province was carried out from 1996 to 2009. Basic information was obtained from the health care network for women and children and the vital statistics system, from specially trained monitoring personnel in 25 selected monitoring sites and by household survey in each case of maternal death. This data was subsequently reported to the Henan Provincial Maternal and Child Healthcare Hospital. The total MMR in Henan Province declined by 78.4%, from 80.1 per 100 000 live births in 1996 to 17.3 per 100 000 live births in 2009. The decline was more pronounced in rural than in urban areas. The most common causes of maternal death during this period were obstetric hemorrhage (43.8%), pregnancy-induced hypertension (15.8%), amniotic fluid embolism (13.9%) and heart disease (8.0%). The MMR was higher in rural areas with lower income, less education and poorer health care.

Conclusion

There was a remarkable decrease in the MMR in Henan Province between 1996 and 2009 mainly in the rural areas and MMR due to direct obstetric causes such as obstetric hemorrhage. This study indicates that improving the health care network for women, training of obstetric staff at basic-level units, promoting maternal education, and increasing household income are important interventional strategies to reduce the MMR further.