Epidemiological danger of patients with pulmonary tuberculosis and alcoholism refusing treatment

The comparative evaluation of the epidemiological danger of alcohol-addicted persons with pulmonary tuberculosis who evaded treatment (the test group of 133 persons) and that of tuberculosis patients receiving adequate treatment under hospital conditions (the control group of 162 patients) was made. The morbidity level among relations having contacts with the patients evading treatment exceeded the morbidity level in the families of tuberculosis patients undergoing adequate treatment 4.5-fold for adults and 3.4-fold for children and adolescents, the contamination level in the latter group being twice as high. Although no cases of the disease were registered in the foci of infection where sick persons evading treatment had low bacterial discharge, still the elevated level of infection among children and adolescents in these foci as compared with the foci where tuberculosis patients did not evade treatment (35.0% and 21.7% respectively) indicated that the foci of infection where such aggravating factors as alcohol addiction in the source of infection was present were rightly considered to be epidemiologically most dangerous. Persons suffering with both tuberculosis and alcoholism should be subjected to compulsory hospitalization as early as possible.     

Epidemiologic situation of brucellosis in the regions of the Republic of Dagestan affected by the flood of 2002

The Republic of Daghestan is at present one of the most unsafe territories in the Russian Federation with respect to brucellosis morbidity among humans. The figures of human morbidity in brucellosis grew from 3.4 per 100,000 of the population in 1999 to 10.5 per 100,000 of the population in 2002, thus exceeding the figures for the whole of Russia 15- to 20-fold. The analysis of human morbidity in the Kizlyar region (where the interregional regrouping of the cattle was made) after the natural calamity, as well a in other regions where live-stock was evacuated, indicated that by the end of 2002 an essential deterioration of the epidemiological situation took place in these regions. In view of grave epizootological situation and the absence of epidemiological safety in brucellosis in the Republic of Daghestan the sanitary, epidemiological and veterinary services should, together with other priority tasks in their work aimed at the liquidation of the emergency situation, pay greater attention to measures for the prevention of the spread of brucellosis.     

Measles morbidity among children inoculated against this infection

In the serological survey of 2009 children immunized against measles 285 children (14.2%) were found to be seronegative to this infection in the hemagglutination inhibition test with 4 hemagglutinating units of the antigen. Among 1724 immunized children showing positive response to vaccination and placed under dynamic observation for 11 years, 2 cases of measles were registered. At the same time, in the dynamic observation of 111 seronegative children 66 measles cases (59.5%) were registered during the above period, while among 169 children, also seronegative, but receiving booster immunization against measles, morbidity rate was only 1.2%. In some vaccinees the decrease of postvaccinal immunity to seronegative values was observed, but such decrease had no essential influence on the morbidity level among the vaccines. The increase of measles morbidity among schoolchildren immunized against this infection was due not to the decrease of their postvaccinal immunity, but to their concentration in schools and to their more intensive contacts with the sources of infection in comparison with children of preschool age.     

Everyday contact spread of viral hepatitis B

The results obtained in the study of the characteristic features of the spread of viral hepatitis B under the conditions of family foci are presented. Children with viral hepatitis B have been found to infect 4-5 persons per 1,000 contacts, while adults infect not more than 1 person per 1,000 contacts. The results of the study have led to the conclusion that the idea of the potential danger of hepatitis B patients as the source of infection depends on the forms of the infectious process taken into account in evaluating its epidemiological significance. Latent cases of hepatitis B virus infection appear more frequently among the contacts of sick children than among those of sick adults, but the manifest forms of the disease are more frequently caused by infection contacted from sick adults.     

Epidemiological significance of carriers of hyaluronidase-active meningococci

To find out the epidemiological role of the carriers of hyaluronidase-positive meningococcal strains, their spread in the foci of meningococcal infection, as well as outside these foci, was studied. For this purpose, altogether 5059 persons from 40 family foci of infection and 40 organized groups were examined. The number of carriers of hyaluronidase-active meningococci, detected among those of them who had contacts with sick persons, was 13 times greater than among the persons having no such contacts. In preschool institutions with unfavorable morbidity situation this number was 16 times greater than in those with favorable situation. In the family foci carriers of hyaluronidase-active meningococci constituted 80-88 %. The percentage of the carriers of hyaluronidase-active meningococci causing cases of the generalized form of meningococcal infection varied in different groups. According to the results obtained in this study, the threshold percentage of such carriers constituted 30 in preschool institutions, 36 in boarding schools and 50 in common school and in hostels for adults.     

Paediatric home nursing scheme in Gateshead.

A scheme to provide specialised nursing care for sick children in their own homes was begun in Gateshead in 1974. Selected district nurses were retrained in the paediatric unit on which the scheme was based and nursed at home 22 children referred to them by general practitioners as the alternative to hospital admission and 39 discharged to their care by the hospital. Most of the children were aged 3 years or less and came from working-class homes. Most of the mothers who were asked were in favour of the scheme.     

Characteristics and trends in the development of an epidemic process of Sonne and Flexner dysentery among preschool children

The results of studies indicate that the morbidity rates of dysentery among children attending preschool institutions and children brought up at home converged in recent years. This phenomenon was most pronounced among children of the kindergarten age group. At the same time dysentery caused by Sh. sonnei and Sh. flexnery produced a higher morbidity rate among children attending nursery in comparison with that among children of the same age group brought up at home. Group infections in preschool institutions were caused by Sh. sonnei in 89.1% of cases and by Sh. flexneri in 10.9% of cases. Outbreaks due to the transfer of infection through everyday contacts were observed only in dysentery caused by Sh. sonnei, constituting 71.4% of the total number of dysentery outbreaks.     

Prevalence of intestinal parasitic infestation,salmonellosis, brucellosis,tuberculosis, and hepatitis B among immigrant children in Glasgow.

Two hundred Asian and 100 each of African, Chinese, and Scottish children were screened for intestinal parasitic infestations, salmonellosis, brucellosis, hepatitis B antigen (HBsAg), and tuberculosis. There was a fairly high incidence of Giardia lamblia among Asian and Scottish children and of Trichuris trichiura among the Chinese. Hookworm ova were seen only in Africa children. There were no chronic carriers of Salmonella or Brucella, and no one was suffering from salmonellosis or brucellosis. Tuberculin sensitivity was found in only 4% of immigrant and 1% of Scottish children: the difference was small and neither figure suggests a continuing high incidence of tuberculosis in Glasgow. Only seven immigrant children were found to be HBsAg carriers. Among the families of these carriers there was a high incidence (84%) of HBsAg or antibody (HBsAb). The survey shows that immigrant children in Glasgow do not constitute a health hazard to the indigenous population. Moreover, severe overcrowding is not a prominent feature among the immigrant families in Glasgow but is greatest among the local Scots.     

Epidemiological problems of ozena and the means for controlling this infection

Clinical, bacteriological, serological and epidemiological studies of ozena morbidity among the population of Minsk were carried out in 1970-1980. On January 1, 1981, the ozena morbidity rate among the inhabitants of Minsk was 26.72%. Ozena was found to affect mainly children and women. A wide spread of the family foci of this disease (31.68%) was revealed. The results of this study indicate that the source of K. ozaenae is a sick person who begins to excrete the bacteria in the prodromal period of the disease and may continue to excrete them for many years. The transfer of K. ozaenae occurs probably by droplet or contact infection. The droplet infection is less active in the absence of symptoms (coughing, sneezing) facilitating excretion of the infective agent into the air and in cases of the low susceptibility of persons to ozena. The main measures for controlling ozena are the timely detection and sanitation of the sources of ozena, as well as the current disinfection of the infection foci in apartments.     

Immunostructure of school-age children inoculated against measles

The mass serological survey of school children immunized against measles was carried out by means of the hemagglutination inhibition test. As a result, 20.4% of these school children were found to be seronegative, and in 9.5% of them even the minimum concentration of measles antihemagglutinins (when titrated with 1 hemagglutinating unit of the antigen) was not detected. The accumulation of a considerable seronegative (measles-susceptible) stratum among children of school age occurred due to the low immunogenic potency of some batches of live measles vaccine, used for immunization in 1973, as well as due to the formerly practiced immunization of children under 1 year of age. A direct and close dependence of focal measles morbidity among immunized children having had contacts with the source of infection on the number of children among them, found to be seronegative after titration with 1 hemagglutination unit of measles antigen, was established.     

Clinico-epidemiological characteristics of Q fever in the Carpathian region

The study of the specific epidemiological and clinical features of Q fever revealed the existence of an active focus of infection among humans due to their contacts with agricultural animals in one of the districts of the region. The focus was manifested by group morbidity among the cattle-tending personnel of a dairy farm. The source of this infection was cattle. The infection was transferred mainly through the air. The disease took a moderately severe course. The study of the rickettsial contamination of humans, animals and ticks suggested the presence of the active epidemic process and made it possible to work out concrete antiepidemic measures.     

Hepatitis A in Estonia (1990-1999)

During recent 10 years (1990-1999) essential changes occurred the epidemiology of viral hepatitis A (VHA) in Estonia: simultaneously with a decreased level of morbidity (morbidity rate per 100,000 of the population was 78.4 in 1990 and 7.7 in 1996, or 1,241 and 112 cases, respectively), a shift in the age structure of patients from children of preschool age to older age groups took place. Everyday contacts were the main established route of VHA transmission in recent years, but in more than 80% of cases the risk factors of the virus transmission remained obscure. During the regional outbreak of VHA in North Estonia in 1998 (937 out of 989 cases registered in the country) a rise in morbidity was observed among young people aged 15-29 years, when a wide spread of parenteral viral hepatitides B and C and drug addiction were registered in this region. During this outbreak VHA was transmitted mainly through everyday contacts. Still the considerable prevalence of injection drug users who practiced the group use of syringes and needles and took drugs from common containers, a sufficiently high level of the mixed forms of the disease (more than 18% of all registered cases of VHA), detected for the first time, make it possible to suggest that the parenteral transmission route could appear among persons belonging to the above mentioned group. Vaccination is regarded as the most effective measure for the prophylaxis of VHA.     

Epidemiology of viral hepatitis in the Estonian SSR

The epidemiological peculiarities of viral hepatitis in the Estonial SSR as a whole, as well as in Tallinn and in the surrounding Harju region were studied. The study revealed that during the last 10 years the total decrease of morbidity in viral hepatitis was observed due to a decrease in infectious hepatitis, pronounced periodic and seasonal morbidity fluctuations being absent. A sharp decrease in infectious hepatitis morbidity had been achieved by carrying out planned gamma globulin prophylaxis among children. Viral hepatitis morbidity in the republic was determined by the adult population and manifested as sporadic cases of infectious and serum hepatitis. Infectious hepatitis was transmitted mainly through every day contacts, while the leading factor in the transmission of serum hepatitis consisted in various injections. The relatively high morbidity level of serum hepatitis was mainly determined by morbidity in large cities.     

Economic effectiveness of using a live measles vaccine in an agricultural area of the Ukrainian SSR

Economic effectiveness of vaccination against measles in an agricultural region of the Ukrainian SSR has been studied. At the period preceding vaccination expenses for each measles patient in the country were three times as low as those in towns. At the period of vaccination a considerable decrease in expenses covering the payment of sick-leave certificates given to mothers taking care of their sick children, in losses connected with absenteeism, in expenses for gamma globulin prophylaxis and the hospital treatment and outpatient servicing of measles patients was observed due to the sharp drop of the total morbidity rate and the increased number of school children among measles patients. In urban and rural areas the equalization of expenses for each patient occurred. In spite of increased expenses for each measles patient, the considerable economy of sums spent for controlling measles was achieved: about 70,000 rubles per annum.     

The Rose Bengal Test in human brucellosis: a neglected test for the diagnosis of a neglected disease

Brucellosis is a highly contagious zoonosis affecting livestock and human beings. The human disease lacks pathognomonic symptoms and laboratory tests are essential for its diagnosis. However, most tests are difficult to implement in the areas and countries were brucellosis is endemic. Here, we compared the simple and cheap Rose Bengal Test (RBT) with serum agglutination, Coombs, competitive ELISA, Brucellacapt, lateral flow immunochromatography for IgM and IgG detection and immunoprecipitation with Brucella proteins. We tested 208 sera from patients with brucellosis proved by bacteriological isolation, 20 contacts with no brucellosis, and 1559 sera of persons with no recent contact or brucellosis symptoms. RBT was highly sensitive in acute and long evolution brucellosis cases and this related to its ability to detect IgM, IgG and IgA, to the absence of prozones, and to the agglutinating activity of blocking IgA at the pH of the test. RBT was also highly specific in the sera of persons with no contact with Brucella. No test in this study outperformed RBT, and none was fully satisfactory in distinguishing contacts from infected patients. When modified to test serum dilutions, a diagnostic titer >4 in RBT resulted in 87.4% sensitivity (infected patients) and 100% specificity (contacts). We discuss the limitations of serological tests in the diagnosis of human brucellosis, particularly in the more chronic forms, and conclude that simplicity and affordability of RBT make it close to the ideal test for small and understaffed hospitals and laboratories.     

Unmet need for additional medical care for sick children in mother's view in rural Bangladesh: implications for improving child health services

While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users' perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child's socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children's chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers' views to manage the illness. The survey also recorded household socioeconomic data. Logistic regression was used to examine the data. The results reveal that unmet needs for additional medical care were 5.4% for children with acute illnesses, and 30.2% for children with chronic illnesses. For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0.42 (95% CI: 0.28-0.64) times that for sick children of the very poor households. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.     

Epidemiological pattern of scarlet fever in recent years

During the period of 1953-2001 scarlet fever morbidity level fluctuated from 670.3 to 65.9 per 100,000 of the population in Moscow and from 531.9 to 35.0 per 100,000 of the population of the Russian Federation. In recent years an increased morbidity was more pronounced in Moscow than in the Russian Federation as a whole. Children formed the greater part of scarlet fever patients, the cases of scarlet fever among children in Moscow occurring more often than, on the average, in Russia. As before, annual morbidity among children attending children's institutions was higher 3- to 4-fold than among children brought up at home. This difference was most sharply pronounced among young children during the first two years of their life. In contrast to morbidity observed during previous 20-30 years, a drop in morbidity among children during the first two years of their life was registered, while morbidity level among children aged 3-6 years and 7-14 years increased. Scarlet fever morbidity had a pronounced seasonal (autumn-winter) pattern. In a group of children aged 3-5 years who attended organized groups, on the average, 78.6% of scarlet fever cases fell on seasonal morbidity, the most prolonged one.     

Human monkey pox: its clinico-epidemiological characteristics

During the course of the smallpox eradication programme, a new eruptive disease clinically resembling smallpox was discovered in Zaire. The disease, which was named monkeypox after the virus, is a zoonosis occurring sporadically in countries of western and central Africa with tropical rain forest. The studies carried out in Zaire from 1980 through 1985 showed that monkeypox affects mainly children in relatively small remote villages whose population has traditionally frequent contacts with wild animals. Apart from the wildlife, the virus can be transmitted from man to man, but among other sources of infection sick persons did not exceed 20%. Presumed human transmission has occurred in 38 out of 61 outbreaks of human monkeypox and only once reached the third and once the fourth generation; the transmission in all affected villages under observation has extinguished itself. Considering the sporadic and relatively rare occurrence of the disease and expected complications following the immunization with vaccinia which protects from monkeypox, introduction of mass vaccination in the areas at risk is hardly justified at present.     

Data on the study of the epidemiology of rotavirus infection in Leningrad

The results obtained in the study of rotavirus infection in Leningrad in 1984-1987 are presented. Enzyme immunoassay techniques were used for the examination of 4,715 children aged 0-14 years and 1,162 adults with diagnosed acute enteral infection of unknown etiology, as well as the control group of 556 of healthy children aged 0-6 years and 77 healthy adults. The rotavirus antigen was detected in 1.210 sick children (25.7%) and 133 sick adults (11.4%), as well as in 6 healthy children (1.1%), but not detected in healthy adults. The following epidemiological regularities of rotavirus infection were established: the highest sick rate among children aged 0-2 years and a low level of rotavirus carriership among healthy persons; the seasonal character of rotavirus infection, its outbreaks occurring in winter and the epidemic periods varying in their character and duration in different years; the prevailing role of rotaviruses in the development of winter rises of acute enteral infection of unknown etiology in the city among children aged 0-2 years. The problem of the respiratory syndrome in rotavirus diarrhea is discussed. The rotavirus antigen was detected in 39 out of 144 children (27%) with diagnosed acute respiratory virus diseases and in 4 out of 99 nasopharyngeal washings (4%) from diarrhea patients. Adenoviruses were shown to play an insignificant role in the etiology of diarrhea (10% of cases).     

Prevalence of Bacterial Febrile Illnesses in Children in Kilosa District,Tanzania

Introduction

Bacterial etiologies of non-malaria febrile illnesses have significantly become important due to high mortality and morbidity, particularly in children. Despite their importance, there are few reports on the epidemiology of these diseases in Tanzania, and the true burden of such illnesses remains unknown. This study aimed to identify the prevalence of leptospirosis, brucellosis, typhoid fever and urinary tract infections and their rate of co-infections with malaria.

Methods

A cross-sectional study was conducted at Kilosa district hospital in Tanzania for 6 months. Febrile children aged from 2–13 years were recruited from the outpatient department. Patients were screened by serological tests such as IgM and IgG ELISA, and microscopic agglutination test.

Results

A total of 370 patients were enrolled; of these 85 (23.0%) had malaria parasites, 43 (11.6%) had presumptive acute leptospirosis and 26/200 (13%) had confirmed leptospirosis. Presumptive acute brucellosis due to B. abortus was identified among 26 (7.0%) of patients while B. melitensis was detected in 57 (15.4%) of the enrolled patients. Presumptive typhoid fever due to S. Typhi was identified in thirty eight (10.3%) of the participants and 69 (18.6%) had urinary tract infections. Patients presented with similar symptoms; therefore, the identification of these diseases could not be done based on clinical ground alone. Co-infections between malaria and bacterial febrile illnesses were observed in 146 patients (39.5%). Although antibacterials and/or anti-malarials were prescribed in most patients, some patients did not receive the appropriate treatment.

Conclusion

The study has underscored the importance of febrile bacterial diseases including zoonoses such as leptospirosis and brucellosis in febrile children, and thus such illnesses should be considered by clinicians in the differential diagnoses of febrile diseases. However, access to diagnostic tests for discrimination of febrile illnesses is needed. This would allow febrile patients to receive the correct diagnoses and facilitation of accurate and prompt treatment.