Neighborhood Inequalities in Hepatitis C Mortality: Spatial and Temporal Patterns and Associated Factors

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.

Major publications in the critical care pharmacotherapy literature: January-December 2016

PURPOSE

To summarize select critical care pharmacotherapy guidelines and studies published in 2016.

SUMMARY

The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 31 journals monthly for relevant pharmacotherapy articles and selected 107 articles for review over the course of 2016. Of those included in the monthly CCPLU, three guidelines and seven primary literature studies are reviewed here. The guideline updates included are as follows: hospital-acquired pneumonia and ventilator-associated pneumonia management, sustained neuromuscular blocking agent use, and reversal of antithrombotics in intracranial hemorrhage (ICH). The primary literature summaries evaluate the following: dexmedetomidine for delirium prevention in post-cardiac surgery, dexmedetomidine for delirium management in mechanically ventilated patients, high-dose epoetin alfa after out-of-hospital cardiac arrest, ideal blood pressure targets in ICH, hydrocortisone in severe sepsis, procalcitonin-guided antibiotic de-escalation, and empiric micafungin therapy.

CONCLUSION

The review provides a synopsis of select pharmacotherapy publications in 2016 applicable to clinical practice.

[Initial examination and screening of migrants : What makes sense and what is evidence-based?]

The medical treatment of migrants and refugees has recently become an important topic in the German healthcare system due to the large numbers of migrants. Healthcare for migrants includes treatment of acute illnesses and trauma on arrival, screening for chronic communicable and non-communicable diseases and in the long term, the integration into the local healthcare system. As health problems of migrants are diverse and dependent on the region of origin, guidelines should be readily available for all healthcare professionals involved in migrant healthcare. A literature search for comprehensive guidelines for screening and treatment of migrant's health problems detected 47 different guidelines including 2 comprehensive ones from the US Centers of Disease Control and Prevention and the Canadian Collaboration for Immigrant and Refugee Health. Comparative analysis of these guidelines could be a starting point for evidence-based European guidelines on migrant health.

[Recommendations for the diagnosis and prevention of infectious diseases in pediatric and adolescent refugees in Germany : Statement of the German Society of Pediatric Infectious Diseases, the Society of Tropical Pediatrics and International Child Health, and the Professional Association of Pediatricians]

Child and adolescent refugees in Germany represent a particularly vulnerable social group and treating infectious diseases forms a crucial part of providing their medical care. From an infectious diseases perspective, refugees themselves, as a result of their difficult personal circumstances, are the ones at highest risk. Even in crisis situations, medical practitioners are medically and ethically obliged to provide a high standard of care. The guidelines presented here propose recommendations for diagnosing and preventing infectious diseases among refugees under 18 in Germany. The guidelines are intended to assist in optimizing vaccine protection and treatment of diseases while taking into consideration factors such as refugees' challenging living conditions, cultural differences and potential language barriers.Upon refugees' arrival at the first housing sites, it is recommended that a basic clinical screening (and not just a brief visual inspection) be provided in order to identify and initiate treatment for acute medical problems and potentially contagious diseases (including tuberculosis), as well as to close gaps in vaccination coverage. Documentation of the clinical findings is critical, both to avoid redundant investigations and to optimize individual medical care. For this, an effective communication system must be established.Once refugees have been transferred into their destination community, outpatient and inpatient care providers should collaborate to bring refugees up-to-date with all vaccines recommended by STIKO (German Standing Committee on Vaccination). The same high standard of medical care should be delivered to refugees as would be to the general population. Due to the high prevalence of multi-resistant organisms (MRO) in the refugees' countries of origin, MRO screening is recommended for most patients receiving inpatient care.

Seroprevalence of influenza A and B viruses among unvaccinated children in the United Arab Emirates: a cross-sectional study

Background

Young children are at increased risk of severe influenza disease and, thus, are good candidates for receiving annual vaccination. Nevertheless, the influenza vaccine is infrequently given to children in our region. The primary objectives of this study are to monitor the serologic immunities against influenza A and B viruses, and provide pediatric data that support the need for influenza vaccination in the community.

Methods

Influenza A and B virus-specific IgG antibodies were measured in 294 children (median age 4.1 years; range 1.9–12.5 years) between July 2014 and September 2015.

Results

The percentage of children who were seropositive for influenza A IgG was 15.8%, equivocal 7.4%, and negative 76.8%. The corresponding values for influenza B IgG were 31.3, 9.6, and 59.1%, respectively. There was a higher seropositivity rate for influenza B than for influenza A in all age groups. The percentage of children who were seropositive for either influenza A or B IgG was 27.9% and for both was only 2.7%.

Conclusions

Most of the studied children are serologically naïve and, thus, are likely to acquire primary influenza disease. A national policy that endorses childhood influenza vaccination is highly advisable.

Incidence Patterns and Occupational Risk Factors of Human Brucellosis in Greece, 2004-2015

Background:

Brucellosis is the most common bacterial zoonosis worldwide. Greece has the highest reported incidence among EU countries. However, occupational risk factors have not been well described.

Objective:

To determine the incidence patterns and exposure risk factors of brucellosis in Greece.

Methods:

We used national-level surveillance and occupational denominator data to estimate the incidence patterns and exposure risk factors of brucellosis in Greece, with particular emphasis on occupation.

Results:

Between November 2003 and December 2015 a total of 2159 human brucellosis cases was reported. The mean incidence rate was 1.62 per 100 000 population per year. A large majority of cases (77.1%) reported consumption of unpasteurized milk or contact with livestock animals. Most cases occured in farmers and livestock breeders (1079 [87.7%] of 1231 cases reporting their occupation), corresponding to an annual incidence of 7.1 per 100 000. However, there were other occupations with a similar or higher risk: butchers and abattoir workers (12.7 per 100 000), laboratory personnel (3.1 per 100 000), while the highest risk was for veterinarians (53.2 per 100 000).

Conclusion:

Brucellosis incidence in specific occupational groups was much higher than in the general population. These results underline the importance of collecting information on occupation, both during the diagnostic process and in the surveillance system. Besides efforts to control brucellosis in animals, organized prevention efforts are needed within an occupational health framework, especially for the most vulnerable workers.

The direction of restructuring of a Korea field epidemiology training program through questionnaire survey among communicable disease response staff in Korea

We used a survey about the need for an educational training of infectious disease response staff in Korea Centers for Disease Control and Prevention (KCDC) and officer in metropolitan cities and provincial government to conduct field epidemiological investigation. The survey was conducted from January 25 to March 15, 2016. A total of 173 participants were selected from four different groups as follows: 27 clinical specialists, 22 Epidemic Intelligence Service (EIS) officers, 82 KCDC staff, and 42 local health department officials. Results revealed that 83% of KCDC staff and 95% of local health department officials agreed on the need for educational training to strengthen capability of personnel to conduct epidemic research and investigation. The level of their need for training was relatively high, while self-confidence levels of individuals to conduct epidemic research and investigation was low. It was concluded that there was a need to develop training programs to enhance the ability of public health officials, EIS officers, KCDC staff, and local health department personnel to conduct epidemic research and investigation.

Foodborne Illness Outbreak Investigation in a High-Profile Sports Club

A foodborne illness outbreak involving an elite sports team was investigated by a public health unit in Sydney, Australia. An epidemiological association was established between gastrointestinal illness and the consumption of food supplied by an external caterer, with a lamb meal most strongly associated with illness. Genetically identical Salmonella isolates were identified from clinical specimens, residual food items, and an environmental swab taken from the catering premises. The training schedule and other club operations were significantly affected by this outbreak. Increased susceptibility due to regular shared activities and the potential for significant impact upon performance indicates that sports clubs must ensure that food suppliers comply with the highest standards of hygiene. Collaboration with public health authorities assists in source identification and prevention of further transmission.

Individual- and neighborhood-level contextual factors are associated with Mycobacterium tuberculosis transmission: genotypic clustering of cases in Michigan, 2004-2012

PURPOSE

Using genotyping data of Mycobacterium tuberculosis isolates from new cases reported to the tuberculosis (TB) surveillance program, we evaluated risk factors for recent TB transmission at both the individual- and neighborhood- levels among U.S.-born and foreign-born populations.

METHODS

TB cases (N = 1236) reported in Michigan during 2004 to 2012 were analyzed using multivariable Poisson regression models to examine risk factors for recent transmission cross-sectionally for U.S.-born and foreign-born populations separately. Recent transmission was defined based on spoligotype and 12-locus-mycobacterial interspersed repetitive unit-variable number tandem repeat typing matches of bacteria from cases that were diagnosed within 1 year of each other. Four classes of predictor variables were examined: demographic factors, known TB risk factors, clinical characteristics, and neighborhood-level factors.

RESULTS

Overall, 22% of the foreign-born cases resulted from recent transmission. Among the foreign-born, race and being a contact of an infectious TB case were significant predictors of recent transmission. More than half (52%) of U.S.-born cases resulted from recent transmission. Among the U.S.-born, recent transmission was predicted by both individual- and neighborhood-level sociodemographic characteristics.

CONCLUSIONS

Interventions aimed at reducing TB incidence among foreign-born should focus on reducing reactivation of latent infection. However, reducing TB incidence among the U.S.-born will require decreasing transmission among socially disadvantaged groups at the individual- and neighborhood- levels. This report fills an important knowledge gap regarding the contemporary social context of TB in the United States, thereby providing a foundation for future studies of public health policies that can lead to the development of more targeted, effective TB control.

Google dengue trends: An indicator of epidemic behavior. The Venezuelan Case

INTRODUCTION

Dengue Fever is a neglected increasing public health thread. Developing countries are facing surveillance system problems like delay and data loss. Lately, the access and the availability of health-related information on the internet have changed what people seek on the web. In 2004 Google developed Google Dengue Trends (GDT) based on the number of search terms related with the disease in a determined time and place. The goal of this review is to evaluate the accuracy of GDT in comparison with traditional surveillance systems in Venezuela.

METHODS

Weekly epidemic data from GDT, Official Reported Cases (ORC) and Expected Cases (EC) according the Ministry of Health (MH) was obtained Monthly and yearly correlation between GDT and ORC from 2004 until 2014 was obtained. Linear regressions taking the reported cases as dependent variable were calculated.

RESULTS

The overall Pearson correlation between GDT and ORC was r=0.87 (p <0.001), while between ORC and EC according the Ministry of Health (MH) was r=0.33 (p<0.001). After clustering data in epidemic and non-epidemic weeks in comparison with GDT correlation were r=0.86 (p<0.001) and r=0.65 (p <0.001) respectively. Important interannual variation of the epidemic was observed. The model shows a high accuracy in comparison with the EC, particularly when the incidence of the disease is higher.

CONCLUSIONS

This early warning tool can be used as an indicator for other communicable diseases in order to apply effective and timely public health measures especially in the setting of weak surveillance systems.

[Epidemiology of Campylobacteriosis in Castile and Leon, Spain,during the period 2008-2015]

OBJECTIVE

Campylobacter is considered the most frequent agent of gastroenteritis in humans all around the world. The aim of this study was to know the incidence, trend and seasonality of notified campylobacteriosis cases in Castile and Leon, Spain, from 2008 to 2015. In addition, to describe the type of case and source of notification, and study the influence of age, sex and Campylobacter species on the hospitalization of cases.

METHODS

Retrospective cross-sectional study with a time series analysis. Data on notified campylobacteriosis cases were collected from the Epidemiological Surveillance System of Castile and Leon (2008-2015). Incidence rates and incidence rate ratios by age, sex and year of notification were calculated. In order to estimate trend and seasonality, a time series analysis was performed using a multiplicative method and adjusted to a linear and exponential model.

RESULTS

From 4,330 cases analyzed, 49.4% of children aged under 5 were affected. The ratio of men to women was 1.43 and 61.8% of cases were notified from secondary care. C. jejuni was isolated from 72.3% of samples (n=2,593). Incidence rate ranged from 11.42 cases per 100,000 inhabitants in 2008 to 33.53 in 2015. The seasonality range was from 71.97% (13th four-week period) to 125.54% (9th four-week period). Hospitalization reached 62.5% for people aged 60 or over.

CONCLUSIONS

A growing trend of notified campylobacteriosis cases is observed in Castile and Leon (2008-2015), mainly in children aged under 5, with a peak in summer months. Males are more affected than females and hospitalization increases with age.

Characteristics of foodborne outbreaks in which use of analytical epidemiological studies contributed to identification of suspected vehicles, European Union, 2007 to 2011

Foodborne disease outbreaks (FBDOs) occur frequently in Europe. Employing analytical epidemiological study designs increases the likelihood of identifying the suspected vehicle(s), but these studies are rarely applied in FBDO investigations. We used multivariable binary logistic regression analysis to identify characteristics of investigated FBDOs reported to the European Food Safety Authority (2007-2011) that were associated with analytical epidemiological evidence (compared to evidence from microbiological investigations/descriptive epidemiology only). The analysis was restricted to FBDO investigations, where the evidence for the suspected vehicle was considered 'strong', i.e. convincing. The presence of analytical epidemiological evidence was reported in 2012 (50%) of these 4038 outbreaks. In multivariable analysis, increasing outbreak size, number of hospitalizations, causative (i.e. aetiological) agent (whether identified and, if so, which one), and the setting in which these outbreaks occurred (e.g. geographically dispersed outbreaks) were independently associated with presence of analytical evidence. The number of investigations with reported analytical epidemiological evidence was unexpectedly high, likely indicating the need for quality assurance within the European Union foodborne outbreak reporting system, and warranting cautious interpretation of our findings. This first analysis of evidence implicating a food vehicle in FBDOs may help to inform public health authorities on when to use analytical epidemiological study designs.

The global dynamics of diabetes and tuberculosis: the impact of migration and policy implications

The convergence between tuberculosis (TB) and diabetes mellitus (DM) will represent a major public health challenge in the near future. DM increases the risk of developing TB by two to three times and also increases the risk of TB treatment failure, relapse, and death. The global prevalence of DM is predicted to rise significantly in the next two decades, particularly in some of the low- and middle-income countries with the highest TB burden. Migration may add further complexity to the effort to control the impact on TB of the growing DM pandemic. Migration may increase the risk of DM, although the magnitude of this association varies according to country of origin and ethnic group, due to genetic factors and lifestyle differences. Migrants with TB may have an increased prevalence of DM compared to the native population, and the risk of TB among persons with DM may be higher in migrants than in autochthonous populations. Screening for DM among migrants, screening migrants with DM for active and latent TB, and improving access to DM care, could contribute to mitigate the effects of DM on TB.

The Impact of Inflammatory and Infectious Diseases of Vulvar on Quality of Life

Objectives

This study aimed to evaluate the effects of vulvar dermatoses (VD) and vulvar infections (VE) on anxiety, depression scores, general, and dermatological quality of life (QOL) of women.

Methods

We conducted a cross-sectional survey on patients diagnosed with VD and VE. All patients were assessed using a sociodemographic form, Skindex-29 scale, World Health Organization QOL (WHOQOL) BREF scale, Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D).

Results

HAM-A score was significantly higher in the VD group than in the control group. Based on age groups, all subscales of Skindex-29 were found to be higher in women > 50 years. For women with severe pruritus, the symptom subscale was higher in patients with skin involvement and the function and emotion subscales were higher in patients with and emotion subscales were higher in patients with mucosal involvement.

Conclusions

We found that VD was particularly significantly associated with decreased QOL.

The public health planners' perfect storm: Hurricane Matthew and Zika virus

Hurricane Matthew threatened to be one of the most powerful Hurricanes to hit the United States in a century. Fortunately, it avoided making landfall on Florida, the eye of the Hurricane remaining centered 40 miles off the Florida coast. Even so it has resulted in over $7 Billion USD in damage according to initial estimates with much of the damage ongoing in severe flooding. Response to and recovery from Hurricane Matthew challenged Florida's public health services and resources just as emergency Zika-specific congressional funding to combat Zika outbreaks in Florida had become available. Hurricanes can disrupt the urban environment in a way that increases the likelihood of vector-borne illnesses and their aftermath can severely strain the very infectious disease and infection control academe needed to combat vector-borne outbreaks. This commentary attempts to examine the challenges posed by Hurricane Matthew in Florida's efforts to contain Zika.

Vaccination in Hajj: An Overview of the Recent Findings

Background:

About two million people annually travel to Kingdom of Saudi Arabia to perform Hajj. The pilgrims may be at risk of exposure to communicable diseases in this mass gathering and their vaccination against contagious diseases can prevent many morbidities and mortalities. The aim of our study was to review the papers which evaluated effectiveness and compliance of the vaccines applied in Hajj.

Methods:

We used PubMed and Scopus to search international medical databases. The key words were as follows: Hajj, Haj, vaccine, vaccination, and immunization. The time interval of the search was from the beginning of 2010 to May 23, 2016. One hundred and thirty papers were extracted, and their contents were subsequently reviewed after title and abstract screenings. The original articles were included in the study and non-English articles were excluded from the study.

Results:

Considering the extracted papers, almost all pilgrims were vaccinated against meningococcal diseases. Using of influenza and pneumococcal vaccine rates were different among the pilgrims. The other vaccines have been taking according to specific conditions.

Conclusions:

The findings regarding influenza vaccine effectiveness are contradictory. A few studies confirmed the flu vaccine effectiveness while some others rejected its usefulness. Meningococcal immunization is an effective preventive tool with high compliance for Hajj pilgrims. Further investigations are recommended for the other vaccines.

Knowledge, attitudes and behaviors of the Italian population towards Neisseria meningitidis, Streptococcus pneumoniae and HPV diseases and vaccinations: A cross-sectional multicentre study

OBJECTIVES

This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them.

STUDY DESIGN

This is a cross-sectional, multicentre study.

METHODS

Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013.

RESULTS

Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination.

CONCLUSIONS

Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

Adult immunization-Need of the hour

Immunization is the process or the act of making individuals immune, which is usually done during childhood. Everyone is aware about immunization during childhood, however, very few know about adult immunization. This led us to review the adult immunization literature for the preventive strategies through various vaccination protocols. Adults do require vaccination protocols with booster doses for hepatitis B, Shingles, communicable diseases, traveler's diseases, etc. In this context, this article revises much of the available adult immunization literature and presents comprehensive guidelines. This article will increase the awareness regarding the importance of vaccination for adults to prevent a variety of conditions prevalent in our country as well as epidemics. The article comprehensively provides insights into the available vaccination and preventive strategy of human papilloma virus (HPV), hepatitis, and human immunodeficiency virus (HIV) infection in this part of the review. We strongly recommend all the health care professionals to educate their co-professionals and the public to use the benefits of adult immunization. It is the need of the hour and reduces the burden of treatment and increases productivity.

Hepatitis E: Discovery, global impact, control and cure

Hepatitis E was identified as an epidemic of non-A, non-B hepatitis from Kashmir, India in 1978. Hepatitis E virus (HEV), the etiological agent is the sole member of family Hepeviridae. The virus has marked heterogeneity and infects many animals like bats, camel, chicken, deer, boar, mongoose, pigs, rats, rabbit and cutthroat trout. Hepatitis E is a disease with a major global impact and has two distinct epidemiological patterns. Hepatitis E is an imperative health issue in developing nations, transmitted through sullied water and happens most every now in young adults. The disease is particularly severe during pregnancy and in people with underlying liver cirrhosis. Autochthonous hepatitis E is increasingly recognized in developed countries. The virus infects domestic pigs, wild boar and Sika deer in these countries. HEV infections in humans occur by eating the undercooked game flesh, raw liver from supermarkets and Figatelli sausages. Blood transfusion-associated HEV infections occur in many countries and screening of donors for HEV RNA is under consideration. Hepatitis E causes a number of extrahepatic diseases, including a wide spectrum of neurological syndromes. HEV genotype 3 causes prolonged viremia, chronic hepatitis, liver fibrosis and cirrhosis in organ transplant patients. The virus is amenable to ribavirin monotherapy and most patients clear the virus in a few weeks. Hepatitis E vaccine -239, marketed in China, has shown high efficacy with sustained protection for over four years.

Zika Virus and the Blood Supply: What Do We Know?

Zika virus (ZIKV), a mosquito-borne Flavivirus and emerging infectious disease, is the focus of an international public health emergency after its rapid spread through the Americas and the Caribbean. Although most ZIKV infections are subclinical or characterized by mild febrile illness, ZIKV has been implicated in severe complications, most notably microcephaly in babies born to incident infected mothers during pregnancy. As yet, the extent to which ZIKV is transfusion transmissible remains undefined. Nonetheless, a high prevalence of asymptomatic infection during outbreaks, the demonstration of ZIKV in blood donors, and 4 possible cases of transfusion-transmitted ZIKV in Brazil have raised concern for risk to the blood supply. Consequently, a proactive response is underway by blood collection agencies, regulatory bodies, national funding agencies, and industry alike. Mitigation strategies differ between endemic and nonendemic areas. In the continental United States, the American Association of Blood Banks and Food and Drug Administration guidelines recommend travel-based deferral for those returning from affected areas, and nucleic acid testing is being initiated under an investigational new drug application in Puerto Rico and selected areas of the United States. Options are less clear for countries where autochthonous vector-borne transmission is active. The burden of Zika falls in low-resource countries where high cost and technical barriers associated with testing and pathogen reduction pose barriers to implementation. Additional strategies include maintaining selective inventory for high-risk recipients (eg, pregnant women). We review the available data as of July 2016 on ZIKV in relation to the blood supply including risk, mitigation strategies, and barriers to implementation in addition to the research that is needed to address current uncertainty.

Outcomes analysis of new entrant screening for active tuberculosis in Heathrow and Gatwick airports, United Kingdom 2009/2010

Background

In 2012, the United Kingdom (UK) Government announced that the new entrant screening for active tuberculosis (TB) in Heathrow and Gatwick airports would end. Our study objective was to estimate screening yield and diagnostic accuracy, and identify those at risk of active TB after entry.

Methods

We designed a retrospective cohort study and linked new entrants screened from June 2009 to September 2010 through probabilistic matching with UK Enhanced TB Surveillance (ETS) data (June 2009 to December 2010). Yield was the proportion of cases reported to ETS within three months of airport screening in the screened population. To estimate screening diagnostic accuracy we assessed sensitivity, specificity, positive and negative predictive values. Through Poisson regression we identified groups at increased risk of TB diagnosis after entry.

Results

We identified 200,199 screened entrants, of these 59 had suspected TB at screening and were reported within 3 months to ETS (yield = 0.03 %). Sensitivity was 26 %; specificity was 99.7 %; positive predictive value was 13.2 %; negative predictive value was 99.9 %. Overall, 350 entrants were reported in ETS. Persons from countries with annual TB incidence higher than 150 cases per 100,000 population and refugees and asylum seekers were at increased risk of TB diagnosis after entry (population attributable risk 77 and 3 % respectively).

Conclusion

Airport screening has very low screening yields, sensitivity and positive predictive value. New entrants coming from countries with annual TB incidence higher than 150 per 100,000 population, refugees and asylum seekers should be prioritised at pre- or post-entry screening.

A new diagnostic tool for rapid and accurate detection of Mycobacterium tuberculosis

Mycobacterium tuberculosis, acid fast bacilli from the family of Mycobacteriaceae, is the causative agent of most cases of tuberculosis. Tuberculosis, as a communicable disease, remains a serious public health threat, killing more than one million people globally every year. Primary diagnosis of tuberculosis bacilli (TB) relies mainly on microscopic detection of acid fast bacilli (AFB), but the method suffers from low sensitivity and the results largely depend on the technician’s skill. New diagnostic tools are necessary to be introduced for rapid and accurate detection of the bacilli in sputum samples. We, in collaboration with Anda Biologicals, have developed a new platform, named as “Patho-tb”, for rapid detection of AFB with high sensitivity and with low dependence on human skills. Evaluation of Patho-tb test performance was done in two settings: (1) primary field study conducted using 38 sputa from high TB prevalence area of Iran (Zabol city near to the Afghanistan border), and (2) main study conducted using 476 sputa from Tehran, capital of Iran. Patho-tb was applied for processed sputum samples in parallel with routine diagnostic methods (including AFB microscopy, culture and PCR). All test results were compared to final clinical diagnostic state of an individual and diagnostic sensitivity (DSe), specificity, positive predictive value, negative predictive value and accuracy of each test results were calculated using standard formulations. Analytical sensitivity and specificity of the Patho-tb test were also determined. Calculated values for five above mentioned parameters are as follows: for field study: AFB (DSe: 29.6, DSp: 81.8, PPV: 80, NPV: 23.1, AC: 44.7), Patho-tb (DSe: 63, DSp: 72.7, PPV: 85, NPV: 44.4, AC: 65.8), and for main study: AFB (DSe: 86.1, DSp: 99.4, PPV: 98.5, NPV: 93.9, AC: 95.2), Patho-tb (DSe: 97.4, DSp: 92.9, PPV: 86.5, NPV: 98.7, AC: 94.3). Reproducibility of Patho-tb test results were near to 100% (Cohen’s kappa value between 0.85 and 1). The detection limit of Patho-tb test with 100% positivity rate was 3 × 10³ cells/ml of sputum. In the field study, Patho-tb test was 33.4% more sensitive than AFB microscopy, while the improvement was only 11.3% during the main study. Patho-tb results are easy to interpret and the test can be merged with other screening tests, like AFB. Totally, Patho-tb test alone or in conjunction with AFB microscopy is a useful screening tool for TB detection especially in poor geographical lab conditions.

Diabetes as a model for the disparate public response to acute versus chronic diseases

The public health outcry toward infectious entities appears to dwarf chronic diseases such as diabetes. This disparity is particularly astonishing given the considerable prevalence of diabetes and prediabetes. Diseases associated with short-term morbidity and mortality therefore seem to garner attention and demand an immediate public health response, whereas chronic illnesses, which can be considerably more devastating in the longer term, receive relatively less notoriety. It should not, however, be misconstrued that one disease entity is more important than the other--it is critical that both acute and chronic entities are given balanced attention in the public health, governmental, and scientific realms. The current perspective reflects on the disparate public health purviews toward acute and chronic illnesses, describes why prevention is so difficult and challenging, and addresses what can be done to reverse this trend. If there is any hope of conquering the spiraling prediabetes and diabetes epidemics, the medical community must grapple with the complex issues herein raised.

Brazilian infectious diseases specialists: who and where are they?

Background

The infectious diseases specialist is a medical doctor dedicated to the management of infectious diseases in their individual and collective dimensions.

Objectives

The aim of this paper was to evaluate the current profile and distribution of infectious diseases specialists in Brazil.

Methods

This is a cross-sectional study using secondary data obtained from institutions that register medical specialists in Brazil. Variables of interest included gender, age, type of medical school (public or private) the specialist graduated from, time since finishing residency training in infectious diseases, and the interval between M.D. graduation and residency completion. Maps are used to study the geographical distribution of infectious diseases specialists.

Results

A total of 3229 infectious diseases specialist registries were counted, with 94.3% (3045) of individual counts (heads) represented by primary registries. The mean age was 43.3 years (SD 10.5), and a higher proportion of females was observed (57%; 95% CI 55.3–58.8). Most Brazilian infectious diseases specialists (58.5%) practice in the Southeastern region. However, when distribution rates were calculated, several states exhibited high concentration of infectious diseases specialists, when compared to the national rate (16.06). Interestingly, among specialists working in the Northeastern region, those trained locally had completed their residency programs more recently (8.7 yrs; 95% CI 7.9–9.5) than physicians trained elsewhere in the country (13.6 yrs: 95% CI 11.8–15.5).

Conclusion

Our study shows that Brazilian infectious diseases specialists are predominantly young and female doctors. Most have concluded a medical residency training program. The absolute majority practice in the Southeastern region. However, some states from the Northern, Northeastern and Southeastern regions exhibit specialist rates above the national average. In these areas, nonetheless, there is a strong concentration of infectious diseases specialists in state capitals and in metropolitan areas.