Attitudes and knowledge among parents or guardians of 12-year-old girls about HPV vaccination - A population-based survey in Iceland

PURPOSE

To assess attitude and knowledge among parents or guardians of 12-year-old girls about human papillomavirus (HPV), cervical cancer, and HPV vaccination. Material andMethods: A mail survey was sent to a randomized sample of 1,000 parents or guardians of 12-year-old girls from a cohort of total 2,092 girls born in 1995 and registered in the Icelandic National Register by the end of December 2007.

RESULTS

Of the 994 eligible parents, 583 (59%) returned the questionnaire. Majority of the respondents were mothers who had two or three children. More than one-third of respondents had university education and 84% were married or living with a partner. Over two-thirds did not know that HPV causes cervical cancer and genital warts. Almost all (> 90%) would vaccinate theirs daughters with a HPV vaccine, 73% said they would vaccinate their sons, or themselves if the vaccine was effective for them. Only 11% believed HPV vaccination would increase promiscuity or decrease cervical screening attendance.

CONCLUSION

In Iceland, willingness to vaccinate young girls with HPV vaccine is high, however, knowledge about HPV infections is limited.

A national epidemic of campylobacteriosis in Iceland, lessons learned

Epidemics often result in organizational, policy and technical changes within a country. In 1999, an epidemic of campylobacteriosis was reported in Iceland. The recent availability of fresh poultry products in the marketplace was suggested as the source of infection. This paper reports on the context of the epidemic, reviews interventions implemented to prevent campylobacteriosis, and discusses lessons learned. A retrospective study of interventions implemented in Iceland from June 1995 to December 2007 was conducted by interviewing key informants and reviewing Iceland's literature. Cumulative incidence rates of domestic campylobacteriosis by year and average incidence rates per epidemic period were calculated. Interventions included on-farm surveillance of Campylobacter, producer education, enhanced biosecurity measures, changes in poultry processing, a leak-proof packaging policy, a freezing policy for products from Campylobacter-positive poultry flocks, consumer education, and the creation of a legislated inter-organizational response committee. These interventions appear to have collectively contributed to a decrease in campylobacteriosis' incidence rate near pre-epidemic baseline levels. Expert consultations revealed that the implementation of a Campylobacter surveillance program in poultry and the freezing policy were critical to controlling the disease in the Icelandic population. It was also recognized that new multidisciplinary collaborations among public health, veterinary, and food safety authorities and a sustained co-operation from the poultry industry were integral factors to the mitigation of the epidemic. Iceland's response to the campylobacteriosis epidemic is a lesson learned of inter-disciplinary and inter-organizational precautionary public health action in the face of a complex public health issue.

Surveillance of influenza in Iceland during the 2009 pandemic

In a pandemic setting, surveillance is essential to monitor the spread of the disease and assess its impact. Appropriate mitigation and healthcare preparedness strategies depend on fast and accurate epidemic surveillance data. During the 2009 influenza A(H1N1) pandemic, rapid improvements in influenza surveillance were made in Iceland. Here, we describe the improvements made in influenza surveillance during the pandemic , which could also be of great value in outbreaks caused by other pathogens. Following the raised level of pandemic influenza alert in April 2009, influenza surveillance was intensified. A comprehensive automatic surveillance system for influenza-like illness was developed, surveillance of influenza-related deaths was established and laboratory surveillance for influenza was strengthened. School absenteeism reports were also collected and compared with results from the automatic surveillance system. The first case of 2009 pandemic influenza A(H1N1) was diagnosed in Iceland in May 2009, but sustained community transmission was not confirmed until mid-August. The pandemic virus circulated during the summer and early autumn before an abrupt increase in the number of cases was observed in October. There were large outbreaks in elementary schools for children aged 6–15 years throughout the country that peaked in late October. School absenteeism reports from all elementary schools in Iceland gave a similar epidemiological curve as that from data from the healthcare system. Estimates of the proportion of the population infected with the pandemic virus ranged from 10% to 22%. This study shows how the sudden need for improved surveillance in the pandemic led to rapid improvements in data collection in Iceland. This reporting system will be improved upon and expanded to include other notifiable diseases, to ensure accurate and timely collection of epidemiological data.

Long-term effect of clofibrate on albumin turnover and distribution in man

The long-term effect of clofibrate (at least 6 months' treatment) on albumin metabolism was investigated in 7 subjects and the results were compared with those from 15 control subjects. Human albumin labelled with 131I was used as a tracer. A significant difference between the groups was found in the following parameters: The clofibrate-treated group had a prolonged rapid component (t1 1/2) of the disappearance curve (p less than 0.05), relatively increased albumin in the extravascular space (i.e. decreased distribution ratio, p less than 0.01) and increased extravascular albumin space when corrected for body size by calculating it as per cent of the extravascular bromide space (p less than 0.01). There was no significant difference between the groups in albumin synthesis, fractional catabolic rate or the slow component (t2 1/2) of the disappearance curve. The results suggest that long-term treatment with clofibrate causes changes in the intercellular matrix.

An international outbreak of Shiga toxin-producing Escherichia coli O157 infection due to lettuce, September-October 2007

Between 14 September and 20 October 2007, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157 simultaneously occurred in the Netherlands and Iceland. A total of 50 laboratory-confirmed cases were reported with a STEC O157 infection caused by the same clone. The strain was of type O157:H-, PT8, positive for stx1, stx2, eae and e-hly, and sorbitol negative. The most probable cause of this international outbreak was contaminated lettuce, shredded and pre-packed in a Dutch food processing plant. Samples of the environment, raw produce and end products, taken at several vegetable growers and processing plants all tested negative for STEC O157. However, the only epidemiological link between the cases in the Netherlands and in Iceland was the implicated Dutch processing plant. In Europe, food products are often widely distributed posing the risk of potential spread of food borne pathogens simultaneously to several countries. This international outbreak emphasises the importance of common alert and surveillance systems in earlier detection of international outbreaks and better assessment of their spread.

An interactive central database of vaccinations in Iceland

Binary file ES_Abstracts_Final_ECDC.txt matches

STEC O157 outbreak in Iceland, September-October 2007

From 28 September to 22 October, nine domestically acquired cases of Shiga toxin (Stx)-producing Escherichia coli (STEC) O157 were diagnosed in Iceland, one of which is probably a secondary case.

A European outbreak of Salmonella enterica serotype Typhimurium definitive phage type 204b in 2000

OBJECTIVE

To describe the clinical, epidemiologic and microbiological features of a large outbreak of infection with a multiresistant Salmonella enterica serotype Typhimurium definitive type DT204b infection involving at least 392 people in five European countries.

METHODS

Icelandic public-health doctors responded to a report on an Internet news site of an outbreak of infection with a multiresistant strain of Typhimurium DT104 in England by contacting the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). An international alert was sent out through Enter-net. All strains from England & Wales, The Netherlands, Scotland and Germany, and 17 of the outbreak isolates from Iceland, were phage-typed, screened for antimicrobial resistance, and subjected to molecular typing. Hypothesis-generating interviews were conducted, followed by case-control studies performed in Iceland and England.

RESULTS

Isolates from cases in Iceland, England and Wales, The Netherlands, Scotland and Germany were identified as Typhimurium DT204b. The antimicrobial resistance pattern was ACGNeKSSuTTmNxCpL. All strains tested displayed an identical plasmid profile. Strains from five cases in England & Wales and five cases in Iceland possessed identical pulsed-field profiles. Although a common source was suspected, only Iceland implicated imported lettuce as a vehicle, with an analytic epidemiologic study (OR = 40.8; P = 0.005; 95% CI 2.7-3175).

CONCLUSION

The identification of international outbreaks, necessary for investigation and control, can be facilitated by standardized phage-typing techniques, the electronic transfer of molecular typing patterns, formal and informal links established through international surveillance networks, and the early reporting of national outbreaks to such networks.

Campylobacter spp. in Icelandic poultry operations and human disease

We describe the observed relationship of campylobacter in poultry operations to human cases in a closed environment. During 1999 in Iceland, domestic cases of campylobacteriosis reached peak levels at 116/100,000 and in 2000 dropped to 33/100,000. Approximately 62% of broiler carcass rinses were contaminated with Campylobacter spp. in 1999. During 2000, only 15% of the broiler flocks tested Campylobacter spp. positive. In 2000, carcasses from flocks which tested positive on the farms at 4 weeks of age were subsequently frozen prior to distribution. We suggest that public education, enhanced on-farm biological security measures, carcass freezing and other unidentified factors, such as variations in weather, contributed to the large reduction in poultry-borne campylobacteriosis. There is no immediate basis for assigning credit to any specific intervention. We continue to seek additional information to understand the decline in campylobacteriosis and to create a risk assessment model for Campylobacter spp. transmission through this well defined system.

[Quality control of antimicrobial usage in Reykjavik Hospital in 1994 - 1998: economic impact.]

AIMS

To investigate the effect of guidelines and supervision of the prescription of antimicrobial agents at Reykjavik Hospital on the cost and the amount used of these agents.

MATERIAL AND METHODS

The investigation was conducted from 1994 to 1997. Guidelines were issued for the prescription of antimicrobial agents in empirical treatment and for prophylactics in surgery. The availability of these agents was reduced and the physicians had to order these drugs by filling out a special application form. These forms were later on used for the supervision by a pharmacist and an infectious disease physician of the use of antmicrobial agents and to monitor any change in the prescription of the agents. If needed the supervisors gave advice to the clinicians responsible for the patients care. The supervision took place at eight of the wards of the hospital and started at different times during May 1995 to March 1996.

RESULTS

The cost of the usage of antimicrobial agents was reduced after the introduction of the supervision. However, as time passed from the implementation of the supervision the cost tended to increase again. The greatest cost reduction was achieved at the departments of surgery or 8.5 million Icelandic crowns. At the departments of medicine the cost reduction was 2.3 million crowns. By correcting for the cost of supervisory staff the real cost decrease was approximately 6 million crowns. The total amount of prescribed antimicrobial agents measured by the Standardised Daily Dosage was reduced in all the concerned wards by 3-14%.

CONCLUSIONS

The real cost decreases after the implementation of supervision of the prescription of antimicrobial agents was approximately six million Icelandic crowns during 1994 to 1997. Also, the proportion of antimicrobial agents in the total cost of drugs was reduced after the supervision started in spite of increasing mean cost per Standardised Daily Dosage increased at the departments during the study period. The goal of reducing the amount of antimicrobial agents prescribed was also achieved.

Multiple-conformation and protonation-state representation in 4D-QSAR: the neurokinin-1 receptor system

Using a 4D-QSAR approach (software Quasar) allowing for multiple-conformation, orientation, and protonation-state ligand representation as well as for the simulation of local induced-fit phenomena, we have validated a family of receptor surrogates for the neurokinin-1 (NK-1) receptor system. The evolution was based on a population of 500 receptor models and simulated during 40 000 crossover steps, corresponding to 80 generations. It yielded a cross-validated r(2) of 0.887 for the 50 ligands of the training set (represented by a total of 218 conformers and protomers) and a predictive r(2) of 0.834 for the 15 ligands of the test set (70 conformers and protomers). A series of five "scramble tests" (with an average predictive r(2) of -0.438) demonstrates the sensitivity of the surrogate toward the biological data, for which it should establish a QSAR. On the basis of this model, the activities of 12 new compounds - four of which have been synthesized and tested in the meantime - are predicted. For most of the NK-1 antagonists, the genetic algorithm selected a single entity - out of the up to 12 conformers or protomers - to preferably bind to the receptor surrogate. Moreover, the evolution converged at an identical protonation scheme for all NK-1 antagonists. This indicates that 4D-QSAR techniques may, indeed, reduce the bias associated with the choice of the bioactive conformation as each ligand molecule can be represented by an ensemble of conformations, orientations, and protonation states.

TT virus infections among blood donors in Iceland: prevalence, genotypes, and lack of relationship to serum ALT levels

BACKGROUND

The TT virus (TTV) is a newly identified blood-borne virus. Its association with disease is still unknown, and screening of blood donors has not been implemented. Several genotypes of the TTV have been identified.

STUDY DESIGN AND METHODS

Three hundred seventy healthy blood donors were randomly selected and tested for TTV by the PCR method. Sequencing of a part of the genome was performed to identify various genotypes of the virus. ALT levels were determined in both infected and uninfected individuals.

RESULTS

The TT virus (TTV), was detected in the sera of 23 (6.2%) of 370 healthy Icelandic blood donors; this prevalence is lower than that reported in Japan but higher than that in Scotland. The virus was found in all groups over the age of 19. Sequencing and phylogenetic analysis of 202 bp from open reading frame 1 demonstrated genotypes 1b and 2b 2c and genotype 4 isolates, with the latter bearing 89-percent nucleotide homology with other genotype 4 sequences deposited at GenBank. One sample showed a mixed genotype 1b/2c infection. Serum ALT levels were within normal limits in all infected individuals.

CONCLUSION

The TTV carrier state does not cause significant liver injury.

[Measurements of plasma HIV-1 RNA in Iceland.]

OBJECTIVE

First to measure plasma HIV-1 RNA in Icelandic HIV infected individuals and second to evaluate the initial effects of new combination regimens on viral load and CD4+ cell counts in HIV infected patients in Iceland.

MATERIAL AND METHODS

The cohort studied consis notted of all HIV infected individuals we received samples from during the period September 1995 to November 1996. HIV-1 RNA and CD4+ cells were measured initially and subsequently every three to six months except when a change was made in the antiretroviral regimen, when samples were measured before the change, three to four weeks later and then every three to six months. The quantitative measurement of viral RNA was performed using the Amplicor HIV Monitor Test (Roche Diagnostic Sys nottems). CD4+ cell counts were measured by flow cytometry.

RESULTS

A total of 44 patients were evaluated. The initial RNA ranged from %lt; 2.6 logio to 6.13 logio with a mean of 5.02 log. CD4+ cell counts ranged from 2 to 641 per mm3 (mean 230 cells/mm3). Eleven patients had never been treated with antiretroviral drugs and had greater than 10 000 viral copies per mL of plasma. Twenty five of the patients were evaluated following a change in or initiation of a new treatment. The initial change in treatment led to a +0.7 to -2.88 log change in plasma RNA (mean -0.9 log) and a mean of 6.9 cells per mm3 increase in CD4+ cells. Saquinavir was added to two reverse transcriptase (RT) inhibitors in 11 patients with a resulting mean of 0.23 log fall in RNA levels (range +0.70 log to -0.78 log). Saquinavir plus one RT inhibitor were added to one RT inhibitor in six patients with a subsequent mean of 0.65 log reduction in viral load (range +0.24 to -2.26 log). Saquinavir plus two RT inhibitors were given to four antiretroviral naive patients with a resulting mean of 2.37 log reduction in viral load (range -1.8 log to -2.67 log).

CONCLUSIONS

1. In a mixed cohort of RT inhibitor naive and treated patients, the viral RNA ranged throughout the range of the RNA assay. 2. Changes in viral load following changes in treatment were quite variable. 3. Saquinavir alone added to two RT inhibitors did not lead to a significant reduction in viral load. 4. In antiretroviral naive patients the viral load was reduced 100 fold following treatment with saquinavir and two RT inhibitors.

Synthesis of cyclic dipeptide templates, their incorporation into peptides and studies on their conformational and biological properties

This study investigated the diastereoselective synthesis of three dipeptide templates 1, 2 and 3, which may be regarded as conformationally restricted analogs of H-Gly-Xaa-OH, in which Xaa constitutes an aromatic amino acid. Bond formation between alpha-C of Gly and the aromatic moiety was achieved by proton-catalyzed intramolecular electrophilic aromatic substitution. The absolute configuration of the dipeptide templates was determined by single-crystal X-ray crystallography or by nuclear Overhauser enhancement measurements. A protective group strategy was elaborated to allow their incorporation into peptide sequences by liquid phase as well as by solid-phase peptide synthesis. The templates were used to generate an enkephalin analog 15, a modified peptidic neurokinin antagonist 20 and two dermorphin derivatives (24 and 33). Molecular dynamic simulations with 15 and 20 revealed the preference for a turn-like motif for 15. The biological activity, as investigated by respective receptor binding and functional assays, was strongly diminished with all four derivatives, indicating that their receptor-relevant molecular geometries lie outside the examined conformational space.

Immunogenicity of two efficacious outer membrane protein-based serogroup B meningococcal vaccines among young adults in Iceland

Serum bactericidal activity (SBA) and ELISA antibody levels elicited by two efficacious serogroup B meningococcal vaccines were measured in a controlled trial involving 408 15- to 20-year-olds. Subjects were given two doses at a 6-week interval of a serogroup B or control vaccine. Response was defined as > or = 4-fold rise in antibody level. After two doses of the Finlay Institute (Havana) vaccine at 12 months, the proportions of SBA and ELISA responders were not different from those of the control group (15% and 17% [vaccine] vs. 13% and 9% [control], P > .05). After two doses of the National Institute of Public Health (Oslo) vaccine, there were more SBA and ELISA responders than in the control group (47% and 34% [vaccine] vs. 10% and 1% [control]) or the Finlay Institute vaccine group (P < .05 for both). SBA and ELISA may be insensitive correlates for protective efficacy for some outer membrane protein-based serogroup B meningococcal vaccines.

[Tuberculous infection and tuberculosis in the foreign born in Iceland.]

OBJECTIVE

The purpose of the study was to find the incidence and prevalence of tuberculosis among the foreign-born in Iceland.

MATERIAL AND METHODS

The study material was obtained from (a) the National TB register and (b) the files of the Immigration Office on recidency applicants in 1995.

RESULTS

In 1975-1996 there were 32 cases of TB in the foreign-born out of a total of 468. The proportion of cases among the foreign-born rose significantly during the period (p<0.001). In 22 years the incidence of TB among the foreign-born was 18.0 but 8.4 among those born in Iceland (p<0.001). The incidence of TB in Asian-born was 173.7, or 21 times that among those born in Iceland (p<0.001). The second highest incidence (18.8) was in those born in North and South America. Tuberculosis usually appeared within five years of immigration. During 1995 the 559 applicants for recidence permit provided health certificates. Of these 363 had a tuberculin skin test (TST) and 42% were positive. The corresponding figure for those born in Africa was 68%, in Asia 58% and in East Europa 50%. Most of those with positive TST had a chest x-ray but also 23% of the others. 26.2% had neither a TST nor a chest x-ray but still received a health certificate. Only 33% of those positive received isoniazide to eliminate infection and 88% of these completed at least six months of isoniazide treatment.

CONCLUSION

A TST is an indispensable part of health screening for immigrants and also a chest x-ray when appropriate. Treatment of TB infection should be used more often.

[Incidence and prevalence of positive tuberculin skin test reactions among schoolchildren.]

OBJECTIVES

To investigate the incidence and prevalence of positive tuberculin skin test reactions in schoolchildren from six to 16 years of age.

MATERIAL AND METHODS

Data from tuberculin test school surveys in Reykjavik during the years 1958 to 1991 are available for almost all individuals of each age cohort. During 1958 to 1991 schoolchildren from six to 16 years of age were tested annually. In Iceland regular BCG vaccination in children or aldults has never been applied.

RESULTS

Incidence of positive tests in all ages fell from 2.5 (per 1000 tested per year) from 1958 down to 0.5 in the mid seventies and after that the incidence remained low. Prevalence of positive tests for the same age group in different age cohorts showed that for each age group from seven to 16 years positive tests were most common at the beginning of the study period but decreased successively to the beginning of the seventies. The prevalence of positive tests was low and almost unchanged during 1976 to 1991 and varied from 0 -1.6 (per 1000 tested per year) among children seven to eight years of age, 0-2.9 among children 11 to 12 years of age and from 0-3.8 among those aged 15 to 16 years.

CONCLUSION

During the last decade little has been gained by systematic testing for tuberculosis as a tool for finding newly infected persons or carriers of M. Tuberculosis. It seems to us that the results of this study do not justify systematic testing for tuberculous infection in all schoolchildren. Increased emphasis should be placed on testing among risk groups such as immigrants from countries where tuberculosis is endemic. Recent infection due to M. Tuberculosis is a high risk factor for tuberculosis. Search for newly infected persons in close contact with infectious patients with tuberculosis should have priority next to the diagnosis and treatment of the patients. Tests for tuberculosis among those who want to immigrate to Iceland circumscribe another risk group where containment of tuberculosis is possible.

Molecular similarity based on DOCK-generated fingerprints

An alternative method for defining molecular similarity is presented. By using the docking program DOCK and a reference panel of protein binding sites, fingerprints for a set of molecules have been generated, based on calculated interaction energies. These binding patterns allowed us to calculate matrices of similarity coefficients which subsequently were used for nearest-neighbor searches within the database. Our results indicate that the method is suitable for finding significant similarities of compounds of the same biological activity. Although the overall performance of a traditional 2D similarity method is better in the test systems investigated, our 3D approach can be regarded as complementary since it is able to detect similarities independent of the covalent structure of the compounds. Thus it should be a useful 3D database-searching tool for rational lead discovery.

Characteristics of hepatitis C virus among intravenous drug users in Iceland

According to antibody analysis, approximately two of every three intravenous drug users in Iceland have become infected with hepatitis C virus (HCV). In this study, serum samples from 55 HCV antibody-positive intravenous drug users (39 males and 16 females) were analyzed by polymerase chain reaction, and the viral strains were grouped into genotypes. Only three genotypes--1a, 3a, and 1b--were found among the drug users. Of 40 persons who were positive by polymerase chain reaction, 23 (57.5%) had type 1a, 15 (37.5%) had type 3a, and one (2.5%) had type 1b. One serum sample was untypeable. HCV viral RNA was detectable in 84.6% of the males and 43.7% of the females, which is a significant difference between the sexes (p < 0.01). In addition, 41 randomly selected HCV antibody-positive intravenous drug users (17 males and 24 females) were tested for HCV viral RNA with a commercially available polymerase chain reaction technique. In this subset of drug users, 76.4% of the males and 33.3% of the females had detectable HCV RNA in their serum, which is also a significant sex difference (p < 0.01). This study shows that two HCV genotypes predominate among intravenous drug users in Iceland, and the results indicate that women eliminate virus more effectively than men.

[The epidemiology of AIDS in Iceland. The first ten years.]

Objective. To describe the epidemiology of AIDS and HIV infection in Iceland with demographic characteristics and associated risk factors. Design. Survey of national data reported to the Office of the Director General of Public Health in Iceland from November 1985 to December 311994. The dates of diagnosis of HIV infection, AIDS and death due to AIDS were collected from the patients physicians. Patients. All patients diagnosed with HIV and AIDS in Iceland during the study period. Methods. The expanded European AIDS surveillance case definition was used (Lancet 1993 ;341:441). Reporting of individuals with AIDS and HIV infection is semianonymous in Iceland according to the act of law on sexually transmitted diseases. Results. As of December 31 1994 overall 79 males and 14 females were diagnosed with HIV infection. Of those infected 30 males and five females were diagnosed with AIDS. Most of those infected with HIV were 20-29 years old (44%) and most of those diagnosed with AIDS were 30-39 years old (40%). The incidence of AIDS (number of cases/100,000/ year) was 1.36 (2.3 for males and 0.4 for women) during the first 10 years. Of those 35 diagnosed with AIDS 26 died (74%) during this period. The median survival time after the diagnosis of AIDS was 22 months (95% CI; 16-28 months). The majority of the patients with AIDS (91%) and the HIV infected cases (65%) were homosexual or bisexual males but the proportion of those infected by heterosexual contact has been increasing and was at the end of the study period 16%. HIV infection among i.v. drug abusers has been rare in Iceland hitherto. No paediatric cases were observed. Conclusion. The spread of AIDS in Iceland is not as rapid as in many other countries. The incidence rate has not changed significantly during the study period. At the same time the death rate of AIDS patients has been increasing indicating a slowing of the AIDS epidemic. The major changes regarding transmission categories are the increasing proportion of heterosexuals and decreasing proportion of homosexual and bisexual males.

Synthesis of a new dipeptide template, its X-ray structure, and modeling studies on its conformational features

The diastereoselective synthesis is reported of a dipeptide template which is closely related to H-Gly-Trp-OH. Intramolecular bond formation between alpha-C of Gly and ring position 2 of the Trp unit has been achieved by a Pictet-Spengler-type electrophilic aromatic substitution. The absolute configuration of the N-Moc protected dipeptide template 9.2H2O was determined by single-crystal X-ray crystallography and found to be (2S,5S). The cis orientation of the amino and carboxy termini prompted us to investigate the potential of 9 as a beta-turn mimic. MD calculations on the model pseudopeptide Ac-Ala-Gly-Trp-Ala-NHMe 11 suggest that an unusually tight turn should be favoured rather than a beta-turn. The proper protective situation as a pre-requisite for the incorporation of the template into a peptide has been established, and comments about its chemical properties are given.

Immunogenicity and safety in adults of hepatitis A virus vaccine administered as a single dose with a booster 6 months later

An inactivated vaccine against hepatitis A was administered as a single 1,440 enzyme-linked immunosorbent assay (ELISA) units dose at month 0 with a booster at month 6 to 200 subjects divided into two age groups: group 1, 20-39 years (n = 134) and group II, 40-62 years (n = 66). At day 15, the seropositivity rates were 90% and 77% in groups I and II, respectively. At month 1 the seropositivity rate was 97% in both groups. At month 6 the seropositivity rates were 94% and 88% in groups I and II, respectively. One month after the booster, at month 7, 100% in both groups had become seropositive. The vaccine was well tolerated and did not cause any severe reactions. The results indicate that a single high vaccine dose offers protection against hepatitis A virus (HAV) for at least 6 months in the majority of cases where rapid vaccination is required even in travellers of older age. A booster dose will ensure long-term protection.

Age specific prevalence of antibodies against Chlamydia pneumoniae in Iceland

Chlamydia pneumoniae is a newly recognized common cause of respiratory tract infections. The aim of this study was to examine its prevalence in Iceland. The study was based on 1020 serum samples from individuals 0-99 years old. The samples were divided into 10-year age groups. IgG and IgM antibodies were determined with microimmunofluorescence assay. An IgG titer > or = 32 and IgM titer > or = 16 were considered positive. The prevalence of positive IgG titer in the study population was 53 +/- 16% (mean +/- SD, age group range 14-66%). Neither seasonal nor gender-based difference in IgG antibody prevalence was demonstrated. It was lowest in the youngest group, 0-9 years old (p < 0.001), but rose linearly to age 70 (p < 0.005). 34 samples were IgM positive on initial testing; most from the older age groups. 12 were rheumatoid factor positive as well. After treatment with caprine antihuman IgG antibodies all became negative. The prevalence of C. pneumoniae infections is high in Iceland according to these results and similar to that in neighbouring countries. The presence of IgM rheumatoid factor may cause false positive tests for pathogen-specific IgM by immune complex binding with pathogen-specific IgG, thereby requiring its removal before testing.

Oropharyngeal colonization in the elderly

A cross-sectional prevalence study of gram-negative bacillary oropharyngeal colonization in the geriatric population with single oropharyngeal cultures was performed on three different groups of individuals, the first consisting of healthy individuals, living independently, the second residing in a nursing facility and the third hospitalized. A longitudinal incidence study by serial weekly cultures was in addition conducted on a fourth group of hospitalized individuals. In the cross-sectional study, gram-negative bacilli were isolated from 23% of the hospitalized group, whereas only 7-10% of the other two groups were colonized (p less than 0.05). In the longitudinal study, the colonization was intermittent and transient, being most prevalent on admission, i.e. 23%, but gradually decreasing during the hospital stay to 7% after ten weeks. Only hospitalization and prior treatment with antimicrobials increased prevalence of colonization. On only one occasion was a lower respiratory infection predated by oropharyngeal colonization with the same organism, indicating that such colonization may not be a risk factor for the development of pneumonia in the elderly.

Declining prevalence of antibodies to hepatitis A virus infection in Iceland

The prevalence of antibodies to hepatitis A virus (anti-HAV) was investigated in 445 outpatients in Iceland in 1987. No difference in anti-HAV prevalence according to sex or residence was found. The prevalence rates were low in persons less than 50 years with a sharp increase in persons greater than or equal to 50 years. The prevalence of anti-HAV was now significantly lower in the age groups of 40-49 years and 50-59 years than in 1979 indicating a cohort effect. These findings correspond to a marked decrease in notified cases of hepatitis (epidemic jaundice) after 1950 in Iceland.

Prevalence of hepatitis B virus markers in Icelandic outpatients and hospital personnel in 1979 and in 1987

The prevalence of hepatitis B virus (HBV) infections in Iceland was investigated in 619 outpatients and 72 hospital personnel in 1979 and in 445 outpatients and 284 hospital personnel in 1987 by anti-HBc testing. The overall prevalence of anti-HBc among outpatients remained almost unchanged and was 5.7% in 1979 and 5.4% in 1987. In 1987 the prevalence rate in outpatients increased significantly from 0% in persons less than 20 years to 9.8% in persons greater than 60 years (p = 0.008). Among hospital personnel tested in 1987 the prevalence rate also increased significantly with age from 4% in those 20-29 years of age to 26% in those greater than 60 years (p = 0.024). A significant increase of the prevalence rate with years of employment was, however, not found. Laboratory technicians with frequent blood contacts had a significantly higher prevalence rate than other health care workers and outpatients tested in 1987 (p less than 0.001). Laboratory technicians had an annual attack rate of HBV infection of 1.4% from 1979 to 1987. The results indicate that the prevalence of HBV infection in 1979 and 1987 has remained unchanged in the general population and that hospital personnel exposed to blood are at increased risk of getting HBV infection.

Creatine kinase isoenzyme BB in the cerebrospinal fluid of patients with acute neurological diseases

In order to predict the outcome of patients with acute neurological symptoms at discharge, the concentration of creatine kinase isoenzyme BB (CK-BB) was determined by radioimmunoassay in the cerebrospinal fluid (CSF) of 115 consecutive patients. On admission and over the next 3 days the concentration of CK-BB was significantly increased in patients with brain death and other neurological sequelae compared with those with favourable outcome. There was a variation in time in concentrations of CK-BB between diseases causing neurological sequelae. Thus, cerebrovascular haemorrhages caused highest concentrations on admission, but cerebral ischaemia due to cardiac arrest caused highest concentrations 3 days after admission. On admission the CK-BB measurements were highly specific with high predictive value of positive result when distinguishing patients with brain death and other neurological sequelae from those without complications at discharge. However, when distinguishing patients with brain death from those with other neurological sequelae, the test was most specific and had highest predictive value of a positive result 3 days after admission.

Prevalence of IgM antibodies to nine Legionella species in Icelandic children

In order to evaluate the prevalence of antibodies to Legionella species among children in Iceland, a prospective study was conducted in 424 children aged 1 month to 12 years, 28 of whom had an acute respiratory tract infection. Antibody titers to L. pneumophila serogroup 1-6, L. bozemanii, L. dumoffii, and L. micdadei were measured by microagglutination technique. Seroreactivity to Legionella spp. was found in 30% of the children greater than 3 years of age and in 22% of all children. The majority of the children with legionella antibodies had no history of previous or present respiratory tract infection. The children with previous pneumonia or bronchial asthma did not show a higher seroreactivity to legionella than children without such a history. Our observations suggests that Icelandic children are frequently exposed to Legionella species or closely related bacteria.

Diffusion of HIV-1 virus into non-habitual categories at risk in European countries

The ECP Working Group on AIDS has evaluated the available data on seropositivity to HIV-1 supplied by research groups in 12 Eastern and Western European countries. The period covered is 1985 and 1986. A significantly elevated incidence of seropositives was observed in both females and males in heterosexual contact with members of high risk groups. In contrast heterosexuals with no such contact had an incidence below 1%. For male homosexuals from Italy, Denmark and Switzerland the trend was no detectable increase in prevalence from 1985 to 1986. Hungary and Poland now have a few per cent seropositive male homosexuals, but no seropositives were found in a group of Polish drug abusers.

Comparison between cerebrospinal fluid concentrations of glucose, total protein, chloride, lactate, and total amino acids for the differential diagnosis of patients with meningitis

The purpose of this study was to compare the ability of cerebrospinal fluid (CSF) concentrations of glucose, protein, chloride, lactate, and total amino acids, as well as CSF/blood glucose ratio to distinguish bacterial meningitis from aseptic meningitis. 56 patients with proven bacterial meningitis, 102 patients with aseptic meningitis, and 108 controls were investigated. On admission CSF lactate determination was the most sensitive and the most efficient test to distinguish bacterial meningitis from aseptic meningitis. In patients with bacterial meningitis reexamined after 24-48 h of treatment with antibiotics and compared with patients with aseptic meningitis also reexamined 24-48 h after admission determination of CSF total amino acids was the most sensitive and efficient test.

Creatine kinase isoenzyme BB in cerebrospinal fluid from patients with meningitis and encephalitis

High CK BB isoenzyme activity has been demonstrated in the CSF of many patients with various neurologic disorders and is considered to reflect brain tissue damage [1, 2]. Increased CK BB activity in the CSF has been described in a patient with fatal pneumonococcal meningitis [3] and also in two patients with viral encephalitis [1]. Since routine laboratory tests are of limited value for assessing the prognosis of patients with CNS infections, the present investigation was undertaken to study the possibility of early detection of brain tissue damage in such patients by determining the CK BB activity in the CSF. The CK BB activity in the control subjects was less than or equal to 10 nkat/liter, which is in accordance with a previous study based on bioluminescence assay [2]. Six of the seven patients with neurologic complications in the present study had marked increases of the CK BB activity. In the patient with brain death due to HSV infection, serial measurements of the CK BB activity in the CSF have shown a maximal fourfold increase from the value of 45 nkat/liter found on admission. In one of the patients with purulent meningitis who developed a slight hydrocephalus, the CK BB activity was normal, but no focal brain damage was found by computed tomography in this case. The results indicate that increased CK BB activity in the CSF is related to the clinical outcome of patients with infections of the CNS. Thus, the determination of the CK BB activity seems to be useful for assessing the prognosis of patients with bacterial and viral meningitis and encephalitis.

Prevalence of antibody to hepatitis A in Iceland in relation to age, sex, and number of notified cases of hepatitis

The prevalence of antibody to hepatitis A virus (anti-HAV) was investigated in 623 outpatients in Iceland. No difference in anti-HAV prevalence according to sex or rural vs. urban residence was found. The prevalence rates in different age groups were found to be comparable to those in the Scandinavian countries, increasing from 1.6% (1/63) in persons below 20 years of age to 66% (51/77) in persons above 60 years of age. The numbers of notified cases of hepatitis (epidemic jaundice) in Iceland during the 20th century showed a pattern of repeated epidemics up to the early 1950s, after which low rates were noted. The incidence of hepatitis dropped 30-fold during the 20th century. Persons born after the latest epidemic in 1952 were positive for anti-HAV in only 4.7% (7/150).

Increased total concentration of amino acids in the cerebrospinal fluid of patients with purulent meningitis

Total concentrations of amino acids, as measured by fluorometry of primary amino nitrogen with the use of fluorescamine, were determined in the cerebrospinal fluid (CSF) of 50 patients with purulent meningitis, 40 patients with aseptic meningitis, and 36 control subjects. On admission total concentrations of amino acids in the CSF were significantly higher in patients with purulent meningitis (mean +/- SEM, 2.27 +/- 0.27 mM) than in patients with aseptic meningitis (1.07 +/- 0.03 mM, P less than 0.001) or in control subjects (1.16 +/- 0.04 mM, P less than 0.001). This value was higher when the patients with purulent meningitis were reexamined one to two days later and reached a maximum after three to four days of illness. The fluorometry method proved to be simple, rapid, and precise and may be used as an additional test in diagnosing bacterial meningitis, especially in patients who are treated with antibiotics before admission. For patients with bacterial meningitis, a high concentration of amino acids in the CSF on admission may indicate a poor outcome.

Rapid diagnosis of meningitis with use of selected clinical data and gas-liquid chromatographic determination of lactate concentration in cerebrospinal fluid

The usefulness of determination of lactate concentration in cerebrospinal fluid (CSF) for differentiation between various types of meningitis was evaluated. Lactate concentration in the CSF was assayed by gas-liquid chromatography for 115 patients, 17 of whom had serous meningitis and 38 had bacterial meningitis. The mean lactate concentration in the CSF of patients with bacterial meningitis was significantly higher than in the CSF of patients with serous meningitis and in a control group. The mean concentration in patients with serous meningitis was significantly higher than in controls. The highest lactate level in serous meningitis overlapped with the lowest level in bacterial meningitis. Elevated lactate concentrations in CSF were found also in patients with noninfectious disorders of the central nervous system. Misleading results may therefore be obtained if the lactate concentration in CSF alone is used to distinguish between serous and bacterial meningitis. The study suggests, however, that measurements of lactate levels in CSF, when combined with clinical and conventional laboratory observations, can increase the reliability of rapid diagnosis of bacterial meningitis.

Cerebrospinal fluid content of adenylate kinase, lactate and glutathione in patients with meningitis

Adenylate kinase activity and lactate concentration were measured in the cerebrospinal fluid (CSF) of 5 patients with bacterial meningitis, of 4 patients with probable bacterial meningitis, and of 18 patients with serous meningitis. Furthermore, for comparison measurements were also performed in CSF of 27 patients with meningism. Concomitantly glutathione was measured in CSF in most of the patients. Significantly higher values of these 3 parameters were found in the CSF of patients with bacterial and probable bacterial meningitis compared with those having serous meningitis and meningism. Adenylate kinase activity and lactate concentration in patients with serous meningitis were significantly higher than in those with meningism. All patients with a clinical diagnosis of meningitis studied so far also displayed an adenylate kinase activity in their CSF. The determination of adenylate kinase, lactate and glutathione levels in CSF might be a useful aid for the diagnosis not only of meningitis but also for the discrimination between bacterial and serous meningitis.