Notifiable Communicable Diseases Research Articles

Non-Linear Association between Exposure to Ambient Temperature and Children's Hand-Foot-and-Mouth Disease in Beijing, China.

BackgroundHand, foot and mouth disease (HFMD) was listed as a notifiable communicable disease in 2008 and is an emerging public health problem in China, especially for children. However, few data are available on the risk assessment of the potential reasons for HFMD in Beijing. This study examined the association of temperature with the incidence of children’s HFMD in Beijing at the daily scale for the first time.MethodsA newly developed case-crossover design with a distributed lag nonlinear model (DLNM) was used to assess the delayed and cumulative associations of daily temperature with gender- and age-specific HFMD in Beijing, China, during 2010–2012. Relative humidity, day of the week, public holiday, season and long-term trends were controlled in the model.ResultsAmong the total of 113,475 cases, the ratio between males and females was 1.52:1. HFMD was more prevalent in May-July. The temperature-HFMD relationships were non-linear in most age groups except for children aged 6–15 years, with a peak at 25.0~27.5°C. The high-temperature risks were greater, appeared earlier and lasted longer than the low-temperature risks. The relative risks for female children and those aged 6–15 years were higher than those among other groups.ConclusionRising temperatures increased the incidence of children’s HFMD, with the largest association at 25.0~27.5°C. Females and children aged 6–15 years were more vulnerable to changes in temperature with regard to the transmission of HFMD than males and other age groups, respectively. Further studies are warranted to confirm these findings in other populations.

법정감염병 발생자료와 감염병관리사업 평가지표와의 관계 실증분석

This study examined the interrelationship between the evaluation indicators of communicable disease control and prevention activities, and the communicable disease incidence data. This study analyzed the incidence data of communicable disease in local governments of south Korea and evaluated the data of communicable disease control and prevention activities by the Ministry of Health of the central government in South Korea during 2004-2005. Frequency analysis was carried out to understand the character of the participant, t-test to compare the mean value between the two groups and stepwise multiple regression analysis to understand the significance between the dependent and independent variables. In this study, the finance related to communicable diseases (group I diseases in both city and rural center), keep rate of periodic reports on notifiable communicable diseases based on the law for communicable disease control and prevention (group II in city), the level of education on personal hygiene (group II in rural center), level of education on AIDS prevention and the reporting rate of cases of tuberculosis (group III in city), and reporting rate of incident cases of tuberculosis (tuberculosis and Hansen disease in both rural and city) were significant indicators. The level of education on AIDS prevention and the reporting rate of the cases of tuberculosis (in city), and number of adverse reactions after immunization (in rural area), reporting rate of cases of tuberculosis (in total center) were significant indicators in total communicable disease and all types of public health centers. The authors verified core evaluation indicators as actual proof. This study provides useful data for a summative evaluation, standardization, and guidelines on communicable disease control and prevention activities of public health centers and local government.

Is over-reporting a problem in mandatory communicable disease reporting? The Taiwanese experience on enterovirus 71.

In Taiwan, severe enteroviral infections must be reported to the government within 24 hours to ensure that severe enterovirus 71 (EV71) infections can be detected early. The objective of this research was to ascertain whether over-reporting is a problem in mandatory disease-reporting systems. A multiyear cross-sectional study methodology was applied based on secondary data analyses. Data from the national notifiable communicable disease surveillance system of Taiwan Centers for Disease Control were analyzed to assess the trends and factors influencing reporting accuracy. From July 1999 to December 2008, 2,611 cases of severe enteroviral infection were reported in Taiwan. Among these cases, 1,516 were confirmed to be EV71 cases, and the remaining 1,095 were confirmed to be non-EV71 infections. The overall accuracy rate was 58%. The accuracy rate was 60%-70% higher during epidemics (2000-2002, 2005, and 2008) and high seasons than it was in other seasons. The accuracy rate was highest among medical centers and lowest among district hospitals. The results indicated that reports are more accurate during high seasons and peak years than during other periods. This might be attributable to the adequate level of specific educational programs for professionals when more cases occur, which could facilitate identification. Based on experiences in Taiwan, optimal training can ensure that surveillance systems are not inundated by false-positive reports.

Risk factors for infections in international travelers: an analysis of travel-related notifiable communicable diseases.

We sought to describe travel-related illness among our residents and gain insight into targeting pre-travel health advice to prevent travel-related illness. A supplemental travel questionnaire was developed and administered for cases with a legally notifiable communicable disease reported in 2011-2012, who spent at least part of their exposure period outside the United States. Among 451 cases meeting the eligibility criteria, 259 were interviewed. Forty four percent reported receiving pre-travel advice. Two-thirds adhered fully with risk behavior recommendations; 94% followed immunization recommendations partially or fully; and 84% adhered fully with malaria prophylaxis recommendations. The primary reasons for not obtaining pre-travel advice were being unaware of the need (47.5%), or believing they already knew what to do (34.5%). Adults (OR = 2.8, 95% CI = 1.4-5.5), males (OR = 1.8, 95% CI = 1.1-3.0), those born outside the United States (OR = 2.0, 95% CI = 1.1-3.7), and those with planning time under two weeks (OR = 4.8, 95% CI = 1.5-15.9) or travel duration less than 7 days (OR = 7.9, 95% CI = 3.0-20.9) were more likely to travel without seeking pre-travel advice. The majority of cases reported not receiving pre-travel advice. Understanding the predictors of failure to receive pre-travel advice may help target public health prevention efforts.

Evaluating the Effectiveness of Contact Tracing on Tuberculosis Outcomes in Saskatchewan Using Individual-Based Modeling

Tuberculosis (TB) is a potentially fatal disease spread by an airborne pathogen infecting approximately one third of the globe. For decades, contact tracing (CT) has served a key role in the control of TB and many other notifiable communicable diseases. Unfortunately, CT is a labor-intensive and time-consuming process and is often conducted by a small and overworked nursing staff. To help improve the effectiveness of CT, we introduce a detailed, individual-based model of CT for the Canadian province of Saskatchewan. The model captures the detailed operation of TB CT, including loss to follow-up, and prophylactic and case treatment. This representation is used to assess the impact on active TB cases and TB infection prevalence of differential scoping, speed, prioritization of the CT process, and reduced loss to follow-up. Scenario results are broadly consistent with--but provide many additional insights beyond--our previously reported findings using an aggregate model. In the context of a stylized northern community, findings suggest that age- and ethnicity-prioritized schemes could improve CT effectiveness compared to unprioritized schemes by dramatically reducing TB infection and preventing on average roughly 11% (p < .0001) of active TB cases over a period of 20 years. Reducing loss to follow-up to 10% could yield 5.4% (p = .02) TB cases prevented on average with lower prevalence of TB infection, but improving the CT speed does not yield significant improvement in TB outcomes. Finally, although the work emphasized the value of social network analysis, we found that caution should be exercised in directly translating social network analysis-observed associations into prioritization recommendations.

Seroepidemiology of Toxoplasma gondii Infection among Healthy Blood Donors in Taiwan

Toxoplasma gondii is an opportunistic, zoonotic pathogen with a worldwide distribution. There are large variations in the seroprevalence of T. gondii infection in different regions of the world. Although toxoplasmosis became a notifiable communicable disease in Taiwan in 2007, little is known about its epidemiology among the general population. This cross-sectional study aimed to survey the seroprevalence of T. gondii infection and its risk factors among healthy blood donors in Taiwan. Through collaborating with the Taiwan Blood Services Foundation, a total of 1,783 healthy blood donors from all six-branch blood service centers participated in this study. The blood samples were tested for the presence of T. gondii antibodies and DNA using enzyme immunoassays and real-time PCR, respectively. Structured questionnaires were used to gather information on risk factors for T. gondii infection. Of the 1,783 participants, 166 (9.3%) tested positive for anti-Toxoplasma IgG, while 5 (0.28%) tested positive for anti-Toxoplasma IgM. The five IgM positive donors had high avidity antibodies suggestive of past infection. No active parasitemia was detected by real-time PCR assays. Multivariate logistic regression showed that undercooked pork meat consumption (adjusted odds ratio [OR] = 2.9; 95% confidence interval [CI]: 1.3–6.5), raw mussels consumption (adjusted OR = 5.3; 95% CI: 1.5–19.1), having a cat in the household (adjusted OR = 2.0; 95% CI: 1.2–3.2), a lower education level (adjusted OR = 1.6; 95% CI: 1.1–2.3), and donation place in eastern Taiwan (adjusted OR = 2.5; 95% CI: 1.6–3.9) were independent risk factors for Toxoplasma seropositivity. These findings provide information on the seroprevalence and epidemiology of T. gondii infection among healthy blood donors in Taiwan.

Low compliance and need for changes in national isolation guidelines for group 1 nationally notifiable communicable diseases in Korea

The national guidelines for group 1 nationally notifiable communicable diseases(cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection) recommend a universal isolation of the patients and screening for fecal shedding after finishing antibiotic therapy in Korea. This study was performed to evaluate the adequacy of the isolation guidelines.

Evaluation on quality of notifiable communicable diseases network direct reporting and discussion about evaluation indicators in China, 2009

Objective To evaluate the quality of notifiable communicable diseases network direct reporting in China (except Hong Kong, Macao SARs and Taiwan area) in 2009 and discuss the evaluation indicators. Methods All the notifiable communicable diseases reporting cards from 1 January to 31 December 2009 (excluding those deleted) were analyzed with SAS 9.1 software to understand the monthly/yearly zero/miss reporting rates in counties (district), timeliness and accuracy of reporting. Results A total of 6 487 969 notifiable communicable diseases cards were reported from 67 671 medical institutions in China in 2009. The monthly average zero reporting rate was 1.65%, which was mainly found in western China. The timely reporting rate was 98.09%, the median of the interval between diagnosis and reporting was 0.86 day. The timely verifying rate was 99.69%, the median of interval between reporting and verifying was 0.10 day. The timely reporting rate of class A communicable diseases (including those managed as class A communicable diseases) was low, the monthly average re-reporting rate was 0.02%. The proportion of reporting cards with errors declined significantly compared with 2008. Conclusion The quality of notifiable communicable diseases network direct reporting was further improved in China in 2009 The government at all level should strengthen the financial support to the direct network reporting system of notifable communicable diseases, especially in western China, The reporting of class A communicable diseases (or managed as class A communicable diseases) and chronic communicable diseases reporting and its management should be strengthened. The evaluation of reporting quality should be combined with field survey, and the evaluation indicator system should be improved.

Evaluation of Mandatory Case-based Reporting System for Varicella in the Prevaccine Era

Varicella is a mandatory reportable disease in Slovenia but it is not notifiable in most European countries. The aim of the study was to explore the completeness of mandatory varicella reporting in Slovenia. Data were extracted from three electronic datasets, including: mandatory notifiable communicable diseases dataset (SURVIVAL), health statistics dataset - consultations in primary care (ZUBSTAT), and health statistics dataset --hospitalizations (BOLOB). Age- and sex-specific reporting rates were compared during the period 1997-2006. During the ten-year period studied 168,089 cases were recorded via ZUBSTAT, and 128,222 cases by SURVIVAL. On average 76.2% (range: 62.9%-94.9%) were notified. In both datasets, the notified incidence of varicella was highest for preschool children, with a downward shift in age at contracting varicella. The percentage of notified cases decreased with increasing age. The number of hospitalized cases was low for BOLOB and SURVIVAL. On average 74% of hospitalized cases were reported. The mandatory notification system in Slovenia provides enough information to survey age/sex-specific varicella trends in the prevaccine era.

General practitioners’ role in the notification of communicable diseases – study in Malta

General practitioners (GPs) have an essential role in notification of communicable diseases. The main aim of the study described here was to assess the GPs' awareness of and attitudes towards the notification system in Malta, with special focus on infectious intestinal disease (IID). A questionnaire collecting demographic data, information on reporting practices, opinions on the existing notification system and suggestions for improvement was sent to 256 GPs working in either private or public health sector. In all, 150 GPs took part in the survey (response rate 58.6%). The responses revealed that Maltese GPs were aware of their obligations to notify communicable diseases but often did not report them, relying on the hospitals or laboratories to do so. The Disease Surveillance Unit (DSU) website and medical school training were the main sources of information on notification. Notification forms were obtained from health centres and usually kept at the place of work. Most GPs reported filling in the forms during the patients' visits. Private GPs tended to notify earlier than GPs working in public health centers. Among IID, food-borne illness was reported more frequently than person-to-person transmitted gastroenteritis and was considered to be of a higher priority with regard to public health importance (p<0.001). The survey highlighted also some areas for improvement, including need of feedback especially by direct communication or a newsletter.

Risk of Travel-Associated Typhoid and Paratyphoid Fevers in Various Regions

Although enteric fever (typhoid and paratyphoid fevers) is a major global public health problem, comparable data on the risks of contracting travel-associated enteric fever in various regions of the world are scarce. From the Swedish database on notifiable communicable diseases, we retrieved all case records from 1997 to 2003 on typhoid and paratyphoid fevers. The data set was compared with data on travel patterns obtained from a comprehensive travel database with information from interviews with more than 16,000 Swedish residents with recent overnight travel outside Sweden. The overall risk of being notified with enteric fever after travel was 0.42 in 100,000 travelers. The highest risk for typhoid fever was seen in travelers from India and neighboring countries (41.7 in 100,000), the Middle East (5.91 in 100,000), and Central Africa (3.33 in 100,000), whereas the risk was comparatively low in East Asia (0.24 in 100,000). Almost the same risk areas stood out for paratyphoid fever: India and neighbors (37.5 in 100,000), the Middle East (3.64 in 100,000), and East Africa (3.33 in 100,000). The epidemiology of paratyphoid fever was considerably affected by a large outbreak of paratyphoid B in a Turkish tourist resort in 1999. The youngest children were at highest risk for typhoid fever (odds ratio 44.2), whereas youths ages 7 to 18 years were at highest risk for paratyphoid fever (odds ratio 9.7). Detailed risk data for enteric fever after travel could form the basis for travel advice. Vaccination against typhoid fever should always be considered for travelers to the Indian subcontinent, the Middle East, and Africa but should not routinely be given to travelers to the Malay Peninsula.

The comparative burden of salmonellosis in the European Union member states, associated and candidate countries

BackgroundSalmonella is an infectious agents causing numerous cases of illness each year, and thereby having significant economic impact. Using returning Swedish travellers we estimated the burden of salmonellosis in different European countries.MethodsFrom the Swedish database on notifiable communicable diseases 15,864 cases with travel-associated salmonellosis acquired in Europe from 1997–2003 were retrieved. These cases were compared to a dataset from the same years on 14,171 randomly selected Swedish residents, with a history of recent overnight travel in Europe. Distribution of salmonellosis in returning travellers and the distribution of Salmonella Enteritidis was analysed for different member states in the European Union, associated and candidate countries. The risk of being notified with a salmonella infection after return from each European country/region was calculated, and compared with official reporting data rom these countries. Using Norway as reference country, we could 1) construct comparable incidence estimates and 2) calculate the "under-reporting" in each country compared to Norway.ResultsThe highest burden of salmonellosis was estimated for Bulgaria (2741/100,000), followed by Turkey with 2344/100 000 and Malta with 2141/100 000. S. Enteritidis is the dominating serotype, 66.9 % of all cases and phage type 4 accounts for 37.5 % of the S. Enteritidis casesConclusionUsing returning tourists as a sentinel population can provide a useful base for comparison of disease burdens in different countries/regions. Focusing prevention of salmonellosis to prevention of egg and poultry associated S. Enteritidis infection will have a major impact from a public health perspective and will significantly lower the burden of disease in most European countries.

Sensitivity of the Swedish statutory surveillance system for communicable diseases 1998–2002, assessed by the capture–recapture method

To assess the sensitivity of the Swedish surveillance system, four notifiable communicable diseases in Sweden were examined during 1998-2002 with the two-sources capture-recapture method, based on parallel clinical and laboratory notifications. The sensitivity (proportion of diagnosed diseases actually being notified) was highest for salmonellosis (99.9%), followed by meningococcal infection (98.7%), and tularaemia (98.5%). For penicillin-resistant pneumococci, introduced as a notifiable disease in 1996, the overall sensitivity was 93.4%--increasing from 86.5% in 1998 to 98.5% in 2002. The system benefited from parallel reporting, with a sensitivity of clinical and laboratory notifications alone (all diseases combined) of 91.6% and 95.9% respectively. The sensitivity of both clinical and laboratory notifications was markedly higher in counties using the national electronic reporting system, SmiNet. Thus, sensitivity was higher for diseases with a long tradition of reporting, and there is a run-in period after a new disease becomes notifiable.

Travel-associated non-typhoidal salmonellosis: geographical and seasonal differences and serotype distribution

The Swedish database on notifiable communicable diseases was used to identify 24 803 cases of travel-associated non-typhoidal salmonellosis from the period 1997-2003. Serotype data were available for 24 358 (98.2%) of these cases, which were compared with a data set from the same period of 16 255 randomly selected Swedish residents with a history of recent overnight travel outside Sweden. The highest risk of disease was seen in travellers returning from East Africa (471/100 000 travellers; 95% CI 294-755), or the Indian subcontinent (474/100 000; 95% CI 330-681). Children aged 0-6 years were at higher risk than travellers of other ages (OR 2.4; 95% CI 2.1-2.8). Some distinct seasonal patterns could be distinguished, with highest (adjusted) risk in December in East Asia, and in August in Europe. Marked geographical differences in serotype distribution were noted. Salmonella Enteritidis was especially dominant in Europe, but was much less common in Africa, Asia and America, where the variety of circulating serotypes was greater. Overall, the two data sets provided important information on travel risks which are also likely to apply to travellers from other western countries.

Epidemiology of tuberculosis and leprosy, Sabah, Malaysia

The objectives in this epidemiology review are to measure and report the extent of morbidity and mortality due to tuberculosis (TB), the proportion of new sputum smear positive cases in districts and the status of cohort analysis as of 1999. As for leprosy, the main objective is to determine morbidity and the treatment outcomes of Multiple Drug Therapy (MDT). Based on the results obtained, a comprehensive action plan for prevention, control and monitoring of tuberculosis and leprosy cases and patients is being produced and implemented throughout the state. The analysis concentrated on patients diagnosed at all out-patient units and admitted in all of the state's hospitals. The patient particulars were recorded using a standardized format based on TB and Leprosy Health Management Information System (TB HMIS). TB was the second highest by notification of communicable diseases in Malaysia in 2001. 29% or about one-third of the national TB cases are from Sabah. However, it has been noted that there was an average decline of 2.6% in annual notification since 10 years ago to date. There was also a reduction of 11.4% in 2001 as compared to annual notification in 2000. Immigrants contribute more than 24% in detection of new cases since 1990. Treatment success rate in term of completion of treatment to date is 82%. Mortality rate has steadily declined from 14 deaths to 7 deaths per 100,000 population. Leprosy in Sabah also contributes to 30% of the yearly total caseload of Malaysia and has the highest notification rate of 2 per every 100,000 population as compared to other states. The average registered leprosy cases over the past 5 years are 239 cases and the prevalence rate is 0.7/10,000 population. The state has successfully achieved its goal to decrease leprosy as per the World Health Organization (WHO) goal of yearly overall prevalence rate of less than 1 case for every 10,000 population. However, the districts of Kudat, Tawau, Lahad Datu, Kota Kinabalu and Semporna are still within the prevalence rate of more than one per 10,000 population. This review highlights some interesting findings which can be incorporated into the State and Districts action plans and strategies. It is also noted that in order to translate National Plans and Strategies into effective action at the community level, health workers need relevant up-to-date knowledge of the pattern of health and disease, and of their determinants, in each district. The Sabah Health Department continues to organize and support programs related to management and control of tuberculosis and leprosy to progressively reduce the incidence of these diseases in the community by breaking the chain of transmission of Mycobacterium tuberculosis and M. leprae, respectively.

Surveillance and Management of Notifiable Communicable Diseases

Surveillance and Management of Notifiable Communicable Diseases

Epidemiology of varicella in Slovenia over a 20-year period (1979-98).

Varicella is one of the most common childhood diseases. The course of the disease is usually mild and uncomplicated. In Slovenia, varicella is a notifiable communicable disease which must be reported. Data collected from 1979-98 were analysed. Over the 20-year period the number of varicella cases reported ranged from a low of 11,086 (in 1994) to a maximum of 21,141 (in 1987). During the last 10 years, the highest incidence of varicella was reported in children aged from 12 months to 2 years. In adults over 20, incidence has slightly but steadily increased over the 20 year period. Overall, the number of males with varicella exceeded that of females. The proportion of females was higher only in the 20-30-year age group, probably as a consequence of more frequent and closer contact with infected children by mothers. The highest number of reported cases was during winter and early spring.

Mandatory notification of communicable diseases: what physicians think

To find out the opinion of family doctors concerning the statutory notification of communicable diseases (SNCD) and to analyse factors associated to a good attitude towards SNCD. Guimarães Health Centre, Guimarães. Analytical cross-sectional study. Questionnaire survey. The 52 family doctors of the Health Centre were asked to express their opinion on some issues, including the utility of SNCD, reasons for the under-reporting of communicable diseases, up-to-dateness of the list of notifiable conditions, facility of filling in the notification form, and their own attitude towards notification. The variables utility of SNCD and attitude towards notification were then considered together with other variables (including postgraduate time, length of the family doctor's lists of patients, working in exclusivity, and how the degree of general practitioner is obtained). The SNCD was considered at least somewhat useful by 96% of the doctors. Thirty percent of the doctors considered excess work and/or lack of time as the main reason for under-reporting, and 29% it attributed to lack of sufficient motivation. The list of notifiable conditions was considered out dated by 46% of the doctors. Thirty eight percent of them considered the multiple notification of a case of disease not inconvenient and 54% stated that they had used it to notify all or almost all of cases they knew. The doctors who worked exclusively as civil servants and who had smaller lists of patients seemed to have a greater compliance regarding notification (p < 0.05). The majority of doctors considered the notification useful. They attributed the under-reporting to some conditions that are difficult to change. In this population, the doctors who worked exclusively as civil servants and who had smaller lists of patients showed a more favourable attitude towards reporting notifiable conditions.

Communicable disease surveillance during the Sydney 2000 Olympic and Paralympic Games.

A computerised communicable disease surveillance system has been operating in NSW since 1990. The existing system for surveillance of notifiable communicable diseases will be used during the Olympics, with some enhancements to improve timeliness and reliability.

Community-acquired notifiable infectious diseases in a pediatric hospital: effect on infection control work load.

In a study of the impact of notifiable communicable disease admissions on infection control work load, we found notifiable disease cases to be responsible for less than 10% of admissions but 27% of infection control ward visits and to require extensive community liaison. Measures of work load based on nosocomial infections alone will underestimate infection control activity considerably.