Public Health Bodies Research Articles

La gale en France entre 1999 et 2010 : augmentation de l’incidence et implications en santé publique

Scabies is a contagious parasitic infestation that is benign in most cases; however, delay in diagnosis and treatment can cause numerous problems for patients and people in their vicinity, as well as a risk of secondary spread. Following numerous reports suggesting increased incidence of scabies in France, we analysed various available indicators. We analysed spontaneous and mandatory reports submitted to public health bodies as well as sales figures for scabies treatments in France over the period between 1999 and 2010. Reports submitted to public health structures suggest an increase in the number of cases of scabies both within the community and in healthcare establishments. An increase was seen in regional and national sales of scabies treatments. At the national level, between 2005 and 2009, sales rose from 283 to 402 bottles per 100,000 persons per year (+10% per year) for benzyl benzoate and from 216 to 495 treatments per 100,000 persons per year (+22%) for ivermectin. Based on these data, the minimum estimated annual incidence of scabies in France is 328 cases per 100,000 persons. There is some discussion surrounding the interpretation of these data, particularly the bias associated with reporting practice and with the protocols used to treat affected subjects and those in their vicinity. However, all of the information gathered indicates a real increase in the incidence of scabies in France, as a result of which we recommend increased information for the general public, clinical practitioners and public health partners in order to ensure early diagnosis and treatment.

Evaluation of Travel Medicine Practice by Yellow Fever Vaccination Centers in England, Wales, and Northern Ireland

The National Travel Health Network and Centre (NaTHNaC) introduced a program of registration, training, standards, and audit for yellow fever vaccination centers (YFVCs) in England, Wales, and Northern Ireland (EWNI) in 2005. Prior to rolling out the program, NaTHNaC surveyed YFVCs in England. To reassess the practice of YFVCs in 2009, 4 years after the institution of the NaTHNaC program, to identify areas for ongoing support, and to assess the impact of the program. In 2009, all YFVCs in EWNI were asked to complete a questionnaire on type of practice, administration of travel vaccines, staff training, vaccine storage and patient record keeping, use of travel health information, evaluation of NaTHNaC yellow fever (YF) training, and resource and training needs. Data were analyzed using Microsoft Excel® and STATA 9®. The questionnaire was completed by 1,438 YFVCs (41.5% of 3,465 YFVCs). Most YFVCs were based in General Practice (87.4%). In nearly all YFVCs (97.0%), nurses advised travelers and administered YF vaccine. An annual median of 50 doses of YF vaccine was given by each YFVC. A total of 96.7% of nurses had received training in travel medicine, often through study days run by vaccine manufacturers. The internet was frequently used for information during travel consultations (84.8%) and NaTHNaC's on-line and telephone advice resources were highly rated. Following YF training, 95.8% of attendees expressed improved confidence regarding YF vaccination issues. There was excellent adherence to vaccination standards: ≥ 94% correctly stored vaccines, recorded refrigerator temperatures, and maintained YF vaccination records. In the 4 years since institution of the NaTHNaC program for YFVCs, there has been improved adherence to basic standards of immunization practice and increased confidence of health professionals in YF vaccination. The NaTHNaC program could be a model for other national public health bodies, as they establish a program for YF centers.

Global Alcohol Producers, Science, and Policy: The Case of the International Center for Alcohol Policies

In this article, I document strategies used by alcohol producers to influence national and global science and policy. Their strategies include producing scholarly publications with incomplete, distorted views of the science underlying alcohol policies; pressuring national and international governmental institutions; and encouraging collaboration of public health researchers with alcohol industry-funded organizations and researchers. I conclude with a call for an enhanced research agenda drawing on sources seldom used by public health research, more focused resourcing of global public health bodies such as the World Health Organization to counterbalance industry initiatives, development of technical assistance and other materials to assist countries with effective alcohol-control strategies, and further development of an ethical stance regarding collaboration with industries that profit from unhealthy consumption of their products.

Street-level policing in the Downtown Eastside of Vancouver, Canada, during the 2010 winter Olympics

BackgroundPolice presence within street-based drug scenes has the potential to disrupt injection drug users’ (IDUs) access to health services and prompt increased injection-related risk behaviour. We examined street-level policing in the Downtown Eastside (DTES) of Vancouver during the Olympic Winter games, to assess the potential impact on access to harm reduction services and injection-related risk behaviour. MethodsWe analysed data from observational activities documenting police and drug user behaviour, unstructured interviews with drug users in street settings (n=15), expert interviews with legal and health professionals (n=6), as well as utilisation statistics from a local supervised injection facility (SIF). ResultsAlthough police presence was elevated within the DTES during the Olympics, there was little evidence to suggest that police activities influenced IDUs’ access to health services or injection-related risk behaviour. SIF attendance during the Olympics was consistent with regular monthly patterns. ConclusionPolice presence during the Olympics did not reduce access to health services amongst local IDUs or prompt increased injection-related risk behaviour. Increased cooperation between local law enforcement and public health bodies likely offset the potential for negative health consequences resulting from police activity.

Re: Nicoll A, Sprenger M. Learning lessons from the 2009 pandemic: putting infections in their proper place. Eur J Epidemiol 2011; 26:191–194

The article by Nicoll et al. [1] claims that learning lessons from the 2009 swine-flu pandemic means placing infectious diseases in proper perspective. We do not find a single proof for that. Moreover, the article misinterprets our paper [2]. The authors [1] agree that ‘‘sound infectious disease epidemiology must be applied to the surveillance of influenza epidemics’’ and that ‘‘data currently provided by the Global Influenza Surveillance Network are insufficient.’’ However, they do not respond to the cited work by Jefferson [3] that ‘‘the data on the seasonal influenza are similarly weak and the estimates of disease frequency, mortality, and case fatality are vague. Consequently, the effectiveness of seasonal influenza vaccination campaigns and of antiviral medications is more than questionable [3]’’. WHO’s changing of the definition or description of a pandemic in May 2009, removing the phrase ‘‘enormous numbers of deaths and illnesses’’ from WHO’s website, is not a myth [1] but has been documented [4]. To imply the invention of a new myth by proposing that the improvement of social conditions prevents epidemics of non-communicable (NCD) and communicable diseases (CD) alike, is remarkable, but contradicts the literature [5, 6, 7]. Tuberculosis is an example; although no effective drug or vaccination against tuberculosis was available in the nineteenth and first half of the twentieth century, this major scourge declined dramatically with the improvement of social conditions. Life expectancy ‘‘in the record holding countries’’ increased linearly from 1840 to 2000 by 40 years, i.e. 2.5 years per decade [8]. The life expectancy increase of 20 years from 1840 to 1920 cannot be linked to the invention of effective drugs or vaccinations but to the improvements in social conditions such as income, housing, working conditions, nutrition, education and sanitation. Nowhere did we criticise ‘‘the modern public health approach to tuberculosis control such as case finding and ensuring completion of proper antimicrobial treatment’’; nowhere did we question the present strategies of public health bodies to combat tuberculosis or vaccinations against diseases such as measles, mumps, whooping cough, etc. The attempt to label us vaccination opponents is unfounded. On the other hand, side effects of vaccinations must be monitored and investigated: Why do the authors not mention two epidemiological studies from Sweden and Finland indicating a fourto nine-fold increased risk of narcolepsy in children vaccinated with adjuvant containing Pandemrix as compared to unvaccinated children [9]. Deaths associated with Pandemrix vaccination have been reported from Sweden [10]. The willingness of the public to accept influenza vaccination depends primarily on the credibility, quality, and independence of advising institutions [11, 12]. Fear-mongering such as performed by industry-dependent marketing U. Keil (&) Institute of Epidemiology and Social Medicine, University of Munster, Domagkstrasse 3, 48149 Munster, Germany e-mail: keilu@uni-muenster.de

A Standardised Protocol for Evaluation of Anthelminthic Efficacy

A Standardised Protocol for Evaluation of Anthelminthic Efficacy

Vaccination of health-care workers against influenza: our obligation to protect patients

Please cite this paper as: Maltezou and Tsakris. (2011) Vaccination of health‐care workers against influenza: our obligation to protect patients. Influenza and Other Respiratory Viruses 5(6), 382–388.Nosocomial influenza poses a threat for specific groups of patients and is associated not only with the disruption of health‐care services but also excess costs. Although vaccination of health‐care workers (HCWs) has been recommended for almost three decades and constitutes the most convenient and effective means to prevent nosocomial transmission, vaccine uptake within this group remains unacceptably low worldwide. In regard to the pandemic influenza A H1N1, HCWs constitute a priority group for immunization. Nevertheless, low vaccination rates have been documented regarding the influenza pandemic and associated with the onset of nosocomial cases and outbreaks. HCWs, health‐care institutions, and public health bodies have the moral obligation to protect vulnerable patients and therefore weigh the benefits of mandatory vaccination. Key effective interventions, such as the education of HCWs concerning the benefits and safety of influenza vaccination, the reinforcement of on‐site, free of charge vaccinations, and the use of mobile vaccination teams in conjunction with incentives, should be widely implemented.

Natural products as starting points for future anti-malarial therapies: going back to our roots?

BackgroundThe discovery and development of new anti-malarials are at a crossroads. Fixed dose artemisinin combination therapy is now being used to treat a hundred million children each year, with a cost as low as 30 cents per child, with cure rates of over 95%. However, as with all anti-infective strategies, this triumph brings with it the seeds of its own downfall, the emergence of resistance. It takes ten years to develop a new medicine. New classes of medicines to combat malaria, as a result of infection by Plasmodium falciparum and Plasmodium vivax are urgently needed.ResultsNatural product scaffolds have been the basis of the majority of current anti-malarial medicines. Molecules such as quinine, lapachol and artemisinin were originally isolated from herbal medicinal products. After improvement with medicinal chemistry and formulation technologies, and combination with other active ingredients, they now make up the current armamentarium of medicines. In recent years advances in screening technologies have allowed testing of millions of compounds from pharmaceutical diversity for anti-malarial activity in cellular assays. These initiatives have resulted in thousands of new sub-micromolar active compounds – starting points for new drug discovery programmes. Against this backdrop, the paucity of potent natural products identified has been disappointing. Now is a good time to reflect on the current approach to screening herbal medicinal products and suggest revisions. Nearly sixty years ago, the Chinese doctor Chen Guofu, suggested natural products should be approached by dao-xing-ni-shi or ‘acting in the reversed order’, starting with observational clinical studies. Natural products based on herbal remedies are in use in the community, and have the potential unique advantage that clinical observational data exist, or can be generated. The first step should be the confirmation and definition of the clinical activity of herbal medicinal products already used by the community. This first step forms a solid basis of observations, before moving to in vivo pharmacological characterization and ultimately identifying the active ingredient. A large part of the population uses herbal medicinal products despite limited numbers of well-controlled clinical studies. Increased awareness by the regulators and public health bodies of the need for safety information on herbal medicinal products also lends support to obtaining more clinical data on such products.ConclusionsThe relative paucity of new herbal medicinal product scaffolds active against malaria results discovered in recent years suggest it is time to re-evaluate the ‘smash and grab’ approach of randomly testing purified natural products and replace it with a patient-data led approach. This will require a change of perspective form many in the field. It will require an investment in standardisation in several areas, including: the ethnopharmacology and design and reporting of clinical observation studies, systems for characterizing anti-malarial activity of patient plasma samples ex vivo followed by chemical and pharmacological characterisation of extracts from promising sources. Such work falls outside of the core mandate of the product development partnerships, such as MMV, and so will require additional support. This call is timely, given the strong interest from researchers in disease endemic countries to support the research arm of a malaria eradication agenda. Para-national institutions such as the African Network for Drugs and Diagnostics Innovation (ANDi) will play a major role in facilitating the development of their natural products patrimony and possibly clinical best practice to bring forward new therapeutics. As in the past, with quinine, lapinone and artemisinin, once the activity of herbal medicinal products in humans is characterised, it can be used to identify new molecular scaffolds which will form the basis of the next generation of anti-malarial therapies.

Dépistage du diabète gestationnel : vers un nouveau consensus ?

The choice of thresholds to diagnose gestational diabetes mellitus (GDM) is a topic of ongoing controversy. In 2008, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study showed continuous graded relationships between increasing maternal plasma glucose and increasing frequency of adverse perinatal outcomes. Macrosomia (birth weight > 90th percentile for gestational age), primary cesarean delivery, clinical neonatal hypoglycemia and hyperinsulinemia (cord serum C peptide > 90th percentile) were all related to each of the 3 glucose values (fasting plasma glucose and at 1 and 2 hours after the 75 g oral glucose test). The associations were continuous with no obvious thresholds at which risks increased. The International Association of Diabetes and Pregnancy Study Group (IADPSG) recently issued recommendations that the diagnosis of GDM be made when any of the following thresholds are met or exceeded: fasting plasma glucose: 0,92 g/L; 1 hour: 1,80 g/L; or 2 hours: 1,53 g/L after the 75 g oral glucose test. These criteria were chosen to identify pregnancy with increased risk of adverse perinatal outcomes. By the new criteria, the total incidence of gestational diabetes in the HAPO population was 17, 8%. Fasting plasma glucose (FPG) in early pregnancy appears as an important predictive factor. Higher first trimester FPG (lower than those diagnostic of diabetes) are associated with increased risks of later diagnosis of gestational diabetes and adverse pregnancy outcomes. Whether this new consensus will be adopted by public health bodies and professionals remains to be seen.

Surveillance of the 2009 flu pandemic in Belgium

Surveillance of the 2009 flu pandemic in Belgium

Determinants of intention to get vaccinated against novel (pandemic) influenza A H1N1 among health-care workers in a nationwide survey

A nationwide survey was conducted in October-November 2009 to investigate determinants of intention to get vaccinated against novel (pandemic) influenza A H1N1 among health-care workers (HCWs) in Greece. Out of 12,879 participating HCWs (response rate: 12.1%) working in 152 (40%) of 380 health-care facilities in Greece, 2814 (21.8%) reported that they intend to get vaccinated against novel influenza A N1H1. Intention rates to get vaccinated increased with age, male sex, being a physician, history of vaccination against seasonal influenza, training in use of personal protective equipment and hand hygiene, and training and involvement in the management of novel influenza cases. Main reasons for refusing vaccination were concerns about vaccine safety (43.1%), inadequate information about the vaccine (27.8%), and perception that they were not at risk for contracting novel influenza (10.7%). Given the low rates of acceptance of pandemic vaccination among HCWs, as found in this study, public health bodies should consider the implementation of a mandatory vaccination policy for HCWs for future pandemics, in order to prevent nosocomial transmission and to protect patients at high-risk for influenza-related complications and death, and to assure the continuity of the essential health-care infrastructure. New strategies should be explored to built safety perception towards influenza vaccines and enhance vaccination rates among HCWs.

Photoprotection and vitamin D status

The adverse effects of solar ultraviolet radiation on the skin are well documented, especially in fair-skinned people. These can be ameliorated by photoprotection strategies advocated by many public health bodies and typically include sun avoidance, sunscreen use and clothing. The UVB waveband which is the main cause of all adverse effects investigated in the laboratory to date is also the waveband for vitamin D photosynthesis which is the only established benefit of solar exposure. This is especially important because solar UVB is the main source of vitamin D for most people. There is increasing evidence that vitamin D plays a much greater role in human health than was previously thought. This has given rise to concerns that photoprotection, especially sunscreen use, could adversely affect vitamin D status and human health. Furthermore, it is stated that people with heavily pigmented skins often have poor vitamin D status because of photoprotection by melanin. In this paper we review the effect of photoprotection strategies and pigmentation on vitamin D status. Clothing can clearly be very effective at inhibiting vitamin D synthesis. Sunscreens are effective in theory and some limited human studies support this. However, most studies show little or no effect and the most likely reason for this is that sunscreens have not been applied in the manner that was used to determine their labelled index of protection against sunburn. This could change in the future if public health campaigns and the sunscreen industry are successful in encouraging the public to apply sunscreens more liberally and/or use much higher levels of labelled protection. The role of melanin on vitamin D status is not clear and requires further investigation.

Hormone Replacement Therapy advertising: sense and nonsense on the web pages of the best-selling pharmaceuticals in Spain

BackgroundThe balance of the benefits and risks of long term use of hormone replacement therapy (HRT) have been a matter of debate for decades. In Europe, HRT requires medical prescription and its advertising is only permitted when aimed at health professionals (direct to consumer advertising is allowed in some non European countries). The objective of this study is to analyse the appropriateness and quality of Internet advertising about HRT in Spain.MethodsA search was carried out on the Internet (January 2009) using the eight best-selling HRT drugs in Spain. The brand name of each drug was entered into Google's search engine. The web sites appearing on the first page of results and the corresponding companies were analysed using the European Code of Good Practice as the reference point.ResultsFive corporate web pages: none of them included bibliographic references or measures to ensure that the advertising was only accessible by health professionals. Regarding non-corporate web pages (n = 27): 41% did not include the company name or address, 44% made no distinction between patient and health professional information, 7% contained bibliographic references, 26% provided unspecific information for the use of HRT for osteoporosis and 19% included menstrual cycle regulation or boosting feminity as an indication. Two online pharmacies sold HRT drugs which could be bought online in Spain, did not include the name or contact details of the registered company, nor did they stipulate the need for a medical prescription or differentiate between patient and health professional information.ConclusionsEven though pharmaceutical companies have committed themselves to compliance with codes of good practice, deficiencies were observed regarding the identification, information and promotion of HRT medications on their web pages. Unaffected by legislation, non-corporate web pages are an ideal place for indirect HRT advertising, but they often contain misleading information. HRT can be bought online from Spain, without a medical consultation or prescription constituting a serious issue for public health. In our information society, it is the right and obligation of public health bodies to ensure that such information is not misleading.

Foreword: Oseltamivir for seasonal, avian and pandemic influenza: 10 years of clinical experience

Foreword: Oseltamivir for seasonal, avian and pandemic influenza: 10 years of clinical experience

Vietnam moves forward with harm reduction: An assessment of progress

Historically, the response of the Vietnamese government to illicit drug use and HIV has been slow and ineffective. However, 2006 saw the government formally endorse harm reduction interventions. This paper examines the views of senior key informants inside Vietnam on the development of an advocacy strategy for harm reduction. Twenty-nine informants were interviewed across public health, public security, social affairs and other international bodies, including United Nations agencies and international non-governmental organisations. Challenges and barriers identified for harm reduction progress included: promoting a nationwide understanding and acceptance of harm reduction and the HIV Law; lack of skilled resources, training programmes and technical capacity; poor coverage of interventions; and gaps in the sharing of information. There is currently a government-led shift in Vietnam in the response to the prevailing HIV epidemic among drug users, but ensuring that the HIV Law can operate unhindered is critical. The implementation of a response to illicit drug use and HIV remains an enormous challenge. With appropriate technical education and training, ongoing advocacy, and a cohesive, coordinated multi-sectoral effort, the capacity of the government and community to adopt, support and promote measures to reduce HIV and other drug-related harms will be markedly strengthened.

A systematic review of the effect of breakfast on the cognitive performance of children and adolescents

Breakfast is recommended as part of a healthy diet because it is associated with healthier macro- and micronutrient intakes, BMI and lifestyle. Breakfast is also widely promoted to improve cognitive function and academic performance, leading to the provision of breakfast initiatives by public health bodies. Despite this positive and intuitive perception of cognitive benefits, there has been no systematic review of the evidence. Systematic review methodology was employed to evaluate the effects of breakfast on cognitive performance in well-nourished children and nutritionally at-risk or stunted children. Acute experimental studies, school feeding programmes and studies of habitual breakfast intake are reviewed. Comparisons of breakfast v. no breakfast and breakfasts differing in energy and macronutrient composition are discussed. Included are forty-five studies described in forty-one papers published between 1950 and 2008. The evidence indicates that breakfast consumption is more beneficial than skipping breakfast, but this effect is more apparent in children whose nutritional status is compromised. There is a lack of research comparing breakfast type, precluding recommendations for the size and composition of an optimal breakfast for children's cognitive function. Few studies examined adolescents. Studies of school breakfast programmes suggest that such interventions can have positive effects on academic performance, but this may be in part explained by the increased school attendance that programmes encourage. The present systematic review considers methodological issues in this field and makes recommendations for future research design and policy priorities.

Survey of rotavirus surveillance, laboratory capacity and disease burden in the eastern part of the WHO European Region

Following the licensure of two rotavirus vaccines in Europe, we aimed to assess factors, such as surveillance, disease burden and laboratory capacity, which will be relevant for making decisions about rotavirus vaccine introduction in the different countries. We conducted an email-based survey of the national public health bodies in the World Health Organization (WHO) European Region in 2006 and report here the results from the 23 countries in the eastern part of the region. The survey included questions on rotavirus surveillance, laboratory capacity, burden (in children under the age of five years) and intention to introduce rotavirus vaccination. Countries were grouped into the four per-capita income categories defined by the World Bank. Fourteen of the 23 countries responded to the survey. All except one country reported that less than a quarter of their laboratories had rotavirus diagnostic capacity. Four countries had some form of specific rotavirus surveillance, but half were of very limited coverage. Ten countries did not report data on the incidence of rotavirus hospital admissions, although nine were able to report some data on rotavirus burden. Six of the responding countries said they were likely to introduce universal rotavirus vaccination. Rotavirus surveillance and laboratory capacity in the eastern part of the WHO European Region is limited but most countries had some estimate of rotavirus burden, often from special studies. The reported mortality rates were lower than those from a WHO mortality data source. Many countries in the eastern part of WHO European Region face a number of challenges before vaccine implementation, including strengthening surveillance, improving laboratory capacity and addressing financial barriers.

Acute hepatitis C virus infection

Around 25% of people infected with hepatitis C virus (HCV) are able to clear the infection spontaneously, while the majority become chronically infected, with a subsequent risk for the individual patient of progressive inflammatory liver disease, cirrhosis, hepatocellular carcinoma and liver-related death (Figure 1). Much is known about the epidemiology, pathogenesis, diagnosis and management of chronic HCV infection. In comparison, knowledge about acute HCV infection is patchy. In this article, we will highlight concerns relating to acute HCV infection and suggest that public health bodies responsible for managing the HCV epidemic should redirect at least some of their resources to dealing with these issues.

French Toxicovigilance Organization

ISEE-270 Objective: French poison control centers answer to inquiries from health professionals and also citizens. Human exposure cases are collected in each center's database. In 2004, the French Ministry of Health has transferred the field of toxic vigilance to the French Institute for Public Health Surveillance (InVS). Material and Methods: A national coordination committee for toxic vigilance (NCCT) was created including in its executive board experts from other French Public Agencies involved in many fields (AFSSET: environmental and occupational health safety, AFSSA: food safety, AFSSAPS: drug and human products). The president and vice-president of the committee are heads of 2 poison control centers. The NCCT includes all members cited above, directors of the 11 other French poison control centers and delegates from the Ministry of Health. The main missions of the NCCT are to participate in poisoning alerts (generated by the poison centers or other survey systems); to respond to specific requests from the Ministry of Health or other Public Health authorities (also to relay European working group requests to all member states); to implement postmarketing surveillance of new drugs; and to participate in all working groups created by national public health bodies needing a clinical toxicologist. Four thematic working groups were created within the NCCT to answer specifically to these missions: drugs, domestic poisonings, insecticides, and toxic deaths. Results: A national information system will be operational by mid-2007 allowing data use to detect incidents. Analysis of national mortality and hospital admissions associated with poisoning will be performed annually by the NCCT.

FINGERS BURNT: A COMMENT ON FOXCROFT (2005)

FINGERS BURNT: A COMMENT ON FOXCROFT (2005)