A large rubella outbreak, Romania--2003

Romania experienced a large rubella outbreak in 2002-03, with more than 115,000 reported cases nationwide, and an incidence of 531 reported cases per 100,000 population. The incidence was highest in children of school age. The cohorts of adolescent girls vaccinated in 1998 and 2002 (when a rubella-containing vaccine was available) had significantly lower incidence rates (p<0.001) compared with those in boys in the same age groups who were not vaccinated. In 2003, of the 150 suspected congenital rubella syndrome (CRS) cases reported, seven (4.6%) were confirmed by positive rubella IgM antibodies. In the absence of available rubella containing vaccine for outbreak control, an outbreak response plan to improve the detection of cases and to limit rubella virus transmission was developed. The following activities were conducted: surveillance of pregnant women with suspected rubella or history of exposure to rubella virus was implemented, with follow up of pregnancy outcomes; surveillance for CRS was strengthened; existing infection control guidelines to prevent disease transmission within healthcare facilities were reinforced; and a communication plan was developed. In May 2004, Romania is introducing measles, mumps and rubella (MMR) vaccine for routine vaccination of children aged 12 to 15 months, while continuing vaccination of girls in the 8th grade of school (13-14 years of age) with rubella-only vaccine.     

Parasitic nematodes of anseriform birds in Hokkaido, Japan

Summary  Parasitic nematodes of 176 individuals of 15 bird species belonging to the order Anseriformes from Hokkaido, Japan were investigated. A total of 12 nematode species were obtained, namely Amidostomum anseris, A. acutum, Epomidiostomum crami, E. uncinatum, Tetrameres fissispina, Eucoleus contortus, Capillaria anatis, Baruscapillaria mergi, Contracaecum rudolphii, Echinuria uncinata, Streptocara crassicauda and Sarconema eurycerca. Among these, E. uncinatum (hosts: Anas platyrhynchos, A. poecilorhyncha, A. acuta, Mel. nigra) and E. crami (hosts: Anser albifroms, Ans. fabalis, C. cygnus, C. columbianus) were the first geographical records in Japan. There appeared to be strict host-parasite relationships between the wild swans/geese and A. anseris/E. crami, and between wild duck species and A. acutum/E. uncinatum, respectively.     

Incidence rate of acute myocardial infarction in Hokkaido, Japan

A survey of acute myocardial infarctions (AMI) that occurred from October 1990 through September 1993 in Obihiro City, Hokkaido, was conducted. A total of 114 new cases of AMI was registered over the 3-year period. The incidence rate of AMI was 33.4 cases per 100,000 men per year and 137 cases per 100,000 women per year (total, 23.2 cases). The mean age at which AMI occurred was 11 years higher in women (71.1 +/- 9.4 years) than in men (60.0 +/- 11.8 years). In men, AMI was most common during the eighth decade of life, while in women the incidence of AMI increased after menopause. The ratio of cases of AMI to cases of stroke in the same period was 1:4.5. These results did not differ from the results of other surveys done over the same period in seven other area of Japan. To study risk factors for myocardial infarction, the data were grouped according to the results of medical examinations. Hypertension, diabetes, obesity and smoking were common among people with AMI. The incidence rate of hypercholesterolemia did not differ between those with AMI and those without, and only a relatively small number of people with AMI drank alcohol. Past reports have pointed out changes in the 'structure' of cardiovascular disease in Japan, which have accompanied changes in diet and lifestyle. This study has shows that aging hypertension, diabetes, obesity, and smoking are risk factors for myocardial infarction. Proper management, including early detection of these factors, will help to prevent of ischemic heart disease in Japan.     

An unexpected outbreak of Japanese encephalitis in the Chugoku district of Japan, 2002

Six patients unexpectedly presented with Japanese encephalitis (JE) from early August to mid-September 2002 in the Chugoku district of Japan. The mean age was 67.5 years (range 42 - 89 years); the onset period in two patients shifted to the middle of September. The JE virus was isolated from the cerebrospinal fluid samples from two patients, and the strain isolated in the one was identified as genotype III. Neurologically, consciousness impairment, meningeal signs, rigidity, hemiparesis, tetraparesis, and convulsive seizures were commonly observed. Magnetic resonance imaging uniformly revealed high signal intensities in the bilateral thalami, brainstem (substantia nigra), hippocampi, and brain cortices. In all patients, acyclovir was used, due to the unexpected outbreak of JE. Five patients, except for one without sequelae, had a severe outcome, including one death. This report indicates that JE in Japan is still a threat to adults and the elderly with decreased or absent immunity to the JE virus.     

Mass screening for hepatocellular carcinoma: Experience in Hokkaido, Japan

Abstract Mass screening for liver cancer based mainly on abdominal ultrasound was begun in major cities of Hokkaido, Japan, in November 1981, to enable early detection and treatment of hepatocellular carcinoma (HCC). Serum alpha-fetoprotein levels were also measured to minimize false negative studies. Examinees included those who sought liver disease screening as well as high risk individuals: hepatitis B surface antigen carriers and those with a past or current liver disease, history of blood transfusion, family history of liver cancer, and more recently those with positive anti-hepatitis C antibodies. The examination was carried out on each Saturday and Sunday as one round, and by February 1992 48 rounds had been performed. A total of 8090 individuals were investigated, and HCC was detected in 91 with a detection rate of 1.12%. This rate was 1.6% among 5684 individuals who were selected for high risk. Cumulative rates of survival among these patients were 79.0% at 1 year, 43.8% at 3 years, 19.3% at 5 years and 15.4% at 7 years. These survival rates were comparable with those for the patients with HCC diagnosed during follow-up of chronic liver disease and treated at our hospital. The cost for detecting one HCC patient in this programme was ¥ 2 660 000 (∼US$25 000), which was less than those for some other types of cancer in a similar setting. Considering the high detection rate in this programme, we feel that similar programmes should be encouraged and supported.     

Measles outbreak in a suburb of Tokyo, Japan, in 1998-1999

A 1998-1999 outbreak of measles in Kawasaki City was studied to provide an up-to-date epidemiological understanding of the disease in Japan. 21 of the 69 total patients (30.4%) seen at the hospital were under 1 y of age. None of the 69 patients had received measles vaccine. 43 out of 50 nasopharyngeal swabs subjected to polymerase chain reaction assay (86%) were positive for the hemagglutinin (H) gene. The measles strain isolated from patients was classified as a D3 genotype. Such outbreaks are important epidemiologically, and these findings shed light on vaccination and immunity patterns in this urban population.     

HIV incidence during a cluster-randomized trial of two strategies providing voluntary counselling and testing at the workplace, Zimbabwe

OBJECTIVE: To investigate HIV incidence during a trial of two voluntary counselling and testing (VCT) strategies. Counselling may promote beneficial behavioural change, although knowledge of negative status does not appear to contribute further benefit. DESIGN: The parent cluster-randomized trial demonstrated much greater uptake of VCT when counselling and rapid testing were available on-site (intensive VCT) than through pre-paid vouchers to an external provider (standard VCT). Anonymous HIV tests had been requested from all employees at enrolment and after 2 years intervention. METHODS: The study setting was 22 businesses in Harare, Zimbabwe. Participants were 3146 HIV-negative individuals remaining in employment at the end of intervention, of whom 2966 (94.3%) consented to repeat testing. VCT linked to basic HIV care was provided and the main outcome measures were HIV incidence under each study arm, as a retrospective secondary analysis. RESULTS: Mean VCT uptake in this cohort was 70.7 and 5.2%, respectively, in the intensive and standard arms. Crude HIV incidence was 1.21 per 100 person-years, with non-significantly higher rates in the intensive VCT arm [mean site incidence 1.37 and 0.95 per 100 person-years, respectively; adjusted rate ratio 1.49 (95% confidence interval 0.79-2.80). CONCLUSIONS: Highly acceptable VCT did not reduce HIV incidence in this predominantly male cohort. HIV incidence was highest in the high uptake VCT arm, lending support to a US trial in which rapid testing appeared to have adverse behavioural consequences in some HIV-negative clients. Careful comparison of outcomes under different counselling and testing strategies is needed to maximize HIV prevention from global scale-up of VCT.