Dengue type 1 epidemic with haemorrhagic manifestations in Fiji, 1989-90.

A dengue type 1 epidemic occurred in Fiji between July 1989 and July 1990. Virus isolation in C6/36 cell cultures and Toxorhynchites mosquitos yielded 36 strains. Of the 3686 cases recorded by the Ministry of Health, 60% involved indigenous Fijians and 37%, Indians. A house-to-house survey revealed that a large majority of patients had classical dengue symptoms and 8% reported haemorrhagic manifestations. Among the children and adults hospitalized for dengue, 43% had haemorrhagic manifestations, including epistaxis, gingival bleeding, haematemesis, melaena and haematuria. A total of 15 patients with haemorrhagic manifestations and/or shock died, 10 of whom were aged 0-15 years; the diagnoses were confirmed in four cases by virus isolation or serology.     

The 1988-1989 measles epidemic in Hungary: assessment of vaccine failure.

Hungary has had a successful measles vaccination programme, achieving over 93% coverage in targeted groups. However, from September 1988 until December 1989, 17,938 measles cases were reported among the civilian population (attack rate [AR] = 169 per 100,000 population) with the majority of cases occurring in vaccinated people. National surveillance data were analysed to determine reasons for the outbreak and risk factors for vaccine failure. People born during 1971 and 1972 had been targeted for vaccination during campaigns in April and September of 1973 and had the highest AR (1332 and 1632 per 100,000, respectively). Epidemiological studies of vaccine efficacy conducted among secondary school students corroborated these findings. Among 754 secondary school students, those vaccinated during the April 1973 campaign were at highest risk compared with those vaccinated at routine health care after 1974 (relative risk = 10.9, 95% confidence interval [Cl]: 2.5-47.9). Among 341 primary school students, one-dose recipients were at higher risk compared with two-dose recipients controlling for age at and time elapsed since vaccination (P = 0.04).     

Enteroviruses in Spain: virological and epidemiological studies over 10 years (1988-97)

A total of 15,662 clinical samples were analysed for enterovirus (EV) isolation in cell cultures during a 10-year period (1988-97). Furthermore, 210 isolates of EV obtained in primary laboratories within Spain from patients with meningitis were characterized. The total number of EV typed was 758, including 727 non-polio EV and 31 Sabin-like (SL) polioviruses. Twenty-eight EV serotypes were represented. Echoviruses comprised 90% (653/727) of fully typed non-polio EV. The four most prevalent serotypes were echovirus 30, echovirus 9, echovirus 6 and echovirus 4. Echovirus 30 was the main serotype associated with meningitis. Echovirus 9 was the aetiological agent in 20 outbreaks of meningitis while the occurrence of echovirus 6 was localized in 1 year (1997). Coxsackieviruses A and B occurred in 3 and 7% of the non-polio EV respectively. Coxsackievirus B5 presented the relative greater abundance. This paper examines the epidemiology of EV in Spain to serotype level over a 10-year period with special attention to non-polio EV associated with meningitis.     

Seroepidemiology and evaluation of passive surveillance during 1988-1989 measles outbreak in Taiwan.

A seroepidemiological study was carried out to explore the risk factors of a measles outbreak that occurred among school children at a rural village (Li-Tse) in Taiwan. Among the 1166 participants, the percentage susceptible before the outbreak was 10.5% (122/1158) which was estimated as the sum of measles IgG-negative (29/1158) and IgM-positive (93/1166) individuals. Among 340 vaccinated children, 16 (4.7%) were measles IgM-positive and 10 (2.9%) were measles IgG-negative; therefore the vaccine failure rate was estimated to be 7.6% (26/340) and vaccine efficacy was 79.7% (95% confidence interval [CI] : 65.0-88.5). The most important risk factors for acquiring measles infection were the presence of other measles cases in the family (Odds Ratio [OR] = 32.5, P = 0.002) and the presence of more than two cases in a class (OR = 29.1, P = 0.003). The physician reporting rate was 6.1% (4/66), and the sensitivity of passive measles surveillance was only 4.3% (4/93) by active serosurvey. A concomitant rubella epidemic also amplified the inaccuracy of a passive reporting system based only on clinical diagnosis. Five children developed measles IgM but did not experience any symptoms, indicating that asymptomatic measles infection can occur. Our experience has highlighted three important areas for future measles elimination: (1) the need for serological evaluation of vaccinees, particularly those who were born during the introduction of mass immunization; (2) improvement in measles vaccine efficacy; and (3) further investigations on the role of asymptomatic transmission and susceptibles who remain after mass immunization.     

Influenza surveillance in Korea: establishment and first results of an epidemiological and virological surveillance scheme

Surveillance is an important component of influenza control. This report describes the establishment and first results of the Korean Influenza Surveillance Scheme (KISS), an integrated clinical and laboratory surveillance network involving 622 public health centres (PHCs) and private clinics. Sentinel physicians reported cases of influenza-like illness (ILI) weekly and forwarded specimens for virus isolation and characterization. Influenza activity during the opening 2000-2001 season was milder and delayed compared with previous years. The ILI consultation rate corresponded well with the number of influenza virus isolates, both peaking in week 10 of 2001. Influenza A(H3N2) was the dominant isolate. The peak ILI consultation rate was higher in private clinics than in PHCs (5.04 vs 1.79 cases/1000 visits). An evaluation questionnaire generated potential enhancements to the scheme. KISS appears to represent the pattern of influenza activity accurately and will have a valuable role in monitoring and preventing epidemics in Korea.     

Twenty-five years of the AIDS epidemic in Brazil: principal epidemiological findings, 1980-2005

The Brazilian AIDS epidemic is undergoing important changes in its third decade. The present article reviews some central findings: the proportional reduction in cases related to injection drug use; the stability, in recent years, of new cases in the male homosexual/bisexual population; and the relative and absolute increment in heterosexual transmission, even though the estimates of incident rates still point to the first two categories mentioned as those most affected by the epidemic. Still should be detached the persistent increase in incidence rates among women and its stability in the younger age groups, probably the result of behavior changes (such as the consistent use among youth of condoms in sexual relations with casual partners and a reduction in cases related to injection drug use). It is well-know that HIV prevalence in the general population has stabilized at less than 1%, which characterizes Brazil as one of the countries with a concentrated epidemic. The article also emphasizes the growth of AIDS morbidity-mortality in the less favored socioeconomic strata and in women, and the stability of the mortality rate among men.     

Cancer screening behaviors among U.S. women: breast cancer, 1987-1989, and cervical cancer, 1988-1989.

Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to examine trends in breast and cervical cancer screening behaviors among U.S. women in selected states. Data reported are from the 1987, 1988, and 1989 BRFSS for breast cancer screening (mammography) and from the 1988 and 1989 BRFSS for cervical cancer screening (Papanicolaou [Pap] smear). Results are presented as either state-specific or state-aggregate data for the years noted above. State-specific analyses indicated that self-reported mammography utilization increased between 1987 and 1989. Although whites and blacks reported similar mammography utilization rates both for screening and for a current or previous breast problem, disparities were evident among women of different ages and incomes. The proportion of women who reported ever having had a Pap smear and having heard of a Pap smear were extremely high and remained fairly consistent across the 2 survey years. State-aggregate analyses, however, showed that the percentage of women who had had a Pap smear within the previous year was negatively associated with age and positively associated with income. A higher proportion of blacks than whites obtained Pap smears. These results indicate that certain segments of the population are not taking full advantage of available breast and cervical cancer screening technologies. Public health strategies, such as those outlined in the Breast and Cervical Cancer Mortality Prevention Act of 1990 (Public Law 101-354), should enhance screening opportunities for these women.     

Dengue epidemic in the stage of Rio de Janeiro, Brazil, 1990-1: co-circulation of dengue 1 and dengue 2 serotypes.

During 1990 and 1991, dengue fever was detected in the State of Rio de Janeiro, Brazil. It occurred in two epidemic waves; one, from January to August 1990, caused predominantly by dengue virus type 1 (DEN-1) the other from October 1990 to May 1991 caused by type 2 virus (DEN-2). Dengue was confirmed by virus isolation and/or IgM capture enzyme-linked immunosorbent assay (MAC-ELISA) in 2109/5964 (35.4%) of the cases. DEN-2 virus was isolated from 180 patients. HAI tests indicated that of these previous infection with DEN-1 had occurred in 130 (72%). The epidemic was classified as dengue fever, but severe and even fatal cases occurred in association with secondary infection.     

A fatal case of Crimean-Congo haemorrhagic fever in Mauritania: virological and serological evidence suggesting epidemic transmission

Crimean-Congo haemorrhagic fever (CCHF), a tick-borne viral zoonosis, is focally endemic throughout parts of Eurasia, the Middle East and Africa. In sub-saharan West Africa only 2 previous cases, both non-fatal, have been reported. We documented a fatal human case of CCHF in south-western Mauritania during May 1988 by demonstrating CCHF virus-specific class M antibodies and by isolating CCHF virus. Five of 7 other patients simultaneously in hospital with haemorrhagic fever symptoms also exhibited elevated immunoglobulin (Ig) G. Healthy family members and contacts of these patients showed an IgG prevalence of 36%; similarly 29% of their sheep also had antibodies. A serosurvey of 1219 sheep from 14 widely dispersed sites throughout southern Mauritania demonstrated IgG prevalences ranging from 4.9% to 43.6%. IgM was found in many herds. These observations demonstrate that CCHF virus is enzootic in southern Mauritania, and suggest a recent period of intense transmission in parts of the region.     

Dengue surveillance in French Polynesia: An attempt to use the excess number of laboratory requests for confirmation of dengue diagnosis as an indicator of dengue activity

The excess number of weekly laboratory requests for confirmation of dengue diagnosis over the expected number of requests forecasted by the modified Serfling method is proposed for the surveillance of dengue in French Polynesia, in addition to conventional methods. Retrospective analysis of the seasonal curves of dengue activity related to the number of laboratory requests is described for the years 1982–1987 where dengue type 4 was the only active flavivirus at the time when the forecast was initiated. By using past epidemic data, the probability of,failing to recognize an increase in excess of requests as possibly epidemic was of 13.2% and 5.8%, respectively, when the criterion for epidemic increase was set respectively at 2 and 3 successive weeks during which the epidemic threshold is exceeded. A weekly surveillance was set up prospectively for 1988 using these criteria.Corresponding author.     

Kala-azar in displaced people from southern Sudan: epidemiological, clinical and therapeutic findings.

Six hundred and ninety-three patients with kala-azar were seen in Khartoum, Sudan, from January 1989 to February 1990. They were almost exclusively from the Nuer tribe, originating from the western Upper Nile province in southern Sudan, an area not known previously to be endemic for kala-azar. Because of the civil war in southern Sudan no treatment was available locally and massive migration to northern Sudan occurred; many died on the way. All age groups were affected; there was a slight male preponderance (56%). In the clinical presentation, marked generalized lymphadenopathy was prominent (84%). Splenomegaly was absent in 4% of cases. Patients usually showed anaemia, leucopenia and/or thrombocytopenia. 623 patients were treated with sodium stibogluconate, 10 mg/kg for 30 d; relapse occurred in 4% and death in 12%. Latterly, 70 patients were treated with sodium stibogluconate at 2 x 10 mg/kg for 15 d, with relapse in 6% and death in 6%. The difference between the 2 regimens in the number of relapses and deaths was not significant. The outbreak may have been caused by a combination of factors: the introduction of the parasite from an endemic area to a non-immune population, the presence of malnutrition caused by loss of cattle and unavailability of other food sources, and possibly an ecological change in favour of the sandfly vector.     

Pregnancy-induced hypertension in North Carolina, 1988 and 1989.

INTRODUCTION. Pregnancy-induced hypertension (PIH) is a highly prevalent pregnancy complication with adverse effects on maternal and infant health. Epidemiologic research concerning its etiology is limited. METHODS. Birth records from North Carolina for the period 1988 through 1989 included an indication of the presence of PIH. The risk of PIH was examined in relation to several maternal characteristics and exposures, including reproductive history, demographic characteristics, and tobacco use during pregnancy. Risk ratio estimates, adjusted for confounders, were calculated contrasting PIH among exposed vs unexposed women. RESULTS. The overall risk of PIH was 43.1 per 1000 births, with multiple pregnancies, nulliparity, and advanced maternal age associated with markedly increased risks. Tobacco use was inversely associated with PIH, and Blacks and Whites were at virtually equal risk. CONCLUSIONS. Problems in diagnosis and classification impede research in this area, with birth certificates limited in quality and breadth of information. Nonetheless, several patterns emerged that are worthy of further epidemiologic evaluation using more sophisticated designs.     

Dengue vector surveillance programs: a review of methodological diversity in some endemic and epidemic countries

Vector surveillance is a cornerstone of dengue management yet there is a diversity of surveillance programs evident internationally. Such diversity is described in this review to enable a broader assessment of dengue vector surveillance methods. This review describes the diversity of surveillance programs for dengue vectors in several endemic and epidemic countries. Furthermore, strengths and weaknesses of vector surveillance methods, including larval surveys, BG-Sentinel trap, and autocidal and sticky ovitraps, are also discussed. The ability to compare and contrast these programs could contribute to the finding of better methods both locally and nationally and facilitate interregional technology transfer. Health authorities in both endemic and epidemic countries alike could benefit from adopting technologies and practices from other regions.     

Polio outbreak in Algeria: epidemiological, virological and vaccinational aspects

During a poliomyelitis outbreak (October 1983) in El Oued territory (Algeria) 28 cases were diagnosed. All the patients were under 4 years old. The ratio of females to males was 0.33. No deaths occurred during this epidemic. 25 of the 28 polio cases were diagnosed by cell culture and 81% were polio type 1. The epidemiological survey established that the epidemic was due to the insufficiency of vaccination coverage, since the consumption of antipolio vaccine in the epidemic area had dropped by 25% from 1982 to 1983. 7 of the 28 polio cases had been given at least 3 injections of vaccine at the correct intervals. 5 of 8 vaccine samples from the epidemic area had an insufficient titre of polio type 1. These observations showed that the nature of the vaccine, whether killed or live virus, was less important for controlling poliomyelitis than providing medical and sanitary facilities to ensure good vaccination coverage.     

Human and animal epidemic of Yersinia enterocolitica O:9, 1989-1997, Auvergne, France.

Yersinia enterocolitica O:9 infections were reported in Auvergne in 1988 to 1989, while brucellosis due to Brucella abortus was almost eliminated. The serologic cross-reactions between the two bacteria complicated the diagnosis of brucellosis cases. In 1996, human cases of Yersinia enterocolitica O:9 infection were detected, with a peak incidence of 12 cases. Veterinary surveillance could have predicted the emergence of this disease in humans.     

连云港市赣榆区1～10岁健康儿童流行性脑脊髓膜炎A、C群、百日咳、白喉、破伤风抗体水平的监测

目的 了解江苏省连云港市赣榆区1～10岁健康儿童流行性脑脊髓膜炎A、C群（分别简称A群流脑和C群流脑）、百日咳、白喉、破伤风特异性抗体水平,从而为免疫规划工作提供参考依据。方法 通过儿童计划免疫管理系统,从本地25个接种点接种数据库中随机抽取1～10岁全程免疫健康儿童,采集末梢血样18 747份,采用酶联免疫吸附试验法检测上述5 种传染病特异性IgG抗体水平,并对结果进行统计学分析。结果 调查的18 747份末梢血样中,A群流脑、C群流脑、百日咳、白喉、破伤风IgG 抗体阳性率分别为97.9%、98.0 %、 99.1%、 98.5%、99.0%,各个年龄组的5种抗体阳性率均在94.9%以上。城镇儿童和农村儿童间5种抗体阳性率差异均有统计学意义,城镇儿童5种抗体阳性率均低于农村儿童。 结论 赣榆区1～10岁儿童上述5类传染病特异性抗体均维持在较高水平,城镇儿童5种抗体阳性率均低于农村儿童,应加强流动人口的免疫规划疫苗接种工作。     

Influenza deaths in Leicestershire during the 1989-90 epidemic: implications for prevention.

There is an association between excess winter mortality and epidemics of influenza and it has been suggested that annual influenza vaccination should be offered to all over 65 years old as in the United States. This paper identifies the number of people dying from influenza in Leicestershire UK during the 1989-90 epidemic and the factors associated with a fatal outcome. The findings show that deaths attributed to influenza occur predominantly in very elderly people with underlying ill-health. The risk of influenzal death is greater in residential patients and increases substantially with the number of underlying medical conditions. The estimated death rates in vaccinated and non-vaccinated groups were not significantly different, but there were trends towards protection in both residential and non-residential groups. Influenza vaccine is not reaching the principal target groups and improved methods of influenza control are required.     

2009-2013年上海市普陀区流感样病例监测及流行特征分析

目的 掌握2009-2013年普陀区流感样病例流行特征.方法 收集2009-2013年流感样病例(Influenza-like illness,ILI)监测数据,分析各周次和月次的就诊百分比和病原学分型阳性率、构成比等变化趋势.结果 2009-2013年普陀区流感样病例就诊百分比分别为2.50％、2.46％、2.11％、3.27％、7.15％,每年有两个季节高峰;2009-2013年,共检测标本3 656份,阳性率为27.13％,以A型为主;聚集性流感样病例共接报41起,发生地主要在中小学校.2、3、9、1 1和12月份发生起数较高,占全部事件的78％.结论 近五年流感样病例就诊百分比在波动中逐渐走高,每年有两个就诊高峰,尤其冬春季,需警惕学校和幼托机构的聚集性病例的发生;流行毒株每年发生变化.