A serosurvey of Coxiella burnetii infection in children and young adults in South West Queensland

Objective: To describe the seroepidemiology of Coxiella burnetii , the causative agent of Q fever, in those under 25 years of age in South West Queensland.
Methods: A convenience sample of residual sera from a diagnostic laboratory was tested for C. burnetii antibodies by immunofluorescence at 1:10 dilution. Prevalence and annual incidence were calculated from the results.
Results: Twenty-nine of 447 (6.5%, 95% CI 4.5%-9.2%) samples were positive. Seropositivity increased from 2.5% in those <15 (95% CI 1.0%-5.5%) to 11.0% in those 15-24 years old (95% CI 7.4%-16.0%). The estimated annual incidence for the latter age group was 7.7 per 1,000.
Conclusions: Q fever is a relatively common infection in South West Queensland, even in those aged <15 years for whom the vaccine is not recommended.
Implications: Vaccination programs, such as the federally funded National Q fever Management Program, are needed in this and similar high risk rural areas.     

Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa

Background  

Worldwide there is growing attention paid to the reproductive decisions faced by HIV-infected individuals. Studies in both developed and developing countries have suggested that many HIV-infected women continue to desire children despite knowledge of their HIV status. Despite the increasing attention to the health care needs of HIV-infected individuals in low resource settings, little attention has been given to reproductive choice and intentions. Health care providers play a crucial role in determining access to reproductive health services and their influence is likely to be heightened in delivering services to HIV-infected women. We examined the attitudes of health care policy makers and providers towards reproductive decision-making among HIV-infected individuals.     

A serosurvey of pathogens associated with shellfish: prevalence of antibodies to Vibrio species and Norwalk virus in the Chesapeake Bay region.

Recent concerns regarding the safety of shellfish consumption have focused on the risk posed by naturally occurring marine bacteria such as Vibrio species and by viruses such as Norwalk and related agents. Despite the widespread environmental presence of Vibrio species in the Chesapeake Bay, the rate of reported infections remains low; there have also been no reports of major Norwalk outbreaks associated with shellfish in this area. As infections with these agents may not always be recognized because of difficulties in making the diagnosis and/or their mild or subclinical presentation, a serosurvey was conducted among healthy volunteers living in the Chesapeake Bay region. Serum and questionnaire data were collected during the fall of 1987 from 267 persons with varying levels of exposure to shellfish: shellfish industry workers, persons attending a local seafood festival, and Seventh-day Adventists (who traditionally abstain from eating shellfish). In comparisons among groups, a significant association could not be demonstrated between shellfish consumption or contact and antibody response to Vibrio cholerae O1 or Norwalk virus. Rates of seropositivity were high for both agents (up to 22% seropositive with a V. cholerae O1 Inaba vibriocidal assay, 14% with an enzyme-linked immunosorbent assay for cholera toxin, and up to 70% seropositive with an enzyme-linked immunosorbent assay for antibodies to Norwalk virus); the basis for these responses in population-based studies remains to be determined. Shellfish industry workers did have a significantly elevated antibody response to the unencapsulated phase variant of Vibrio vulnificus as compared with the other groups studied. Infection with V. vulnificus may be relatively common among persons with high levels of exposure to shellfish.     

The 'dop' system, alcohol abuse and social control amongst farm workers in South Africa: a public health challenge.

Many farm workers in South Africa continue to live and work under adverse conditions that are the legacy of apartheid policies. Despite its official prohibition, the arrangement by which workers are given alcohol' as a benefit of employment, known as the 'dop' system, appears to persist. Even though it is a minority of farms that currently actively practice the dop system, the ramifications of the historical 'institutionalisation of massive alcohol consumption are widespread. Heavy alcohol consumption is not only directly injurious to the health of farm workers and their families, but places them at risk to various social and environmental hazards. This is illustrated in a case of pesticide poisoning in which 24 workers were poisoned when given wine contaminated with the carbamate insecticide aldicarb. The case illustrates (i) the ongoing application of the dop system on farms in South Africa and (ii) the interaction between social factors and chemical exposures amongst farm workers. Public perceptions about the natural tendencies of 'coloured' people to drink heavily have much to do with perpetuating the dop system, and reinforcing a system geared towards the social control of rural farm workers and their families. The dop system poses a major challenge to the public health authorities in South Africa who are charged with the task of restructuring health services to address the human rights and health needs of marginal farming communities within a primary health care framework.     

Potential risk factors for asbestos exposure amongst six-month-old infants living in the township of Soweto,South Africa

During recent years there has been increased attention paid to public exposure to asbestos in the non-occupational environment. As part of a longitudinal cohort study of urban child health and development (the Birth to Ten Project) undertaken in Soweto-Johannesburg, environment and health conditions were assessed, including the potential for exposure to asbestos in low-income housing settlements. Respondents from Soweto reported that 52% of a sample of 1488 six-month-old infants, were living in asbestos-roofed houses. Analyses in relation to the asbestos-roofed houses, showed that more than 63% were older than 20 years, and that ceilings were absent in 62% of such houses. Leaking roofs, water damage and flaking interior paint in 17%, 13% and 14% of asbestos-roofed houses, respectively, indicated considerable infrastructural decay. In 6% of houses, household members themselves had undertaken work involving cutting or sawing the asbestos roofs, during the six-month period prior to the interview. Only 10% of respondents thought that asbestos could adversely affect their health, or that of their children. The study indicated a need for vigilance in relation to the potential for current and future community exposure to asbestos in low-cost, ageing housing settlements in South Africa.     

A century of miners' compensation in South Africa

The year 2011 marked the centenary of compensation legislation for miners' lung disease in South Africa. This commentary aims to demonstrate that the current compensation system does not serve its intended beneficiaries, particularly the large population of former gold miners affected by high rates of silicosis and tuberculosis. The system has a complex legislative history, reflecting contending political, and economic forces, and characterized by racial discrimination. The financial basis of the system is currently in crisis owing to historical underfunding and failure to take into account the mounting burden of disease among black former miners. The real value of compensation awards fell sharply between 1973 and 1993, only partly recovering in recent years. Barriers to claiming benefits, particularly by black former miners who know little about the process, have been extensively documented. Integration of miners' compensation into general workers' compensation has been mooted since the 1980s but has stalled, owing to the high cost of closing the gap between the mostly inferior financial benefits under the mining legislation and those available under workers' compensation legislation. A recent constitutional court decision has opened the way for unprecedented civil litigation against the gold mining industry for silicosis, adding to the pressure for reform. A number of changes are called for: harmonization of financial benefits with retention of certain of the special arrangements for miner claims, a regional cross-border system of medical examination points for former miners, education of miners about the system, and some degree of privatization of claims processing.     

Diarrhoeagenic bacterial pathogens in HIV-positive patients with diarrhoea in rural communities of Limpopo Province,South Africa

Potential enteric bacterial pathogens in 60 HIV-positive patients with chronic diarrhoea in rural communities of the Limpopo Province, South Africa, were identified using standard microbiological methods. The Kirby-Bauer disk-diffusion method was employed to determine antibiograms of isolated bacteria. Results revealed that diarrhoeagenic bacterial agents were isolated from 48 (80%) of the 60 HIV-positive patients with diarrhoea. Forty-four (73.3%) and 16 (26.7%) of the 60 patients were female and male respectively in the age range of 17-55 years with a mean of 34 years. Bacterial pathogens isolated comprised Campylobacter species (20.0%), Plesiomonas shigelloides (16.6%), Aeromonas species (13.3%), and Escherichia coli, Shigella and Salmonella species (10.0% each). No attempts were made to isolate parasites, fungi, or viruses. Antibiotic susceptibility profiles revealed resistance of the isolates to ampicillin, cephalothin, chloramphenicol, erythromycin, and streptomycin. However, all (100%) of P. shigelloides and Salmonella species were sensitive to nalidixic acid and ciprofloxacin. Most isolates were susceptible to nalidixic acid, ciprofloxacin, and gentamicin, indicating the usefulness of these drugs, although antibiograms may not always correlate with clinical usefulness.     

A rubella serosurvey in postpartum women in the three regions of Peru.

OBJECTIVE: To determine the proportion of postpartum women aged 15-49 in Peru who are susceptible to rubella, in order to help address strategies to eliminate rubella and to prevent congenital rubella syndrome (CRS) in the country. METHODS: A cross-sectional survey was conducted during March and April 2003 in six main regional hospitals, in the three geographic regions (coast, mountain, and jungle) of Peru. For the postpartum women who provided written informed consent, a questionnaire was administered and a blood specimen was collected. Sera were tested for rubella immunoglobulin G (IgG) antibody, using a commercial enzyme-linked immunosorbent serologic assay (ELISA) kit. Univariate, bivariate, and multivariate analyses were carried out to assess risk factors for susceptibility. RESULTS: In total, 1 236 postpartum women were enrolled. The overall proportion of IgG-antibody negative women was 12.8% (95% confidence interval (CI): 10.9%-14.6%). Bivariate analysis found the following variables associated with susceptibility: living in the jungle region (odds ratio (OR) = 1.65; 95% CI: 1.13-2.42); age < 19 years (OR = 2.02; 95% CI: 1.35-3.03); being a housewife (OR = 1.69; 95% CI: 1.12-2.55); and having < or = 11 years of education (OR = 2.12; 95% CI :1.20-3.75). Multivariate analysis found the following variables were associated with susceptibility: living in the jungle region (OR = 1.67; 95% CI: 1.13-2.46); age < 19 years (OR = 1.62; 95% CI: 1.07-2.47); having < 4 children born alive (OR = 1.85; 95% CI: 1.00-3.40); and having < or = 11 years of education (OR = 2.07; 95% CI: 1.16-3.71). CONCLUSIONS: The proportion of postpartum women at the study sites who were found to be susceptible to rubella was 12.8%, placing Peru among the countries facing a moderate level of risk for the occurrence of CRS cases. The findings suggest the need to also provide the rubella vaccine to other population groups, especially women of childbearing age.