The burden of parvovirus B19 infection in women of childbearing age in England and Wales

A serological survey has been used to investigate the epidemiology of parvovirus B19 infection in England and Wales. A total of 2835 sera representing the complete age range were selected from a convenience collection obtained in 1996 that reflects the general population and screened for parvovirus B19-specific IgG. Antibody prevalence rose nonlinearly with age from 21% in those aged 1-4 years to >75% in adults aged > or = 45 years. Force-of-infection estimates were similar to those previously made in 1991, being highest in those aged <15 years. There was no association between evidence of previous infection and sex or region. Quantitatively strongest antibody responses were found in those aged 15-34 years and IgG levels in females were 28.5% higher than those found in males (P=0.004, 95% CI 8.2-52.6). Applying the upper 95% confidence interval for the force of infection to maternity estimates for England and Wales in 1996, parvovirus infection in pregnancy was estimated to occur on average in up to 1 in every 512 pregnancies each year. This represents 1257 maternal infections, causing up to an estimated 59 fetal deaths and 11 cases of hydrops fetalis annually. An analysis of all available laboratory-confirmed parvovirus infections found a mean of 944 infections per year in women aged 15-44 years highlighting a need for enhanced surveillance of maternal parvovirus B19 infection in England and Wales, including information on both pregnancy and outcome of pregnancy.     

人微小病毒B19母婴感染的血清学调查

目的调查该地区B19病毒母婴感染情况。方法用ELISA和套式PCR分别检测母婴血清B19病毒IgG、IgM抗体和DNA。结果92例孕妇血清B19病毒IgG抗体阳性率3704%,720例孕妇血清B19病毒IgM抗体阳性率902%,而95例婴儿脐血IgM抗体阴性;720例孕妇血清和95例婴儿脐血B19病毒DNA亦均为阴性。结论部分孕妇存在B19病毒感染既往史,少数孕妇有近期或急性B19病毒感染,但母婴垂直传播B19病毒风险很低。     

Current epidemiological aspects of human parvovirus B19 infection during pregnancy and childhood in the western part of Germany

This investigation was undertaken to provide detailed information on the epidemiology of human parvovirus B19 (B19) infection during pregnancy and childhood in the western part of Germany. Between 1997 and 2004, 40,517 sera from pregnant women aged 17-45 years and 6060 sera from children and young adults were tested for B19 IgG and IgM in our laboratory. In pregnant women, both the history of a 'specific' (OR 7.7, 95% CI 5.2-11.4) and a 'non-specific' rash (OR 3.3, 95% CI 1.5-7.1) was predictive for B19 IgM positivity. The B19 IgG prevalence was 69.2% (4097/5924) in a subgroup of asymptomatic pregnant women screened for B19 antibodies. In children, the age-specific IgG-positivity rate increased from 12.2% (66/541) at 2 years of age to 71.9% (396/551) in those older than 10 years. In conclusion, the prevalence of B19 IgG in pregnant women from the western part of Germany is higher then previously reported. Contact with children aged 3-10 years is a major risk factor for exposure to B19. Pregnant women with the history of a 'non-specific' rash should also be evaluated for acute B19 infection.     

Parvovirus B19 infection in pregnancy: a cause of non-immune hydrops fetalis

Four pregnancies, in two women aged 39 and two women aged 34 years respectively, were complicated by foetal parvovirus B19 infection. First-trimester intrauterine death resulting from multiple congenital anomalies was diagnosed in one patient with proven foetal parvovirus B19 infection. In three patients foetal hydrops was found in the second trimester with variable clinical course. In one of them, foetal hydrops resulted in second-trimester foetal death; in another, foetal hydrops resolved following intrauterine blood transfusion and in a third foetal hydrops resolved spontaneously. Foetal parvovirus B19 infection was diagnosed by polymerase chain reaction (PCR) using foetal cells obtained by amnioscentesis. It is concluded that maternal parvovirus B19 infection is mostly asymptomatic. However, the clinical impact of maternal infection on the foetus is diverse, i.e. infection may result in foetal death or--transient--foetal morbidity, in particular foetal anaemia. In mothers with proven foetal parvovirus B19 infection close monitoring of the foetus by ultrasound is warranted. Occasionally intrauterine transfusion is required. From the literature to date, the estimated incidence of maternal parvovirus B19 infection in pregnancy is 3-7%. The vertical transmission rate approximates 30%. When pregnancy is complicated by foetal hydrops foetal parvovirus B19 infection should be kept in mind.     

The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe

Cost-effectiveness analyses are usually not directly comparable between countries because of differences in analytical and modelling assumptions. We investigated the cost-effectiveness of rotavirus vaccination in five European Union countries (Belgium, England and Wales, Finland, France and the Netherlands) using a single model, burden of disease estimates supplied by national public health agencies and a subset of common assumptions. Under base case assumptions (vaccination with Rotarix^®, 3% discount rate, health care provider perspective, no herd immunity and quality of life of one caregiver affected by a rotavirus episode) and a cost-effectiveness threshold of €30,000, vaccination is likely to be cost effective in Finland only. However, single changes to assumptions may make it cost effective in Belgium and the Netherlands. The estimated threshold price per dose for Rotarix^® (excluding administration costs) to be cost effective was €41 in Belgium, €28 in England and Wales, €51 in Finland, €36 in France and €46 in the Netherlands.     

47360例育龄妇女细小病毒B19感染情况分析

目的分析孕前和孕期妇女细小病毒B 19(human parvovirus B 19,简称B 19)感染情况,为临床医生提供参考。方法采用酶联免疫的方法对2013~2015年来广西壮族自治区妇产医院就诊的18~45岁孕前及孕期妇女血清中细小病毒B 19的特异性抗体IgM进行检测,并按照不同条件进行分析。结果 B19 IgM抗体阳性率2013年11.34%,2014年4.93%,2015年8.75%;不同年龄段的阳性率差异无统计学意义(P0.05);第三、第四季度感染率高于其它季度,不同季节之间差异有统计学意义(P0.05)。结论南宁地区育龄妇女B 19感染率较高,应广泛检测,提高优生优育质量。     

Seroprevalence of parvovirus B19 infection in daycare educators

This study was undertaken to provide first-time estimates for the seroprevalence of parvovirus B19 infection among daycare educators in Montréal, Canada, and to identify factors associated with seropositivity. A cross-sectional design was used. Directors and educators from 81 daycare centres (DCCs) were surveyed about DCC and personal characteristics respectively, and serum samples from 477 female educators were tested for parvovirus B19 IgG antibodies. The seroprevalence of parvovirus B19 was 70%. Parvovirus B19 seropositivity was significantly associated with age and with working experience in DCCs, but the latter association was restricted to educators aged less than 40 years. In conclusion, working as a daycare educator appears to be associated with increased risk of acquiring parvovirus B19 infection, but this finding will require further investigation. Because of the large proportion of educators susceptible to acquiring parvovirus B19 infection, our findings also highlight the need for preventive measures.     

The prevalence of hepatitis B infection in adults in England and Wales

Cost effectiveness analyses of alternative hepatitis B vaccination programmes in England and Wales require a robust estimate of the lifetime risk of carriage. To this end, we report the prevalence of infection in 3781 anonymized individuals aged 15-44 years whose sera were submitted in 1996 to 16 microbiology laboratories in England and Wales. One hundred and forty-six individuals (3.9%) were confirmed as anti HBc positive, including 14 chronic carriers (0.37%). The prevalence of infection and carriage was higher in samples collected in London and increased with age. No increased risk of infection was seen in sera from genito-urinary (GUM) clinics. Only 15 sera positive for hepatitis B were also positive for hepatitis C. Our results confirm the low prevalence of hepatitis B in England and Wales, are consistent with previous estimates of carriage and suggest that many infections were acquired while resident outside the UK. Future prevalence studies should determine the country of birth and other risk factors for each individual in order to confirm these findings.     

Hepatitis C virus: laboratory surveillance in England and Wales, 1992-2004

Between 1992 and 2004, a total of 49,819 confirmed hepatitis C infections have been reported to the Health Protection Agency (HPA) by laboratories in England and Wales; the annual number of reports increased from 241 in 1991 to 8149 in 2004. Most reports with a known risk factor were in injecting drug users (87%, 12,438/14,221), but 71% (35,598/49,819) of the total had no reported identified risk. The age-sex distribution of the latter cases was similar to that in injecting drug users. Using names to assign ethnicity, individuals with South Asian names had an older age distribution and a different risk factor profile from non-South Asians. Using published age-specific prevalence data from 1996, it was estimated that around 28,1764 cases of hepatitis C infection exist in England and Wales, and that only 17% of these cases have been reported to the HPA. Surveillance reports continue to provide important information regarding trends in hepatitis C infection in specific risk groups.     

Trends in mortality by labour market position around retirement ages in three European countries with different welfare regimes

Objectives

In the face of economic downturn and increasing life expectancy, many industrial nations are adopting a policy of postponing the retirement age. However, questions still remain around the consequence of working longer into old age. We examine mortality by work status around retirement ages in countries with different welfare regimes; Finland (social democratic), Turin (Italy; conservative), and England and Wales (liberal).

Methods

Death rates and rate ratios (RRs) (reference rates = ‘in-work’), 1970 s–2000 s, were estimated for those aged 45–64 years using the England and Wales longitudinal study, Turin longitudinal study, and the Finnish linked register study.

Results

Mortality of the not-in-work was consistently higher than the in-work. Death rates for the not-in-work were lowest in Turin and highest in Finland. Rate ratios were smallest in Turin (RR men 1972–76 1.73; 2002–06 1.63; women 1.22; 1.68) and largest in Finland (RR men 1991–95 3.03; 2001–05 3.80; women 3.62; 4.11). Unlike RRs for men, RRs for women increased in every country (greatest in Finland).

Conclusions

These findings signal that overall, employment in later life is associated with lower mortality, regardless of welfare regime.     

The burden of Helicobacter pylori infection in England and Wales

The prevalence of active infection with Helicobacter pylori in the general population of England and Wales was estimated using high reactivity for specific IgG in serum ELISA as a marker. A total of 10,118 anonymized residues of serum samples collected in 1986 and 1996 from persons aged 1-84 years were used. Estimated prevalence of active infection varied by region and was highest in London. Prevalence was related to decade of birth and increased from 4-3% in those born during the 1980s to 30% in those born before 1940. An estimated total of 7.5 million people living in England and Wales have an active infection and analysis by decade of birth showed no significant difference between samples collected in 1986 and 1996. These data suggest H. pylori infection is becoming less common, is acquired at an early age and is unlikely to be resolved unless suitable antimicrobial treatment is sought.     

Parvovirus B19 antibodies in the blood in 17-34-year-old women

In order to assess the proportion of women in fertile age who lack antibodies against parvovirus B19 the authors assessed in 2 groups of sera (63 and 40 sera) taken from 17-34-year-old women antibodies against this virus by the ELISA method (Seiken). Virus-specific antibodies, class IgG were detected only in 67% of the examined subjects which indicates that in one third of the women there is a risk of transplacental infection of the foetus in case of infection with the parvovirus B19 during pregnancy.     

A comparison of the alcohol-attributable mortality in four European countries

Background: Deaths due to alcohol consumption are an important component of all-cause mortality, particularly premature mortality. However, there are considerable regional variations, the reasons for which are unclear. Methods: Estimates were made as reliably as possibly using vital statistics and best estimates of risk of the alcohol-attributable mortality, by age, sex and cause for four European countries (England and Wales, Germany, Denmark and Italy). Twenty-seven alcohol-related conditions were considered including the possible cardio-protective effects of alcohol. Results: It was estimated that there are approximately 2% fewer deaths annually in England and Wales than would be expected in a non-drinking population and 0.3% fewer deaths among East German females. In West Germany, Denmark, Italy and among East German males there are more deaths caused by alcohol than are prevented (between 0.7 and 2.6% of all deaths). The highest age-specific proportion of alcohol-attributable deaths is found in East Germany where around 30% of deaths among males aged 25–44 years are due to drinking. Among young men in all four countries the largest contributor to alcohol-related deaths is road traffic accidents involving alcohol. Conclusions: Possible explanations for the variation in alcohol-attributable deaths between countries include different underlying heart disease rates, different patterns of alcohol consumption and beverage preferences, and different use of mortality classification. Differences in the reported alcohol consumption levels explain little of the variation in alcohol-attributable deaths. Estimating alcohol-attributable mortality by age and sex across countries may be a useful indicator for developing alcohol strategies and exploring ways of preventing premature mortality.     

Prevalence of toxoplasma antibodies according to age with comments on the risk of prenatal infection.

Sera from 1661 persons in 12 age groups from 0 to 79 years were titrated for toxoplasma antibodies in the indirect immunofluorescence test. The sera were collected from patients with symptoms suggestive of acute, mainly respiratory, viral infections. After the first year of life, the prevalence of antibodies started to rise, reaching 59% between 40 and 79 years of age. From the prevalence of antibodies in different age groups the annual infection risk, i.e, the risk of a non-immune person acquiring toxoplasma infection, was estimated for successive age periods. The estimated annual infection risk increased from 0 . 5% in early childhood to 3% during adolescence and early adult life. Approximately 70--80% of females entered the age of reproduction without evidence of seroimmunity to toxoplasma. The risk of primary infection during pregnancy was estimated from the age distribution of parturient women in The Netherlands in 1975 and the age-specific incidence of primary infections, i.e. the incidence in the total population of susceptible and immune persons. This incidence of primary infection decreased from 1 . 62% per 9 months at the age of 17 1/2--20 years to 0 . 37% at the age of 37--45 years. The incidence of primary infections in pregnant women was estimated to be 1 . 25%.     

An update to “The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe”

A cost-effectiveness analysis of rotavirus vaccination in Belgium, England and Wales, Finland, France and the Netherlands published in 2009 was updated based on recent studies on rotavirus burden of disease and vaccine efficacy. All the qualitative conclusions in the previous study were found to remain valid. Vaccination remains cost-effective in Finland only when using plausible tender prices.     

Epidemiology of hepatitis B infection in Finland: Implications for immunisation policy

ObjectivesWe describe the current epidemiology of acute and chronic hepatitis B infections in Finland. We estimate the total incidence of chronic hepatitis B following from the current incidence of acute infections and the influx of chronic carriers of hepatitis B associated with net immigration. We evaluate the incidence of hepatitis B infections preventable by a universal vaccination programme among infants.MethodsWe analysed hepatitis B cases reported to the National Infectious Disease Register during 2004–2012 and used pre-developed methods to adjust for acute asymptomatic infections. We estimated the projected incidence of chronic infection by applying age-specific risks of chronic infection to the estimated incidence of acute infection. We estimated the influx of chronic carriers associated with immigration by utilising data on immigration during 2004–2012 and the WHO regional estimates of carriage prevalence.ResultsThe estimated incidence of acute hepatitis B infection in Finland, adjusted for asymptomatic infections, was 1.67 per 100,000 per year (95% Crl 1.43–1.94) which is 4.2-fold to the register-based incidence. The estimated lifetime risks of acute and chronic hepatitis B infections were 0.13% and 0.01%, respectively. We estimated that annually seven new chronic infections would result from infections acquired in Finland. These new chronic infections accounted for 1.2% of the total incidence of chronic infections. We estimated that eventually three chronic infections per year would be potentially preventable by a universal infant vaccination programme.ConclusionsPartly due to the fact that hepatitis B infections in neonates and in children are rare, a very limited number of chronic hepatitis B infections resulted from infection acquired within the country. A vast majority of chronic hepatitis B infections occurred among foreign-born persons and were therefore not preventable by a universal infant immunisation programme in Finland. Even with a targeted immunisation programme, the incidence of hepatitis B infection has remained low.     

Excess mortality in England and Wales, and in Greater London, during the 1995 heatwave

STUDY OBJECTIVE: To assess the impact on mortality of the heatwave in England and Wales during July and August 1995 and to describe any difference in mortality impact between the Greater London urban population and the national population. DESIGN: Analysis of variation in daily mortality in England and Wales and in Greater London during a five day heatwave in July and August 1995, by age, sex, and cause. SETTING: England and Wales, and Greater London. MAIN RESULTS: An estimated 619 extra deaths (8.9% increase, approximate 95% confidence interval 6.4, 11.3%) were observed during this heatwave in England and Wales, relative to the expected number of deaths based on the 31-day moving average for that period. Excess deaths were apparent in all age groups, most noticeably in women and for deaths from respiratory and cerebrovascular disease. Using published daily mortality risk coefficients for air pollutants in London, it was estimated that up to 62% of the excess mortality in England and Wales during the heatwave may be attributable to concurrent increases in air pollution. In Greater London itself, where daytime temperatures were higher (and with lesser falls at night), mortality increased by 16.1% during the heatwave. Using the same risk coefficients to estimate the excess mortality apparently attributable to air pollution, more than 60% of the total excess in London was apparently attributable to the effects of heat. CONCLUSION: Analysis of this episode shows that exceptionally high temperatures in England and Wales, though rare, do cause increases in daily mortality.

 

     

应用因子分析探讨妊娠期人微小病毒B19感染的影响因素

目的 探讨妊娠期人微小病毒B19感染的影响因素。方法 对489名孕妇血清进行B19病毒检测,在多元logistc逐步回归分析的基础上,应用探索性因子分析,探索支配病毒感染影响因素的潜在公因子。结果 应用多元logistic逐步回归模型筛选出16个妊娠期人微小病毒B19感染的影响因素,经因子分析,该16个影响因素由6个公因子支配,分别为农村与不良卫生习惯、精神因素、医务行业与环境因素、健康与疾病、不良行为与健康教育、血型等。结论 妊娠期B19病毒感染的控制,要从合理配置城乡卫生资源、培养孕妇良好的卫生习惯及健康的身心状况、高危孕妇的职业保护等多个方面来进行。     

人微小病毒B19感染与自然流产的关系

目的通过分析自然流产与正常妊娠晚期待产孕妇人微小病毒B19(HPV B19) DNA及IgM抗体检测情况,探讨HPV B19与自然流产的关系。方法采集自然流产孕妇（观察组,28例）与正常待产孕妇（对照组,33例）的静脉血,以聚合酶链反应（PCR）法检测HPV B19 DNA, 酶联免疫吸附试验（ELISA）检测HPV B19 IgM抗体。结果观察组HPV B19 DNA阳性率为28.57%（8/28）,对照组为9.09%（3/33）,两组HPV B19 DNA阳性率比较,差异有统计学意义（χ2=3.98 ,P＜0.05）。观察组检测出1例（3.57%,1/28）HPV B19 IgM抗体阳性,对照组未检测到阳性者（0.00%）。结论自然流产孕妇HPV B19感染率高于妊娠晚期待产孕妇,推测HPV B19感染可能是导致自然流产的原因之一。     

Socioeconomic inequalities in mortality among elderly people in 11 European populations

STUDY OBJECTIVE: To describe mortality inequalities related to education and housing tenure in 11 European populations and to describe the age pattern of relative and absolute socioeconomic inequalities in mortality in the elderly European population. DESIGN AND METHODS: Data from mortality registries linked with population census data of 11 countries and regions of Europe were acquired for the beginning of the 1990s. Indicators of socioeconomic status were educational level and housing tenure. The study determined mortality rate ratios, relative indices of inequality (RII), and mortality rate differences. The age range was 30 to 90+ years. Analyses were performed on the pooled European data, including all populations, and on the data of populations separately. Data were included from Finland, Norway, Denmark, England and Wales, Belgium, France, Austria, Switzerland, Barcelona, Madrid, and Turin. MAIN RESULTS: In Europe (populations pooled) relative inequalities in mortality decreased with increasing age, but persisted. Absolute educational mortality differences increased until the ages 90+. In some of the populations, relative inequalities among older women were as large as those among middle aged women. The decline of relative educational inequalities was largest in Norway (men and women) and Austria (men). Relative educational inequalities did not decrease, or hardly decreased with age in England and Wales (men), Belgium, Switzerland, Austria, and Turin (women). CONCLUSIONS: Socioeconomic inequalities in mortality among older men and women were found to persist in each country, sometimes of similar magnitude as those among the middle aged. Mortality inequalities among older populations are an important public health problem in Europe.