Spatial and temporal epidemiology of sporadic human cases of Escherichia coli O157 in Scotland, 1996-1999

In Scotland, between 1995 and 2000 there were between 4 and 10 cases of illness per 100000 population per year identified as being caused by Escherichia coli O157, whereas in England and Wales there were between 1 and 2 cases per 100000 population per year. Within Scotland there is significant regional variation. A cluster of high rate areas was identified in the Northeast of Scotland and a cluster of low rate areas in central-west Scotland. Temporal trends follow a seasonal pattern whilst spatial effects appeared to be distant rather than local. The best-fit model identified a significant spatial trend with case rate increasing from West to East, and from South to North. No statistically significant spatial interaction term was found. In the models fitted, the cattle population density, the human population density, and the number of cattle per person were variously significant. The findings suggest that rural/urban exposures are important in sporadic infections.     

The spatial and temporal determinants of campylobacteriosis notifications in New Zealand, 2001-2007

Despite recent improvements, New Zealand still has one of the highest per-capita incidence rates of campylobacteriosis in the world. To reduce the incidence, a thorough understanding of the epidemiology of infection is needed. This retrospective analysis of 36 000 notified human cases during a high-risk period between 2001 and 2007 explored the spatial and temporal determinants of Campylobacter notifications at a fine spatial scale in order to improve understanding of the complex epidemiology. Social deprivation was associated with a decreased risk of notification, whereas urban residence was associated with an increased risk. However, for young children rural residence was a risk factor. High dairy cattle density was associated with an increased risk of notification in two of the three regions investigated. Campylobacter notification patterns exhibit large temporal variations; however, few factors were associated with periods of increased risk, in particular temperature did not appear to drive the seasonality in campylobacteriosis.     

The regionality of campylobacteriosis seasonality in New Zealand

New Zealand has one of the highest incidences of campylobacteriosis in the developed world, which leads a global trend of increasing notifications of Campylobacter infections over the last decade. Foodborne and waterborne transmission have been implicated as significant mechanisms in the complex ecology of the disease in New Zealand. We examined both regional and temporal variation in notification rates to gain some insight into the role of the New Zealand environments in modifying disease incidence. Firstly, there is a marked difference in the seasonality of campylobacteriosis between the North and South Islands of New Zealand. The Far North and much of the rural North Island were found to display relatively low summer incidence and small inter-seasonal variation. Secondly, there appears to be a dispersed grouping of North Island urban areas, including Auckland, Hamilton, Napier and their hinterlands as well as a few areas on the South Island that exhibit higher summer incidence and more seasonality than the first group. Thirdly, Christchurch, Dunedin, much of the South Island and the lower North Island cities of Wellington and Upper Hutt appear to experience the highest summer incidence and strongest inter-seasonal variation in New Zealand. These three broad groupings of campylobacteriosis seasonality, constructed using a principal components analysis, suggest that the importance of transmission routes may vary regionally in New Zealand. The observed variation in seasonal incidence indicates a complex ecology that is unlikely to be explained by a single dominant transmission route across these three groupings.     

Regional differences in health care delivery: implications for a national resource allocation formula

In several countries formulae for allocating resources to regions are derived using national average relationships between population characteristics and health service use. However, there may be significant regional heterogeneity in health care delivery which, has two main implications for a national resource allocation formula. First, it offers alternative ways of measuring the relative needs of different population groups. Since the primary focus of research and policy is on the difficulty of targeting resources at high-need populations, it is proposed that progressivity in the delivery of health care could be seen as a frontier problem analogous to efficiency. The effects of using the slope parameters from the most progressive region are simulated. Second, regional heterogeneity may thwart the objective of the formula of securing equitable use of resources by different population groups. An adjustment mechanism is developed to illustrate the trade-off between the levels of geographical and vertical equity achieved. A locus of equity possibilities for acute care in Scotland is derived. Traditional formulae represent a corner solution indicating extreme relative aversion to geographical inequity. Because regional variation in need dominates regional variation in progressivity in Scotland, high-need rather than progressive regions gain from the pursuit of vertical equity.     

Is the major increase in notified campylobacteriosis in New Zealand real?

Notifications of campylobacteriosis by New Zealand medical practitioners have increased steadily in the last two decades. To determine if this increase is real, as opposed to a surveillance artefact, we examined both available notification (1980-2003) and hospitalization data (1995-2003). The similarity in the temporal pattern of increasing hospitalizations for campylobacteriosis, with that of notifications, is suggestive that this increase is indeed real. Although some risk factors for this disease have been identified (e.g. uncooked poultry consumption) it is unclear what the likely causes of the increasing rates are. The overall disease burden is also high compared with other developed countries (an annual notification rate of 396 cases per 100000 population in 2003), with highest rates in children aged 1-4 years, males, Europeans, and those living in urban areas. Given the large disease burden, further research and intervention studies should be public health priorities in this country.     

Marked campylobacteriosis decline after interventions aimed at poultry, New Zealand

Beginning in the 1980s, New Zealand experienced rising annual rates of campylobacteriosis that peaked in 2006. We analyzed notification, hospitalization, and other data to explore the 2007-2008 drop in campylobacteriosis incidence. Source attribution techniques based on genotyping of Campylobacter jejuni isolates from patients and environmental sources were also used to examine the decline. In 2008, the annual campylobacteriosis notification rate was 161.5/100,000 population, representing a 54% decline compared with the average annual rate of 353.8/100,000 for 2002-2006. A similar decline was seen for hospitalizations. Source attribution findings demonstrated a 74% (95% credible interval 49%-94%) reduction in the number of cases attributed to poultry. These reductions coincided with the introduction of a range of voluntary and regulatory interventions to reduce Campylobacter spp. contamination of poultry. The apparent success of these interventions may inform approaches other countries could consider to help control foodborne campylobacteriosis.     

Trends in violence in England and Wales 1995-2000: an accident and emergency perspective

BACKGROUND: Prevention of violence-related injury has become an important public health issue but national, regional and local data are lacking. The aims of this study were to determine trends, seasonality and rates of violence-related injury according to Accident and Emergency (A&E) recorded data in England and Wales over a 5 year period, 1995-2000. METHODS: A stratified sample of 58 major A&E departments in England and Wales were recruited for the study. Electronic data on age, gender and date of attendance of all those reporting violence-related injury over a 5 year period, May 1995 to April 2000, were retrieved. Injury rates (number of injured per 100 resident population) were computed and ordinary least-squares regression analysis was used to evaluate linear and non-linear trends in these time series data. RESULTS: A total of 353442 (258719 males: 73 per cent) violence-related attendances were identified. Overall annual violence-related attendance did not change significantly (p > 0.05) but attendance of females aged 11-17 years increased steadily and significantly (p < 0.05) over the 5 year period. Health-region, gender- and age-specific increases in violence-related attendance slowed (p < 0.05). Compared with spring there were significantly lower levels of violence in autumn and winter for both males and females (p < 0.05). Violence affecting males aged 18-30 years was not subject to seasonality. Males, those aged 18-30 years and those living in the northern and western regions in England and Wales were at highest risk of violence-related injury. CONCLUSIONS: This national study from the perspective of health services suggests that violence did not increase over the period 1995-2000. Slowing of age-, gender- and health-region-specific increases in violence-related injury suggests that violence is coming under control. The reasons for significant trends in individual urban centres deserve further study, and could provide important new directions for violence prevention.     

Trends in the incidence of salmonellosis and campylobacteriosis in the Czech Republic

Salmonellosis and campylobacteriosis are the most frequently reported acute enteric diseases of infectious origin in the Czech Republic. Epidemiological data on salmonellosis and campylobacteriosis have been reportable in this country since 1951 and 1984, respectively. In 2003, 53,486 cases of acute enteric infections were reported: 26,899 (52%) diagnosed as salmonellosis and 20,063 (almost 40%) diagnosed as campylobacteriosis. In 1989, the annual incidence of salmonellosis was three times as high as in the previous year, the upward trend continued until 1995 (528/100,000) and since 1998 the salmonellosis incidence rates have been declining. The incidence of campylobacteriosis showed a progressive increase since 1984 to peak in 2002 with a following slight decline in 2003. Morbidity from salmonellosis and campylobacteriosis is highest in the age group 0-4-year-olds. The most frequent causative agents are Salmonella Enteritidis (96%) and Campylobacter jejuni, respectively. Both infections are foodborne. Ready-to-eat meals, poultry, confectionery and eggs seem to be most frequently implicated in outbreaks of salmonellosis in public catering and families. Sporadic cases of campylobacteriosis are mostly associated with ingestion of poultry and chopped meat. The incidence rates of these two infections are positively correlated with the average daily temperatures.     

2012-2016年毕节市自然疫源及虫媒传染病流行病学特征分析

目的 分析2012-2016年毕节市自然疫源及虫媒传染病流行病学的特征及其变化趋势,为有效制定防控策略提供科学依据。方法 采用描述性流行病学方法对毕节市自然疫源及虫媒传染病报告病例进行统计分析。结果 (1)毕节市2012-2016年自然疫源及虫媒传染病共报告发病7种268例,年均发病率0.62/10万(0.47/10万～0.88/10万);总体呈下降趋势,发病率差异有统计学意义(P<0.001);发病数居前3位的病种依次为:乙脑、出血热和布病;(2)地区分布,发病数居前三位的是金沙县67例(25%)、威宁县42例(15.7%)、黔西县37例(13.8%);(3)时间分布,每月均有病例报告,每年发病高峰集中在7-9月份,8月发病高峰;(4)人群分布,重点发病人群年龄小于15岁;男性发病数占比明显高于女性(P<0.001),在职业分布以农民、散居儿童为主,近5年自然疫源及虫媒传染病职业分布存在差异(P<0.001);结论 毕节市自然疫源及虫媒传染病的流行病学疫情分布总体呈现下降趋势,发病有地区聚集性特点、季节性特点和人群分布特征。     

Socio‐economic inequality in health service utilisation: Does accounting for seasonality in health‐seeking behaviour matter?

Seasonal variation exists in disease incidence. The variation could occur across the different regions in a country. This paper argues that using national household data that are not adjusted for seasonal and regional variations in disease incidence may not be directly suitable for assessing socio‐economic inequality in annual outpatient service utilisation, including for cross‐country comparison. In fact, annual health service utilisation may be understated or overstated depending on the period of data collection. This may lead to miss‐estimation of socio‐economic inequality in health service utilisation depending, among other things, on how health service utilisation, across geographical areas, varies by socio‐economic status. Using a nationally representative dataset from South Africa, the paper applies a seasonality index that is constructed from the District Health Information System, an administrative dataset, to annualise public outpatient health service visits. Using the concentration index, socio‐economic inequality in health service visits, after accounting for seasonal variations, was compared with that when seasonal variations are ignored. It was found that, in some cases, socio‐economic inequality in outpatient health service visits depends on the socio‐economic distribution of the seasonality index. This may justify the need to account for seasonal and geographical variations.     

云南省2008-2019年手足口病流行病学特征分析

目的 对云南省2008-2019年手足口病的流行模式及季节变化特征进行分析,为手足口病疫情防控提供科学依据及参考。 方法 采用描述性流行病学方法对云南省手足口病疫情数据进行分析。 结果 云南省2008-2019年累计报告手足口病的病例数763 526例,年均报告发病率136.2018/10万,手足口病呈现逐年上升趋势;病例以散居儿童为主,病例集中在6岁以下人群。云南省2008年手足口病发病呈现较强季节性,2009年、2010年、2011年、2013年和2015年发病呈现一定的季节性; 2008-2019年各年手足口病均存在发病高峰日和发病高峰期,各年手足口病高峰日不同（F=7 659.08,P＜0.01）。 结论 应根据疫情流行变化趋势,积极调整防控策略,以降低重点人群和重点地区发病水平,避免疫情持续蔓延。     

Campylobacter infection in urban and rural populations in Scotland

A review of campylobacter infection in Scotland over five years (1978-82), during which 7808 human isolates were recorded (mean annual isolation rate of 30 per 100000), revealed differences in the epidemiology of the disease between rural and urban populations which were not apparent in the national data. The incidence of infection in the two rural areas studied was greatest in the early months of the year, whereas that in the two urban areas showed a third-quarter predominance. In both urban and rural populations, age-specific infection rates were highest in children less than 5 years old, but this trend was more pronounced in rural than urban populations. Conversely, secondary peaks in age-specific infection rates observed in young adults were more pronounced in the urban than rural populations. It is postulated that rural children were being infected by campylobacters at an early age by drinking contaminated raw milk which was not normally available to city residents. The lower incidence in adults in the rural populations is interpreted as indicating more widespread immunity, resulting from greater exposure to infection during childhood. The effect of compulsory heat treatment of milk sold in Scotland, introduced in August 1983, is currently being studied.     

Campylobacter infection in urban and rural populations in Scotland.

A review of campylobacter infection in Scotland over five years (1978-82), during which 7808 human isolates were recorded (mean annual isolation rate of 30 per 100000), revealed differences in the epidemiology of the disease between rural and urban populations which were not apparent in the national data. The incidence of infection in the two rural areas studied was greatest in the early months of the year, whereas that in the two urban areas showed a third-quarter predominance. In both urban and rural populations, age-specific infection rates were highest in children less than 5 years old, but this trend was more pronounced in rural than urban populations. Conversely, secondary peaks in age-specific infection rates observed in young adults were more pronounced in the urban than rural populations. It is postulated that rural children were being infected by campylobacters at an early age by drinking contaminated raw milk which was not normally available to city residents. The lower incidence in adults in the rural populations is interpreted as indicating more widespread immunity, resulting from greater exposure to infection during childhood. The effect of compulsory heat treatment of milk sold in Scotland, introduced in August 1983, is currently being studied.     

Does vitamin d deficiency account for ethnic differences in tuberculosis seasonality in the UK?

Objectives. Notifications of tuberculosis in England and Wales are reported to peak in the summer season. The purpose of this study was to confirm that finding and to determine to what extent patients of Indian Subcontinent (ISC) ethnic origin contributed to the seasonality. The clinical presentation of the disease is presumed to occur some months following reactivation of the endogenous latent focus of tuberculosis infection. There arises the possibility of vitamin D deficiency producing immunological inadequacy at the end of winter and beginning of spring.

Patients and methods. Monthly (or 4‐weekly) aggregated data over 7 years were collected from the three countries of mainland Britain, England, Wales, Scotland and from the city of Birmingham in England. The notifications from Birmingham were divided into those of ISC ethnic origin and ‘whites’. The presence or absence of seasonality was determined by fitting a sinusoidal curve by the technique called ‘cosinor analysis’. In this method amplitude gives a measure of the extent of the seasonal variation.

Results. The summer peak of clinical diagnosis was confirmed in the UK series from England, Wales and Scotland. In England and Wales without Scotland a larger seasonal variation was present. Scotland, with a lower proportion of population of ISC ethnic origin, was examined separately and the results in Scotland alone failed to confirm seasonality. In the data from Birmingham, seasonality was confirmed with a greater amplitude, particularly in those over 60 years of age. The finding was influenced by those of ISC ethnic origin, seasonality not being present in the ‘white’ population.

Conclusion. The results from Birmingham are very striking, but there were almost three times as many patients in the ISC ethnic group as in indigenous ‘white’ patients. A series with larger numbers of ‘white’ patients would be necessary to confirm the absence of seasonality in the ‘white’ population. The discussion reviews the evidence that vitamin D may have an important hormonal role in immunological defence in the prevention of tuberculosis.     

The Scottish Heart and Arterial Risk Prevention (SHARP) survey of cardiovascular risk: regional differences.

The objective was to explore variation in cardiovascular risk profiles within the Scottish workforce over different regions of Scotland by a planned review of survey data of workplaces throughout Scotland, surveyed between December 1991 and March 1996. The subjects sampled were 19,400 men and women aged between 18 and 70, who were in work and apparently healthy at the time of screening. The results showed that the regions of Scotland may be distinguished through particular risk factors and also by using a single summary score (the SHARP risk score). Overall the Perth and Kinross region tops the league for cardiovascular risk (with the main contributing factors being smoking and high blood pressure); regions of least risk are Inverness-shire and Edinburgh. There are statistically significant differences to be discerned in the regional distribution of cardiovascular risk within the working population of Scotland.     

2009-2014年湖州市手足口病流行特征分析

目的：分析浙江省湖州市2009—2014年手足口病（ HFMD ）的流行病学特征,为防控提供依据。方法收集国家疾病监测信息报告管理系统中2009—2014年湖州市HFMD的疫情数据,利用描述性流行病学方法和SPSS17.0统计软件进行流行特征分析,采用实时荧光定量RT-PCR进行病原学检测。结果2009—2014年湖州市共报告HFMD 25930例,平均发病率148.58/10万,主要发生在5—7月份;人群分布上主要发生在5岁以下儿童,男性病例多于女性,以散居儿童和幼托儿童居多,流动人口较多的区域发病率较高;每年优势病原体有所变化,肠道病毒71型是造成大部分重症病例和所有死亡病例的病原体。结论 HFMD在湖州市广泛流行,当前应着重加强城乡结合部散居儿童健康教育和托幼机构聚集性疫情的防控工作。     

Estimation of incidence of poliomyelitis by three survey methods in different regions of the United Republic of Cameroon

Surveys were conducted in one urban and two rural regions of the United Republic of Cameroon to estimate the annual incidence of paralytic poliomyelitis. Three different survey methods were used: a review of hospital and clinic registers, a school survey, and a house-to-house survey. The house-to-house survey identified the highest number of lame children and gave estimates of incidence of between 18.8 and 32.6 per 100 000 population in the three regions. The estimates of incidence obtained by the two other survey methods in the urban region did not differ significantly from that obtained by house-to-house survey but, in the rural regions, were significantly lower. It is concluded that house-to-house surveys are a sensitive method of identifying lame children in both urban and rural regions. School surveys and review of hospital and clinic registers, while equally sensitive in urban regions, are less sensitive in rural regions and may significantly underestimate the annual incidence of paralytic poliomyelitis. These limitations should be borne in mind when using the survey methods.     

A comparison of health inequalities in urban and rural Scotland

Previous research suggests that there are significant differences in health between urban and rural areas. Health inequalities between the deprived and affluent in Scotland have been rising over time. The aim of this study was to examine health inequalities between deprived and affluent areas of Scotland for differing ruralities and look at how these have changed over time. Postcode sectors in Scotland were ranked by deprivation and the 20% most affluent and 20% most deprived areas were found using the Carstairs indicator and male unemployment. Scotland was then split into 4 rurality types. Ratios of health status between the most deprived and most affluent areas were investigated using all cause mortality for the Scottish population, 1979-2001. These were calculated over time for 1979-1983, 1989-1993, 1998-2001. Multilevel Poisson modelling was carried out for all of Scotland excluding Grampian to assess inequalities in the population. There was an increase in inequalities between 1981 and 2001, which was greatest in remote rural Scotland for both males and females; however, male health inequalities remained higher in urban areas throughout this period. In 2001 female health inequalities were higher in remote rural areas than urban areas. Health inequalities amongst the elderly (age 65+) in 2001 were greater in remote rural Scotland than urban areas for both males and females.     

2004-2008年四川省遂宁市船山区肺结核疫情流行病学分析

目的分析2004-2008年遂宁市船山区肺结核流行特征,为控制结核病传播提供科学依据。方法采用描述流行病学方法对船山区2004-2008年肺结核发病情况进行分析。结果 2004-2008肺结核年平均发病率为105.75/10万,年平均死亡率为0.06/10万。地区分布全区无明显区域差异;时间分布季节性弱;年龄分布以青、壮年为主;性别分布男性明显大于女性;职业分布以农民为主。结论应加强船山区肺结核防治工作,特别是农民结核病防治工作,采用现代肺结核病控制技术,控制肺结核病疫情。