STI surveillance by a sentinel network of physicians in Belgium

The STI sentinel surveillance network by physicians in Belgium started in 2000. During 4 months a year, from October until January, STI patients were registered using a standardized protocol. The main goal is to determine STI incidence trends by comparing the results of the analyses using the data of the physicians that registered in all registration periods (Oct. 2000-Jan. 2001; Oct. 2001-Jan. 2002; Oct. 2002-Jan. 2003; Oct. 2003-Jan. 2004). Between the registration periods 2000-2001 and 2002-2003, there was a significant increase in the number of syphilis diagnoses (p<0.01), largely attributable to infections in men who have sex with men (MSM). A high proportion of MSM with syphilis were HIV positive. 83% of HIV positive MSM were already aware of their HIV positive status. The proportion of STI patients with HIV co-infection increased significantly throughout the different periods (from 7.4% in 2000-2001 to 18.1% in 2003-2004; p<0.01). These findings emphasize the importance of the proposal of a HIV test in a STI patient and call for intensification of prevention measures, particularly in MSM and people living with HIV.     

筛查和行为干预在梅毒控制中的作用

目的探讨性病哨点机构（包括哨点医院和专科哨点机构）开展梅毒筛查和行为干预,在梅毒控制中的作用。方法按照哨点医院和专科哨点机构分层抽样,选取广州市15个性病监测哨点,统计2005—2010年各机构梅毒快速血浆反应素试验（RPR）筛查量,分析两类哨点梅毒筛查的人次及阳性率变化趋势,以及同期因卖淫嫖娼被治安收容人群的梅毒感染率趋势。同时,统计同期哨点机构开展的行为干预的工作量。结果6年间,累计筛查39.8万人次,发现RPR阳性1.41万人次,阳性率3.54％;哨点机构初诊RPR筛查人次年均递增22.00％,RPR阳性率由4.06％下降至2.83％。按照不同哨点机构来源分析,性病专科哨点机构RPR阳性率分别从7.81％上升到12.19％,而哨点医院RPR阳性率则从3.79％下降到2.56％。卖淫嫖娼人群的RPR和梅毒螺旋体明胶凝集试验双阳性率,由2005年的5.85％下降到2011年的4.03％。结论广州市性病哨点医院普通人群梅毒筛查量逐年增加,结合性病哨点专科机构对高危人群的梅毒筛查及行为干预,在广州市梅毒控制中有重要作用。     

Syphilis surveillance and trends of the syphilis epidemic in Germany since the mid-90s

Recent surveillance reports from Europe and the United States show an increase in syphilis cases. Accurate epidemiological information about the distribution of syphilis is important for targeting screening and intervention programmes. The German syphilis notification system changed in 2001 from physician to laboratory-based reporting, which is complemented by a newly introduced sexually transmitted infection (STI) sentinel system. After reaching an all time low during the 1990s, syphilis notifications have increased significantly since 2001, coinciding with the introduction of the new reporting system. However, the increased reported incidence is reflecting a true rise in the number of cases and is not predominantly determined by more underreporting through the previous reporting system. The increase reflects syphilis outbreaks among men who have sex with men (MSM). The first of these outbreaks was observed in Hamburg in 1997. In 2003, incidence in men was ten times higher than in women. An estimated 75% of syphilis cases are currently diagnosed among MSM. A high proportion (according to sentinel data, up to 50%) of MSM diagnosed with syphilis are HIV positive. The continuously high number of syphilis cases diagnosed among heterosexuals in Germany in recent years compared with other western European countries may reflect the higher population movement between Germany and syphilis high incidence regions in south-east and eastern Europe.     

Combining surveillance systems to investigate local trends in tuberculosis-HIV co-infection

ABSTRACT

Alameda County has some of the highest human immunodeficiency virus (HIV) and tuberculosis (TB) case rates of California counties. We identified TB-HIV co-infected patients in 2002–2015 by matching county TB and HIV registries, and assessed trends in TB-HIV case rates and estimated prevalence ratios for HIV co-infection. Of 2054 TB cases reported during 2002–2015, 91 (4%) were HIV co-infected. TB-HIV case rates were 0.29/100,000 and 0.40/100,000 in 2002 and 2015, respectively, with no significant change (P = 0.85). African-American TB case-patients were 9.77 times (95% confidence interval [CI] 5.90–16.17) more likely than Asians to be HIV co-infected, and men 2.74 times (95% CI 1.66–4.51) more likely co-infected than women. HIV co-infection was more likely among TB case-patients with homelessness (6.21, 95% CI 3.49–11.05) and injection drug use (11.75, 95% CI 7.61–18.14), but less common among foreign-born and older case-patients (both P < 0.05). Among foreign-born case-patients, 42% arrived in the U.S. within 5 years of TB diagnosis. TB-HIV case rates were low and stable in Alameda County, and co-infected patients were predominantly young, male, U.S.-born individuals with traditional TB risk factors. Efforts to reduce TB-HIV burden in Alameda County should target persons with traditional TB risk factors and recently arrived foreign-born individuals.     

2007年广东省性病实验室梅毒血清学室间质评结果分析

目的了解2007年广东省性病实验室梅毒血清学检测能力的总体情况,分析影响检测能力的相关因素和存在问题。方法制备并发放梅毒血清样本,各性病实验室按照分级管理要求,分别做非梅毒螺旋体和梅毒螺旋体血清学定性和定量试验,统计分析各实验室的检测结果。结果2007年,共计186家性病实验室参与了非梅毒螺旋体定性（930份）和定量（930份）样本的检测,其中104家实验室同时进行了梅毒螺旋体定性（520份）和定量（520份）样本的检测,共计2900份样本中,符合的2650份,全省总体符合率为91.4％。非梅毒螺旋体和梅毒螺旋体血清学定性试验的总体符合率分别为94．7％和95．4％,两者的假阴性率和假阳性率分别只有6．3％和3．8％、7．4％和0．5％。非梅毒螺旋体和梅毒螺旋体血清学定量试验总体符合率分别为92．7％和91．2％,总体几何标准差分别为2．29和2．57。结论全省性病实验室梅毒血清学总体检测能力较好,但仍需加强室内质控,促进梅毒血清学检测能力的进一步提高。     

Recent trends in empyema thoracis

One hundred and twenty-three patients with empyema thoracis presenting between 1968 and 1978 were studied. The predominant cause was pneumonia, with thoracic and gastrooesophageal surgery as the other important predisposing factors. 99 patients had received antibiotics before hospital admission and organisms were isolated from the empyema of 62 of these (63%). Of the 62 patients with organisms 39 (63%) had previously received an antibiotic appropriate to the sensitivity of the pathogen. Staph. aureus, Str. pneumoniae and anaerobes were the organisms most frequently found in empyemata following pneumonia, whilst Gram-negative enteric bacilli, the most frequently isolated organisms, were the predominant pathogens in postoperative cases.Following treatment with antibiotics alone or with closed chest drainage 29% of empyemata resolved but another 64% required subsequent surgery. The former group had a mean duration of symptoms of 2.8 (se ± 0.8) weeks before hospital treatment whereas the surgically treated group had symptoms for a mean period of 8.3 (se ± 1.5) weeks. 83% of patients who required thoracotomy had a history of more than four weeks at the time of admission.Thirty-six deaths were recorded, 11 of which were attributable to the empyema, giving an empyema mortality-rate of 9%.We conclude that with widespread use of antibiotics the nature of empyemata has changed and that those now seen are more often refractory to closed chest drainage, particularly if the history prior to hospital admission is longer than four weeks.     

境外人群梅毒血清学检测结果分析

目的 对潜伏期梅毒的外籍人群进行监测,以防止性传播疾病的蔓延。方法 应用快速血浆素反应试验、苍白螺旋体明胶颗粒凝集试验和酶联免疫吸附实验方法。结果2000年度上海口岸应用血清学方法对出入境的境外人群 8 583人次进行梅毒监测,发现阳性者 39例,感染率为 0.454％,并对其中的 20例,用 EIA方法检测了梅毒特异性抗体IgG和IgM,4例IgG+和IgM+,16例IgM-和IgG+。结论 根据检测到的IgG和IgM抗体结果,应对早期潜伏期梅毒和晚期潜伏期梅毒,分别采取不同的卫生检疫措施。     

A syphilis outbreak: recent trends in infectious syphilis in Birmingham, UK, in 2005 and control strategies

The objective of this study was to identify the demographic characteristics and sexual behaviour associated with primary, secondary and early latent syphilis in Birmingham and its epidemiologic and public health implications. All new patients diagnosed as having infectious syphilis in a genitourinary service in Birmingham in the period from January 2005 to December 2005 were studied retrospectively (history, physical examination, serology) to determine the stage of their disease. During the 12-month period, 69 new cases of primary, secondary and early latent syphilis were diagnosed. Patients were most commonly male (96%), aged between 20 and 44 years, symptomatic (84%) and were white men who had sex with men or Asian/Black Caribbean heterosexual men. Unemployment and having multiple partners were common in infected patients. Based on the results of this study, control measures are being undertaken, using enhanced surveillance, to focus on appropriate health promotion initiatives.     

Recent trends in endoscopic management of achalasia

Esophageal achalasia is a chronic and progressive motility disorder characterized by absence of esophageal body peristalsis associated with an impaired relaxation of lower esophageal sphincter(LES) and usually with an elevated LES pressure, leading to an altered passage of bolus through the esophago-gastric junction. A definitive cure for achalasia is currently unavailable. Palliative treatment options provide only food and liquid bolus intake and relief of symptoms. Endoscopic therapy for achalasia aims to disrupt or weaken the lower esophageal sphincter. Intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides superior results than botulinum toxin injection and a similar mediumterm efficacy almost comparable to that attained after surgery. Per oral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and further objective and long-term follow up. This article will review different endoscopic treatments in achalasia, and summarize the short-term and long-term outcomes.     

Recent trends and prognosis of pulmonary diseases in Japan

To determine trends of death rates for patients with chronic pulmonary diseases the author compiled the numbers of deaths per 100,000 Japanese population per annum based on the annual reports of the Japan Vital Statistics for the past 43 years. Death rates for the newborn population as well as for the younger population decreased while those for the aged population remained unchanged. Increasing numbers of deaths from lung cancer and decreasing numbers of death from pulmonary tuberculosis were noted. The death rate from the chronic obstructive lung diseases was maintained while the death rate for diffuse fibrotic lung diseases tended to be elevated. Baseline reference values for respiratory physiology parameters, established by the Special Commission for Respiration Physiology of the Japan Society of Chest Diseases, were presented by single linear regression equations represented in terms of age covering the subject's whole age span, including the aged population. The author carried out further analyses based on the data collected in a multi-center cross-sectional survey and concerning, some parameters found consistent differences the linear regression equation calculated for the aged population from those for the younger population. A longitudinal survey conducted by follow-up observations at Keio University Hospital to determine the annual decline of parameters on respiration physiology was designed to cover healthy subjects as well as subjects with chronic pulmonary diseases. Annual declines in vital capacity, forced vital capacity, forced expiratory volume in one second, arterial oxygen tension and arterial carbon dioxide tension showed linear changes throughout the entire age span. Some parameters, such as flow max at 25% vital capacity or alveolar-arterial oxygen tension difference (AaDO2), demonstrated statistically consistent differences in annual decline between younger and older age populations. The annual decline of parameters in patients with chronic pulmonary diseases demonstrated consistently larger values compared with those for healthy subjects. In a study on the pathophysiology and prognosis of patients with respiratory failure with/or without cor pulmonale extension of the survival period for the patients with cor pulmonale was demonstrated.