Changing epidemiology of human brucellosis, Germany, 1962-2005

Trends in the epidemiology of human brucellosis in Germany were investigated by analyzing national surveillance data (1962-2005) complemented by a questionnaire-based survey (1995-2000). After a steady decrease in brucellosis incidence from 1962 to the 1980s, a persistent number of cases has been reported in recent years, with the highest incidence in Turkish immigrants (0.3/100,000 Turks vs. 0.01/100,000 in the German population; incidence rate ratio 29). Among cases with reported exposure risks, 59% were related to the consumption of unpasteurized cheese from brucellosis-endemic countries. The mean diagnostic delay was 2.5 months. Case fatality rates increased from 0.4% (1978-1981) to a maximum of 6.5% (1998-2001). The epidemiology of brucellosis in Germany has evolved from an endemic occupational disease among the German population into a travel-associated foodborne zoonosis, primarily affecting Turkish immigrants. Prolonged diagnostic delays and high case fatality call for targeted public health measures.     

1997—2006年宜昌市钩端螺旋体病流行病学分析

目的通过对宜昌市1997—2006年钩端螺旋体病（钩体病）发病情况分析，为制定预防和控制措施提供依据。方法采用描述性流行病学方法分析宜昌市1997—2006年钩体病的发病情况，揭示其流行病学特征。结果1997—2006年宜昌市累计发生钩体病病例526例，死亡18例，年均发病率为1．32／10万。高发人群为20～50岁年龄组男性青壮年，尤其是田间耕作的农民；高发季节为每年的8—9月；各地区发病不均，以枝江地区平均发病率最高。结论宜昌市1997—2006年钩体病发病率总体上呈下降趋势，但应继续开展监测工作，警惕因恶劣天气引起的雨水型和洪水型钩体病的暴发流行；加强灭鼠工作，强化预防接种，提高易感人群免疫力，控制钩体病的发生和流行。     

Leptospirosis in Hawaii, USA, 1999-2008

Although infrequently diagnosed in the United States, leptospirosis is a notable reemerging infectious disease throughout developing countries. Until 1995, when the disease was eliminated from the US list of nationally notifiable diseases, Hawaii led the nation in reported annual incidence rates. Leptospirosis remains a notifiable disease in Hawaii. To ascertain the status of leptospirosis in Hawaii since the most recent US report in 2002, we reviewed 1999-2008 data obtained from case investigation reports by the Hawaii State Department of Health. Of the 345 case reports related to in-state exposures, 198 (57%) were laboratory confirmed. Our findings indicate a change in seasonal disease occurrence from summer to winter and in the infective serogroup from Icterohemorrhagiae to Australis. Also, during the past 20 years, recreational exposures have plateaued, while occupational exposures have increased. Ongoing surveillance is needed to clarify and track the dynamic epidemiology of this widespread zoonosis.     

Acute flaccid paralysis (AFP) surveillance in the Marche region (1997-2003)

As referral centre for the Marche region, within the national acute flaccid paralysis (AFP) surveillance program, coordinated by the National Institute of Health, the Department of Hygiene of the University of Ancona, launched its surveillance activities in February 1997, by involving pediatric, neurology and infectious disease departments of 20 hospitals. The expected number of AFP cases in the Marche region is 2 per year. Between 1997 and 2003, a total of 16 cases were reported, 2 of which in 1997 (yielding an incidence rate of 1/100000), 4 in 1998 (incidence rate 2/100000), 2 in 1999 (incidence rate 1/100000), 1 in 2000 (incidence rate 0.5/100000), 6 in 2001(incidence rate 3/100000), 2 in 2002 (incidence rate 1/100000) and no cases in 2003. These results are very encouraging and point to active participation of all the hospital centres involved.     

Socio-environmental determinants of the leptospirosis outbreak of 1996 in western Rio de Janeiro: a geographical approach

The environmental and social context in which a leptospirosis outbreak took place during the summer of 1996 in the Rio de Janeiro Western Region was examined by using spatial analysis of leptospirosis cases merged with population and environmental data in a Geographical Information System (GIS). Important differences were observed between places where residences of leptospirosis cases are concentrated and other places in the region. Water supply coverage, solid waste collection, sewerage system coverage and flood risk area were the main determining variables from an initial list of ten. The influence of these unfavorable social and environmental factors is verified hundreds of meters distant from the leptospirosis case residences, demonstrating a necessity to broaden the area of health surveillance practices. The geocoding indicated that some cases did not report contact with flood water, even though they were geographically adjacent to cases who did report this contact. Cases may only report exposures they believe are related to the disease. Geocoding is a useful tool for evaluating such bias in the exposure recall.     

Incidence of leptospirosis in a select population in Nepal

The geographic distribution of leptospirosis is widespread but no national surveillance program exists in Nepal to establish the incidence of leptospirosis or the disease burden. This study reports the incidence of symptomatic leptospirosis in military personnel participating in an efficacy study of a hepatitis E virus vaccine in Nepal. Among the 1566 study volunteers who completed follow-up, we evaluated 271 illnesses over 2.2 years for the presence of leptospira IgM antibodies by ELISA. Positive ELISA results were confirmed by the microscopic agglutination test. The annual incidence of disease was between 3.5 and 6.1 cases/1000. The prevalence of confirmed leptospirosis was 9% among hepatitis cases and 8% among febrile cases. The most reactive serovars were Bratislava, Autumnalis, Icterohaemorrhagiae, and Sejroe. Leptospirosis should be considered in the differential diagnosis of febrile illnesses and icteric syndromes in Nepal. Additional studies are needed to establish the broader distribution and the spectrum of disease in Nepal.     

Epidemiology of sexually transmitted infections in France

BACKGROUND: Sexually transmitted infections (STI) in France are reported on a voluntary basis through several sentinel surveillance systems. METHODS: To monitor STI, sentinel laboratory- or clinician-based surveillance systems were set up by the Institut de Veille Sanitaire: gonorrhea surveillance (Renago) in 1986, Chlamydia infections surveillance (Renachla) in 1989, and more recently, syphilis surveillance in 2000 and rectal lymphogranuloma venereum (LGV) in 2004. RESULTS: From 2000 to 2003, 1,089 syphilis infections were reported. Most of the cases were diagnosed in men having sex with men (MSM) and were mainly reported by STI clinics located in the Paris area. From 1997 to 2000, an increase of gonorrhea was observed each year. After two years of stable trend, the prevalence of gonorrhea increased again in 2003. From 2002 to 2004, 123 LGV cases were diagnosed in France and were observed only in MSM. Since 2001, Chlamydia infections have steadily increased, particularly in women. COMMENTS: Because STI surveillance is based on a voluntary basis, the number of reported cases is probably lower than the number of STI diagnosed in France. However, the data provided by the different surveillance systems reveals that STI have been increasing in France since 1997. Moreover, the resurgence of syphilis in 2000 and the emergence of rectal LGV in 2004 indicate that these STI occur mainly in MSM. Trends on incidence and patients characteristics observed in France are similar to those of several Europeans countries. European Public Health interventions are becoming necessary to prevent and control STI.     

Capture-recapture analysis to estimate the incidence of invasive meningococcal disease in Germany, 2003

The incidence of invasive meningococcal disease (IMD) in Germany in 2003 was estimated by the two-source capture-recapture method. As a unique personal identifier was unavailable, cases with IMD tested at the National Reference Centre for Meningococci (NRZM) were matched with cases reported to the Robert Koch Institute (RKI) through the statutory surveillance system by using demographic and disease-specific variables common to both datasets. The estimated overall incidence was 1.1 IMD cases/100,000 inhabitants, with a sensitivity of ascertainment of 64.8% for NRZM and 89.4% for RKI. Case-fatality rate was estimated at 8.8%. Adjustment for heterogeneity of capture according to age, region and serogroup observed in the NRZM (but not RKI) source had minimal effect on the estimated incidence. The IMD incidence estimated by capture-recapture analysis is thus only slightly higher than through statutory surveillance data. As a degree of positive dependence between the systems cannot be ruled out, this estimate may still be an underestimate. However, under ascertainment appears insufficient to explain the low incidence of IMD in Germany compared to other European countries.     

Underreporting of human alveolar echinococcosis, Germany

We estimated the total number of human alveolar echinococcosis cases in Germany from 2003 through 2005 using the multiple source capture-recapture method. We found a 3-fold higher incidence of the disease than that shown by national surveillance data. We propose a revision of the reporting system to increase case ascertainment.     

The epidemiology of leptospirosis and the emergence of Leptospira borgpetersenii serovar Arborea in Queensland, Australia, 1998-2004

Leptospirosis is one of the most commonly encountered zoonoses in both Australia and the rest of the world. The incidence of leptospirosis in Queensland over the 7-year study period (1998-2004) was 3.1/100000 population. Enhanced surveillance questionnaires were used to collect patient data and facilitate an epidemiological investigation of leptospirosis in Queensland. Farming occupations comprised the majority of occupational exposure cases, however, recreational exposure accounted for 18% of the 883 cases. Rainfall and the presence of animal hosts had the most influence on the incidence of leptospirosis. Several trends in serovar numbers over this period are noted, in particular the emergence of L. borgpetersenii serovar Arborea, which accounted for 22% of all leptospirosis cases in Australia and 68% of South-East Queensland cases in 2004. Assessment of epidemiological trends in leptospirosis is important to obtain directed public health intervention and outcomes in the reduction of leptospirosis cases.     

1996-2010年广元市虫媒传染病流行病学特征分析

目的分析广元市虫媒传染病流行特征,为制定虫媒传染病防控措施,提供科学依据。方法运用流行病学方法分析1996-2010年虫媒传染病三间分布。结果广元市1996-2010年共报告8种虫媒传染病1 302例,死亡48人,年均发病率2.86/10万。1996-2000年报告乙脑、钩体、出血热及疟疾4种虫媒传染病;2001-2005年新增报告狂犬病、血吸虫和黑热病,报告7种虫媒传染病;2006-2010年新增报告布鲁菌病,报告8种虫媒传染病病例;2006-2010年年均发病率较1996-2000年下降73.70%;1996-2000年病种以乙脑、钩体为主,占虫媒传染病的81.97%;2001-2005年与1996-2000年一致,病种以乙脑、钩体为主,占虫媒传染病的77.37%;2006-2010年病种以乙脑为主,占虫媒传染病的64.04%。乙脑病例集中在7～9月,其中8月为发病高峰,占乙脑报告病例的59.12%;发病年龄主要集中在10岁以下,占乙脑病例的95.13%;钩体分布在5～11月,其中10月为发病高峰,占钩体报告例数的74.41%;发病年龄主要在20～59岁组,占钩体病例的87.60%;出血热以6～7月、11月～翌年1月发病较多;发病年龄主要集中在40～59岁,占出血热病例的64.16%。发病职业以农民、散居儿童、幼托儿童和学生为主,占报告病例的93.70%。结论广元市虫媒传染病总体呈下降趋势,但报告病种有增加趋势,虫媒传染病发病有明显的季节性和重点人群,应实施重点人群、重点区域、重点疾病、重点环节的防控策略。     

Longitudinal epidemiology of leptospirosis in the Czech Republic (1963-2003)

After higher rates of occupational or leisure diseases recorded in the Czech Republic in the second half of the last century it was found that the last climatic changes and catastrophic floods of 1997 and 2002 were followed by outbreaks of leptospirosis as the only re-emerging postflood infection. While in tropics and subtropics the monsoon season is typically followed by highly increased rates of leptospirosis in humans, even, with fatal outcomes, this phenomenon remained unknown under the climatic conditions of the Czech Republic where human leptospirosis has been reported rather sporadically, mostly in natural foci of infection, and its incidence rate is usually about 0.3% per 100,000 population. Nevertheless, after the unexpected vast floods of 1997 and 2002 that also afflicted natural foci of leptospirosis, the rates of reported and serologically confirmed cases of leptospirosis in the Czech Republic were three times as high as usual with the specific morbidity reaching 0.9 case per 100,000 population. In 1997, as many as 7156 persons were tested for leptospirosis in the Czech Republic: the disease was diagnosed and reported in 94 patients and in 2002, 92 out of 4999 persons tested were diagnosed with leptospirosis. Two thirds of these cases were from inundation areas, half of them being directly associated with floods (exposure to residual water, flood mud in cellars, etc.). Four case of Weil disease reported in 1997 were fatal. As many as 41 deaths from Weil disease have been reported in the Czech Republic since 1963 when the disease became reportable.     

Surveillance program of neck and upper limb musculoskeletal disorders: assessment over a 4 year period in a large company

OBJECTIVE: A company-wide surveillance program for musculoskeletal disorders (MSDs) based on the assessment of health and risk factors was implemented between 1996 and 2000 in a large shoe factory. The study aimed to compare the results of the surveillance program in 1996 and 1997 with the occurrence of MSDs in 2000. METHODS: A health and ergonomic assessment of workstations was performed for 253 workers in 1996. Of these, 166 were examined again in both 1997 and 2000. A set of criteria was used to predict whether or not a job category could be predicted to have a potentially high risk of MSDs in 1996 and 1997 and the results were compared with the incidence rate of MSDs in the job category in 2000. RESULTS: The criteria based on prevalence data in 1996 were unable to detect the job categories characterized by the occurrence of MSDs in 2000. The criterion based on an incidence rate >1% in 1997 was sensitive and specific. The agreement between the ranking of the job categories according to incidence rate of MSDs in 1997 and 2000 was good (rho=0.57, P=0.11). Agreement of the prediction based on ergonomic exposure was lower than that based on incidence data. CONCLUSION: The efficacy of the surveillance program to predict on a collective basis the job categories in which numerous cases of MSDs occurred in 2000 depended on the decision criteria used. The criteria based on the incidence of MSDs were more reliable to predict the risk of MSDs than those based on prevalence data or on exposure assessment. Because exposure assessment plays a greater role in determining the priorities for ergonomic intervention, surveillance of health and exposure must nevertheless be combined to predict the risk of MSDs in the plant in the short and middle terms.     

江西省钩端螺旋体病流行病学分析

目的分析江西省钩端螺旋体病的流行状况,为钩端螺旋体病防治提供科学依据。方法采用描述流行病学方法对江西省2001-2008年钩端螺旋体病疫情资料和监测资料进行流行病学分析。结果2001-2008年全省共报告钩端螺旋体病病例1 405例,年报告发病率在0.11/10万~1.15/10万,年均发病率为0.42/10万;共报告钩端螺旋体病死亡病例38例,病死率为2.75%,病例以散发为主;病例主要发生在江西省的赣州市、宜春市和上饶市,3市病例占全省总病例数的74.59%;7-8月为钩体病发病高峰,占总病例数的71.96%;职业以农民为主,占总病例数的76.44%;发病年龄集中在10~59岁,占全部病例的91.74%;男女性别之比约为2∶1;2002-2007年钩体病监测发现流行菌群为黄疸出血群(32.61%)和澳洲群(15.94%)。结论2001-2008年江西省钩体病发病率呈逐年下降趋势,但部分地区发病率仍较高,7-8月为高发季节,与早晚季水稻"双抢"有关,也与职业人群相符,表现为稻田型流行特征;主要传染源及流行菌群分别为野外鼠和黄疸出血群钩体。     

浙江省2001～2003年麻疹流行病学分析

目的　了解浙江省麻疹流行病学特征 ,探讨加速控制麻疹的策略。方法　对 2 0 0 1～ 2 0 0 3年麻疹发病情况进行描述性流行病学分析。结果　浙江省 2 0 0 1～ 2 0 0 3年麻疹年平均发病率高于 1 998～ 2 0 0 0年。病例分布广泛 ,散发和局部爆发并存 ,个别高发县影响全省麻疹发病水平。 3～ 6月为麻疹高发季节 ,≤ 2岁和 6～ 8岁为麻疹高发年龄组。对麻疹病例的免疫史分析表明 ,<1 5岁的病例 2 9.8%未接种麻疹疫苗 (MV) ,2 9 .9%免疫史不详。结论　根据报告病例的年龄和免疫史状况表明 ,MV的常规免疫仍需加强 ,同时要考虑对大年龄组人群接种MV ,继续加强麻疹监测     

鼠类种群数量变动对钩端螺旋体病流行的影响

目的 研究鼠类种群数量变动对钩端螺旋体病（简称钩体病）流行的影响，以便制定控制钩体病流行的对策。方法 采取回顾性研究和现况研究相结合的方法，通过法定传染病报告系统收集发病情况，按全国爱卫办颁布的鼠情调查方法开展鼠情监测。将获得的资料进行直线相关等统计学分析。了解鼠密度与钩体病发病之间的关系。水文气象与鼠类密度之间的关系。结果 鼠密度和钩体病发病关系密切。鼠密度（夹夜法）达10%以上即可能造成钩体病流行。结论 鼠密度对钩体病发病影响很明显。鼠密度可以做为钩体病流行预测的一项重要监测指标。     

Predictive factors for incident musculoskeletal disorders in an in-plant surveillance program

OBJECTIVES: A surveillance program for upper-limb work-related musculoskeletal disorders (UWMSD) based on assessment of health and risk factors was implemented between 1996 and 2000 in a large shoe factory with overall high levels for biomechanical exposure. The study aimed to identify workers with an increased risk of UWMSD incidence. METHODS: In 1996, 1997 and 2000, 166 workers filled out a questionnaire and underwent a standardized physical examination. Factors from the 1996 questionnaire (general, personal and occupational factors) associated with UWMSD incidence in 1997 were selected. The predictive role of these variables was studied with a logistic model, taking into account also gender and age. The performance of a risk score based on this model was studied in 2000, using the Wilcoxon test and ROC curves. RESULTS: In 1997, 28 incident cases of UWMSD were observed (N = 107, 26.2%). Work pace and prior history of UWMSD were the only factors significantly associated with UWMSD incidence in 1997 (respectively 33% versus 13%, P = 0.02 and 58% versus 22%, P = 0.01). Psychological distress (36% versus 21%, P = 0.10), physical fatigue (35% versus 22%, P = 0.14), repetitiveness (30% versus 18%, P = 0.17) and task precision (33% versus 21%, P = 0.16) were also included in the logistic model for 1997 UWMSD incidence. Controlling for these variables, prior history of UWMSD remained associated with incidence in 1997 (OR = 5.5, 95% CI = 1.4-21.8). In the period from 1997 to 2000, 24 incident cases were observed (N = 102, 23.5%). The risk score, based on variables from the 1997 model, was significantly higher for incident cases (median = 6 in incident cases versus 4.5 for healthy subjects, P = 0.02). ROC curves indicated that the highest agreement reached 67% for sensitivity and 59% for specificity. Among subjects who did not change their task (N = 71, 18 incident cases), performance reached 66% for specificity with the same sensitivity. CONCLUSION: These results suggest that surveillance programs of UWMSD at a company level are possible even with overall high levels for biomechanical exposure and should take into account occupational and personal factors, including prior history of UWMSD.     

Changing epidemiology of Q fever in Germany, 1947-1999.

The epidemiology of Q fever in Germany was examined by reviewing relevant studies since 1947 and by analyzing available surveillance data since 1962. The average annual Q fever incidence nationwide from 1979 to 1989 was 0.8 per million and from 1990 to 1999, 1.4 per million. The mean annual incidence from 1979 to 1999 ranged from a minimum of 0.1 per million in several northern states to 3.1 per million in Baden-Württemberg, in the South. We identified 40 documented outbreaks since 1947; in 24 of these sheep were implicated as the source of transmission. The seasonality of community outbreaks has shifted from predominantly winter- spring to spring-summer, possibly because of changes in sheep husbandry. The location of recent outbreaks suggests that urbanization of rural areas may be contributing to the increase in Q fever. Prevention efforts should focus on reducing sheep-related exposures, particularly near urban areas.     

Impact of conjugate Haemophilus influenzae type b (Hib) vaccine introduction in South Africa

OBJECTIVE: To analyse trends in reported invasive Haemophilus influenzae disease in South Africa within the first five years of introduction of conjugate Haemophilus influenzae type b (Hib) vaccine in the routine child immunization schedule. METHODS: We used national laboratory-based surveillance data to identify cases of invasive H. influenzae disease between July 1999 and June 2004, and submitted isolates for serotyping and antimicrobial susceptibility testing. FINDINGS: The absolute number of Hib cases (reported to the national surveillance system) among children below one year of age decreased by 65%, from 55 cases in 1999-2000 to 19 cases in 2003-04. Enhanced surveillance initiated in 2003, identified human immunodeficiency virus (HIV)-infection and incomplete vaccination as contributing factors for Hib transmission. The total number of laboratory-confirmed cases of H. influenzae remained unchanged because non-type b disease was being increasingly reported to the surveillance system concomitant with system enhancements. Children with non-typable disease were more likely to be HIV-positive (32 of 34, 94%) than children with Hib disease (10 of 14, 71%), P = 0.051. Recent Hib isolates were more likely to be multidrug resistant (2% in 1999-2000 versus 19% in 2003-04, P = 0.001). CONCLUSION: Data from a newly established national laboratory-based surveillance system showed a decrease in Hib disease burden among South African children following conjugate vaccine introduction and identified cases of non-typable disease associated with HIV infection.     

Perinatal group B streptococcal disease after universal screening recommendations--United States, 2003-2005

Group B streptococcus (GBS) is a leading cause of neonatal morbidity and mortality in the United States. In 2002, CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) issued revised guidelines for the prevention of perinatal GBS disease. These guidelines recommend universal screening of pregnant women by culture for rectovaginal GBS colonization at 35-37 weeks' gestation and the use of intrapartum antibiotic prophylaxis for GBS carriers. To examine rates of neonatal and pregnancy-associated GBS disease after the revised guidelines were issued, CDC analyzed surveillance data from the Active Bacterial Core surveillance (ABCs) system from the period 2003-2005 and compared them with data from 2000-2001, the period immediately preceding the universal screening recommendations. This report describes the results of that analysis, which indicated that annual incidence of early onset GBS disease (i.e., in infants aged 0-6 days) was 33% lower during 2003-2005 than during 2000-2001. However, although incidence among white infants decreased steadily during 2003-2005, incidence increased 70% among black infants. Incidence of GBS disease among infants aged 7-89 days (i.e., late-onset disease) and pregnant women remained stable after revised universal screening guidelines were issued. Continued surveillance is needed to monitor the impact of the guidelines on perinatal GBS disease and trends in racial disparities and to guide interventions to reduce disparities.