TB and AIDS

The Indian National Tuberculosis Survey has indicated that 10 million persons above 5 years of age have pulmonary tuberculosis (TB), of whom 2.5 million are infectious. The annual infection rate amounts to 1.5%. In an average district with a population of 1.5 million, there are about 500 active, infectious TB cases and about 20,000 radiologically active cases. The World Health Organization has declared TB a global health emergency. The pandemic of AIDS had infected 13 million people worldwide by early 1993, and by the year 2000 over 40 million will be infected. In May 1986 only 1 AIDS case was reported, but by May 31, 1994, 728 cases of AIDS and 15,325 cases of HIV infections were reported. At the present rate of infection, there will be 5 million people infected with HIV by 2000 in India. HIV infection is the greatest risk factor for developing TB because of the multiplication of tubercle bacilli in quiescent foci, the progression of dormant infection to disease, and superinfection. The incidence of TB has doubled in the course of 5 years in some countries where HIV is epidemic. 30-70% of TB patients in these countries are estimated to be HIV-positive, imposing significant burden on national health services. On the other hand, efficient health services can still cure TB in HIV-positive patients and forestall the spread of the diseases. One-third of the world's population is infected with TB, and the lives of these people are shortened if they contract HIV. Worse still, for HIV-infected people exposure to TB means death, often within weeks. The only protection against the airborne TB germ is the complete cure of TB patients. At a 1993 conference in London several TB control measures were suggested: national TB control programs offering affordable treatment; faster diagnosis; education and incentives to increase patient compliance; proper drug supplies and quality control; education of influential people; and fight against poverty.     

2004—2009年辽宁口岸出入境人员传染病监测情况分析

〔目的〕通过分析辽宁口岸出入境人员的传染病监测情况,明确辽宁口岸出入境人员中的常见传染病和需要重点监测传染病流行病学特征,为口岸传染病监测工作提供科学依据。〔方法〕对2004年1月—2009年12月辽宁口岸出入境人员传染病监测情况进行统计分析。〔结果〕辽宁口岸2004—2009年检出传染病病例1746例,总检出率为331.02/10万(0.331%),其中病毒性肝炎、梅毒、开放性肺结核、艾滋病等4种传染病的检出率分别为166.84/10万、113.94/10万、32.23/10万、11.00/10万。登革热、疟疾等传染病的检出率较低。31~50岁年龄组患病人数最多为1 052例,占传染病检出人数的60.25%。1746例病例来自32个国家和地区,其中88.83%为中国籍。梅毒、HIV/AIDS、病毒性肝炎检出率最高的职业是驾驶员,开放性肺结核检出率最高的是涉外婚姻人员。〔结论〕辽宁口岸出入境人员传染病监测重点应为病毒性肝炎、梅毒、开放性肺结核、艾滋病,重点监测年龄为31~50岁人群,中国、韩国、朝鲜籍人员应被列为重点监测对象,重点监测职业为驾驶员。此外,登革热、疟疾传染病的监测工作也不可忽视。     

Aspects of tuberculosis in Africa. 1. Tuberculosis in Africa in the AIDS era--the role of chemoprophylaxis.

An estimated 2.8 million people in Africa have dual infections with tuberculosis and human immunodeficiency virus (HIV). Because of the increasing numbers of cases of tuberculosis as a consequence of the HIV epidemic, chemoprophylaxis may become a cost effective tuberculosis control measure in high prevalence countries. Although isoniazid (INH) is the only drug evaluated in controlled trials of preventive tuberculosis therapy, studies are now under way to determine the efficacy of INH and other drugs, including rifampicin and pyrazinamide, in preventing tuberculosis reactivation in persons with HIV infection. If chemoprophylaxis is effective in persons with dual infection, further studies will be required to determine whether chemoprophylaxis is cost effective for tuberculosis prevention and control and whether it is feasible to introduce it as a community control measure.     

Progress in prevention of infectious disease

Current issues in preventing infectious diseases and their implications for the future are examined, looking broadly at technologies, program strategies, and the growing influence of public and professional attitudes and perceptions in maintaining and achieving infectious disease control. It is concluded that the technologies to control infectious diseases are available, implementation of delivery programs is feasible, and current attitudes of public and professions dampen but should not impede progress. The need for distributing the benefits of available preventive medical technology to the developing world is obvious, but achievements will be difficult and costly. It is equally important for the economically developed countries that have achieved successes in infectious disease prevention to sustain their progress and confront the concerns of public compliance, liability, management, and program support which threaten to hinder progress. Obviously, the needs must be clearly enunciated and the problems solved in order for the job of infectious disease prevention to be done.     

镇江口岸2005年出入境人员传染病监测结果分析

目的了解镇江口岸出入境人员中乙型肝炎、丙肝、梅毒及艾滋病的感染情况,为口岸传染病预防和监测提供科学依据。方法对镇江口岸2005年出入境人员部分传染病结果进行了整理和分析。结果共检查3534名出入境人员,检出传染病及指标异常111例(检出率3.14%),其中HBsAg阳性者69例(其中乙肝DNA阳性33例),丙肝抗体阳性26例,肺结核2例,梅毒阳性12例,HIV抗体阳性2例(均为再次出国人员)。结论通过了解传染病的感染现状,加强出入境人员传染病监测工作,制定有效防治措施,尤其应对归国人员及时进行艾滋病监测相关法规的制定已迫在眉睫。     

Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated blood transfusions and medical injections?

We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.     

Investigating interactions between HIV infection and tropical diseases

The health of developing country populations in Africa where there is a high incidence of human immunodeficiency virus (HIV) infection is already seriously compromised by malnutrition and endemic diseases such as tuberculosis. Not only may HIV infection compromise currently used methods for the treatment of tropical diseases, but there may be a synergistic relationship between HIV and other diseases. Epidemiologic studies are thus needed to identify and quantify and such interactions. At present, evidence of such interactions may be limited by the fact that tropical diseases are most prevalent in rural areas while HIV cases have so far been concentrated in urban areas. However, any unexplained rise in the incidence or severity of a specific disease in areas where HIV is prevalent should be investigated as a possible interaction effect. Likewise, if the progression from HIV infection to acquired immunodeficiency syndrome (AIDS) seems to be occurring particularly rapidly in an area, AIDS patients should be examined for the presence of other diseases that may be triggering AIDS. Possible interactions between HIV infection and tropical diseases can be set forth in a schematic form in which both are divided into 3 infection states--uninfected, infected without clinical symptoms, and infected and diseases--and arrows are used to represent the transitions between states and possible interactions.     

Availability of indicators of migration in the surveillance of HIV, tuberculosis and hepatitis B in the European Union – a short note

Background and aim

Data regarding infectious diseases in migrant populations in Europe are scarce. We aimed to assess whether information on migration status is collected in countries of the European Union (EU) as part of their national surveillance systems for major infectious diseases (HIV/AIDS, tuberculosis (TB) and hepatitis B infection).

Methods

Using different electronic sources we collected information about whether indicators of migration status were collected in national infectious diseases surveillance systems in European countries.

Results

Of 27 EU countries, migration status was recorded in all 27 countries for TB surveillance (100%), in 22 countries for HIV (~82%) and in 23 countries for AIDS (~85%). Eight of 20 countries (40%) recorded migration status in hepatitis B surveillance systems. The most commonly recorded indicator of migration status was country of birth. Among countries which conducted migrant specific surveillance, country of birth was collected in ~82% of TB, ~86% of HIV, and ~83% of AIDS surveillance systems. Other indicators of the migration status were ethnicity (used in HIV and AIDS surveillance) and citizenship (TB surveillance).

Conclusion

We showed differences in how migration status is recorded in surveillance systems from European countries. This was especially true for tuberculoses and hepatitis B, whereas data collection as part of HIV/AIDS surveillance was nearly uniform. These results suggest the need for a more uniform reporting of migration status as part of infectious disease surveillance in EU countries.     

腾冲口岸出入境人员传染病监测结果分析

目的分析腾冲口岸出入境人员传染病监测情况,掌握出入境人员传染病感染情况、疫情特点、流行病学特征,正确评估出入境人员健康风险,为传染病监测工作提供依据。方法对2007—2010年腾冲口岸出入境人员传染病监测情况进行流行病学调查、分析和统计。结果 4年间共进行传染病监测体检9104人,检出各种传染病481例,总检出率为5.28%,各年度检出率呈逐年上升趋势;检出率最高的疾病是HBsAg阳性,为3.93%,其次是HIV抗体阳性、HCV抗体阳性、疟疾,检出率分别为0.63%、0.31%、0.28%;HIV抗体阳性和疟疾感染呈现境外输入性传播特点;调查对象以劳务人员和外籍人员为主,不同职业类别传染病检出率具有统计学意义(P<0.01)。结论 HBsAg阳性和HIV抗体阳性是腾冲口岸出入境人员感染的主要传染病,劳务和外籍人员是重点监测对象。     

Tuberculosis control and research strategies for the 1990s: memorandum from a WHO meeting.

Tuberculosis is the largest cause of death from a single infectious agent in the world, killing nearly 3 million people every year. This death toll represents 25% of avoidable adult deaths in developing countries. It imposes a heavy burden on the 8 million new individuals who contract the disease each year, and on their households; morbidity and mortality are concentrated in young adults. The association of tuberculosis and HIV infection will significantly exacerbate the situation in developed and developing countries, making the need for action all the more pressing. Effective control measures are available. Broad action is therefore warranted and should be aimed at introducing the effective strategies on as wide a scale as possible to reach the targets of 70% case detection and 85% cure of smear-positive patients, by the year 2000. Research is needed to implement these strategies throughout the world and to ensure that effective tools will remain available for controlling tuberculosis despite emerging problems such as resistance to the major drugs currently available. To make a real impact on the tuberculosis problem, a focused global programme must be created, under the leadership of WHO, to bring tuberculosis to the world''s attention, to mobilize support on a major scale, and to provide direct guidance and support to national programmes.     

Clinical research, prophylaxis, therapy, and care for HIV disease in Africa.

By the end of the century, citizens of resource-poor countries will constitute 90% of the world's human immunodeficiency virus (HIV)-infected people. Clinical management of such persons in developing countries has been neglected; most AIDS research has concentrated on epidemiology, and donor agencies have generally invested in the prevention of HIV infection. The heavy burden of HIV disease in Africa requires that care for AIDS be addressed, and prevention and care should be seen as interrelated. Prevention and treatment of tuberculosis, the commonest severe infection in persons with AIDS in Africa, illustrate this interrelationship. We outline priorities for applied research on the management of HIV disease in a resource-poor environment, and discuss prophylaxis, therapy for opportunistic diseases, terminal care, and use of antiretroviral therapy. Research should define the standard of care that can realistically be demanded for HIV disease in a resource-poor environment. Research and public health programs for AIDS in developing countries must address AIDS care and attempt to reduce the widening gap between interventions available for HIV-infected persons in different parts of the world.     

Epidemiological study designs appropriate for investigating interactions between HIV infection and tropical diseases

Infections with the human immunodeficiency virus(es) (HIV) are likely to have a profound impact on the health of those in many parts of Africa over the next several decades. If there are adverse interactions between HIV infections and the endemic tropical diseases the overall impact of the HIV epidemic will be worse than that predicted based on observations on the natural history of HIV infections in developed countries. With the exception of tuberculosis, the evidence for such interactions is presently lacking, but this may be largely due to the dearth of informative studies. In this paper we outline the kinds of epidemiological studies required to investigate such interactions and discuss some of the problems associated with the investigations.     

Contribution of fluoro-deoxyglucose PET/CT for the diagnosis of infectious diseases

The diagnosis of some infectious diseases is sometimes difficult to make and new diagnostic tools have been regularly assessed to that end. 18fluoro-deoxyglucose (¹⁸FDG) positron-emission tomography (PET) coupled with computed tomography (CT) is one of these new procedures. It has been evaluated for numerous infectious diseases with uneven results. A literature review allowed drawing some conclusions. First, ¹⁸FDG-PET/CT is not currently a first-line procedure for infectious diseases. Second, it has proved useful for the evaluation of patients presenting with fever of unknown origin (FUO). Its negative predictive value is 100%: the symptoms of patients experiencing FUO with negative first-line investigations and a negative ¹⁸FDG-PET/CT will almost always spontaneously disappear. Third, ¹⁸FDG-PET/CT also seems to be contributive for the diagnosis of vascular prosthesis infections or osteomyelitis. Fourth, it has promising results for patients presenting with infective endocarditis, especially for secondary infectious foci, or for patients presenting with suspected infection of pacemakers or implanted defibrillator; but results are still preliminary and must be confirmed. Finally¹⁸FDG-PET/CT cannot be recommended yet for other infectious diseases due to lack of published data.     

Low-cost tools for diagnosing and monitoring HIV infection in low-resource settings

Low-cost technologies to diagnose and monitor human immunodeficiency virus (HIV) infection in developing countries are a major subject of current research and health care in the developing world. With the great need to increase access to affordable HIV monitoring services in rural areas of developing countries, much work has been focus on the development of point-of-care technologies that are affordable, robust, easy to use, portable and of sufficient quantitative accuracy to enable clinical decision-making. For diagnosis of HIV infection, some low-cost tests, such as lateral flow tests and enzyme-linked immunosorbent assays, are already in place and well established. However, portable quantitative tests for rapid HIV monitoring at the point of care have only recently been introduced to the market. In this review, we discuss low-cost tests for HIV diagnosis and monitoring in low-resource settings, including promising technologies for use at the point of care, that are available or close to market.     

Tuberculosis: a disease of the 1990s

In the United States, the decades preceding the 1980s were characterized by a decline in the incidence of tuberculosis. More recently, the trend has undergone a significant reversal: Case rates have been increasing by 3% to 6% annually. In 1990, more than 25,700 cases were reported to the Centers for Disease Control. In a sense, tuberculosis is adapting to the '90s. The recent increase in its incidence tends to affect populations with identifiable characteristics. Among the most important of these groups are the populations at high risk for infection by the human immunodeficiency virus. The increase is also fueled by cases in populations that are medically underserved, including foreign-born persons from high-prevalence countries, persons with low incomes, and persons living in long-term-care facilities--especially persons with previous tuberculosis infection. Thus, factors such as homelessness, chronic alcohol or drug abuse, malnutrition, and crowded living conditions continue to favor development and transmission of disease. The increase in the incidence of tuberculosis appears to be greatest when subpopulations in such circumstances are also at high risk for HIV infection. Complex issues in the diagnosis and treatment of tuberculosis arise from these epidemiologic patterns. HIV infection is associated with unusual presentations of tuberculosis. Thus, the clinician must maintain a high index of suspicion for the disease in the setting of HIV infection or risk of the infection. The populations at greatest risk are likely to be mistrustful of the medical system, making the long-term administration of potentially toxic chemotherapy more difficult than it already is. Chronic substance abuse may complicate compliance and add further difficulties to the monitoring of chemotherapy. At the same time, the monitoring becomes even more important in the physician's effort to minimize adverse effects of the medications. Outbreaks of drug-resistant disease have recently occurred, complicating the selection of drugs and affecting the duration of treatment. Despite all of these problems, it is essential to establish a diagnosis and initiate treatment rapidly, both to arrest the disease process and to limit its transmission. Since Mycobacterium tuberculosis is spread to uninfected persons in aerosols generated by coughing or sneezing, the infectiousness of a patient with active disease can be related, at least in part, to the number of organisms seen on sputum smears. Initiation of therapy is followed by a rapid decline in infectivity.     

Public health law and tuberculosis control in Europe

BACKGROUND: Tuberculosis control is an important public health challenge in many European countries. Law is an important tool that policy-makers can draw upon to support control efforts and, according to the World Health Organization, represents a tangible expression of political commitment and will. Despite this, little national research, and even less cross-national comparative research, has been conducted to describe and analyse legislative approaches to tuberculosis control. METHODS: We conducted a survey of 14 European countries to identify, describe, map and analyse legislative tools used to support tuberculosis control. RESULTS: We found a wide range of legislative models. Legal measures available to nation states, such as compulsory examination, compulsory screening, compulsory detention, compulsory treatment and compulsory vaccination, vary widely in both scope and number. We identified a typology of legal frameworks, from the most authoritarian to the least restrictive. It seems likely that the application of some laws might not withstand scrutiny under the European Convention for the Protection of Human Rights and Fundamental Freedoms. CONCLUSIONS: Harmonization of legislative response to infectious diseases, based upon sound evidence, may be necessary if collaborative efforts in support of infectious disease control, as envisaged in the new International Health Regulations, are to be most effective and are to reflect more appropriately a globalized 21st century world.     

Surveillance and control of infectious diseases: progress toward the 1990 objectives.

Great progress has been made in the United States in reducing infectious disease mortality. However, infectious diseases remain the greatest cause of morbidity in this country. Newer infectious diseases or agents have been recognized, but newer tools for surveillance and control have also been made available. Specific objectives for the reduction of infectious diseases by 1990 have been set by the Public Health Service. The opportunities appear to be good for achieving by 1990 objectives for nosocomial infections, Legionnaires'' disease, tuberculosis, and surveillance and control of infectious diseases. Achievement of the 1990 objectives for hepatitis B, pneumococcal pneumonia, and bacterial meningitis, however, will require both scientific advances and additional resources.     

2010 - 2017年中国大陆法定传染病疫情分析

目的 分析2010 - 2017年中国大陆(不含港澳台)法定传染病的发生水平、构成及流行特征,为制定更为有效的传染病预防控制政策和措施提供依据。方法 运用描述性流行病学方法,对2010 - 2017年法定传染病数据进行整理统计。结果 2010 - 2017年法定传染病发病37种53 665 896例,年均发病率494.2617/10万,主要为乙类和丙类（共35种53 665 495例）。乙类中病毒性肝炎（主要为乙肝）和艾滋病具有血源性及性传播特点,病毒性肝炎发病率和死亡率随年份下降（P = 0.037,P = 0.023）,而艾滋病上升（P = 0.003,P = 0.002）;肺结核和人感染H7N9禽流感属于呼吸道传染病,肺结核发病率随年份下降（P = 0.001）,而人感染H7N9禽流感2017年发病率（≥1.75倍）和死亡率（≥1.90倍）均显著高于其他年份;狂犬病属于虫媒及自然疫源性传染病,发病率和死亡率均随年份下降（P = 0.002,P = 0.002）。丙类中手足口病通过肠道传播,发病率（≥120.2142/10万）一直较高。结论 中国法定传染病以乙类和丙类流行为主,且主要集中在手足口病、病毒性肝炎、肺结核、狂犬病、艾滋病、人感染H7N9禽流感中。病毒性肝炎、肺结核、狂犬病的防治效果显著,但仍应重点防控,其余病种应根据其特点,改进防治措施。     

Male circumcision and HIV heterosexual transmission

Since the early years of the AIDS epidemic significant geographic differences in HIV prevalence were reported within neighboring countries and neighboring regions within the same country in sub-Saharan Africa. These differences could not be fully explained by factors such as sexual behavior and condom use. Mounting epidemiological data have demonstrated that male circumcision is a major protective factor against male heterosexual HIV infection in sub-Saharan Africa and probably contributes to these significant differences in HIV prevalence. This is a review of African studies on the association between male circumcision and HIV infection, the origin of circumcision practices in human societies, potential prepuce mechanisms for increasing male vulnerability to heterosexual HIV infection, its association with other infectious and neoplastic diseases, controversies on the convenience of male circumcision as an HIV control strategy in Africa, the scarce Brazilian literature on male circumcision and perspectives of future research.