Anthropogenic environmental factors and their role in the occurrence of acute respiratory diseases

The incidence of acute respiratory diseases (ARD) in two districts of the Orenburg Region which have different levels of environmental pollution was comparatively analyzed. The higher incidence of ARD in the more polluted district (Kuvandyksky) than in the control one (Belyaevsky). The incidence rate (41.8%) of ARD correlated with the level of the ambient air pollution by dust, CO, NO2, NF and fluoride aerosols in the Kuvandyksky district.     

The role of benzathine penicillin G in predicting and preventing all-cause acute respiratory disease in military recruits: 1991–2017

The adenovirus vaccine and benzathine penicillin G (BPG) have been used by the US military to prevent acute respiratory diseases (ARD) in trainees, though these interventions have had documented manufacturing problems. We fit Poisson regression and random forest models (RF) to 26 years of weekly ARD incidence data to explore the impact of the adenovirus vaccine and BPG prophylaxis on respiratory disease burden. Adenovirus vaccine availability was among the most important predictors of ARD in the RF, while BPG was the ninth most important. BPG was a significant protective factor against ARD (incidence rate ratio (IRR) = 0.68; 95% confidence interval (CI) 0.67–0.70), but less so than either the old or new adenovirus vaccine (IRR = 0.39, 95% CI 0.38–0.39 and IRR = 0.11, 95% CI 0.11–0.11), respectively. These results suggest that BPG is moderately predictive of, and significantly protective against ARD, though to a lesser extent than either the old or new adenovirus vaccine.Key words: Adenovirus, military, predictive models, prophylaxis, respiratory disease     

Distribution of acute respiratory diseases in Brazil from 1996 to 2001, Brazil

OBJECTIVE: Acute respiratory diseases -- ARD, mainly pneumonias, are the most important cause of death among children under five years of age and are responsible for severe diseases among people over sixty years of age. This study aims to describe the main epidemiological characteristics of ARD cases notified by healthcare centers. METHODS: ARD patients' records from medical consultations at 100 public health care centers and hospitals were reviewed every week in the period from 1996 to 2001 and data was filled out on a specific form. Data was classified as pneumonia and not pneumonia according to age groups. RESULTS: During this period, 2,050,845 ARD cases were informed. May and June were the months with the largest number of cases. ARDs were more frequent among children aged one to four years old. The latter concentrated about twice the number of cases of other age groups. Pneumonias represented approximately 7.7% of the ARD cases. CONCLUSIONS: The magnitude of ARD numbers may be observed and it should stimulate appropriate diagnosis, early treatment, and prevention, both in regard to the event itself and complications ensuing from it.     

Respiratory disease in Army recruits: surveillance program overview, 1995-2006

BACKGROUND: Since 1966, the U.S. Army has had in place a comprehensive surveillance system for acute respiratory disease (ARD) because of its continued high incidence in the recruit population. A retrospective review of the program from 1995 to 2006, a continuation of an earlier analysis from 1985-1994, was performed to describe the program and to summarize group A streptococcal (GAS) outbreaks identified through this program. METHODS: Weekly incidence data and daily sentinel case data collected as part of the ARD surveillance program were analyzed in 2007 to report rates of ARD and GAS outbreaks over this 12-year period (1995-2006) for five participating Army sites. RESULTS: Average ARD rates were consistently higher from 2000 to 2006 than from 1995 to 1999. Rate ratios of winter rates to summer rates were greater than 1.0 prior to 2000, but from 2000 to 2006, ratios were consistently near 1.0. Rheumatogenic M types were available for three of five outbreaks. CONCLUSIONS: Continuing high incidence of ARD in the military, re-emerging rheumatogenic M types, and a highly mobile military underscore the need for continued surveillance efforts. The continued employment of interventions with demonstrated effectiveness, such as chemoprophylaxis and basic preventive measures, is essential to reducing the burden of ARD.     

Tuberculosis in Canadian Eskimos

The tuberculosis rates among Canadian Eskimos are among the highest in the world, in the period 1967 to 1969, the average annual incidence was 131 cases per 10,000 while the corresponding rate for all Canadians was just over 2 per 10,000. The rates are highest in eastern Arctic where the peak incidence occurs in young women and reaches almost 4% per annum. The risk of developing tuberculosis is very high in all epidemiological groups such as inactive cases, positive tuberculin reactors with normal chest x-ray film, and even BCG-vaccinated individuals.     

Prevention of Adenoviral Acute Respiratory Disease in Army Recruits:: Cost-Effectiveness of a Military Vaccination Policy

Introduction:Since 1971 widespread vaccination has limited the number of adenoviral acute respiratory disease (ARD) outbreaks in Army recruits. Increased vaccine costs have recently threatened the continuation of the vaccination program.Methods:We conducted a cost-effectiveness analysis to assess the consequences of changing the year-round Army adenovirus vaccination program to (1) seasonally targeted vaccine administration (only during the high-risk period) or (2) complete discontinuation of the program from the perspective of total cost to the Army. Costs included vaccination costs and direct and indirect medical and military training costs. Health outcomes were estimated as the number of hospitalizations for ARD prevented. In the reference case, the incidence rate among unvaccinated and vaccinated individuals was 4.06 and 1.5 per 100 person weeks, respectively. Results are expressed for a cohort of 76,171 recruits.Results:In the absence of adenoviral vaccination, a projected 12,370 cases of ARD hospitalization would occur, costing $26.4 million annually. A seasonally targeted program would prevent 7,800 cases of ARD and save $16.1 million over no vaccination. Year-round immunization would not prevent any additional cases but would save $15.5 million over no vaccination. Year-round vaccination would become the cost-effective strategy if ARD incidence during the low-risk months were to increase.Conclusion:Vaccination of Army recruits by any schedule was cost-saving due to the high level of prevented disease and averted hospitalizations. Even though a seasonally targeted program provided the greatest cost-savings, year-round vaccination must remain an option due to the potential for adenoviral ARD outbreaks in the low-risk period.     

河北省磁县近三十年食管癌发病死亡趋势分析

目的分析河北省磁县1974-2002年食管癌发病、死亡趋势.方法食管癌发病资料取自磁县肿瘤登记处,全部资料录入计算机,采用SPSS 11.5软件进行统计分析.结果磁县19742002年食管癌新发病例18 471例,年平均发病率为118.2/10万,其中男性11 068例,女性7403例.男女性年平均发病率分别为140.13/10万和95.66/10万.29年来食管癌发病率总体有下降的趋势.从25岁组开始,各年龄组发病率均随时间推移有所降低,低年龄组发病下降较为明显,发病年龄逐渐后移.1974-2002年山区共发生食管癌2511例,年平均发病率为104.57/10万.经过近30年的防治,山区食管癌发病率明显下降.丘陵地区共发生5934例,年平均发病率114.17/10万,丘陵地区食管癌发病率也有下降.平原地区共发生食管癌10 026例,年平均发病率124.73/10万,平原地区食管癌发病率基本稳定,近年来略有上升趋势.磁县1969-2002年,全县34年共死亡食管癌患者18 736例,年平均死亡率106.00/10万,其中男性11 598例,女性7138例,年平均死亡率分别为129.91/10万、81.61/10万.2002年较1969年食管癌死亡率下降53.48/10万,下降了37.96%.各年代食管癌死亡占恶性肿瘤总死亡的百分比明显下降.结论1974-2002年磁县食管癌发病呈现下降趋势,发病年龄逐渐后移.山区下降尤为显著,丘陵地区下降幅度较小,平原地区发病基本稳定,近年来略有上升趋势.1969-2002年磁县食管癌死亡有明显的下降.     

Trends in cancer incidence in Allegheny County,Pennsylvania, 1937-71.

Cancer incidence rates by race, sex, and cancer site were obtained from the Third National Cancer Survey for the years 1969-71 for residents of Allegheny County, Pennsylvania. When the sex-site-specific rates for 1969-71, as well as incidence rates from surveys in the county in 1937, 1947, and 1957-58, were compared with U.S. rates for 1937, 1947, and 1969-71, a number of significant changes in incidence were observed. Male incidence of cancers of the lung, bronchus, and trachea increased steadily between 1937 and 1969-71 both in Allegheny County and the United States. In the county, female incidence rates for these cancers decreased in the period 1947 to 1957-58 but showed an average annual increased of 9.2 percent in the interval 1957-58 to 1969-71. Incidence rates for county males increased by an average of 4.4 percent per year from 1957-58 to 1969-71. For stomach cancer, incidence rates for both sexes have decreased sharply in the county and in the United States. In the county, stomach cancer rates for females declined by an annual average of 4 percent from 1957-58 to 1969-71, while those formales dropped 2.1 percent. There appears to have been a steady decline over time in cervical cancer in Allegheny County, although the average annual rate of decrease of 2.8 percent for the latest interval (1957-58 to 1969-71) is not as large as the decrease of 3.9 percent per year from 1947 to 1957-58. Breast cancer rates for the county appear to have been steadily, although slowly, increasing at an average rate of about 0.6 percent per year, in contrast to almost constant U.S. rates. The county''s breast cancer incidence rate for 1969-71 almost equals the U.S rate. There have been steady increases in prostate cancer incidence in both Allegheny County and the United States since 1937. For all sites combined, male cancer incidence rates increased, while those for females slowly decreased in both Allegheny County and the United States during the interval 1937 to 1969-71. In the county, male rates for the interval 1937 to 1969-71 increased an average of 1 percent per year, while female rates declined approximately 0.3 percent annually.     

Congenital malaria due to Plasmodium vivax: a case report from Sri Lanka

A case of Plasmodium vivax malaria in an eight-week-old infant in Colombo is documented, with epidemiological and circumstantial evidence which strongly supports a transplacental route of infection. The malarial antibody levels detected by the indirect fluorescent antibody technique in both mother and child are discussed in terms of the present epidemiological pattern of malaria in the country. We also comment on the species incidence of congenital malaria, this case being the first caused by P. vivax in Sri Lanka, despite this species being more prevalent than P. falciparum which has been reported in six previous cases of congenital malaria in Sri Lanka.     

Characterization of carbapenemases,extended spectrum β-lactamases,quinolone resistance and aminoglycoside resistance determinants in carbapenem-non-susceptible Escherichia coli from a teaching hospital in Chongqing,Southwest China

Carbapenem-resistant Escherichia coli isolates harboring carbapenemases or combining an extended-spectrum β-lactamase (ESBL) enzyme with loss of porins present an increasingly urgent clinical danger. Combined resistance to aminoglycosides and fluoroquinolones in carbapeneme non-susceptible (CNS) isolates will inevitably create problems. In the current study, we characterized the carbapenemases and ESBLs, and the prevalence of quinolone resistance determinants and aminoglycoside resistance determinants in carbapenem-non-susceptible (CNS) E. coli isolates from a teaching hospital in Chongqing, Southwest China in 2012. Thirty non-duplicated CNS E. coli isolates were screened via antimicrobial susceptibility testing, and the drug resistance profiles of the 30 strains were analyzed. Carbapenemase genes bla_KPC-2, ESBL genes including bla_CTX-M-3, bla_CTX-M-14, bla_CTX-M-55 and bla_TEM, ARD genes including aac(6′)-Ib, armA and rmtB, and QRD genes including qnrA, qnrB, qnrC, qnrD, qnrS and aac(6′)-Ib-cr were identified and clonal relatedness was investigated by pulsed-field gel electrophoresis. Of the 30 isolates, 2 (6.7%) harbored carbapenemase gene bla_KPC-2; 29 (96.7%) carried ESBLs; 20 (66.7%) were QRD positive; and 11 (36.7%) were ARD positive. Between the two bla_KPC-2 positive strains, one contained ESBL, QRD and ARD genes, while the other expressed ESBL genes but was negative for both QRD and ARD genes. Of the 29 ESBLs positive isolates, 2 (6.9%) were carbapenemase positive, 19 (65.5%) were QRD positive, and 11 (37.9%) were ARD positive. PFGE revealed genetic diversity among the 30 isolates, indicating that the high prevalence of CNS E. coli isolates was not caused by clonal dissemination. Production of ESBLs was associated with the carbapenem resistance and QRD genes were highly prevalent among the CNS E. coli isolates. Multiple resistant genes were co-expressed in the same isolates. This is the first report of a multidrug resistant carbapenem-non-susceptible E. coli co-harboring resistant determinants bla_KPC-2, bla_CTX-M-14, bla_CTX-M-55, bla_TEM, aac(6′)-Ib-cr, qnrB, aac(6′)-Ib and rmtB from Chongqing, mainland China.     

The epidemiology of abortion services

The incidence of abortion and general characteristics of women obtaining legal abortions in the US, and the trends and effects of abortion during the 1970s are described. Statistics on the abortion ratio and abortion rate for the US by year from 1969 to 1978 are presented. Sociodemographic characteristics of women obtaining abortions (age, marital status, parity, gestational age and previous abortions) are described. The availability of abortion services and facilities and the types of procedures used and their safety are discussed. Factors which have contributed to the increasing number of legal abortions are discussed. The benefits of epidemiological data on abortion are noted.     

An updated review on asbestos and related diseases in China

Abstract

Background: Asbestos is an industrial mineral that can cause diseases such as asbestosis, lung cancer, and mesothelioma. Asbestos consumption in China has increased steadily since the 1960s and is currently at half a million tonnes per year. Work conditions in the asbestos-related industries are poor and exposure levels frequently exceed the occupational exposure limit.

Objective: To provide an updated overview on asbestos production and consumption in China and discuss what is known about the resulting burden of asbestos-related diseases.

Findings: China is the world's top chrysotile consumer and second largest producer. Over a million people may be occupationally exposed, yet reliable disease statistics are unavailable and the national burden of asbestos-related disease (ARD) is not well known. Nevertheless, ARD prevalence, incidence, and mortality are expected to be high and will increase for many decades due to the volume of asbestos consumed historically, and a long latency period.

Conclusions: Government policies to prevent ARD have been implemented but more actions are necessary to ensure compliance and ultimately, the complete elimination of asbestos to prevent a heavy future disease burden.     

Epidemiologische und statistische Methoden der Risikoabschätzung

Risk assessment offers a variety of methods which comprise different risk concepts to assess population-based or individual risks. A central epidemiological measure of risk is incidence which is used to derive the relative risk as the ratio between the incidence among subjects exposed and the incidence among subjects unexposed to a certain risk factor. The excess risk quantifies the risk of an exposed population that exceeds the background risk of a non-exposed population. In environmental epidemiology the latter is frequently based on a constant exposure dose over a certain period and is expressed as unit risk. Since the application of different risk concepts depends on the respective study type, we first discuss the different epidemiological study designs. Next, methods to derive the different risk concepts are evaluated and the corresponding statistical measures are presented. Finally, an example illustrates the application of the discussed concepts for individual risk assessment.     

The seroepidemiology of rubella: The independent analysis of current prevalence and past incidence in serological surveys in Spain

Epidemiological patterns of rubella transmission were studied by performing haemagglutination-inhibition (HI) tests on 1 132 sera collected from urban and rural areas of Spain in the period 1969-71. Different epidemiological values were ascribed to 3 levels of HI titre in order to analyse current prevalence and past incidence independently. Titres below 8 were considered negative, while low titres (8-32) were taken to indicate old immunity, medium titres (64-512) to indicate well-established immunity, and high titres (≥1 024) to indicate recent infection. The method appears to be of value for the surveillance of rubella. The findings confirmed that transmission takes place mainly among children of school age and continues at a substantial level up to about 30 years of age. The pattern of transmission differed markedly between city and rural populations.     

Infectious diseases and natural disasters: the effects of Hurricane Mitch over Villanueva municipal area, Nicaragua

BACKGROUND: A three month relief operation for the 25,303 people living in the municipal area of Villanueva, Nicaragua, hit by Hurricane Mitch, was carried out jointly by the staff of an international non-government organization and an Italian Regional Hospital's staff. METHODS: Health Mobile Teams joined the local health facilities (Health Centers and Health Posts) in responding to the people's urgent health problems. From their files the thirty-day post-disaster incidence of acute diarrheas (AD), respiratory tract infectious diseases (ARD), and malaria were estimated and compared with off-crisis data. New cases of leptospirosis were searched, but no control group was available. RESULTS: The incidence of AD and ARD increased significantly in comparison with pre-disaster data (6,798 vs. 2,849 per 100,000 inhabitants (p < 0.01) and 1,205 vs. 295 per 100,000 inhabitants (p < 0.01)). The increase in incidence of malaria was not explicit. Only three cases of leptospirosis were ascertained. The relief operators used the gathered data to make decisions to allocate the poorly available resources. CONCLUSIONS: The feasibility of the infectious disease surveillance and the reliability of the results under such conditions may change according to the setting. In this case study the infectious disease surveillance was feasible, and the gathered data were reliable and of some help to the relief operators in order to allocate the resources efficiently.     

An epidemiological review of Japanese encephalitis.

Twenty-five years ago, Japanese encephalitis (JE) was known as an endemic, mosquito-borne disease in East Asia. Today, the causative virus is known to be distributed from maritime Siberia to the north, eastern India to the west, the Archipelago of Japan presumably the Philippines to the east, and from Indonesia to the south. Since the late-1960s, the geopathological status of JE epidemics has undergone considerable changes. The sizes of JE epidemics in Japan and China (Province of Taiwan) have steadily declined. In fact the JE virus itself appears to be disappearing from Japan. Long-term prediction of JE epidemics is more difficult for Korean Peninsula, nevertheless, reported JE morbidity rate in the Republic of Korea has remained at a relatively low level since 1969. In contrast to the trend in East Asia, new epidemic foci of JE have been emerging in the northern part of Tropical Eastern South Asia starting in 1969. Of particular importance are the continued high incidence (annual morbidity rate: 8.67-22.04/100 000) of reported JE in the northern part of Viet Nam between 1969 and 1974, and the high incidence (14.7/100 000) recorded in Chiang Mai Valley, Thailand, between 1969 and 1970. Apparently, the epidemic in Chiang Mai Valley spread to the neighbouring Shan State of Burma in 1974. Another JE epidemic broke out in West Bengal State, India in 1973. The occurrence of JE in the endemic zone south of these areas has remained sporadic. An increasing number of pathogens have been shown to cause signs and symptoms clinically indistinguishable from JE. In this review, the quality and international comparability of available JE statistics are also examined. Only a few countries and areas with reasonably developed statistical and laboratory services are able to provide national JE statistics in a form ready for epidemiological analysis. A practical surveillance system for JE needs to be organized in those countries where JE is a newly emerging health problem.     

Time Trends in Liver Cancer Mortality, Incidence, and Risk Factors by Unemployment Level and Race/Ethnicity, United States, 1969–2011

This study examined unemployment and racial/ethnic disparities in liver cancer mortality, incidence, survival, and risk factors in the United States between 1969 and 2011. Census-based unemployment rates were linked to 1969–2009 county-level mortality and incidence data, whereas 2006–2011 National Health Interview Surveys were used to examine variations in hepatitis infection and alcohol consumption. Age-adjusted mortality rates, risk-ratios, and rate-differences were calculated by year, sex, race, and county-unemployment level. Log-linear, Poisson, and logistic regression and disparity indices were used to model trends and differentials. Although liver-cancer mortality rose markedly for all groups during 1969–2011, higher unemployment levels were associated with increased mortality and incidence rates in each time period. Both absolute and relative inequalities in liver cancer mortality according to unemployment level increased over time for both males and females and for those aged 25–64 years. Compared to the lowest-unemployment group, those aged 25–64 in the highest-unemployment group had 56 and 115 % higher liver-cancer mortality in 1969–1971 and 2005–2009, respectively. Regardless of unemployment levels, Asian/Pacific Islanders and Hispanics had the highest mortality and incidence rates. The adjusted odds of hepatitis infection and heavy drinking were 38–39 % higher among the unemployed than employed. Liver-cancer mortality and incidence have risen steadily among all racial/ethnic, sex, and socioeconomic groups. Faster increases in mortality among the highest-unemployment group have led to a widening gap in mortality over time. Disparities in mortality and incidence are consistent with similar inequalities in hepatitis infection and alcohol consumption.     

Genotype heterogeneity of Mycobacterium tuberculosis within geospatial hotspots suggests foci of imported infection in Sydney,Australia

In recent years the State of New South Wales (NSW), Australia, has maintained a low tuberculosis incidence rate with little evidence of local transmission. Nearly 90% of notified tuberculosis cases occurred in people born in tuberculosis-endemic countries. We analyzed geographic, epidemiological and genotypic data of all culture-confirmed tuberculosis cases to identify the bacterial and demographic determinants of tuberculosis hotspot areas in NSW. Standard 24-loci mycobacterium interspersed repetitive unit-variable number tandem repeat (MIRU-24) typing was performed on all isolates recovered between 2009 and 2013. In total 1692/1841 (91.9%) cases with confirmed Mycobacterium tuberculosis infection had complete MIRU-24 and demographic data and were included in the study. Despite some year-to-year variability, spatio-temporal analysis identified four tuberculosis hotspots. The incidence rate and the relative risk of tuberculosis in these hotspots were 2- to 10-fold and 4- to 8-fold higher than the state average, respectively. MIRU-24 profiles of M. tuberculosis isolates associated with these hotspots revealed high levels of heterogeneity. This suggests that these spatio-temporal hotspots, within this low incidence setting, can represent areas of predominantly imported infection rather than clusters of cases due to local transmission. These findings provide important epidemiological insight and demonstrate the value of combining tuberculosis genotyping and spatiotemporal data to guide better-targeted public health interventions.     

重庆市渝西地区新冠肺炎确诊病例首发症状及流行病学特征

 

目的 分析新型冠状病毒肺炎（简称新冠肺炎）确诊病例首发症状和流行病学特征,为制定新冠肺炎疫情防控措施提供理论依据。方法 选取重庆医科大学附属永川医院收治的90例新冠肺炎确诊患者,根据国家卫健委制定的《新型冠状病毒感染的肺炎病例流行病学调查方案》,对患者进行回顾性流行病学调查。结果 该院收治的90例确诊新冠肺炎患者均无野生动物接触史,武汉及周边地区旅居史（A型流行病学史）病例29例（32.22%）;有新型冠状病毒感染者接触史病例49例（54.44%）,有病例报告社区的发热或有呼吸道症状的患者接触史12例（13.33%）,均为B型流行病学史病例。聚集性发病73例（81.11%）。年龄为3~89岁,平均（48.19±17.85）岁。A型流行病学史病例主要集中在18~60岁,且以务工人员为主;B型流行病学史病例中≥60岁患者所占比例高于A型流行病学史病例,以农民为主。A、B型流行病学史两组患者不同年龄、职业构成比较,差异均有统计学意义（均P<0.05）。首发症状为发热及寒战（43例,47.78%）、咳嗽（干咳为主,27例,30.00%）等。发病初期有73例（81.11%）自行服药。患者患病前行为心理状态调查总均分为（15.16±7.64）分。A型流行病学史患者在知晓新型冠状病毒、了解防护措施、知晓开窗通风及室内消毒等方面优于B型流行病学史患者,差异均有统计学意义（均P<0.05）;B型流行病学史患者在知晓不去人口密集地方面优于A型流行病学史患者,差异有统计学意义（P<0.05）。结论 新冠肺炎具有早期散发,后期聚集性发病,人传人感染的强传染性。中老年人群为高发人群,新型冠状病毒感染与职业暴露密切相关,具有人群普遍易感性。早期诊断、早期隔离、综合治疗,积极控制慢性基础疾病对控制新冠肺炎病情至关重要。

     

Cancer morbidity investigations: Lessons from the Duluth study of possible effects of asbestos in drinking water

In 1973, 1 to 30 million asbestos-like fibers per liter of tap water were discovered in Duluth drinking water. Previous studies had linked mesothelioma, lung, and gastrointestinal cancers with occupational exposure to asbestos, so surveillance of cancer morbidity in Duluth was initiated to investigate effects from ingestion of asbestos in drinking water. Gastrointestinal and lung cancer incidence data for 1969–1974 were collected in the same manner as in the Minneapolis-St. Paul component of the Third National Cancer Survey; Duluth rates for 1969–1971 were compared with incidence rates for the cities of Minneapolis and St. Paul during the same time period; and Duluth rates for 1972–1974 were compared with Duluth rates for 1969–1971. Duluth females and both sexes combined had statistically significantly higher rates of pancreatic cancer than in Minneapolis and St. Paul in 1969–1971. These rates subsequently decreased in 1972–1974 for both sexes combined in Duluth. Duluth males and both sexes combined had similar excesses for gastrointestinal tract not specified in comparison with Minneapolis and St. Paul. Duluth and Minneapolis cancer incidence rates yielded less-exaggerated differences between the two study areas compared with mortality rates. Resources required for morbidity surveillance are described.