Subacute sclerosing panencephalitis (SSPE) in Papua New Guinea: a high incidence in young children.

Eighty-seven cases of subacute sclerosing panencephalitis (SSPE) were diagnosed from September 1988 to April 1991 in Papua New Guinea (PNG), by demonstration of high-titre measles-specific antibodies in cerebrospinal fluid (CSF). For 1990 the annual incidence of SSPE, for the study provinces, was calculated to be 56 cases per million under 20 years of age and it is expected that this figure will be higher in 1991. The mean age of presentation was 4.9 years, with a male to female ratio of 1.8:1. An elevation in the ratio of immunoglobulin G as a percentage of total protein in CSF and an increase in the CSF:serum immunoglobulin G ratio was shown in SSPE patients. The dramatic appearance and high frequency of the disease in PNG might relate to the early age of measles infection encountered in children in this country.     

Incidence of subacute sclerosing panencephalitis following measles and measles vaccination in Japan

The Japanese Committee for the National Registry of Subacute Sclerosing Panencephalitis (SSPE) confirmed that 215 cases of SSPE occurred in the 20 years from 1966 to 1985, as discovered in the 10-year surveillance from April 1976 through March 1986. The annual incidence in recent years has been between 10 and 23 cases. Among cases with a certain history of measles illness or measles vaccination, 184 (90.2%) had a history of measles illness without receiving measles vaccine. There were 11 probable measles vaccine-associated cases (5.4%), three (1.5%) being vaccinated with a combined use of killed and live vaccine and eight (3.9%) with further attenuated live vaccine. There were nine cases (4.4%) without a history of either measles illness or measles vaccination. Intervals between measles illness and the onset of SSPE varied from 1 to 16 years (mean, 7.0 years). The periods following measles vaccination with further attenuated live vaccine were 2 to 11 years (mean, 4.6 years). Annual incidence rates of SSPE per million cases of measles ranged between 6.1 and 40.9 (mean, 16.1) in the 10 measles epidemic years 1968-1977, and those following vaccination with further attenuated live vaccine were zero in most years and at the highest 3.08 (mean, 0.9) per million doses of distributed vaccine.     

Observations of subacute sclerosing panencephalitis in South Africa.

Analysis of 75 cases of subacute sclerosing panencephalitis (SSPE) reported to the National Institute for Virology, South Africa, in 1984-1990 does not support the role of intensive exposure to measles virus in the pathogenesis of SSPE. The incidence of SSPE per million population was similar in Blacks and Whites, although that of reported measles is up to 10 times greater in Blacks. The age of SSPE follows the distribution of measles cases; thus, significantly more younger SSPE cases were found in Blacks than in Whites. The distribution between males and females was approximately equal. These data suggest SSPE to be a fortuitous complication of measles infection associated with as yet unidentified risk factors rather than a consequence of an excessive dose of infecting virus or immunological immaturity.     

Mesothelioma in South Africa, 1976-84: incidence and case characteristics

Malignant mesothelioma is a rare tumour known to be associated with prior exposure to asbestos. Previous studies have described the occupational and clinical features of cases of mesothelioma in the Republic of South Africa (RSA) but none has set out to determine incidence of this disease. To estimate incidence, a case register was compiled for 1976-84 by contacting all medical practitioners and institutions likely to have seen cases of mesothelioma in this period; demographic, diagnostic and exposure details were sought. Cases were accepted if they provided evidence of histological diagnosis of mesothelioma. Fifty-two per cent of 1347 cases identified were in whites, 31% in blacks, 16% in coloureds and 1% in Asians. Seventy-three per cent of cases occurred in males. The majority of whites were aged 51-70 years, while the majority in other race groups were aged 41-60 years. The ratio of only pleural to only peritoneal mesothelioma was 11:1, although there were marked differences by race. Eighty-five per cent of males with exposure information available had prior exposure to asbestos, mostly occupational. A similar proportion of women had contact with asbestos but mostly through other types of exposure. Standardized incidence rates per million population aged 15 years and over were calculated for sex-race subgroups and were highest in white males (32.9 per million per year, 95% Cl 22.7-46.4), coloured males (24.8 per million per year, 95% Cl 16.2-36.9) and coloured females (13.9 per million per year, 95% Cl 7.7-23.5). These incidence rates are amongst the highest ever reported for a national population. Age-specific standardized incidence rates were highest in white males (over 100 per million per year in men over 55 years). Reasons for the differing rates by population group are likely to include differential access to health services. More rigorous control of asbestos exposure in the RSA is recommended.     

Cost effectiveness of pertussis vaccination in adults

BACKGROUND: Prior economic analyses have reached disparate conclusions about whether vaccinating adults against pertussis would be cost effective. Newly available data on pertussis incidence were used to evaluate the cost effectiveness of one-time adult vaccination and adult vaccination with decennial boosters. METHODS: A Markov model was used to calculate the health benefits, risks, costs, and cost effectiveness of the following strategies: (1) no adult pertussis vaccination, (2) one-time adult vaccination at 20-64 years, and (3) adult vaccination with decennial boosters. The impact of the severity of pertussis illness, vaccine adverse events, and herd immunity on model outcomes were also examined. RESULTS: At a disease incidence of 360 per 100,000, the one-time adult vaccination strategy would prevent 2.8 million cases, and the decennial vaccination strategy would prevent 8.3 million cases. As disease incidence varied from 10 to 500 per 100,000, the one-time adult vaccination strategy was projected to prevent 79,000 to 3.8 million adult pertussis cases, while the decennial vaccination program would prevent 239,000 to 11.4 million cases. A one-time adult vaccination strategy would result in 106 million people vaccinated, or approximately 64% of the adult cohort, for a total program cost of $2.1 billion, while a decennial vaccination strategy would cost $6.7 billion. The one-time and decennial booster vaccination strategies result in cost-effectiveness ratios of <$50,000 per quality-adjusted life year saved if disease incidence in adults were greater than 120 cases per 100,000 population. CONCLUSIONS: Routine vaccination of adults aged 20 to 64 years with combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis is cost effective if pertussis incidence in this age group is greater than 120 per 100,000 population.     

Changing trend of SSPE over a period of ten years

Sub acute sclerosing pan-encephalitis (SSPE) is a slowly progressive inflammatory disorder of the central nervous system. A decline in frequency has been noticed in most of the developed countries, whereas it continues to be high in developing countries. Though a number of studies have been carried out, the exact trend of SSPE is still not clear. Hence the present study was carried out to analyze the trend of SSPE over the past ten years in and around Chandigarh. A total of 205 patients with clinical features suggestive of SSPE were enrolled for the study during Jan'92 to Dec. 2001. Measles specific antibodies were detected in blood and CSF by HAI method. 114 patients were found to be positive for measles specific HAI antibody with a male preponderance. The number of SSPE cases were found to be more during the period 1992-95 in comparison to the next 6 years (p < 0.05). The high incidence of SSPE in our country could be due to improper vaccine coverage, poor cold chain maintenance or circulation of atypical measles virus strain.     

Childhood leukaemia in Costa Rica, 1981-96

Childhood leukaemia incidence in Costa Rica during 1981-96, among the highest in the world, was analysed by histology, gender, birth year, time period of diagnosis, age at diagnosis and region. Numbers of cases were extracted from the database of the National Cancer Registry (RNT) of Costa Rica. Person-years at risk were calculated from census data and post-census population estimates. During the follow-up, 918 cases of leukaemia in children under 15 years (510 boys, 408 girls) were reported to the RNT (41% of all childhood malignancies), with an overall age-standardised incidence rate of 56 per million person-years. Acute lymphocytic leukaemia (ALL) represented 79% and acute non-lymphocytic leukaemia (ANLL) 16% of the cases, with rates of 43 and 9 per million person-years respectively. There were downward trends in incidence of total leukaemias, ALL and ANLL and 'not otherwise specified' (NOS) combined. Incidence of ALL was highest at 1-4 years of age in boys and girls, whereas ANLL peaked in girls during the first year of life. During 1991-96, the decrease in ALL was significant (P = 0.042). A multivariable Poisson regression model identified significant excesses of ALL for boys, for age groups 1-4 and 5-9 years and for three out of seven regions. Possible reasons for the high rates in Costa Rica are discussed.     

合肥市2009～2010年麻疹流行病学特征分析

目的 分析2009～2010年合肥市麻疹流行病学特征,为消除麻疹策略的制定与实施提供科学依据.方法 利用麻疹专病监测数据资料进行描述性统计.结果 2009年麻疹发病率为10.00/10万,2010年大幅度下降至0.81/10万.3～6月份为发病高峰.以小年龄组发病为主,＜1岁病例构成比最高超过35％,2009、2010年＜1岁组发病率分别为287.41/10万、24.02/10万.暴发病例以散居儿童和小学生为主,流动人口病例构成比＞30％.麻疹病例无免疫史者占半数,1剂次和≥2剂次免疫史者构成比低.结论 完善麻疹病例监测体系,强化免疫规划管理,确保小年龄组人群初次和2剂次疫苗及时接种,适时开展重点人群强化免疫,控制流动人口发病,获得良好持续的防控效果是消除麻疹的关键.     

上海市儿童恶性肿瘤发病情况和时间趋势分析

目的 描述上海市 <15岁儿童恶性肿瘤发病情况和发病变化趋势。方法 利用上海市恶性肿瘤病例报告系统收集的儿童恶性肿瘤发病资料,采用儿童肿瘤国际分类(ICCC-3)进行归类,分析2009-2011年上海市儿童恶性肿瘤的发病情况及其性别、年龄别分布特征,并应用Joinpoint软件计算年度变化百分比(APC),对2002-2013年上海市儿童恶性肿瘤发病率时间趋势进行分析。结果 2009-2011年上海市共诊断儿童恶性肿瘤病例460例,占所有部位肿瘤的0.3%,粗发病率为129.0/100万,标化发病率(ASR)为129.6/100万。男童恶性肿瘤发病率高于女童,ASR分别为142.1/100万和116.4/100万,男女童发病比为1.2(95%CI:1.0～1.5)。白血病是最常见的儿童恶性肿瘤(35.9%,165/460,ASR:47.0/100万),其次为中枢神经系统(19.8%,91/460,ASR:25.6/100万)和淋巴瘤(9.8%,45/460,ASR:12.6/100万)。2002-2011年性别、年龄组(0～、5～和10～14岁)儿童恶性肿瘤发病率无明显改变,不同肿瘤[白血病、中枢神经系统(CNS)肿瘤以及淋巴瘤]发病率也无明显改变。结论 上海市男童恶性肿瘤发病率高于女童。白血病、CNS肿瘤和淋巴瘤是最常见的儿童恶性肿瘤。2002-2011年上海市儿童恶性肿瘤发病率无明显改变。     

The epidemiology of subacute sclerosing panencephalitis in England and Wales 1970-1989.

Two hundred and ninety cases of subacute sclerosing panencephalitis (SSPE) registered in England and Wales from 1970 to 1989 were followed at 6-monthly intervals. Male to female ratio was 2.8:1. Age at onset increased significantly over the period. Measles was recorded for 81% of cases; in nearly half this had occurred under 2 years. Measles vaccine was documented in 20 cases; in 10 measles was also documented and it could not be positively excluded in the remainder. The calculated risk of SSPE following measles was 4.0/100,000 cases compared with the risk after vaccine of 0.14/100,000 doses. Measles under 1 year carried a risk 16 times greater than measles over 5 years. There was an excess of cases in third and subsequent children. The incidence was higher in the northwest than in the southeast of the country. Survival time varied from 4 weeks to 16 years and was shorter when measles had occurred over the mean age of 2.5 years. Of the cases 9% had a history of mental retardation before the onset of SSPE. The incidence of SSPE has fallen following the reduction in measles resulting from vaccination. However, because of the median 8-year interval between measles and onset of SSPE, further cases arising from measles during the study period must still be expected, particularly in adolescents.     

亚急性硬化性全脑炎与麻疹免疫

亚急性硬化性全脑炎 (SSPE)是由缺陷型麻疹病毒引起的严重的中枢神经系统疾病。此病的特征是智力减退 ,节律性肌阵挛伴典型的脑电图改变 ,脑脊液IgG增多 ,血清和脑脊液中抗麻疹抗体水平升高。此病呈进行性发展 ,病人一般于发病后 1～ 3年死亡。虽然一些药物可缓解病情 ,但目前仍无特效治疗。麻疹疫苗接种可显著降低SSPE发病率。     

The relation between acute persisting spinal paralysis and poliomyelitis vaccine �� results of a ten-year enquiry

Most of the 13 countries that participated in this ten-year study of the incidence of acute persisting spinal paralysis (APSP) used trivalent live poliomyelitis vaccine (Sabin strains), but monovalent vaccines were used for all or part of the time in 3 countries and inactivated vaccines were used wholly by 2 countries and in part by 2 other countries. Altogether 698 cases of APSP were recorded in a total population of about 509 million over the 10-year study period — an incidence of 0.14 per million per annum. The incidence varied widely between countries and not all the cases were related to immunization. In six countries where live vaccines were used three methods of assessment of risk were employed. The risk in relation to the child population under 3 years of age was less than 1 per million children in all six countries.     

Epidemiology of tetanus in the Marches Region of Italy, 1992-95.

Reported is the incidence of tetanus in the Marches Region of Italy for the period 1992-95. Data were obtained from both the regional public health committee''s notification forms for infectious diseases and from hospital clinical records. A total of 36 cases were examined, comprising 7 males (19.4%) and 29 females. The raw annual incidence was 6.3 per million population; the standardized incidence for females was four times greater than that for males (9.2 and 2.4 per million population annually, respectively). The patients'' ages varied from 31 years to 88 years (median, 73.5 years). The incidence among subjects older than 65 years was approximately ten times greater than that among younger individuals. Chronic wounds, such as trophic lesions, represented the site of tetanus infection in 14.3% of cases whose infection entry point was identified. Treatment of the 36 cases required a total of 1239 hospital days, of which 58.7% were in intensive care and 29.6% were in infectious diseases departments. The raw annual mortality rate for the period considered was 0.7 per million population; the case-fatality ratio was 11%. The results of our study confirm the limits of the current Italian immunization programmes, which exclude a large portion of the population from antitetanus protection.     

2014年广西疑似预防接种异常反应监测分析

目的：了解广西2014年疑似预防接种异常反应（adverse events following immunization,AEFI）的发生特征,评价广西AEFI监测系统运转情况。方法通过疑似预防接种异常反应监测信息管理系统收集2014年广西报告的AEFI 个案数据,采用描述性流行病学方法进行分析。结果2014年广西报告 AEFI 个案1293例,113个县（区、市）均有AEFI数据报告,县级覆盖率为100%,48小时报告率为96.75%,48小时调查率为99.46%。男、女性别比为1.71∶1;按广西2014年免疫规划信息系统中疫苗接种剂次估算,总的报告发生率为5.00/10万剂次,非严重AEFI报告发生率为4.87/10万剂次,严重AEFI 报告发生率为0.14/10万剂次。预防接种异常反应报告发生率为1.56/10万剂次。异常反应的临床诊断以过敏性皮疹、卡介苗淋巴结炎为主。在所有的AEFI中,治愈和好转的占99.30%。结论广西的AEFI 监测系统运转正常.要加强 AEFI 因果关联评估、分类及处理等相关知识的培训工作,确保 AEFI 监测数据的质量。     

Residual paralytic poliomyelitis in a tropical region of Brazil, 1969-1977: prevalence surveys in different age groups as indicators of changing incidence

The magnitude of the problem of paralytic poliomyelitis in recent years in the tropical Federal District of Brazil was estimated in 1980 by determining the prevalence of residual paralytic poliomyelitis in 10,007 schoolchildren born in 1969-1970 and in 10,794 schoolchildren born in 1973-1974. About 98% of these children attended school in the Federal District. The rate of residual paralytic poliomyelitis of 5.4 per 1000 children born in 1969-1970 was 2.3 times higher than the rate of 2.3 per 1000 born in 1973-1974, which may be related to increasing vaccination of children under one year of age. Paralysis appeared before four years of age in 96.5% of these children. These prevalence rates indicate a minimal average annual incidence of acute persisting paralytic poliomyelitis of 187 cases per million total population during the period 1969-1973 and of 80 per million total population during the period 1973-1977 compared with an average annual incidence of 135 reported persisting and non-persisting paralytic cases per million total population in the United States in the prevaccine era and of four persisting cases per 100 million during 1973-1978.     

合肥市适龄儿童麻疹疫苗强化免疫效果评价

目的了解合肥市适龄儿童麻疹疫苗(MV)强化免疫活动(SIA)效果及影响因素,为调整和实施消除麻疹策略提供参考。方法应用分层随机抽样法,选择合肥市社区疫苗接种门诊、幼儿园、小学、中学等作为研究点,分析8月龄～14岁儿童SIA前后麻疹抗体水平。SIA前后分别调查儿童340名和348名,应用描述统计方法,分析SIA前后麻疹流行状况。结果合肥市适龄儿童MV总体接种率为98.04%。SIA后麻疹抗体阳性率、几何平均滴度(GMT)均上升,麻疹抗体阳性率为91.38%。1～4岁组、≥3次免疫史者GMT分别为最高,Logistic多元回归分析显示,1次免疫史者抗体保护水平低。2010年麻疹发病率为0.81/10万,较2009年下降91.86%,发病年龄以婴儿为主,≥2次免疫史者病例构成比最低。结论在麻疹逐渐减弱流行阶段,需要规范适龄儿童首剂次、2剂次MV常规免疫,开展必要强化免疫,加强免疫规划和病例监测质量管理。     

Incidence of fatal myocarditis: a population-based study in Finland

To study the incidence of fatal myocarditis in the general population, the authors retrospectively collected all death certificates recording myocarditis as the underlying cause of death in Finland in 1970-1998. The incidence of myocarditis and its proportion of all deaths were calculated from 141.4 million person-years and 1.35 million deaths. Myocarditis was recorded as the underlying cause of death in 639 cases. Thus, its death certificate-based incidence was 0.46 (95% confidence interval (CI): 0.43, 0.49) per 100,000 person-years, and it caused 0.47 (95% CI: 0.44, 0.51) of 1,000 deaths. The incidence of 0.51 (95% CI: 0.46, 0.56) in males was higher than the incidence of 0.42 (95% CI: 0.37, 0.47) in females, the odds ratio being 1.34 (95% CI: 1.15, 1.58) (p < 0.001). The proportion of deaths caused by myocarditis was highest (up to six of 1,000 deaths) in children and adults aged less than 45 years. Because previous histopathologic reanalysis showed that only 32% of cases fulfilled the Dallas criteria, the authors estimated the incidence of histopathologically certain fatal myocarditis to be 0.15 (95% CI: 0.13, 0.17) per 100,000. The death certificate-based incidence of fatal myocarditis was found to be 0.46 per 100,000, and the histopathologically corrected incidence was 0.15 per 100,000.     

The epidemiology of appendicitis and appendectomy in the United States

To describe the epidemiology of appendicitis and appendectomy in the United States, the authors analyzed National Hospital Discharge Survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred annually in the United States during this period, accounting for an estimated 1 million hospital days per year. The highest incidence of primary positive appendectomy (appendicitis) was found in persons aged 10-19 years (23.3 per 10,000 population per year); males had higher rates of appendicitis than females for all age groups (overall rate ratio, 1.4:1). Racial, geographic, and seasonal differences were also noted. Appendicitis rates were 1.5 times higher for whites than for nonwhites, highest (15.4 per 10,000 population per year) in the west north central region, and 11.3% higher in the summer than in the winter months. The highest rate of incidental appendectomy was found in women aged 35-44 years (43.8 per 10,000 population per year), 12.1 times higher than the rate for men of the same age. Between 1970 and 1984, the incidence of appendicitis decreased by 14.6%; reasons for this decline are unknown. A life table model suggests that the lifetime risk of appendicitis is 8.6% for males and 6.7% for females; the lifetime risk of appendectomy is 12.0% for males and 23.1% for females. Overall, an estimated 36 incidental procedures are performed to prevent one case of appendicitis; for the elderly, the preventive value of an incidental procedure is considerably lower.     

Cost-effectiveness of adult pertussis vaccination in Germany

BACKGROUND: The incidence of pertussis in adults is high despite good childhood vaccination coverage. An adult formulation of an acellular pertussis vaccine is licensed and available for use in Germany. OBJECTIVE: To evaluate the potential health benefits, risks, costs and cost-effectiveness of routine pertussis vaccination programs for German adults. METHODS: A Markov model was used to simulate health states and immunity levels associated with pertussis disease and vaccination. The following strategies were evaluated: (1) no adult pertussis vaccination, (2) one-time adult vaccination at 20-64 years, and (3) adult vaccination with decennial boosters. Our main outcome measures were costs (2006 Euros), cases prevented, incremental cost per case prevented and incremental cost per quality-adjusted life year (QALY) saved. We performed sensitivity analyses for key assumptions in the model including disease incidence, vaccine cost, vaccine efficacy, disease costs and frequency of adverse events. Future costs and benefits were discounted at 3%. RESULTS: At a disease incidence of 165 per 100,000, the one-time adult vaccination strategy would prevent 498,000 cases, and the decennial adult vaccination strategy would prevent 1 million cases. Approximately 31 million adults ( approximately 62% of the cohort) would be vaccinated with a one-time adult vaccination strategy for a total program cost of 366 million Euros, while a decennial vaccination strategy would cost 687 million Euros. The one-time adult vaccination strategy resulted in CE ratios of 5800 Euros per QALY saved, or 160 Euros per pertussis case prevented. The decennial booster strategy cost 7200 Euros per QALY saved, or 200 Euros per case prevented. The results were most sensitive to assumptions about disease incidence and vaccine cost. CONCLUSIONS: Routine vaccination of German adults aged 20-64 years with Tdap is cost-effective.