Journal of Infection and Public Health

Type-specific prevalence of Human Papillomavirus infection among women in the Northwest Territories, Canada

2011-11-01

Summary: Background: Certain types of Human Papillomavirus (HPV) are highly associated with cervical cancer and precursor lesions (dysplasia), but the distribution of HPVs in Northern Canada is largely unknown. This study determined the prevalences of HPV infection due to different virus types and the association of different virus types with cervical dysplasia in the Northwest Territories (NWT).Methods: Between April 2008 and March 2009, women who underwent routine Pap testing in the NWT were included in the study. An in-house Luminex assay detected type-specific HPV infections. The HPV prevalence rates and population attributable risk fractions were calculated.Results: In 5725 bio-samples, the overall HPV prevalence was 24.2%, and of the HPV-positive samples, 76.6% harbored high-risk types, 35.2% harbored multi-type infections, and 21.6% harbored HPV16 or 18 infections. The HPV prevalence was approximately 50% higher among Aboriginal than non-Aboriginal women. The age-specific HPV prevalence exhibited a U-shape distribution in the Aboriginal group. The prevalence of HPV16 or 18 infections found in high-grade lesions was 34.1%. Among this study population, 89.5% of the cases with cervical dysplasia were attributable to HPV infection, with 27.1% attributable to HPV16/18.Conclusion: The high prevalence of high-risk HPV in this population, particularly in the Aboriginal group, will require further studies to identify specific predictors of infection.

Pandemic influenza A (2009 H1N1) in hospitalized patients in a Saudi Arabian hospital: Epidemiology and clinical comparison with H1N1-negative patients

2011-11-01

Summary: Background and objectives: The World Health Organization (WHO) declared that pandemic influenza A (H1N1) was a public health emergency of international concern in April 2009. Herein, we describe the characteristics of patients in a Saudi Arabian hospital with and without H1N1 infection.Methods: We reviewed the records of patients admitted with influenza-like illness and compared confirmed pandemic H1N1 cases to the H1N1-negative patients admitted to the hospital. Infections due to the novel H1N1 virus were confirmed using real-time reverse transcriptase polymerase chain reaction (rRT-PCR).Results: During the study period, a total of 165 patients were admitted with influenza-like illness and underwent rRT-PCR testing. Of these patients, 47 (28.4%) had confirmed novel H1N1 virus infection. Thus, the hospitalization incidence rate was 13.4 cases per 100,000 persons. The remaining patients had negative H1N1 rRT-PCR test results. The mean age±SD of the H1N1-positive patients was 30.3±28.5 years compared with 25.3±23 years for the H1N1-negative group (P=0.28). Severe obesity was observed in 6.7% and 8.5% of H1N1-positive and H1N1-negative patients, respectively (P=0.74). The clinical picture was similar between the two groups, except for the higher prevalence of nausea (25.5% vs. 11%) and diarrhea (21.3% vs. 7.6%) in the H1N1-positive group than in the H1N1-negative group (P=0.03) The mortality rate was low in both groups.Conclusion: The clinical presentation and outcome are insufficient to differentiate between influenza-like illness (ILI) caused by H1N1 and that cause by other pathogens. In general, both groups had mild disease in this cohort of patients in Saudi Arabia.

Clinical relevance of peripheral blood eosinophil count in allergic bronchopulmonary aspergillosis

2011-11-01

Summary: Background and aims: Currently, there is not a uniform consensus regarding the number of criteria or specific cut-off values for the variety of tests that are used to diagnose allergic bronchopulmonary aspergillosis (ABPA). Traditionally, an eosinophil count >1000cells/μl is considered an important criterion in the diagnosis of ABPA. The goal of this study was to delineate the significance of the peripheral blood eosinophil count in the diagnosis of ABPA, and the relationship between eosinophil counts and lung function and immunological and radiological parameters.Methods: This study was a retrospective analysis of the data from ABPA patients who were managed in our chest clinic. Based on their eosinophil count, the patients were classified into the following three categories: <500, 500–1000 and >1000cells/μl. The spirometric, immunological and radiological characteristics were also assessed.Results: We studied 108 males and 101 females with a combined mean (±SD) age of 34.1±12.5years. The median (IQR) eosinophil count at diagnosis was 850 (510–1541)cells/μl, and 60% of the patients had an eosinophil count of <1000cells/μl. We found no relationship between eosinophil count and lung function using spirometry and other immunological parameters. The median eosinophil count was higher in patients with an high resolution computed tomography (HRCT) chest finding of bronchiectasis (986 vs. 620, p<0.001) vs. those without and in patients with high-attenuation mucus (1200 vs. 800, p<0.001) compared to those without high-attenuation mucus.Conclusions: A peripheral blood eosinophil count has limited utility in the diagnosis of ABPA, and there is no relationship between eosinophil count and lung function or other immunological parameters. The higher eosinophil count that we observed in patients with central bronchiectasis or high-attenuation mucus suggests that eosinophils are primary mediators of inflammatory activity in ABPA.

Evidence for chronic lung impairment in patients treated for pulmonary tuberculosis

2011-11-01

Summary: Background: Patients with pulmonary tuberculosis are likely to develop pulmonary impairment after tuberculosis (PIAT). The stability of PIAT and the relationship of PIAT to the duration of delay in tuberculosis diagnosis and treatment have not been fully characterized.Methods: We performed serial pulmonary function tests (PFTs) in a cohort treated for pulmonary tuberculosis after 20 weeks of tuberculosis therapy and again on or after treatment completion to determine the stability of PIAT. PFTs were compared with the duration of delay in tuberculosis diagnosis and treatment, as well as other demographic variables.Results: The median duration between the first and second tests was 15 (interquartile range 9–34) weeks. The mean change in FVC was −0.02l (95% confidence interval [CI] −0.09, 0.06), and the % predicted was −0.02 (95% CI −2.17, 2.12). FEV1 changes were 0l (95% CI −0.05, 0.06), and the % predicted was −0.11 (95% CI −1.82, 1.60). PIAT was not related to the duration of delay in tuberculosis diagnosis or treatment, age or smoking.Conclusions: PIAT was not associated with the duration of delay in tuberculosis diagnosis and treatment and did not significantly change during follow-up. These data demonstrate that, for many individuals, the completion of tuberculosis treatment is the beginning, not the end, of their tuberculosis illness.

Iranian surgeons’ compliance with the American Society of Health-System Pharmacists guidelines: Antibiotic prophylaxis in private versus teaching hospitals in Shiraz, Iran

Hamideh Mahdaviazad, Seyed Masoom Masoompour, Mehrdad Askarian — 2011-11-01

Highlights: ► Most patients received inappropriate surgical prophylaxis. ► Conducting a surveillance system for antibiotic prescription is mandatory in our hospitals.Abstract: Objectives: To assess compliance with the American Society of Health-System Pharmacists (ASHP) guidelines of prophylactic antibiotic use in private hospitals in Shiraz, Iran.Methods: This cross-sectional study was performed using prospective data gathered from April to September 2010 in the surgical wards of all private hospitals in Shiraz. Administrative data, patient characteristics, and antibiotic prophylaxis criteria were collected. Adherence to five criteria according to ASHP guidelines was evaluated: justification of the use of prophylactic antibiotics, appropriateness of the agent, dose, initiation time, and duration of the agent's effect. Only if all of the above criteria were fulfilled would the individual be labeled as completely compliant. We used descriptive analysis, including frequencies, to evaluate the results.Results: From April to September 2010, 365 patients from 63 surgical wards of eleven private hospitals were enrolled in our study. Prophylactic antibiotics were inappropriately given to 64.6% of patients. Twenty out of 26 patients did not receive an appropriate course of antibiotics. In cases requiring antibiotic prophylaxis per ASHP guidelines, antibiotic choice was concordant in 32 (25.4%) out of 126 procedures. In cases that required and received prophylactic antibiotics, the duration and initiation time of prophylaxis were concordant with the guidelines for 37 (29.4%) and 77 (61.1%) cases, respectively. The overall compliance with ASHP guidelines was 10.13%.Conclusions: Our study revealed that in private hospitals in Shiraz, Iran, approximately 90% of patients received inappropriate surgical prophylaxis. Practical measures to improve the implementation of guidelines are urgently needed.

First description of gastroenteritis viruses in Lebanese children: A pilot study

Mahmood Dhahir Al-Mendalawi — 2011-11-01

I have 2 comments on the interesting study by Al-Ali et al. on the first description of gastroenteritis viruses in Lebanese children. First, I presume that the frequency distribution of rotavirus gastroenteritis (RVGE) [48%] in Lebanese children addressed by Al-Ali et al. needs to be considered with caution. Apart from seasonal influence (April–May), short study period (2 months), and limited number of the studied patients (n=79), the prior immunization status of the studied patients against rotavirus (RV) represents an additional important limitation. Rotavirus vaccine (RVV) has been incorporated in the immunization schedule worldwide as it was shown to mimic the immunity following natural RV infection that confers protection against severe gastroenteritis and consequently, reduces the risk of primary healthcare utilization, hospitalization, and death. It not only reduces rotavirus activity in infancy but it also decreases rates of RVGE in older and unimmunized children . Moreover; it tends to be very cost-effective and is projected to substantially reduce childhood mortality, particularly in poor countries . I wonder whether RVV is incorporated in the routine immunization schedule of infants and young children in Lebanon as Al-Ali et al. did not consider prior RVV coverage of their studied patients.

Response to Letter by: Al-Mendalawi et al., doi:10.1016/j.jiph.2011.08.002

Wassim Chehadeh — 2011-11-01

In response to the question raised by Prof. Al-Mendalawi about rotavirus immunization coverage in Lebanon, we would like to emphasize that the rotavirus vaccine is not incorporated in the routine immunization schedule; the vaccine is however available in the private clinics. Unfortunately, the anti-rotavirus immunity of patients included in our study has not been investigated. Our results are not different from those obtained in Europe. In France where rotavirus vaccination is not included in the routine immunization program, a recent study has reported that rotavirus was the cause of more than 50% of the total hospitalizations for gastroenteritis per year in a pediatric unit in Paris, followed by norovirus causing 8% of the total hospitalizations .

Seroprevalence of the human immunodeficiency virus (HIV) among pregnant women in eastern Sudan

Mahmood Dhahir Al-Mendalawi — 2011-11-01

I have two comments on the interesting study by Mohammed et al. on the seroprevalence of the human immunodeficiency virus (HIV) among pregnant women in eastern Sudan . First, I presume that 0.23% seroprevalence of HIV-1 infection among the studied pregnant women in eastern Sudan reported by Mohammed et al. is not the actual prevalence while considering the following points: (1) HIV is a significant health threat in Sudan as the available data shows that the HIV prevalence in adults aged 15–49 years is 1.4% and that 59% of all new infections have occurred in women of child bearing age (15–49 years) . (2) I presume that the Kassala New Maternity Hospital, the major hospital in Kassala state where the study was conducted, offers health services to aboriginal rural people in addition to refugees from neighboring countries like Eretria and Ethiopia as well as internally displaced people. I wonder whether the study was only conducted on pregnant Sudanese women as Mohammed et al. did not address the demographic characteristics of their studied pregnant women. (3) Limited access to antenatal healthcare services and traditional home deliveries, particularly for those residing in far districts, are the usual scenario in many African countries, including Sudan. This means that a substantial number of Sudanese pregnant women with potential HIV infections had escaped medical supervision and opportunities for conducting serological screening for HIV. Therefore, they could not be included in the Mohammed et al. study . Though it is expensive to perform and practically a little bit difficult, a community-based study is a better alternative and could give a better idea on the exact seropositive prevalence of HIV-1 among Sudanese pregnant women and guide health policy. (4) Mohammed et al. used Bio-Line (Standard Diagnostics, South Korea) in their study as initial rapid immunochromatographic screening test for HIV-1. Though this test was reported to have the sensitivity and specificity for the assay on serum samples of 100% and 99.4% respectively , it is still not considered as an ideal rapid test for screening HIV infection as there is a possibility that some potential cases of HIV infection could escape medical diagnosis. Recently, the new First Response HIV 1-2.O with the 450 characterized specimens has shown the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and efficiency of 100% for HIV-1 with reference assay. Moreover, it has several advantages: low-cost (U.S. $0.70); only 10μL of specimen; involves only two steps; room temperature storage; ability to differentiate HIV-1 and 2; and use of whole blood specimen. Hence, this test kit could be a better alternative for initial rapid screening in the HIV-1 testing algorithm in resource-limited settings like Sudan . Applying that test might alter the seroprevalence of HIV-1 infection reported by Mohammed et al. .

Response to Letter by: Al-Mendalawi MD, 2011, doi:10.1016/j.jiph.2011.07.002

2011-11-01

The epidemiology of the human immunodeficiency virus (HIV) is usually described as low-level, concentrated, or generalised and these patterns are characterised by HIV prevalence rates not consistently exceeding 5% in any defined sub-population, consistently >5% in at least one defined sub-population but <1% in pregnant women in urban areas, or consistently >1% in pregnant women, respectively . We reported a maternal HIV prevalence rate of 0.23% among pregnant women attending a major maternity hospital in Kassala state in eastern Sudan . A recently published antenatal sentinel sero-surveillance carried out in 15 Sudanese northern states, including Kassala state, tested 9164 serum samples collected from 26 antenatal care clinics (ANC) and reported an estimated maternal HIV prevalence of 0.19% . Moreover, the overall prevalence of HIV among adults in Sudan has been revised down to 1.1% and further geographical stratification of HIV prevalence revealed an estimate of 0.67% in northern Sudan compared to 3.1% in southern Sudan . It is noteworthy that, for various geopolitical reasons, the term “northern Sudan” currently refers to 15 states located in central, northern, eastern and western parts of the country.