Fatal accidents and injuries among merchant seafarers worldwide.

BACKGROUND: The British merchant fleet has expanded in recent years but it is not known whether this expansion has led to proportionate changes in mortality. AIMS: To investigate mortality from accidents and injuries in British merchant shipping, to determine whether this has increased in recent years, to compare fatal accident rates across British industries and to review fatal accident rates in merchant shipping worldwide over the last 70 years. METHODS: Examinations of marine accident investigation files, death registers and death inquiry files, national mortality statistics, worldwide surveys and review methodology. The main outcome measure was the fatal accident rate per 100 000 worker-years. RESULTS: Of 66 deaths in British shipping from 2003 to 2012, 49 were caused by accidents, which largely affected deck ratings. The fatal accident rate in British shipping increased by 4.7% per annum from 2003, although this was not significant (95% confidence interval: -5.1 to 15.6%). During 2003-12, the fatal accident rate in shipping (14.5 per 100 000) was 21 times that in the general British workforce, 4.7 times that in the construction industry and 13 times that in manufacturing. Of 20 merchant fleets worldwide with population-based fatal accident rates, most have shown large reductions over time. CONCLUSIONS: The expansion of the British merchant fleet in recent years does not appear to have had a major impact on fatal accidents. Further preventive measures should target fatalities during mooring and towing operations. Internationally, most shipping fleets have over time experienced large decreases in fatal accident rates.

Epidemiology and clinical features of vivax malaria imported to Europe: sentinel surveillance data from TropNetEurop.

BACKGROUND: Plasmodium vivax is the second most common species among malaria patients diagnosed in Europe, but epidemiological and clinical data on imported P. vivax malaria are limited. The TropNetEurop surveillance network has monitored the importation of vivax malaria into Europe since 1999. OBJECTIVES: To present epidemiological and clinical data on imported P. vivax malaria collected at European level. MATERIAL AND METHODS: Data of primary cases of P. vivax malaria reported between January 1999 and September 2003 were analysed, focusing on disease frequency, patient characteristics, place of infection, course of disease, treatment and differences between network-member countries. RESULTS: Within the surveillance period 4,801 cases of imported malaria were reported. 618 (12.9%) were attributed to P. vivax. European travellers and immigrants were the largest patient groups, but their proportion varied among the reporting countries. The main regions of infection in descending order were the Indian subcontinent, Indonesia, South America and Western and Eastern Africa, as a group accounting for more than 60% of the cases. Regular use of malaria chemoprophylaxis was reported by 118 patients. With 86 (inter-quartile range 41-158) versus 31 days (inter-quartile range 4-133) the median symptom onset was significantly delayed in patients with chemoprophylaxis (p < 0.0001). Common complaints were fever, headache, fatigue, and musculo-skeletal symptoms. All patients survived and severe clinical complications were rare. Hospitalization was provided for 60% and primaquine treatment administered to 83.8% of the patients, but frequencies varied strongly among reporting countries. CONCLUSIONS: TropNetEurop data can contribute to the harmonization of European treatment policies.

Age as a risk factor for severe manifestations and fatal outcome of falciparum malaria in European patients: observations from TropNetEurop and SIMPID Surveillance Data.

Previous studies have indicated that age is a risk factor for severe falciparum malaria in nonimmune patients. The objectives of this study were to reevaluate previous findings with a larger sample and to find out how strongly clinical outcomes for elderly patients differ from those for younger patients. Results of adjusted analyses indicated that the risks of death due to falciparum malaria, of experiencing cerebral or severe disease in general, and of hospitalization increased significantly with each decade of life. The case-fatality rate was almost 6 times greater among elderly patients than among younger patients, and cerebral complications occurred 3 times more often among elderly patients. Antimalarial chemoprophylaxis was significantly associated with a lower case-fatality rate and a lower frequency of cerebral complications. Women were more susceptible to cerebral complications than were men. Our study provides evidence that falciparum malaria is more serious in older patients and demonstrates that clinical surveillance networks are capable of providing quality data for investigation of rare events or diseases.

Imported Falciparum malaria in Europe: sentinel surveillance data from the European network on surveillance of imported infectious diseases.

Malaria continues to have a high morbidity rate associated among European travelers. Thorough recording of epidemiological and clinical aspects of imported malaria has been helpful in the detection of new outbreaks and areas of developing drug resistance. Sentinel surveillance of data collected prospectively since 1999 has begun within TropNetEurop, a European network focusing on imported infectious diseases. TropNetEurop appears to cover approximately 10% of all patients with malaria seen in Europe. Reports of 1659 immigrants and European patients with Plasmodium falciparum malaria were analyzed for epidemiological information and data on clinical features. Regional data were quite diverse, reflecting local patterns of immigration and international travel. By far, the most infections were imported from West Africa. Europeans had more clinical complications; consequently, all deaths occurred in this group. Compared with European standards, the mortality rate was low (0.6% in Europeans). Data from TropNetEurop member sites can contribute to our understanding of the epidemiological and clinical findings regarding imported falciparum malaria.

[In vitro resistance of Candida species to antifungal agents]. / Badania in vitro lekoopornosci szczepow grzybów z rodzaju Candida.

The purpose of this study was to determine the in vitro susceptibility to 6 antifungal agents of 143 strains of Candida species isolated from 545 patients with suspicion of fungal infection. Test ATB Fungus (bioMérieux) was used. Among all Candida isolates 91.6% were susceptible to tested polyenes and 32.9% to all azoles. Less susceptible to polyenes isolates were noted in low percentage (0.7 to 4.2%) and to azoles more frequently (32.9 to 41.2%). Candida isolates resistant to antifungal agents tested were dependent from the kind of clinical samples and species of fungi. Monitoring of the susceptibility to antifungal agents by ATB commercial test seems to be useful tool for therapeutic purposes.

[Own clinical observations of toxocara infections]. / Infekcje Toxocara w swietle materialów wlasnych.

Toxocarosis clinical forms wers diagnosed according to Kraus et. al. (1995). There were three forms: 1) asymptomatic - marked by hypereosynophilia and ELISA positive serologic reaction, 2) minor - with cutaneous, pulmomary and pseudorheumatic lesions, 3) major - with hepatosplenomegaly and multifocal inflammatory lesions of organ of sight. Over the years of 1994-1997 in Infectious, Parasitic and Tropical Diseases clinic of the Voivodship Specialist Hospital of Lódz we found and treated 137 Toxocara canis cases. Among them 63 (46:0%) asymptomatic, 57 (42.6%) minor and 17 (12.4%) major forms were diagnosed. The disease was detected in 80 (58.4%) adults and 57 (41.6%) children. Seventy six patients lived in towns and 61 in country. Minor form patients had the symptoms as follows: skin allergy, large joints lesions, augmentation in lymph nodes. Radiology examinations revealed pulmonary lesions. Using ultrasonography there was found hepatosplenomegaly and changes echogenity in patients with major form. Biochemical tests showed elevation in hepatic enzymes activity. Lesions of organ of sight were multifocal and usually included uveitis, retinitis, inflammation of anterior chamber and inflammation of vitreous body.

Malaria as an Occupational Disease in Polish Citizens.

Background: Since 1963, malaria has been exclusively recognized in Poland as an imported disease, which has become increasingly frequent in recent years. When associated with performing duties in malaria-endemic areas, malaria is acknowledged as an occupational disease. Methods: Ninety five cases of malaria recognized as an occupational disease in Polish citizens in the years 1984-1993 were studied retrospectively in terms of working conditions, epidemiologic and clinical features, and permanent disability sequelae. Results: Among patients examined, young and professionally active persons who called at tropical ports or who worked in rural areas or in the regions of military conflict were predominant. Most infections were contracted in Africa during the first few months of the stay. The observed morbidity and recrudescence rates were mainly attributable to Plasmodium falciparum. Disregard of prevention and chemoprophylaxis of malaria were key risk factors. In 33% of the patients, severe symptoms and complications occurred and these required long-term therapy. In seven cases, disturbances of the central nervous system, hepatic, renal, or cardiac system occurred 6 months after termination of treatment, and these occurrences resulted in permanent disability and an inability to work. Conclusions: The disability and inability to work and its legal consequences, such as indemnity, demonstrate that malaria may present a serious socioeconomic problem, even in the country where it is an imported disease.

Malaria as an occupational disease.

In Poland, cases of imported malaria are noted at present. In Polish citizens who work abroad, malaria is considered as an occupational disease. 95 cases of malaria in Polish citizens treated at the Clinic of the Institute of Maritime and Tropical Medicine in 1984-1993 were subjected to retrospective analysis, considering their occupational, epidemiological and clinical aspects as well as permanent sequelae of the disease. The most numerous groups among the patients examined were seafarers, fishermen, priests and missionaries. They were infected mostly in West Africa, during the first year of work. The majority of patients neglected chemoprophylaxis of malaria. In about 1/3 of patients, the resulting incapacity for work exceeded 1 month and more. In 7% of patients, 6 months after the treatment, permanent sequelae of the disease were observed: damage to the central nervous system, liver, kidneys and heart. The social and material costs of this invasive occupational disease were high. Malaria is an important health problem in Poles who work in endemic areas. Malaria prevention should be intensified.

Selected epidemiological and clinical aspects of malaria in the material of the Institute of Maritime and Tropical Medicine in Gdynia.

Despite numerous endeavours to eradicate malaria remains a problem to be solved. This is reflected in high morbidity and mortality rates in endemic zones of this disease, and in the continually growing parasites resistance to the drugs applied within chemoprophylaxis and the treatment employed. In the compass of 1976-1987 a group of 20 thousand people, back from the tropics, was examined. In that number 415 having suffered from malaria while stay in the endemic zone of the disease, in 64 patients malaria was diagnosed in the course of the examinations. They were all subjected to the therapy in the IMTM. In several cases serious complications occurred. In the conclusions the authors point at the insufficient and inaccurate use of chemoprophylaxis the necessity of adopting individual procedure towards each patient and of considering the possibility of Plasmodium sp. infection in the people with the fever of the aetiology unknown, referring their stay in malarial regions.