[Tuberculosis in indigenous children and adolescents in Brazil: factors associated with death and treatment dropout]. / Tuberculose entre crianças e adolescentes indígenas no Brasil: fatores associados ao óbito e ao abandono do tratamento.

The study aimed to describe clinical and sociodemographic characteristics, estimate incidence, and analyze factors associated with dropout and death during treatment of TB cases reported in indigenous children and adolescents in Brazil from 2006 to 2016. A historical case series was performed on incidence according to age bracket and major geographic region, and multinomial logistic regression was used to explain factors associated with treatment dropout and death. Of the 2,096 reported cases, 88.2% evolved to cure, 7.2% dropped out of treatment, and 4.6% evolved to death. There was a predominance of cases in boys 15-19 years of age and a higher proportion of deaths (55.7%) in children < 4 years. Considering indigenous children and adolescents with TB in Brazil as a whole, mean incidence was 49.1/100,000, ranging from 21.5/100,000 to 97.6/100,000 in the Northeast and Central, respectively. Cases with insufficient and irregular follow-up showed higher odds of dropout (OR = 11.1; 95%CI: 5.2-24.8/OR = 4.4; 95%CI: 1.9-10.3) and death (OR = 20.3; 95%CI: 4.9-84.9/OR = 5.1; 95%CI: 1.2-22.7). Cases in retreatment (OR = 2.4; 95%CI: 2.08-8.55) and with HIV coinfection (OR = 8.2; 95%CI: 2.2-30.9) were also associated with dropout. Extrapulmonary (OR = 1.8; 95%CI: 1.1-3.3) and mixed clinical forms (OR = 5.6; 95%CI: 2.8-11.4), age < 4 years (OR = 3.1; 95%CI: 1.5-6.4), and cases from the North (OR = 2.8; 95%CI: 1.1-7.1) and Central (OR = 2.8; 95%CI: 1.1-7.0) were associated with death. TB control in indigenous children and adolescents cannot be achieved without investments in research and development and without reducing social inequalities.

O objetivo deste estudo foi descrever características clínicas e sociodemográficas, estimar a incidência da tuberculose (TB), além de analisar fatores associados ao abandono e ao óbito na vigência do tratamento dos casos de TB notificados entre crianças e adolescentes indígenas, no Brasil, entre 2006-2016. Realizou-se análise da série histórica de incidência, segundo faixa etária e macrorregião e utilizou-se regressão logística multinomial para elucidar fatores associados ao abandono e ao óbito. Do total de 2.096 casos notificados, 88,2% tiveram cura, 7,2% abandonaram o tratamento e 4,6% evoluíram para óbito. Houve predomínio de casos em meninos de 15-19 anos e maior proporção de óbitos (55,7%) em < 4 anos. Considerando o conjunto de crianças e adolescentes indígenas com TB no Brasil, a incidência média foi 49,1/100 mil, variando de 21,5/100 mil a 97,6/100 mil nas regiões Nordeste e Centro-oeste, respectivamente. Os casos com acompanhamento insuficiente e regular tiveram maiores chances de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) e óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Os casos em retratamento (OR = 2,4; IC95%: 2,08-8,55) e com anti-HIV positivo (OR = 8,2; IC95%: 2,2-30,9) também mostraram-se associados ao abandono. As formas clínicas extrapulmonar (OR = 1,8; IC95%: 1,1-3,3) e mista (OR = 5,6; IC95%: 2,8-11,4), os casos em < 4 anos (OR = 3,1; IC95%: 1,5-6,4) e os casos provenientes das regiões Norte (OR = 2,8; IC95%: 1,1-7,1) e Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) mostraram-se associados ao óbito. Acreditamos que o controle da TB em crianças e adolescentes indígenas não poderá ser alcançado sem investimentos em pesquisa e desenvolvimento e sem a redução das desigualdades sociais.

El objetivo de este estudio fue describir características clínicas y sociodemográficas, estimar la incidencia de la tuberculosis (TB), además de analizar factores asociados al abandono y al óbito en la vigencia del tratamiento de los casos de TB, notificados entre niños y adolescentes indígenas, en Brasil entre 2006-2016. Se realizó un análisis de la serie histórica de incidencia, según la franja de edad y macrorregión y se utilizó la regresión logística multinomial para elucidar factores asociados al abandono y al óbito. Del total de 2.096 casos notificados, un 88,2% tuvieron cura, un 7,2% abandonaron el tratamiento y un 4,6% evolucionaron hacia óbito. Hubo un predominio de casos en chicos de 15-19 años y mayor proporción de óbitos (55,7%) en < 4 años. Considerando el conjunto de niños y adolescentes indígenas con TB en Brasil, la incidencia media fue 49,1/100.000, variando de 21,5/100.000 a 97,6/100.000 en las regiones Nordeste y Centro-oeste, respectivamente. Los casos con un seguimiento insuficiente y regular tuvieron mayores oportunidades de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) y óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Los casos de retorno al tratamiento (OR = 2,4; IC95%: 2,08-8,55) y con anti-VIH positivo (OR = 8,2; IC95%: 2,2-30,9) también se mostraron asociados al abandono. Las formas clínicas extrapulmonares (OR = 1,8; IC95%: 1,1-3,3) y mixta (OR = 5,6; IC95%: 2,8-11,4), los casos en < 4 años (OR = 3,1; IC95%: 1,5-6,4) y los casos procedentes de las regiones Norte (OR = 2,8; IC95%: 1,1-7,1) y Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) se mostraron asociados al óbito. Creemos que el control de la TB en niños y adolescentes indígenas no se podrá alcanzar sin inversiones en investigación y desarrollo y sin la reducción de las desigualdades sociales.

Tuberculose entre crianças e adolescentes indígenas no Brasil: fatores associados ao óbito e ao abandono do tratamento / Tuberculosis in indigenous children and adolescents in Brazil: factors associated with death and treatment dropout / Tuberculosis entre niños y adolescentes indígenas en Brasil: factores asociados al óbito y al abandono del tratamiento

Resumo: O objetivo deste estudo foi descrever características clínicas e sociodemográficas, estimar a incidência da tuberculose (TB), além de analisar fatores associados ao abandono e ao óbito na vigência do tratamento dos casos de TB notificados entre crianças e adolescentes indígenas, no Brasil, entre 2006-2016. Realizou-se análise da série histórica de incidência, segundo faixa etária e macrorregião e utilizou-se regressão logística multinomial para elucidar fatores associados ao abandono e ao óbito. Do total de 2.096 casos notificados, 88,2% tiveram cura, 7,2% abandonaram o tratamento e 4,6% evoluíram para óbito. Houve predomínio de casos em meninos de 15-19 anos e maior proporção de óbitos (55,7%) em < 4 anos. Considerando o conjunto de crianças e adolescentes indígenas com TB no Brasil, a incidência média foi 49,1/100 mil, variando de 21,5/100 mil a 97,6/100 mil nas regiões Nordeste e Centro-oeste, respectivamente. Os casos com acompanhamento insuficiente e regular tiveram maiores chances de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) e óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Os casos em retratamento (OR = 2,4; IC95%: 2,08-8,55) e com anti-HIV positivo (OR = 8,2; IC95%: 2,2-30,9) também mostraram-se associados ao abandono. As formas clínicas extrapulmonar (OR = 1,8; IC95%: 1,1-3,3) e mista (OR = 5,6; IC95%: 2,8-11,4), os casos em < 4 anos (OR = 3,1; IC95%: 1,5-6,4) e os casos provenientes das regiões Norte (OR = 2,8; IC95%: 1,1-7,1) e Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) mostraram-se associados ao óbito. Acreditamos que o controle da TB em crianças e adolescentes indígenas não poderá ser alcançado sem investimentos em pesquisa e desenvolvimento e sem a redução das desigualdades sociais.

Abstract: The study aimed to describe clinical and sociodemographic characteristics, estimate incidence, and analyze factors associated with dropout and death during treatment of TB cases reported in indigenous children and adolescents in Brazil from 2006 to 2016. A historical case series was performed on incidence according to age bracket and major geographic region, and multinomial logistic regression was used to explain factors associated with treatment dropout and death. Of the 2,096 reported cases, 88.2% evolved to cure, 7.2% dropped out of treatment, and 4.6% evolved to death. There was a predominance of cases in boys 15-19 years of age and a higher proportion of deaths (55.7%) in children < 4 years. Considering indigenous children and adolescents with TB in Brazil as a whole, mean incidence was 49.1/100,000, ranging from 21.5/100,000 to 97.6/100,000 in the Northeast and Central, respectively. Cases with insufficient and irregular follow-up showed higher odds of dropout (OR = 11.1; 95%CI: 5.2-24.8/OR = 4.4; 95%CI: 1.9-10.3) and death (OR = 20.3; 95%CI: 4.9-84.9/OR = 5.1; 95%CI: 1.2-22.7). Cases in retreatment (OR = 2.4; 95%CI: 2.08-8.55) and with HIV coinfection (OR = 8.2; 95%CI: 2.2-30.9) were also associated with dropout. Extrapulmonary (OR = 1.8; 95%CI: 1.1-3.3) and mixed clinical forms (OR = 5.6; 95%CI: 2.8-11.4), age < 4 years (OR = 3.1; 95%CI: 1.5-6.4), and cases from the North (OR = 2.8; 95%CI: 1.1-7.1) and Central (OR = 2.8; 95%CI: 1.1-7.0) were associated with death. TB control in indigenous children and adolescents cannot be achieved without investments in research and development and without reducing social inequalities.

Resumen: El objetivo de este estudio fue describir características clínicas y sociodemográficas, estimar la incidencia de la tuberculosis (TB), además de analizar factores asociados al abandono y al óbito en la vigencia del tratamiento de los casos de TB, notificados entre niños y adolescentes indígenas, en Brasil entre 2006-2016. Se realizó un análisis de la serie histórica de incidencia, según la franja de edad y macrorregión y se utilizó la regresión logística multinomial para elucidar factores asociados al abandono y al óbito. Del total de 2.096 casos notificados, un 88,2% tuvieron cura, un 7,2% abandonaron el tratamiento y un 4,6% evolucionaron hacia óbito. Hubo un predominio de casos en chicos de 15-19 años y mayor proporción de óbitos (55,7%) en < 4 años. Considerando el conjunto de niños y adolescentes indígenas con TB en Brasil, la incidencia media fue 49,1/100.000, variando de 21,5/100.000 a 97,6/100.000 en las regiones Nordeste y Centro-oeste, respectivamente. Los casos con un seguimiento insuficiente y regular tuvieron mayores oportunidades de abandono (OR = 11,1; IC95%: 5,2-24,8/OR = 4,4; IC95%: 1,9-10,3) y óbito (OR = 20,3; IC95%: 4,9-84,9/OR = 5,1; IC95%: 1,2-22,7). Los casos de retorno al tratamiento (OR = 2,4; IC95%: 2,08-8,55) y con anti-VIH positivo (OR = 8,2; IC95%: 2,2-30,9) también se mostraron asociados al abandono. Las formas clínicas extrapulmonares (OR = 1,8; IC95%: 1,1-3,3) y mixta (OR = 5,6; IC95%: 2,8-11,4), los casos en < 4 años (OR = 3,1; IC95%: 1,5-6,4) y los casos procedentes de las regiones Norte (OR = 2,8; IC95%: 1,1-7,1) y Centro-oeste (OR = 2,8; IC95%: 1,1-7,0) se mostraron asociados al óbito. Creemos que el control de la TB en niños y adolescentes indígenas no se podrá alcanzar sin inversiones en investigación y desarrollo y sin la reducción de las desigualdades sociales.

Accelerating TB notification from the private health sector in Delhi, India.

INTRODUCTION: In India, almost half of all patients with tuberculosis (TB) seek care in the private sector as the first point of care. The national programme is unable to support such TB patients and facilitate effective treatment, as there is no information on TB and Multi or Extensively Drug Resistant TB (M/XDR-TB) diagnosis and treatment in private sector. OBJECTIVE: To improve this situation, Government of India declared TB a notifiable disease for establishing TB surveillance system, to extend supportive mechanism for TB treatment adherence and standardised practices in the private sector. But TB notification from the private sector is a challenge and still a lot needs to be done to accelerate TB notification. METHODS: Delhi State TB Control Programme had taken initiatives for improving notification of TB cases from the private sector in 2014. Key steps taken were to constitute a state level TB notification committee to oversee the progress of TB notification efforts in the state and direct 'one to one' sensitisation of private practitioners (PPs) (in single PP's clinic, corporate hospitals and laboratories) by the state notification teams with the help of available tools for sensitising the PP on TB notification - TB Notification Government Order, Guidance Tool for TB Notification and Standards of TB Care in India. RESULTS: As a result of focussed state level interventions, without much external support, there was an accelerated notification of TB cases from the private sector. TB notification cases from the private sector rose from 341 (in 2013) to 4049 (by the end of March 2015). CONCLUSION: Active state level initiatives have led to increase in TB case notification.

Surveillance of imported hospital requiring malaria in Portugal: can it be improved?

Although eradicated in Portugal, malaria keeps taking its toll on travellers and migrants from endemic countries. Completeness of hospital requiring malaria notification in Portugal 2000-11 was estimated, using two-source capture-recapture method. Data sources were: national surveillance database of notifiable diseases and the national database of the Diagnosis-Related Groups resulting from National Health Service (NHS) hospital episodes. The completeness of notification was 21,2% for all malaria cases and 26,5% for malaria deaths, indicating significant underreporting and urging for complementary data source in surveillance, for disease burden estimates and retrospective monitoring, namely hospital episodes statistics.

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia.

BACKGROUND: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates. AIM: We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB. SETTING: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. METHODS: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities. RESULTS: Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications. CONCLUSION: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS).

[Foodborne illness report systems in China].

OBJECTIVE: To introduce the current foodborne illness report system in China. METHODS: Foodborne illness (food poisoning included) report system and food related unusual cases reported system were characterized by their report definitions, scopes and report procedures as well as their differences. RESULTS: From October, 2010 to June, 2012, there are 2961 centers of disease control and prevention and heath executive organizations at the different local levels registered in the foodborne illness (food poisoning included) report system and 1525 incidents were reported. There were 553 hospitals registered in the food related unusual cases reported system while only 38 cases reported. CONCLUSION: The foodborne illness report system has been set up in China and further efforts in capacities building are needed.

Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan.

To improve involvement of the private sector in the national tuberculosis (TB) programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37,656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification (58.3%), followed by the hospital-based model (18.9%). Treatment success was highest for the district-led model (94.1%) and lowest for the hospital-based model (74.2%). The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects.

Under-reporting of measles: an evaluation based on data from north rhine-westphalia.

BACKGROUND: Eliminating measles in Europe by 2015 is a WHO health goal. In Germany, physicians are legally required to report measles cases, yet it seems likely that reporting is less than universal. The goal of this study is to compare the number of measles cases that are reflected by data from the statutory health insurance (SHI) carriers with the number of physician-reported cases during and after a recent outbreak in the German state of North Rhine-Westphalia (NRW). METHODS: We analyzed the billing data of SHI carriers relating to measles in 2006 and 2007, as well as the measles cases that were reported in NRW over this period as required by law. We calculated the incidence of measles as the number of measles cases per 100 000 insurees (SHI carrier data) or per 100 000 persons in the overall population (reporting data). RESULTS: The measles outbreak in the first half of 2006 comprised 1713 measles cases according to the SHI data and 1665 cases that were reported as required by law (ratio, 1.02:1). From mid-2006 to the end of 2007, the SHI data reflected 821 cases, but only 349 cases were reported (ratio, 2.35:1). Younger patients were more commonly found among the cases reflected in the SHI data than among the reported cases. CONCLUSION: Our study confirms that the system of legally mandated reporting underestimates the true number of measles cases, particularly in times when most cases are sporadic, and particularly in children who are less than 5 years old.

Tuberculose entre os indígenas de São Gabriel da Cachoeira, AM: estudo epidemiológico com base em casos notificados e dados provenientes do Distrito Indígena de Iauaretê / Tuberculosis among the Indians of San Gabriel da Cachoeira, AM: epidemiological study based on data from reported cases and the District of Indigenous Iauaretê

A tuberculose (TB) se mantém como um dos principais problemas de saúde para os povos indígenas no Brasil. Realizou-se um estudo que caracterizou o perfil epidemiológico dos casos de TB notificados no SINAN, em São Gabriel da Cachoeira (SGC), no período 1997-2007, e analisaram-se os dados provenientes de uma investigação de indivíduos com sintomas respiratórios realizada no Distrito Indígena de Iauaretê, em 2010. Observaram-se altas taxas de incidência (216,1 / 100.000 habitantes) e de mortalidade (8,9/100.000) por TB entre a população de SGC com uma expressiva proporção de casos (15,6 por cento) diagnosticados em Iauaretê. A análise das notificações revelou que houve concentração de casos em homens (56,9 por cento), em maiores de 45 anos (37,1 por cento), em pessoas sem escolaridade (41,6 por cento), e na zona rural (74,8 por cento). De acordo com o modelo de regressão logística, a variável faixa etária de 20-45 anos foi considerada preditora para o óbito nos pacientes que iniciaram tratamento para TB (OR: 3,0; IC95 por cento: 1,1-8,3). A análise dos dados provenientes de Iauaretê mostrou alta prevalência de infecção pelo Mycobacterium tuberculosis (...) e antecedente de TB (...) mostraram associação com respostas à prova tuberculínica (..) 5 mm. Dos 184 entrevistados em Iauaretê, 54 (29,8 por cento) referiram história anterior de TB. Esse subgrupo narrou como principal causa para o adoecimento sopro e/ou envenenamento (13/54; 24,1 por cento), e o itinerário terapêutico inicial utilizado foi uso de plantas medicinais e/ou pajelança / xamanismo, seguido do uso de medicamentos farmacêuticos (42,6 por cento e 42,7 por cento, respectivamente). Os resultados indicam que a transmissão da TB em SGC se mantém em altos patamares ao longo do tempo, fazendo com que a população esteja submetida a um permanente risco de infecção e doença. Por fim, as evidências indicam que outros problemas devem ser considerados no diagnóstico diferencial ou como fatores de risco para TB mostrando a necessidade de estabelecer protocolos específicos para o controle da TB em indígenas, sobretudo no que tange à detecção, ao diagnóstico, ao tratamento e acompanhamento dos casos identificados, e também aos problemas relacionados ao acesso aos serviços de saúde.

Perfil clínico epidemiológico de infección por hantavirus en la Provincia de Buenos Aires, Argentina, periodo 1996 – 2009 / Clinical epidemiological profile hantavirus infection the Buenos Aires province, Argentina, during 1996-2009

Introducción: La infección denominada hantavirus es considerada una zoonosis viral. Se han identificado más de 21 especies en todo el mundo, transmitidas por diferentes roedores, que son su reservorio natural. Argentina hasta el año 2004 fue el país con mayor incidencia en América del Sur siendo Buenos Aires una de las provincias de mayor incidencia del país. Objetivo: El objetivo del presente trabajo fue analizar las variables clínico-epidemiológicas de la enfermedad en la Provincia de Buenos Aires analizando la serie histórica de 14 años (1996-2009). Material y método: Se analizaron 704 fichas de notificación clínica-epidemiológica. La detección serológica de anticuerpos se realizó mediante Elisa. Las variables estudiadas fueron sexo, edad, residencia según partido y región sanitaria, semana epidemiológica (SE), tasa de incidencia y letalidad, evolución clínica y la presencia de diferentes síndromes. Resultados: 622 casos (88.3 por ciento) presentaron estudio de laboratorio serológico, siendo 291 los casos (46.8 por ciento) positivos o confirmados con IgM. Analizando la evolución clínica, (194 pacientes con dato, 67 por ciento) 112 pacientes curaron y 79 fallecieron. La edad promedio de pacientes fallecidos fue de 33 años. La letalidad para cada síndrome fue: gripal 39.9 por ciento, respiratorio 42.1 por ciento con el, renal 43.9 por ciento, hepático 38.5 por ciento, neurológico 57.1 por ciento y hematológico 40 por ciento. El estudio resulta un aporte al conocimiento de la prevalencia del perfil clínico epidemiológico del hantavirus en la Provincia de Buenos Aires, Argentina.

Introduction: Hantavirus infection is considered a viral zoonosis. More than 21 species have been indentified throughout the world, transmitted by different rodents, which are its natural reservoir. Until 2004, Argentina was the country with the highest incidence in South America, Buenos Aires being one of the provinces with the highest incidence in the country. Objective: The objective of this study was to analyze the clinical and epidemiological variables of the disease in the Buenos Aires Province, analyzing 14 years of historical trends (1996-2009). Materials and methods: 704 clinical-epidemiological notifications were analyzed. Serological detection of antibodies was carried out using ELISA. The variables studied were sex, age, residence according to health system district, epidemiological week (EW), incidence rate, lethality, clinical evolution, and the presence of different syndromes. Results: 622 cases (88.3 percent) had a laboratory serological report, 291 (46.8 percent) of those being positive cases or those confirmed with IgM. Analyzing clinical evolution, (194 patients included this data, 67 percent) 112 patients were cured y 79 died. The average age of deceased patients was 33 years. Lethality for each syndrome was: influenza 39.9 percent, respiratory 42.1 percent, renal 43.9 percent, hepatic 38.5 per cent, neurological 57.1 percent y hematological 40 per cent. This study contributes to knowledge of the clinical epidemiological profile of hantavirus in Buenos Aires Province, Argentina.

Genital chlamydia in southern New South Wales: an ecological analysis of testing and notification patterns 2004-2008.

OBJECTIVE: To identify demographic patterns for chlamydia testing rates on reported general practice (GP) visits and notification rates in residents of Greater Southern Area Health Service (GSAHS) for the period 2004-2008. DESIGN: Descriptive analysis of presentation and chlamydia-specific Medicare data and chlamydia notifications made to GSAHS Public Health Unit. SETTING: Rural and remote southern New South Wales. PARTICIPANTS: Residents of GSAHS who had a Medicare recorded visit to a GP and chlamydia pathology collected in the period July 2004 to June 2008, and those residents notified to the GSAHS Public Health Unit with a positive chlamydia test results. MAIN OUTCOME MEASURES: Age and gender trends for GP visits, chlamydia testing and chlamydia notifications. RESULTS: While chlamydia testing and notification rates increased over the review period, the percentage of chlamydia tests performed remained low. There was a greater increase in testing rates among women than men, and the highest were among women aged 15-24. Chlamydia notification rates increased across all age groups and were greater in women aged 15-24 than men of the same age group. CONCLUSION: The low proportion of tests performed to presentations (in conjunction with the high proportion of notifications to tests performed) reflects that chlamydia testing among providers is still being undertaken in a targeted approach rather than from a population-focused screening perspective. Further work with GPs is required to improve chlamydia screening rates, and ensure practice is consistent with national guidelines.

Diagnosis and outcome of childhood tuberculosis: implementing public health policy in three districts of Pakistan.

SETTING: All nine public sector hospitals in three districts of Pakistan. OBJECTIVE: To estimate case notifications of children with tuberculosis (TB) and their outcomes. DESIGN: A retrospective cohort following all children aged <15 years placed on TB treatment under the National TB Control Programme (NTP) in public hospitals. The study period was 2 years before and 2 years after the implementation of new NTP policy guidelines for childhood TB. Data were collected from hospital TB registers, patient treatment cards and quarterly reports. RESULTS: With the introduction of the new NTP policy, case notification of childhood TB increased from 189 (2004-2005) to 731 for the 2 years 2006-2007. The annual notification rate of childhood TB cases increased from 1.4 (2004-2005) to 5.2 per 100 000 population (2006-2007). Of the total 920 childhood TB cases registered, 610 were pulmonary, 202 extra-pulmonary and the remaining 108 unclassified. The three-fold increase in case notification was accompanied by a lack of follow-up, resulting in an increase in unknown treatment outcomes from 21.7% to 73.3%. CONCLUSION: Managing children with TB in routine NTP practice is possible, but without adequate operational guidelines, expanding services and follow-up, it can lead to suboptimal results.

Chlamydia trachomatis in Tasmania 2001-2007: rising notification trends.

OBJECTIVES: To investigate trends in notification rates of Chlamydia trachomatis in Tasmania, Australia, by population sub-groups, from 1 January 2001 to 31 December 2007. METHODS: An enhanced surveillance dataset was used to supplement case notifications. Rates based on age group were analysed by sex, geographic region, indigenous status, sexual exposure, reason for testing and healthcare provider. RESULTS: In all age groups, the notification rate increased steeply. The highest rates were seen in the ages 15-24 years; this age group represented 15% of the population but accounted for 74% of the chlamydial notifications. The increased rates in females aged 15-24 years and males 15-19 years in Tasmania were larger than the increases observed nationally. Rates were consistently higher in urban areas. Females were more likely to have been tested as a result of screening, and males were more likely to have been tested when presenting with symptoms or as a result of contact tracing. The majority of cases reported sexual exposure with opposite sex partners only. CONCLUSIONS: This study highlights the increasing significance of chlamydial infection as a public health issue, the gender differences in health-seeking behaviour, and the discrepancies in testing patterns. These findings will assist with the design of health promotion programs.

Notificación de sospecha de reaccionesadversas a medicamentos mediantela tarjeta amarilla / Reporting of suspected adverse reactions to drugs by means of the yellow card

Las Reacciones Adversas a Medicamentos (RAM) constituyen un problema de saludpública en nuestra sociedad. Se estima que en los países occidentales el 5,3%de los ingresos hospitalarios están asociados a RAM, el 6,7% de los pacienteshospitalizados sufre una RAM grave y que este problema supone el 5-9% del costeintrahospitalario. A pesar de que la notificación espontánea de sospecha deRAM a través de la “tarjeta amarilla” es el método más eficiente para la detecciónde reacciones adversas nuevas y/o serias a medicamentos, se estima que sólose notifican alrededor del 10%. La legislación española obliga a todos los profesionalessanitarios a notificar las sospechas de reacciones adversas a los medicamentosautorizados. Sin embargo, durante 2006, los enfermeros sólo aportaronel 3% de todas las Tarjetas Amarillas al Sistema Español de Farmacovigilancia. Lainfranotificación de RAM en los profesionales de Enfermería es un fenómeno pendientede estudio (AU)

Adverse reactions to drugs (ARD) are a public health problem in our society. It isestimated that in western countries, 5,3% of hospital admissions are associatedwith ARD, 6,7% of hospitalised patients suffer from severe ARD and that this problemaccounts for 5-9% of intrahospital cost. Despite the fact that spontaneousreporting of suspected ARD via the “Yellow Card” is the most efficient method forthe detection of new and/or severe adverse reactions to drugs, it is estimated thatonly about 10% are reported. Spanish legislation stipulates that all health care professionalsare mandatory reporters of suspected adverse reactions to authoriseddrugs. However, in 2006, nurses contributed only 3% of all Yellow Cards to theSpanish System of Drug Surveillance. The underreporting of ARD on the part ofnursing professionals is a phenomenon pending future study (AU)

Arboviral diseases and malaria in Australia, 2007/08: annual report of the National Arbovirus and Malaria Advisory Committee.

The National Notifiable Diseases Surveillance System (NNDSS) received 8,671 notifications of diseases transmitted by mosquitoes in Australia for the season 1 July 2007 to 30 June 2008. This represented a 39% increase from the annual average of 6,259 notifications for the previous 5 years. The alphaviruses, Barmah Forest and Ross River, accounted for 7,760 (89%) of these notifications during the 2007/08 season and represents an increase when compared with the mean of the past 5 seasons. Detection of flavivirus seroconversions in sentinel chicken flocks across Australia provides an early warning of increased levels of Murray Valley encephalitis virus (MVEV) and Kunjin virus activity. Unusual MVEV activity in mosquitoes and sentinel chicken flocks was reported in southeast Australia during the 2007/08 season. Two cases of MVEV were reported, one each from New South Wales and Western Australia. There were 365 notifications of dengue virus infection that were acquired overseas compared with an average of 164 overseas-acquired dengue cases per annum reported to NNDSS over the 5 seasons from 2002/03 to 2006/07. There were no reports of locally-acquired malaria notified in Australia and 505 notified cases of overseas-acquired malaria during the season 2007/08. The exotic dengue vector Aedes aegypti was first detected on Groote Eylandt, Northern Territory in October 2006 and led to a 2-year Ae. aegypti eradication project. The successful eradication of Ae. aegypti from Groote Eylandt was officially announced in May 2008. The success of the program was due to the selection of appropriate chemicals that were successful in treating mosquito adults, larvae and egg infested receptacles. This annual report presents information on diseases transmitted by mosquitoes in Australia and notified to NNDSS.

Underreporting and underestimation of gonorrhea cases in the Taiwan National Gonorrhea Notifiable Disease System in the Tainan region: evaluation by a pilot physician-based sentinel surveillance on Neisseria gonorrhoeae infection.

OBJECTIVES: We established a pilot sentinel surveillance system for Neisseria gonorrhoeae infection in Tainan to evaluate underreporting in the National Gonorrhea Notifiable Disease System (NGNDS), and also conducted a survey to understand physicians' specific reasons for underreporting in the Tainan region. METHODS: A sentinel surveillance network consisting of six specialty clinics was created in Tainan City. Three hundred seventeen patients who were clinically diagnosed with urethritis, cervicitis, or gonorrhea were enrolled. N. gonorrhoeae infection was detected by urine-based PCR. A questionnaire was mailed to healthcare providers who potentially see patients with gonorrhea in the Tainan region. RESULTS: Forty-eight N. gonorrhoeae-positive subjects were identified from the sentinel surveillance, and none of these gonorrhea cases were notified to the NGNDS by their healthcare providers. During the study period, there were 67 notified cases in the NGNDS, depicting an underestimation of at least 42% for this epidemic. Of the 16 healthcare providers who had seen cases in the past 3 months, only seven (43.8%) reported that they notified the authorities and only 23 (32%) of 71 cases were reported. 'Not collecting a specimen' and 'afraid of the invasion of patient privacy by the authorities' were the main reasons for the lack of notification. CONCLUSIONS: The underreporting of gonorrhea identified in this pilot is substantial. An overhaul of Taiwan's NGNDS that streamlines the reporting procedures and the requirement for laboratory confirmation, along with a continuing medical education program is warranted.