Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin.

The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.

Value of targeting at-risk populations at outreach venues: findings from a local sauna.

An assessment of the need to increase access to an outreach venue, the local sauna in Walsall, UK, frequented only by men who have sex with men, was undertaken. A case-notes review of the clients who attended the monthly outreach sessions at the sauna in the year 2007 was performed. Among the 287 men seen at the 12 outreach sessions, 37% had a sexually transmitted infection (STI). Of those tested positive, 88% had never had a previous STI. Twenty-one men had syphilis and a further six tested positive for HIV. Hepatitis B vaccination was completed for 41% of the clients seen. Those who tested positive for an STI said they would not have attended a conventional setting but accepted screening at the sauna. This confirmed the need to increase access at this outreach venue, and further funding has now been provided to have outreach sessions twice a month.

Syphilis outbreak in Walsall, UK: lessons for control and prevention.

An assessment of risk-taking behaviour among men who have sex with men (MSM) attending a sauna venue was undertaken, using a standardized questionnaire, after which outreach screening was introduced targeting MSM. The epidemiology of the continuing outbreak of syphilis was reviewed to determine the factors driving the outbreak and assess the benefit of continuing outreach screening. Findings among the 163 respondents at the sauna included a high rate of casual sex and a tendency not to disclose HIV status. Over 12 months, 51 cases of early syphilis were recorded. Our review showed a decline in incidence in MSM after outreach screening, but an increase in heterosexual spread. Given the frequent anonymous nature of syphilis transmission, traditional contact tracing is ineffective. Outreach screening is required at gay venues and other community settings to target at-risk populations.

The cytocentrifuge NBT test.

The NBT test is a non-specific test of neutrophil membrane stimulation which has application to the study of neutrophil function, particularly in the septicaemic patient. An improved cytochemical test which eliminates potential sources of laboratory error has been developed. Venous or capillary blood samples may be studied and the technique can be applied to the neutropenic patient since available neutrophils are concentrated by cytocentrifugation. Clinical evaluation in 443 patients is described.

Long-term efficacy of single-dose oral treatment in schistosomiasis haematobium.

A two-year follow-up was conducted in children who had been the subjects of a six-month double-blind trial in the single-dose treatment of Schistosoma haematobium infection. The trial had assessed therapeutic efficacy of three oral preparations-praziquantel 40 mg/kg, metrifonate 10 mg/kg, and the 'combination' (concurrent niridazole 25 mg/kg and metrifonate 10 mg/kg administration). Reduction in urinary egg excretion remained high up to follow-up at two years, based on a comparison of pre- and post-treatment geometric mean counts-praziquantel 96.9% (n = 96 at six months, 51 at two years); the 'combination' 93.9% (n = 97 at six months, 48 at two years); and metrifonate 90.3% (n = 92 at six months, 49 at two years). The differences in percentage reduction were not significant (p greater than 0.1). However, a significantly greater reduction in egg output was produced by praziquantel (81.7%) and the 'combination' (82.5%) than by metrifonate (54.2%), on comparing pre- and post-treatment arithmetic mean counts (p less than 0.01). A significantly smaller percentage of subjects were excreting greater than or equal to 125 ova/10 ml urine two years after treatment with praziquantel (10.3%), compared to treatment with the 'combination' (25.7%) and metrifonate (35.8%) (p less than 0.01). The cure rate was significantly higher in the praziquantel group (47.4%) compared to the 'combination' (24.7%) and metrifonate (17.4%) groups, for the six to 24-month follow-up period (p less than 0.001). The pattern and level of transmission had contributed to the long-term efficacy recorded in this study.

Varicella infection and pneumonia among adults.

OBJECTIVES: To demonstrate the clinical importance of adult chickenpox in terms of morbidity, mortality, and impact on hospital services, in Al Ain, United Arab Emirates. METHODS: A review was conducted of 607 consecutive hospitalized cases of adult chickenpox (1985-1996, Al Ain Hospital) for clinical findings and risk of developing varicella pneumonia. RESULTS: Leading clinical features were fever (98.9%), myalgia (26.9%), cough (24.6%), headache (15.4%), pharyngitis (14.7%), and profuse rash (12.2%). There were 26 cases of varicella pneumonia, of whom three died with respiratory failure (hospital case fatality 0.5%). Multivariate analysis (odds ratios in parenthesis) showed that cough (12.1), profuse rash (4.5), fever for more than 1 week (3.9), and age over 34 years (2.3) were the most significant predictors of pneumonia. CONCLUSIONS: Early aggressive therapy with intravenous acyclovir is recommended in patients at risk of pneumonia. In the community setting, there is a large proportion of adult immigrants (especially from South Asia) who are seronegative and at risk of complications and hospitalization. It is recommended that the varicella vaccine be offered to new immigrants after screening, to benefit themselves and the nonexposed community, and to reduce the economic burden of chickenpox on the health services and employers.

Dogs, zoonoses and immunosuppression.

Dogs are the source of a wide range of zoonotic infections that pose a significant threat to human health. This is particularly the case for immunocompromised people, although there are few robust studies that determine immunosuppression as a risk factor for transmission of zoonoses from dogs to humans. An increasing proportion of human society is immunodeficient, principally through the advent of HIV infection and through more people, particularly the expanding elderly group, being subjected to immunosuppressive agents. This is happening at a time when more such people are capitalizing on the acknowledged benefits of dog ownership, making for a potentially dangerous mix. Enteric pathogens (for example, Salmonella, Campylobacter and Cryptosporidium species, that may be canine derived) are a frequent risk to the health of immunocompromised persons. Veterinarians and physicians can be criticised for not communicating with each other, and for not providing adequate risk assessment to pet owners. There is scope for voluntary groups to provide information and support for the immunosuppressed who wish to keep their dogs. Key recommendations are to maintain a clean personal environment and intact mucocutaneous barriers. Public health professionals could help rectify the current communications gap between veterinary and medical staff and so facilitate in the appropriate management of dog-owning immunocompromised people.

Can plasma fructosamine substitute for glycated haemoglobin (HbA1c) estimation in the assessment of diabetic control?

The 'gold standard' marker of overall glycaemic control in diabetes mellitus is the level of glycated haemoglobin (HbA1c). It is, however, an expensive and technically difficult assay and is rarely appropriate to tropical laboratories. Plasma fructosamine measurement is cheaper and easier, though it reflects shorter-term glycaemia. We have measured both indices of control in a group of 154 diabetic patients. There was close correlation between the two measurements (r = 0.6506, P < 0.001), but many patients with abnormal HbA1c levels had normal fructosamine levels. This resulted in an assay sensitivity (compared with HbA1c as gold standard) of only 30%, though specificity was 98%. We conclude that fructosamine measurement cannot be regarded as a substitute for HbA1c determination.

Malumfashi Endemic Diseases Research Project, X. Schistosoma haematobium and bacteriuria in the Malumfashi area.

No association was found between bacteriuria and Schistosoma haematobium infection in the Malumfashi area, and no male had a confirmed significant bacteriuria. The overall bacteriuria prevalence rate in a separate group of schoolgirls was 0.96%, while in females over the age of 20 it was 1.37%; there was an estimated prevalence of 3.2% in women over the age of 30. These figures for females agree with those from populations which have no experience of bilharzia. No urinary S. typhi carriers were found. The lack of association between urinary bacterial infection and schistosomiasis probably reflects the low intensity of S. haematobium infection in the Malumfashi area of northern Nigeria.

Incidence and mortality on snake bite in savanna Nigeria.

Snake bite is a major medical problem among farming communities in the Benue and Niger Valley savanna region of Nigeria. Surveys in the more densely populated northern savanna areas such as Malumfashi (incidence 48 per 100 000 population, mortality 5.1%) show that the spitting cobra, Naja nigricollis, was the predominant species of medical importance. In the less cultivated Benue Valley area the annual snake-bite incidence was estimated to be 497 per 100 000 population, with a 12.2% mortality due mainly to the carpet viper, Echis carinatus. From these findings we estimate a yearly total of almost 10 000 deaths from snake bite in savanna Nigeria and about 23 000 deaths in West Africa. To rectify this serious health problem, concerted efforts are urgently needed.

A clinical study of viper bite poisoning.

Thirty-one consecutive cases of snake bite were studied in the Benue Valley, Nigeria where carpet viper (Echis carinatus) bite constitutes a serious health problem. E. carinatus was responsible for 26 cases, the night adder (Causus maculatus) for three and the puff adder (Bitis arietans) for two. There were two fatalities, both late admissions following E. carinatus poisoning. One patient died after a subarachnoid haemorrhage and the other after tissue necrosis and the complications of a tightly applied tourniquet. Another fatality after E. carinatus bite was suspected in a patient who discharged himself from hospital after Behringwerke antivenom failed to control bleeding and coagulopathy. Other cases of Behringwerke antivenom's failure and of slow response to treatment confirmed the pressing need for a more effective Echis antivenom in West Africa. The enzyme-linked immunosorbent assay (ELISA) was used for diagnosing the biting species and was the only means of identifying the three cases bitten by C. maculatus and one case bitten by B. arietans.

Single dose oral treatment in urinary schistosomiasis: a double blind trial.

A double blind trial of three oral preparations given in single doses for the treatment of Schistosoma haematobium infection was carried out in schoolchildren; selection was biased towards those who excreted large quantities of eggs. Praziquantel 40 mg/kg was the most effective drug giving a greater than 97% reduction in egg output six months after treatment; combined treatment with niridazole 25 mg/kg and metrifonate 10 mg/kg gave a reduction of greater than 92% and metrifonate 10 mg/kg alone a reduction of greater than 86%. Fewer children continued to have moderate to heavy infections (excretion greater than 124 ova/10 ml urine) six months after treatment with praziquantel (5%) and the combined regimen (7%) than with metrifonate (16%). Though our findings show that praziquantel appears to be the most effective and convenient drug available for individuals with S haematobium infection, the combined regimen is a cheaper alternative for treatment where cost is important and parasitological cure not an essential objective.

Survey of NHS staff attitudes to influenza immunisation.

There was a low uptake of influenza vaccination among health care workers in year 1999-2000. The study aimed to identify reasons for low uptake and to use the results to improve uptake during current and future campaigns.

Enzyme-linked immunosorbent assay of venom-antibodies in human victims of snake bite.

The development, incidence, persistence, and significance of specific venom-antibodies were studied in 357 human victims of snake bite in Nigeria using the enzyme-linked immunosorbent assay (ELISA). Venom-antibody was not detected within 2 weeks of envenoming but was present within 2 months of the bite despite therapeutic antivenom being given. ELISA confirmed the medical importance of the carpet viper Echis carinatus in Nigeria but also showed that bites by other venomous species are more common than previously suspected. Venom-antibodies may wane with time but nevertheless were still present 40 years after the original envenoming. Clinical studies suggested that venom-antibody titres too low to be detected by ELISA may be boosted with further bites; and more importantly, homologous venom-antibody may afford significant protection against further envenoming. ELISA can help both in advancing the epidemiology of snake bite and in exploring the role of active immunization.

Malumfashi Endemic Diseases Research Project, XI. Water-contact activities in the schistosomiasis study area.

Fishing, bathing, swimming and playing in water were the most important activities at the Ruwan Sanyi dam site, northern Nigeria, in terms of schistosomiasis transmission. Various washing activities were important in exposure to the infection. Males were responsible for 98% of activity involving contamination and exposure. This accounted for the marked male predominance of Schitosoma haematobium infection in the Muslim communities of this area, where boys under the age of 21 years were responsible for more than 77% of environmental egg contamination. Peak water-contact activity occurred in the afternoon and this coincided with the peak cercarial shedding period and the peak urinary egg output. As a result of the construction of many such dams in this part of northern Nigeria, the recent upward trend in schistosomiasis tramission is likely to be maintained. Fishing is a new and a potentially important activity in transmission. Any future programme to control urinary schistosomiasis in this area should pay particular attention to this activity as well as group swimming activity by young males, who should be the prime target.