Measles virus genotyping an important tool in measles outbreak investigation in Norway, 2011.

This study describes 33 laboratory-confirmed cases of measles that occurred in Norway in 2011, mainly among unvaccinated children between seven months and 10 years of age. Laboratory testing included detection of anti-measles IgM- and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and molecular detection and characterisation of measles virus by polymerase chain reaction (PCR) and sequencing. Epidemiological data and genotyping revealed that the measles cases originated from eight separate importations, resulting in four outbreaks and four sporadic cases. Except for the first outbreak which affected 18 cases, limited secondary spread occurred in each of the three other outbreaks. The outbreaks were caused by measles virus genotypes B3, D4 and D9, whereas genotypes D8 and B3 were detected in the sporadic cases. This study highlights that genetic characterisation of measles virus is an essential tool in the laboratory surveillance of measles, especially in countries like Norway which are approaching the measles elimination goal. The investigation revealed that importation of measles resulted in subsequent transmission within Norway to non-vaccinated individuals, and twelve cases occurred in healthcare settings, involving both staff and children. The four cases detected among healthcare workers (HCWs) emphasised that the coverage of measles-mumps-rubella (MMR) vaccination among healthcare personnel needs to be improved and both primary and secondary vaccine failure was demonstrated in two fully immunised HCWs.

Increased incidence of Mycoplasma pneumoniae infection in Norway 2011.

Epidemics of Mycoplasma pneumoniae have recently been reported from England and Wales and from Denmark. A similar increase in M. pneumoniae infections was noted in Norway late autumn 2011.The epidemic has resulted in shortage of erythromycin and the use of alternative antibiotics has been recommended.

Ongoing outbreak of measles in Oslo, Norway, January-February 2011.

Between 19 January and 17 February 2011, 10 cases of measles (eight laboratory-confirmed and two probable) were reported in Oslo with the majority of cases in a mainly unvaccinated immigrant community. Of these, two cases were identified outside the immigrant community, in Norwegian children.

Chlamydia antibody testing and diagnosing tubal pathology in subfertile women: an individual patient data meta-analysis.

BACKGROUND: The Chlamydia IgG antibody test (CAT) shows considerable variations in reported estimates of test accuracy, partly because of the use of different assays and cut-off values. The aim of this study was to reassess the accuracy of CAT in diagnosing tubal pathology by individual patient data (IPD) meta-analysis for three different CAT assays. METHODS: We approached authors of primary studies that used micro-immunofluorescence tests (MIF), immunofluorescence tests (IF) or enzyme-linked immunosorbent assay tests (ELISA). Using the obtained IPD, we performed pooled receiver operator characteristics analysis and logistic regression analysis with a random effects model to compare the three assays. Tubal pathology was defined as either any tubal obstruction or bilateral tubal obstruction. RESULTS: We acquired data of 14 primary studies containing data of 6191 women, of which data of 3453 women were available for analysis. The areas under the curve for ELISA, IF and MIF were 0.64, 0.65 and 0.75, respectively (P-value < 0.001) for any tubal pathology and 0.66, 0.66 and 0.77, respectively (P-value = 0.01) for bilateral tubal pathology. CONCLUSIONS: In Chlamydia antibody testing, MIF is superior in the assessment of tubal pathology. In the initial screen for tubal pathology MIF should therefore be the test of first choice.

Fatal and mild primary dengue virus infections imported to Norway from Africa and south-east Asia, 2008-2010.

Between 2008 and 2010, eight cases of viraemic dengue fever in travellers were diagnosed in Norway. They had returned from Eritrea, Thailand and Indonesia. All cases were primary dengue infections, seven non-complicated dengue fever and one dengue shock syndrome with a fatal outcome. Four patients were infected with dengue virus serotype 1, one with type 2 and three with type 3. Two cases from Thailand, the fatal case and the two imported from Eritrea were infected with type 1.

Detection of measles- and mumps-specific IgG antibodies in paired serum and oral fluid samples from Norwegian conscripts.

The aim of this study was to measure the seroprevalence to mumps in Norwegian conscripts belonging to the first children vaccination cohorts that had been offered two doses of MMR vaccine. The seroprevalence to mumps was 76% with the Microimmune assay and 85% with the Enzygnost assay. We also compared the performance of the Microimmune assay for detection of mumps- and measles-specific IgG antibodies in 340 paired serum and oral fluid samples from the conscripts and evaluated the effect of revaccination. Mumps-specific IgG antibodies were detected in only 61% of the oral fluids. In contrast, high levels of measles-specific IgG antibodies were detected in both the serum and oral fluid samples. Based on these results, we are only able to recommend the use of oral fluid for surveillance of measles in Norway. Our results may also indicate that the seroprevalence necessary to interrupt transmission of mumps has not been reached in vaccinated young adult Norwegians. Seroconversion was observed in all initially measles seronegative conscripts after revaccination, whereas 23 of 27 initially mumps seronegative conscripts failed to seroconvert.

Seroprevalence of measles among Norwegian military conscripts in 2004.

The study presented here was conducted in order to evaluate the impact of Norway's childhood immunization program against measles, which was implemented in 1969. In the study, the level of measles immunity was measured among 1,405 military conscripts belonging to the first childhood immunization cohorts that were offered two doses of the measles, mumps and rubella vaccine. The overall seroprevalence of measles antibodies in this cohort was 89.3%. Two commercially available antibody assays were used, and the discordance between the two assays was 10.5%. Similar levels of immunity to measles were detected in earlier studies of Norwegian conscripts belonging to different childhood immunization cohorts.

IL-6 cerebrospinal fluid levels are related to laryngeal IgA and epithelial HLA-DR response in sudden infant death syndrome.

The objective was to investigate whether there is any correlation between signs of central and peripheral immune stimulation in victims of sudden infant death syndrome (SIDS), the former expressed by IL-6 in cerebrospinal fluid (CSF), the latter by IgA, IgG, and IgM immunocytes, T lymphocytes, and HLA-DR expression in laryngeal mucosa. Seventeen SIDS cases with low CSF IL-6 levels (< or =5 pg/mL) and 20 cases with high CSF IL-6 levels (> or =30 pg/mL) were subjected to immunohistochemical quantitation of IgA, IgG, and IgM immunocytes; semiquantitative scoring of T lymphocytes in the mucosa of epiglottis and larynx, and semiquantitative evaluation of HLA-DR expression. SIDS cases with IL-6 levels > or =30 pg/mL had a significantly higher number of IgA immunocytes in laryngeal mucosa (p = 0.007) and in epiglottis (p = 0.03) than cases with IL-6 levels < or =5 pg/mL. Furthermore, laryngeal HLA-DR expression was significantly more extensive in SIDS cases with IL-6 levels > or =30 pg/mL than in those with levels < or =5 pg/mL (p = 0.05). No differences were found for IgG and IgM immunocytes or for T cells. In addition, babies found prone more often had symptoms of slight infection before death and had a higher number of IgA immunocytes in the larynx (p = 0.02) than babies sleeping on their side or back. Because IL-6 levels > or =30 pg/mL correspond to the levels found in infants who die from infectious diseases such as meningitis/septicemia and pneumonia, the findings favor the hypothesis that many SIDS cases may be caused by an "overreaction" of the immune system to an otherwise harmless infection.

False-negative results of a ligase chain reaction assay to detect Chlamydia trachomatis due to inhibitors in urine.

The aim of this study was to assess the presence of inhibitors in urine specimens causing false-negative results in a commercial Chlamydia trachomatis gap-filling ligase chain reaction (Gap-LCR) assay. On testing of urine samples by the Gap-LCR assay and urethral swab specimens by cell culture, 73 (19%) Chlamydia trachomatis positive subjects were detected among 382 men attending a clinic for sexually transmitted diseases. In 56 subjects, the agent was detected in both the urine and the urethral samples, while 309 subjects were negative in both tests. In seven subjects urine samples were Gap-LCR positive (confirmed by a different Gap-LCR assay), but the corresponding urethral swab samples were cell culture-negative. In another ten subjects the urethral swab samples were cell culture positive, but their urine samples were Gap-LCR negative. Subsequent re-analysis of the urine samples including the addition of external Chlamydia trachomatis DNA indicated full or partial inhibition in nine of the cell culture-positive Gap-LCR negative subjects. When urine preparations were freeze-thawed and diluted prior to testing, Chlamydia trachomatis was detected in six of the ten initially Gap-LCR-negative samples. Gap-LCR inhibitors were present in at least nine (12%) of the 73 urine preparations from the Chlamydia trachomatis positive individuals. Identification of samples containing Gap-LCR inhibitors and subsequent processing to reduce the inhibition increased the sensitivity of the test from 86% to 95%.

[Chlamydia pneumoniae infections in Norway]. / Chlamydia pneumoniae-infeksjoner i Norge.

During the last 5-6 years our understanding of Chlamydia pneumoniae has changed radically. C. pneumoniae is no longer considered a dangerous, obligatory pathogen. Rather, it is a common, highly contagious intracellular opportunist, inducing poor immunity and with a tendency to repeated reinfections. At present, a possible role in the formation of atheromatous plaques is being discussed. There is a significantly higher prevalence of antibodies against C. pneumoniae in coronary heart disease patients than in controls. Another unsolved problem is that of therapy, since chronic lung infection resists long-term macrolide antibiotic treatment. Should additional treatment with cortisone be given? Here we clearly need clinical trials before we move in a totally new direction.

[Homeopathy--time for official authorization?]. / Homøopati--tid for offentlig godkjenning?

The Norwegian government has recently appointed a committee to scrutinise alternative therapies and distinguish between serious and nonserious practitioners in preparation for future authorisation. Homoeopathy seems to be the most popular of alternative therapies in Norway, and counts Prime Minister Thorbjørn Jagland among contented patients. For this reason we have taken a closer look at the principles of homoeopathy, and the documentation. Just as in a recent report on documentation and the effect of selected alternative therapies, we too were unable to find studies of reasonable quality that were confirmed by others. Homoeopathists use theoretical physics to explain how water "remembers" the information from molecules no longer existing in the solution, when the liquid is shaken in a special way between every dilution. It does not matter whether the homoeopathist is serious or not as long as the remedy consists only of pure water. We conclude, therefore, that homoeopathy should not be authorised as a serious medical treatment in the Norwegian Health Service.

Screening urine samples by leukocyte esterase test and ligase chain reaction for chlamydial infections among asymptomatic men.

Urine samples from 358 asymptomatic males were screened for urethral inflammation by the leukocyte esterase (LE) test and for Chlamydia trachomatis by the ligase chain reaction (LCR). LE and LCR positivity rates were 7.5% (27 of 358 samples) and 2.8% (10 of 358 samples), respectively. Eight of the 10 LCR-positive samples were detected by the LE screening test. The urine LE prescreening test in combination with the LCR assay may be a reasonable approach for genitourinary chlamydial disease control.

Ectopic pregnancy and chlamydial serology.

OBJECTIVES: To determine the prevalence of humoral IgG antibodies to Chlamydia trachomatis in women with tubal pregnancies. METHODS: A study was made of 49 women with tubal pregnancies. The control group consisted of 50 pregnant women without any known fertility problems. RESULTS: Compared with the pregnant group of women, a statistically significant higher prevalence of chlamydial IgG antibody titer > or = 64 was observed among the patients with gross abnormalities in the fallopian tube contralateral to the ectopic gestation (P = 0.002). The differences in geometric mean titer (GMT) were also statistically significant (P = 0.0004) between those two groups. The recall frequency of past pelvic inflammatory disease (PID) was increased 5-6-fold in patients with ectopic pregnancy, compared with the intrauterine pregnant women. Twenty-five of 30 patients (83%) with ectopic pregnancy and macroscopic tubal sequelae recalled a history of PID. The prevalence of chlamydial IgG antibody titer > or = 64 among women with a past history of PID was 75.6% (34/45), compared with 44.4% (24/54) among the women without any history of past PID history (P = 0.002). Concerning GMT, the numbers were 27 and 154 among women with and without a past history of PID, respectively (Fig. 2). CONCLUSIONS: These findings suggest that C. trachomatis is a major cause of oviductal damage, which predisposes to ectopic pregnancy.

Detection of Chlamydia trachomatis in the urine of young Norwegian males by enzyme immunoassay.

First-void urine samples from 392 Norwegian military conscripts were investigated for the presence of Chlamydia trachomatis by enzyme immunoassay (EIA) on day 1 and day 5 after collection. Positive samples were subsequently investigated by direct immunofluorescence (IF) microscopy for the presence of chlamydial elementary bodies (EBs) in the urine pellet, and urethral swab material taken from the EIA-positive individuals was cultured. 4.8% (19/392) of the urine samples were EIA-positive on day 1, and 5.4% (21/392) were positive on day 5, with a combined total of 6.6% (26/392). Twenty-four of the 26 urine samples were confirmed as positive on IF microscopy. Urethral swabs were taken from 21 EIA-positive individuals. Six of the swabs were positive on cell culture, whereas nine were positive on IF microscopy of swab material, suggesting that these techniques perform better in symptomatic cases than in male Chlamydia trachomatis carriers. In the urine samples a notable discrepancy in EIA results was seen when the same refrigerated samples were retested on day 5 compared to day 1. This discrepancy was probably due to storage-related factors.