The physician-based sentinel surveillance project - a pilot programme for internet-based sentinel surveillance - Poster abstract

OBJECTIVE: To establish and evaluate an internet-based pilot programme for sentinel surveillance of emerging health problems among the private sector physicians in three Caribbean countries. DESIGN AND METHODS: Participating physicians were identified in cooperation with local chapters of the Caribbean College of Family Physicians in Jamaica, Trinidad andTobago and St Lucia. A menu-driven Epi Info programme was used for reporting as well as on-site analysis of individual site data. Hardware was installed,participants were trained and surveillance data entry began in September-October, 1999. Three disease entities were chosen by consensus as the initial targets for surveillance - diarrhoeal disease, fever/rash syndrome, and sexually transmitted diseases. Evaluation criteria for the programme included the achievement of timely data entry and reporting, the establishment of regular feedback, and the regular use of internet-based data transfer for reporting and communication. RESULTS: The practices of twenty-one physicians were chosen as initial pilot sites. All Ministries valued the enhancement of their existing surveillance through the project and cited improved public-private partnership as a positive impact. Reduced cost of communication through use of theinternet was partially offset by the high initial cost of computer hardware, and the relatively high cost of local internet connections. Other limitations included a constrained communication infrastructure, limited baseline computer skills administrative barriers, and cost. CONCLUSION: The strengths of the programme were simplicity; potential for improved data quality; and improved competency in computer skills and surveillance among participating physicians. Proposed changes in the next phase include improvement in the software programme and development of a more extended network and e-mail forum. (Au)

Emergence of salmonella enteritidis in the Caribbean: case control study in Trinidad and Tobago

OBJECTIVE: To determine the aetiology, sources and risk factors of Salmonella enteritidis (SE) infections in Trinidad and Tobago. METHODS: A prospective case control study of 46 cases and 92 age-and neighbourhood-matched controls was conducted between March 1998 and May 1999 to explore hypothesized risk factors for SE infections. A written questionnaire was administered through face-to-face interviews. Standard culture and serological laboratory methods were used to confirm SE isolates from food and clinical samples. Data were analyzed using Epi Info version 6.04 software. RESULTS: SE infection was associated with the consumption of shell eggs, particularly raw or undercooked eggs. There was a positive association between SE infection and the number of eggs consumed (p<0.001). Persons with SE infection were less likely than well controls to purchase refrigerated eggs and to refrigerate their eggs at home (p<0.001). SE isolates from 30/34 (88 percent) patients and from 9 implicated egg or egg-containing food samples were phage type (PT) 4. Thirty (65 percent) of 46 patients were hospitalised and 2 died. CONCLUSION: SE infection are sporadic and seasonal and are associated with eating raw-egg foods such as homemade eggnog and ice cream, cake batter and egg-containing beverages. PT 4 is the dominant phage type. Public health education programmes on the risks of eating raw or undercooked eggs, egg-traceback studies and on-farm testing of flocks for SE are needed to reduce the incidence of this infection.(AU)

International investigation of an outbreak of Legionnaires' Disease at a major hotel associated with portable water - Antigua, 1996 -abstract

On November 9, 1996, the Caribbean Epidemiology Centre and the UK Public Health Laboratory Service began an investigation of 3 cases of legionnaires' disease (LD) in English tourist staying at an Antiguan hotel in September and October, 1996. The medical records at the two islands hospitals and the hotel's nursing records were reviewed to identify any additional cases. A suspect case was defined as any guest or employee of the hotel since August 1, 1996 with fever and cough, and a confirmed as one with clinical or radiological evidence of pneumonia plus laboratory evidence of recent Legionella pneumophila infection. Two cases were confirmed by high titre to Lp-1, and third by culture of Lp-1 from sputum. Thirteen other suspected cases from four other countries were identified and are being followed up. Chlorine residual levels were satisfactory in the cold water. The hotel's mains supply and hot and cold water distribution system contained L. pneumophila including Lp-1. Concentrations were highest in the hot water system, particularly the solar storeage tanks, and in samples collected from rooms that had not been used for several days. Water samples from the rooms where the cases had stayed contained Lp-1 in high concentration. We concluded that the hotel's hot water supply was the source of the outbreak and recommendations were made to prevent further cases form occurring. This outbreak has important implications for clinical practice and public health in the Caribbean, and for the region's hotel industry. (AU)

A survey of hepatitis B among health workers in Jamaica

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or expose to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 percent of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29 percent compared with 18 percent, Odds Ratio 1.6;95 percent CI 0.98-2.9). HBsAg was found in 5.3 percent of 562 persons tested compared with 1 percent of blood donors. One or more needlestick accidents were reported by 60 percent of the sample, and blood or liquid splashing on the face was reported by 48 percent. Jaundice and hepatitis were reported by 1.2 percent and 3.5 percent of health staff, respectively. HBaAg carrier status was associated with years of service (p=0.039). Prevalence of antibodies to HBV increased with age (p=0.004) and years of service (p=0.028). The effect of age and years of service appears to be largely independent (r=0.44). This survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice (AU)

A survey of hepatitis B among health workers in Jamaica

One thousand, five hundred and thirty-seven health staff, presenting for hepatitis B vaccination in Jamaica, were surveyed in 1990/91 for hepatitis B markers and/or expose to blood or hepatitis. Antibodies to either hepatitis B surface antigen (HBsAg) or hepatitis B core (HBc) were found in 19.8 por ciento of 817 persons tested. Males were more likely to have antibodies to Hepatitis B Virus (HBV) than females (29 por ciento compared with 18 por ciento , Odds Ratio 1.6;95 por ciento CI 0.98-2.9). HBsAg was found in 5.3 por ciento of 562 persons tested compared with 1 por ciento of blood donors. One or more needlestick accidents were reported by 60 por ciento of the sample, and blood or liquid splashing on the face was reported by 48 por ciento . Jaundice and hepatitis were reported by 1.2 por ciento and 3.5 por ciento of health staff, respectively. HBaAg carrier status was associated with years of service (p=0.039). Prevalence of antibodies to HBV increased withe age (p=0.004) and years of service (p=0.028). The effect of age and years of service appears to be largely independent (r=0.44). this survey reaffirms the importance of health workers being immunized with hepatitis B vaccine, and adhering rigorously to universal precautions in patient care and laboratory practice.

Private sector response against the cholera treat in Trinidad and Tobago

During the first half of 1992 the threat of cholera to Trindad and Tobago prompted a strong health education effort by public authorities and the private sector. To help assess the private sector effort, the cost of cholera-related advertisements and private announcements placed in the country's two leading newspapers during January-June 1992 were received. The review indicated that an estimated TT$ 540 660 was spent on these ads and announcements, that they contributed strongly to keeping cholera prevention continuously in the public eye, and that most of the messages published were accurate, specific, and safe. The strength and success of the private contribution to cholera prevention in this case suggests that similar approaches could be applied to other health problems and to the cholera problem outside Trinidad and Tobago. Overall, the lesson appears to be that if one can find congruence between private sector motives and public health interests, then the potential prospects for a successful partnership are great (AU)

A study of the use and impact of pesticides in St. Lucia - abstract

This paper presents the results of a survey of 130 pesticide users designed to identify attitudes, gaps in knowledge, and unsafe practices which contribute to the risk of pesticide usage to health. A tintometric field method was compared to a standard laboratory method to detect cases of cholinesterase inhibition (pesticide poisoning). Sixty-five per cent of the agricultural workers and vector control officers never wear protective clothing. Their knowledge of routes of absorption was inadequate, but even if warnings are printed boldly on the product labels, <50 percent of the users were capable of consistently understanding written warnings. However, <60 percent of the individuals who understood the labels generally followed the advice provided. The 53 percent of respondents who had received training were no more likely than their untrained colleagues to adhere to safety practices. No significant differences existed between the cholinesterease levels of the exposed and the unexposed workers, but this may be the result of several conservative biases (AU)

Epidemiological indicators and epidemiology of measles in the English-speaking Caribbean and Suriname

The main purpose of this article is to discuss the definitions and limitations of the indicators used to study the epidemiology of measles in the English-speaking Caribbean and Suriname. In addition, the epidemiology of measles over the past ten years is briefly reviewed, with a focus on recent epidemics. The predicted epidemioogical picture of measles over the next few years is also discussed and, finally, the difference between elimination and eradiction of measles is explained. (AU)

A health situation analysis in Trinidad and Tobago, 1990: the local health systems approach

This HSA exercise confirmed known patterns of health and disease in Trinidad and Tobago but produced valuable new information on health status, particularly as it relates to the different local health administrative areas. This was perhaps the most valuable aspect of the analysis. We cannot overemphasize the need for disaggregated data as summary statistics often mask the true state of affairs. This report has focussed on the health status of the population and emphasized again the dominant role of chronic non-communicable diseases and accidents as causes of death. Among males, aged 15 - 44 years, AIDS was the third leading cause of death in 1987, and can be expected to become even more important as a cause of death over the next few years. Other and equally important information on the status of the health information system and the health services situation was also produced and will be discussed elsewhere. (Summary)

HIV study of cocaine-dependent persons - abstract

In Trinidad and Tobago, the crude incidence rate for AIDS rose ten-fold from 0.7 in 1983 to 7.1 in 1987. Cocaine use is epidemic and female addicts commonly support their habit by prostitution, thus creating a behavioural pattern likely to enhance transmission of the virus between groups with different sexual behaviours. It was postulated that, despite the absence of IV drug use in Trinidad and Tobago, drug users may be significant in the transmission of the HIV virus to and within the heterosexual population. In this preliminary investigation conducted in 1988, cocaine individuals were tested for exposure to the HIV. Subjects satisfied the DSM IIIR criteria for cocaine dependence and were relatively heavy users. ELISA HIV-positive blood was confirmed by Western blot analysis. Nine (3.3 percent) of the 276 male addicts and 6 (14.3 percent) of the 42 women tested were HIV-positive. HIV-positive subjects reported having > 10 sexual partners over the past year more often than those who were HIV negative. Prostitution was significant among the female addict population (14/42 or 33 percent). Two-thirds of female addicts who were HIV-positive were prostitutes as compared to 28 percent (10/36) of those who were HIV-negative. It was concluded that cocaine addicts, especially females, are at increased risk for HIV infection through sexual behaviour which involved multiple partners and included prostitution. Further research is recommended to confirm these findings and to develop appropriate intervention strategies (AU)