Hepatitis B carrier state in young Jamaican children [abstract]

OBJECTIVE: To determine the seroprevalence of the hepatitis B carrier state in Jamaican children. METHODS: Serum specimens from 525 randomly-selected students attending one of 6 basic/pre-schools in the Kingston and St.Andrew region were tested at the MIcrobiology Laboratory of the University Hospital of the West Indies for hepatitis B surface antigen and hepatitis B antibodies. A second specimen was sent from each patient to a private laboratory where the tests were repeated and cross-checked against the results obtained from the UHWI laboratory. Demographic data concerning patients age and sex, maternal age and socio-economic status obtained from a parent interview were recorded on a pre-coded questionnare. The age of the students ranged from 3 years to 6 years with a mean age of 4 years. The male to female ratio was 2:3. Eighty percent of the mothers were under thirty-five years of age. RESULTS: The carrier state was identified in 12 percent of students. Six percent of the study sample had a reactive test for antibodies to hepatitis B surface antigen. CONCLUSION: The high prevalence of hepatitis B carrier state in children under 6 years of age supports infection acquired perinatally from infected mothers. This seroprevalence rate would classify Jamaica as an area of high endemicity and further support the urgent need for a national hepatitis B screening. (AU)

Antibiotic susceptibility of clostridium difficile isolates from adult patients at two Jamaican hospitals. Clinical and epidemiological implications

The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and Toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. Erythromycin and cotrimoxazole showed a clear-cut discrimination in resistance and susceptibility, while all isolates were sensitive to vancomycin. Erythromycin sensitive isolates demonstrates a significant association with diarrhoea (60.9 percent, 14/23, p<0.001). These strains were predominantly found at the University Hospital of the West Indies (UHWI, 94.1 percent, 16/17). Strains resistant to erythromycin and clindamycin together were commonly found at the National Chest Hospital (NCH, 68.2 percent, 15/22). All erythromycin sensitive strains found at the NCH were from patients transfered to that hospital. These findings suggest that there is a common strain of C difficile (erythrmycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there suppression of the normal microflora by antibiotics and colonic over growth with C difficile. (AU)

Epidemiology of hepatitis A virus in Jamaica

OBJECTIVE: Between January 1995 and August 1998, a study was conducted to elucidate the epidemiology of hepatitis A virus (HAV) in Jamaica. DESIGN AND METHODS: Participants were recruited from seven sites located in rural and urban areas of Jamaica. There were 128 and 211 females. The ages of the participants ranged from 3 to 90 years. The average ages of males and females were 24.9 and 25.6 years, respectively. Social and demographic data were collected by questionnaire. Potential risk factors which were studied included age of the individual, gender residence in an urban and rural are, type of toilet facilities and source of domestic water supply (indoor or outdoor plumbing). RESULTS: The seroprevalence of HAV in the study population using ELISA was 59.9 percent. Based on logistic regression, age and source of domestic water supply were found to be the major contributors to exposure to HAV (p<0.001) and p=0.006, respectively). The rate of exposure to the virus increased with age. By age 10 years, 30 percent of children were exposed. This was followed by a steady increase to about 73 percent by age 30 years. Prevalence remained at a plateau up to age 50 years after which there was an increase to almost 100 percent in the oldest individuals. Rates of exposure to HAV were higher amongst households with outdoor plumbing which included standpipes, rivers and tanks than those with indoor plumbing. CONCLUSIONS: The seroprevalence of HAV in Jamaica is higher than that seen generally in developed countries, although the age related acquisition of infection was similar. It is expected that the pattern and severity of disease from the virus is similar to that seen in developed countries. Improved water supply and educating the public on the epidemiology of HAV could reduce the prevalence of HAV in Jamaica.(AU)

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted (STD) clinics in Jamaica, we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphillis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63 percent of cases of NGU but high prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71 percent vs 58 percent; x2=4.78; odds ratio OR=1.76; P<0.05) and previous history of gonococcal infection (83 percent vs 42 percent; x2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occured in 5.2 percent of cases of NGU and 50 percent and 90 percent, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.(Au)

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35 percent, 47 percent, and 55 percent in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95 percent confidence interval (CI) = 1.2 - 3.9; p= 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95 percent CI = 1.4 - 10.6; p= 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95 percent CI = 1.8 - 6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence if C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk. (AU)

Rubella susceptibility in Jamaican women, 1996

The 1995 rubella outbreak in Jamaica indicated a need to survey the susceptibility rate in Jamaican antenatal women at risk. In this 1996 study, 389 women in the reproductive age group were investigated for rubella antibodies. In the public sector urban group (A), rubella susceptibility was 20.2 percent, while in a private sector urban clinic (B) practising routine rubella surveillance and recommending postpartum immunization in seronegatives, the susceptibility rate was 13.8 percent. The latter rate was 21.3 percent. Rubella susceptibility has improved overall in women of childbearing age compared with levels in the prevaccine year of 1968. A significant thrust in rubella prevention will still be required before the next rubella epidemic in order to reduce the risk of congenital rubella syndrome.(AU)

Evaluation of the MRL diagnostics dengue fever virus IgM capture ELISA and the PanBio Rapid Immunochromatographic Test for diagnosis of dengue fever in Jamaica

We evaluated two new commercial dengue diagnostic tests, the MRL Diagnostics Dengue Fever Virus IgM Capture ELISA and the PanBio Rapid Immunochromatographic Test, on serum samples collected during a dengue epidemic in Jamaica. The MRL ELISA method correctly identified 96 percent (78 of 80) of the samples as dengue positive, while the PanBio test identified 100 percent (80 of 80). Both tests were 100 percent (20 samples of 20) specific.(Au)

Clostridium difficile infection in immunocompromised patients a three health-care facilities in Jamaica

A cross-sectional study was conducted (April 96 to July 97) to investigate the prevalence of Clostridium difficile infection in immunocompromised patients at 3 health care institutions. Standard bacteriological procedure, tissue culture and enzyme immunoassay were used to investigate faecal specimens from immunocompromised inpatients (N = 113) including 21 patients treated with immunosuppressive drugs, 39 patients had received radiotherapy and 53 patients who were not treated with immunosuppressive drugs. The overall prevalence of C. difficile infections was 14.2 percent (16/113). All the C. difficile isolates were identified as toxigenic strains. The prevalence of C. difficile infection in patients who had received immunosuppressive drugs (23.8 percent, 5/21) did not differ significantly from those who had not (20.7 percent, 11/53), but was significantly lower in patients who received radiotherapy (p<0.01). The occurrence of C. difficile was not significantly associated with antibiotics in patients who were on immunosuppressive drugs (2/13, 15.4 percent vs 3/8, 37.5 percent) or patients who were not (7/32, 21.8 percent vs 4/21, 19.0 percent). Eighty percent (4/5) of C. difficile isolates from patients on immunosuppressive drugs were from those whose regimens include cytotoxic drugs. Similarly, anti-tubercolosis drugs were the antibiotics most frequently associated with C. difficile infections (4/8, 50 percent). C. difficile infections are likely to occur in patients treated with cytotoxic drugs and certain antibiotics.(AU)

Investigations of central nervous system viral infection at UHWI, 1998-1999

Preliminary results are presented for viral infections of the CNS at UHWI between July 1998 and June 1999. A total of 168 cases were referred from the following hospitals and distributed as follows: UHWI 119 (70 percent); Bustamante Children's 31 (18 percent); Spanish Town 10 (6 percent); Kingston Public 7 (4 percent); Other 2 (1 percent). Specimens received were acute and convalescent sera, throat swabs, rectal swabs and CSF. Laboratory investigations included viral culture and serology; confirmatory methods included neutralization tests, immunofluorescence (IFA) and polymerase chain reaction (PCR). The clinical diagnoses in the 168 cases included for viral CNS investigations were submitted from only 47/168 (30 percent) of cases. Viral agents were identified in 31/47 (66 percent) of the appropriate specimens received. These viruses included enteroviruses 12/31 (38 percent), human immunodeficiency virus (HIV) 9/31 (29 percent), 3/31 (9 percent) of the HIV positive patients were also positive for toxoplasmosis), dengue 6/31 (19 percent), herpes simplex virus 1/31 (3 percent), rotavirus 1/31 (3 percent), cytomegalovirus 1/31 (3 percent) and influenza 1/31 (3 percent). Enteroviruses, HIV and dengue were the viruses most frequently associated with CNS infections among the 31 cases identified. This however is not a complete representation of CNS associated with viral agents, as appropriate specimens were received from only 30 percent of the cases. This study also demonstrated a definite need for an increased understanding of appropriate specimen collection and submission necessary for the diagnosis of viral CNS infections.(AU)

Antibiotic susceptibility of 39 Clostridium difficile isolates from adult patients at the University Hospital of the West Indies (UHWI) and the National Chest Hospital (NCH)

The antibiotic susceptibility to six antibiotics of 39 C. difficile isolates (38 toxigenic) from stool specimens (14 adult diarrhoeal and 25 adult nondiarrhoeal) was determined by disc diffusion. Susceptibility to clindamycin (CC), cotrimoxazole (SXT), erythromycin (E), vancomycin (VA), tetracycline (TE) and chloramphenicol (C) was correlated with diarrhoeal and nondiarrhoeal cases. With the exception of VA, a wide variation in susceptibility was noted with CC, E, SXT, TE, and C, with a strong correlation between E sensitive isolates in diarrhoeal cases (69.8 percent). Compartively and of equal significance were erythromycin resistant isolates, primarily form NCH (93.8 percent). All erthromycin resistant isolates were simultaneously resistant to clindamycin (no zone) with only one isolate associated with a diarrhoeal case from UHWI. A review of patients' dockets revealed that actual transferrals to hospitals were largely responsible for the differences in erythromycin susceptibility among isolates.(AU)

Prevalence of viral and bacterial sexually transmitted pathogens in Jamaican pregnant women

In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19 percent of the women had at least one pathogen: C. trachomatis was found in 16 percent, HTLV-1 in 2 percent, HIV-1, HBV and N. gonorrhoeae each in 0.5 percent C. trachomatis infection was more prevalent in women less than 20 years of age (31 percent) than in those 20 years and older (16 percent, OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica(AU)

Genital Chalmydia trachomatis (serotypes D-K) infection in Jamaican commercial street sex workers

OBJECTIVE: To determine in the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmuofluorescence (MIF) test. RESULTS: The DFA detect C trachomatis in 16 percent (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24 percent (31/129) and 25 percent (33/129) respectively. The overall prevalence of current chalmydial infection detected by the isolation techniques used was 25 percent (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95 percent, 61/64) was found in CSSW compared with blood donors (53 percent, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9 percent) and Candida albicans (7 percent) were found in comparatively low frequencies, while Trichomonas vaginalis (0 percent) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequeles of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.(AU)

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group were studied to determine the prevalence of hepatitis C viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by enzyme-linked immunoassay (EIA) for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 per cent - 0.4 per cent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases.

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group were studied to determine the prevalence of hepatitis C viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by enzyme-linked immunoassay (EIA) for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 per cent - 0.4 per cent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases. (AU)

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica - abstract

Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group, were studied to determine the prevalence of Hepatitis C Viral (HCV) infection in Jamaica. The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated. Sera were screened by EIA for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA). In the blood donors, the prevalence of anti-HCV was low, 0.3 percent - 0.4 percent, the same level as that reported by several European countries. In the multiply transfused sicklers, the prevalence was more than seven times higher. No HCV infection was detected in the antenatal group. There was little correlation between HCV infection and surrogate markers alanine transferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases (AU)

Fostering collaboration between researchers and non-governmental organizations on women and AIDS in Jamaica

Reports findings of a study of researchers and community-based NGOs in Jamaica and a forum held to build stronger bonds between persons from the two groups. Presents the objectives of the project which were to: document and analyze research efforts on women and AIDS and the program experiences of NGOs with the aim of identifying progress in research and successful interventions that could be replicated in other settings; identify the lessons learned from existing collaborations between the research and action communities; conduct a forum in which researchers and NGOs could share their experiences and needs, as well as to identify ways to strengthen communication and collaboration. In addition disseminate to researchers, NGOs, policy makers, and donors at the national and international level, the findings from analyzing the progress in research and program experience, as well as the lessons learned from the collaborative process. Suggests the need for: training and educating women and men about HIV/AIDS; collaboration among NGOs, churches and public institutions; a central pool of research findings and materials; more research; and more funding for more programs(AU)

Chlamydial infections in selected populations in Jamaica

The importance of Chlamydia trachomatis as a cause of genital tract infection in Caribbean countries is largely unknown. Two hundred and sixteen cervical and urethral specimens were collected from patients with cervicitis and urethritis attending a Sexually Transmitted Diseases (STD) Clinic, a Gynaecology Clinic and a Family Planing Clinic in Kingston. Specimens were tested for chlamydiae by direct immunofluorescence and cell culture methods. They were also investigated for N. gonorrhoeae infections. Seventy-two of 138 patients (52.2 percent) at the STD Clinic were positive for chlamydiae; 28 of 50 ((56.0 percent ) from the Gynaecology Clinic and 11 of 28 (39.3 percent) from the Family Planning Clinic were positive. The prevalence of C. trachomatis (52.3 percent) was higher than that of N. gonorrhoeae (11.1 percent) in all groups. The results indicate that C. trachomatis is a common cause of genital tract infections in Jamaica(AU)

Seroprevalence of chlamydia trachomatis, hepatitis B and retroviruses in female STD patients and pregnant women in Jamaica - abstract

The seroprevalence of chlamydia trachomatis (Ct), hepatitis B (HBV), human immunodeficiency nirus (HIV) and human T-lymphotropic virus-type 1 (HTLV-I) was investigated in a high-risk group, patients from a sexually transmitted diseases clinic and prostitutes, as well as a low-risk group, antenatal group. In the STD group 100 sera were tested. Seropositivity for Ct was 82 percent,for HBsAg 3 percent, HBcAb 23 percent, HIV-Ab 2 percent and HTLV-1 Ab 8 percent. Among the 76 prostitutes, the seropsitivity was even higher: Ct 97 percent, HBsAg 8 percent, HBc,Ab 41 percent, HIV-Ab 9 percent and HTLV-1 Ab 17 percent. The antenatal women studied as a normal control population had lower levels: Ct 52 percent, HBsAg 0.7 percent, HBcAb 9 percent, HIV-Ab 0.7 percent and HTLV-1 Ab 2.8 percent. It is noteworthy that the seroprevalence for all the STDs investigated was markedly higher in the promiscuous group. Although the level for Ct antibodies was in the antenatal women, even this group showed a high prevalence of this very commonly occurring STD. (AU)

Response of chlamydial non-gonococcal urethriti (NGU) to treatment with rosythromycin - abstract

The efficacy of roxythromycin 150 mg twice daily was evaluated for treatment of NGU caused by Chlamydia trachomatis in an adult outpatient setting with a high non-compliance level. Eligible patients were male adults (> 18 years) attending a sexually transmitted diseases (STD) clinic in Kingston with uncomplicated NGU. Chlamydial aetiology was identified by direct immunofluorescence and tissue culture techniques using monoclonal antibodies for final confirmation. In a 14-week study, 245 cases of NGU were identified of which 178 (72.7 per cent) were Chlamydia-positive. The results showed that C. trachomatis was eradicated from 87.2 per cent of the 125 patients finally evaluable. The prevalence of C. trachomatis is high in genital infections in Jamaica. These results indicated that roxythromycin was a suitable alternative for treatment in view of reports of resistance to tetracycline. A distinct advantage of roxythromycin was the twice daily dosage compared with four times daily for tetracycline, in treating a common sexually transmitted disease in a population group with a high non-compliance rate (AU)

An outbreak of acute flaccid paralysis in Jamaica associated with echovirus

An outbreak of acute flaccid paralysis in Jamaica in 1986 associated with echovirus type 22 is described. Six patients aged 1 to 27 years developed acute onset of severe flaccid paralysis, with inability to walk. Three cases had facial weakness, four required intensive care with assisted ventilation and two died. Echovirus type 22 was isolated from the stool of two patients who showed a significant increase in antibody titre. Echovirus type 22 was also isolated from the stool of another patient who had aseptic meningitis without any neurological deficit. There was no evidence of poliovirus infection in any of these patients, most of whom were fully immunized. Of the four surviving cases with flaccid paralysis, three had residual weakness in their lower limbs and walked with an abnormal gait 3 years after the acute paralytic attack. This is the first report in the literature of acute flaccid paralysis associated with type 22 echovirus. (AU)