Chronic Consequences of Uncomplicated Yersinia Enterocolitica Infection:A Retrospective Study(2004)of Military Recruits Previously(1987)Screened for Antibodies to Yersinia Enterocolitica O:3

In 1987, a serological survey among 755 male Norwegian military recruitsshowed that 68 (9.0%) had IgG (7.4%) and / or IgA (4.5%) antibodiesto Y.enterocolitica O:3, consistent with previous infection.In 2004,433 of the former recruits (mean age 37.5 years, range 35 - 42 years) answered a questionnaire, in order to investigatedevelopment of possible chronic disorders and complaints related to uncomplicated Y.enterocolitica infection. The questionnaire covered per-sonal and demographic data, behavioral risk factors, and possible chronic complaints related to yersiniosis.Among the 433 responders, 51 (11.8%) were seropositive for IgG or IgA in the 1987 survey, 380 were seronegative, and 2 had ambiguous results.No difference was observed between the seropositive and seronegativegroups regarding education, annual income, general behavioral risk factors like smoking, alcohol consumption, physical activity, and dietary parameters;or diagnosed chronic illness. However, the seropositives weresignificantly more likely than the seronegatives to report recurrent diarrhea, painful or swollen joints, and muscle pain. Also, presence of all three complaints was more common among seropositives. Conclusion: The present study shows that uncomplicated Y.enterocolitica O:3 infection is a risk factor regarding future development of chronic complaintssuch as diarrhea, and joint and muscle complaint.

1986～1999年挪威外国出生人群的结核病流行情况

目的:估算挪威外国出生人群的标准化结核病发病比(SIR)。方法:根据挪威出生人群的性别和年龄别发病率计算外国出生人群的结核病期望发病数。标准化发病比为观察发病数与期望发病数的比值。结果:所有入选国家的结核病期望发病数均在0～3之间;明显低于观察发病数。SIR最高者为非洲(160,95％CI:144～175),最低者为美国/加拿大(0.4,95％CI:0.1～1.0)。索马里的 SIR为 883(95％CI:775～991),越南为122(95％CI:106～139),巴基斯坦为 119(95％CI:105～134),菲律宾为 115(95％CI:91～144),前苏联为49(95％CI:40～57)。所有外国出生人群的SIR为21(95％CI:20～22),人群归因危险度为38％。其中以15～39岁组的SIR为最高(95,95％CI:89～101);65 岁以上组为最低(3,95％CI:2.1～3.3)。此外,15～39岁组的肺外结核SIR也很高(159,95％CI:146～173)。结论:人群的结核病标准化发病比(SIR)因出生地而异。了解移民国当地的结核病流行病学以及移民模式有助于提高预防措施的针对性。

Tuberculosis Case Notification and Treatment Outcomes in West Gojjam Zone, Northwest Ethiopia: A Five-Year Retrospective Study

Introduction: Tuberculosis (TB) is a major public health concern in Ethiopia. Analysis of TB case notification and treatment outcomes is crucial to understand the TB control program performance. The current study was carried out to assess trends of TB case notifications, treatment success rate and factors associated with unsuccessful treatment outcome among TB patients in West Gojjam Zone of Amhara Region, Ethiopia. Method: A retrospective cohort study was conducted in West Gojjam Zone. Demographic and clinical data were reviewed for all TB patients registered between July 2007 and June 2012 at 30 randomly selected public health facilities of the study zone. In addition, annual case notification reports of the study zone were used to analyze trends in TB case notifications. Logistic regression analysis was used to assess the association between potential predictor variables and unsuccessful treatment outcomes. Results: Tuberculosis case notification for all forms of TB decreased from 203/100,000 population in 2007 to 155/100,000 population in 2012. Among patients whose treatment outcomes were evaluated, 94.4% were successfully treated, 0.3% had treatment failure, 1.5% defaulted and 3.7% died. In multivariate analysis, the odds of unsuccessful treatment outcome was higher among retreatment cases than new cases (adjusted OR, 3.44;95% CI: 1.92, 6.19). HIV co-infected cases were more likely to have unsuccessful treatment outcome compared to HIV negatives (adjusted OR, 2.68;95% CI: 1.92, 3.72). Conclusion: Tuberculosis case notification rates showed a decreasing trend between 2007 and 2012. The treatment success rate exceeded the 90% treatment success rate target as set by the WHO. Special attention is required for patients with high risk of unsuccessful treatment outcome. Therefore, retreatment cases, and HIV positive cases need strict follow up throughout their treatment period.

非中心化治疗结核病:转型期间病人的随访

背景:老挝,Vientiane自治区。目的:为了说明和评价标准化登记制度的实施及在该自治区实行非中心化期间的报告程序。标准化的目的是为获得完整的及可靠的病人发现和治疗结果的信息。设计:对病人发现和治疗结果的季报资料进行评价,并且用病人个人记录资料与督导员的记录作比较。结果:自1994—1998年,病人发现有所增加。治疗成功率提高,从26.8％(95％CI 21.5—44.0)提高到74.6％(95％CI 69.9—79.3)。在选择自服药的长程治疗或直接面视下的短程治疗时,1998年登记的病人中97％接受后者。随着非中心化的实施,由于‘迁出’病人的比例较高(16.4％,95％CI11.5—21.3),治疗结果的评价不甚完善。经干预后这个比例下降到2.3％(95％CI 0.7—3.9)。1998年,在国家结核病中心诊断并居住在该区的涂阳病人中,约40％是‘迁移’或‘转诊’到该区。68例中,除3例外均能到区综合医院治疗,大多数没有延误。登记和报告相当正确。在评价期结束时,只有一部分实施非中心化和在病人掌握方面显然仍存在一些问题。结论:为了对该工作给予评价,并有助于正确地分析存在的问题,在非中心化服务时建立信息流动的管理程序是很重要的。

城市地区结核病高发病率相关因素分析

背景:荷兰鹿特丹地区,1995—2006年。目的:探明城市地区结核病高发病率的相关因素。设计:将研究地分为城市和近郊/农村二类,比较其结核病患者的特征,并按照年龄、移民状况,以及结核菌感染的时间和地点进行分层,分别比较两类地区的结核病登记报告率。结果:城市地区的结核病登记报告率是近郊/农村地区的3.8倍;经出生地分层后,这比率有所下降(移民为1.7,非移民为2.8)。移民在境外获得结核菌感染的比例最高(47%的城市移民患者和62%的近郊/农村地区移民患者)。40%的城市患者和27%的近郊/农村患者是在荷兰境内近期感染结核菌的,以致在城市地区人群中因近期传播所致的患者登记报告率是其他地区的5.7倍。结论:城市地区较高的结核病登记报告率与城市移民较多有关,而这些移民结核病患者常常是因其在境外感染结核菌而发病的。近期传播也是城市地区移民和非移民结核病高发的重要因素。建议对已知的相关因素采取一系列针对性干预措施,以解决城市地区结核病高发的问题。

Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia

Background:Measuring the size of the infectious pool of tuberculosis(TB)is essential to understand the burden and monitor trends of TB control program performance.This study applied the concept of TB management time to estimate and compare the size of the TB infectious pool between 2009 and 2014 in West Gojjam Zone of Amhara Region,Ethiopia.Methods:New sputum smear-positive and smear-negative pulmonary TB(PTB)and retreatment cases who attended 30 randomly selected public health facilities in West Gojjam Zone from October 2013 to October 2014 were consecutively enrolled in the study.In order to determine the infectious period,the TB management time(number of days from the onset of cough until start of anti-TB treatment)was computed for each patient category.The number of undiagnosed TB cases was estimated and hence the TB management time for the undiagnosed category was calculated.The total size of the TB infectious pool during the study period for the study zone was estimated as the annual number of infectious person days.Results:New smear-positive and smear-negative PTB cases contributed 25,050 and 12,931 infectious person days per year to the TB infectious pool,respectively.The retreatment and presently undiagnosed cases contributed 8840 and 34,310 infectious person days per year,respectively.The total size of the TB infectious pool in West Gojjam Zone during the study period was estimated at 81,131 infectious person days per year or 3405 infectious person days per 100,000 population per year.Compared to a similar study done in 2009 in the study area,the current study showed reduction of the TB infectious pool by 244,279 infectious person days.Conclusions:TB management time is a simple and practical tool that may help to estimate and compare the changes in the size of the TB infectious pool at local level.It may also be used as an indicator to monitor the changes in TB control program performance.

Towards an actionable One Health approach

Background Despite the increasing focus on strengthening One Health capacity building on global level,challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region.Recognizing these gaps,the One Health Action Commission(OHAC)was established as an academic community for One Health action with an emphasis on research agenda setting to identify actions for highest impact.Main text This viewpoint describes the agenda of,and motivation for,the recently formed OHAC.Recognizing the urgent need for evidence to support the formulation of necessary action plans,OHAC advocates the adoption of both bottom-up and top-down approaches to identify the current gaps in combating zoonoses,antimicrobial resistance,addressing food safety,and to enhance capacity building for context-sensitive One Health implementation.Conclusions By promoting broader engagement and connection of multidisciplinary stakeholders,OHAC envisions a collaborative global platform for the generation of innovative One Health knowledge,distilled practical experience and actionable policy advice,guided by strong ethical principles of One Health.

A practical community-based response strategy to interrupt Ebola transmission in sierra Leone, 2014–2015

Background:The Ebola virus disease spread rapidly in West Africa in 2014,leading to the loss of thousands of lives.Community engagement was one of the key strategies to interrupt Ebola transmission,and practical community level measures needed to be explored in the field and tailored to the specific context of communities.Methods:First,community-level education on Ebola virus disease(EVD)prevention was launched for the community’s social mobilizers in six districts in Sierra Leone beginning in November 2014.Then,from January to May of 2015,in three pilot communities,local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures,by involving them in alert case report,contact tracing,and social mobilization.The epidemiological indicators of transmission interruption in three study communities were evaluated.Results:A total of 6016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts,and EVD message reached an estimated 631680 residents.In three pilot communities,72 EVD alert cases were reported,with 70.8%of them detected by trained local community members,and 14 EVD cases were finally identified.Contact tracing detected 64.3%of EVD cases.The median duration of community infectivity for the cases was 1 day.The secondary attack rate was 4.2%,and no third generation of infection was triggered.No health worker was infected,and no unsafe burial and noncompliance to EVD control measures were recorded.The community-based measures were modeled to reduce 77 EVD cases,and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra Leone.Conclusions: The community-based strategy of social mobilization and community engagement was effective in casedetection and reducing the extent of Ebola transmission in a country with weak health system. The successfullypractical experience to reduce the risk of Ebola transmission in the community with poor resources would potentiallybe helpful for the global community to fight against the EVD and the other diseases in the future.