August 15, 2003

Group B Streptococcal Disease in Neonates: Alberta
Over the last 3 decades, infection with group B streptococcus (GBS) has emerged as a major cause of neonatal mortality and morbidity. Before the implementation of preventive guidelines in 1994, Canadian rates of GBS infection ranged from 0.44 to 2.1 per 1000 live births, but they declined to 0.25 per 1000 by 1999. Most studies identifying risk factors for neonatal GBS infection have lacked a comparison group, have been institution-based rather than population-based or have not included maternal interviews. Researchers examined known and new risk factors for GBS disease in all neonates in Alberta, using a population-based case–control study with multiple information sources. There were no differences between the 90 cases and 489 controls in sociodemographic variables or in many reproductive and behavioural variables. Case infants were more likely than control infants to be of low birth weight, to have been delivered preterm, or to have a mother with amnionitis, intrapartum fever or premature rupture of the membranes. After adjustment for potential confounders, intrauterine fetal monitoring was associated with a more than 2-fold increase in the risk of neonatal GBS disease. The researchers concluded that intrauterine fetal monitoring should be added to the list of risk factors in risk-based screening, and that since many of the cases had no identifiable maternal risk factors, universal screening for GBS may be appropriate.
Source: Canadian Medical Association Journal, Volume 169, No. 3, 5 August 2003

Syphilis: Quebec
After only six months, the number of reported cases for 2003 has surpassed the total number for 2002. All cases in 2003 occurred in gay males (three cases were in individuals of unknown sexual orientation). A new prevention campaign in the gay community. À quand remontent tes derniers tests de dépistage? [When was your last screening test?], has just begun with the assistance of the community organization Séro-Zéro. The campaign is aimed at raising awareness of the signs and symptoms of syphilis and gonorrhea and the screening of these diseases, using posters and pamphlets in various commercial establishments and articles and advertising in local publications. The campaign also includes a screening offer for the two diseases in some saunas.
Source: Explanatory note, Montréal-Centre Regional Health and Social Services Board, Period 07 of 2003.

Syphilis: United Kingdom
Over the past 12 months, south London has seen almost three times as many heterosexual cases of syphilis as were diagnosed in 2001 (25 in 2001, 72 in 2002 and over 40 cases in the first five months of 2003). Cases are occurring among those who have had unprotected oral or vaginal sex with casual partners or strangers, and people buying or selling sex. Of 73 cases diagnosed between July 2002 and May 2003, 17 cases (23%) had documented links with the commercial sex industry. Twenty patients (54% of those engaging in oral sex) reported having unprotected oral sex and 48 patients (69% of those engaging in vaginal sex) reported having unprotected vaginal sex. A number of outbreaks of infectious syphilis have occurred in western Europe over the past seven years. Each has been geographically localized within behaviourally vulnerable groups and has typically involved several hundred cases, although smaller outbreaks have been reported. Most of the outbreaks have been seen in men who have sex with men, a high proportion of whom had co-infections with HIV. A high number of cases reported unprotected oral sex. Cases were mainly seen in nationals of the country of origin, and were not travel associated. Few cases have been reported in heterosexuals, and these have predominantly been associated with travel, commercial sex work and ‘crack' cocaine use. This increase in heterosexual syphilis seen in south London is, however, an important reminder that the rise in syphilis infection has not been confined to men who have sex with men. Neither has this recent rise been exclusive to south London, as heterosexual cases have also been reported in other parts of London, some of which have been linked with the commercial sex industry.
Source: Eurosurveillance Weekly, Volume 7, No 31, 31 July 2003

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.