Infectious Diseases News Brief - January 15, 2010

[Current Issue -Table of contents]

IU Study: Screening And Treating Girls Doesn't Reduce Prevalence Of Chlamydia In Teens

Frequent testing and treatment of infection does not reduce the prevalence of chlamydia in urban teenage girls, according to a long term study by Indiana University School of Medicine researchers published in the January 1, 2010 issue of the Journal of Infectious Diseases. Despite the fact they were screened every three months and treated when infected, the proportion of infected girls did not change over the course of the study. On entering the study, 10.9 percent of the young women were infected. After 18 months of participation, 10.6 percent were infected; 10.4 percent were infected at the four-year mark. Eighty-four percent of repeated infections were reinfections. In spite of being so highly motivated that they kept diaries of their sexual encounters and interacted at least quarterly with the study staff, some of the young women had unprotected sex with either an untreated partner or a new partner and subsequent infection occurred. The researchers determined that 13 percent of repeated infections were due to failure of antibiotics to cure an earlier infection; considering all infections, antibiotic treatment was 92.1 percent effective.

Source: Medical News Today 9 January 2010
http://www.medicalnewstoday.com/articles/175471.php

Report Recommends Steps to Tackle Hepatitis B and C

Stepped-up vaccination requirements, a boost in resources for prevention and treatment, and a public awareness campaign similar to the effort that dispelled the stigma of HIV/AIDS are needed to curb the health threats posed by hepatitis B and hepatitis C, says a new report from the Institute of Medicine. Chronic hepatitis B and C cause thousands of cases of liver cancer, liver disease, and death each year taking the heaviest toll among Asians, Pacific Islanders, and blacks in the U.S. An estimated 800,000 to 1.4 million Americans have chronic hepatitis B and between 2.7 million and 3.9 million have chronic hepatitis C. The majority of infected individuals are not aware of their condition until they develop symptoms of liver cancer or liver disease. Few among the populations most at risk immigrants from countries where the diseases are endemic, non-Hispanic black men, injection-drug users, and people who had blood transfusions before 1992 seek testing or information on how to protect themselves from infection. The report calls for a public awareness initiative along the lines of the effort that succeeded in increasing recognition, prevention, and treatment of HIV/AIDS, which affects three to five times fewer Americans than viral hepatitis. Educational programs and materials that outline risk factors for viral hepatitis and provide information on immunization, prevention, and proper monitoring of infected individuals should be developed and made available to all health professionals and social service providers. Steps need to be taken to eliminate the stigma associated with viral hepatitis. Negative attitudes about hepatitis B in some cultures may contribute to immigrants' reluctance to seek testing. In China, for example, people with chronic hepatitis B face job and social discrimination. In addition, negative perceptions about illicit-drug users, who make up the greatest percentage of those with hepatitis C, can affect the care they receive or their willingness to seek care. Although the availability of an effective vaccine against hepatitis B has significantly reduced its spread, some 1,000 infants born to infected mothers develop chronic infections each year, a number that has not declined over the past decade. Moreover, three states -- Alabama, Montana, and South Dakota -- still do not require that children be vaccinated against hepatitis B before entering daycare or school. All full-term newborns whose mothers test positive for hepatitis B should receive the vaccine once they are stable and before leaving the delivery room rather than up to 12 hours after birth as is currently recommended. All states should make hepatitis B vaccination a requirement for school attendance, and health plans need to fully cover the costs associated with the immunization. Particular attention should be given to screening and vaccinating children who were born in countries where hepatitis B circulates widely. Each year, roughly 40,000 to 45,000 people legally emigrate to the United States from countries where hepatitis B is endemic.

Source: Science Daily News 14 January 2010
http://www.sciencedaily.com/releases/2010/01/100111112847.htm

Temporal Trends in Invasive Pneumococcal Disease and Pneumococcal Serotypes over 7 Decades

Background: Pneumococcal infections have historically played a major role in terms of morbidity and mortality. The researchers explored historical trends of invasive pneumococcal disease (IPD) and pneumococcal serotypes in a population exposed to limited antibiotic selective pressure and conjugate pneumococcal vaccination (PCV).
Methods: Retrospective cohort study based on nationwide laboratory surveillance data on IPD collected uninterruptedly in Denmark during 1938–2007. Changes in the reported incidence and trends of pneumococcal serotypes were explored using nonlinear regression analysis.

Results: There were 25,502 IPD cases included in the study. The median incidence of IPD increased from 2.8 cases per 100,000 population (interquartile range [IQR], 1.5–2.6) during the first 4 decades to 15.7 cases per 100,000 population (IQR, 7–20.4) during the 1980s and 1990s, mainly attributed to an increase in the number of bacteremia cases. The incidence of meningitis remained relatively stable, with a median of 1.3 cases per 100,000 population (IQR, 0.9–1.6). The proportions of serotypes/groups 4 and 9 increased; the proportion of serotype 18C decreased; the proportions of serotypes 6, 7F, 14, and 23F remained stable; and serotype 2 nearly disappeared. Before the 1960s, serotypes 1, 2, 3, and 5 presented peaks every 2–3 years, becoming less frequent during the 1970s with peaks every 7–10 years. Between 20% and 90% of IPD in children <5 years were caused by PCV serotypes during the last 4 decades. Cases of IPD caused by serotype 19A increased before introduction of PCV. Between 1993 and 2007, the level of resistance to macrolides and β-lactams was 6%.
Conclusions: The epidemiology of IPD and single serotypes has constantly changed over the past 7 decades. PCV serotypes appeared to dominate the pneumococcal population.

Source: Clinical Infectious Diseases Journal volume 50, number 3
http://www.journals.uchicago.edu/doi/abs/10.1086/649872