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Canada Communicable Disease Report
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ARCHIVED - Infectious Diseases News Brief - November 25, 2011

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Syphilis Rises 36% In USA In Four Years

From 2006 to 2010, the number of reported syphilis cases in the USA rose 36%. Among young, African-American males the rate rose by 135%, according to a report issued by the Centers for Disease Control and Prevention (CDC). The authors explained that sexually transmitted diseases (STDs) are hidden epidemics of huge health and economic consequences in the USA. STDs are called hidden epidemics because a considerable number of infected people are unwilling to come forward openly, and also because of the social and biologic characteristics of these types of diseases. The CDC believes that sexually active males with male partners should be screened for STDs once every three months, rather than yearly.

Gonorrhea - reported cases of gonorrhea fell 16% over the four-year period, down to their lowest levels ever. However, over the last year they have risen slightly. In 2010 there were over 300,000 reported cases. According to some CDC surveillance systems, gonorrhea is becoming resistant to the only medication available for this disease.

Chlamydia - the number of reported cases rose 24%, due to an increase in screenings. There were approximately 1.3 million cases reported in 2010. The majority of people in America with Chlamydia are undiagnosed - they don't know they have it. The CDC recommends that all sexually active young women be screened annually; less than half of them do so.

Syphilis - after a long period of increased rates, the incidence of syphilis dropped 1.6 since 2009. The rate among young, African-American males rose 134% from 2006 to 2010. The rate among African-American MSM (men who have sex with men) rose considerably, the reported added.Nineteen million new cases of STDs are diagnosed annually in the USA. STDs cost the health-care system $17 billion a year. Of those in high risk groups, only half are being tested, the authors wrote. A significant number of infected individuals are unaware, because they have no symptoms.

Source: Medical News Today 17 November 2011 This link will take you to another Web site (external site)

Community case management of severe pneumonia with oral amoxicillin in children aged 2-59 months in Haripur district, Pakistan: a cluster randomised trial

Background
First dose oral co-trimoxazole and referral are recommended for WHO-defined severe pneumonia. Difficulties with referral compliance are reported in many low-resource settings, resulting in low access to appropriate treatment. The objective in this study was to assess whether community case management by lady health workers (LHWs) with oral amoxicillin in children with severe pneumonia was equivalent to current standard of care.

Methods
In Haripur district, Pakistan, 28 clusters were randomly assigned with stratification in a 1:1 ratio to intervention and control clusters by use of a computer-generated randomisation sequence. Children were included in the study if they were aged 2-59 months with WHO-defined severe pneumonia and living in the study area. In the intervention clusters, community-based LHWs provided mothers with oral amoxicillin (80-90 mg/kg per day or 375 mg twice a day for infants aged 2-11 months and 625 mg twice a day for those aged 12-59 months) with specific guidance on its use. In control clusters, LHWs gave the first dose of oral co-trimoxazole (age 2-11 months, sulfamethoxazole 200 mg plus trimethoprim 40 mg; age 12 months to 5 years, sulfamethoxazole 300 mg plus trimethoprim 60 mg) and referred the children to a health facility for standard of care. Participants, carers, and assessors were not masked to treatment assignment. The primary outcome was treatment failure by day 6. Analysis was per protocol with adjustment for clustering within groups by use of generalised estimating equations.

Findings
The researchers assigned 1995 children to treatment in 14 intervention clusters and 1477 in 14 control clusters, and they analysed 1857 and 1354 children, respectively. Cluster-adjusted treatment failure rates by day 6 were significantly reduced in the intervention clusters (165 [9%] vs 241 [18%], risk difference −-8·9%, 95% CI −-12·4 to −-5·4). Further adjustment for baseline covariates made little difference (−-7·3%, −-10·1 to −-4·5). Two deaths were reported in the control clusters and one in the intervention cluster. Most of the risk reduction was in the occurrence of fever and lower chest indrawing on day 3 (−-6·7%, −-10·0 to −-3·3). Adverse events were diarrhoea (n=4) and skin rash (n=1) in the intervention clusters and diarrhoea (n=3) in the control clusters.

Interpretation
Community case management could result in a standardised treatment for children with severe pneumonia, reduce delay in treatment initiation, and reduce the costs for families and health-care systems.

Source: The Lancet, Volume 378, Issue 9805, Pages 1796-1803, November 19, 2011 This link will take you to another Web site (external site)