Southern African Journal of Epidemiology and Infection - latest Issue
Volume 28, Issue 4, 2013
Tuberculosis continues to be a public health problem in South Africa from diagnosis to treatment : editorialSource: Southern African Journal of Epidemiology and Infection 28 (2013)More Less
The latest Global tuberculosis report 2013 released by the World Health Organization indicates that South Africa, together with other African countries, is unlikely to meet the Millennium Development Goals (MDGs) set for 2015. The intrinsic impact of human immunodeficiency virus (HIV) control on the burden of tuberculosis is an important confounder for countries in sub-Saharan Africa. The prospects of an improved vaccine becoming available, as part of efforts to control tuberculosis, will take years to come to fruition. The primary strategy for control is likely to continue to rely on early diagnosis and initiation of appropriate treatment.
Source: Southern African Journal of Epidemiology and Infection 28, pp 192 –196 (2013)More Less
Tuberculosis is one of the leading causes of morbidity and mortality globally. Vitamin D directly influences the body's immunological response to tuberculosis by modulating the production of certain antimicrobial peptides and the release of cytokines. Vitamin D deficiency has been extensively described in patients with tuberculosis. Currently, it is a recognised risk factor for tuberculosis. Genetic polymorphisms of the vitamin D receptor may influence host susceptibility to tuberculosis and response to antituberculosis therapy. This review article explores the close association between tuberculosis and vitamin D, with the aim of forming a strong basis for further interventional and genetic studies on patients with active tuberculosis.
Author T.R. GrimmondSource: Southern African Journal of Epidemiology and Infection 28, pp 197 –201 (2013)More Less
Reusable waste containers are used to transport healthcare risk waste (sharps and non-sharps) in many countries, and are becoming increasingly common in South Africa. Initially, there may be a perception of risk of pathogen or disease transmission with their introduction. This paper assessed the international literature on reusable waste container infection risk and found there to be negligible to nil risk of pathogen or disease transfer. The literature confirms that disinfection and microbiological monitoring and validation of reusable waste containers is not indicated, and that washing with hot water and detergent, using visual criteria for cleanliness and due diligence with regard to contractor selection, enable reusable containers to be safely used.
The seroprevalence of Bordetella pertussis antibodies in adolescents in the Western Cape : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 202 –206 (2013)More Less
Pertussis is a highly contagious respiratory disease that can occur in all age groups. Over the past 15 years, an increase in the incidence of reported cases has been observed globally. Local surveillance data have also shown an increase in the number of laboratory-confirmed cases. This raises concerns about waning immunity in adolescents and adults. The aim of this study was to screen for seropositivity against pertussis infection by measuring immunoglobulin G (IgG) antibody titers of Bordetella pertussis in an adolescent population in the Western Cape, South Africa. Serum samples were collected from 182 adolescents aged 15-18 years from different racial groups. The SERION ELISA® classic B. pertussis IgG assay was used to detect human antibodies in serum. Twenty-seven subjects (15%) were seronegative and 135 (74%) seropositive for IgG antibodies. Racial breakdown showed that 84% of the black, 74% of the coloured, and 69% of the white subjects were seropositive, while the largest percentage (24%) of sero-negative individuals was in the white population group. This study demonstrated a high percentage of individuals in the adolescent age group with sero-positive antibody levels. However, it is unknown if these antibody levels are functionally protective. A more rigourous surveillance system would assist in defining and understanding the epidemiology of pertussis in South Africa, and could provide evidence of the need for booster vaccinations in adolescence and adulthood.
Source: Southern African Journal of Epidemiology and Infection 28, pp 207 –214 (2013)More Less
Sindbis virus (SINV), the prototype virus in the genus, Alphavirus, is an arbovirus with an extensive geographical distribution. Birds are the main vertebrate hosts for SINV, while Culex mosquitoes serve as vectors and occasionally transmit the virus to humans, causing a febrile illness with a maculopapular rash and arthritis. Currently, little information exists on the genetic diversity within SINV strains from South Africa. The E2 envelope glycoprotein gene was partially sequenced for a panel of 27 South African and African Sindbis virus isolates derived from a human case and from mosquito pools. A phylogenetic analysis was performed using these sequences, together with 65 partial E2 gene sequences from Sindbis virus isolates from elsewhere in the world. The resulting phylogenetic tree suggested five distinct Sindbis virus genotypes. The South African Sindbis virus isolates were grouped within genotype I, together with isolates from Sweden, Finland, Germany and Norway. The phylogeny of Sindbis virus reflects its geographical distribution and corresponds with the major migratory bird flyways, indicating that birds play a major role in Sindbis virus distribution.
Knowledge and awareness of human papillomavirus and intention with regard to human papillomavirus vaccine uptake by female tertiary students in the Eastern Cape province : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 215 –220 (2013)More Less
In 2008, two human papillomavirus (HPV) vaccines, Cervarix® and Gardasil®, were licensed for use in South Africa. Initial models showed that vaccination could lead to an approximate 70% decline in cervical cancer cases. This paper describes the knowledge, awareness and health beliefs about HPV and the HPV vaccine, and the intentions of female tertiary students with respect of being vaccinated with the latter. An observational, descriptive and analytical cross-sectional survey was conducted among 150 female tertiary students at a university in the Eastern Cape province in this regard. Knowledge and awareness of HPV and the HPV vaccine were poor. Only 22.7% of the students were aware of HPV and that an HPV vaccine was available in South Africa. However, most respondents (80%) reported a willingness to be vaccinated. Being aware of the existence of a Papanicolaou smear, higher knowledge of HPV, higher perceived vaccine effectiveness and higher perceived severity of HPV infection were significantly associated with increased willingness to be vaccinated. There is a need for education on HPV and its vaccination in South Africa. An effective vaccine marketing strategy should emphasise the effectiveness of the vaccine, the susceptibility of women to contracting HPV and the severity of being infected with the human immunodeficiency virus.
Tuberculosis infection control practices in primary healthcare facilities in three districts of South Africa : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 221 –226 (2013)More Less
South Africa has one of the highest incidence of tuberculosis in the world, which can partly be attributed to poor infection control in public healthcare (PHC) facilities. The aim of the study was to explore the extent of tuberculosis and infection control training, as well as facility-level managerial, administrative, environmental and personal protection, infection control measures, at PHC facilities. Cross-sectional surveys were conducted at 127 PHC facilities across three districts of South Africa. Data collection was achieved through interviews with tuberculosis nurses, observations of infection control practices and a review of the clinic records. Univariate analysis was performed using SPSS® version 17. Limited implementation of World Health Organization infection control measures was identified. In terms of facility controls, 43.3% of the clinics did not have an infection control committee and 40.9% did not have a clinic specific infection control plan. In terms of administrative controls, 94.5% of clinics did not have the tuberculosis signs and symptoms screening tool, 48.8% did not separate coughing patients from other patients, and only 35.4% provided coughing patients with masks or tissues. In terms of environmental controls, only 18.9% of the clinics had an open window register. In terms of personal protection, there was a dire shortage of N95 respirators. In addition, only a third of the professional nurses and one in 10 community health workers had received training on infection control practices. Tuberculosis infection control training for PHC clinic staff, as well as the appropriate implementation of simple and inexpensive infection control measures, is required.
Knowledge of, attitudes towards, and practices of contraception in high school pupils in Tswaing subdistrict, North West province : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 227 –232 (2013)More Less
In South Africa, contraceptive use is low in adolescents in the sense that sexual maturation and initiation of sexual activities is taking place at a younger age. This is evident from the high levels of teenage pregnancy that constitute a major health and social problem in South Africa. The risk-taking behaviour of high school pupils who engage in unsafe sexual practices also predisposes them to sexually transmitted infections (STIs), human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and unplanned pregnancies. A cross-sectional survey was carried out in 2009 among Grade 10-12 high school pupils in 15 schools in the rural Tswaing subdistrict of North West province to determine their contraceptive knowledge, attitudes and practices. Data were collected from 231 pupils using a questionnaire. The mean age for sexual maturation was 14.6 years (a range of 14-15 years). Almost equal numbers of males (88, 50.3%) and females (87,49.7%) indicated that they had engaged in sexual intercourse. The average age of respondents was 14.9 years (males) and 15.4 years (females) when they engaged in sexual intercourse for the first time. One hundred and thirty pupils were reported to have had a previous pregnancy. Of the pupils who used contraception, the most common form used by the females was injectable contraceptives (34/81, 43%), and by the males, condoms (42/54, 77%). A high proportion of respondents knew about, and had awareness of, contraception and STIs, i.e. 83/101 of the males (83%) and 113/130 of the females (86.9%). A high number of pupils (128, 73.1%) indicated that they had used contraceptives when they had sexual intercourse for the first time. Of all of the males, only 32 (36.4%), and of all of the females, only 32 (36.8%) always used contraceptives. Eighty-eight pupils (38.1%) lived with both parents. Pupils in this rural area were familiar with contraception, started sexual intercourse at an early age and were generally inconsistent with their use of contraceptives. The study highlights that knowledge and awareness do not always lead to good practice with regard to contraception. A high level of sexual activity, early sexual initiation and low contraceptive use place these adolescents at risk of pregnancy and STIs, including HIV/AIDS.
Clinical profile of patients diagnosed with primary lung cancer at the Pulmonology Division, Universitas Academic Hospital, Bloemfontein, 2010-2011 : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 233 –239 (2013)More Less
Lung cancer is regarded by the World Health Organization as a leading cause of death globally. Limited data are available on lung cancer epidemiology in South Africa. This study aimed to determine the profile of patients with lung cancer who were seen at a local pulmonology clinic. A retrospective audit was conducted on patients ≥ 18 years of age who were diagnosed with primary lung cancer at the Universitas Academic Hospital (Pulmonology Division) between 1 January 2010 and 31 December 2011. Information was collected with regard to demographic variables, smoking status, performance status, histological subtype and stage of disease. Ninety-two patients' records were included in the study. The median age was 61.2 years (a range of 44-86 years). 57.6% of patients were black, 33.7% white and 8.7% coloured. The male to female ratio was 3:1. The largest group of patients was black men (46.7%). Most patients were current or previous smokers. 45.2% of white patients had a history of ≥ 30 smoking pack years (one pack year of smoking was defined as 20 cigarettes smoked every day for a year), compared to 26.4% of black and 37.5% of coloured patients. Squamous cell carcinoma (SCC) and adenocarcinoma were diagnosed in 34.8% and 32.6% of patients, respectively. Adenocarcinoma occurred more commonly in white patients (38.7%), while SCC was diagnosed more frequently in black patients (34%). The majority of patients presented with advanced stage of disease. Thorough record-keeping on the epidemiology of lung cancer in South Africa is necessary to enable the planning and implementation of a national strategy with regard to treatment options and prevention.
Reality bites of spider bites : a case report and review of the local epidemiology : original researchSource: Southern African Journal of Epidemiology and Infection 28, pp 240 –242 (2013)More Less
Spider bites are a frequent complaint, often prompting patients to seek medical attention. However, the diagnosis of a spider bite is frequently inferred by the patient, and a thorough evaluation subsequently reveals an alternate diagnosis. Gertsch et al demonstrated that of 600 consecutive "spider bite" cases, 80% were incorrectly diagnosed. Alternative diagnoses included bites by arthropods other than spiders, bacterial, viral or fungal infections and malignant tumours. In this study, we describe the case of a patient who was initially misdiagnosed as having been bitten by a spider. Later, the patient was demonstrated to have a spontaneous, soft tissue Staphylococcus aureus infection. We further describe the local epidemiology of cases presenting with spider bites and the subsequent microbiological findings.