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- Volume 23, Issue 4, 2008
Southern African Journal of Epidemiology and Infection - Volume 23, Issue 4, 2008
Volume 23, Issue 4, 2008
Source: Southern African Journal of Epidemiology and Infection 23, pp 3 –4 (2008)More Less
Introduction of the pneumococcal conjugate vaccine into the South African public immunisation programme : dawn of a new era? : reviewAuthor S.A. MadhiSource: Southern African Journal of Epidemiology and Infection 23, pp 5 –9 (2008)More Less
Streptococcus pneumoniae is a leading vaccine-preventable cause of childhood death with an estimated 716,000 deaths occurring annually. Recent advances have seen the development of vaccines targeted against S. pneumoniae that are immunogenic and efficacious in very young children. These pneumococcal conjugate vaccines have now been evaluated in developed and industrialising countries with consistent efficacy against invasive pneumococcal disease at least due to the serotypes included in the vaccine. The vaccine has also been efficacious in preventing radiographically confirmed pneumonia, but has had less effect on pneumococcal acute otitis media. The introduction of the vaccine into the USA has been greatly successful and exceeds its expectations based upon the vaccine efficacy trials. In addition to preventing a greater than expected burden of invasive disease and pneumonia than anticipated in vaccinated children, the vaccine has also been associated with marked reduction in pneumococcal disease among unvaccinated members of the population, referred to as 'indirect protection'. The introduction of the vaccine into the immunisation programme of industrialising countries, such as in South Africa, require robust surveillance to evaluate the effectiveness of the vaccine in such settings where the epidemiology of pneumococcal diseases differs to that in developed countries.
Author S. NaidooSource: Southern African Journal of Epidemiology and Infection 23, pp 10 –12 (2008)More Less
The success of the public health sanitation movement included the use of vaccines, and antibiotics led many to assume that all infectious diseases would sooner or later succumb to medical technology and public health measures. Unfortunately this did not happen. Late in the 20th century and now early in the 21st century we see the onset of new communicable diseases such as HIV / AIDS and severe acute respiratory syndrome (SARS) and the resurgence of old communicable diseases such as tuberculosis (TB) and malaria. The persistence of measles as a major killer of over one million children per year represents a failure in effective use of both the vaccines and the health systems in developing countries. Nowhere else can we see these problems better than in our own backyard.
Potassium uptake systems of Mycobacterium tuberculosis : genomic and protein organisation and potential roles in microbial pathogenesis and chemotherapy : reviewSource: Southern African Journal of Epidemiology and Infection 23, pp 13 –16 (2008)More Less
Mycobacterium tuberculosis (MTB) is a formidable microbial pathogen which uses multiple mechanisms to subvert host immune defences. These include the effective, protective barrier presented by the outer waxy coat, intracellular concealment from host defences, and the ability to enter a prolonged, dormant phase in the infected host. Priority strategies to combat the scourge of TB include the identification of novel and selective targets on/in MTB which are amenable to pharmacological or immune-mediated control. Because they are structurally different from their counterparts in eukaryotic cells and are likely to be essential for survival and growth, the major K+ transporters of MTB represent alternative and novel targets for drug and vaccine design. These K+-uptake systems of MTB are the primary focus of this review, with particular emphasis on their genomic and protein structures, properties and functions, and potential roles in intracellular survival.
Source: Southern African Journal of Epidemiology and Infection 23, pp 17 –19 (2008)More Less
This study was undertaken in order to characterise the occurrence, clinical spectrum and treatment outcomes of tuberculosis (TB) infection among staff at Tygerberg Academic Hospital over an 11-year period. A retrospective analysis was performed of all patients presenting to the occupational health and infectious diseases departments at the facility for the period 1 January 1996 till 31 December 2006. One hundred and thirty cases of TB were identified; 69 cases (53.1%) occurred in healthcare workers and 41 (31.5%) in ancillary hospital staff. Nursing staff were the most commonly affected healthcare worker group. There were 100 cases of pulmonary TB (76.9%) and 23 cases of extra-pulmonary TB (17.7%). HIV infection and diabetes mellitus occurred in 14 (18.2% of patients tested) and 15 (11.5%) patients, respectively. There were six cases of MDR TB; four of these occurred in diabetic staff members. This study highlights the need for improved screening and prevention of TB among hospital staff, specifically among nursing staff. Infection control policies should further emphasise the need for protection of diabetic and HIV-infected staff members.
Low rate of reporting of confirmed AIDS-related deaths using BI-1663 forms by private medical practitioners in the Mafikeng, North West Province : original researchSource: Southern African Journal of Epidemiology and Infection 23, pp 20 –24 (2008)More Less
The aim of the study was to investigate the experiences and perceptions of medical practitioners about the implementation of the current death notification form (BI-1663) in cases of confirmed AIDS-related deaths. The study focused on reporting patterns by private medical practitioners of the deceased's underlying causes of death in BI-1663, together with reasons advanced for the reporting patterns. Using self-administered questionnaires, data were collected from 31 medical practitioners in the Mafikeng area of the North West Province. The findings revealed that the majority of medical practitioners either did not disclose, did omit or mis-report information that HIV / AIDS-related disease was the underlying cause of death in BI-1663 during notification of confirmed AIDS-related death. Reasons advanced for the phenomenon were fears of unauthorised breach of the deceased's confidential information by unintended parties that often led to invalidation of the deceased's insurance and funeral benefits, as well as stigmatisation and social discrimination of the relatives of the deceased. The study recommends that third parties (informants) should be relieved of the duties of conveying the deceased's confidential medical information to the state during death notification processes. Medical practitioners themselves should submit part 2 of BI-1663 that contains the deceased's confidential information directly to public health officials. The study also recommends that the Department of Health should provide formal training to the medical practitioners with respect to death certification to enable them to certify causes of death in a manner that is useful for epidemiological analysis and public policy.
Updated guideline for the management of upper respiratory tract infections in South Africa : 2008 : clinical guidelineSource: Southern African Journal of Epidemiology and Infection 23, pp 27 –40 (2008)More Less
Introduction : Inappropriate use of antibiotics for non-severe upper respiratory tract infections (URTIs), many of which are viral, adds to the burden of antibiotic resistance. Antibiotic resistance is increasing in Streptococcus pneumoniae, the microorganism responsible for most cases of acute otitis media (AOM) and acute bacterial sinusitis (ABS).
Method : The Infectious Diseases Society of Southern Africa held a multidisciplinary meeting to draw up a national guideline for the management of URTIs in 2003. Background information reviewed included randomised controlled trials, existing URTI guidelines and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. The guideline was published in the South African Medical Journal in 2004 and was a consensus document based upon the opinions of the working group. In 2008 it was decided to update and republish the guideline. This was done electronically using the same working group members, including overseas experts.
Output : Penicillin remains the drug of choice for tonsillopharyngitis. Single-dose parenteral administration of benzathine penicillin is effective, but many favour oral administration twice daily for 10 days. Amoxycillin remains the drug of choice for both AOM and ABS. A dose of 90 mg/kg/day is recommended in general, which should be effective for pneumococci with high-level penicillin resistance (this is particularly likely in children ≤2 years of age, in day-care attendees, in cases with prior AOM within the past six months, and in children who have received antibiotics within the last three months). Alternative antibiotic choices are given in the guideline with recommendations for their specific indications. These antibiotics include amoxycillin-clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents and the respiratory fluoroquinolones.
Conclusion : The guideline should assist rational antibiotic prescribing for URTIs. However, it should be continuously updated when new information becomes available from randomised controlled trials and surveillance studies of local antibiotic susceptibility patterns.