Blastomycosis hospitalizations in northwestern Ontario: 2006-2015.

BACKGROUND: Blastomycosis, caused by the organism Blastomyces dermatitidis, is an invasive fungal disease found in Central Canada and Central and Midwestern United States. OBJECTIVE: To describe trends in and epidemiology of hospitalized cases of blastomycosis cases reported among northwestern Ontario residents between 2006 and 2015. METHODS: Blastomycosis hospitalization data were extracted from the Discharge Abstract Database (DAD), accessed through IntelliHEALTH Ontario. The DAD includes administrative, clinical and demographic information on hospital discharges provided by the Canadian Institute for Health Information (CIHI). Blastomycosis records were identified using ICD-10 codes B40.0 to B40.9. Hospitalization rates were calculated for all of Ontario, and age-specific hospitalization rates were calculated for northwestern Ontario and analyzed by local health region, time and seasonality as well as presenting symptoms. RESULTS: There were 581 hospitalizations for blastomycosis reported in Ontario over this 10-year period. Of these, 245 (42%) were from northwestern Ontario, although this region accounts for only 0.6% of the Ontario population. The average hospitalization rate for blastomycosis in northwestern Ontario was 35.0 per 100,000 per year. This rate varied from 1.7 in the Red Lake region to 57.9 in the Kenora region. The most common presentation was acute pulmonary symptoms. Men were 1.36 times more likely to be hospitalized for blastomycosis than were women (95% confidence interval [CI]: 1.06-1.75, P<0.05). Most hospitalizations were registered in the late fall months, suggesting blastomycosis exposure in the spring/summer season followed by a lengthy incubation period. CONCLUSION: Areas of northwestern Ontario have high reported rates of blastomycosis. It is not known to what extent there are regional differences in other states and provinces. Interregional differences may warrant prioritizing strategies for blastomycosis prevention and control as well as additional research and surveillance.

[Migration and health]. / Migracije i zdravlje.

In the last decades of this century we are witnesses of frequent crises in different parts of the world produced by internal disturbance and wars. These crises, together with natural disasters, poverty and hunger, follow the history of mankind often forcing huge population groups to leave their homes. The harmful health consequences are among negative effects of migrations. While stable populations have well-tried routines for maintaining health, migrations mean abandoning such support systems. The increased exposure to harmful factors contributes more to the bad health condition of the migrant population. Setting of newcomers and local people together in the same homes, reduction in food and heating resources, drug shortage as well as importation of new infectious agents, may also endanger health of the native population. These observations have also been confirmed by Yugoslav experience. Depending on the fact whether a migration is elemental or organized i.e. dependent on its place in the large scale between these two extreme endpoints, the size of risk is also dependent on the consequences and degree of their difficulty. Mass health disturbances occur during migrations of the population from war regions, migrations from areas of natural disasters, mass pilgrimage, migrations of seasonal workers and migrations of armies during wars. However, even in these difficult times and conditions, a good organization can contribute to the mitigation of harmful consequences caused by these migrations. For instance, in 1942 there was an epidemic of typhus fever in Bosnia when many refugees crossed the Drina river on the way to Serbia escaping from Ustasha terrorism. At the Serbian side there were checkpoints where the refugees could taka a bath and where their laundry and clothing were depediculated with dry air, and after a two-week quarantine they could continue to Serbian provinces without making new foci of typhus fever. The most vulnerable and numerous group of refugees is usually composed of women, children and old persons. One of the largest migrations took place over the period from 1991 to 1995, when about 1,500,000 people left the war areas of the former Yugoslavia, Bosnia-Herzegovina and Croatia. Of that number, about 700.000 refugees came to Yugoslavia. In August 1995 during an unprecedented exile from the Kninska krajina region (Croatia) over 200,000 people left their homes. During the arrival of refugees and expelled persons health teams offered first aid to these unlucky persons at reception points: drinking water, food, emergency care and indispensable clothing. The next step in their task was to move refugees into families i.e. into collective camps and centres. As in similar situations, this migration had also its negative effects on health of the refugees. At this time, however, the situation was aggravated by international economic sanctions imposed to Yugoslavia although Yugoslavia has accepted and received more refugees than all European countries together. In 1992 a special refugees Law was promulgated in Yugoslavia. In this Law, among other things, it was stated that "the organized reception, temporary lodging, nutrition, appropriate health care, material and other sort of help" will be secured to refugees. The increased infant mortality rate in Yugoslavia may be ascribed to migrations. After several years of decrease it was in constant rise over the period from 1991 to 1995 (Table 1). Disturbed mental balance, loosing of ethic norms, feeling of hopelessness and despair, and underestimation of the risk of infections among refugees, contributed to the rise of promiscuity and increase in sexually transmitted diseases. Thus, the number of registered cases of symphills in the period 1991-1995 was six times greater than in previous years. The number of gonorrhea cases was twice greater in this period than before that time. At the same time, it should be emphasized that the number of recorded cases was smaller than it w

[How the epidemics of typhus and relapsing fever were stopped in Serbia in 1915 year]. / Kako je zaustavljena epidemija pegavog i povratnog tifusa u Srbiji 1915. godine.

Eighty years are passed after the catastrophic epidemics of Typhus and Relapsing Fever in 1915 in Serbia was stopped and put under control. This remarkable achievment was realized in cooperation of the British Military Mission and Serbian health services, one month before the usual seasonal maximum of epidemic wave. The cutting of epidemics was made possible by introducing famous "Serbian barrel" (constructed by Dr Stammers). However, the epidemics of Typhus fever present in the same time in several european countries lasted throughout the whole First World War.

[AIDS throughout the world and possibilities of preventing the spread of HIV infection]. / SIDA u svetu danas i mogucnost obuzdavanja sirenja HIV infekcije.

PIP: At the end of 1992, according the World Health Organization, 611,589 AIDS cases had been reported, but the actual number of cases reached about two million. The actual number of HIV-infected people in the world, according to WHO, in 1992 ranged between 10 and 12 million. It is estimated that by the year 2000 there will be 30-40 million infected people and about 12-18 million AIDS cases. In the 1980's the increase was especially great in Sub-Saharan Africa, with about 6 million infected cases of whom 1/3 were pregnant women in big city maternity wards. In recent years the steep increase of cases in Africa led to its appellation as the AIDS continent. The percentage of infected people is put at 15-20% and it is steadily increasing. On the American continents by the end of 1992, a total of 313,083 cases were reported, of which 242,000 were in the US (970 per 1 million inhabitants). In Brazil there were 31,000, in Mexico 11,000, and in Canada 7000 cases. The highest figure was in the Bahamas: 4087 per 1 million inhabitants. In Asia only 2582 AIDS cases were reported at the end of 1992, because HIV still had not exploded on this continent. The latest data indicated an increase of the infection in Asia among IV drug users and prostitutes, so that seropositive persons were estimated at half a million. The highest number of clinical cases were in Thailand (909), Japan (508), and in Israel (192). In Europe there were 88,810 cases reported, of which 21,487 were in France. At the end of 1992 in Yugoslavia 268 cases were registered (25 per 1 million inhabitants). In Serbia there were 262 cases (in Belgrade 75% of them) and in Montenegro 3 cases. It is worrisome that about 2000 HIV-positive persons have been detected since 1985. AZT (azidothymidine, zidovudin) and ddI (dideoxyinosine) are the main drugs for treatment. Since an effective vaccine is still unavailable, the only means of halting the spread of HIV infection is warning and education, beginning with prepubescents, about first intercourse and IV drug use.^ieng

[Epidemiological features of HIV infection in the world and in Yugoslavia]. / Epidemioloske karakteristike HIV infekcije u svetu i u nas.

The spread of AIDS and HIV infection at the beginning of nineties is decreasing in industrialized countries, whereas it is intensified in the developing ones. In North America and Europe there is further, steady decrease of the infection rate in homo/bisexual persons and increase in IV-drug users, that predominate among patients in Europe in 1991. The slow, continuous increase of cases caused by heterosexual contact is also present. Rates of AIDS cases in hemophiliacs and in children are constantly decreasing since 1984. Further decrease of rate is also expected in cases after receiving blood transfusion. In Aisa, where the transmission of HIV infection used to be relativety slow, there is a significant increase of seropositivity in IV-drug users and prostitutes. In Australia and New Zealand rates of AIDS cases are similar to those in Europe and in North America. The epidemiological model of AIDS in FR of Yugoslavia is similar to the European one. The rate of cases (per million) is lower thar in Western and higher than in Eastern European countries (22.6). The rate of IV-drug users is higher, whereas the rate in homo/bisexuals is lower than the respective rates for whole Europe. Out of 239 cases registered by September 30. 1992. two third were been reported in Belgrade. Only 3 cases have beer notified in Montenegro.

Studies on vaccination against bacillary dysentery. 6. Protection of children by oral immunization with streptomycin-dependent Shigella strains.

A field trial of oral streptomycin-dependent mutant Shigella vaccines in five hyperendemic areas of Yugoslavia in 1969 confirmed the findings of earlier studies by demonstrating the effectiveness of these vaccines against dysentery. For the first time, a high degree of protection was demonstrated in children. The vaccines induced serotype-specific immunity against Shigella flexneri 1 and 2a and S. sonnei. Postvaccinal reactions were minor and consisted of vomiting or diarrhoea, or both, in a small proportion of children within several hours of the administration of the vaccine. These reactions, seen mainly after the first dose, were dose-dependent and could be decreased by reducing the number of live organisms. Reactions to subsequent doses were much fewer. Pretreatment with sodium bicarbonate was necessary. Under the conditions of this study, the vaccines proved to be stable with no evidence of reversion of the mutant strains to the virulent parent.