ABSTRACT
UNLABELLED: Singapore is a modern urban city and endemic typhus is thought to be a disease of the past. This may be due to lack of specific serological testing as indirect immunoperoxidase testing using specific rickettsial antigens (U.S. Army Medical Research Unit, Institute of Medical Research, Kuala Lumpur, Malaysia) has only recently become available. In the last fourteen months, twenty-one cases of endemic typhus were diagnosed in patients hospitalised for acute febrile illnesses at the National University Hospital. We conducted a case control study to define the clinical and laboratory features of endemic typhus in Singapore. METHOD: Demographic, clinical and laboratory data were reviewed for cases and twenty-one age and sex matched controls who had negative serologic tests as part of a work-up for fever of unknown origin. RESULTS: Apart from a higher initial temperature (39 degrees C vs 37.9 degrees C (p < 0.001)) and ALT(p = 0.002), cases and controls had similar presentations of fever, myalgia, headache, cough, normal WBC and platelet counts. Singapore residents and migrant workers were represented in both groups (p = ns). CONCLUSION: Endemic typhus remains an important cause of acute febrile illness in Singaporein both the local and migrant worker populations. The presentation is similar to other causes of acute febrile illnesses and the diagnosis will be missed unless it is specifically sought.
Subject(s)
Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/epidemiology , Typhus, Endemic Flea-Borne/diagnosis , Typhus, Endemic Flea-Borne/epidemiology , Adult , Case-Control Studies , Female , Humans , Immunologic Tests , Male , Middle Aged , Prevalence , Retrospective Studies , Singapore/epidemiology , Transients and MigrantsABSTRACT
Many healthcare workers have frequent household contact with persons at high risk for influenza-related complications. Educating healthcare workers about the risk of domestic transmission of influenza may improve their acceptance of influenza vaccination. Concerns regarding vaccine efficacy and safety also need to be addressed.
Subject(s)
Allied Health Personnel , Disease Transmission, Infectious/statistics & numerical data , Influenza Vaccines , Influenza, Human/prevention & control , Influenza, Human/transmission , Adult , Aged , Female , Hawaii , Health Status , Humans , Influenza, Human/complications , Male , Middle Aged , Risk Factors , Surveys and QuestionnairesABSTRACT
International travel and migration will continue to contribute to the changing patterns of Hansen's disease (HD) in the United States. The majority of cases will be immigrants and refugees entering the country from leprosy-endemic regions. The Compact of Free Association, through its provision of free travel between the Freely Associated States and the United States without need for health screening, has created new public health issues. This cluster of HD cases in Kona, Hawaii, U.S.A., highlights the difficulties in detecting and monitoring the spread of disease in immigrant populations. This is a growing problem only likely to worsen in the coming years. In groups with cultural, language or other socioeconomic barriers, special and creative methods may be needed to tackle the problems of detection, treatment and education. Clinicians must remain mindful of the diagnosis of HD in high-risk groups.
