Prevalence of chronic viral hepatitis in people of south Asian ethnicity living in England: the prevalence cannot necessarily be predicted from the prevalence in the country of origin.

The prevalence of hepatitis B and hepatitis C in immigrant communities is unknown. Immigrants from south Asia are common in England and elsewhere, and the burden of viral hepatitis in these communities is unknown. We aimed to determine the prevalence of viral hepatitis in immigrants from south Asia living in England, and we therefore undertook a community-based testing project in such people at five sites in England. A total of 4998 people attending community centres were screened for viral hepatitis using oral fluid testing. The overall prevalence of anti-hepatitis C virus (HCV) in people of south Asian origin was 1.6% but varied by country of birth being 0.4%, 0.2%, 0.6% and 2.7% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. The prevalence of hepatitis B surface antigen was 1.2%-0.2%, 0.1%, 1.5% and 1.8% in people of this ethnic group born in the UK, India, Bangladesh and Pakistan, respectively. Analysis of risk factors for HCV infection shows that people from the Pakistani Punjab and those who have immigrated recently are at increased risk of infection. Our study suggests that migrants from Pakistan are at highest risk of viral hepatitis, with those from India at low risk. As prevalence varies both by country and region of origin and over time, the prevalence in migrant communities living in western countries cannot be easily predicted from studies in the country of origin.

Value of targeting at-risk populations at outreach venues: findings from a local sauna.

An assessment of the need to increase access to an outreach venue, the local sauna in Walsall, UK, frequented only by men who have sex with men, was undertaken. A case-notes review of the clients who attended the monthly outreach sessions at the sauna in the year 2007 was performed. Among the 287 men seen at the 12 outreach sessions, 37% had a sexually transmitted infection (STI). Of those tested positive, 88% had never had a previous STI. Twenty-one men had syphilis and a further six tested positive for HIV. Hepatitis B vaccination was completed for 41% of the clients seen. Those who tested positive for an STI said they would not have attended a conventional setting but accepted screening at the sauna. This confirmed the need to increase access at this outreach venue, and further funding has now been provided to have outreach sessions twice a month.

Syphilis outbreak in Walsall, UK: lessons for control and prevention.

An assessment of risk-taking behaviour among men who have sex with men (MSM) attending a sauna venue was undertaken, using a standardized questionnaire, after which outreach screening was introduced targeting MSM. The epidemiology of the continuing outbreak of syphilis was reviewed to determine the factors driving the outbreak and assess the benefit of continuing outreach screening. Findings among the 163 respondents at the sauna included a high rate of casual sex and a tendency not to disclose HIV status. Over 12 months, 51 cases of early syphilis were recorded. Our review showed a decline in incidence in MSM after outreach screening, but an increase in heterosexual spread. Given the frequent anonymous nature of syphilis transmission, traditional contact tracing is ineffective. Outreach screening is required at gay venues and other community settings to target at-risk populations.

Syphilis clusters in Walsall: case profiles and public health implications.

Between the beginning of December 2002 and the end of March 2003, eight cases of infectious syphilis were diagnosed in Walsall. Two unrelated clusters were identified. The first consisted of three cases, two heterosexual patients and a baby with congenital syphilis. The infant had no congenital stigmata of syphilis, which is consistent with recent infection. The second cluster consisted of five cases in men who have sex with men (MSM) who attended a local sauna that attracts men from the Midlands and north west England. One infection was detected in an outreach screening initiative of 60 MSM. Both clusters illustrate the problems of case ascertainment and the need for continued vigilance to the potential of syphilis infection in high risk groups. Vigorous public health efforts are required to promote safer sex and awareness to infection with syphilis and human immunodeficiency virus, reinforced by targeted case finding in clinic and community settings.

Survey of NHS staff attitudes to influenza immunisation.

There was a low uptake of influenza vaccination among health care workers in year 1999-2000. The study aimed to identify reasons for low uptake and to use the results to improve uptake during current and future campaigns.

Dogs, zoonoses and immunosuppression.

Dogs are the source of a wide range of zoonotic infections that pose a significant threat to human health. This is particularly the case for immunocompromised people, although there are few robust studies that determine immunosuppression as a risk factor for transmission of zoonoses from dogs to humans. An increasing proportion of human society is immunodeficient, principally through the advent of HIV infection and through more people, particularly the expanding elderly group, being subjected to immunosuppressive agents. This is happening at a time when more such people are capitalizing on the acknowledged benefits of dog ownership, making for a potentially dangerous mix. Enteric pathogens (for example, Salmonella, Campylobacter and Cryptosporidium species, that may be canine derived) are a frequent risk to the health of immunocompromised persons. Veterinarians and physicians can be criticised for not communicating with each other, and for not providing adequate risk assessment to pet owners. There is scope for voluntary groups to provide information and support for the immunosuppressed who wish to keep their dogs. Key recommendations are to maintain a clean personal environment and intact mucocutaneous barriers. Public health professionals could help rectify the current communications gap between veterinary and medical staff and so facilitate in the appropriate management of dog-owning immunocompromised people.

Can plasma fructosamine substitute for glycated haemoglobin (HbA1c) estimation in the assessment of diabetic control?

The 'gold standard' marker of overall glycaemic control in diabetes mellitus is the level of glycated haemoglobin (HbA1c). It is, however, an expensive and technically difficult assay and is rarely appropriate to tropical laboratories. Plasma fructosamine measurement is cheaper and easier, though it reflects shorter-term glycaemia. We have measured both indices of control in a group of 154 diabetic patients. There was close correlation between the two measurements (r = 0.6506, P < 0.001), but many patients with abnormal HbA1c levels had normal fructosamine levels. This resulted in an assay sensitivity (compared with HbA1c as gold standard) of only 30%, though specificity was 98%. We conclude that fructosamine measurement cannot be regarded as a substitute for HbA1c determination.

Varicella infection and pneumonia among adults.

OBJECTIVES: To demonstrate the clinical importance of adult chickenpox in terms of morbidity, mortality, and impact on hospital services, in Al Ain, United Arab Emirates. METHODS: A review was conducted of 607 consecutive hospitalized cases of adult chickenpox (1985-1996, Al Ain Hospital) for clinical findings and risk of developing varicella pneumonia. RESULTS: Leading clinical features were fever (98.9%), myalgia (26.9%), cough (24.6%), headache (15.4%), pharyngitis (14.7%), and profuse rash (12.2%). There were 26 cases of varicella pneumonia, of whom three died with respiratory failure (hospital case fatality 0.5%). Multivariate analysis (odds ratios in parenthesis) showed that cough (12.1), profuse rash (4.5), fever for more than 1 week (3.9), and age over 34 years (2.3) were the most significant predictors of pneumonia. CONCLUSIONS: Early aggressive therapy with intravenous acyclovir is recommended in patients at risk of pneumonia. In the community setting, there is a large proportion of adult immigrants (especially from South Asia) who are seronegative and at risk of complications and hospitalization. It is recommended that the varicella vaccine be offered to new immigrants after screening, to benefit themselves and the nonexposed community, and to reduce the economic burden of chickenpox on the health services and employers.

Arabian Peninsula men tend to insulin resistance and cardiovascular risk seen in South Asians.

OBJECTIVE: To test the hypothesis that peninsular Arabs and South Asians share a tendency to insulin resistance, differing from other ethnic groups living in the United Arab Emirates (UAE). METHODS: A representative sample of 358 apparently healthy men aged 35-49 years drawn from a multiethnic office-based workforce in the UAE was tested. The sample included a reference group of expatriate South Asians, in whom insulin resistance has already been described as the cause of high coronary heart disease (CHD) mortality. All subjects were screened for CHD risk factors, including glucose tolerance and 2-h serum insulin determinations. RESULTS: There was a high prevalence of previously undiagnosed cases of diabetes (10.1%) and hypertension (14.2%). South Asian and peninsular Arab men shared the tendency to significantly higher 2-h glucose and insulin levels, lower HDL cholesterol concentrations and abdominal obesity especially compared to Europeans, who were five times less likely to be glucose-intolerant (OR 5.40, P = 0.015). Three other Arab groups were intermediate in most trends. CONCLUSION: Susceptibility to insulin resistance in Arabian peninsula men is strongly supported, suggesting that control of obesity and promotion of exercise are the best approach to CHD prevention.

Injury mortality and morbidity among children in the United Arab Emirates.

UNLABELLED: The objective of this study was to identify the major causes of accident mortality and morbidity among children (0-14 years) in Al-Ain, United Arab Emirates (UAE). A retrospective descriptive study was set in the Al-Ain Hospital and Preventive Medicine Department, Ministry of Health, Al-Ain. Subjects were all patients aged 0-14 years who were seen at Al-Ain Hospital for injury during the 12-month period January to December 1995, and all recorded deaths aged 0-14 years in Preventive Medicine Department from 1980 to 1995. RESULTS: Mortality: 301 children (69.4% males, 30.6% females) died after accidents from 1980 to 1995. UAE citizens and other Arabs represented the majority of deaths. Most mortality (28.6%) occurred in the 1-4 year age group. Head and neck injury was the major type of injury causing death (57.5%). The most common cause of accidental death was road traffic accidents (boys 67.1%, girls 60.4%), followed by drowning and burns (8%). Morbidity: Pediatric trauma cases seen during 1995 totaled 17,498, representing one third of all patients attending the Hospital Emergency Room. About 70% of encountered injuries occurred among boys; 44.6% of cases were UAE citizens. The most common trauma type was contusion (40.2% boys; 40.6% girls), the most common type of trauma in boys and girls (30.4% and 36%, respectively). In the age group <5 years, the most common causes of trauma were fall (41.1%), blunt trauma (38.7%) and burns or scalds (64%), while in 5-9 year olds, the most common cause was road traffic accidents (40%). Finally, in 10-14 year olds, the most frequent causes were traffic accidents (32.8%) sharp objects injuries (38.3%), and fights and sporting (28.9%). CONCLUSION: More boys than girls presented with injury and the majority were nationals. Road traffic accidents mainly occurred in children over 10 years.

The associations between feeding modes and diarrhoea among urban children in a newly developed country.

The protective effect of breastfeeding against infantile diarrhoea may be less pronounced in areas with modern water supply and sanitation facilities. This finding raises the question whether protection by breastfeeding against infantile diarrhoea in developing countries will decline with improvement in water supply and sanitation. To address this question a historical cohort study of the associations between feeding modes and diarrhoea incidence and severity in children aged 0-14 months at baseline was done in Al Ain city, United Arab Emirates. In this city in a newly developed country, modern water supply and sanitation facilities have become available to everyone during the last two decades. During three months of follow-up of 249 children, the nonbreastfed had more diarrhoea than did the partly breastfed, who in turn had more diarrhoea than did the fully breastfed. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrhoeal morbidity in each child: occurrence or non-occurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the nonbreastfed and fully breastfed subgroups. These results indicate that in Al Ain, despite the universal access to modern water supply and sanitation facilities, breastfeeding plays an important role in reducing the incidence and severity of infantile diarrhoea. This observation is particularly important given the growing concern that, as an unwanted effect of 'modernisation', breastfeeding is on the decline in Al Ain and comparable populations elsewhere.

PIP: Since the protective effect of breast feeding against infantile diarrhea may be less pronounced in areas with modern water supply and sanitation facilities, this effect may decline as developing countries make improvements in these areas. This possibility was addressed in a historical cohort study of the association between feeding modes and diarrhea incidence and severity in 249 children from Al Ain city, United Arab Emirates, who were 0-14 months of age at baseline. During the past two decades, a modern water supply and sanitation facilities have become universally available in this newly developed country. During 3 months of follow-up, 69 (28%) of the 249 children had at least 1 diarrhea episode. The 61 non-breast-fed infants had more diarrhea than the 45 partially breast-fed infants, who in turn had more diarrhea than the 143 fully breast fed ones. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrheal morbidity in each child: occurrence or nonoccurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the non-breast-fed and fully breast-fed infants. These findings indicate that breast feeding remains a critical child health intervention, even in areas with universal access to modern water supply and sanitation facilities.

Diabetes, obesity and hypertension in urban and rural people of bedouin origin in the United Arab Emirates.

In the United Arab Emirates, coronary heart disease has emerged as the leading cause of mortality over a 20-year period of rapid socioeconomic development. CHD risk factors of non-insulin dependent diabetes mellitus (NIDDM), obesity and hypertension were investigated by community based survey among a bedouin-derived Emirati population sample of 322 subjects (> or = 20 years). Diagnosis of diabetes was based on a random capillary blood glucose level > or = 11.1 mmol l-1. Overall diabetes prevalence was 6% (11% in male and 7% in female subjects aged 30-64 years). Urban residence was associated with higher blood glucose levels (P = 0.000), and with higher Body Mass Index (BMI) values (P = 0.002): 27% of all urban residents were obese (BMI > or = 30). The Shamsi were positively associated with higher blood glucose levels compared with other tribal groups (P = 0.000). Female gender was associated with higher BMI values (P = 0.000). Between 19 and 25% of all subjects (male or female; urban or rural residents) have systolic hypertension (> 140 mm Hg). Male gender was associated with raised diastolic BP (P = 0.023). Diabetes was associated with higher mean systolic (P = 0.0274) and diastolic (P = 0.0132) BP levels. Differences in lifestyle between urban and rural residents are becoming blurred with further socioeconomic development and it is expected that the incidence of these CHD risk factors will continue to rise. Further studies are needed to specify changes associated with urbanization. Tribal influence also merits further study given the tradition of consanguinity in the UAE and the genetic basis to NIDDM.

Bacterial meningitis: still a cause of high mortality and severe neurological morbidity in childhood.

Among 121 cases of bacterial meningitis (age 2 months to 12 years; mean, 35 months) treated over a 3-year period, Neisseria meningitidis was the most common pathogen (33 per cent), then Haemophilus influenzae (32 per cent) and Streptococcus pneumoniae (15 per cent). In the H. influenzae group, 95 per cent were aged below 2 years. Overall mortality was 12 per cent: higher in the S. pneumoniae (17 per cent) and less common organism (21 per cent) groups. Neurological sequelae in 21 (20 per cent) of the 106 survivors included hearing impairment in 17 and quadriparesis in eight. Meningitis caused by S. pneumoniae contained a significantly higher proportion of children with neurological morbidity (P = 0.0128). The addition of dexamethasone treatment during the third year produced an apparent but not significant trend towards less mortality (P = 0.7568), fewer neurological sequelae (P = 0.3401) and less hearing impairment (P = 0.3903). Despite the availability of effective chemotherapy, bacterial meningitis will remain an important cause of high mortality and considerable morbidity.

The prevalence and correlates of anaemia among young children and women of childbearing age in Al Ain, United Arab Emirates.

During 1992 and 1993, 309 children aged 1-22 months (mo) and their mothers visiting an immunization facility in Al Ain city, Abu Dhabi Emirate, United Arab Emirates, were studied to (1) define blood haemoglobin (Hb) levels; (2) estimate the prevalence of anaemia; (3) examine the role of iron deficiency in causing anaemia; (4) identify the correlates of anaemia prevalence; and (5) assess the acceptability to parents of an anaemia screening test for their young children. The levels of Hb in all subjects and the levels of serum ferritin in anaemic (Hb < 11 g/dl) children aged > or = 6 mo and in non-pregnant women with Hb < 11 g/dl were determined by a HemoCue Photometer and an enzyme immunoassay, respectively. Each woman was interviewed to obtain pertinent data. In children, anaemia was detected in 3% of those aged 1-2 mo (Hb < 9 g/dl), in 8% of those aged 3-5 mo (Hb < 10 g/dl), and in 25-39% of those aged > or = 6 mo (Hb < 11 g/dl). Of 19 children tested, ten (53%) were iron-depleted (serum ferritin < 12 micrograms/l). After multivariate adjustment, the only significant positive correlate of anaemia in children was older age (1-5 mo vs 6-22 mo; odds ratio [OR]: 9.51; 95% confidence interval [CI]: 3.92-23.08). Anaemia was detected in 14% of pregnant women (Hb < 11 g/dl) and 16% of non-pregnant women (Hb < 12 g/dl).(ABSTRACT TRUNCATED AT 250 WORDS)