Effect of vitamin D3 supplementation on Staphylococcus aureus nasal carriage: a randomized, double-blind, placebo-controlled trial in healthy adults.

Observational studies have reported an inverse association between serum 25-hydroxyvitamin D (25OHD) concentrations and Staphylococcus aureus nasal carriage; however, clinical trials of vitamin D supplementation are lacking. To assess the effect of vitamin D3 supplementation on persistent S. aureus nasal carriage we conducted a randomized, double-blind, placebo-controlled trial among 322 healthy adults. Participants were given an oral dose of either 200 000 IU vitamin D3 for each of 2 months, followed by 100 000 IU monthly or placebo in an identical dosing regimen, for a total of 18 months. Nasal swabs for S. aureus culture and serum for 25OHD measurement were obtained at baseline, 6, 12 and 18 months of study. The mean baseline concentration of 25OHD was 72 nM (SD 22 nM). Vitamin D3 supplementation increased 25OHD levels which were maintained at >120 nM throughout the study. Nasal colonization by S. aureus was found in 31% of participants at baseline. Persistent carriage, defined as those that had positive S. aureus nasal cultures for all post-baseline swabs, occurred in 20% of the participants but vitamin D3 supplementation was not associated with a reduction in persistent carriage (OR = 1.39, 95% CI 0.63-3.06). Risk factor analysis showed that only gender was significantly associated with carriage, where women were less likely to be carriers than men (relative risk 0.83, 95% CI 0.54-0.99). Serum 25OHD concentrations were not associated with the risk of carriage. In conclusion, monthly administration of 100 000 IU of vitamin D3 did not reduce persistent S. aureus nasal carriage.

School toilets: facilitating hand hygiene? A review of primary school hygiene facilities in a developed country.

BACKGROUND: Clean hands play an important role in preventing infectious disease transmission. The physical quality of any toilet and handwashing facilities is an important determinant of whether and how it is used, especially for school children. METHODS: This study assessed the physical quality of toilet and handwashing facilities used by 9 year olds at 68 primary schools in three cities in the South Island of New Zealand. The facilities were assessed for availability, functionality and provision of hand basins, hygiene products and drying facilities. RESULTS: Nineteen schools (28%) followed the New Zealand Ministry of Education Code of Practice for toilet and bathroom facilities in schools, by providing warm water, liquid soap at every basin and functioning hand drying facilities. A further 25 schools (37%) would have met the standards except they provided only cold water (21 schools) or the cloth roller towels were unusable (4 schools). The other 24 schools' toilet facilities were deficient in some way, including one with no soap and six that provided no drying facilities. School socioeconomic position and toilet facility quality were not related. CONCLUSIONS: These results suggest that a significant number of New Zealand children do not currently have access to high quality hygiene facilities at school.

The validity of Maori hospital discharge statistics for ischaemic heart disease in New Zealand.

Data from an Auckland coronary heart disease register for the years 1983 to 1991 have been used to assess the validity of routine national statistics on Maori hospital discharge rates for ischaemic heart disease. Ethnicity as recorded on the hospital admission record was compared with self defined ethnicity as recorded by register interviewers. Unlike routine New Zealand mortality statistics, where there is marked underreporting of Maori mortality, it appears that hospital discharge statistics are not markedly affected by misclassification of ethnicity. Approximately 12% of those classified on the admission record as Maori considered themselves to be of a different ethnicity, and 0.5% of those classified as 'other' considered themselves to be Maori. Because of the small proportion of the population (and of ischaemic heart disease deaths) who are Maori, the two misclassifications cancel out and the overall routinely reported hospital morbidity rates are similar to rates based on self reported ethnicity. For example, in 1990, routine national statistics show that there were 345 Maori hospital discharges or deaths due to ischaemic heart disease, and 8946 events among other ethnic groups. After adjustment using the register figures to reflect self defined ethnicity, the figures were 347 and 8944 respectively.