Implementation of a national electronic reporting system in Lithuania.

Electronic reporting systems improve the quality and timeliness of the surveillance of communicable diseases. The aim of this paper is to present the process of the implementation and introduction of an electronic reporting system for the surveillance of communicable diseases in Lithuania. The project which started in 2002 was performed in collaboration between Lithuania and Sweden and was facilitated by the parallel process of adapting the surveillance system to European Union (EU) standards. The Lotus-based software, SmittAdm, was acquired from the Department of Communicable Diseases Control and Prevention of Stockholm County in Sweden and adopted for Lithuania, resulting in the Lithuanian software, ULISAS. A major advantage of this program for Lithuania was the possibility to work offline. The project was initiated in the two largest counties in Lithuania where ULISAS had been installed and put in use by January 2005. The introduction was gradual, the national level was connected to the system during late 2005, and all remaining counties were included during 2006 and 2007. The reporting system remains to be evaluated concerning timeliness and completeness of the surveillance. Further development is needed, for example the inclusion of all physicians and laboratories and an alert system for outbreaks. The introduction of this case-based, timely electronic reporting system in Lithuania allows better reporting of data to the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) compared to the former reporting system with paper-based, aggregated data.

EHEC outbreak among staff at a children's hospital--use of PCR for verocytotoxin detection and PFGE for epidemiological investigation.

This is the first report of a major foodborne outbreak of enterohaemorrhagic Escherichia coli (EHEC) in Sweden. It occurred among the nursing staff at a children's hospital with approximately 1600 employees. Contaminated lettuce was the most likely source of infection. Nine persons were culture-positive for Escherichia coli (E. coli) O157 and verocytotoxin-positive by PCR and a further two were verocytotoxin-positive by PCR only. All 11 EHEC-positive individuals had attended a party for approximately 250 staff members, which was held at the hospital. In a questionnaire 37 persons stated that they had symptoms consistent with EHEC infection during the weeks after the party. There was no evidence of secondary transmission from staff to patients. The value of PCR as a sensitive and fast method for diagnosis is discussed in this paper. Pulsed-field gel electrophoresis (PFGE) was used to ascertain that staff members were infected by the same clone, and that two patients with E. coli O157 infection were not.

[More elderly persons should be informed about the importance of vaccination against influenza. Extensive needs of information also among the health personnel]. / Fler äldre bör informeras om vikten av influensavaccination. Stort informationsbehov även hos sjukvårdspersonalen.

In Sweden yearly vaccination against influenza for persons over 65 years of age has been recommended since 1997. In the Göteborg area approximately 33.6 percent of this age group were vaccinated during the autumn 1999. The most common reasons given for not being vaccinated were lack of confidence in the vaccine and a belief that influenza is not a serious disease. The study shows that both doctors and the target group need more information about the benefits of influenza vaccination.

Imported rocket salad partly responsible for increased incidence of hepatitis A cases in Sweden, 2000-2001.

An increased incidence of domestic hepatitis A without any obvious source of infection in Sweden and a small outbreak in late spring 2001 led to the undertaking of a case-control study. Consumption of imported rocket salad was clearly associated with disease (odds ratio 9.1, 95% confidence interval 1.5 to 69). The importation of vegetables from countries where hepatitis A is endemic to countries where this disease is not endemic continues to be a public health problem.

Carriage of penicillin-susceptible and non-susceptible pneumococci in healthy young children in Göteborg, Sweden.

OBJECTIVES: To study carriage of Streptococcus pneumoniae among healthy young children, determine the proportion of strains with decreased susceptibility to penicillin, and study possible risk factors for the carriage of penicillin-resistant strains. METHODS: Between February 1996 and February 1997, 620 healthy, 18-month-old children in Goteborg, Sweden were screened for carriage of S. pneumoniae with decreased susceptibility to penicillin. Nasopharyngeal samples were obtained from children visiting child health centres for routine health control. RESULTS: Streptococus pneumoniae was found in 322 samples and 18 strains (5.6%, CI95 3.4; 8.8) of all pneumococci showed decreased susceptibility to penicillin G with minimum inhibitory concentrations (MICs) ranging from 0.125 to 1.0 mg/l. The proportion of strains with decreased susceptibility was similar to that found in a laboratory-based material (6%), from the same geographical area and time period. A majority of the children with strains with decreased susceptibility to penicillin (n = 11) were not attending day-care centres. CONCLUSIONS: The prevalence of S. pneumoniae with reduced susceptibility to penicillin is still low in unselected healthy Swedish children.

Suppressed antibody and interleukin-6 responses to acute pyelonephritis in pregnancy.

This study examined the effect of pregnancy on the host response to acute pyelonephritis. Urine and serum samples were obtained at the time of diagnosis and after two weeks, from non-pregnant and pregnant women with acute pyelonephritis. The samples were analyzed for interleukin-6 (IL-6) and specific antibody activity to antigens extracted from the Escherichia coli strain infecting each patient. The host response to infection was further quantitated as fever, C-reactive protein, and renal concentrating capacity. Acute pyelonephritis in non-pregnant and pregnant women was accompanied by a significant serum and urine antibody response. The serum antibody response was significantly lower in the pregnant group. The IL-6 levels in serum and urine at diagnosis were significantly higher in the non-pregnant compared to the pregnant women. These results demonstrate that the immunosuppression of pregnancy includes the mucosal IL-6 and specific antibody responses to acute pyelonephritis caused by E. coli.

Hepatitis B carriers in Sweden--effects of immigration.

The number of hepatitis B carriers in Gothenburg, the second largest city in Sweden, has gradually increased between 1980 and 1990. Altogether 525 chronic carriers (35% females) were found, corresponding to a prevalence of 0.11%. 401 (76%) were immigrants from high or medium prevalence regions, mainly the Middle East and Southeast Asia. 102 were native Swedes (19%). In 1988-90 the immigrants constituted 85% (154/182) of all new cases. 93% (245/264) of the carriers born in 1960-89 were immigrants, whereof 53% (130/245) were HBeAg positive. The increasing number of hepatitis B carriers in Sweden places demands on the public health service to undertake measures to prevent new cases of hepatitis B, as well as to discover and treat chronic liver disease induced by hepatitis B virus.

Comparison of urine and serum concentrations of interleukin-6 in women with acute pyelonephritis or asymptomatic bacteriuria.

The mucosal and systemic interleukin-6 (IL-6) response to urinary tract infection was analyzed in women with acute pyelonephritis or asymptomatic bacteriuria. Urine and serum samples were obtained at diagnosis and after treatment. IL-6 activity was elevated in urine samples from most bacteriuric women, regardless of the severity of infection. Urinary levels greater than 20 units/mL occurred in 25 of 29 women with acute pyelonephritis and in 36 of 42 women with asymptomatic bacteriuria. Elevated serum IL-6 levels were found mainly in patients with acute pyelonephritis: Levels greater than 20 units/mL occurred in 14 of 28 women with acute pyelonephritis compared with 0 of 28 women with asymptomatic bacteriuria. These results suggest that bacteriuria is accompanied by elevated urinary IL-6 levels and that this IL-6 is locally produced. The spread of IL-6 to the circulation in patients with acute pyelonephritis may contribute to the elevation of fever and C-reactive protein characteristic of the disease.

Bacteriuria in pregnancy. Frequency and risk of acquisition.

A total of 3,254 pregnant women attending two antenatal clinics in Göteborg, Sweden, were screened for bacteriuria. The coverage of the pregnant population in the areas served by the two clinics was estimated to be 88%. Of the women who were registered at the two clinics, 99% took part in at least one screening; 71% were screened during each of the three intervals. The high frequency of screening of the women made it possible to estimate the risk of acquiring bacteriuria during pregnancy. This risk increased with the duration of pregnancy from 0.8% of bacteriuric women in the 12th gestational week to 1.93% at the end of pregnancy. The risk of onset of bacteriuria was highest between the ninth and 17th gestational weeks. The 16th gestational week was the optimal time for a single screening for bacteriuria calculated as the number of bacteriuria-free gestational weeks gained by treatment.

Bacterial adhesion as an indicator of renal involvement in bacteriuria of pregnancy.

The association of bacterial virulence with the host response to bacteriuria was evaluated in 70 pregnant women with acute pyelonephritis or bacteriuria detected at screening. Patients infected with Escherichia coli attaching to Gal alpha 1----4Gal beta-containing receptors, had significantly higher levels of C-reactive protein and lower renal concentrating capacity than patients infected with strains lacking this specificity. The renal concentrating capacity ranged from 419-1151 mOsm/kg in the women with bacteriuria on screening. 5/11 women with a renal concentrating capacity less than or equal to 784 mOsm/kg were infected with Gal alpha 1----4Gal beta-specific bacteria, compared to 0/16 of patients who concentrated the urine greater than 784 mOsm/kg. According to earlier studies the risk for progression to pyelonephritis and recurrences during pregnancy was increased in bacteriuric women with a reduced renal concentrating capacity. The present study demonstrates that this risk group can be identified in part by the properties of the infecting E. coli strains.

Virulence factors of Escherichia coli in urinary isolates from pregnant women.

Urinary isolates from 24 pregnant women with acute pyelonephritis and from 37 pregnant women with bacteriuria detected at screening were characterized for O:K:H serotype, electrophoretic type, adherence, hemolysin production, and serum resistance. Between the two diagnostic groups, only three clones were identical. For the remaining isolates, both the identification markers and virulence traits differed significantly. The strains from pregnant women with pyelonephritis did not significantly differ from those from non-pregnant women. Thus, pregnancy was shown not to abolish the difference in virulence between Escherichia coli causing acute pyelonephritis and asymptomatic bacteriuria.

Effects of subminimal inhibitory concentrations of ampicillin, chloramphenicol, and nitrofurantoin on the attachment of Escherichia coli to human uroepithelial cells in vitro.

An in vitro system with epithelial cells of the human urinary tract and Escherichia coli isolated from the urine of pateints with acute pyelonephritis was used for tests of the effect of antibacterial agents on bacterial adhesion. E. coli treated with subminimal inhibitory amounts of ampicillin attached less than untreated control bacteria. Subminimal inhibitory amounts of chloramphenicol and nitrofurantoin had no effect on adhesion of the 15 strains of E. coli tested. The combination of bacterial pretreatment with ampicillin and addition of antibodies to the adhesion test tube decreased adhesion more than did either treatment separately.

Effects of subinhibitory amounts of ampicillin, amoxycillin and mecillinam on the adhesion of Escherichia coli bacteria to human urinary tract epithelial cells: a preliminary study.

Attachment to mucous surfaces may be a prerequisite for bacteria colonizing these surfaces or invading underlying tissues. Subinhibitory amounts of ampicillin and amoxycillin but not mecillinam decreased the attachment of Escherichia coli bacteria to human uro-epithelial cells in vitro. No significant synergistic effect on the attachment by the antibiotics was obtained. The present report indicates a new parameter for the study of antibacterial actions of drugs.

Humidifier fever and endotoxin exposure.

Three cases of humidifier fever were detected in an office environment. Flavobacteria were found in the contaminated water in a humidifier. After an experimental exposure, the three persons with previous symptoms suffered from fever and slight respiratory symptoms. A leucocytosis and an increase in the number of segmented white blood cells were found the day following the exposure. General immunoglobulins as well as antibodies to Flavobacterium and endotoxin were slightly elevated in the exposed group. The possibility that endotoxins may be the causative agent by means of an indirect complement activation is discussed.