Carrier status of leptospirosis among cattle in Sri Lanka: a zoonotic threat to public health.

Leptospirosis is a zoonotic disease of global importance and one of the notifiable diseases in Sri Lanka. Recent studies on human leptospirosis have suggested that the cattle could be one of the important reservoirs for human infection in the country. However, there is a dearth of local information on bovine leptospirosis, including its implications for human transmission. Thus, this study attempted to determine the carrier status of pathogenic Leptospira spp in cattle in Sri Lanka. A total of 164 cattle kidney samples were collected from the meat inspection hall in Colombo city during routine inspection procedures conducted by the municipal veterinary surgeons. The DNA was extracted and subjected to nested PCR for the detection of leptospiral flaB gene. Amplicons were sequenced, and phylogenic distances were calculated. Of 164 samples, 20 (12.2%) were positive for flaB-PCR. Sequenced amplicons revealed that Leptospira species were deduced to L. borgpetersenii (10/20, 50%), L. kirschneri (7/20, 35%) and L. interrogans (3/20, 15%). The results indicate that a high proportion of the sampled cattle harbour a variety of pathogenic Leptospira spp, which can serve as important reservoirs for human disease.

Gender differences of suicide in Japan, 1947-2010.

BACKGROUND: The effects of socio-economic factors on suicide were gender-dependent. Japanese suicide mortality gender ratio (male: female) had gradually increased during the twentieth century. METHODS: With the data covering 1947-2010 collected from Japanese official websites, we conducted non-parametric rank test, curve estimations, spearman ranking correlation and quantile regression in succession with Stata version 12.0. RESULTS: The suicide mortality rate in male with a "U" shape had been always higher than that in female with a "J" shape. The male suicide mortality peaked around in 1955 (38.5 per 100,000 populations), dropped quickly afterwards until the 1970s; it increased in the 1980s with another peak in 2003 (33.2 per 100,000 populations). For female, an overall decreasing trend was seen with a peak during the 1950s (23.5 per 100,000 populations in 1958). It dropped gradually afterwards with small variations in 1970s and 80s, and was stabilized after 1995 (9.3 per 100,000 populations). The unemployment rate could be used as a single positive predictor of suicide mortality for men (p<0.01), while the total fertility rate (TFR) (p<0.01) and divorce rate (p<0.01) were significantly associated positively and negatively with women's suicide, respectively. LIMITATIONS: The impact of mental disorders was not analyzed and age-specific analysis was not conducted. CONCLUSION: The findings of these gender differences in, and the associated factors with, suicide in Japan, warranted further studies including delineation of the implications of differential economic pressure between genders, as well as child-rearing pressure and marriage satisfaction.

Association between lifestyle activity and depressed mood among home-dwelling older people: a community-based study in Japan.

In the community-based cross-sectional study, we investigated patterns of lifestyle activities among older people and examined the association between specific types of lifestyle activity and depressed mood status. The participants were 656 men and women aged 65 or older in 2004 who lived in a rural town in Japan, neither institutionalized nor hospitalized and who did not have symptoms of dementia. We found that less interaction with neighbors, society and friends was highly associated with depressed mood for men. Additionally, although they were physically active in gardening/farming, it did not necessarily mean that they were mentally healthy if they did not have close ties with friends, family and children/grandchildren. For women, it seemed important to engage in several types of activities relating to society, leisure and children/grandchildren to be in less depressed mood. Even if they were socially inactive, if they had frequent contact with family and children/grandchildren or going out for pleasure they were less likely to be depressed. Distinguishing gender differences in lifestyle activity patterns and the association of activities with depressed mood will help to guide the development of depression intervention programs.

[Health status and lifestyle issues of homeless people in Sapporo city, 2000].

OBJECTIVE: To clarify the health status and lifestyle issues of homeless people in Sapporo city, voluntary "health consultations and medical examinations" were carried out near an emergency kitchen. METHODS: The voluntary activities were held in a park near the shelter tents of homeless people seven times from December 1999 to December 2000. The homeless people who consulted us, medical doctors, were asked detailed questions about past history, present illness, subjective symptoms, lifestyles and so on, and were examined for their blood pressure and urinary parameter. RESULTS: A total of 60 homeless people, including 59 men and 1 woman, were consulted and examined, Fifty-seven percent of them were 50 years old of older, and 30% had been homeless for less than half a year. Forty percent had some dental problems, 28% suffered neck stiffness, and 27% back pain. The medical examination found 53% of them to be hypertensive and 26% to be diabetic. Twenty-five percent had meals only once a day, 55% had meat or fish in their diet not more than twice a week and 57% had vegetables in their diet not more than twice a week. Forty-two percent slept not more than 5 hours a day, 13% often drank alcohol in the daytime, and 83% were smokers. CONCLUSION: The present results suggest that lifestyle-related chronic diseases are more significant problems among homeless people in Sapporo city than common infectious diseases such as tuberculosis or dysentery, probably because it is colder and therefore there are fewer homeless people in Sapporo city than in other major cities in Japan such as Tokyo and Osaka. Further studies of the homeless people living in such a cold environment are warranted to develop better health policies for them in the context of their social and economical determinants. In addition, it is important to establish a more reliable registration system for these people in order to plan and provide a comprehensive social and health support network as needed.

[An Internet-based "distance" learning for health, environment and sustainable development "distance learning without a frontier"].

Quality of the environment is crucial for human health. Environmental hazards may lead to adverse health effects, while a sound environment can support of enable health. It has been clear that health and environment must be understood within the context of social and economic development, which was stressed especially in the Earth Summit held in Rio de Janeiro, Brazil, in 1992. Investing in improvement of people's health and their environment is a prerequisite for sustainable development. The telecommunication revolution enables distance learning without frontiers in a reansparent and interactive environment. Applying the Internet and other telecommunication into public health including environmental health holds the greatest promise for global health. A wide application and access would facilitate and expedite the reduction of inequity prevailing between the south and north in an unprecedented speed. This proposed course is thus designed to provide an overview on health and environment in sustainable development through the Internet.

Re-evaluation of anti-HTLV-I Western blot assay using HTLV-I and HTLV-II serum panels.

BACKGROUND: Western blot assay is accepted to be a confirmatory test of anti-HTLV-I antibodies, and several WB criteria have been proposed for confirming HTLV-I seropositivity. There is a necessity for comprehensive study on the criteria. OBJECTIVES: This study was performed to evaluate anti-HTLV-I WB kits and feasibility of the WB criteria. STUDY DESIGN: We tested 3 commercially available WB kits: PROBLOT HTLV-I, Eitest ATL-WB and HTLV BLOT 2.2, by a standard HTLV-I serum panel which had been established in our previous study. Sensitivity and specificity to detect each component of HTLV-I antigens were evaluated by the correlation coefficient, R-value. Specificity of the anti-HTLV-I WB kits and HTLV BLOT 2.3 was further evaluated by a standard HTLV-II serum panel established from the HTLV-I/II epidemiological surveillance of Colombian natives. RESULTS: PROBLOT HTLV-I showed high R-values (>/=0.980) for p28, p53 and gp46, but low R-values (<0.900) for p19 and p24. Eitest ATL-WB showed a high R-value for p19, but low R-values for p53, gp46 and rgp21. HTLV BLOT 2.2 showed high R-values for p28 and recombinant gp46-I, but low R-values for p53 and gp46. The HTLV-II serum panel showed positive reactions with p24 and p19 of HTLV-I but a little if any reactions with p28 and gp46 of HTLV-I. Although these reactions could not define HTLV-II-specific WB patterns in anti-HTLV-I WB, HTLV-I- and HTLV-II-specific recombinant gp46 in HTLV BLOT 2.3 were useful to distinguish anti-HTLV-II antibodies. CONCLUSIONS: The currently available anti-HTLV-I WB kits are sufficient for confirmatory testing of anti-HTLV-I antibodies with WHO criteria using one gag and one env positivity, but they are inadequate for anti-HTLV-II confirmatory testing.

Evaluation of commercial HTLV-1 test kits by a standard HTLV-1 serum panel.

To evaluate the performance of currently available test kits for human T-cell lymphotropic virus type 1 (HTLV-1), we examined two particle agglutination (PA) tests and nine enzyme immunoassays (EIA) using a standard serum panel consisting of HTLV-1-positive and HTLV-1-negative sera that had been characterized by immunofluorescence and the polymerase chain reaction (PCR). The PA kits exhibited 94.0-100.0% sensitivity and 99.5-100.0% specificity; the sensitivity range was ascribed to the quality of the HTLV-1 antigens coated on the particles. The EIA kits had 99.5-100% sensitivity and 98.5-100% specificity; the 98.5%-99.5% specificity exhibited by five of the EIA kits could have been due to nonspecific reactions that were detected through use of an inadequate cut-off value and the use of recombinant proteins. It can be concluded that the sensitivity of the currently available PA and EIA kits is sufficient to permit their use for screening purposes; however, the specificity of some EIA kits should be optimized.

Sensitivity of HIV-antibody assays determined by seroconversion panels.

OBJECTIVES: To determine the sensitivity of HIV-antibody assays for detecting low levels of HIV antibody using seroconversion and other panels containing plasma of varying titres. METHODS: Eight HIV-antibody assays, available under the World Health Organization bulk-procurement agreement, were evaluated on sets of sequential plasma samples derived from 11 individuals who had recently become HIV-infected (seroconversion panels). In addition, two non-seroconversion panels, consisting of low performance (titre) and mixed titre samples were used to further define the sensitivity of the assays. The eight assays included two rapid tests, one simple test, and five enzyme-linked immunosorbent assays (ELISA). RESULTS: On average, the eight assays detected antibody 0.5-4.8 days later than the reference test (Abbott HIV-1/HIV-2 3rd generation ELISA); these differences were statistically significant for six of the eight tests. All tests performed well on the low performance and mixed titre panels. All eight assays also had comparable sensitivity to that of the reference test on a large panel of known positive plasma. The additional risk of missing an infectious unit of blood during seroconversion by using the least sensitive rather than the reference test was estimated to be 1 in 7600 and 1 in 76 million at annual HIV incidence rates of 1 and 0.0001%, respectively. The cost of eliminating this additional risk by using the reference test is between US$ 15,150 and 151 million per unit detected at the above incidence rates. CONCLUSIONS: Although there are differences in sensitivity between the assays when used to test blood from individuals during the course of seroconversion, the differences are small, and all eight tests are appropriate for use as screening tests.

Sistema internacional de la OMS para evaluar la calidad de las pruebas detectoras de anticuerpos contra el VIH: resultados de la segunda distribución de sueros / WHO international quality assessment scheme for HIV antibody testing: results from the second distribution of sera

El sistema internacional de la OMS para evaluar la calidad de las pruebas detectoras de anticuerpos contra el virus de la inmunodeficiencia humana (VIH) se estableció para controlar la calidad de la labor desempeñada por los laboratorios en este campo. Después de la distribución de unos cuantos especímenes con fines experimentales a comienzos de 1989, una segunda distribución se hizo en febrero de 1990. En total se enviaron 20 especímenes de suero, 10 con anticuerpos contra el VIH-1, a 103 laboratorios en las seis regiones de la OMS. Se pidió a los participantes que aplicaran a los especímenes sus pruebas estandarizadas y que para cada uno notificaran a la OMS los resultados obtenidos con cada tipo de prueba diagnóstica y su interpretación con respecto ala presencia o ausencia de anticuerpos contra el VIH. En lo concerniente a los especímenes con anticuerpos, los resultados se consideraron positivos en 98,2 por ciento de los casos e indeterminados en 1,8 por ciento; no se notificaron resultados negativos falsos. En el caso de los especímenes sin anticuerpos, 90,3 por ciento de los resultados se consideraron negativos, 1,3 por ciento positivos y 8,4 por ciento indeterminados. La mayor parte de los informes con resultados indeterminados correspondieron a un espécimen en particular. Se uso una amplia variedad de pruebas diagnósticas solas y combinadas. Si se tienen en cuenta los resultados técnicos, más que su interpretación, la confiabilidad de las pruebas fue muy buena en lo que respecta a los especímenes positivos: 99,5 por ciento de los resultados registrados fueron positivos, 0,17 por ciento negativos y 0,34 por ciento indeterminados. Los especímenes negativos se asociaron con un mayor número de errores: 93,5 por ciento de los resultados registrados fueron negativos, 3,5 positivos y 3 por ciento indeterminados. Sin embargo, 61 por ciento de los resultados positivos falsos e indeterminados que se obtuvieron al aplicar las pruebas a especímenes negativos correspondieron a dos especímenes solamente. La prueba western blot dio resultados muy variados, a los que se aplicaron distintos criterios de interpretación

Strategies for laboratory HIV testing: an examination of alternative approaches not requiring Western blot.

Advances in laboratory tests for antibodies to human immunodeficiency virus (HIV) have permitted the development of alternative HIV testing strategies that do not require use of the Western blot approach. Three strategies are proposed. In strategy I, sera are tested for HIV antibody using an enzyme-linked immunosorbent assay (ELISA)/rapid/simple (ERS) test; in strategy II, sera reactive in an initial ERS test are retested using a second ERS test; strategy III involves retesting with a third ERS test all sera reactive in two previous ERS tests. Where the objective is identification of asymptomatic HIV-infected individuals, strategy III is proposed where HIV prevalences in the study population are < or = 10%, and strategy II at prevalences > 10%. Strategy II is recommended where the diagnosis of HIV-related disease requires HIV testing. For serosurveillance, strategy II is recommended if the prevalence is < or = 10%, and strategy I if the prevalences are > 10%. Use of strategy I is recommended for transfusion and transplantation safety, at any prevalence. Lower-cost laboratory HIV testing will permit such testing to become more widely available.

PIP: Testing of sera for antibodies to HIV typically involves screening with enzyme-linked immunosorbent assays (ELISA) and subsequent confirmation with Western blot (WB). Western blot testing, however, is relatively expensive and technically demanding. Recent technological advances have produced tests which provide results equivalent in accuracy to those obtained by WB. These include new ELISA tests, simple tests, and rapid tests. Simple tests are those which are easily learned and require no additional equipment or instrumentation, while rapid tests yield results in 30 minutes or less. The lower cost of these methods will allow HIV testing to become more widely available. The authors propose alternative laboratory HIV testing strategies based upon these newer ELISA/rapid/simple tests (ERS). Strategy 1 tests sera for HIV antibody using ERS tests. Strategy 2 retests sera reactive to initial ERS, and strategy 3 simply retests reactive sera a third time with ERS tests. Strategy 1 is recommended for transfusion and transplantation safety at any prevalence of HIV infection is selected populations. Strategy 1 is also recommended for serosurveillance in study populations where the prevalence of HIV infection is greater than 10%, but strategy 2 is recommend where prevalence are less than or equal to 10%. Strategy 2 is generally recommended when diagnosis of HIV-related disease requires HIV testing. Finally, strategy 3 is proposed to identify asymptomatic HIV-infected individuals where HIV prevalence in the study population are less than or equal to 10%, but strategy 2 will suffice where prevalence are greater than 10%.

Serological diagnosis of HIV infection using oral fluid samples.

The serological identification of antibodies to human immunodeficiency virus (HIV) in blood is the most widely used method to diagnose HIV infection. Recently, however, the use of oral fluid samples for the detection of antibodies to HIV has been suggested as an alternative. This review describes some basic information about oral fluids, the application of these samples for HIV testing, and summarizes results from many of the studies performed using HIV tests with oral fluids. The fluids obtained from the oral cavity include saliva and crevicular fluid, and can be collected directly (by dribbling) or by using commercially available devices. The immunoglobulin content of oral fluids is similar to that of blood, but their levels are less. However, the use of an HIV IgG antibody capture assay (GAC ELISA) designed specifically for testing oral fluids, and certain routine HIV blood tests that have been optimized for use with oral fluids, has produced encouraging results. A number of studies, including several in developing countries, report that the sensitivities and specificities of these optimized tests lie in the range 95-100% and 98-100%, respectively. Also, the performance of the GAC ELISA was consistent and in general, excellent. The article identifies several issues that need to be addressed before a recommendation on the routine use of oral fluid samples for HIV antibody detection can be made.

Sistema internacional de la OMS para evaluar la calidad de las pruebas detectoras de anticuerpos contra el VIH: resultados de la segunda distribución de sueros / WHO international quality assessment scheme for HIV antibody testing: results from the second distribution of sera

El sistema internacional de la OMS para evaluar la calidad de las pruebas detectoras de anticuerpos contra el virus de la inmunodeficiencia humana (VIH) se estableció para controlar la calidad de la labor desempeñada por los laboratorios en este campo. Después de la distribución de unos cuantos especímenes con fines experimentales a comienzos de 1989, una segunda distribución se hizo en febrero de 1990. En total se enviaron 20 especímenes de suero, 10 con anticuerpos contra el VIH-1, a 103 laboratorios en las seis regiones de la OMS. Se pidió a los participantes que aplicaran a los especímenes sus pruebas estandarizadas y que para cada uno notificaran a la OMS los resultados obtenidos con cada tipo de prueba diagnóstica y su interpretación con respecto ala presencia o ausencia de anticuerpos contra el VIH. En lo concerniente a los especímenes con anticuerpos, los resultados se consideraron positivos en 98,2 por ciento de los casos e indeterminados en 1,8 por ciento; no se notificaron resultados negativos falsos. En el caso de los especímenes sin anticuerpos, 90,3 por ciento de los resultados se consideraron negativos, 1,3 por ciento positivos y 8,4 por ciento indeterminados. La mayor parte de los informes con resultados indeterminados correspondieron a un espécimen en particular. Se uso una amplia variedad de pruebas diagnósticas solas y combinadas. Si se tienen en cuenta los resultados técnicos, más que su interpretación, la confiabilidad de las pruebas fue muy buena en lo que respecta a los especímenes positivos: 99,5 por ciento de los resultados registrados fueron positivos, 0,17 por ciento negativos y 0,34 por ciento indeterminados. Los especímenes negativos se asociaron con un mayor número de errores: 93,5 por ciento de los resultados registrados fueron negativos, 3,5 positivos y 3 por ciento indeterminados. Sin embargo, 61 por ciento de los resultados positivos falsos e indeterminados que se obtuvieron al aplicar las pruebas a especímenes negativos correspondieron a dos especímenes solamente. La prueba western blot dio resultados muy variados, a los que se aplicaron distintos criterios de interpretación

Publicado en inglés en el Bull. Pan Am. Health Organ. 70(5), 1992