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Rationalisation of antenatal rubella screening
FIS Abstracts
A13
Poster Presentations A PROSPECTIVE COHORT STUDY ON INVASIVE PNEUMOCOCCAL DISEASE. K.Knox, D. Griffiths and Oxford Pueumococcal Surveillance Group. Oxford Vaccine Group, Oxford University, Oxford. A pilot cohort study was undertaken to determinethe outcome of patients admitted to hospital with invasivepneumococcal disease to dete,mhe the feasibility of a larger study. Methods a n d results: Invasivepneumococcal disease is defined by isolating Streptococcus pneumoniae from a potentially sterile site. Between 01/01/94 and 31/07/97, ten centres prospectively identified 700 cases. 193 adult cases detected by one centre, the Oxford Pubic Health Laboratory, were selected for this pilot study. Duration of hospital stay and death were recorded. 169 (87%) patients were followedup for a mean of 315 days. Mean age was 64 years. Crude mortality was 40% (68/169), 24% died during admission and 27 (16%) cases died after discharge. In the latter, the mean duration of survival was 180 days, with 22/27 (82%) of the deaths occurring within 1 year. For cases who died, the mean duration of hospital stay was 26 days and, for survivors, it was 12 days. A total of 9 cases (5%) had received the 23 valent pneumovax. C o n c l u s i o n s : Invasive pneumococcal disease in adults continues to be associated with a high mortality and use of hospital resources. A larger cohort study by the Oxford Pneumococcal Surveillance Group to determine the economic cost of disease and efficacy of pneumovax is feasible. Obiective:
RATIONALISATION OF ANTENATAL RUBELLA SCREENING The objective of the study was to establish compliance with advice given at antenatal rubella screening and to rationalise the number of tests performed. Over an 18 month period all negative antenatal rubella screening results were followed with a questionnaires to GPs for history of immunisation pre and post screening. A third of all women were of Asian origin with no record of school immunisation, which is consistent with a previous study in Bedfordshire. 25% women with documented evidence of immunisation were negative for antibody. Other inconsistencies were also highlighted. 40% of women who were found negative were not immunised postnatally. We conclude that rubella screening practices and advice given needs to be reviewed. Health gain is to be achieved by preconception screening and rationalisation of tests. Special attention should be paid to the immune status of women from ethnic minority. Deirdre Power and Dr Pat Nair
COLLABORATIVE APPROACH FOR THE DETECTION OF TRICHOMONAS VAGINALIS INFECTION IN A LOW PREVALENCE DISTRICT. D. J. Waghorn x, P.K. Tucker ~, Y. Chia2, S. Spencer2, G. A. Luzzi3, Deparmaents of Microbiology~, Cytology2 and Genitourinary Medicine3, Wycombe Hospital, High Wycombe, Bucks, UK. We describe a simple collaborative approach developed by the departments of cytology, microbiology and genitourinary (GU) medicine for the detection, diagnosis and management of microbiologically confirmed Trichomonas vaginal& (TV) infection. In a prospective study over a 2 year period, 54 (0.1%) of 52,440 cervical smears were reported to show TV, but microbiological confmnation was made in only 76% of 34 patients from whom a vaginal swab was subsequently taken. Over the same period, from a total of 96 cases of TV identified in the district (population 270,000), only 12 (13%) were first diagnosed in the department of G U medicine. 40% of the other 84 patients were subsequently seen in the G U clinic for test of cure, contact tracing and screening for other sexually transmitted infections (STIs). Trichomoniasis should not be diagnosed by cytology alone and clinicians need further education on the role of cytology in d i a g n o s i n g STIs. Collaborations between departments may improve the management of trichomoniasis and other conditions in the community and their development should be encouraged.
MEASLES - FORGOTTEN BUT NOT GONE. Y.Young I, C.Piper I, K.Bumke2, M.Sharland2, & M.Ramsay3; Merton, Sutton & Wandsworth HA1, St.George's Hospital2, and Communicable Disease Surveillance Centre3, London, UK. The incidence of confirmed measles continues to decline. However a recent outbreak amongst children at a local day-care nursery has served to highlight the importance of measles and the vulnerability of the unimmtmised and vaccine non-responders when vaccine uptake is low. The outbreak was recognised when three children from the same nursery were admitted to hospital with clinical measles. Further investigation revealed a total of eight children (age range 13-31mths; median I4mths) with similar symptoms during March 1997. All eight cases were subsequently laboratory confirmed. In total five of the children were admitted to hospital and one developed secondary pneumonia. Typing the measles RNA showed all to be Genotype t, one of the current wild types in the UK. Six of the eight children had not been immunised with MMR (mainly because of age); one was immunised during the incubation period of his wild virus infection and one had been immunised a year prior to this infection. Reported coverage of MMR vaccination locally is low (85%) and has declined with the recent adverse publicity. Should measles outbreaks be given wider publicity in the campaign to improve vaccine coverage?
A13
Poster Presentations A PROSPECTIVE COHORT STUDY ON INVASIVE PNEUMOCOCCAL DISEASE. K.Knox, D. Griffiths and Oxford Pueumococcal Surveillance Group. Oxford Vaccine Group, Oxford University, Oxford. A pilot cohort study was undertaken to determinethe outcome of patients admitted to hospital with invasivepneumococcal disease to dete,mhe the feasibility of a larger study. Methods a n d results: Invasivepneumococcal disease is defined by isolating Streptococcus pneumoniae from a potentially sterile site. Between 01/01/94 and 31/07/97, ten centres prospectively identified 700 cases. 193 adult cases detected by one centre, the Oxford Pubic Health Laboratory, were selected for this pilot study. Duration of hospital stay and death were recorded. 169 (87%) patients were followedup for a mean of 315 days. Mean age was 64 years. Crude mortality was 40% (68/169), 24% died during admission and 27 (16%) cases died after discharge. In the latter, the mean duration of survival was 180 days, with 22/27 (82%) of the deaths occurring within 1 year. For cases who died, the mean duration of hospital stay was 26 days and, for survivors, it was 12 days. A total of 9 cases (5%) had received the 23 valent pneumovax. C o n c l u s i o n s : Invasive pneumococcal disease in adults continues to be associated with a high mortality and use of hospital resources. A larger cohort study by the Oxford Pneumococcal Surveillance Group to determine the economic cost of disease and efficacy of pneumovax is feasible. Obiective:
RATIONALISATION OF ANTENATAL RUBELLA SCREENING The objective of the study was to establish compliance with advice given at antenatal rubella screening and to rationalise the number of tests performed. Over an 18 month period all negative antenatal rubella screening results were followed with a questionnaires to GPs for history of immunisation pre and post screening. A third of all women were of Asian origin with no record of school immunisation, which is consistent with a previous study in Bedfordshire. 25% women with documented evidence of immunisation were negative for antibody. Other inconsistencies were also highlighted. 40% of women who were found negative were not immunised postnatally. We conclude that rubella screening practices and advice given needs to be reviewed. Health gain is to be achieved by preconception screening and rationalisation of tests. Special attention should be paid to the immune status of women from ethnic minority. Deirdre Power and Dr Pat Nair
COLLABORATIVE APPROACH FOR THE DETECTION OF TRICHOMONAS VAGINALIS INFECTION IN A LOW PREVALENCE DISTRICT. D. J. Waghorn x, P.K. Tucker ~, Y. Chia2, S. Spencer2, G. A. Luzzi3, Deparmaents of Microbiology~, Cytology2 and Genitourinary Medicine3, Wycombe Hospital, High Wycombe, Bucks, UK. We describe a simple collaborative approach developed by the departments of cytology, microbiology and genitourinary (GU) medicine for the detection, diagnosis and management of microbiologically confirmed Trichomonas vaginal& (TV) infection. In a prospective study over a 2 year period, 54 (0.1%) of 52,440 cervical smears were reported to show TV, but microbiological confmnation was made in only 76% of 34 patients from whom a vaginal swab was subsequently taken. Over the same period, from a total of 96 cases of TV identified in the district (population 270,000), only 12 (13%) were first diagnosed in the department of G U medicine. 40% of the other 84 patients were subsequently seen in the G U clinic for test of cure, contact tracing and screening for other sexually transmitted infections (STIs). Trichomoniasis should not be diagnosed by cytology alone and clinicians need further education on the role of cytology in d i a g n o s i n g STIs. Collaborations between departments may improve the management of trichomoniasis and other conditions in the community and their development should be encouraged.
MEASLES - FORGOTTEN BUT NOT GONE. Y.Young I, C.Piper I, K.Bumke2, M.Sharland2, & M.Ramsay3; Merton, Sutton & Wandsworth HA1, St.George's Hospital2, and Communicable Disease Surveillance Centre3, London, UK. The incidence of confirmed measles continues to decline. However a recent outbreak amongst children at a local day-care nursery has served to highlight the importance of measles and the vulnerability of the unimmtmised and vaccine non-responders when vaccine uptake is low. The outbreak was recognised when three children from the same nursery were admitted to hospital with clinical measles. Further investigation revealed a total of eight children (age range 13-31mths; median I4mths) with similar symptoms during March 1997. All eight cases were subsequently laboratory confirmed. In total five of the children were admitted to hospital and one developed secondary pneumonia. Typing the measles RNA showed all to be Genotype t, one of the current wild types in the UK. Six of the eight children had not been immunised with MMR (mainly because of age); one was immunised during the incubation period of his wild virus infection and one had been immunised a year prior to this infection. Reported coverage of MMR vaccination locally is low (85%) and has declined with the recent adverse publicity. Should measles outbreaks be given wider publicity in the campaign to improve vaccine coverage?