BACKGROUND: Foodborne bacterial gastrointestinal infections are important causes of morbidity and mortality worldwide, and despite successful control programs in some developed countries, these infections continue to have a major impact on public health and economy. METHODS: On the basis of data from 3 national registries, we determined short- and long-term risks of hospitalization due to gastroenteritis, short-term complications, and long-term sequelae after infections with nontyphoid Salmonella enterica, Campylobacter species, Yersinia enterocolitica, diarrheagenic Escherichia coli, and Shigella species. RESULTS: Among 52,121 patients, 7524 (14.4%) were hospitalized with a diagnosis of gastroenteritis within 90 days after microbiological diagnosis. A total of 4941 patients (17.7%) with infections due to S. enterica and 1937 (10.8%) with infections due to Campylobacter species were admitted to the hospital. Complications, such as gastrointestinal perforation and invasive illness, occurred in 647 patients (1.2%). The risk of invasive illness was > 6-fold higher in patients with infections due to S. enterica (odds ratio [OR] compared with the general population, 30.3; 95% confidence interval [CI], 26.2-35.1) than in those with infections due to Campylobacter species (OR, 4.9; 95% CI, 3.5-6.8) (P
ReprintIn: Ugeskr Laeger. 2007 Feb 26;169(9):820-317355849
Climate changes will likely have an impact on the spectrum of infectious diseases in Europe. We may see an increase in vector-borne diseases, diseases spread by rodents such as Hantavirus, and food- and water-borne diseases. As the effects of climate changes are likely to occur gradually, a modern industrialised country such as Denmark will have the opportunity to adapt to the expected changes.
OBJECTIVE: To describe incidence and temporal trends of intussusceptions in Danish children during 1980 to 2001. METHODS: A population-based cohort study was conducted of 1.67 million children who were younger than 5 years during 1980 to 2001 and were followed up for 6.66 million person-years. The Danish National Patient Registry was used to identify cases of intussusception in the cohort. Age-specific incidence rates were main outcome measure. RESULTS: A total of 1814 cases of intussusception among children who were younger than 5 years were reported from 1980 to 2001. The incidence rate remained fairly constant during 1980 to 1990 but decreased by 55% (95% confidence interval: 43%-65%) from 1990 to 2001. The reduction was most pronounced among children aged 3 to 5 months. CONCLUSIONS: The incidence of intussusception among Danish children declined significantly during the 1990s, particularly among infants 3 to 5 months of age.
BACKGROUND: The capsular polysaccharide of group B meningococci (GBM) is structurally identical to a polysaccharide found on neural cell adhesion molecules in humans. This structural identity has raised concern that a vaccine based on the GBM capsular polysaccharide might induce autoimmune disease in vaccinated persons. Because systemic infection with GBM induces serum antibody in adults, we investigated whether persons with a history of GBM disease are at increased risk of developing autoimmune diseases. METHODS: The entire Danish population constituted our study cohort of 7,467,001 individuals, who were observed for autoimmune diseases from 1977 through 2004. At-risk years were counted as the number of uninfected years prior to the first recorded diagnosis of meningococcal disease but changed to person-years at risk at the diagnosis of GBM disease (2984 subjects) or group C meningococcal disease (914 patients). Ratios of incidence rates of autoimmune disease served as measures of the relative risk. RESULTS: Persons with a history of GBM disease experienced a total of 37,290 person-years at risk, ranging from 11 days to 31 years at risk after the onset of GBM disease, during which 49 cases of autoimmune disease occurred. Persons with GBM disease had no increased risk of autoimmune diseases, either compared with persons with a history of group C meningococcal disease (incidence rate ratio, 0.9; 95% confidence interval, 0.5-1.4) or compared with persons without a history of meningococcal disease (incidence rate ratio, 1.1; 95% confidence interval, 0.8-1.5). CONCLUSIONS: Our findings suggest that invasive disease caused by GBM is not associated with autoimmune diseases in humans for up to 31 years after meningococcal disease and should lessen concerns regarding the development of a capsular-based GBM vaccine.
In the past decades efforts to further diminish the case-fatality rate from meningococcal disease have proven challenging due to the often rapid progression of the disease in patients. In this study our objective was to characterise a subset of Neisseria meningitidis isolates to establish which sequence types were associated with increased mortality in Denmark during the period 2000-2007. We designed a matched case control and performed serogrouping, serotyping, serosubtyping and multilocus sequence typing (MLST) on 100 isolates. The clonal complex ST-32/ET-5 was found in 36% of the isolates, followed by the ST-11/ET-37 complex (14%) and ST-41/44 complex/Lineage 3 (14%). Eight new sequence types were found. None of the clonal complexes were significantly associated with increased mortality. Phenotype B:15:P1.7,16 tended to be a better predictor of death than ST-32. Although the numbers were low, the present study indicates that phenotyping may be a better predictor of mortality than MLST, which suggests that each typing method has its advantages and disadvantages. If this notion can be confirmed by other studies, it may stimulate additional research regarding the pathogenesis of severe illness, for example, if certain surface molecules trigger a cytokine storm more than others.
BACKGROUND: Group B meningococcal (GBM) disease induces antibodies that react in vitro with neural cell adhesion molecules in fetal brain tissue. Because IgG antibodies to GBM cross the placenta, the authors investigated whether women with a previous GBM disease had an increased risk of giving birth to preterm or to stillborn infants and whether the live-born children had an increased risk of birth defects. METHODS: Data were obtained from 4 national registries in the period 1974-2005 to form 2 cohorts: (1) 1422 women with confirmed GBM disease, and (2) their 502 firstborn children. RESULTS: Overall, there was no increased risk of preterm or stillbirths among the first cohort. Among the children, there was no increased risk of being born small for the gestational age, having birth defects (OR: 1.00; 95% CI: 0.53-1.90), diseases of the nervous system (HR: 0.38; 95% CI: 0.08-1.74), or any diseases within the first 3 years of life (HR: 1.06; 95% CI: 0.78-1.45) compared to births from a reference population with prior group C meningococcal disease. CONCLUSIONS: The results do not support the proposal that GBM is associated with immunoreactive disease that may affect the health of the offspring and are consistent with previous findings that GBM disease is not associated with an increased risk of autoimmune disease.
Department of Applied Epidemiology, National Center for Epidemiology, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
BACKGROUND: Epidemiologic evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains controversial. METHODS: From Danish and Swedish registries we selected 167 definite and probable sCJD cases (with onset between 1987 and 2003) and 3,059 controls (835 age-, sex-, and residence-matched, and 2,224 unmatched). Independent of case/control status, surgical histories were obtained from National Hospital Discharge Registries. Surgical procedures were categorized by body system group and lag time to onset of sCJD. Exposure frequencies were compared using logistic regression. RESULTS: A history of any major surgery, conducted >/=20 years before sCJD onset, was more common in cases than both matched (OR = 2.44, 95% CI = 1.46-4.07) and unmatched controls (OR = 2.25, 95% CI = 1.48-3.44). This observation was corroborated by a linear increase in risk per surgical discharge (OR = 1.57, 95% CI = 1.13-2.18; OR = 1.50, 95% CI = 1.18-1.91). Surgery of various body systems, including peripheral vessels, digestive system and spleen, and female genital organs, was significantly associated with increased sCJD risk. CONCLUSIONS: A variety of major surgical procedures constitute a risk factor for sCJD following an incubation period of many years. A considerable number of sCJD cases may originate from health care-related accidental transmission.
Worldwide the 3 most common pathogens for bacterial meningitis among infants and young children are Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis. Denmark included in the National Childhood Vaccination Programme vaccination against H. influenzae type B (Hib) in 1993 and invasive pneumococcal disease as of October 2007. Introduction of the conjugated heptavalent pneumococcal vaccine is, as in the post-Hib vaccination era, expected to change the epidemiology of bacterial meningitis in infants and young children. In 1980 it became mandatory to report suspected cases of bacterial meningitis and the surveillance system was further enhanced for laboratory diagnosed cases of N. meningitis in 1992 and S. pneumoniae in 1996 when a reminder procedure to the physician was issued. In this article we review the epidemiology of 418 notified cases of bacterial meningitis in children