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Clustered tuberculosis in a low-burden country: nationwide genotyping through 15 years.

https://arctichealth.org/en/permalink/ahliterature123705
Source
J Clin Microbiol. 2012 Aug;50(8):2660-7
Publication Type
Article
Date
Aug-2012
Author
Z. Kamper-Jørgensen
A B Andersen
A. Kok-Jensen
I C Bygbjerg
P H Andersen
V O Thomsen
M. Kamper-Jørgensen
T. Lillebaek
Author Affiliation
International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark. Kamper-Jørgensen, zazakj@me.com
Source
J Clin Microbiol. 2012 Aug;50(8):2660-7
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cluster analysis
DNA Transposable Elements
DNA, Bacterial - genetics
Denmark - epidemiology
Female
Genotype
Humans
Infant
Infant, Newborn
Male
Middle Aged
Molecular Epidemiology
Molecular Typing
Mycobacterium tuberculosis - classification - genetics - isolation & purification
Polymorphism, Restriction Fragment Length
Retrospective Studies
Tuberculosis - epidemiology - microbiology
Young Adult
Abstract
Molecular genotyping of Mycobacterium tuberculosis has proved to be a powerful tool in tuberculosis surveillance, epidemiology, and control. Based on results obtained through 15 years of nationwide IS6110 restriction fragment length polymorphism (RFLP) genotyping of M. tuberculosis cases in Denmark, a country on the way toward tuberculosis elimination, we discuss M. tuberculosis transmission dynamics and point to areas for control interventions. Cases with 100% identical genotypes (RFLP patterns) were defined as clustered, and a cluster was defined as cases with an identical genotype. Of 4,601 included cases, corresponding to 76% of reported and 97% of culture-verified tuberculosis cases in the country, 56% were clustered, of which 69% were Danes. Generally, Danes were more often in large clusters (= 50 persons), older (mean age, 45 years), and male (male/female ratio, 2.5). Also, Danes had a higher cluster frequency within a 2-year observation window (60.8%), and higher clustering rate of new patterns over time, compared to immigrants. A dominant genotype, cluster 2, constituted 44% of all clustered and 35% of all genotyped cases. This cluster was primarily found among Danish males, 30 to 59 years of age, often socially marginalized, and with records of alcohol abuse. In Danes, cluster 2 alone was responsible for the high cluster frequency level. Immigrants had a higher incidence of clustered tuberculosis at a younger age (0 to 39 years). To achieve tuberculosis elimination in Denmark, high-risk transmission environments, like the cluster 2 environment in Danes, and specific transmission chains in immigrants in the capital area, e.g., homeless/socially marginalized Somalis/Greenlanders, often with alcohol abuse, must be targeted, including groups with a high risk of reactivation.
Notes
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PubMed ID
22675129 View in PubMed
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A dominant Mycobacterium tuberculosis strain emerging in Denmark.

https://arctichealth.org/en/permalink/ahliterature69315
Source
Int J Tuberc Lung Dis. 2004 Aug;8(8):1001-6
Publication Type
Article
Date
Aug-2004
Author
T. Lillebaek
A. Dirksen
A. Kok-Jensen
A B Andersen
Author Affiliation
International Reference Laboratory of Mycobacteriology, Statens Serum Institute, Copenhagen, Denmark. tll@ssi.dk
Source
Int J Tuberc Lung Dis. 2004 Aug;8(8):1001-6
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Adult
Chi-Square Distribution
DNA Fingerprinting
Denmark - epidemiology
Disease Outbreaks
Female
Genotype
Humans
Male
Middle Aged
Mycobacterium tuberculosis - genetics
Prevalence
Tuberculosis - epidemiology - microbiology
Abstract
SETTING: Denmark, a high-income country with a low prevalence of tuberculosis. OBJECTIVE AND DESIGN: Molecular epidemiological studies of Mycobacterium tuberculosis strains are conducted worldwide, and distinct strains have been associated with large outbreaks of tuberculosis. This is the first systematic population-based search for distinct strains of M. tuberculosis in Denmark among 4102 strains DNA fingerprinted nationwide from 1992 to 2001. RESULTS: A specific strain of M. tuberculosis has emerged rapidly in Denmark: in 1992, the Danish Cluster 2 strain accounted for 5.8% of all culture-positive Danish-born cases, increasing to 29.0% in 2001. The Cluster 2 cases were on average younger (41.8 vs. 51.4 years), more likely to be male (81.4% vs. 64.1%), and more likely to have pulmonary involvement only (90.3% vs. 64.6%) than other Danish-born cases. During the first 4 observation years, they were mainly found in the capital city, Copenhagen, but were later increasingly observed in the provinces. CONCLUSION: The reasons for the increasing dominance and change in geographical distribution of Cluster 2 strains in Denmark is unknown, but may be partly explained by the fact that Cluster 2 is associated with younger males with pulmonary disease manifestation. We consider it as an outbreak and believe the situation requires increased focus on early tuberculosis diagnosis and control of transmission in Denmark.
PubMed ID
15305484 View in PubMed
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The effectiveness of BCG vaccination in preventing Mycobacterium tuberculosis infection and disease in Greenland.

https://arctichealth.org/en/permalink/ahliterature257098
Source
Thorax. 2014 Sep;69(9):851-6
Publication Type
Article
Date
Sep-2014
Author
S W Michelsen
B. Soborg
A. Koch
L. Carstensen
S T Hoff
E M Agger
T. Lillebaek
H C F Sorensen
J. Wohlfahrt
M. Melbye
Author Affiliation
Department of Epidemiology Research, Statens Serum Institut, Copenhagen S, Denmark.
Source
Thorax. 2014 Sep;69(9):851-6
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Adjuvants, Immunologic
Adolescent
Adult
BCG Vaccine
Child
Child, Preschool
Cross-Sectional Studies
Female
Follow-Up Studies
Greenland - epidemiology
Humans
Incidence
Interferon-gamma Release Tests
Male
Mycobacterium tuberculosis
Prevalence
Tuberculosis, Pulmonary - epidemiology - microbiology - prevention & control
Young Adult
Abstract
The BCG vaccine's ability to prevent Mycobacterium tuberculosis infection (MTI) remains highly debated. In Greenland, BCG vaccination was introduced in 1955, but was temporarily discontinued (1991-1996) due to nationwide policy changes. The study aimed to use the transient stop in BCG vaccination to evaluate the effect of vaccination on MTI prevalence and TB incidence.
MTI study: A cross-sectional study (2012), comprising East Greenlanders born during 1982-2006, evaluated the effect of BCG vaccination on MTI prevalence; a positive interferon ? release assay defined an MTI case. Associations were estimated using logistic regression. TB study: a cohort study covering the same birth cohorts with follow-up until 2012 evaluated the vaccine's effect on TB incidence. A personal identifier allowed for follow-up in the TB notification system. Associations were estimated using Cox regression.
MTI study: Included 953 participants; 81% were BCG-vaccinated; 29% had MTI, 23% among vaccinated and 57% among non-vaccinated. BCG vaccination reduced the odds of MTI, OR 0.52 (95% CI 0.32 to 0.85), p=0.01. Vaccine effectiveness against MTI was 20%. TB study: Included 1697 participants followed for 21,148 person-years. 6% were notified with TB, 4% among vaccinated and 11% among non-vaccinated. BCG vaccination reduced the risk of TB, HR 0.50 (95% CI 0.26 to 0.95), p=0.03, yielding a vaccine effectiveness of 50%.
BCG vaccination was effective in reducing both MTI and TB disease among children and young adults in a TB high-endemic setting in Greenland.
PubMed ID
24969643 View in PubMed
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[Heroin abuse among Danish prisoners on remand. I. Prevalence related to form of administration]

https://arctichealth.org/en/permalink/ahliterature11186
Source
Ugeskr Laeger. 1996 Aug 19;158(34):4749-53
Publication Type
Article
Date
Aug-19-1996
Author
H S Andersen
D M Sestoft
T. Lillebaek
G. Gabrielsen
Author Affiliation
Psykiatrisk afdeling, Bispebjerg Hospital, København.
Source
Ugeskr Laeger. 1996 Aug 19;158(34):4749-53
Date
Aug-19-1996
Language
Danish
Publication Type
Article
Keywords
Administration, Inhalation
Adolescent
Adult
Comparative Study
Cross-Sectional Studies
Denmark - epidemiology
English Abstract
Female
Heroin Dependence - epidemiology - psychology - rehabilitation
Humans
Male
Methadone - therapeutic use
Middle Aged
Narcotics - therapeutic use
Prevalence
Prisoners - psychology
Substance Abuse, Intravenous
Abstract
Two groups of Danish prisoners on remand (in solitary confinement and not in solitary confinement) were examined by interview on reception (n = 133 & n = 95) in order to evaluate the prevalence and form of administration of opioid abuse/dependence. About 50% had abused opioids during their lifetime; one third were dependent at the time of reception. Twenty percent of opioid dependent prisoners administered opioids by smoking. More intravenous users were treated with methadone before and during imprisonment than those who were dependent on smoking opioids. Few were objectively suffering from withdrawal symptoms. The psycho-social impact of dependence on smoking heroin and intravenous heroin one month prior to imprisonment was at the same level and substantial as measured by the Global Assessment Scale.
PubMed ID
8801682 View in PubMed
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A longitudinal study of prisoners on remand: psychiatric prevalence, incidence and psychopathology in solitary vs. non-solitary confinement.

https://arctichealth.org/en/permalink/ahliterature72132
Source
Acta Psychiatr Scand. 2000 Jul;102(1):19-25
Publication Type
Article
Date
Jul-2000
Author
H S Andersen
D. Sestoft
T. Lillebaek
G. Gabrielsen
R. Hemmingsen
P. Kramp
Author Affiliation
Clinic of Forensic Psychiatry, Ministry of Justice, Copenhagen, Denmark.
Source
Acta Psychiatr Scand. 2000 Jul;102(1):19-25
Date
Jul-2000
Language
English
Publication Type
Article
Keywords
Adult
Comparative Study
Confounding Factors (Epidemiology)
Denmark - epidemiology
Female
Humans
Incidence
Longitudinal Studies
Male
Mental Disorders - epidemiology - etiology - psychology
Middle Aged
Patient Isolation
Population Surveillance
Prevalence
Prisoners - psychology
Psychiatric Status Rating Scales
Questionnaires
Research Support, Non-U.S. Gov't
Risk factors
Sampling Studies
Severity of Illness Index
Social Isolation
Stress, Psychological - etiology
Abstract
OBJECTIVE: To compare two levels of stress (solitary confinement (SC) and non-SC) among remand prisoners as to incidence of psychiatric disorders in relation to prevalent disorders. METHOD: Longitudinal repeated assessments were carried out from the start and during the remand phase of imprisonment. Both interview-based and self-reported measures were applied to 133 remand prisoners in SC and 95 remand prisoners in non-SC randomly selected in a parallel study design. RESULTS: Incidence of psychiatric disorders developed in the prison was significantly higher in SC prisoners (28%) than in non-SC prisoners (15%). Most disorders were adjustment disorders, with depressive disorders coming next. Incident psychotic disorders were rare. The difference regarding incidence was primarily explained by level of stress (i.e. prison form) rather than confounding factors. Quantitative measures of psychopathology (Hamilton Scales and General Health Questionnaire) were significantly higher in subjects with prevalent and incident disorders compared to non-disordered subjects. CONCLUSION: Different levels of stress give rise to different incidence of psychiatric morbidity among remand prisoners. The surplus of incident disorders among SC prisoners is related to SC, which may act as a mental health hazard.
PubMed ID
10892605 View in PubMed
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A longitudinal study of prisoners on remand: repeated measures of psychopathology in the initial phase of solitary versus nonsolitary confinement.

https://arctichealth.org/en/permalink/ahliterature186695
Source
Int J Law Psychiatry. 2003 Mar-Apr;26(2):165-77
Publication Type
Article
Author
Henrik Steen Andersen
D. Sestoft
T. Lillebaek
G. Gabrielsen
R. Hemmingsen
Author Affiliation
Centre for Crisis and Disaster Psychiatry, The State Hospital, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. hsal@rh.dk
Source
Int J Law Psychiatry. 2003 Mar-Apr;26(2):165-77
Language
English
Publication Type
Article
Keywords
Denmark - epidemiology
Forensic Psychiatry
Humans
Interview, Psychological
Interviews as Topic
Longitudinal Studies
Mental Disorders - diagnosis - pathology - psychology
Prisoners - psychology
Questionnaires
Social Isolation
PubMed ID
12581753 View in PubMed
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Mycobacterium tuberculosis outbreak strain of Danish origin spreading at worrying rates among greenland-born persons in Denmark and Greenland.

https://arctichealth.org/en/permalink/ahliterature107042
Source
J Clin Microbiol. 2013 Dec;51(12):4040-4
Publication Type
Article
Date
Dec-2013
Author
T. Lillebaek
A B Andersen
E M Rasmussen
Z. Kamper-Jørgensen
M K Pedersen
K. Bjorn-Mortensen
K. Ladefoged
V O Thomsen
Author Affiliation
International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
Source
J Clin Microbiol. 2013 Dec;51(12):4040-4
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Denmark - epidemiology
Disease Outbreaks
Ethnic Groups
Female
Genotype
Greenland - epidemiology
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Molecular Typing
Mycobacterium tuberculosis - classification - isolation & purification
Retrospective Studies
Tuberculosis - epidemiology - microbiology - transmission
Young Adult
Abstract
Transmission of Mycobacterium tuberculosis continues at high rates among Greenland-born persons in Greenland and Denmark, with 203 and 450 notified cases per 10(5) population, respectively, in the year 2010. Here, we document that the predominant M. tuberculosis outbreak strain C2/1112-15 of Danish origin has been transmitted to Greenland-born persons in Denmark and subsequently to Greenland, where it is spreading at worrying rates and adding to the already heavy tuberculosis burden in this population group. It is now clear that the C2/1112-15 strain is able to gain new territories using a new population group as the "vehicle." Thus, it might have the ability to spread even further, considering the potential clinical consequences of strain diversity such as that seen in the widely spread Beijing genotype. The introduction of the predominant M. tuberculosis outbreak strain C2/1112-15 into the Arctic circumpolar region is a worrying tendency which deserves attention. We need to monitor whether this strain already has, or will, spread to other countries.
Notes
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PubMed ID
24068008 View in PubMed
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19 records – page 1 of 2.