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The regional framework for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis in Asia and the Pacific 2018–. These three diseases have a significant burden in the Western Pacific region: the region alone accounts for 45% of all global hepatitis B infections;2 an increasing trend in syphilis infections is observed among key populations, including women of childbearing age;6 and while HIV prevalence is low across the region at 0.1%, HIV mother-to-child transmission (MTCT) is high at 12%7. Woodring et al. Triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis.

Antenatal HIV and syphilis screening coverage and hepatitis B birth dose coverage in eight countries in the Western Pacific region. Regional framework for the triple elimination of mother-to-child transmission of HIV, hepatitis B and syphilis in Asia and the Pacific DRAFT]. The study aims to describe the epidemiology of CA-MRSA in Aboriginal children in the Hunter New England Local Health District (HNELHD).

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause bacterial skin infections that are common health problems for many Australian Aboriginal and Torres Strait Islander (hereafter Aboriginal) children and families in rural New South Wales (NSW).1 The term CA -MRSA separates the infection from MRSA acquired through the healthcare system, including hospitals. Seasonal analysis of CA-MRSA isolates during the study period showed that most cases occurred in summer and early autumn.

Fig. 1.  Antenatal HIV and syphilis screening coverage and hepatitis B birth-dose coverage in eight countries in  the Western Pacific Region
Fig. 1. Antenatal HIV and syphilis screening coverage and hepatitis B birth-dose coverage in eight countries in the Western Pacific Region

DISCUSSION

Currently NSW treatment guidelines for skin infections may not take into account important, associated and intertwined factors such as social, economic, housing and environmental factors in the management of infections.1 Tailoring treatment guidelines to respond to these social determinants of health for Aboriginal people access to PHC in acute situations can be an effective step in reducing disease recurrence in rural areas.1 The emergency department can be an important institution for improving skin health through health information sharing, initiating referrals and arranging follow-up of children with skin diseases. This would be particularly valuable in rural and remote areas where, in the absence of adequate, culturally safe PHC, many Aboriginal people use hospital emergency departments to treat bacterial skin infections caused by CA-MRSA. Further research using administrative pathology data can be conducted to better understand the phenotypes and antibiotic susceptibility of CA-MRSA in Aboriginal children in NSW.

CA-MRSA surveillance models, which coordinate both hospital and community activities at the local and state levels, have been proposed as a way to provide a more comprehensive epidemiological assessment.13 Local hospitals, primary care physicians and other health facilities should collect data from patients and establish contacts, while the government agencies would collect and distribute surveillance reports. The resources required to implement such a system would be significant (personnel, materials, time, storage and transportation) and under-reporting may be another limitation.13 A five-year study of the incidence of CA-MRSA in remote communities in Canada found high infection rates with 25% of infections being re-infection. The study concluded that surveillance was important for understanding antibiotic resistance and the changing profile of CA-MRSA.14 As this debate continues, surveillance of CA-MRSA in NSW could be improved by adopting a unified surveillance definition for community association.

Surveillance alone will not solve the problem of bacterial skin infections caused by CA-MRSA. Many people with CA-MRSA use PHC, including Aboriginal Community Controlled Health Services, community health centers and general practitioners, from which data were not available for inclusion. These limitations imply that the number of people experiencing CA-MRSA is higher than reported here.

CA-MRSA is not notifiable in NSW; however, pathology and hospital administration data can be linked to help assess the size and scope of the problem. Implementation of routine surveillance warrants further consideration in light of the costs and limitations of CA-MRSA notification. Our results suggested the need to increase opportunities and at the same time improve the uptake rate of community-based screening for non-recent immigrants.

Our results indicated a need to increase opportunities while improving the rate of use of community-based screening for recent immigrants.

Fig. 2.  Individuals aged under 20 years with hospital emergency department wound/skin swabs with CA- CA-MRSA, by season, Hunter New England Local Health District, 2008–2014
Fig. 2. Individuals aged under 20 years with hospital emergency department wound/skin swabs with CA- CA-MRSA, by season, Hunter New England Local Health District, 2008–2014

BACKGROUND

Foreign-born persons are considered one of the high-risk populations for tuberculosis (TB), and numerous studies have discussed the potential role of pre-entry TB screening for immigrants. In Japan, approximately 50% of foreign-born TB occurs among those who entered Japan more than five years before being diagnosed, that is, non-recent immigrants. However, little attention has so far been given to the issue of TB control among the non-recent immigrants.

Therefore, a detailed analysis of Japanese tuberculosis surveillance data was performed to describe the characteristics of tuberculosis among recent immigrants and to discuss policy implications in terms of post-entry interventions in Japan. The main findings were as follows: 1) the proportion of pulmonary tuberculosis cases aged 65 years and older was higher among recent immigrants than non-recent immigrants (9.8%. Ethics clearance was not required as the JTBS electronic data do not include case identifiers). in accordance with the Ethical Guidelines for Epidemiological Research established by the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labor and Welfare of Japan.

RESULTS

Non-recent immigrants: immigrants who entered Japan more than five years before, were diagnosed with TB, or whose time of entry was unknown. Recent immigrants: immigrants who had entered Japan within five years before being diagnosed with TB. General characteristics of non-recent and recent immigrants with pulmonary TB, newly notified Non-recent immigrants Recent immigrants.

Countries of birth among recent and recent immigrants with pulmonary tuberculosis, newly reported, by age group, 2007–2014. For the first number, there was a significantly higher proportion of recent than recent immigrants aged 65 and over (9.8% compared to those from the Republic of Korea and China. We also found the proportion of those with social risk factors such as a history of homelessness and those , receiving welfare was significantly higher among recent immigrants than recent immigrants.

The second question concerned the proportion of those detected through routine school or workplace screening, which was significantly less among non-recent than recent immigrants aged between 25 and 64 (15.4% vs. 28.7%) . No significant difference was observed in the distribution of types of case finding between non-recent and recent immigrants among those aged 65 and over. The proportion of those who had died was significantly higher among the non-recent immigrants (3.2% vs. 0.3%, P < 0.001, with Bonferroni correction); after adjusting for age, the standardized mortality ratio was 2.3.

Methods of detection among non-recent and recent immigrants with pulmonary TB, newly notified, by age group, 2007-2014. Non-recent immigrants: those who entered Japan more than five years before being diagnosed with TB or whose timing of entry was unknown. Recent immigrants: those who entered Japan within five years before being diagnosed with TB.

The denominators do not necessarily equal the total number of non-recent and recent immigrants due to missing data.

Table 1.  General characteristics of non-recent and recent immigrants with pulmonary TB, newly notified, 2007–2014 Non-recent immigrants Recent immigrants
Table 1. General characteristics of non-recent and recent immigrants with pulmonary TB, newly notified, 2007–2014 Non-recent immigrants Recent immigrants

CONCLUSIONS

Objective: To estimate Mongolia's incidence and prevalence trends of gonorrhea and chlamydia in women and men aged 15-49 years to inform control of STIs and HIV, a national health sector priority. Discussion: The incidence of gonorrhea and chlamydia in Mongolia is estimated to have decreased during the early 2000s, possibly associated with syndrome management in primary care facilities and the improvement of treatment coverage since 2001 and the scale-up of HIV/STI prevention interventions since 2003. The however, prevalence remains high with most cases of gonorrhea and chlamydia not treated or recorded in the public health system.

This article presents estimates of the spectrum of adult prevalence and incidence of gonorrhea and chlamydia in Mongolia from 1995 to 2016 using prevalence survey data. Estimated numbers of male gonorrhea and chlamydia cases were compared with UD case reports to assess treatment coverage and completeness of reporting. The Spectrum-STI tool (http://avenirhealth.org/software-spectrum.php)9 assessed the prevalence and incidence of gonorrhea and chlamydia in adults aged 15-49 years.

No data has been identified for men; therefore, male gonorrhea and chlamydia estimates were based on female estimates (see Methods). Assuming 35% treatment coverage of symptomatic gonorrhea and chlamydia episodes in men and 22.5% in women,10,14 we calculated the mean duration of gonorrhea and chlamydia episodes weighted between the treated and untreated fractions (SDC3). The Spectrum estimates of symptomatic cases of gonorrhea and UD were then compared to national-level case reports for laboratory-diagnosed gonorrhea and UD (a non-overlapping set of cases with no laboratory diagnosis) collected from 1995 to 2016 by the National Center for Communicable Diseases15 , 16 (SDC4) to estimate the completeness of the reporting.

Spectrum-estimated cases of gonorrhea and chlamydia in men aged 15–49 years by treatment and reporting status, Mongolia. Spectrally estimated prevalence and incidence rate (per 100,000 person-years) of gonorrhea and chlamydia in women and men aged 15–49, Mongolia in 2016. Sensitivity analysis – effect of different (selected) assumptions and values ​​on national gonorrhea estimates and prevalence and chlamydia incidence and estimated reporting completeness of symptomatically treated gonorrhea among Mongolian men aged 15–49 years in 2016.

In conclusion, model-based estimates based on prevalence studies suggest that gonorrhea and chlamydia have declined in Mongolia but remain high. Finally, assessing the completeness of gonorrhea and UD case reporting required additional assumptions, most of which were global rather than Mongolia-specific. Estimating prevalence trends in gonorrhea and syphilis incidence in adults in low- and middle-income countries with the Spectrum-STI model: results for Zimbabwe and Morocco from 1995 to 2016.

Fig. 2A shows Spectrum-estimated incident gonorrhoea  cases in men from 1995 to 2016 split into episodes  symptomatic and asymptomatic, treated and untreated  and reported and unreported
Fig. 2A shows Spectrum-estimated incident gonorrhoea cases in men from 1995 to 2016 split into episodes symptomatic and asymptomatic, treated and untreated and reported and unreported

Pigura

Fig. 1.  Antenatal HIV and syphilis screening coverage and hepatitis B birth-dose coverage in eight countries in  the Western Pacific Region
Fig. 2.  H    IV, syphilis and hepatitis B screening, treatment and vaccination services offered during antenatal,  delivery, postnatal care and well-child visits
Table 1.  Comparison of study definitions of hospital origin (HO) and health-care-associated community onset  (HACO) methicillin-resistant Staphylococcal aureus (MRSA) with the Centers for Disease Control and  Prevention (CDC) definitions
Fig. 1.  Map of Hunter New England Local Health District and hospitals, NSW, 2017
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Mga Sanggunian

NAUUGNAY NA DOKUMENTO

Submitted: 13 March 2018; Published: 20 August 2018 Objective: The purpose of this survey was to estimate the prevalence of viral load VL suppression and emergence of HIV drug