Charmaine Gauci

A common, symptom-based case definition for gastroenteritis

National studies determining the burden of gastroenteritis have defined gastroenteritis by its clinical picture, using symptoms to classify cases and non-cases. The use of different case definitions has complicated inter-country comparisons. We selected four case definitions from the literature, applied these to population data from Australia, Canada, Ireland, Malta and the United States, and evaluated how the epidemiology of illness varied. Based on the results, we developed a standard case definition. The choice of case definition impacted on the observed incidence of gastroenteritis, with a 1.5-2.1 times difference between definitions in a given country. The proportion of cases with bloody diarrhoea, fever, and the proportion who sought medical care and submitted a stool sample also varied. The mean age of cases varied by <5 years under the four definitions. To ensure comparability of results between studies, we recommend a standard symptom-based case definition, and minimum set of results to be reported.

The magnitude and distribution of infectious intestinal disease in Malta: a population-based study

Routine sources of information on infectious intestinal disease (IID) capture a fraction of the actual disease burden. Population studies are required to measure the burden of illness. A retrospective age-stratified cross-sectional telephone study was carried out in Malta in order to estimate the magnitude and distribution of IID at population level. A random sample of 3504 persons was interviewed by a structured questionnaire between April 2004 and December 2005. The response rate was 99.7%. From the study, the observed standardized monthly prevalence was 3.18% (95% CI 0.7-5.74) with 0.421 (95% CI 0.092-0.771) episodes of IID per person per year. The monthly prevalence was higher in the <5 years age group and in females aged 31-44 years. The mean duration of illness was 6.8 days and a median duration of 3 days. A bimodal seasonal distribution was observed with peaks in June-July and October-November.

What does the food handler in the home know about salmonellosis and food safety

Food-borne illness causes a significant burden of disease globally. The majority of confirmed cases of food-borne illness in Malta are caused by salmonellosis. Detailed case investigations by the Disease Surveillance Unit, Malta, revealed that most of the notified cases of infectious intestinal disease are most likely to be due to poor food safety practices in the home. Consumer awareness studies have shown that, in general, consumers are aware of the recommended food safety precautions, yet still adopt high-risk behaviours. Three focus groups and a small case control group were formed to gather information on local consumer knowledge and attitudes towards safe food handling in the home. The responses from the three focus groups were analysed and grouped into general themes. The information obtained from these results was then used to plan a local food safety health promotion strategy. The results show that individuals who had been exposed to salmonellosis, or who had a dependant who had been exposed, had developed a higher level of food safety knowledge and awareness. Variations between knowledge and self-reported practices make it apparent that persons have to be convinced that food safety measures are effective before they take action to change their behaviour. In conclusion, consumer education strategies need to emphasise the burden of illness, making safe food handling meaningful to consumers. Continuous reinforcement of the messages may be effective in empowering the consumer to foster behaviour change.

Challenges in identifying the methodology to estimate the prevalence of infectious intestinal disease in Malta

Routine surveillance systems capture only a fraction of infectious intestinal disease (IID) that is actually occurring in the community. Different methodologies utilized among various international studies in the field were reviewed in order to devise an appropriate survey to obtain current estimates of prevalence of IID in Malta. An age-stratified retrospective cross-sectional telephone study was selected for the study due to its feasibility in terms of limited resources necessary (funds, time and human). The disadvantages of this type of study include the inherent biases such as selection bias (sampling, ascertainment and participation bias) and information bias (recall and observer bias). A pilot study was carried out using a random age-stratified sample of 100 persons over a 3-month period. A total of 5.0% (95% CI +/-4.27) of the population was estimated to have suffered from IID during that period. This estimate was used in order to assist in sample size calculations for a large-scale community study. It also served to test the survey instrument and methodology and to identify operational problems.

Estimating the burden and cost of infectious intestinal disease in the Maltese community.

The aim of this study was to estimate the burden of infectious intestinal disease (IID) and cost of illness at the community level from a societal aspect. A retrospective, age-stratified cross-sectional telephone study was carried out in Malta in 2004-2005. The number of cases, resources used and cost of resources were computed. The resources involved direct costs (health-care services, stool culture tests, medicines and personal costs) and indirect costs (costs from lost employment by cases and caregivers). This study estimated 0.421 (95% CI 0.092-0.771) separate episodes of IID per person per year in Malta which corresponds to 164 471 (95% CI 35 941-301 205) episodes of IID per year or 450 (95% CI 98-825) episodes of IID each day. The largest proportion of cost is due to provision of health-care services with euro10 454 901 [Maltese liri (Lm) 4 558 970] per year; followed by euro963 295 (Lm 2 209 393) in lost productivity; euro1 286 286 (Lm 561 078) in medicines; euro152 335 (Lm 66 452) in stool culture testing and euro71 487 (Lm 31 183) in personal costs, giving a total cost of illness of over euro16 million (7 million Lm) per year. The burden and cost of IID are high enough to justify efforts to control the illness. Such estimates are important to assess the cost-effectiveness of proposed specific interventions.

Are children attending child play areas at risk of infectious diseases? What can be done?

Aims: Child play areas can pose a risk to children of infectious diseases. The prolonged presence of micro-organisms in the environment has already been established. In order to quantify this risk, specific studies are required when carrying out a risk assessment. Methods: In order to assess the microbiological hazard in play areas in Malta, a study was performed during 2005, which consisted of an examination of the hygienic practices carried out in play areas by means of face-to-face interviews; inspections of the premises; environmental sampling and testing, and a study on the awareness and attitudes of parents to risk factors (face-to-face interviews). Follow up studies were performed after recommendations on risk management were provided. Results: Overall, the hygienic practices in play areas were satisfactory. Of the premises 66% were licensed, 55% of the food handlers were registered, appropriate cooking and cooling facilities were available for most of the premises, temperature control records were available at 80% of premises, 60% were using disinfectant for cleaning play area surfaces and monitoring of refrigerated vehicles was carried out by 60%. There was an overall improvement after recommendations were given. At the first inspection, 67% of the premises were categorized as being fair and 33% as being good. On repeat inspection, after recommendations were made, the grading of the premises were: excellent 7%, satisfactory 33%, good 53% and fair 7%. The results of the environmental swabs taken had low counts of indicator organisms indicating a good overall hygienic condition. Parents stated that 58% of the areas were in good hygienic condition but lacked adequate hand-washing facilities for children. All parents agreed with the importance of hand hygiene and that infectious diseases can be transmitted via contaminated objects and from one person to another. Conclusion: An effective control strategy needs to be implemented involving all stakeholders to ensure that effective hygienic practices in play areas are available to protect children from infectious diseases.

The HepHIV 2017 Conference in Malta: joining forces for the earlier diagnosis of HIV and viral hepatitis

The objective of the article is to provide an overview of the results of the HepHIV 2017 Conference organized by the HIV in Europe initiative under the Maltese EU Presidency in January 2017.

Towards comprehensive and effective strategies to address sexual health

Sexual health is an important global public health concern. Planning effective strategies to improve sexual health requires a high degree of attention to the local epidemiological trends and cultural context where the strategy is to be implemented. The paper by Chemtob et al. describes the process to develop a plan that aims to reduce the burden of Sexually Transmitted Infections in Israel by 2025. This commentary argues that increased attention to planning and implementation of sexual health policy is required in order to address the real burden of disease. Sexual health should not be merely addressed from a communicable disease control perspective but should comprehensively address health and wellbeing of all population groups through a positive approach in line with the WHO current definition of sexual health. As even traditionally culturally conservative societies are experiencing rapid changes in attitudes and practices towards sexual lifestyles, the challenge is to ensure that sexual health strategies combine evidence-informed measures and good practices with culturally appropriate communication and implementation approaches.