Per Nordin

Prevalence of herpes simplex virus antibodies in childhood and adolescence: a cross-sectional study.

The changing spectrum of herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) infections makes it important to define the seroepidemiology of HSV. The object of this study was to determine the prevalence of HSV-1 and HSV-2 immunoglobulin G antibodies in a young Swedish population by investigating 2106 serum samples from people aged 0-19 y. Sera were tested in HSV type-specific enzyme-linked immunosorbent assays using glycoprotein G-1 (gG-1) and glycoprotein G-2 (gG-2) as antigens. The overall seroprevalence was 31% (95% CI 29-33) for HSV-1 and 0.5% (95% CI 0.2-0.9) for HSV-2. The HSV-1 seroprevalence was higher with increasing age, and significantly higher in the age cohort 15-19 y compared with 1-4-y-olds (37% vs 24%). The HSV-1 infection seemed to be acquired early in life. In the age cohort 1-2 y, the prevalence was over 20%, presumably reflecting an established viral infection. In adolescence the HSV-1 seroprevalence may reflect both oral and sexual transmission. The seroprevalence in the oldest age cohort did not differ significantly from that seen in a Swedish study in which sera were sampled from young girls in the 1970s.

Borrelia burgdorferi antibodies in outdoor and indoor workers in south-west Sweden

Two hundred and fifty-three farmers and forest workers and 249 clerks from south-west Sweden were recruited to a cross-sectional seroprevalence study to find out if individuals working outdoors are more prone to acquire Borrelia burgdorferi infection than indoor workers and to find undiagnosed cases of Lyme borreliosis. The participants answered a questionnaire and blood specimens were collected to estimate the prevalence of antibodies to B. burgdorferi in each group. Sera were analysed with an enzyme-linked immunoassay technique to determine IgG antibodies to B. burgdorferi flagellum. The prevalence of B. burgdorferi antibodies was 7.6% in the farmers and forest workers vs. 5.3% in the clerks (adjusted odds ratio [age, sex] = 1.2 [95% confidence interval = 0.5-2.8]). One case of Lyme borreliosis was diagnosed. The positive predictive value of the antibody test was estimated to be 3% in the studied populations. B. burgdorferi infection is of low endemicity in south-west Sweden and is probably not an occupational risk among outdoor workers. Undiagnosed cases of Lyme borreliosis are uncommon. The test used is not acceptable for screening purposes.Two hundred and fifty-three farmers and forest workers and 249 clerks from south-west Sweden were recruited to a cross-sectional seroprevalence study to find out if individuals working outdoors are more prone to acquire Borrelia burgdorferi infection than indoor workers and to find undiagnosed cases of Lyme borreliosis. The participants answered a questionnaire and blood specimens were collected to estimate the prevalence of antibodies to B. burgdorferi in each group. Sera were analysed with an enzyme-linked immunoassay technique to determine IgG antibodies to B. burgdorferi flagellum. The prevalence of B. burgdorferi antibodies was 7.6% in the farmers and forest workers vs. 5.3% in the clerks (adjusted odds ratio \[age, sex] 1.2 \[95% confidence interval 0.5-2.8]). One case of Lyme borreliosis was diagnosed. The positive predictive value of the antibody test was estimated to be 3% in the studied populations. B. burgdorferi infection is of low endemicity in south-west Sweden and is probably not an occupational risk among outdoor workers. Undiagnosed cases of Lyme borreliosis are uncommon. The test used is not acceptable for screening purposes.

Treatment of Tungiasis with Dimeticone: A Proof-of-Principle Study in Rural Kenya

Tungiasis (sand flea disease) is a neglected tropical disease, prevalent in resource-poor communities in South America and sub-Saharan Africa. It is caused by an inflammatory response against penetrated female sand fleas (Tunga penetrans) embedded in the skin of the host. Although associated with debilitating acute and chronic morbidity, there is no proven effective drug treatment. By consequence patients attempt to remove embedded sand fleas with non-sterile sharp instruments, such as safety pins, a procedure that represents a health threat by itself. In this proof-of-principle study we compared the topical application of a mixture of two dimeticones of low viscosity (NYDA) to the topical application of a 0.05% solution of KMnO4 in 47 school children in an endemic area in rural Kenya. The efficacy of the treatment was assessed during a follow up period of seven days using viability signs of the embedded parasites, alterations in the natural development of lesion morphology and the degree of local inflammation as outcome measures. Seven days after treatment, in the dimeticone group 78% (95% CI 67–86%) of the parasites had lost all signs of viability as compared to 39% (95% CI 28–52%) in the KMnO4 group (p<0.001). In the dimeticone group 90% (95% CI 80–95%) of the penetrated sand fleas showed an abnormal development already after 5 days, compared to 53% (95% CI 40–66%; p<0.001) in the KMnO4 group. Seven days after treatment, signs of local skin inflammation had significantly decreased in the dimeticone group (p<0.001). This study identified the topical application of dimeticones of low viscosity (NYDA) as an effective means to kill embedded sand fleas. In view of the efficacy and safety of the topical treatment with dimeticone, the mechanical extraction of embedded sand fleas using hazardous instruments is no longer warranted.

Treatment of tungiasis with a two-component dimeticone : a comparison between moistening the whole foot and directly targeting the embedded sand fleas

BackgroundTungiasis (sand flea disease) is caused by the penetration of female sand fleas (Tunga penetrans, Siphonaptera) into the skin. It belongs to the neglected tropical diseases and is prevalent in South America, the Caribbean and sub-Saharan Africa. Tungiasis predominantly affects marginalized populations and resource-poor communities in both urban and rural areas. In the endemic areas, patients do not have access to an effective and safe treatment. A proof-of-principle study in rural Kenya has shown that the application of a two-component dimeticone (NYDA®) which is a mixture of two low viscosity silicone oils caused almost 80% of the embedded sand fleas to lose their viability within 7 days.MethodsIn this study we compared the efficacy of two distinct modes of application of NYDA®; one targeted application to the area where the parasite protrudes through the skin and one comprehensive application to the whole foot.ResultsIndependent of the two modes of application, the dimeticone caused more than 95% of embedded sand fleas to lose all signs of viability within 7 days. The targeted application killed embedded sand fleas more rapidly compared to when the whole foot was covered. The proportion of viable lesions at day two were 7.0 versus 23.4% (p < 0.01) and at day five 3.9 versus 12.5% (p < 0.02).ConclusionsOur findings suggest that the dimeticone could provide a safe and effective treatment for tungiasis in areas with difficult access to health care.Trial registrationISRCTN ISRCTN74306878

From a weighing scale to a pole: a comparison of two different dosage strategies in mass treatment of Schistosomiasis haematobium.

Background Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium. Methods In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression. Conclusions and interpretation The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.Background Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium. Methods In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression. Conclusions and interpretation The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.

A zebra is not always a zebra and a zero is not always a zero

onstrate normal defecation dynamics on follow-up (2). Therefore, the high clinical relapse rate and the low recovery rate are not explained by a high rate of physiologic relapse (2, 4). It appears, that chronic constipation with encopresis results from an intricate weave of a number of primary, secondary, physical, and psychological factors. As pointed out in our publication, there may be benefits from biofeedback treatment that cannot be measured by evaluating recovery rates (1). Biofeedback-treated patients may achieve all of their treatment gains quicker than conventionally treated patients, and the benefit may be reduction of symptoms such as less laborious defecation or fewer and lower laxative dosages, rather than complete recovery. I hope that my publication (1) and the comments by Dr. Wald will bring about further randomized studies in order to clarify the contribution of biofeedback training to the treatment of chronic constipation, encopresis, and abnormal defecation dynamics in children. VERA LOENING-BAUCKE, M D University of Iowa Iowa City, Iowa

Integrating new knowledge into practice: An evaluation study on a continuing education for Swedish child health nurses on non-synostotic plagiocephaly

The aim of this study was to assess what knowledge on non‐synostotic plagiocephaly prevention and reversal intervention and control group nurses imparted to parents and parents integrated in infant care.