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ISSN 0382-232X
.:_,
Canada Diseases
Weekly Report
C:.f
,, . p 25 1991
Date of publication: 24 August 1991
Rapport hebdomadalre des
maladies au -Canada
Date de publication: 24 aoOt 1991
Vol. 17·34
Contenu du present numero:
Contained In this Issue:
Salmonella poona . . .
Measles • United States, 1990
Announcement . • . .
185
186
190
Sa/monellapoona . . . . . .
La rougeola aux Etats-Unis en 1990
Annonce . . • • • • . • .
185
186
190
Rapport prellmlnalre
Prellmlnary Report
SALMONELLA POONA
SALMONELLA POONA
Since the first week of June, 1991, 77 confirmed cases of
Depuis la premiere semaine de juin 1991, 77 cas confirmes d'infection
a
Salmonel/apoona have been reported to LCDC, Ottawa, 69 from the
Salmonella poona ont ete signales au LLCM aOttawa, soit 69 eri Ontario et le
province of Ontario and the remainder from the provinces of Quebec
(3), Manitoba (3), Saskatchewan (2), and Newfoundland (1). This is a
rare serotype and has been historically associated with imported
turtles and reptiles. More recently, non-human isolates have been
found in beef and poultry feeds. The annual number of human cases
reported to LCDC since 1969 has ranged from 3 to 18.
reste dans les provinces de Quebec (3), du Manitoba (3), de la Saskatchewan
(2) et de Terre-Neuve (1). II s'agitd'un serotype rare qui avaitete relie
auparavant ades tortues et des reptiles importes. Recemment, des isolats non
humains ont ete deceles dans des aliments destines aux bovins et la volaille.
Le nombre annuel de cas humains signales au LLCM depuis 1969 varie de 3
18.
During this same time period, 23 states in the U.S. have also
reported an increased number of cases of infection caused by this
same serotype. Case-control investigations have been conducted in
several of these states. Minnesota, Michigan and Illinois have
associated illness with consuming cantaloupe in fruit salad or salad
bar preparations. Considering the growing season, shipping and
handling of this fruit. the incubation period and the temporal
distribution of the onset of illness, the probable source of these
cantaloupes was traced to 2 counties in Texas. It is still not clear if the
cantaloupes originated from these counties or from other growing
areas south of the border, i.e., Mexico.
Pendant la meme periode, on a signale egalement un nombre accru de cas
d'infection cause par ce meme serotype dans 23 Etats americains. Des
enquetes cas/temoins ont ete effectuees dans plusieurs de ces Etats. Au
Minnesota, au Michigan et en Illinois, la maladie a ete associe ala
consommation de cantaloup en salade de fruit ou dans des mets de "bar a
salade". Compte tenu de lasaison de culture, de !'expedition et.de la
manutention de ces fruits, de la periode d'incubation et de la distribution
temporelle du debut de la maladie, ces cantaloups provenaient probablement
de 2 comtes du Texas. On ignore cependant encore s'ils provenaient
effectivement de ces comtes, ou bien plutOt du Mexique.
Interim analysis of a case-control investigation of the outbreak in
Ontario has not revealed any suspect fruit or vegetable. The
methodology utilised in this investigation is similar to thafused in
many of the implicated states. Results of the final analysis are pending.
L' analyse provisoire de I' etude cas/temoins de I' epidemie ontarienne n' a
pas permis d'identifier un fruit ou un legume suspect quelconque. La
methodologie utilisee clans cette etude ressemble acelle utilisee clans Ies :Btats
americains touches. Les resultats de I' analyse finale doivent para.ltre sous peu.
Acknowledgements
Remerclements
The assistance and cooperation of field epidemiologists in training
and residents from the Community Health Program at the University
of Ottawa are greatly appreciated.
Nous tenons aexprimer notre reconnaissance aI' endroit des
epidemiologistes regionaux stagiaires ainsi que les residents de la Sanre
communautaire de l 'Universite d 'Ottawa. Leur aide a ere precieuse.
Source: C Whalen, MD, J Hocldn, MD, Field Epidemiology
Division, Bureau of Communicable Disease Epidemiology,
H Lior, MSc, National Reference Laboratory for E11teric
Pathogens, LCDC, Ottawa; G Pasut, MD, Public Health
Branch, A Borczyk, MSc, Laboratory Services Branch,
Ontario Ministry of Health, Toronto, Ontario; MT
Osterholm, PhD, Minnesota Department ofHealth,
Minneapolis, Minnesota; D Vugia, MD, !Vational Center for
Infectious Diseases, CDC, Atlanta, Georgia.
Source : Drs C Whalen et J Hockin, Division de l' epidemiologie regionale,
Bureau de l' epidemiologie des maladies transmissibles, H Lior,
MSc, Laboratoire national de reference pour les pathogenes
enteriques, LLCM, Ottawa; Dr(; Pasut, Direction de la sante
publique, A Borczyk, MSc, Direction des services de laboratoire,
Ministere ontarien de la Sante, Toronto (Ontario); MT Osterholm,
PhD, Minnesota Department ofHealth, Minneapolis (Minnesota);
Dr D Vugia, National Center for Infectious Diseases, CDC, Atlanta
(Georgia).
I !ecaid COOi
Mal Ra!illfro!lon No. 6670
Health and Welfare
I.I Canada
a
I COU'riOf da la deuldl!ma cla"9 - ErYag!i1!111lanl n•
I
Sante et
Canada
Bien~tre
social
185
a
6670
Canada
I
Notes lnternatlonales
lnternatlonal Notes
LA ROUGEOLE AUX ETATS.UNIS EN 1990
MEASLES· UNITED STATES, 1990
As of 10 May, 1991, local and state health departments reported
a provisional total of 27,672* measles cases in the United States &9r
1990 - a 52.1 % increase over the 18,193 cases reported for 1989
(Figure 1) - and 89 suspected measles-associated deaths. Cases
were reported from 49 states and the District of Columbia. The
overall incidence rate in 1990 was 11.l cases per 100,000
population. This report summarizes epidemiologic features of
measles cases reported for 1990 and compares findings with cases
reported for 1989.
Characteristics
Jn 1990, children <5 years of age accounted for 48.1 % of
measles cases, compared with 36.6% of cases in 1989 (Table 1).
Persons~ 20 years of age accounted for 22.5% of all reported cases
in 1990, compared with 17.0% in 1989.
En date du 10 mai 1991, le total provisoire de cas de rougeole signales
aux Etats-Unis pour 1990 par les services de sante locaux et des Etats
s'elevait a 27 672- ce chiffre repres~~e une augmentation de 52,l % par
rapport au total de 1989 (18 193 cas) (Figure 1); 89 deces pouvant etre
rapportes a la rougeole ont aussi ete signales. Des cas sont survenus dans
les 49 Etats et dans le District de Columbia. Le tmix global s'elevait a 11,1
cas par 100 000 habitants en 1990. Le present rapport resume les
caracteristiques epidemiologiques des cas declares de rougeole survenus en
1990 et les compare a celles des cas declares en 1989.
Le profll
En 1990, les enfants de moins de 5 ans representent 48,l % de8 cas de
rougeole, comparativement a 36,6 % en 1989 (Tableau 1). Les sujets de 20
ans et plus comptent pour 22,5 % des cas en 1990, comparativement a
17,0%en1989.
Estimated incidence rates were higher in 1990 than in 1989 for
all age groups, except 15- to 19-year olds. The largest increase in
incidence rates were among children <1 year of age (137 .6%) and
adults~ 25 years of age (130.0%). The highest incidence rates were
among children <1 year (119.3 per 100,000) and 1-4 years (58.3 per
100,000).
Les taux estimes de survenue sont plus eleves en 1990 qu 'en 1989 dans
tousles groupes d'age, sauf chez les sujets ages de 15a19 ans. Les
augmentations les plus prononcees ont ete observees chez les enfants de
moins d'un 1 an (137 ,6 %) et chez les 25 ans et plus (130,0 %). Les taux
les plus eleves ont ete ont ete notes chez les enfants de mains d'un an
(119,3 cas par 100 000) et chez ceux de 1 a 4 ans (58,3 cas par 100 000).
Information on race/ethnicity was available for 11,083 (40.l %)
cases reported from 34 states and the District of Columbia (no
race/ethnicity information was available for cases reported from the
other 15 states, including California). Of these, 6,192 (55.9%)
occurred among non-Hispanic whites; 2,472 (22.3%), non-Hispanic
blacks; 2,082 (18.8%), Hispanics; and 337 (3.0%), other racial or
ethnic groups.. Incidence rates were highest for Hispanics (29 .5
cases per 100,000 population) and blacks (12.3 per 100,000) and
lowest for non-Hispanic whites (5.2 per 100,000).
La race et I' appartenance ethnique sont connues pour 11 083 cas
(40,l %) declares dans 34 Etats et dans le District de Columbia (ces
informations ne sont pas foumies pour les cas signales dans les 15 autres
Etats, y compris la Califomie). De ce nombre, 6 192 (55,9 %) sont
survenus chez des sujets non-hispaniques de race blanche; 2 472 (22,3 %),
chez des sujets non-hispaniques de race noire; 2 082 (18,8 %), chez des
sujets hispaniques; et 337 (3,0 %), chez des sujets d 'une autre race ou
d 'une autre appartenance ethnique. Les taux de survenue sont plus eleves
chez les sujets d'origine hispanique (29,5 cas par 100 000) et chez les
sujets de race noire (12,3 cas par 100 000) et plus faibles chez les sujets
non-hispaniques de race blanche (5,2 cas par 100 000).
*
*
As of 31 December, 1990, a total of 26,520 cases had been officially
reported to CDC. Through 10 May, 1991, CDC's Division of
Immunization, Center for Prevention Services, had received reports of
1,152 additional cases reported to have occurred in 1990, for a
provisional total of 27,672 cases. The final total may differ slightly.
Au 31 deceinbre 1990, 26 520 cas avaient ete officiellement declares aux~.
Au 10 mai 1991, 1152 cas supplementaires survenus en 1990 avaient ete
s!&nitles au Center for Prevention SeJYices de la Division of Immunization des
.QX;, portant ainsi (>TOvisoirement a27 672 le nombre de cas declares pour
1990. Le total definitif pourrait differer legerement de ce dernier chiffre.
Figure 1
Cps de rougeole salon l'ann6e
(Etats·Unls 1960·1990*)
Figure 1
Measles cases, by year •
United States, 1960·1990*
.,....
500
..
450
30
25
20
~ 15
: :g 10
"
(.)
""(.) 05
1980
~ 400
'.§
.,
.,
l'O
"O
c
; e-
350
.s
~ 300
"CJ
.,c
l'O
250
::i
0
200
.t:
~
.,
.,"'co
0
Mea1le1 cases, by yaar • United States,
1980-1990
Coe de rouge ale Hlon 1· enn6e
{Etat1·Unl1 1980-1990}
.
150
100
50
·1990 provisional data
0
........._......,_,,~~L-.J
LL-'-..L.....J-'--'-.L-L-'-..L.....l-'--'-.L-L-'-..L-1-'-....1::~
1960 62
64
66
68 70
72
74 76
78 80 82 84 86 88 90
Year/Annee
186
'donnees provisoires pour1990
Table 1ffableau 1
Age distribution and estimated incidence rates* of measles United States, 1989 and 1990**
Repartition des cas de rougeole salon l'age et !aux estim~s· de survenue
(Etats-Unis 1989 et 1990)**
·
Rate
Taux
Age Group (yrs)
Groupe d'age (ans)
No.
f-J°''cire
<1
1-4
1,982
4,668
(10.9)
(25.7)
50.2
31.5
1,757
2,208
4,403
1,578
1,511
86
18,193
(9.7)
(12.1)
(24.2)
(8.7)
(8.3)
(0.5)
(100.0)
9.6
13.0
24.7
8.4
1.0
Ni?re·
(%)
Rate
Taux
% Rate Change
Variation du taux
en%
4,706
(17.0)
119.3
+137.6
8,617
2,657
2,263
3,128
2,539
3,668
(31.1)
(9.6)
(8.2)
(11.3)
(9.2)
(13.3)
(0.3)
(100.0)
58.2
14.6
13.4
17.6
13.6
2.3
+84.8
+61.9
+130.0
11.1
+52.1
5-9
10-14
15-19
20-24
~25
Unknown/lnconnu
Total
Age Group (yrs)
Groupe d'age (ans)
<1
1-4
5-9
10-14
15-19
20-24
~25
Unknown/lnconnu
Total
N
94
27,672
7.3
+52.1
+ 3.1
·28.7
:.cases per 100,000 pogulation/Cas P.OUr 100 000 habitants
1990 provisional data/ onnees provisoires pour 1990
Importations from other countries accounted for 377 (1.4%)
cases; an additional 188 (0.7%) cases were epidemiologically
linked within 2 generations of transmissions to imported cases. Of
the 377 cases, 249 (66.0%) were acquired in Mexico, and 95
(25.2%) in other Central American, South American, or Caribbean
countries.
·
Outbreaks
A total of 240 outbreaks, involving from 5 to 7,514 persons,
accounted for 87 .0% of the cases. Outbreaks affecting
predominantly preschool-aged children involved 19,827 (71.7%)
cases; school-aged persons, 2,842 (10.3%) cases; and
postschool-aged persons, 1,376 (5.0%) cases. The largest outbreaks
involved predominantly preschool-aged children and occurred in
Los Angeles (7,514 cases); Dallas (2,331); New York City (l,108);
San Diego (1,049); and Bakersfield/Kem County, California
(1,011). These outbreaks accounted for 47.0% of all cases reported
for 1990.
Dans 377 cas (1,4 %), les sujets avaientcontracre la maladie dans un
autre pays: 249 (66,0 %) au Mexique et 95 (25,2 %) dans d'autres pays de
l'Amerique centrale, de l' Amenque du Sud ou des Antilles. Dans 188
(0,7 %) autres cas, il a ere possible d'etablir un lien epidemiologique d'au
plus 2 etapes de transmission avec des cas imporres.
Epldemles
Un lien epidemiologique a pu etre etabli entre 80,7 % des cas declares et
l'une OU l'autre des 240 epidemies ayant touchC de 5 a 7 514 sujets. Celles
qui touchaient surtout les enfants d'age prescolaire ont cause 19 827 cas
(71,7 %); surtout les sujets d'age scolaire 2 842.cas (10,3 %); surtout les
sujets ayant termine leurs etudes, 1376 cas (5,0 %). Les epidemies les plus
importantes ont surtout touchC les enfants d' age prescolaire et sont
survenues a Los Angeles (7 514 cas), a Dallas (2 331 cas), a New York
(1108 cas), a San Diego (1 049 cas) et clans le comre de Bakersfield/Kem
(Californie) (1 011 cas); elles ont cause a elles seules 47,0 % de tousles cas
declares en 1990.
Vaccination Status
Etat vacclnal
Vaccination status was known for 27,632 (99.9%) patients. Of
these, 5,100 (18.4%) were known to have been vaccinated on or
after their first birthday (fable 2); approximately 71.4% of these
persons were 5-19 years of age. Of the 22,532 (81.4%) persons
who were unvaccinated or inadequately vaccinated (i.e., vaccinated
before their first birthday), routine vaccination was indicated for
12,268 (54.4% [44.3% of total**]). Almost 40% of these
On le connait pour 27 632 sujets (99,9 %). De ce nombre, 5 100
(18,4 %) Ont ere Vaccines a l'age de 12 mois OU apres (fableaU 2); environ
71,4 % de ces sujets etaient ages de 15a19 ans. La vaccination
sysrematique aurait du etre pratiquee chez 12 268 sujets, soit 54,4 % [44,3
% du nombre total de cas]** des 22 532 sujets (81,4 %) non vaccines ou
incorrectement vaccines (p. ex. sujets vaccines avant d' avoir atteint l'age de
12 mois). Presque 40 % de ces sujets etaient des enfants ages de 16 mois a
187
vaccine-eligible persons were children 16 months to 4 years of age.
Measles occurred in 8,698 (31.4% of total) persons for whom
routine vaccination was not indicated, of whom 7,257 (83.4%) were
children <16 months of age. Of the 1,566 persons (5.7% of total)
who were unvaccinated for other reasons, 1,424 (90.9%) were
persons with religious or philosophic exemption to vaccination.
Compllcatlons of Measles
Complications were reported in 6,274 (22.7%) cases, including
diarrhea in 2,606 (9.4%), otitis media in 1,829 (6.6%), pneumonia
in 1,803 (6.5%), and encephalitis in 36 (0.1 %). Hospitalization was
reported for 5,844 (21.1 %) persons.
Deaths
·
A provisional total of 89 measles-associated deaths were
reported, for a death-to-case ratio of 3.2 deaths per 1,000 reported
cases. Deaths were reported from 15 states. Forty-nine (55.1 %)
deaths occurred among children <5 years of age, including 15
(16.9%) children <12 months of age and 13 (14.6%) children 5-19
years of age. The other 27 (30.3%) deaths occurred among adults
~ 20 years of age. Eighty-one (91.0%) suspected
measles-associated deaths occurred among unvaccinated persons.
**
Unvaccinated persons ~ 16 months of age without medical
contraindications or religious exemption to vaccination. This represents
a minimal estimate, because the Immunization Practices Advisory
Committee (ACIP) recommends that the routine age for the first dose of
measles vaccine be lowered from 15 months to 12 m?:!Jths in areas with
high risk for measles among preschool-aged children ·
4 artS. La rougeole a frappe 8 698 sujets (31,4 % du total de cas) pour qui Ia
vaccination systematique n'etait pas indiquee; de ce nombre, 7 257 (83 4 %)
etaient ages de moins de 16 mois. Parrni les 1 566 sujets (5,7 % du totai de
cas declares) qui n'avaient pas ete vaccines pourd'autres raisons, chez 1
424 (90,9 %) on avait invoque des raisons d'ordre religieux ou
philosophique. ·
Compllcatlons de la rougeole
Biles ont ete signalees dartS 6 274 cas (22,7 %) : diarrhee 2 606 cas
(9,4 %), otite moyenne 1 829 cas (6,6 %), pneumonie 1 803 cas (6,5%),
encephalite 36 cas (0,1 %). On a hospitalise S 844 malades (21,1 %).
o•ch
On es time provisoirement a 89 le nombre de deces attribues a la
rougeole, soit un taux de letalite de 3,2 par 1 000 cas declares. Des deces ont
ere signales dans 15 Etats; 49 (55, 1 %) sont survenus chez des enfants de
moins de 5 artS, dont 15 (16,9 %) chez des enfants de moins de 12 mois 1 et
13 (14,6 %), chezdes sujets de 5a19 llIJJ!. Les 27 autres deces (30,3 %) se
sont produits chez des adultes ages de 20 ans et plus. Au total, 81 (91,0 %)
des deces qu' on croit avoir ete causes par la rougeole sont survenus chez
des sujets non vaccines.
**
Sujets non vaccines llges d'au moins 16 mois et ne presentant pas de
contre-indication medicale ala vacci!lation OQ q_ui en soot exemptes pour des
raisons d'ordre religieux. II s'agit d'une estimation minimale, vu que le
Immuni ration Practices Adyjs~ Committee £AC.IEl recommande d' abaisser de
15 a12 mois l'lige auq_uelles eants devraient nonnalement recevoir leur
premiere dose de vaccm antirougeoleux dans les nSgio~ ou les risques de
rougeole chez les enfants d'llge prescolaire soot eleves •
Table 2/Tableau 2
Classification of measles cases - United States, 1990 •••
Classification des cas de rougeole - Etats-Unis, 1990•••
Classification
N-&>·re
N
Unvaccinated/Non vaccines
Vaccine Indicated/Vaccination indiquee
Vaccine not routinely Indicated
Vaccination systematique non indiquee
Persons <16 months of a~e
Sujets ages de molns de 6 mols
Persons born before 1957
Sujets nes avant 1957
Laboratory immunity/ph~sician diagnosis
lmmunite confirmee en aboratolre ou par le diagnostic du medecin
Medical exemption
Contre-indlcat1on pour des raisons medlcales
Other/Autres
Non-U.S. citizen/Citoyens non-americains
Religious/philos~hic exemption
Exemption pour es raisons d'ordre religieux ou philosophique
Appropriately vaccinated****
Vaccines correctement••••
Subtotal/Sous-total
Unknown/lnconnu
Total
...
uu
o/ooftotal
% du total
22,532
12,268
8,698
81.4
44.3
31.4
7,257
26.2
1,160
4.2
14
267
1.0
1,566
5.7
142
1,424
5.1
5,100
18.4
27,632
99.9
40
27,672
0.1
100.0
Provisional data/Donnees ~rovisoires.
Vaccinated with live meas es on or after the first birthday/Sujets ayant requ le vaccin antirougeoleux vivant l'age de 12 mois ou apres.
188
0.5
Editorial Note
The provisional total of 27,672 measles cases reported in 1990 is
the largest number reported since 1977. Cases were reported from
every state except North Dakota; however, 61 % of all cases were
reported by 2 states, California (12,479 cases) and Texas (4,403
cases).
Note de la redaction
Le total provisoire de 27 672 cas de rougeole recenses en 1990
represente le plus eleve depuis 1977. Des cas ont ere signales dans tous les
Etats a!'exception du Dakota du Nord; toutefois, 61 % de tousles cas ont
ere observes dam 2 Etats, la Califomie (12 479) et le Texas (4 403).
In addition to increases in the U.S., increases in the occurrence
of measles during 1989-1990 were reported by many other countries
ofthe Western Hemisphere, including Canada, El Salvador,
Guatemala, Honduras, Jamaica, Mexico, and Nicaragua. Although
the cause of this hemispherewide trend in measles activity is
unknown, it has increased the likelihood that measles will be
imported into and exported from the U.S.
Ce phenomene de recrudescence n' est pas limite aux Etats-Unis; une
. augmentation des taux de survenue de la rougeole a egalement ere observee
en 1989-1990 dans de nombreux autres pays occidentaux, dont le Canada,
le Guatemala, !'Honduras, la Jamai'que, le Mexique, le Nicaragua, le
Salvador. Bien que la cause de cette tendance observee dans une grande
partie de !'hemisphere occidental demeure inconnue, les risques
d 'importation du virus rougeoleux aux Etats-Unis ou de son exportation
vers d'autres pays semblent accrus.
~) change in age distribution of measles patients noted in
1989 continued in 1990. For the first time since detailed
information on the ages of reported patients became available in
1973, the proportion of cases among children <5 years of age in
1990 exceeded the proportion among school-aged children.
Le changement observe en 1989<3>dans la repartition du nombre de cas
de rougeole selon I' age s' est poursuivi en 1990. Pour la premiere fois
depuis que l'on a commence acompiler des statistiques detaillees sur l'age
des sujets atteints, en 1973, la proportion de cas signales en 1990 parmi !es
enfants de moins de 5 ans depasse celle observee parmi les enfants d'age
scolaire.
The 89 deaths in 1990 are the largest number reported in a single
year since 1971 (90 deaths and 75,290 reported cases) and the
highest' death-to-case ratio documented in the past 30 years.
Although the reasons for these increases have not yet been defined,
probable contributing factors include underreporting of less severe
cases (particularly from areas experiencing large outbreaks) and the
shift of the predominant age of reported cases to children <5 ye~4)
and persons ~ 20 years (groups at higher risk for complications) .
Les 89 deces recenses en 1990 constituent egalement le total le plus
eleve declare en une seule annee depuis 1971 (90 deces et 75 290 cas
declares) et representent le taux de letalite le plus eleve emegistre au cours
des 30 dernieres annees. Siles causes de ces augmentations demeurent
indeterrninees, certains facteurs, tels la sous-declaration des cas les moins
severes (en particulier dans les regions OU sevissaient des epidemies
importantes) et le passage des taux les plus eleves aux groupes d'age de
moins de 5 ans et de 20 ans et plus (groupes presentant des risques
particulierement eleves de complications) y ont peut-etre contribue<4>.
Failure to vaccinate children at the appropriate age was the major
factor contributing to the resurgence of measles in the U.S. in
1989-1990 (National Vaccine Advisory Committee, unpublished
data, 1991). Surveys in areas experiencing measles outbreaks
indicate that as few as 50% of c~f!fen have been vaccinated against
measles by their second birthday , and that black and Hispanic
children are le~& likely to be age-appropriately vaccinated than are
white children .
C'est le manque avaccinerles enfants a!'age indique qui s'estrevele le
facteur le plus important dans la recrudescence de la rougeole aux
Etats-Unis en 1989-1990 <National Vaccine Advisory Committee, donnees
non publiees, 1991). Dans certaines regions aux prises avec des epidemies
importantes de rougeole, on a trouve que la proportion d' enfants vaccines
contre la rougeole av'tW leur deuxieme anniversaire est dans certains cas
aussi faible que 50 % et que les enfants de race noire et d'origine
hispanique sont moins susceptipJes d' avoir ere immunises aun age correct
que les enfants de race blanche .
Prevention of measles outbreaks among preschool-aged children
will require intensive efforts to increase age-appropriate vaccination
levels among inner-city preschool-aged children. Strategies that
should improve immunization levels include: 1) reducing barriers to
vaccination (e.g., increasing the number of clinic hours when
vaccines are given and the availability of walk-in vaccination
services); 2) taking advantage of all opportunities to vaccinate (e.g.,
simultaneous use of multiple vaccines whenever possible, and
excluding from vaccination only persons with valid
contraindications); 3) using innovative vaccine delivery techniques,
such as vaccination in hospital emergency departments; and 4)
increasing the number of children who return for vaccination at the
appropriate age by improving follow-up and recall systems.
Pour prevenir I' apparition d' epidemies de rougeole chez les enfants
d'age prescolaire, on devra s'efforcer de hausser leur taux de vaccination a
un age correct dans les quartiers centraux des villes. Diverses voies
d' approche sont susceptibles d' accro1tre ces taux. On devra chercher a1)
reduire les obstacles ala vaccination (p. ex. en augmentant les heures
d'ouverture des cliniques d'immunisation et l'accessibilire des services de
vaccination sans rendez-vous), 2) profiter de toutes les occasions pour
vacciner (p. ex. en administrant des vaceins multiples lorsque cela est
possible et en restreignant les exemptions de vaccination aux personnes qui
ont des contre-indications valables), 3) recourir ade nouvelles methodes,
comme par exemple la vaccination dans les services d'urgence hospitaliers,
et 4) accro1tre le taux de revaccination al'age indique chez les enfants en
ameliorant les systemes de suivi et de rappel.
References
1. CDC. Summary of notifiable diseases, United States, 1989.
References
1. CDC. Summary Qfnotifiable diseases. UnitedStates.1989. MMWR
MMWR 1989;38(54).
2. ACIP. Measles prevention: recommendations of the
Immunization Practices Advisory Committee (ACIP ). MMWR
1989;38(no.S-9).
3. CDC. Measles - United States, 1989, and first 20weeks1990.
MMWR 1990;39:353-5,361-3.
4. Atkinson WL, Markowitz LE. Measies and measles vaccine.
Seminars in Pediatric Infectious Diseases 1991;2:100-7.
5. CDC. Measles vaccination levels among selected groups of
preschool-aged children - United States. MMWR 1991;40:36-9.
6. CDC. Update: measles outbreak - Chicago, 1989. MMWR
1990;39:317-9,325-6.
1989;38(54).
2. ACIP. Measles prevention.· recommendations Qf the Immunization
Practices Advisory Committee (AC/Pl. MMWR 1989;38(no.S-9).
Source: Morbidity and Mortality Weekly Report, Vol 40, No 22,
1991.
3. CDC. Measles - United States. 1989. and first 20weeks'1990. MMWR
1990;39:353-5,361-3.
4. Atkinson WL, Markowitz LE. Measles and measles yaccine.Seminars
in Pediatric Infectious Diseases 1991;2:100-7.
5. CDC. Measles vaccination levels amon~ selected ~rou1Js of
prescbool-ned children - United States. MMWR 1991 ;40:36-9.
6. CDC. Update.· measles outbreak - Chicq~o. 1989. MMWR
1990;39:317-9,325-6.
Source: Morbidity and Mortality Weekly Report, Vol 40, N° 22, 1991.
189
· Announcement
An nonce
New WHO Publication
Nouvelle publlcatlon de l'OMS
SAMPLE SIZE DETERMINATION IN HEALTH STUDIES
A Practical Manual
DETERMINATION DE LATAILLE D'UN ECHANTILLON
DANS LES ETUDES SANOMETRIQUES
Manuel pratlque
Well designed studies are vital to provide information for the
efficient planning, operation, monitoring and evaluation of health
services. For any such study - whether of the efficacy of an
immunization program or of the availability of maternity care - the
decision on how large a sample to select from the population in
question must take into account the need both to obtain statis'tically
valid results and to avoid unnecessary expenditure of time and
resources.
Des enquetes bien conc;:ues sont indispensables pour obtenir les informations
qui permettront de planifier, gerer, surveiller et evaluer efficacement les services
de sanre. Pour toute enquete de ce type, que l'on cherche adeterminer l'efficacite
d 'un programme de vaccination ou la disponibilite des soins maternels, i1 faut
decider de la taille de l 'echantillon aprelever dans la population etudiee en
tenant compte de lanecessite d'obtenir des resultats statistiquement valables·et
d'eviter un gaspillage de temps et de ressources.
This manual has been prepared to provide guidance for health
workers and managers responsible for making such decisions, and
in particular for those undertaking studies at local or district level
without detailed knowledge of statistical methodology. It presents a
variety of situations in which minimum sample size must be
determined, including studies to estimate population proportion,
odds ratio, relative risk and disease incidence. The illustrative
examples of health studies are accompanied by over 50 tables that
enable the reader to determine the sample size required without
recourse to complicated calculations.
Ce manuel est destine aguider l' agent de sante et 1' administrateur aqui i1
incombe de prendre ces decisions, notamment ceux qui entreprennent des
enquetes au niveau local ou acelui du district sans avoir une connaissance
detaillee de la methodologie statistique. 11 expose diverses situations OU i1 faut
fixer une tail le minimum d' echantillon, que 1' etude vise adeterminer une
proportion au sein d 'une population, 1'odds ratio, le risque relatif ou I'incidence
d 'une maladie. Les exemples d' etudes sanometriques sont accompagnes de plus
de 50 tableaux permettant au lecteur de choisir la taille de l'echantillon sans
avoir afaire des calculs compliques.
The manual is not intended to help the reader decide what type
of study, confidence level or degree of precision is most
appropriate, nor does it discuss the theoretical basis of sample size
determination. It is designed to be used in "cookbook" fashion as a
practical guide to making decisions on sample size once a proposed
study and its objectives have been clearly defined.
Ce manuel ne pretend pas aider achoisir le type d'enquete, le niveau de
confiance ou le degre de precision les plus appropries, et ne comporte aucun
expose theorique Sur fa determination de la taille d 'un ehantillon. 11 est conyU a
la maniere d'un "livre de recettes" pour guider le choix de la taille de
1'echantillon des lors que l' etude proposee et ses objectifs ont ete clairement
definis.
This publication, available only in English at this time (French
version is in preparation), can be obtained in Canada from the
Cette publication n' est presentement offerte qu 'en version anglaise (version
franyaise en preparation). Pour se procurer un exemplaire au Canada, s 'adresser
Canadian Public Health Association,
1565 Carling Avenue, Suite 400,
Ottawa, Ontario, KlZ 8Rl
(fel: (613) 725-3769)
Attention: Ms L.A. Clarke.
I' Association canadlenne de sante publlque,
1565, avenue Carling, Suite 400,
Ottawa (Ontario) KlZ 8Rl
(tel: (613) 725-3769)
a!'attention de: Madame L.A. Clarke.
Cost is $18.73 per copy including postage and OST.
Prix: 18,73$ l'exemplaire, frais de port et de TPS inclus.
Tho Canada Diseases Weekly Report pzescnlll cummt information on infectiou and othor diseases
for rurvcillancc purposes and is available free of charge upon request. Many of tho articles
contain prelimhwy information'and furtb:lr conlirmationm•y bo obtained from tho sources
quolcd. Tho Department of Health .riid Welfare doe> not assumo rosponsibilily for accuracy or
authenticity. Contributions arc welcomed (in the official language of your choice) from anyone
working in tlw health field and will not preclude publication elsewhere.
Scientific Advisory Board:
Editor.
AsriJtantllditor:
Do1ktop Publishing
Cir<ulo.tion:
Bureau of Communicable Disease Epidemiology
Labor•tory Centm for Disease Control
T=y'1PutUie
OTTAWA, Ontario
Can&d&
K1AOL2
Dr.J.Spika
Dr.K.Rozoo
Eleanor Paulson
Nicole Beaudoin
Joanne Regnier
Gertrude Tardiff
(613) 957-4243
(613) 957-1329
(613) 957-1788
(613) 957·0841
(613) 957-7845
(613) 957-0842
a:
Le R&pport hebdoi:na&iro do• maladies au Canada, qui fournit do1 donn6cs pertinonte1 aur !01 maladies infcctiouse1 ot
leuutm• maladies dans le but do facilitorlour aurveillanco, peut 8trc oblcnu gratuilcment 1ur domando. Un grand
nombre d'articlcs nc contlonnont quo dos darui6c1 WIIUD.&iro1 mW do1 ronse!gnemont> comp!6ment&lre1 pouvont 8tm
obtonus on 1'addreS!ant aux sources ci!Ces. LcminLitrc do la Sant6 n&timale et du Bion·8trc socW no pout 8tm
rosponnblc do !'exactitude, ni do l'authenticit6 dos articles. Tout< pemmnc oouvrant dans lo d<m&ino do 1& 111r116 oil
invit6c Acollaborer (dans l• langue officlolle pc son choix) et l• publicaticn d'un article dans lo prescnl R&ppart n'cn
cmp8chc pas l• publication aillourJ.
Groupe do conscillen sclontifiques:
D' J.Spika
(613) 957-4243
D'K.Roz.ce
(613) 957-1329
R6dactricc en chef:
E!emor P&ulscn
(613) 957-1788
R6dactrico adjointc:
Nicole Beaudoin
(613) 957-0841
&litique:
(613) 957-7845
Joanno Regnier
Distribution:
Clortrudo Tardiff
(613) 957-0842
BUieau d16pid6miologic des maladies tran.nnilsiblc1
Labor&toirc do Jutte contrc la maladlo
i'I6Tunney
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Canada
KlAOL2
190
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