Lifrarbólga A á Íslandi

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesInngangur: Faraldrar af völdum lifrarbólgu A veiru (hepatitis A virus, HAV) komu endurtekið upp á Íslandi á fyrrihluta 20. aldar en síðan þá hafa fá tilfelli greinst og engir þekktir faraldrar komið upp síðan 1952. Síðustu íslensku rannsóknir á lifrarbólgu A frá því um 1990 sýndu lágt nýgengi sýkingar og lækkandi algengi mótefna. Markmið rannsóknarinnar var að kanna nýgengi og birtingarmynd lifrarbólgu A á Íslandi og uppruna smits, er­lendis eða innanlands. Efniviður og aðferðir: Klínískum upplýsingum var safnað afturskyggnt úr sjúkraskrám um einkenni við greiningu, blóðprufuniðurstöður og mögulegar smitleiðir hjá öllum einstaklingum með jákvæð lifrarbólgu A IgM mótefni í gagnagrunni veirufræðideildar Landspítala á 11 ára tímabili, 2006-2016. Niðurstöður: Alls greindust 12 manns með bráða lifrarbólgu A á tímabilinu en framkvæmdar voru 6691 mæling á heildarmótefnum og 1984 mælingar á IgM mótefnum. Níu (75%) höfðu verið erlendis innan 7 vikna frá upphafi einkenna. Algengustu einkennin voru gula (10/12, 83%), hiti (67%) og ógleði og/eða uppköst (58%). Alls lögðust 50% inn á sjúkrahús og 42% fengu hækkun á INR/PT. Allir lifðu af sýkinguna án fylgikvilla. Ályktun: Að meðaltali greindist um eitt tilfelli af bráðri lifrarbólgu A árlega á Íslandi en mjög margar mótefnamælingar voru gerðar. Mikill meirihluti tilfella greindist hjá einstaklingum sem höfðu nýlega dvalið erlendis. Ef sjúklingar hafa gulu, hita og ógleði er ástæða til að kanna lifrarbólgu A sýkingu. Lifrarbólga A er ekki landlæg á Íslandi.Senda grein,Prenta greinEnglishFacebookTwitter Introduction: Hepatitis A virus (HAV) epidemics occurred repeatedly in Iceland in the early 20th century, but since then few cases have been reported and no epidemics since 1952. The latest Icelandic studies on HAV from around 1990 showed low incidence of infection and de­- creasing prevalence of antibodies. The objective of this study was to determine the incidence, clinical presentation and origin of HAV, abroad or in Iceland. Material and methods: A retrospective search was undertaken on all patients with positive anti-HAV IgM during the 11 years period of 2006-2016 in the virological database of the National University Hospital of Iceland. Clinical data was collected from medical records on symptoms at diagnosis, blood test results and possible route of transmission. Results: A total of 12 individuals were diagnosed with acute hepatitis A during the period and 6691 HAV total andibody tests and 1984 HAV IgM antibody tests were performed. Nine (75%) had been abroad within 7 weeks from initial symptoms. The most common symptoms were jaundice (83%), fever (67%) and nausea and/or vomiting (58%). 50% were admitted to a hospital. 42% had elevated INR/PT. Everyone sur­vived without complications. Conclusion: Annually, approximately one case of acute hepatitis A was diagnosed in Iceland during the study period but a very high number of antibody tests were performed. The majority of cases occurred among individuals who had recently been abroad. If patients have jaundice, fever and nausea, testing for HAV infection should be undertaken. HAV is not endemic in Iceland

Varicella in Icelandic children - epidemiology and complications

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIntroduction: Varicella is a common disease with possible consequences. The disease is usually contracted in childhood and persistent antibodies are produced. Varicella vaccine is not widely used in Iceland. The aim of the study was to investigate the epidemiology of varicella in Icelandic children and it s complications. The results may prove important when deciding on varicella immunization in Iceland. Material and methods: The study was retrospective cross sectional. Varicella antibodies were measured from children 10 years had antibodies. Hospital admittions were 58, annual admittions were or 3.6/100.000 children 10 ára með mótefni. Börn sem lögð voru inn vegna hlaupabólu eða fylgikvilla voru 58 eða 3,6 /100.000 börn á ári. Bakteríusýkingar voru algengasta ástæða innlagnar, einkum húðsýkingar en hnykilslingur, þurrkur og vannæring voru einnig algeng. Ályktun: Flest börn á Íslandi fá hlaupabólu fyrir 10 ára aldur. Fylgikvillar geta verið alvarlegir. Mikilvægt er að þekkja sjúkdóminn, viðbrögð við honum og kanna hvort hefja eigi almenna bólusetningu gegn honum hér á landi

European outbreak of Hepatitis A in Iceland in 2017. Common radiological changes of the gallbladder

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesTILGANGUR Lifrarbólga A er afar sjaldgæf á Íslandi og hefur greinst um eitt tilfelli á ári undanfarin 20 ár. Frá árinu 2016 hefur verið greint frá faraldri í Evrópu meðal karla sem hafa haft mök við karla. Tilgangur rannsóknarinnar var að skoða hugsanleg tengsl tilfella af lifrarbólgu A á Íslandi árið 2017 við þennan faraldur. EFNIVIÐUR OG AÐFERÐIR Farið var afturskyggnt yfir gögn allra sjúklinga sem greindust með lifrarbólgu A á Íslandi árið 2017. NIÐURSTÖÐUR Af 5 sjúklingum sem greindust árið 2017 voru fjórir karlar og ein kona. Þrjú tilfelli greindust á innan við viku sumarið 2017. Sjúklingarnir voru á aldrinum 25 til 39 ára. Hjá karlkyns sjúklingum var smitleið talin vera gegnum mök við karlmenn frá meginlandi Evrópu. Allir sjúklingarnir voru með klíníska mynd lifrarfrumuskaða og í þremur af tilfellunum voru merki um væga lifrarbilun. Sjúklingarnir voru allir jákvæðir fyrir lifrarbólgu A mótefnum. Aðrar orsakir lifrarbólgu voru útilokaðar með viðeigandi prófum. Myndgreiningar vöktu grun um gallblöðrubólgu hjá fjórum af 5 sjúklingum og fór einn þeirra síðar í gallblöðrutöku sem valaðgerð. ÁLYKTUN Faraldur lifrarbólgu A í Evrópu meðal karla sem áttu mök við karla náði til Íslands sumarið 2017. Mikilvægt er að áhættuhópar láti bólusetja sig gegn veirunni. Breytingar í gallblöðru á myndgreiningu, svo sem þykknun á gallblöðruvegg án steina, eru algengar við bráða lifrarbólgu A. Nauðsynlegt er að gera greinarmun á þessum breytingum og bráðri steinalausri gallblöðrubólgu sem getur haft alvarlega fylgikvilla í för með sér.Senda grein,Prenta greinEnglishFacebookTwitter Aim The incidence of hepatitis A (HAV) in Iceland is low with about one case per year in the last decades. Since 2016, there has been an ongoing outbreak of HAV in men who have sex with men (MSM). The aim of this study was to inves­tigate whether cases diagnosed in Iceland during 2017 had any link to the HAV outbreak in Europe. Methods All cases of HAV in Iceland during 2017 were reviewed retrospectively. Results Four of five cases diagnosed during 2017 were MSM and one was a female. Three cases presented the same week in the summer 2017. The age of the patients was between 25 and 39 years. All the male patients had had sex with men from Europe and/or had travelled to Europe prior to admission. All cases had typical signs and symptoms of HAV infection and in all cases recent infection was confirmed by positive serology and exclusion of other causes of acute hepatitis. Four of five patients had radiological signs of changes in the gallbladder with thickening of the wall and oedema and one underwent later an elective cholecystectomy. Conclusion The outbreak of HAV in MSM Europe reached Iceland in the summer 2017, emphasizing the importance of vaccination in this risk group as recommended by the Icelandic Health Authorities. The review of these cases indicate that changes such as thickening of the gallbladder wall without gallstones in patients with HAV are common. It is important to discrimi­nate patients with these changes associated with HAV from patients with acute acalculus cholecystitis

Herpes simplex encephalitis in Iceland 1987-2011.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Herpes simplex encephalitis (HSE) is a serious disease with 10-20% mortality and high rate of neuropsychiatric sequelae. This study is a long-term, nationwide study in a single country, Iceland. Clinical data were obtained from patient records and from DNA PCR and antibody assays of CSF. Diagnosis of HSE was classified as definite, possible or rejected based on symptoms, as well as virological, laboratory and brain imaging criteria. A total of 30 definite cases of HSE were identified during the 25 year period 1987-2011 corresponding to incidence of 4.3 cases/106 inhabitants/year. Males were 57% of all patients, median age 50 years (range, 0-85). Fever (97%), cognitive deficits (79%), impaired consciousness (79% with GCS < 13), headache (55%) and seizures (55%) were the most common symptoms. Brain lesions were found in 24 patients (80%) by MRI or CT. All patients received intravenous acyclovir for a mean duration of 20 days. Three patients (10%) died within one year and 21/28 pts (75%) had a Karnofsky performance score of <70% with memory loss (59%), dysphasia (44%), frontal symptoms (44%) and seizures (30%) as the most frequent sequelae. Mean delay from onset of symptoms to treatment was 6 days; this was associated with adverse outcome. In conclusion, the incidence of `HSE is higher than recently reported in a national registry study from Sweden. Despite advances in rapid diagnosis and availability of treatment of HSE, approximately three of every four patients die or are left with serious neurological impairment

Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesBACKGROUND: The microbial etiology of community-acquired pneumonia (CAP) is often unclear in clinical practice, and previous studies have produced variable results. Population-based studies examining etiology and incidence are lacking. This study examined the incidence and etiology of CAP requiring hospitalization in a population-based cohort as well as risk factors and outcomes for specific etiologies. METHODS: Consecutive admissions due to CAP in Reykjavik, Iceland were studied. Etiologic testing was performed with cultures, urine-antigen detection, and polymerase chain reaction analysis of airway samples. Outcomes were length of stay, intensive care unit admission, assisted ventilation, and mortality. RESULTS: The inclusion rate was 95%. The incidence of CAP requiring hospitalization was 20.6 cases per 10000 adults/year. A potential pathogen was detected in 52% (164 of 310) of admissions and in 74% (43 of 58) with complete sample sets. Streptococcuspneumoniae was the most common pathogen (61 of 310, 20%; incidence: 4.1/10000). Viruses were identified in 15% (47 of 310; incidence: 3.1/10000), Mycoplasmapneumoniae were identified in 12% (36 of 310; incidence: 2.4/10000), and multiple pathogens were identified in 10% (30 of 310; incidence: 2.0/10000). Recent antimicrobial therapy was associated with increased detection of M pneumoniae (P < .001), whereas a lack of recent antimicrobial therapy was associated with increased detection of S pneumoniae (P = .02). Symptoms and outcomes were similar irrespective of microbial etiology. CONCLUSIONS: Pneumococci, M pneumoniae, and viruses are the most common pathogens associated with CAP requiring hospital admission, and they all have a similar incidence that increases with age. Symptoms do not correlate with specific agents, and outcomes are similar irrespective of pathogens identified.Icelandic Center for Research, Rannis Landspitali University Hospital Science Fund University of Iceland Research Fun

Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, population-based study.

Characteristics of patients with community-acquired pneumonia (CAP) due to pandemic influenza A 2009 (H1N1) have been inadequately compared to CAP caused by other respiratory pathogens. The performance of prediction rules for CAP during an epidemic with a new infectious agent are unknown. Prospective, population-based study from November 2008-November 2009, in centers representing 70% of hospital beds in Iceland. Patients admitted with CAP underwent evaluation and etiologic testing, including polymerase chain reaction (PCR) for influenza. Data on influenza-like illness in the community and overall hospital admissions were collected. Clinical and laboratory data, including pneumonia severity index (PSI) and CURB-65 of patients with CAP due to H1N1 were compared to those caused by other agents. Of 338 consecutive and eligible patients 313 (93%) were enrolled. During the pandemic peak, influenza A 2009 (H1N1) patients constituted 38% of admissions due to CAP. These patients were younger, more dyspnoeic and more frequently reported hemoptysis. They had significantly lower severity scores than other patients with CAP (1.23 vs. 1.61, P= .02 for CURB-65, 2.05 vs. 2.87 for PSI, P<.001) and were more likely to require intensive care admission (41% vs. 5%, P<.001) and receive mechanical ventilation (14% vs. 2%, P= .01). Bacterial co-infection was detected in 23% of influenza A 2009 (H1N1) patients with CAP. Clinical characteristics of CAP caused by influenza A 2009 (H1N1) differ markedly from CAP caused by other etiologic agents. Commonly used CAP prediction rules often failed to predict admissions to intensive care or need for assisted ventilation in CAP caused by the influenza A 2009 (H1N1) virus, underscoring the importance of clinical acumen under these circumstances.Icelandic Center for Research, Rannis 100436021 Landspitali University Hospital Science Fun

Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents

Publisher's version (útgefin grein)A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct‐acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long‐term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016–2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale‐up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.Sigurdur Olafsson: Speaker's fee from Merck. Magnus Gottfredsson: Speaker's fee from Astellas and Gilead. MH and the Burnet Institute receive investigator‐initiated research funding from Gilead Sciences, AbbVie and BMS.Peer Reviewe

Molecular benchmarks of a SARS-CoV-2 epidemic.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadA pressing concern in the SARS-CoV-2 epidemic and other viral outbreaks, is the extent to which the containment measures are halting the viral spread. A straightforward way to assess this is to tally the active cases and the recovered ones throughout the epidemic. Here, we show how epidemic control can be assessed with molecular information during a well characterized epidemic in Iceland. We demonstrate how the viral concentration decreased in those newly diagnosed as the epidemic transitioned from exponential growth phase to containment phase. The viral concentration in the cases identified in population screening decreased faster than in those symptomatic and considered at high risk and that were targeted by the healthcare system. The viral concentration persists in recovering individuals as we found that half of the cases are still positive after two weeks. We demonstrate that accumulation of mutations in SARS-CoV-2 genome can be exploited to track the rate of new viral generations throughout the different phases of the epidemic, where the accumulation of mutations decreases as the transmission rate decreases in the containment phase. Overall, the molecular signatures of SARS-CoV-2 infections contain valuable epidemiological information that can be used to assess the effectiveness of containment measures

Infectious diseases among immigrants [editorial]

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/Openþessu hefti Læknablaðsins birtist athyglisverð grein "Lifrarbólga af völdum lifrarbólguveira B og C hjá innflytjendum á Íslandi". Er þar fjallað um greiningu lifrarbólguveiranna tveggja á árunum 2000-2002 hjá einstaklingum sem sóttu um dvalarleyfi hérlendis og voru frá löndum utan EES. Ekki er krafist læknisskoðunar hjá þeim sem koma frá löndum innan EES og voru því ekki með í þessari athugun. Niðurstöður voru flokkaðar eftir upprunasvæði umsækjanda og aldri. Þær komu ekki á óvart þar sem svipaðar rannsóknir hefur verið gerðar á Norðurlöndum og víðar, en alltaf er fróðlegt að sjá niðurstöður athugana á heimavelli. Það vekur athygli að af skráðum nýgreindum lifrarbólguveiru B sýkingum á Íslandi á tímabilinu voru um 57% þeirra dvalarleyfisumsækjendur og einnig yfir 10% skráðra lifrarbólguveiru C sýkinga