Childhood Lead Exposure in the Palestinian Authority, Israel, and Jordan: Results from the Middle Eastern Regional Cooperation Project, 1996–2000

In the Middle East, the major sources of lead exposure have been leaded gasoline, lead-contaminated flour from traditional stone mills, focal exposures from small battery plants and smelters, and kohl (blue color) in cosmetics. In 1998–2000, we measured blood lead (PbB) levels in children 2–6 years of age in Israel, Jordan, and the Palestinian Authority (n = 1478), using a fingerstick method. Mean (peak; percentage > 10 μg/dL) PbB levels in Israel (n = 317), the West Bank (n = 344), Jordan (n = 382), and Gaza (n = 435) were 3.2 μg/dL (18.2; 2.2%), 4.2 μg/dL (25.7; 5.2%), 3.2 μg/dL (39.3; < 1%), and 8.6 μg/dL (> 80.0; 17.2%), respectively. High levels in Gaza were all among children living near a battery factory. The findings, taken together with data on time trends in lead emissions and in PbB in children in previous years, indicate the benefits from phasing out of leaded gasoline but state the case for further reductions and investigation of hot spots. The project demonstrated the benefits of regional cooperation in planning and carrying out a jointly designed project

HIV Testing among Canadian Tuberculosis Cases from 1997 to 1998

BACKGROUND: Recent evidence suggests a global rise in adult tuberculosis (TB) cases associated with HIV/AIDS. The World Health Organization, the United States Centers for Disease Control and Prevention, and the Public Health Agency of Canada advocate universal screening of all TB cases for HIV. The contribution of HIV to the TB burden in Canada remains unclear

Characterization of Acute and Chronic Hepatitis B Virus Genotypes in Canada

<div><p>Objective</p><p>The prevalence and distribution of hepatitis B virus (HBV) genotypes in Canada is not known. Genotypic analysis may contribute to a better understanding of HBV strain distribution and transmission risk.</p><p>Methods</p><p>HBV surface antigen (HBsAg) positive samples of acute (n = 152) and chronic (n = 1533) HBV submitted for strain analysis or reference genotype testing between 2006 and 2012 were analyzed. The HBsAg coding region was amplified to determine the HBV genotype by INNO-LiPA assay or sequence analysis. Single and multivariate analyses were used to describe genotypes’ associations with known demographic and behavioral risk factors for 126 linked cases of acute HBV.</p><p>Results</p><p>Nine genotypes were detected (A to I), including mixed infections. Genotype C (HBV/C) dominated within chronic infections while HBV/D and A prevailed among acute HBV cases. History of incarceration and residing with a chronic HBV carrier or injection drug user were the most frequently reported risks for acute HBV infection. Over time, HBV/A increased among both acute and chronic infections, and HBV/C and HBV/D decreased among chronic infections.</p><p>Conclusion</p><p>Chronic and acute HBV genotypes in Canada differ in the relative distribution and their associations with known risk factors, suggesting different routes of transmission and clinical progression of infection.</p></div

Genotype distribution for chronic HBV cases from Western Canada (n = 636; a), Central Canada (n = 298; b), the Prairies region (n = 532; c), and the Maritimes region (n = 67; d).

<p>Genotype distribution for chronic HBV cases from Western Canada (n = 636; a), Central Canada (n = 298; b), the Prairies region (n = 532; c), and the Maritimes region (n = 67; d).</p

Phylogenetic analysis of Canadian HBV acute and prevalent case genotype A and D sequences from 2006 to 2012.

<p>An alignment of 50 genotype D and 43 genotype A sequences having sufficient length (519 bp; nucleotide 311 to 829) together with GenBank reference sequences and sequences from the prevalent population within the same regions as acute cases (2 per year per genotype, except 2010, with 1 for genotype D for the same geographic region, due to almost exclusive INNO-LiPA analysis for reference requests in 2010) were analyzed by maximum likelihood analysis using MEGA5.2 software with 500 bootstrap replicates. Acute case sequences are shown as circles, by year; 2006 (black filled circle), 2007 (blue filled circle), 2008 (open circle), 2009 (green filled circle), 2010 (pink filled circle), 2011 (red filled circle), 2012 (yellow filled circle). Comparative prevalent population sequences are shown as squares together with the year. GenBank sequences are designated by the HBV subgenotype followed by the accession number and country or city, if referring to an acute case reference sequence. Bootstrap confidence values of ≥60% are given. The ruler shows the branch length for a pairwise distance equal to 0.01.</p

Relative distribution of acute HBV cases by genotype and year of report (a), and relative distribution of prevalent HBV cases by genotype and year of report (b).

<p>Relative distribution of acute HBV cases by genotype and year of report (a), and relative distribution of prevalent HBV cases by genotype and year of report (b).</p

Genotype distribution for acute HBV cases from Western Canada (n = 118; a), and Central Canada (n = 34; b).

<p>Genotype distribution for acute HBV cases from Western Canada (n = 118; a), and Central Canada (n = 34; b).</p

Complete relative distribution of risk factors associated with acute HBV.^a

<p>^aDefining has been carried out in a pre-determined and re-iterative way: First, all exposures were ranked according to their potential to cause an acute HBV by a measure of transmission risk and the likely duration of exposure as follows: High = IDU, Sex with HBV and MSM, having a household HBV carrier or IDU, heterosexual exposure; Medium-High = Immigration, prison history, occupational exposure; Medium-low = tattoo or piercing; low = invasive medical procedures or non-injection drug use.</p><p>Complete relative distribution of risk factors associated with acute HBV.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136074#t003fn001" target="_blank">^a</a></p

Phylogenetic analysis of Canadian acute case HBV sequences from 2006 to 2012.

<p>An alignment of 139 acute case sequences having sufficient length (519 bp; nucleotide 311 to 829) together with GenBank reference sequences were analyzed by maximum likelihood analysis using DIVEIN software with tree construction by the BioNJ algorithm with 100 bootstrap replicates. Acute case sequences are shown as circles, by year; 2006 (black filled circle), 2007 (blue filled circle), 2008 (open circle), 2009 (green filled circle), 2010 (pink filled circle), 2011 (red filled circle), 2012 (yellow filled circle). GenBank sequences are designated by the HBV genotype or subgenotype followed by the accession number. Bootstrap confidence values of ≥60% are given. The ruler shows the branch length for a pairwise distance equal to 0.05.</p