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Effectiveness in prevention of travellers' diarrhoea by an oral cholera vaccine WC/rBS. Travel Med Infect Dis. 2007 Nov;5(6):380-4. Epub 2007 Jul 30. López-Gigosos R, García-Fortea P, Reina-Doña E, Plaza-Martín E. OBJECTIVE: To investigate the effectiveness of an oral cholera vaccine Dukoral in preventing travellers' diarrhoea. MATERIAL AND METHODS: A retrospective study was conducted among travellers who had attended the International Vaccination Centre in Malaga, Spain, before starting their journey. A telephone interview was undertaken from November 2005 to January 2006 after the travellers had returned from their trip. The relationship between vaccination with Dukoral and travellers' diarrhoea was analysed by means of a logistic regression model, adjusting for possible confounding variables (traveller's age, duration of trip and region visited). RESULTS: The overall incidence of diarrhoea in vaccinated travellers was 23% compared with 40% in non-vaccinated travellers (historical control group) (p=0.004). Short episodes of diarrhoea were reported in significantly more travellers of the vaccinated group than of the non-vaccinated group (average duration of diarrhoea 2.21 days versus 3.97 days, p=0.005). The incidence of diarrhoea was significantly lower among vaccinated than non-vaccinated travellers who went to Africa for less than 3 weeks (16% versus 48%, p=0.002) or India and South East Asia (19% versus 50%, p =0.052) for more than 3 weeks. No adverse events were reported in the group of vaccinated travellers. DISCUSSION: Vaccination reduced the risk of travellers' diarrhoea by 43%; possibly due to the protective effect of the oral vaccine Dukoral against travellers' diarrhoea caused by enterotoxigenic Escherichia coli (ETEC) or cholera. The efficacy of vaccination increased after adjusting for confounding factors, being modified by traveller age (under 30 years, or 45 years and older the protective effect of the vaccine is 4.8 greater, 95% confidence interval (CI): 2.1-10.7). The number needed to treat to prevent one traveller from suffering from one or more episodes of travellers' diarrhoea was 5.8.
Antibiotic resistance: recent abstract Low-level fluoroquinolone resistance among Campylobacter jejuni isolates in Australia. Clin Infect Dis. 2006 May 15;42(10):1368-74. Epub 2006 Apr 13. Unicomb LE, et al; Australian Campylobacter Subtyping Study Group. BACKGROUND: Ciprofloxacin-resistant Campylobacter jejuni isolates obtained from infected patients in Australia have not been detected in studies of isolates from specific geographic areas. The Australian government has prohibited the use of fluoroquinolone in food-producing animals. To assess the impact of this policy, we have examined the antimicrobial susceptibility of isolates from 5 Australian states. METHODS: We conducted a period-prevalence survey of the susceptibility of C. jejuni isolates to 10 antimicrobial agents. C. jejuni isolates obtained from 585 patients from 5 Australian states (Queensland, South Australia, Tasmania, Victoria, and Western Australia) were identified by means of notifiable disease databases and were systematically selected from September 2001 to August 2002. RESULTS: Among locally acquired infections, only 2% of isolates (range, 0%-8% in different states) were resistant to ciprofloxacin. The locally acquired isolates also exhibited resistance to sulfisoxazole (55%), ampicillin (46%), roxithromycin (38%), tetracycline (7%), nalidixic acid (6%), chloramphenicol (3%), erythromycin (3%), gentamicin (2%), and kanamycin (0.2%). Treatment with antimicrobial agents in the 4 weeks before onset was not associated with ciprofloxacin resistance. CONCLUSIONS: The very low level of ciprofloxacin resistance in C. jejuni isolates likely reflects the success of Australia's policy of restricting use of fluoroquinolones in food-producing animals. Return to scenarios
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