Infectious diseases genomic surveillance capacity in the Caribbean: A retrospective analysis of SARS-CoV-2.

Background: The ongoing coronavirus diseases 2019 (COVID-19) pandemic with its numerous variants of concern has shown the need to have a robust and complete global infectious diseases genomic surveillance network worldwide. Various clinical and research institutions have stepped up to perform SARS-CoV-2 sequencing thus enhancing the understanding of this virus' global evolution. However, given that genomic sequencing capacities and capabilities are not available in every region or country, significant gaps exist, which lead to geographic blind spots. One such region is the Caribbean. This paper measures the Caribbean region's SARS-CoV-2 genomic sequencing capacity and highlights the need to improve further regional genomics surveillance capacities and capabilities, which are essential for efficient health interventions for infectious diseases. Methods: A map showing SARS-CoV-2 sequences available for each Caribbean Island was constructed using SARS-CoV-2 genomic, epidemiological and populational data obtained from GISAID, the World Health Organization, the United Nations, and the World Bank. The number of reported SARS-CoV-2 cases and the proportion of cases sequenced in each Caribbean Island was then analysed by the Gross Domestic Product per capita and political status. Findings: As of August 6, 2022, the number of SARS-CoV-2 sequences from the Caribbean are underrepresented with only 40,190 (1.07%) of the over 3.76 million documented cases sequenced, which is further exacerbated by a disparity based not only on the country's income but also on its political status (sovereign country versus dependent or integrated) and accessibility to sequencing technologies. There are a limited number of sequencing centres based in the Caribbean islands with the majority located on the American and European continents. Using mobile sequencing technologies while concomitantly investing in data analysis training could lead to greater and more sustainable coverage. Interpretation: Considering the Caribbean region's dispersed heterogeneous populations, varying political regimes, and resource-constrained healthcare systems, further development of local next-generation sequencing capacity and capabilities in the Caribbean region is needed to achieve global public health goals. Funding: No funding source was required for this study.

Evaluation of Bisphenol A in Pregnant Women from 10 Caribbean Countries.

Bisphenol A (BPA), a phenolic chemical incorporated into many plastic products, has been found to act as an endocrine disruptor that potentially is linked to adverse neurodevelopmental outcomes. Prenatal BPA concentration levels were assessed in 10 English-speaking Caribbean countries by randomly selecting 15 maternal urine samples from approximately 50 pregnant women samples collected in each island and then comparing the findings with comparable data from Canada and the U.S. BPA was detected in all samples ranging from a low geometric mean of 1.46 µg/L (St. Lucia) to a high of 4.88 µg/L (St. Kitts & Nevis). All of the Caribbean islands sampled had geometric mean concentration levels that were higher than those recorded in two Canadian biomonitoring surveys (1.26 µg/L and 0.80 µg/L) and the U.S. NHANES survey (1.39 µg/L). This first biomonitoring survey of BPA concentration levels in maternal urine samples taken from Caribbean countries clearly points to the need for Caribbean governments and public health officials to first engage in legislative and regulatory efforts to ban or minimize the importation and use of BPA products used the Caribbean and, second, to continue to conduct biomonitoring surveys so as to ensure that these laws and regulations are indeed leading to a decrease of BPA concentrations in Caribbean populations.

Public health response and lessons learned from the 2014 chikungunya epidemic in Grenada.

In June 2014, the first cases of chikungunya virus (CHIKV) were diagnosed on the island of Carriacou, part of the tri-island state of Grenada. In the three months that followed, CHIKV spread rapidly, with conservative estimates of the population infected of at least 60%. Multiple challenges were encountered in the battle to manage the spread and impact of this high-attack rate virus, including 1) limited indigenous laboratory diagnostic capabilities; 2) an under-resourced health care system; 3) a skeptical general public, hesitant to accept facts about the origin and mode of transmission of the new virus; and 4) resistance to the vector control strategies used. Lessons learned from the outbreak included the need for 1) a robust and reliable epidemiological surveillance system; 2) effective strategies for communicating with the general population; 3) exploration of other methods of mosquito vector control; and 4) a careful review of all health care policies and protocols to ensure that effective, organized responses are triggered when an infectious outbreak occurs.

Seroprevalence of five parasitic pathogens in pregnant women in ten Caribbean countries.

To date, published epidemiological studies of parasitic infections in humans in the Caribbean region are very limited. Here, we report the seroprevalence of five parasitic pathogens, including Ascaris lumbricoides, Entamoeba histolytica, Giardia lamblia, Schistosoma mansoni, and Toxocara canis in 435 serum samples collected between 2008 and 2011 from pregnant women in ten Caribbean islands. We tested the serum samples for IgG antibodies against the five parasites by enzyme-linked immunosorbent assay (ELISA). Among them, 66.2 % were serologically positive for at least one parasite. The most prevalent parasite was G. lamblia (40.5 %), followed by A. lumbricoides (37.9 %), T. canis (14.5 %), E. histolytica (6.7 %), and S. mansoni (3.0 %). Evidence of infections of G. lamblia and A. lumbricoides were detected in all ten Caribbean countries. Seroprevalence estimates significantly differed between countries for A. lumbricoides, E. histolytica, and T. canis (p values <0.001). For S. mansoni, significance was observed by Fisher's exact test (p = 0.013) but not by multiple comparisons. The prevalence of G. lamblia was not significantly different between countries (p = 0.089). A significant negative correlation between the gross domestic product (GDP) per capita and overall seroprevalence by country was also observed (Pearson's r = -0.9202, p = 0.0002). The data strongly indicates that neglected parasitic infections remain a significant health burden on people in these countries. Thus, justification has been provided to regional health planners to enhance existing public health surveillance programs on parasitic diseases and to heighten the public's awareness through education and outreach programs on how they can minimize the occurrence of parasitic infections.

Toxoplasmosis in the Caribbean islands: literature review, seroprevalence in pregnant women in ten countries, isolation of viable Toxoplasma gondii from dogs from St. Kitts, West Indies with report of new T. gondii genetic types.

Little is currently known of clinical toxoplasmosis in humans and animals in the Caribbean. We investigated the prevalence of IgG and IgM antibodies in 437 pregnant women from 10 English speaking Caribbean countries. Overall, antibodies (IgG) to Toxoplasma gondii (modified agglutination test, MAT, cut-off 1:6) were found in 174 (39.8 %) of 437 human sera; specifically 12 of 38 from Antigua-Barbuda, 26 of 52 from Belize, 9 of 50 from Bermuda, 29 of 49 from Dominica, 18 of 49 from Grenada, 16 of 47 from Jamaica, 5 of 15 from Montserrat, 8 of 44 from St. Kitts/Nevis, 24 of 45 from St. Lucia, and 27 of 50 from St. Vincent/Grenadines were seropositive. All IgG-positive sera were tested for IgM antibodies using the immunocapture method; all sera were negative for IgM antibodies. Additionally, tissues and sera of 45 dogs from St. Kitts were examined for T. gondii infection. Antibodies (IgG, MAT, 1:≥25) were found in 19 (42.2 %) of 45 dogs. Muscle samples (tongue, leg) of 19 seropositive dogs were digested in pepsin, and homogenates were bioassayed in mice. Viable T. gondii were isolated from 6 dogs. T. gondii isolates were further propagated in cell culture. PCR-RFLP genotyping of cell culture derived tachyzoites using 10 genetic markers, SAG1, SAG2 (5' and 3' SAG2, and alt.SAG2) SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico revealed that 4 isolates were ToxoDB PCR-RFLP genotype #2, and 2 were new genotypes #264 and #265. Review of 22 viable T. gondii isolates from chickens, dogs, and cats from Grenada and St. Kitts revealed that 1 isolate was type II, 13 were type III, and 8 were atypical. Thus, type III strains were predominant. Overall, the study revealed high prevalence of T. gondii in the Caribbean islands.

Evaluation of exposure to organophosphate, carbamate, phenoxy acid, and chlorophenol pesticides in pregnant women from 10 Caribbean countries.

Pesticides are commonly used in tropical regions such as the Caribbean for both household and agricultural purposes. Of particular concern is exposure during pregnancy, as these compounds can cross the placental barrier and interfere with fetal development. The objective of this study was to evaluate exposure of pregnant women residing in 10 Caribbean countries to the following commonly used classes of pesticides in the Caribbean: organophosphates (OPs), carbamates, phenoxy acids, and chlorophenols. Out of 438 urine samples collected, 15 samples were randomly selected from each Caribbean country giving a total of 150 samples. Samples were analyzed for the following metabolites: six OP dialkylphosphate metabolites [dimethylphosphate (DMP), dimethylthiophosphate (DMTP), dimethyldithiophosphate (DMDTP), diethylphosphate (DEP), diethylthiophosphate (DETP) and diethyldithiophosphate (DEDTP)]; two carbamate metabolites [2-isopropoxyphenol (2-IPP) and carbofuranphenol]; one phenoxy acid 2,4-dichlorophenoxyacetic acid (2,4-D); and five chlorophenols [2,4-dichlorophenol (DCP), 2,5-dichlorophenol (2,5-DCP), 2,4,5-trichlorophenol (TCP), 2,4,6-trichlorophenol (2,4,6-TCP), and pentachlorophenol (PCP)]. OP metabolites were consistently detected in ≥60% of the samples from Antigua and Barbuda, Bermuda, and Jamaica. Of the carbamate metabolites, 2-IPP was detected in seven of the 10 Caribbean countries with a detection frequency around 30%, whereas carbofuranphenol was detected in only one sample. The detection frequency for the phenoxy acid 2,4-D ranged from 20% in Grenada to a maximum of 67% in Belize. Evidence of exposure to chlorophenol pesticides was also established with 2,4-DCP by geometric means ranging from 0.52 µg L(-1) in St Lucia to a maximum of 1.68 µg L(-1) in Bermuda. Several extreme concentrations of 2,5-DCP were detected in four Caribbean countries-Belize (1100 µg L(-1)), Bermuda (870 µg L(-1)), Jamaica (1300 µg L(-1)), and St Kitts and Nevis (1400 µg L(-1)). 2,4,5-TCP, 2,4,6-TCP, and pentachlorophenol were rarely detected. This biomonitoring study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to become more aware of the potential routes of exposure to pesticides and to utilize these chemicals more cautiously given the possible adverse effects such exposures can have on their unborn children and infants.

Mercury and lead blood concentrations in pregnant women from 10 caribbean countries.

Maternal mercury (Hg) and lead (Pb) blood concentrations were measured in a total of 442 samples taken from pregnant and delivering women in 10 Caribbean countries. Hg was detected in all 10 countries with the geometric mean ranging from a low of 0.83 µg L(-1) (Jamaica) to a high of 3.13 µg L(-1) (Grenada). When compared to comparable U.S. and Canadian data, Hg concentrations in Caribbean women are on average more than 2 times higher. With the exception of St. Kitts & Nevis, Pb was detected in at least one of the samples taken from the other 9 countries with two countries-Grenada and St. Vincent - having Pb detected in ≥60% of those sampled. In these two countries, the Pb concentrations ranged from a low of 1.17 µg dL(-1) (Grenada) to a high of 1.98 µg dL(-1) (St. Vincent). Compared to comparable U.S. and Canadian data, Pb concentrations in Caribbean women are generally higher than that measured in North America. This study confirms that neonates in the Caribbean are being exposed to both Hg and Pb and highlights the need to implement surveillance programs that continuously monitor, intervene, and evaluate the levels of these toxic elements to ensure that they are reduced as far as possible.

Prenatal exposure to persistent organic pollutants and polybrominated diphenyl ethers in 10 Caribbean countries.

Prenatal exposures to legacy persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) and dioxin-like compounds (DLC), as well as polybrominated diphenyl ethers (PBDE), were analyzed in pregnant women from 10 Caribbean countries. A total of 438 samples were collected and descriptive statistics calculated and compared to comparable Canadian Health Measure Survey (CHMS) and U.S. National Health and Nutritional Examination Survey (NHANES) datasets. Maternal POPs blood concentrations were found to be generally relatively low in the Caribbean samples compared with the U.S. and Canada datasets. Evidence of exposure to DLC and PBDE was established. DLC levels ranged from a geometric mean low of 3.96 pg/g lipids in Antigua and Barbuda to a high of 11.4 pg/g lipids in St. Lucia. Several of the PBDEs (15, 17, 25, 28, 33, 100) were detected in less than 60% of the country' samples. For PBDE-47, significantly higher levels were found in Bermuda, while Jamaica recorded a significantly low level. The overall calculated concentration of PBDE-47 for the Caribbean (5.33 µg/kg lipids) was significantly lower than the concentrations measured for the U.S. (10.83 µg/kg lipids) and Canada (23.90 µg/kg lipids). This study confirms that prenatal expose to multiple environmental chemicals is taking place in the Caribbean and highlights the need to implement surveillance programs that continuously monitor, intervene, and evaluate the levels of these toxic environmental contaminants to ensure that they are reduced as much as possible and that the health risk to humans, in particular the unborn child, are minimized.

Estimating the burden of acute gastrointestinal illness in Grenada.

This is the first study conducted in Grenada, with a population of approximately 108,000, to quantify the magnitude, distribution, and burden of self-reported acute gastroenteritis (AGE). A retrospective population survey was conducted in October 2008 and April 2009 and a laboratory survey from October 2008 to September 2009. The estimated monthly prevalence of AGE was 10.7% (95% CI 9.0-12.6; 1.4 episodes/ person-year), with a median of 3 days of illness. Of those who reported AGE, 31% sought medical care (stool samples were requested from 12.5%); 10% took antibiotics; 45% took non-prescribed medication; and 81% reported restricted activity. Prevalence of AGE was significantly higher among children aged <5 years (23.5%, p < 0.001). Of the AGE stool samples submitted to the laboratory for analysis, 12.1% were positive for a foodborne pathogen. Salmonella enteritidis was the most common foodborne pathogen associated with AGE-related illness. The estimated percentage of underreporting of syndromic AGE to the Ministry of Health was 69%. In addition, for every laboratory-confirmed foodborne/AGE pathogen, it was estimated that there were 316 additional cases occurring in the population. The minimum estimated cost associated with treatment for AGE was US$ 703,950 each year, showing that AGE has a potentially significant economic impact in Grenada.

Prevalence of musculoskeletal disorders in union ironworkers.

The prevalence of musculoskeletal disorder (MSD) symptoms and doctor-diagnosed musculoskeletal disorders (DDMDs) were estimated among union construction ironworkers by a telephone-administered questionnaire. Of 1996 ironworkers eligible, 1566 were contacted and 981 were interviewed. The prevalence of self-reported MSD symptoms was high for the lower back (56%), wrist/hands/fingers (40%), knees (39%), and shoulders (36%). The most common DDMDs were tendonitis (19%), ruptured disk in the back (18%), bursitis in the shoulder (15%), and carpal tunnel syndrome (12%). Generally, the prevalence of DDMDs and MSD symptoms increased with duration of employment. In age-adjusted logistic regression analyses, those who worked 25 to 35 years were more likely to have tendonitis (odds ratio [OR] 7.1, 95% confidence interval [CI] 3.116.6), shoulder bursitis (OR 13.7, 95% CI 3.160.4), knee bursitis (OR 5.1, 95% CI 1.025.1), and ruptured intervertebral back disk (OR 6.7, 95% CI 2.617.5). The effect of prior injury was also consistently high (upper extremities, OR 4.6; lower extremities OR 5.1; lower back, OR 6.0). Among workers without prior injuries, MSD symptoms were more frequent for the lower back in structural ironwork (OR 1.7, 95% CI 1.12.6), and for the upper extremity in concrete reinforcement ironwork (OR 1.9, 95% CI 1.22.9). These findings suggest that some musculoskeletal morbidity in construction ironworkers may be work related and thus preventable.

Pathomechanisms of work-related musculoskeletal disorders: conceptual issues.

Work-related musculoskeletal disorders (WRMSDs) by definition are a subset of musculoskeletal disorders (MSDs) that arise out of occupational exposures. While traditional exposure assessment techniques have proved to be successful in identifying ergonomic exposures that are epidemiologically linked to these disorders, some are troubled by the lack of one-to-one correspondence between specific occupational exposure profiles and specific MSDs. In the absence of more sophisticated hypotheses that might explain the occurrence of WRMSDs in a variety of exposure patterns, the aetiologic relationships may (again) be called into question. Another unanswered question is whether specific types of WRMSDs have qualitatively different exposure-response relationships. A clearer understanding of the underlying pathomechanisms associated with specific WRMSDs could help future researchers better determine how and when various occupational exposure profiles become pathogenic. Such knowledge could also be used to design exposure assessment tools to capture exposure information more relevant to the risk of WRMSDs. The main goals of this paper are to summarize several recently described pathomechanisms, most of which have been discussed primarily in clinical and experimental literature that might not be widely read by occupational health scientists. Suggestions are made as to how future research could evaluate whether these phenomena are relevant to the effects of physical exposures and the underlying disease processes of common WRMSDs.