Caracterización y evolución temporal de la mortalidad por zoonosis bajo declaración obligatoria, entre los años 1997 y 2018 / Characterization and temporal evolution of mortality due to zoonoses under mandatory declaration, between the years 1997 and 2018

INTRODUCCIÓN: Las zoonosis son enfermedades transmitidas desde un hospedador animal al ser humano o viceversa. En Chile, las zoonosis de Notificación Obligatoria (NO) son: brucelosis, carbunco, triquinosis, hidatidosis, leptospirosis, dengue, enfermedad de Chagas, hantavirosis y rabia. OBJETIVO: Evaluar la tendencia y caracterizar la mortalidad por zoonosis de NO en Chile entre 1997-2018. METODOLOGÍA: Estudio ecológico de la mortalidad por zoonosis de NO. Se utilizaron bases de mortalidad y población oficiales. Se describió la mortalidad relativa, general y específica, según variables sociodemográficas. Se calcularon tasas de mortalidad anuales brutas (TMb) y ajustadas (TMa, método directo). Se evaluó la tendencia temporal con modelos de regresión de Prais-Winsten. Resultados: Entre 1997 y 2018 la mortalidad por zoonosis de NO correspondió al 0,12% (2.359 muertes) de la mortalidad total, siendo las principales causas la enfermedad de Chagas (59,8%), hidatidosis (23,9%) y hantavirosis (13,8%). La TMa general disminuyó significativamente (B: -0,017; IC95%: -0,024; -0,009) al igual que hidatidosis (B: -0,011; IC95%: -0,013; -0,008), sólo hantavirosis mostró un aumento (no significativo). CONCLUSIÓN: La mortalidad por zoonosis de NO disminuyó durante el período estudiado; solo la hantavirosis mostró un aumento en su tendencia. Se sugiere enfocar estrategias para prevenir la transmisibilidad y mortalidad por hanta, así como mejorar el acceso a tratamiento para las otras zoonosis.

BACKGROUND: Zoonoses are diseases transmitted from an animal host to humans or vice versa. In Chile, the zoonoses of mandatory notification are brucellosis, anthrax, trichinosis, hydatidosis, leptospirosis, dengue, Chagas disease, hantavirosis and rabies. AIM: To assess the trend and characterize the mortality from zoonoses of mandatory notification in Chile between 1997-2018. METHODS: An official mortality and population data were used. Relative, general and specific mortality rates were described according to sociodemographic variables. Crude and adjusted annual mortality rates (direct method) were calculated. Temporal trend was evaluated with the Prais-Winsten regression model. RESULTS: Between 1997 and 2018, the mortality rate due to zoonosis of mandatory notification corresponded to 0.13% (2152 deaths) of the total mortality, being Chagas disease (59.2%), hydatidosis (24.6%) and hantavirosis (13.5%) the main causes. The general adjusted mortality rate decreased significantly (B: -0.017; IC95%: -0.024; -0.009) as did hydatidosis (B: -0.011; IC95%: -0.013; -0.008), and only hantavirosis showed an increase trend (not significant). CONCLUSION: Mortality due to zoonoses decreased during the period; only hantavirosis showed an increasing trend. It is suggested to focus on strategies to prevent contagion and mortality by hantavirosis, as well as to improve access to treatment for the other zoonoses.

Zoonotic and reverse zoonotic transmission of severe acute respiratory syndrome coronavirus 2: a review and implications for Africa.

There is an urgent need to properly understand the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the event of continuous rise in morbidity in both humans and animals as well as an increase in the mortality rate in man. Since the novel SARS-CoV-2 emerged in Wuhan, China with its global spread in over 200 countries, several studies have been published on the epidemiology of the virus in man with limited information on the roles of animals and the possibility of reverse zoonosis. We therefore collected published research literature on COVID-19 from public search engines for information on SARS-CoV-2 in animals and reverse zoonosis from man. A critical and thorough study appraisal/evaluation was performed to include recent quality publications that focus on the scope of this write-up including zoonosis and reverse zoonosis of SARS-CoV-2. We highlighted what is known about SARS-CoV-2 in animals, identify gaps for future research, summarized possible reverse zoonotic transmission of SARS-CoV-2 from man to animals and included the likely implications of our summary for Africa, despite the dearth of information in Africa on the key concepts of this study.

Infection pattern, case fatality rate and spread of Lassa virus in Nigeria.

BACKGROUND: Lassa fever (LF) is a zoonotic infectious disease of public concern in Nigeria. The infection dynamics of the disease is not well elucidated in Nigeria. This study was carried out to describe the pattern of infection, case fatality rate and spread of lassa virus (LASV) from 2017 to 2020. METHODS: Weekly epidemiological data on LF from December, 2016 to September, 2020 were obtained from Nigeria Centre for Disease Control. The number of confirmed cases and deaths were computed according to months and states. Descriptive statistics was performed and case fatality rate was calculated. Distribution and spread maps of LF over the four years period was performed on ArcMap 10.7. RESULTS: A total of 2787 confirmed cases and 516 deaths were reported in Nigeria from December, 2016 to September, 2020. Increase in number of cases and deaths were observed with 298, 528, 796 and 1165 confirmed cases and 79, 125, 158 and 158 deaths in 2017, 2018, 2019 and 2020 respectively. Over 60% of the cases were reported in two states, Edo and Ondo states. The LF cases spread from 19 states in 2017 to 32 states and Federal Capital Territory (FCT) in 2020. Ondo state (25.39%) had the highest of deaths rate from LF over the four years. Case fatality rate (CFR) of LF was highest in 2017 (26.5%) with CFR of 23.7, 19.6 and 13.4% in 2018, 2019 and 2020 respectively. The peak of infection was in the month of February for the four years. Infections increases at the onset of dry season in November and decline till April when the wet season sets-in. CONCLUSION: There is an annual increase in the number of LASV infection across the states in Nigeria. There is need to heighten control strategies through the use of integrated approach, ranging from vector control, health education and early diagnosis.

Occupational Fatalities Due to Mammal-Related Accidents in Japan, 2000-2019.

INTRODUCTION: Animal-related fatal accidents occur annually while individuals are outside working. This study intended to evaluate the trends of occupational fatal accidents related to mammals and compare them with nonoccupational accidents. METHODS: We collected occupational and nonoccupational fatalities related to mammals between 2000 and 2019 from data on fatal occupational accident cases certified by the Ministry of Health, Labor and Welfare, Japan, in addition to other statistics from relevant ministries, media reports such as newspapers, and academic case reports. RESULTS: A total of 109 fatal accidents related to mammals were confirmed as occurring during work, and 129 were confirmed as taking place outside of work. Of the former, accidents among livestock farmers and horse racing-related workers accounted for about half. Among the accidents not related to work, dog attacks, infectious diseases from cats or dogs, traffic accidents with wild animals, and bear attacks during wild vegetable picking were common. Deaths from infectious diseases caused by dogs and cats have rarely been reported in the mass media. CONCLUSIONS: Although the number of fatal occupational accidents related to mammals is not large, we concluded that it is necessary to continue preventive measures centered on accidents at livestock farms and in horse racing-related workplaces. It is also necessary to inform people about the risks of infectious diseases mediated by dogs and cats.

Selected wetland soil properties correlate to Rift Valley fever livestock mortalities reported in 2009-10 in central South Africa.

Outbreaks of Rift Valley fever have devastating impacts on ruminants, humans, as well as on regional and national economies. Although numerous studies on the impact and outbreak of Rift Valley fever exist, relatively little is known about the role of environmental factors, especially soil, on the aestivation of the virus. This study thus selected 22 sites for study in central South Africa, known to be the recurrent epicenter of widespread Rift Valley fever outbreaks in Southern Africa. Soils were described, sampled and analyzed in detail at each site. Of all the soil variables analyzed for, only eight (cation exchange capacity, exchangeable Ca2+, exchangeable K+, exchangeable Mg2+, soluble Ca2+, medium sand, As, and Br) were statistically identified to be potential indicators of sites with reported Rift Valley fever mortalities, as reported for the 2009-2010 Rift Valley fever outbreak. Four soil characteristics (exchangeable K+, exchangeable Mg2+, medium sand, and Br) were subsequently included in a discriminant function that could potentially be used to predict sites that had reported Rift Valley fever-associated mortalities in livestock. This study therefore constitutes an initial attempt to predict sites prone to Rift Valley fever livestock mortality from soil properties and thus serves as a basis for broader research on the interaction between soil, mosquitoes and Rift Valley fever virus. Future research should include other environmental components such as vegetation, climate, and water properties as well as correlating soil properties with floodwater Aedes spp. abundance and Rift Valley fever virus prevalence.

Contribution of Anthropogenic Factors and Climate Variables to Human Cystic Echinococcosis Mortality in Chile (2001-2011).

Here we assess the effect of weather and anthropogenic environmental variables, particularly urbanization, on cystic echinococcosis mortality in Chile from 2001 to 2011 using a nonparametric regression model, multivariate adaptive regression splines, and Poisson nonlinear regression models. This study integrated data from various sources on weather and anthropogenic variables. The canine population had the greatest influence on human cystic echinococcosis mortality during the period analyzed. Urbanization among anthropogenic variables and temperature and precipitation among the weather-related variables were the main factors related to cystic echinococcosis deaths. Deaths decreased with urbanization level. Temperature showed a nonlinear impact on mortality, with an optimum value ∼11°C. Public policies aimed at improving safe management of companion animal populations are crucial in controlling the spread of this disease. Effective animal management strategies would have wide-ranging public health benefits, advance the welfare of companion animals and livestock, and decrease the number of human cystic echinococcosis cases.

Nipah virus persists in the brains of nonhuman primate survivors.

Nipah virus (NiV) is an emerging zoonotic paramyxovirus that causes highly lethal henipavirus encephalitis in humans. Survivors develop various neurologic sequelae, including late-onset and relapsing encephalitis, several months up to several years following initial infection. However, the underlying pathology and disease mechanisms of persistent neurologic complications remain unknown. Here, we demonstrate persistent NiV infection in the brains of grivets that survived experimental exposure to NiV. Encephalitis affected the entire brains, with the majority of NiV detected in the neurons and microglia of the brainstems, cerebral cortices, and cerebella. We identified the vascular endothelium in the brain as an initial target of NiV infection during the acute phase of disease, indicating a primary path of entry for NiV into the brain. Notably, we were unable to detect NiV anywhere else except the brains in the examined survivors. Our findings indicate that late-onset and relapsing encephalitis of NiV in human survivors may be due to viral persistence in the brain and shed light on the pathogenesis of chronic henipavirus encephalitis.

Case fatality rate and risk factors for Nipah virus encephalitis: A systematic review and meta-analysis.

BACKGROUND: A wide range of Nipah virus (NiV) encephalitis case fatality rates (CFR) have been reported. Data on the involvement of several potential risk factors in Nipah virus transmission remain controversial. We performed a systematic review and meta-analysis to estimate the pooled CFR of NiV encephalitis and to assess the risk factors for NiV infection. METHODS: Articles published up to the 27thof November 2018 in MedLine, Embase and Web of knowledge databases were considered for this study. We included cross-sectional, cohort, and case-control studies that have reported NiV CFR and/or risk factors. Data were pooled with random-effects model. This review was registered in the PROSPERO, CRD42018116242. FINDINGS: This global review included 22 citations (25 studies) including 2156, 1682, and 474 suspected, probable, and confirmed cases of NiV encephalitis, respectively. We determined a pooled CFR for NiV encephalitis at 61.0% (95% CI, 45.7-75.4; I² = 96.8%). Climbing trees (OR = 1.4; 95% CI; 1.0-1.9), male gender (OR = 1.5; 95% CI; 1.1-2.0), travel outside their own sub-district (OR = 2.0; 95% CI; 1.4-2.9), and exposure to date palm sap (DPS) (OR = 5.7; 95% CI; 3.8-8.6) or pigs (OR = 7.6; 95% CI; 1.2-45.4) were significantly associated with NiV infection. CONCLUSION: Findings from this study suggest that NiV Encephalitis is associated with a high CFR and that male gender, travel outside their sub-district, climbing trees, and exposure to pigs and DPS are associated with an increased risk of NiV encephalitis.

[Hospitalizations and deaths related to sporotrichosis in Brazil (1992-2015)]. / Hospitalizações e óbitos relacionados à esporotricose no Brasil (1992-2015).

Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

Hospitalizações e óbitos relacionados à esporotricose no Brasil (1992-2015) / Hospitalizations and deaths related to sporotrichosis in Brazil (1992-2015) / Hospitalizaciones y óbitos relacionados con la esporotricosis en Brasil (1992-2015)

Resumo: A esporotricose é uma micose subcutânea de distribuição global e, em geral, os pacientes são tratados ambulatorialmente. Desde 1998, observa-se aumento dos casos no Estado do Rio de Janeiro, Brasil, especialmente por transmissão zoonótica envolvendo gatos. Os pacientes coinfectados pelo vírus da imunodeficiência humana (HIV), muitas vezes, necessitam de hospitalizações e evoluem a óbito. Este estudo analisa e descreve dados de 1992 a 2015, provenientes de bancos de dados do Sistema Único de Saúde. No Brasil, ocorreram 782 hospitalizações e 65 óbitos. Em 6% das hospitalizações e 40% dos óbitos, havia coinfecção pelo HIV. No Rio de Janeiro, foram 250 hospitalizações e 36 óbitos, com aumento progressivo, ao longo do período. Destacaram-se, ainda, São Paulo e Goiás. Homens, não brancos, com baixa escolaridade evoluíram mais frequentemente a óbito. Conclui-se que a esporotricose está associada a hospitalizações e óbitos em todo o Brasil, com destaque para o Rio de Janeiro.

Abstract: Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

Resumen: La esporotricosis es una micosis subcutánea de distribución global y, en general, los pacientes son tratados ambulatoriamente. Desde 1998, se observa un aumento de los casos en el estado de Río de Janeiro, Brasil, principalmente por transmisión zoonótica implicando gatos. Los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH), muchas veces, necesitan de hospitalizaciones y evolucionan a óbito. Este estudio analiza y describe datos de 1992 a 2015, provenientes de bancos de datos del Sistema Único de Salud (SUS). En Brasil, se produjeron 782 hospitalizaciones y 65 óbitos. En un 6% de las hospitalizaciones y 40% de los óbitos, había coinfección por el VIH. En Río de Janeiro, fueron 250 hospitalizaciones y 36 óbitos, con un aumento progresivo a lo largo del período. Se destacaron, incluso, São Paulo y Goiás. Hombres, no blancos, con baja escolaridad evolucionaron más frecuentemente a óbito. Se concluye que la esporotricosis está asociada a hospitalizaciones y óbitos en todo Brasil, destacando Río de Janeiro.

Origins of the 1918 Pandemic: Revisiting the Swine "Mixing Vessel" Hypothesis.

How influenza A viruses host-jump from animal reservoir species to humans, which can initiate global pandemics, is a central question in pathogen evolution. The zoonotic and spatial origins of the influenza virus associated with the "Spanish flu" pandemic of 1918 have been debated for decades. Outbreaks of respiratory disease in US swine occurred concurrently with disease in humans, raising the possibility that the 1918 virus originated in pigs. Swine also were proposed as "mixing vessel" intermediary hosts between birds and humans during the 1957 Asian and 1968 Hong Kong pandemics. Swine have presented an attractive explanation for how avian viruses overcome the substantial evolutionary barriers presented by different cellular environments in humans and birds. However, key assumptions underpinning the swine mixing-vessel model of pandemic emergence have been challenged in light of new evidence. Increased surveillance in swine has revealed that human-to-swine transmission actually occurs far more frequently than the reverse, and there is no empirical evidence that swine played a role in the emergence of human influenza in 1918, 1957, or 1968. Swine-to-human transmission occurs periodically and can trigger pandemics, as in 2009. But swine are not necessary to mediate the establishment of avian viruses in humans, which invites new perspectives on the evolutionary processes underlying pandemic emergence.

Human impact on the diversity and virulence of the ubiquitous zoonotic parasite Toxoplasma gondii.

A majority of emerging infectious diseases in humans are zoonoses. Understanding factors that influence the emergence and transmission of zoonoses is pivotal for their prevention and control. Toxoplasma gondii is one of the most widespread zoonotic pathogens known today. Whereas only a few genotypes of T. gondii dominate in the Northern Hemisphere, many genotypes coexist in South America. Furthermore, T. gondii strains from South America are more likely to be virulent than those from the Northern Hemisphere. However, it is not clear what factor(s) shaped modern-day genetic diversity and virulence of T. gondii Here, our analysis suggests that the rise and expansion of farming in the past 11,000 years established the domestic cat/mouse transmission cycle for T. gondii, which has undoubtedly played a significant role in the selection of certain linages of T. gondii Our mathematical simulations showed that within the domestic transmission cycle, intermediately mouse-virulent T. gondii genotypes have an adaptive advantage and eventually become dominant due to a balance between lower host mortality and the ability to superinfect mice previously infected with a less virulent T. gondii strain. Our analysis of the global type II lineage of T. gondii suggests its Old World origin but recent expansion in North America, which is likely the consequence of global human migration and trading. These results have significant implications concerning transmission and evolution of zoonotic pathogens in the rapidly expanding anthropized environment demanded by rapid growth of the human population and intensive international trading at present and in the future.

Macroecology of birds potentially susceptible to West Nile virus.

Zoonotic diseases transmitted by wildlife affect biological conservation, public and animal health, and the economy. Current research efforts are aimed at finding wildlife pathogens at a given location. However, a meta-analytical approach may reveal emerging macroecological patterns in the host-pathogen relationship at different temporal and spatial scales. West Nile virus (WNV) is a pathogen with worldwide detrimental impacts on bird populations. To understand macroecological patterns driving WNV infection, we aimed to recognize unknown competent reservoirs using three disease metrics-serological prevalence (SP), molecular prevalence (MP) and mortality (M)-and test if these metrics are correlated with the evolutionary history, geographical origin of bird species, viral strain, time-space and methodology. We performed a quantitative review of field studies on birds sampled for WNV. We obtained 4945 observations of 949 species from 39 countries. Our analysis supported the idea that MP and M are good predictors of reservoir competence, and allowed us to identify potential competent reservoirs. Furthermore, results indicated that the variability of these metrics was attributable to phylogeny, time-space and sample size. A macroecological approach is needed to recognize susceptible species and competent reservoirs, and to identify other factors driving zoonotic diseases originating from wildlife.

Severe population collapses and species extinctions in multihost epidemic dynamics.

Most infectious diseases, including more than half of known human pathogens, are not restricted to just one host, yet much of the mathematical modeling of infections has been limited to a single species. We investigate consequences of a single epidemic propagating in multiple species and compare and contrast it with the endemic steady state of the disease. We use the two-species susceptible-infected-recovered model to calculate the severity of postepidemic collapses in populations of two-host species as a function of their initial population sizes, the times individuals remain infectious, and the matrix of infection rates. We derive the criteria for a very large, extinction-level, population collapse in one or both of the species. The main conclusion of our study is that a single epidemic could drive a species with high mortality rate to local or even global extinction provided that it is coinfected with an abundant species. Such collapse-driven extinctions depend on factors different than those in the endemic steady state of the disease.

Fatal and non-fatal animal-related injuries and illnesses to workers, United States, 2011-2014.

BACKGROUND: Study provides update of national estimates for work-related fatal injuries and non-fatal injuries and illnesses by animals in US. METHODS: Between 2011 and 2014, injuries and illnesses were retrieved from US Department of Labor and were translated to economic losses using National Safety Council estimates. RESULTS: Total of 222 fatalities (36% by cattle and other bovines) and 71 460 non-fatal injuries and illnesses (38% by insects, arachnids, mites) were identified from animal sources. For non-fatal injuries and illnesses from primary animal sources, annual incidence rates were 1.5-1.6/10 000 full-time workers and annual median days lost from work were 3-4 days. Work-related costs were $222M for fatalities and $2.8B for non-fatal injuries and illnesses that resulted in at least 1 day lost from work. CONCLUSIONS: Study provides evidence of specific animals contributing to more severe injuries and potential for more severe injuries when there is more than one source of injury.

[Epidemiological description of human and animal hydatidosis in Los Ríos region, 1999- 2009]. / Caracterización epidemiológica de hidatidosis humana y animal en la Región de Los Ríos, 1999-2009.

OBJECTIVE: To determine the prevalence of hydatidosis in humans and livestock in the Los Ríos region during the years 1999-2009. METHODS: A retrospective survey of all discharge records of patients undergoing removal of cysts produced by Echinococcus granulosus during the period 1999-2009 in the Hospital Clinico Regional of Valdivia was conducted. With the information provided incidence rate, mortality rate and fatality rate were calculated. Additionally, with the aim of determining prevalence of hydatidosis in livestock (i.e. cattle, sheep and pigs) official records of slaughtered animals for the same period from the Ministry of Health of Los Ríos region were searched. RESULTS: During the ten-year period 238 new human cases were recorded, the average incidence rate for the period was 6.1 per 100,000 inhabitants, the mortality rate was 0.1 per 100,000 inhabitants, and the fatality rate was 1.3%. The most affected class group was the 15-64 years old with a 70% of cases. The districts more affected were Valdivia and Río Bueno. Most cases (54%) were from patients from rural areas, while the occupation more affected was housekeeping (29%). The liver (56%) and lungs (33%) were the localization where cysts were most frequently found. On 55% of cases, patients did not show any complication; meanwhile, infected cyst (11%) and unspecified complicated (8%) were the more frequent complication. Overall, 89% of cases recovered totally after surgery. Finally, the average in patient time was 14.7 bed-days. Prevalence of hydatidosis in livestock was 23% in cattle, 23% in sheep and 12% in pigs. The highest prevalence was found in slaughter houses in the districts of Panguipulli and San José de la Mariquina. DISCUSSION: Human and animal hydatidosis is highly prevalent in humans and livestock in Los Ríos region compared to national and international records. Further research is recommended to assess risk factors for human infection and improving record-keeping and trazability of slaughtered animals to implement control measures at the farm level to help to stop the life cycle of the parasite and thus reduce human infections.

Risks of Death and Severe Disease in Patients With Middle East Respiratory Syndrome Coronavirus, 2012-2015.

Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging pathogen, first recognized in 2012, with a high case fatality risk, no vaccine, and no treatment beyond supportive care. We estimated the relative risks of death and severe disease among MERS-CoV patients in the Middle East between 2012 and 2015 for several risk factors, using Poisson regression with robust variance and a bootstrap-based expectation maximization algorithm to handle extensive missing data. Increased age and underlying comorbidity were risk factors for both death and severe disease, while cases arising in Saudi Arabia were more likely to be severe. Cases occurring later in the emergence of MERS-CoV and among health-care workers were less serious. This study represents an attempt to estimate risk factors for an emerging infectious disease using open data and to address some of the uncertainty surrounding MERS-CoV epidemiology.

Caracterización epidemiológica de hidatidosis humana y animal en la Región de Los Ríos, 1999-2009 / Epidemiological description of human and animal hydatidosis in Los Ríos region, 1999- 2009

Objective: To determine the prevalence of hydatidosis in humans and livestock in the Los Ríos region during the years 1999-2009. Methods: A retrospective survey of all discharge records of patients undergoing removal of cysts produced by Echinococcus granulosus during the period 1999-2009 in the Hospital Clinico Regional of Valdivia was conducted. With the information provided incidence rate, mortality rate and fatality rate were calculated. Additionally, with the aim of determining prevalence of hydatidosis in livestock (i.e. cattle, sheep and pigs) official records of slaughtered animals for the same period from the Ministry of Health of Los Ríos region were searched. Results: During the ten-year period 238 new human cases were recorded, the average incidence rate for the period was 6.1 per 100,000 inhabitants, the mortality rate was 0.1 per 100,000 inhabitants, and the fatality rate was 1.3%. The most affected class group was the 15-64 years old with a 70% of cases. The districts more affected were Valdivia and Río Bueno. Most cases (54%) were from patients from rural areas, while the occupation more affected was housekeeping (29%). The liver (56%) and lungs (33%) were the localization where cysts were most frequently found. On 55% of cases, patients did not show any complication; meanwhile, infected cyst (11%) and unspecified complicated (8%) were the more frequent complication. Overall, 89% of cases recovered totally after surgery. Finally, the average in patient time was 14.7 bed-days. Prevalence of hydatidosis in livestock was 23% in cattle, 23% in sheep and 12% in pigs. The highest prevalence was found in slaughter houses in the districts of Panguipulli and San José de la Mariquina. Discussion: Human and animal hydatidosis is highly prevalent in humans and livestock in Los Ríos region compared to national and international records. Further research is recommended to assess risk factors for human infection and improving record-keeping and trazability of slaughtered animals to implement control measures at the farm level to help to stop the life cycle of the parasite and thus reduce human infections.

Objetivos y Métodos: Para determinar la prevalencia de hidatidosis humana y animal en la Región de Los Ríos durante los años 1999-2009, se realizó un análisis retrospectivo de las fichas clínicas de operados por esta enfermedad en el Hospital Clínico Regional de Valdivia. Se cuantificó morbilidad, mortalidad y letalidad y se determinaron algunas características epidemiológicas de la enfermedad. Adicionalmente, para determinar la prevalencia de equinococosis quística en el ganado, se analizaron los registros oficiales sobre la frecuencia de presentación de quistes en vísceras decomisadas en bovinos, ovinos y porcinos faenados en mataderos de la región durante el mismo período, obtenidos de la SEREMI de Salud. Resultados: Se registraron 238 casos nuevos en humanos con una tasa de incidencia promedio de 6,1 por 100 mil habs., una tasa de mortalidad de 0,1 por 100 mil habs. y una tasa de letalidad de 1,3%. En total, 53% de los casos fueron hombres y 47% mujeres. El grupo de edad entre 15 y 64 años fue el más afectado (70% del total). Las comunas con mayor número de casos fueron Valdivia y Río Bueno. Se detectaron más casos (54%) en zonas rurales que urbanas (46%). Por otro lado, la ocupación más afectada correspondió a dueñas de casa. La localización más frecuente fue hepática exclusiva (56%). Un 55% de los pacientes no mostró complicación de los quistes tratados. Después de la operación, 89% de los casos se recuperó totalmente, mientras que el período de hospitalización promedio fue de 14,7 días-cama por paciente. La prevalencia de equinococosis en ganado fue de 23% en bovinos, 23% en ovinos y 12% en porcinos. Las mayores prevalencias se reportaron en mataderos de Panguipulli y San José de la Mariquina. Discusión: La hidatidosis humana y animal son altamente prevalentes en la Región de Los Ríos comparadas con el resto del país y otras naciones. Se recomienda la realización de estudios avanzados para determinar factores de riesgo para la infección en humanos y realizar mejoras en la trazabilidad de los animales sacrificados para implementar medidas de control a nivel del predio y de esa forma cortar el ciclo del parásito y ayudar a reducir la infección en humanos.

Alveococcosis of the liver - strategy of surgical treatment with special focus on liver transplantation.

BACKGROUND: Echinococcosis is a zoonosis caused by infestation with any of 4 (of the 16) members of the Echinococcus genus, namely Echinococcus granulosus, Echinococcus multilocularis, Echinococcus oligarthus, and Echinococcus vogelii. The aim of this retrospective analysis was to present the outcomes of patients undergoing liver resection and liver transplantation (LT) for E. multilocularis infection. METHODS: A total of 44 patients who underwent surgical treatment of E. multilocularis infection in the period between 1989 and 2014 were included in the study cohort and retrospectively analyzed. RESULTS: LT was performed in 22 patients (50.0%), including 4 of 26 patients undergoing initial non-transplant management. Non-transplant procedures comprised liver resection in 23 patients (88.5%), diagnostic laparoscopy in 2 (7.7%), and left adrenalectomy in 1 patient (3.8%). Post-transplantation survival rates were 90%, 85%, and 75% at 1, 5, and 10 years, respectively. CONCLUSION: In conclusion, LT for E. multilocularis infection is a safe and effective treatment method.