Burden of diarrhea and antibiotic use among children in low-resource settings preventable by Shigella vaccination: A simulation study.

BACKGROUND: Shigella is a leading cause of diarrhea and dysentery in children in low-resource settings, which is frequently treated with antibiotics. The primary goal of a Shigella vaccine would be to reduce mortality and morbidity associated with Shigella diarrhea. However, ancillary benefits could include reducing antibiotic use and antibiotic exposures for bystander pathogens carried at the time of treatment, specifically for fluoroquinolones and macrolides (F/M), which are the recommended drug classes to treat dysentery. The aim of the study was to quantify the reduction in Shigella attributable diarrhea, all diarrhea, and antibiotic use in the first 2 years of life that could be prevented by a Shigella vaccine. METHODS AND FINDINGS: We used data from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, a birth cohort study that followed 1,715 children with twice weekly surveillance for enteric infections, illnesses, and antibiotic use for the first 2 years of life from November 2009 to February 2014 at 8 sites. We estimated the impact of 2 one-dose (6 or 9 months) and 3 two-dose (6 and 9 months, 9 and 12 months, and 12 and 15 months) Shigella vaccines on diarrheal episodes, overall antibiotic use, and F/M use. Further, we considered additional protection through indirect and boosting effects. We used Monte Carlo simulations to estimate the absolute and relative reductions in the incidence of diarrhea and antibiotic use comparing each vaccination scenario to no vaccination. We analyzed 9,392 diarrhea episodes and 15,697 antibiotic courses among 1,715 children in the MAL-ED birth cohort study. There were 273.8 diarrhea episodes, 30.6 shigellosis episodes, and 457.6 antibiotic courses per 100 child-years. A Shigella vaccine with a mean vaccine efficacy of 60% against severe disease given at 9 and 12 months prevented 10.6 (95% CI [9.5, 11.5]) Shigella diarrhea episodes of any severity per 100 child-years (relative 34.5% reduction), 3.0 (95% CI [2.5, 3.5]) F/M courses for Shigella treatment per 100 child-years (relative 35.8% reduction), and 5.6 (95% CI [5.0, 6.3]) antibiotic courses of any drug class for Shigella treatment per 100 child-years (relative 34.5% reduction). This translated to a relative 3.8% reduction in all diarrhea, a relative 2.8% reduction in all F/M courses, a relative 3.1% reduction in F/M exposures to bystander pathogens, and a relative 0.9% reduction in all antibiotic courses. These results reflect Shigella incidence and antibiotic use patterns at the 8 MAL-ED sites and may not be generalizable to all low-resource settings. CONCLUSIONS: Our simulation results suggest that a Shigella vaccine meeting WHO targets for efficacy could prevent about a third of Shigella diarrhea episodes, antibiotic use to treat shigellosis, and bystander exposures due to shigellosis treatment. However, the reductions in overall diarrhea episodes and antibiotic use are expected to be modest (<5%).

Doença Diarreica Aguda por Norovírus / Acute Diarrheal Norovirus Disease

A Doença Diarréica Aguda (DDA) é um grupo de gastroenterites compreendida como uma síndrome que apresentam sinais e sintomas em comuns, sendo os principais a diarreia (mais de 3 episódios em 24 horas) com duração limitada (1 a 14 dias), vômitos, desidratação que varia de leve a grave, podendo aparecer dores abdominais, náuseas, febre e cefaleia. Pode ser causada por vários agentes etiológicos como vírus (norovírus, rotavírus, entre outros), bactérias (salmonelas não tifóide, Escherichia coli, entre outras) e parasitas (Entamoeba histolytica, Giardia lamblia, etc) (BRASIL, 2021). Sendo o norovírus (NoV) o principal responsável por surtos de gastroenterite aguda de origem não bacteriana em todo o mundo (ROCHA, 2012). O tratamento é sintomático e é baseado na hidratação oral ou endovenosa, reposição de sais e minerais, e repouso.

ADD is a group of gastroenteritis understood as a syndrome with signs and symptoms in common, the main ones being diarrhea (more than 3 episodes in 24 hours) with limited duration (1 to 14 days), vomiting, dehydration ranging from mild to severe, abdominal pain, nausea, fever and headache may appear. It can be caused by several etiological agents such as viruses (noroviruses, rotaviruses, among others), bacteria (non-typhoid salmonellae, Escherichia coli, among others) and parasites (Entamoeba histolytica, Giardia lamblia, etc.) (BRASIL, 2021). Norovirus (NoV) is the main responsible for outbreaks of acute gastroenteritis of non-bacterial origin worldwide (ROCHA, 2012). Treatment is symptomatic and is based on oral or intravenous hydration, replacement of salts and minerals, and rest.

Assessment of the Feasibility and Acceptability of Using Water Pasteurization Indicators to Increase Access to Safe Drinking Water in the Peruvian Amazon.

Approximately two billion people lack access to microbiologically safe drinking water globally. Boiling is the most popular household water treatment method and significantly reduces diarrheal disease, but is often practiced inconsistently or ineffectively. The use of low-cost technologies to improve boiling is one approach with potential for increasing access to safe drinking water. We conducted household trials to evaluate the feasibility and acceptability of water pasteurization indicators (WAPIs) in the Peruvian Amazon in 2015. A total of 28 randomly selected households were enrolled from a rural and a peri-urban community. All households trialed two WAPI designs, each for a 2-week period. Ninety-six percent of participants demonstrated the correct use of the WAPIs at the end of each trial, and 88% expressed satisfaction with both WAPI models. Ease of use, short treatment time, knowledge of the association between WAPI use and improved health, and the taste of treated water were among the key factors that influenced acceptability. Ease of use was the key factor that influenced design preference. Participants in both communities preferred a WAPI with a plastic box that floated on the water's surface compared with a WAPI with a wire that was dipped into the pot of drinking water while it was heating (77% versus 15%, P < 0.001); we selected the box design for a subsequent randomized trial of this intervention. The high feasibility and acceptability of the WAPIs in this study suggest that these interventions have potential to increase access to safe water in resource-limited settings.

The Pretravel Consultation: Recent Updates.

Estimates suggest that 43%-79% of international travelers may develop travel-related illnesses. Most such illnesses are considered mild and self-limited; however, some are life-threatening. The pretravel consultation is aimed at assessing risks for a range of illnesses, communicating these risks, and then providing individualized recommendations and interventions to minimize or manage such risks. The effective consultation is predicated on a well-prepared clinician and motivated traveler, understanding the traveler's perception of, and tolerance for, risk, and providing education applicable to the actual itinerary. Integral to the clinician's preparation is regular review of up-to-date trip-specific recommendations; country-specific information and recommendations are readily available and can now be efficiently accessed. From the infectious diseases perspective, immunizations, malaria chemoprophylaxis, insect repellent use, and travelers' diarrhea and its self-management are cornerstones of the consultation. This review focuses primarily on updating these 4 topics with recently published information relevant to adult travelers.

Strain-Specific Probiotic Properties of Bifidobacteria and Lactobacilli for the Prevention of Diarrhea Caused by Rotavirus in a Preclinical Model.

Probiotic supplementation with different lactobacilli and bifidobacterial strains has demonstrated beneficial effects in infectious diarrhea caused by rotavirus (RV) in young children. Preclinical models of RV infection might be a good strategy to screen for the efficacy of new probiotic strains or to test their comparative efficacy. Neonatal Lewis rats were supplemented with Bifidobacterium breve M-16V, Lactobacillus acidophilus NCFM, Lactobacillus helveticus R0052, or Lactobacillus salivarius PS2 from days 2-14 of life. On day five, animals received RV SA-11 orally. Fecal samples were collected daily, weighed, and scored for the calculation of severity and incidence of diarrhea. In addition, fecal pH and fecal viral shedding were measured. Animals were sacrificed at the end of the study and their blood was obtained for the quantification of RV-specific immunoglobulins. RV infection was induced in ~90% of the animals. All probiotics caused a reduction of several clinical variables of severity and incidence of diarrhea, except L. salivarius PS2. L. acidophilus NCFM, B. breve M-16V, and L. helveticus R0052 seemed to be very effective probiotic strains. In addition, all Lactobacillus strains reduced the viral elimination one day post-inoculation. No differences were detected in the specific anti-RV humoral response. The present study highlights the strain-specific effects of probiotics and identifies promising probiotics for use in ameliorating and preventing RV-induced diarrhea in children, for example by including them in infant formulas.

An optimal control problem for carrier dependent diseases.

In developing countries, several diseases spread in human population due to the abundance of houseflies (a kind of carrier). The main reason behind the spread of these diseases is the lack of awareness among peoples regarding the sanitation practices and economic constraints. To understand the dynamics of the spread and control of these diseases, in this paper, we propose a mathematical model by considering logistic growth of houseflies. In the model formulation, it is assumed that houseflies transport the bacteria responsible for the disease transmission from the environment to the edibles of human population. To reduce the density of houseflies and number of infected individuals, an optimization problem is also formulated and analyzed. Numerical simulations are performed to support analytically obtained results.

Caracterización clínica-epidemiológica según la edad de pacientes diagnosticados con cólera / Clinic-epidemiological description according to the age of patients diagnosed with cholera

Introducción: Se estima que 1,4 billones de personas están en riesgo de infectarse por cólera y la mitad de los fallecidos son menores de 5 años. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes afectados por vibrión colérico según la edad de los enfermos y el tiempo que medió entre la aparición de los síntomas de la enfermedad y la asistencia al Sistema Nacional de Salud. Métodos: Estudio clínico, epidemiológico, descriptivo y prospectivo desde 2013-2017 a los pacientes que se les confirmó por coprocultivo el V. cholerae como causa de enfermedad diarreica aguda en el hospital pediátrico de Centro Habana. Se analizaron variables cualitativas y cuantitativas. Resultados: Se registraron 115 niños mayores de 5 años y 44 menores de 5 años afectados por el cólera. El 54,7 por ciento del total de pacientes estudiados estuvo en la zona afectada, el 94,3 por ciento presentó deposiciones líquidas, el 18,2 por ciento con aspecto de agua de arroz, el 7,5 por ciento con olor a pescado, el 47,2 por ciento presentó vómitos, el 6,9 por ciento fiebre y el 12,8 por ciento dolor abdominal. El valor de la mediana del tiempo que medio entre la aparición de los síntomas y la asistencia al médico fue de 24 horas. Conclusiones: Los pacientes más afectados son los mayores de 5 años y los que más tardíamente acudieron al Sistema Nacional de Salud. En todos predomina la procedencia de la zona afectada, las deposiciones líquidas y los vómitos(AU)

Introduction: It is estimated that 1.4 billion people are at risk of being infected by cholera and half of them are children under 5 years old. Objective: To describe clinically and epidemiologically the patients affected by Vibrio cholerae according to their age and the time passed from the onset of symptoms of disease to their attendance to the National Health System. Methods: Clinical, epidemiological, descriptive and prospective study from 2013 to 2017 in patients with confirmed V. cholerae by stool culture as a cause of acute diarrheal disease in the Pediatric Hospital of Centro Habana municipality.Qualitative and quantitative variables were analyzed. Results: There was a record of 115 children over 5 years and 44 children under 5 years affected by cholera. The 54.7percent of the total number of patients studied was in the affected area, 94.3 percent presented liquid stool, 18.2 percent of those looked like rice water, 7.5 percent with fishy smell; 47.2 percent of the patients presented vomiting, and 6.9 percent fever and 12.8 percent abdominal pain. The value of the mean time between the onset of symptoms and the assistance to the physician was of 24 hours. Conclusions: Most affected patients and that attended late to the National Health System were the ones over 5 years. In all predominated coming from the affected area, liquid stools and vomiting(AU)

Determinación de biopelículas y betalactamasas de espectro extendido en Vibrio cholerae no-O1, no-O139 aislados de pacientes con diarreas en Cuba / Determination of biofilms and extended-spectrum beta-lactamases in Vibrio cholerae non-O1, non-O139 isolates from patients with diarrhea in Cuba

. Vibrio cholerae no-O1, no-O139 es el tercer grupo de bacterias del género Vibrio que con más frecuencia producen diarreas. Sobrevive en los ambientes acuáticos, utilizando la formación de biopelícula como mecanismo de supervivencia que propicia la transmisión de la enfermedad diarreica. Desde 1977 se caracterizan aislados de V. cholerae con resistencia múltiple, y algunos de los mecanismos involucrados incluyen la producción de β-lactamasas de espectro extendido (BLEE). Este trabajo tuvo como objetivo determinar la formación de biopelícula en los aislados cubanos de V. cholerae no-O1, no-O139, causantes de enfermedad diarreica aguda (EDA), y detectar la producción de BLEE en aquellos con resistencia total e intermedia a ampicilina. Se realizó un estudio descriptivo de corte transversal, entre enero 2014 y junio 2015. Se estudiaron 55 aislados caracterizados previamente, que formaban parte del cepario del Laboratorio Nacional de Referencia de EDA del Instituto Pedro Kourí. Para la determinación fenotípica de BLEE se estudiaron 43, de los que ya se conocía su susceptibilidad a ampicilina. El 54,5 por ciento de los aislados resultaron positivos a la formación de biopelícula, y predominaron los clasificados como formadores moderados (46,6 por ciento ) y débiles (36,6 por ciento ). De los 34 resistentes a ampicilina, 26,5 por ciento resultaron positivos a la producción de BLEE. En el caso de los nueve aislados con resistencia intermedia a ampicilina, 44,4 por ciento resultaron positivos. Los resultados del presente estudio contribuyen al conocimiento sobre la capacidad que tienen de persistir en el ambiente y permiten profundizar sobre los mecanismos de resistencia a los antimicrobianos(AU)

Vibrio cholerae non-O1, non-O139 is the third bacterium group from the genus Vibrio most commonly causing diarrhea. It survives in aquatic environments, using the formation of biofilm as a survival mechanism facilitating the transmission of diarrheal disease. Multi-drug resistant V. cholerae isolates have been characterized since the year 1977, and some of the mechanisms involved include the production of extended-spectrum β-lactamases (ESBLs). The purpose of the study was to determine the formation of biofilm in Cuban isolates of V. cholerae non-O1, non-O139 causing acute diarrheal disease (ADD), and detect the production of ESBLs in those with total or intermediate resistance to ampicillin. A descriptive cross-sectional study was conducted from January 2014 to June 2015. The study sample was 55 previously characterized isolates obtained from the strain collection at the ADD National Reference Laboratory of Pedro Kourí Institute. For phenotypic determination of ESBLs, 43 were studied which were known to be susceptible to ampicillin. 54.5 percent of the isolates tested positive for biofilm formation, with a predominance of those classified as moderate (46.6 percent) and weak (36.6 percent) biofilm producers. Of the 34 isolates resistant to ampicillin, 26.5 percent were positive for ESBL production. Of the 9 with intermediate ampicillin resistance, 44.4 % were positive. The results of the present study contribute knowledge about their ability to persist in the environment, and provide insight into antimicrobial resistance mechanisms(AU)

[Retrospective study on the eradication of Swine Dysentery (Brachyspira hyodysenteriae) in Switzerland]. / Retrospektive Studie zur Sanierung von Beständen mit Schweinedysenterie (Brachyspira hyodysenteriae) in der Schweiz.

INTRODUCTION: The eradication of Swine Dysentery (infection with Brachyspira hyodysenteriae) within farm populations is extremely complex and its success is significantly linked to the compliance of pig farmers performing the onsite eradications, emphasizing the importance of their motivation. The present study focuses on the motivation and satisfaction of Swiss pig farmers concerning eradication of Swine Dysentery on their farms and has the intention of generating data to establish a basis for decision-making regarding future eradications. A structured survey was conducted on 68 Swiss pig farms where an eradication of Swine Dysentery had already taken place. The data collected were then statistically analyzed. Of the study's population, 50 (73.5%) farms underwent eradication using the total depopulation method and 18 (26.5%) farms conducted an eradication process using the partial depopulation method; both in accordance to the guidelines of Switzerland's Pig Health Service (SUISAG Schweinegesundheitsdienst; SGD). When asked about the driving factors behind their decision to perform the eradications, owners cited their own interest (57.4%; 39/68) (primarily due to financial aspects (38.5%; 15/39)) or external pressure (42.7%; 29/68) (predominantly through marketers as well as through the health status assigned by the SGD (each 11/29)). The duration of the eradication on farms differed significantly and costs varied considerably within the different production types as well as the type of eradication performed. Utilized means and processes for eradication were the same (drugs, disinfectant for manure) or much alike (e.g. emptying of the pigpens) however stock-specific and individual variations were exhibited. The majority of the interviewed livestock owners were motivated to perform the eradication (86.6%; 58/67), satisfied with having performed the eradication and satisfied with the outcome of the eradication (89.7%; 61/68). The cost efficiency of the farms (54.4%; 37/68) and the health status of the herds (63.2%; 43/68) were perceived as having improved and the usage of drugs having diminished (59.7%; 40/67) post eradication. The effort of an eradication was described as acceptable to too great. The study showed herd eradication of Swine Dysentery to be perceived as mainly positive. However, effort as well as costs are felt to be considerable and could, therefore, provide the most important starting point to increasing the willingness of pig owners to perform eradications.

INTRODUCTION: L'assainissement d'exploitations avec de problèmes de dysenterie porcine (infection à Brachyspira hyodysenteriae) peut prendre beaucoup de temps et son succès est étroitement lié à l'observance des personnes qui l'exécutent. C'est pourquoi les éleveurs de porcs doivent être motivés pour effectuer cette lutte. La présente étude a notamment porté sur la motivation et la satisfaction des détenteurs suisses de porcs en ce qui concerne l'assainissement de la dysenterie porcine afin de générer des données et, partant, des aides à la décision pour de futures mesures de lutte. Pour cela, des données ont été collectées au moyen d'un entretien structuré et analysées statistiquement dans 68 exploitations suisses après un assainissement complet de la dysenterie. Dans ces exploitations, 50 assainissements totaux (73.5%) et 18 assainissements partiels (26,5%) ont été effectués conformément aux directives du Service sanitaire porcin suisse (SUISAG SGD). L'intérêt propre (57,4%, 39/68) (principalement dû aux aspects financiers (38,5%; 15/39)) et la pression externe (42,7%; 29/68) (principalement par statut SGD ou par les négociants (chacun pour 11/29)) étaient les raisons de l'assainissement. La durée de l'assainissement et les coûts variaient considérablement selon les types de production de même que selon les types d'assainissement. Dans le cadre de l'assainissement, les moyens utilisés et les processus étaient les mêmes (médicaments, désinfectant de fumier) respectivement étaient similaires (par exemple, la vidange des écuries) mais présentait des variations individuelles spécifiques à l'exploitation. La majorité des propriétaires d'animaux interrogés étaient motivés à un assainissement (86,6%, 58/67) et étaient également satisfaits de l'avoir fait (97,1%, 66/68) et du résultat (89,7%, 61/68). Après l'assainissement, la rentabilité (54,4%; 37/68) et la santé du cheptel (63,2%; 43/68) ont été jugées subjectivement meilleures et la consommation de médicaments (59,7%; 40/67) inférieure. Le coût de l'assainissement était, selon le type de production, considéré comme justifié jusqu'à élevé. On a pu montrer que l'assainissement de la dysenterie porcine est généralement évalué positivement. Cependant, les efforts et les coûts sont considérables et représentent des points de départ possibles pour optimiser la volonté des éleveurs de porcs.

Dysentery by CTX-M Type ESBL Producing Shigella flexneri / Disentería por Shigella flexneri productora de BLEE tipo CTX-M

According to the World Health Organization, diarrheal infections cause 525 000 deaths of children under five years of age every year, and shigellosis. Shigellosis is a relevant cause of dysentery, which increases the morbidity and mortality in pediatric patients. Therefore, emergingthe emergence of antimicrobial resistant strains of Shigella is a concerningworrisome problem worldwide. We report the case of a 7-year-old patient with acute dysentery caused by CTX-M Type ESBL Producing Shigella flexneri, being. This was the first case treated in the Specialties Hospital of Specialties of the Armed Forces N°1, in Quito, Ecuador. The antibiogram demonstrated sensibilityshowed sensitivity to ampicillin-sulbactam. As a result, after five days of microbiologically directed treatment, the patient improved his condition without relapse. Proper clinical diagnoses and accurate laboratory studies like stool culture and antibiogram are crucial to givingindicate an appropriate therapy in infections caused by Shigella and other enteric bacilli(AU)

Según la Organización Mundial de la Salud, las infecciones diarreicas provocan 525 000 muertes de niños menores de cinco años de edad cada año. La shigelosis es una causa importante de disentería que aumenta la morbilidad y mortalidad de los pacientes pediátricos. Es por eso que el surgimiento de cepas de Shigella resistentes a los antibióticos es un preocupante problema a nivel mundial. Presentamos el caso de un paciente de 7 años de edad con disentería aguda provocada por Shigella flexneri productora de BLEE tipo CTX-M. Se trata del primer caso tratado en el Hospital de Especialidades de las Fuerzas Armadas Nº 1, en Quito, Ecuador. El antibiograma mostró sensibilidad a la combinación ampicilina/sulbactam. Al cabo de cinco días de tratamiento microbiológico, el paciente mejoró su estado y no se produjeron recaídas. Un diagnóstico clínico correcto, así como estudios precisos de laboratorio como los cultivos de heces y los antibiogramas, son vitales para indicar una terapia apropiada en las infecciones causadas por Shigella y otros bacilos entéricos(AU)

Bovine colostrum and product intervention associated with relief of childhood infectious diarrhea.

This meta-analysis aimed to investigate the protective effects of bovine colostrum against childhood infectious diarrhea. A systematic search was conducted using PubMed, Cochrane Library databases and clinicaltrial.gov. Among 166 research articles, only five RCTs were included into final analysis. Review manager (version 5.2) was used to pool the effect-size across studies. Sensitivity and risk of bias were estimated accordingly. Under a pooled analysis, bovine colostrum consumption correlated with a significant reduction in stool frequency of infectious diarrhea, by 1.42 times per day (95% CI: -2.70, -0.14). Bovine colostrum intervention also reduced occurrence of diarrhea by 71% (pooled OR = 0.29, 95%CI 0.16, 0.52). The OR of positive detection of pathogen in the stool was 0.29 (95%CI 0.08, 0.71) in bovine colostrum treated group, compared with placebo group. In the sensitivity analysis of studies with low risk of biases, bovine colostrum significantly reduced stool frequency, occurrence of diarrhea and pathogen detection. BC and related products have a significant benefit in reducing the frequency and relieving the symptoms of childhood infectious diarrhea.

WHO consultation on ETEC and Shigella burden of disease, Geneva, 6-7th April 2017: Meeting report.

According to the 2015 Global Burden of Disease Study, diarrhea ranked ninth among causes of death for all ages, and fourth among children under 5 years old, accounting for an estimated 499,000 deaths in this young age group. It was also the second most common cause of years lived with disability (2.39 billion YLDs). The goal of the WHO/UNICEF Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) is to reduce deaths from diarrhea in children under 5 years of age to less than 1 per 1000 live births, by 2025. Development of new and improved vaccines against diarrheal infections is a fundamental element of the strategy towards achieving this goal. Enterotoxigenic Escherichia coli (ETEC) and Shigella are enteropathogens that cause significant global mortality and morbidity, particularly in low- and middle-income countries. In 2016, WHO's Product Development for Vaccines Advisory Committee (PDVAC) recommended that the WHO's Initiative for Vaccine Research (IVR) engage in this area, based on PDVAC's criteria of prioritizing the development of vaccines against pathogens that will address a major unmet public health need, and for which clinical candidates with a good probability of technical success are in the pipeline. As a first step, WHO's IVR convened global subject matter experts to discuss the current global ETEC and Shigella disease burden estimates, including the current understanding of the long-term indirect effects of ETEC and Shigella infection, and how these data may affect future decision making on vaccine development for both pathogens. The available global burden estimates for ETEC and Shigella differ with respect to the relative importance of these two pathogens. The mortality estimates vary between iterations published by the same group, as well as between estimates of different groups, although the uncertainty intervals are broad and overlapping. These variances are attributable to differences in the data available and incorporated in the models; the methods used to detect the pathogens; the modelling methodologies; and, to actual changes in the total number of diarrheal deaths over time. The changes in the most recently reported mortality estimates for these pathogens, as compared to previous iterations, has led to debate as to whether investment in development of stand-alone vaccines, rather than combined vaccines, is warranted from cost-effectiveness and vaccine impact perspectives. Further work will be needed to understand better the variances and uncertainties in the reported mortality estimates to support investment decision making, and ultimately policy recommendations for vaccine use. In addition, a comprehensive assessment of the value proposition for vaccines against these pathogens is needed and will be strengthened if the long-term health consequences associated with diarrhea and dysentery due to these pathogens are better defined.

[Dramatic achievements in infectious disease prevention and treatment in China during the past 70 years].

At the beginning of the founding of People's Republic of China, infectious diseases, such as smallpox, plague, cholera, dysentery, typhoid, measles, diphtheria, pertussis, meningitis, mumps, schistosomiasis, Kala Azar, hemorrhagic fever, leptospirosis, encephalitis B, typhus, malaria, Kala Azar, leprosy, scarlet fever and pinkeye, remained as epidemic in the country and endangered people's health. During the past 70 years, the Chinese government spent huge efforts in infectious disease prevention and treatment by promulgating and implementing series of relative policies, laws and strategies, and also encouraged all Chinese people to participate in. The achievements of these efforts in controlling infectious disease epidemic were extremely successful. Today, the outbreaks and epidemic of infectious diseases in China were rarely happened with the rapid decreases in incidence and mortality rates of all notifiable infectious diseases. Smallpox was eradicated, and polio, filariasis, leprosy and neonatal tetanus were nearly eradicated. In addition, the incidence rates of vaccine-preventable diseases, i.e. measles, diphtheria, pertussis, meningitis, encephalitis B, hepatitis A, mumps, rubella, tuberculosis, were dramatically decreased and remained at relatively low levels for years. The incidence and prevalence rates of hepatitis B infection in Children decreased significantly and reached the phase objectives. Moreover, incidence rates of natural iatrogenic infectious diseases, i.e. diarrhea, typhoid and other intestinal infectious diseases, leptospirosis and schistosomiasis, and vectorborne diseases, i.e. typhus, malaria, Kala Azar, reached the lowest and some even closed to be eliminated in China. In general, infectious diseases dropped to the tenth from the top one leading cause of all deaths, which means that the achievement of Chinese infectious disease prevention and treatment strategies contributed tremendously in improving Chinese people's health status and life expectancy.

Lessons learnt from a porcine epidemic diarrhea (PED) case in France in 2014: Descriptive epidemiology and control measures implemented.

An acute epidemic of porcine epidemic diarrhea (PED) has affected the USA since 2013 and spread all around the world. In France, the immune status of the pig population against PED virus (PEDV) was expected to be low due to the absence of circulation of the virus since the 80's and a compulsory notification of PED was set up in 2014. Here, we reported the first case of a PED outbreak in December 2014 in the North of France after a long absence of the disease, the monitoring of the excretion and the control measure implementation. The isolated strain in France in December 2014 was a PEDV "S-InDel" strain which was close to the "S-InDel" German PEDV strain isolated in May 2014. The individual shedding duration of PEDV in feces was estimated around 20 days for pigs of different ages. Biosecurity measures implemented allowed the limitation of PEDV spread to fattening and farrowing rooms without dissemination to the nursery block. Using strict biosecurity measures, direct shipment of infected fatteners to the slaughterhouse, strict decontamination protocols with a quarantine of 6 weeks for replacement gilts without voluntary contamination helped PEDV fade out within the herd and avoided the spread to other herds. PEDV presence in manure was investigated as well as the inactivation treatment of the virus present in the liquid manure. An increase to a pH 12 of liquid manure by liming led to the absence of PEDV detection by RT-PCR after seven days.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades transmitidas por agua y alimentos. No. 03 / Protocol of the National Epidemiological Surveillance System: water and foodborne diseases. No. 03

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. Las enfermedades transmitidas por alimentos y agua (ETA´s), constituyen un importante problema de Salud Pública, debido a su magnitud, trascendencia, tendencia fluctuante y aumentos en su comportamiento durante el año, lo que ha significado etapas de emergencia, re emergencia, aparición de agentes nuevos con potencial epidémico y el incremento a la resistencia a los antimicrobianos con impacto negativo económico, en grupos de población. Las enfermedades transmitidas por alimentos y agua, se registran entre las primeras diez causas de morbilidad y mortalidad en el país; evento notificado como enfermedad diarreica, con frecuencia los servicios de salud tienen poca capacidad de respuesta para identificación del agente etiológico, limitándose a implementar medidas de control eficientes de las fuentes de infección o contaminación y divulgación de acciones dirigidas a minimizan los factores de riesgo identificados.

Aspectos clínicos y epidemiológicos de las enfermedades diarreicas agudas secretoras. Hospital General Docente "Juan B. Viñas González". 2014 / Clinical and epidemiological aspects of acute diarrheal secretory diseases. General Hos-pital "Juan B. Viñas González". 2014

Se realizó un estudio observacional, descriptivo, de corte transversal, con una población de estudio compuesta por 634 pacientes pediátricos con cuadro de diarrea aguda secretoria, que fueron ingresados en el Hospital General Docente "Juan B. Viñas González" de Palma Soria-no, Cuba, durante el período enero-diciembre, 2014. Los resultados arrojaron un predominio del rango de edades de 1 a 4 años, para un 30.4%; la mayoría de ellos, residentes en zonas rurales (64.5%), donde la calidad del agua de consumo no era la adecuada (46.8%) y la dispo-sición de las excretas tenían deficiencias en un 45.1% de los casos. Los síntomas predomi-nantes fueron fiebre y vómitos para un 47.4% y 45 % respectivamente y los signos fueron: los ojos hundidos en un 57.4% y sequedad de las mucosas (45.1%), como complicaciones se reportó: la deshidratación con 55.2%, la hipoglucemia (50.9%) y la acidosis metabólica (34.9%), presentando en ocasiones, un niño más de una complicación, lo que motivó un 35% de ingresos en los servicios de cuidados progresivos; sin embargo, no hubo fallecidos por esta causa en el tiempo estudiado.

An observational, descriptive, and cross-sectional study was carried out. 634 pediatric patients with acute diarrhea were the study population who were admitted to the General Hospital "Juan B. Viñas González" of Palma Soriano, Cuba, during the period January-De-cember 2014. The results showed a predominance of the age range between 1 and 4 years (30.4%); most of them, residents in rural areas (64.5%) where the quality of drinking water was not adequate (46.8%) and the disposal of excreta were deficient in 45.1% of cases. The predominant symptoms were fever and vomiting 47.4% and 45% respectively and the signs were: the sunken eyes (57.4%) and dryness of the mucous membranes (45.1%). There were some complications such as: dehydration (55.2%), hypoglycaemia (50.9%) and metabolic acidosis (34.9%); it was sometimes presented a child with more than one complication, which motivated a 35% of income in the progressive care services. However, there were no deaths due to this cause in the time studied.

Household sanitation is associated with lower risk of bacterial and protozoal enteric infections, but not viral infections and diarrhoea, in a cohort study in a low-income urban neighbourhood in Vellore, India.

OBJECTIVE: This study examined associations between household sanitation and enteric infection - including diarrhoeal-specific outcomes - in children 0-2 years of age in a low-income, dense urban neighbourhood. METHODS: As part of the MAL-ED study, 230 children in a low-income, urban, Indian neighbourhood provided stool specimens at 14-17 scheduled time points and during diarrhoeal episodes in the first 2 years of life that were analysed for bacterial, parasitic (protozoa and helminths) and viral pathogens. From interviews with caregivers in 100 households, the relationship between the presence (and discharge) of household sanitation facilities and any, pathogen-specific, and diarrhoea-specific enteric infection was tested through mixed-effects Poisson regression models. RESULTS: Few study households (33%) reported having toilets, most of which (82%) discharged into open drains. Controlling for season and household socio-economic status, the presence of a household toilet was associated with lower risks of enteric infection (RR: 0.91, 95% CI: 0.79-1.06), bacterial infection (RR: 0.87, 95% CI: 0.75-1.02) and protozoal infection (RR: 0.64, 95% CI: 0.39-1.04), although not statistically significant, but had no association with diarrhoea (RR: 1.00, 95% CI: 0.68-1.45) or viral infections (RR: 1.12, 95% CI: 0.79-1.60). Models also suggested that the relationship between household toilets discharging to drains and enteric infection risk may vary by season. CONCLUSIONS: The presence of a household toilet was associated with lower risk of bacterial and protozoal enteric infections, but not diarrhoea or viral infections, suggesting the health effects of sanitation may be more accurately estimated using outcome measures that account for aetiologic agents.