[Telephone surveys for the study of catastrophic costs due to tuberculosis in Colombia: a novel toolPesquisas telefônicas para um estudo de custos catastróficos da tuberculose na Colômbia: uma ferramenta inovadora]. / Encuestas telefónicas para el estudio de costos catastróficos por tuberculosis en Colombia: una herramienta innovadora.

The study of catastrophic costs incurred by people affected by tuberculosis (TB), conducted in Colombia during the COVID-19 pandemic, provided the opportunity to implement telephone surveys for data collection. This constitutes a methodological innovation regarding the standards established by the World Health Organization (WHO) which, for this type of study, usually rely on face-to-face surveys of patients attending health facilities. The study design, objectives, and methodology were adapted from the WHO publication Tuberculosis patient cost surveys: a handbook. A total of 1065 people affected by tuberculosis were selected as study participants and, by telephone, were administered a standard questionnaire adapted to the Colombian context. This allowed the collection of structured data on the direct and indirect costs faced by TB patients and their families. Greater than 80% completeness was achieved for all variables of interest, with an average survey duration of 40 minutes and a rejection rate of 8%. The described survey method to determine the baseline for further study of catastrophic costs in Colombia was novel because of its telephone-based format, which adheres to the information standards required to allow internationally comparable estimates. It is a useful means of generating standardized results in contexts in which the ability to conduct face-to-face surveys is limited.

O estudo dos custos catastróficos incorridos pelas pessoas afetadas pela tuberculose realizado na Colômbia durante a pandemia de COVID-19 representou uma oportunidade de implementar pesquisas telefônicas como forma de coleta de dados. Constitui-se uma inovação metodológica dos padrões estabelecidos pela Organização Mundial da Saúde (OMS), que, para esse tipo de estudo, geralmente se baseiam no uso de pesquisas presenciais com os pacientes que frequentam estabelecimentos de saúde. O delineamento, os objetivos e a metodologia do estudo foram adaptados do manual prático da OMS para a realização de pesquisas de custos da tuberculose. Um total de 1065 pessoas afetadas pela tuberculose foram selecionadas para participar do estudo. O questionário padrão, adaptado ao contexto colombiano, foi aplicado pelo telefone. Foi possível obter dados estruturados sobre os custos diretos e indiretos enfrentados pelos pacientes com tuberculose e suas famílias. Em geral, observou-se que todas as variáveis de coleta atingiram uma completude de mais de 80%, com um tempo médio de pesquisa de 40 minutos e uma taxa de recusa de 8%. A metodologia de pesquisa telefônica desenvolvida para determinar a linha de base do estudo de custos catastróficos na Colômbia foi inovadora devido ao formato telefônico, que mantém os padrões de informação necessários para permitir estimativas comparáveis internacionalmente e é uma forma útil de gerar resultados padronizados em circunstâncias em que há limitações para a realização de pesquisas presenciais.

Elimination of Taenia solium Transmission in Northern Peru.

BACKGROUND: Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. METHODS: We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention strategies that involved screening of humans and pigs, antiparasitic treatment, prevention education, and pig replacement in 42 villages. In phase 2, we compared mass treatment with mass screening (each either with or without vaccination of pigs) in 17 villages. In phase 3, we implemented the final strategy of mass treatment of humans along with the mass treatment and vaccination of pigs in the entire rural region of Tumbes (107 villages comprising 81,170 people and 55,638 pigs). The effect of the intervention was measured after phases 2 and 3 with the use of detailed necropsy to detect pigs with live, nondegenerated cysts capable of causing new infection. The necropsy sampling was weighted in that we preferentially included more samples from seropositive pigs than from seronegative pigs. RESULTS: Only two of the strategies implemented in phase 1 resulted in limited control over the transmission of T. solium infection, which highlighted the need to intensify the subsequent strategies. After the strategies in phase 2 were implemented, no cyst that was capable of further transmission of T. solium infection was found among 658 sampled pigs. One year later, without further intervention, 7 of 310 sampled pigs had live, nondegenerated cysts, but no infected pig was found in 11 of 17 villages, including all the villages in which mass antiparasitic treatment plus vaccination was implemented. After the final strategy was implemented in phase 3, a total of 3 of 342 pigs had live, nondegenerated cysts, but no infected pig was found in 105 of 107 villages. CONCLUSIONS: We showed that the transmission of T. solium infection was interrupted on a regional scale in a highly endemic region in Peru. (Funded by the Bill and Melinda Gates Foundation and others.).

A qualitative socio-ecological characterization of the plague threat at Hermelinda Market, La Libertad, Peru.

OBJECTIVE: To identify 1) the main determinants of persistent Yersinia pestis circulation and the associated threat of plague at Hermelinda Market-a large farmers' market in the city of Trujillo, La Libertad, Peru-and the main actions taken against it, as perceived by local stakeholders; 2) the level of plague risk perception among local actors; and 3) recommended actions to solve the plague threat at the market. METHODS: A conceptual framework was developed combining a social determinants approach with a complex systems-thinking framework and a knowledge management perspective. A four-step qualitative protocol was carried out (literature review; stakeholder mapping; 37 semi-structured interviews; and coding/analysis). In the fourth step, the data collected in the semi-structured interviews were coded for eight social determinants of health (SDH) variables and analyzed with ATLAS.ti®, and an emerging category analysis was performed to identify risk perception levels. RESULTS: Based on analysis by SDH variable, the three main determinants of the plague threat at Hermelinda Market were: 1) local (Trujillo City) governance, 2) infrastructure and basic services, and 3) local culture. According to the same analysis, actions most frequently undertaken against plague involved 1) infrastructure and basic services, 2) social vigilance, and 3) communication. The emerging category analysis indicated local risk perception levels were low, with most of the data pointing to "unhygienic" ("naturalized") lifestyles and a general lack of awareness about the disease prior to plague-related health concerns at the market as the cause. CONCLUSIONS: The results indicate that the persistent circulation of Yersinia pestis at Hermelinda Market is not simply a technical matter but more of a managerial and cultural problem. As local governance was found to be a main factor in the persistence of this public health threat, future efforts against it should focus on sustainable inter-sectoral planning and education. Actions taken exclusively by the health sector and the improvement of infrastructure and basic services alone will not be enough to reduce the threat of plague at the market.

An unforgettable event: a qualitative study of the 1997-98 El Niño in northern Peru.

During the 1997-98 El Niño, Tumbes, Peru received 16 times the annual average rainfall. This study explores how Tumbes residents perceived the impact of the El Niño event on basic necessities, transport, health care, jobs and migration. Forty-five individuals from five rural communities, some of which were isolated from the rest of Tumbes during the event, participated in five focus groups; six of these individuals constructed nutrition diaries. When asked about events in the past 20 years, participants identified the 1997-98 El Niño as a major negative event. The El Niño disaster situation induced a decrease in access to transport and health care and the rise in infectious diseases was swiftly contained. Residents needed more time to rebuild housing; recover agriculture, livestock and income stability; and return to eating sufficient animal protein. Although large-scale assistance minimized effects of the disaster, residents needed more support. Residents' perspectives on their risk of flooding should be considered in generating effective assistance policies and programmes.

Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness.

Background: Mass drug administration (MDA) with niclosamide (NSM) can be used to control taeniasis, the cause of neurocysticercosis. NSM is 84.3% effective against taeniasis and is considered safe as it is not absorbed from the intestinal tract. However, information on its safety and effectiveness during MDA is limited. We evaluated the effectiveness of NSM and reported adverse events (AEs) during a cysticercosis elimination program in Tumbes, Peru. Methods: Three rounds of NSM at 4-month intervals were offered to 77,397 eligible residents. We revisited all participants in their homes 72 h after each round to collect information regarding AEs. We also collected post-treatment stool samples to diagnose taeniasis after the first round, followed by a second sample at 30 days from those infected to evaluate NSM's effectiveness. Findings: During implementation, 68,751 individuals were administered at least one dose of NSM (mean age 29 years, SD 20; 52% male), and 65,551 (95.3%) were visited post-treatment. 988 (1.5%) reported experiencing at least one AE. Almost all AEs (99.2%) were of mild intensity, with no severe AEs recorded. Of 211 participants diagnosed with taeniasis, 188 provided a follow-up stool sample 30-days after treatment and 141 were cured (treatment effectiveness 75.0%). Older age and higher coproantigen levels were significantly associated with treatment failure. Interpretation: MDA with NSM is safe in Taenia solium endemic settings. However, the effectiveness following one dose is lower than expected, which suggests additional treatment may be necessary to enhance the infection control efforts. Funding: The Bill and Melinda Gates Foundation.

Effect of urbanisation on the relationship between total serum IgE and asthma.

It is unclear if the relationship of total serum IgE with asthma varies with degree of urbanisation. We hypothesised that the relationship of total serum IgE to asthma is more pronounced in an urban versus a rural environment. We enrolled 1441 children aged 13-15 years in a peri-urban shanty town in Lima, Peru (n=725) and 23 villages in rural Tumbes, Peru (n=716). We asked participants about asthma and allergy symptoms, environmental exposures and sociodemographics; and performed spirometry, and exhaled nitric oxide and allergy skin testing. We obtained blood for total serum IgE in 1143 (79%) participants. Geometric means for total serum IgE were higher in Lima versus Tumbes (262 versus 192 kU·L(-1); p<0.001). The odds of asthma increased by factors of 1.6 (95% CI 1.3-2.0) versus 1.4 (95% CI 0.9-2.1) per log unit increase in total serum IgE in Lima versus Tumbes, respectively. Atopy was an effect modifier of the relationship of total serum IgE on asthma. Among atopics and non-atopics, the odds of asthma increased by a factor of 2.0 (95% CI 1.5-2.7) and 1.0 (95% CI 0.7-1.4) per log unit increase in total serum IgE, respectively. Total serum IgE was associated with atopic asthma but not with non-atopic asthma. Urbanisation did not appear to be an effect modifier of this relationship.

Effect of urbanisation on asthma, allergy and airways inflammation in a developing country setting.

BACKGROUND: Asthma is a growing public health problem in developing countries. However, few studies have studied the role of urbanisation in this phenomenon. It was hypothesised that children living in a peri-urban setting in Peru have higher rates of asthma and allergy than rural counterparts. METHODS: 1441 adolescents aged 13-15 years were enrolled from two settings: a peri-urban shanty town in Lima (n = 725) and 23 rural villages in Tumbes (n = 716). Participants filled in questionnaires on asthma and allergy symptoms, environmental exposures and sociodemographics, and underwent spirometry, and exhaled nitric oxide (eNO) and allergy skin testing. Indoor particulate matter (PM) concentrations were measured in 170 households. RESULTS: Lima adolescents had higher rates of lifetime wheezing (22% vs 10%), current asthma symptoms (12% vs 3%) and physician-diagnosed asthma (13% vs 2%; all p <0.001). Current rhinitis (23% vs 12%), eczema (12% vs 0.4%), atopy (56% vs 38%), personal history of cigarette smoking (7.4% vs 1.3%) and mean indoor PM (31 vs 13 µg/m(3)) were also higher in Lima (all p < 0.001). The peri-urban environment of Lima was associated with a 2.6-fold greater odds (95% CI 1.3 to 5.3) of asthma in multivariable regression. Forced expiratory volumes were higher and FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratios were lower in Lima (all p < 0.001). Higher eNO values in Lima (p < 0.001) were attributable to higher rates of asthma and atopy. CONCLUSIONS: Peri-urban adolescents had more asthma, atopy and airways inflammation and were exposed to more indoor pollution. The findings provide evidence of the risks posed to lung health by peri-urban environments in developing countries.

Epilepsy and neurocysticercosis: an incidence study in a Peruvian rural population.

BACKGROUND: Epilepsy is a serious neurological disorder and neurocysticercosis (NCC), the central nervous system infection by the larvae of Taenia solium, is the main cause of acquired epilepsy in developing countries. NCC is becoming more frequent in industrialized countries due to immigration from endemic areas. Previously reported epilepsy incidences range from 30 to 50/100,000 people in industrialized countries and 90 to 122/100,000 people in developing countries. OBJECTIVES: To determine the incidence of epilepsy in a cysticercosis endemic area of Peru. METHODS: A screening survey for possible seizure cases was repeated biannually in this cohort for a period of 5 years (1999-2004) using a previously validated questionnaire. All positive respondents throughout the study were examined by a trained neurologist in the field to confirm the seizure. If confirmed, they were offered treatment, serological testing, neuroimaging (CT scans and MRI) and clinical follow-up. RESULTS: The cohort study comprised 817 individuals. The overall epilepsy incidence rate was 162.3/100,000 person-years, and for epileptic seizures, 216.6/100,000 person-years. Out of the 8 individuals who had epileptic seizures, 4 had markers for NCC (neuroimaging and/or serology). CONCLUSION: The incidence of epilepsy in this area endemic for cysticercosis is one of the highest reported worldwide.

Clustering of Necropsy-Confirmed Porcine Cysticercosis Surrounding Taenia solium Tapeworm Carriers in Peru.

The pork tapeworm, Taenia solium, is among the leading causes of preventable epilepsy in the world and is common in rural areas of developing countries where sanitation is limited and pigs have access to human feces. Prior studies in rural villages of Peru have observed clusters of T. solium cysticercosis among pigs that live near human tapeworm carriers. Such spatial analyses, however, have been limited by incomplete participation and substandard diagnostic tests. In this study, we evaluated the association between necropsy-confirmed cysticercosis in pigs and their distance to T. solium tapeworm carriers in six villages in northern Peru. A total of six (1.4%) tapeworm carriers were detected using copro-antigen enzyme-linked immunosorbent assay and seven of 10 (70%) pigs belonging to the tapeworm carriers were found with viable cyst infection on necropsy. This was significantly greater than the prevalence of viable cyst infection among pigs living < 500 m (11%) and > 500 m (0.5%) from a tapeworm carrier (P < 0.001 for distance trend). Similar statistically significant prevalence gradients were observed after adjustment for possible confounders and for other pig-level outcomes including infection with > 10 viable cysts, degenerated cyst infection, and serological outcomes. This investigation confirms that porcine cysticercosis clusters strongly around tapeworm carriers in endemic rural regions of northern Peru and supports interventions that target these hotspots.

Encuestas telefónicas para el estudio de costos catastróficos por tuberculosis en Colombia: una herramienta innovadora / Telephone surveys for the study of catastrophic costs due to tuberculosis in Colombia: a novel tool / Pesquisas telefônicas para um estudo de custos catastróficos da tuberculose na Colômbia: uma ferramenta inovadora

[RESUMEN]. El estudio de costos catastróficos que experimentan las personas afectadas por tuberculosis realizado en Colombia durante la pandemia de COVID-19 trajo consigo la oportunidad de implementar encuestas telefónicas como medio para la recopilación de información. Lo anterior se constituye como una innovación metodológica en los estándares establecidos por la Organización Mundial de la Salud (OMS) que, para este tipo de estudios, suelen tener base en el empleo de encuestas cara a cara con los pacientes que acuden a las instalaciones de salud. El diseño del estudio, sus objetivos y metodología fueron adaptados del manual práctico para la realización de encuestas de costos de la tuberculosis de la OMS. Se seleccionaron 1 065 personas afectadas por tuberculosis como participantes del estudio, a quienes se les administró de manera telefónica el cuestionario estándar adaptado al contexto colombiano. Fue posible obtener datos estructurados sobre los costos directos e indirectos que enfrentan los pacientes con tuberculosis y sus familias; de manera general, se observó que todas las variables de recopilación alcanzaron una completitud mayor a 80%, con un tiempo promedio de encuesta de 40 minutos y una tasa de rechazo de 8%. La metodología de encuestas telefónicas desarrollada para determinar la línea base del estudio de costos catastróficos en Colombia resultó innovadora por el formato telefónico, que mantiene los estándares de información requerida para permitir estimaciones comparables a nivel internacional, y es un medio útil en la generación de resultados estandarizados en eventos en los cuales existe limitación para la realización de encuestas cara a cara.

[ABSTRACT]. The study of catastrophic costs incurred by people affected by tuberculosis (TB), conducted in Colombia during the COVID-19 pandemic, provided the opportunity to implement telephone surveys for data collection. This constitutes a methodological innovation regarding the standards established by the World Health Organization (WHO) which, for this type of study, usually rely on face-to-face surveys of patients attending health facilities. The study design, objectives, and methodology were adapted from the WHO publication Tuberculosis patient cost surveys: a handbook. A total of 1065 people affected by tuberculosis were selected as study participants and, by telephone, were administered a standard questionnaire adapted to the Colombian context. This allowed the collection of structured data on the direct and indirect costs faced by TB patients and their families. Greater than 80% completeness was achieved for all variables of interest, with an average survey duration of 40 minutes and a rejection rate of 8%. The described survey method to determine the baseline for further study of catastrophic costs in Colombia was novel because of its telephone-based format, which adheres to the information standards required to allow internationally comparable estimates. It is a useful means of generating standardized results in contexts in which the ability to conduct face-to-face surveys is limited.

[RESUMO]. O estudo dos custos catastróficos incorridos pelas pessoas afetadas pela tuberculose realizado na Colômbia durante a pandemia de COVID-19 representou uma oportunidade de implementar pesquisas telefônicas como forma de coleta de dados. Constitui-se uma inovação metodológica dos padrões estabelecidos pela Organização Mundial da Saúde (OMS), que, para esse tipo de estudo, geralmente se baseiam no uso de pesquisas presenciais com os pacientes que frequentam estabelecimentos de saúde. O delineamento, os objetivos e a metodologia do estudo foram adaptados do manual prático da OMS para a realização de pesquisas de custos da tuberculose. Um total de 1065 pessoas afetadas pela tuberculose foram selecionadas para participar do estudo. O questionário padrão, adaptado ao contexto colombiano, foi aplicado pelo telefone. Foi possível obter dados estruturados sobre os custos diretos e indiretos enfrentados pelos pacientes com tuberculose e suas famílias. Em geral, observou-se que todas as variáveis de coleta atingiram uma completude de mais de 80%, com um tempo médio de pesquisa de 40 minutos e uma taxa de recusa de 8%. A metodologia de pesquisa telefônica desenvolvida para determinar a linha de base do estudo de custos catastróficos na Colômbia foi inovadora devido ao formato telefônico, que mantém os padrões de informação necessários para permitir estimativas comparáveis internacionalmente e é uma forma útil de gerar resultados padronizados em circunstâncias em que há limitações para a realização de pesquisas presenciais.

"Can it be that god does not remember me": a qualitative study on the psychological distress, suffering, and coping of Dominican women with chronic filarial lymphedema and elephantiasis of the leg.

The psychological states of Dominican women with chronic lymphedema and elephantiasis of the leg and the coping strategies they used to ameliorate the negative psychological effects of this condition were explored using modified precepts of grounded theory method. Qualitative data were gathered through in-depth interviewing and focus group discussions held in the Dominican Republic. Thematic results found that compounding their physical disfigurement, functional limitations, and social losses were feelings of depression, embarrassment, social isolation, and despair. Adaptive problem solving and emotion-focused coping strategies that emerged during analysis also are discussed. It is recommended that management of psychological distress should be a significant component of lymphedema management programs in developing countries.

Strategies for the elimination of taeniasis/cysticercosis.

Advances in the field of neurocysticercosis continue to shape our understanding of the disease and our efforts to control it. Several attempts have been made to eradicate the disease with active interventions such as changing domestic pig-raising practices, mass chemotherapy of porcine cysticercosis and taeniasis, selective detection and treatment of taeniasis, and community health education. Moreover, ongoing progress in the diagnosis of taeniasis and the development of a porcine vaccine against cysticercosis in Australia, Mexico and Peru has yielded at least one effective vaccine that is currently available. Thus far, however, attempted interventions have only been successful in temporarily disrupting transmission of the disease. Controlled data on the efficacy and acceptability of the different interventions is urgently needed to provide a base-line schematic for intervention which could later be tailored to each particular endemic scenario.

Hymenolepis nana infection: symptoms and response to nitazoxanide in field conditions.

A matched case-control study on clinical symptoms of Hymenolepis nana and an open trial of nitazoxanide treatment were conducted in a village on the northern coast of Peru. Interview data were obtained from 25 individuals with hymenolepiasis only and 46 matched controls. Individuals with other intestinal helminths or giardiasis were excluded. Twenty nitazoxanide-treated cases were followed with stool examination a month later. There were no significant differences between groups in the prevalence of symptoms except headache, which was less frequent in the cases. Treatment efficacy was 75%. Hymenolepiasis in this community did not have significant impact on specific symptoms.

A qualitative study of the psychosocial and health consequences associated with lymphedema among women in the Dominican Republic.

To date, few studies have addressed the sequelae of lymphatic filariasis, a mosquito-transmitted disease, on the quality of life of affected women in the Americas. In this qualitative study, we conducted 28 semi-structured interviews and 3 focus groups of women with lymphedema or elephantiasis of the leg living in filariasis-endemic areas of the Dominican Republic. Women in our study described a spectrum of consequences associated with their lymphedema but physical, functional, and psychological limitations were not always associated with severity of lymphedema. Data suggests that management frameworks need to be expanded to address women's explanatory models of illness, the cultural practices of seeking traditional healers for initial care, psychological distress, coping strategies unique to women, and the practice of self treating with antibiotics without medical supervision. Further research to better understand the depth and breadth of psychological states and coping strategies of women; the health seeking and self-management practices; and the strain on social support networks of women is needed in order to assist health program planners in establishing culturally tailored and gender-specific interventions for Dominican women.

Prevalence, Age Profile, and Associated Risk Factors for Hymenolepis nana Infection in a Large Population-Based Study in Northern Peru.

Hymenolepis nana, the dwarf tapeworm, is a common intestinal infection of children worldwide. We evaluated infection and risk factor data that were previously collected from 14,761 children aged 2-15 years during a large-scale program in northern Peru. We found that 1,124 of 14,761 children (7.61%) had H. nana infection, a likely underestimate given that only a single stool sample was examined by microscopy for diagnosis. The strongest association with infection was lack of adequate water (adjusted prevalence ratio [aPR] 2.22, 95% confidence interval [CI] 1.82-2.48) and sanitation infrastructure in the house (aPR 1.94, 95% CI 1.64-2.29). One quarter of those tested did not have a bathroom or latrine at home, which doubled their likelihood of infection. Similarly, one quarter did not have piped public water to the house, which also increased the likelihood of infection. Continued efforts to improve access to basic water and sanitation services will likely reduce the burden of infection in children for this and other intestinal infections.

High Prevalence of Asymptomatic Neurocysticercosis in an Endemic Rural Community in Peru.

BACKGROUND: Neurocysticercosis is a common helminthic infection of the central nervous system and an important cause of adult-onset epilepsy in endemic countries. However, few studies have examined associations between neurologic symptoms, serology and radiographic findings on a community-level. METHODOLOGY: We conducted a population-based study of resident's ≥2 years old in a highly endemic village in Peru (pop. 454). We applied a 14 -question neurologic screening tool and evaluated serum for antibodies against Taenia solium cysticercosis using enzyme-linked immunoelectrotransfer blot (LLGP-EITB). We invited all residents ≥18 years old to have non-contrast computerized tomography (CT) of the head. PRINCIPAL FINDINGS: Of the 385 residents who provided serum samples, 142 (36.9%) were seropositive. Of the 256 residents who underwent CT scan, 48 (18.8%) had brain calcifications consistent with NCC; 8/48 (17.0%) reported a history of headache and/or seizures. Exposure to T. solium is very common in this endemic community where 1 out of 5 residents had brain calcifications. However, the vast majority of people with calcifications were asymptomatic. CONCLUSION: This study reports a high prevalence of NCC infection in an endemic community in Peru and confirms that a large proportion of apparently asymptomatic residents have brain calcifications that could provoke seizures in the future.

West Nile virus survey of birds and mosquitoes in the Dominican Republic.

We report West Nile virus (WNV) activity from a new area on Hispaniola, in the vicinity of Monte Cristi National Park in northwest Dominican Republic. Specific anti-WNV antibodies were detected in 12 of 58 (21%) resident birds sampled in March 2003, representing six species in the orders Cuculiformes (cuckoos), Strigiformes (owls), and Passeriformes (song birds). This seroprevalence is the highest reported from any site in the Caribbean Basin. Virus was not detected in any mosquitoes or tissues from bird specimens. Testing of 20 sick or dead birds was negative for WNV. Undetermined flavivirus antibodies were detected in four resident birds at Monte Cristi, as well as in five resident birds at Sierra de Baoruco National Park in southwest Dominican Republic. These data suggest that an unidentified flavivirus, as well as WNV, is active in the Dominican Republic.

Seasonal prevalence and container preferences of Aedes albopictus in Santo Domingo City, Dominican Republic.

The seasonal prevalence and container preferences of Aedes albopictus (Skuse) were studied in the park, Parque Mirador del Norte in Santo Domingo City, Dominican Republic, from January to December 1994. Tire ovitraps were set along a transect through the park and monitored weekly while two larval surveys were conducted in both the park and surrounding houses using standard entomological methodology. No seasonal pattern of oviposition was observed with similar numbers of positive tire traps collected in the wet and dry season. Most of the positive ovitraps were located in the middle of the park. Within ovitraps, Aedes aegypti (L.), Ae. albopictus, Culex corniger (Theobald), Ochlerotatus albonotatus (Coquillett), and Toxorhynchites sp. were collected. The larval surveys found 7 associated mosquito species, including Ae. aegypti, Ae. albopictus, Ochleotatus mediovittatus (Coquillett), Anopheles albimanus (Weidemann), Culex nigripalpus (Theobald), and Culex quinquefasciatus Say. The Ae. albopictus breeding sites were plastic buckets (4), rock holes (3), and Styrofoam lunch containers (3). We suggest that further studies should be conducted to determine its geographic distribution and vector potential in the Dominican Republic.

Neurocysticercosis as a cause of epilepsy and seizures in two community-based studies in a cysticercosis-endemic region in Peru.

BACKGROUND: The prevalence of epilepsy added to inadequate treatment results in chronic morbidity and considerable mortality in poor populations. Neurocysticercosis (NCC), a helminthic disease of the central nervous system, is a leading cause of seizures and epilepsy in most of the world. METHODS: Taking advantage of a cysticercosis elimination program, we performed two community-based cross-sectional studies between 2006 and 2007 in 58 rural communities (population 20,610) to assess the prevalence and characteristics of epilepsy and epileptic seizures in this endemic region. Serological and computed tomography (CT) data in individuals with epilepsy were compared to previous surveys in general population from the same region. PRINCIPAL FINDINGS: In two surveys, 17,450 individuals were evaluated. Lifetime prevalence of epilepsy was 17.25/1000, and prevalence of active epilepsy was 10.8/1000 inhabitants. The prevalence of epilepsy increased after age 25 years and dropped after age 45. Only 24% (45/188) of patients with active epilepsy were taking antiepileptic drugs, all at sub-therapeutic doses. Antibodies to cysticercosis were found in approximately 40% of individuals with epilepsy in both studies. In one survey only individuals presenting strong antibody reactions were significantly associated with having epilepsy (OR 5.74; p<0.001). In the second, the seroprevalence as well as the proportion presenting strong antibody reactions were both significantly higher in individuals with epilepsy (OR 2.2 and 4.33, respectively). Brain CT showed NCC-compatible images in 109/282 individuals with epilepsy (39%). All individuals with viable parasites on CT were seropositive. CONCLUSION: The prevalence of epilepsy in this cysticercosis endemic region is high and NCC is an important contributor to it.