RESUMO
BACKGROUND: Dengue is a major and rapidly increasing public health problem. In Argentina, the southern extreme of its distribution in the Americas, epidemic transmission takes place during the warm season. Since its re-emergence in 1998 two major outbreaks have occurred, the biggest during 2016. To identify the environmental factors that trigger epidemic events, we analyzed the occurrence and magnitude of dengue outbreaks in time and space at different scales in association with climatic, geographic and demographic variables and number of cases in endemic neighboring countries. METHODS: Information on dengue cases was obtained from dengue notifications reported in the National Health Surveillance System. The resulting database was analyzed by Generalized Linear Mixed Models (GLMM) under three methodological approaches to: identify in which years the most important outbreaks occurred in association with environmental variables and propose a risk estimation for future epidemics (temporal approach); characterize which variables explain the occurrence of local outbreaks through time (spatio-temporal approach); and select the environmental drivers of the geographical distribution of dengue positive districts during 2016 (spatial approach). RESULTS: Within the temporal approach, the number of dengue cases country-wide between 2009 and 2016 was positively associated with the number of dengue cases in bordering endemic countries and negatively with the days necessary for transmission (DNT) during the previous autumn in the central region of the country. Annual epidemic intensity in the period between 1999-2016 was associated with DNT during previous autumn and winter. Regarding the spatio-temporal approach, dengue cases within a district were also associated with mild conditions in the previous autumn along with the number of dengue cases in neighboring countries. As for the spatial approach, the best model for the occurrence of two or more dengue cases per district included autumn minimum temperature and human population as fixed factors, and the province as a grouping variable. Explanatory power of all models was high, in the range 57-95%. DISCUSSION: Given the epidemic nature of dengue in Argentina, virus pressure from endemic neighboring countries along with climatic conditions are crucial to explain disease dynamics. In the three methodological approaches, temperature conditions during autumn were best associated with dengue patterns. We propose that mild autumns represent an advantage for mosquito vector populations and that, in temperate regions, this advantage manifests as a larger egg bank from which the adult population will re-emerge in spring. This may constitute a valuable anticipating tool for high transmission risk events.
RESUMO
In order to determine the prevalence and risk factors for shedding of Cryptosporidium spp. in dairy calves, a cross-sectional study was carried out in the northeastern region of Buenos Aires Province, Argentina. Fecal samples from a total of 552 calves from 27 dairy herds were collected, along with a questionnaire about management factors. Cryptosporidium spp. oocysts were detected by light microscopy using Kinyoun staining. Putative risk factors were tested for association using generalized linear mixed models (GLMMs). Oocyst shedding calves were found in 67% (CI95% = 49-84) of herds (corresponding to a true herd prevalence of 98%) and 16% (CI95% = 13-19) of calves (corresponding to a true calve prevalence of 8%). Within-herd prevalence ranged from 0 to 60%, with a median of 8%. Cryptosporidium spp. excretion was not associated with the type of liquid diet, gender, time the calf stayed with the dam after birth, use of antibiotics, blood presence in feces, and calving season. However, important highly significant risk factors of oocyst shedding of calves was an age of less or equal than 20 days (OR = 7.4; 95% CI95% = 3-16; P < 0.0001) and occurrence of diarrhea (OR = 5.5; 95% CI95% = 2-11; P < 0.0001). The observed association with young age strongly suggests an early exposure of neonatal calves to Cryptosporidium spp. oocysts in maternity pens and/or an age-related susceptibility. Association with diarrhea suggests that Cryptosporidium spp. is an important enteropathogen primarily responsible for the cause of the observed diarrheal syndrome. Results demonstrate that Cryptosporidium spp. infection is widespread in the study region. Monitoring and control of this parasitic protozoan infection in dairy herds is recommended.