Migration in French Guiana: Implications in health and infectious diseases.

In French Guiana, more than a third of the population, and nearly half of the adults, are of foreign origin. This immigration is explained by the French standard of living, which is attractive to nationals of surrounding countries. Infectious diseases remain in the top 10 causes of premature death, often in the most precarious populations. In this context we aimed to synthesize the state of the knowledge regarding immigration and infectious diseases in French Guiana and the general implications that follow this diagnosis. For HIV, although the majority of patients are of foreign origin, estimates of the presumed date of infection based on CD4 erosion modelling and from molecular analyses suggest that the majority of transmissions in foreign-born individuals occur in French Guiana and that the Guiana shield has been a crossroad between Latin America and the Caribbean. Among key populations bridging these regions illegal gold miners are very mobile and have the greatest proportion B Caribbean HIV viruses. Gold miners have been a key vulnerable population for falciparum malaria and other tropical diseases such as leishmaniasis, leprosy, or leptospirosis. The complex history of migrations in French Guiana and on the Guiana Shield is also reflected in the fingerprinting of mycobacterium tuberculosis and the high incidence of tuberculosis in French Guiana, notably in immigrants, reflects the incidences in the countries of origin of patients. The high burden of infectious diseases in immigrants in French Guiana is first and foremost a reflection of the precarious living conditions within French Guiana and suggests that community-based proactive interventions are crucial to reduce transmission, morbidity, and mortality from infectious diseases.

Current status of infectious diseases among migrants and non-citizens in Malaysia.

The mass movement of migrants to Malaysia for employment is one of the factors contributing to the emergence and re-emergence of infectious diseases in this country. Despite mandatory health screening for migrants seeking employment, prevalence records of infectious diseases amongst migrant populations in Malaysia are still within negligible proportions. Therefore, the present review highlights the incidence, mortality and overall status of infectious diseases amongst migrants' populations in Malaysia, which maybe be useful for impeding exacerbation of inequalities among them and improving our national health system thru robust and effective emergency responses in controlling the prevalent diseases found among these populations and maybe, Malaysian citizens too. Peer-reviewed articles from January 2016 to December 2020 were searched through online platform including SCOPUS, PubMed, Science Direct, and Google Scholar. Non-peer-reviewed reports and publications from ministry and government websites including data from related agencies were also scoured from in order to ensure that there are no cases being overlooked, as most published articles did not have migrants as the research subjects. A total of 29 studies had been selected in the final analysis. Migrants in Malaysia were at higher risk for tuberculosis, malaria, lymphatic filariasis, cholera, leprosy and leptospirosis. Lymphatic filariasis was still endemic among this population while thousand cases of TB and cholera had been reported among them due to cramp living conditions and poor sanitation in their settlements respectively. While malaria had gradually decreased and become sporadic, the influx of migrant workers had led to the rising of imported malaria cases. Low cases of leprosy had been recorded in Malaysia but a significant proportion of it was contributed by migrant workers. As for leptospirosis, studies found that there are prominent cases among migrant workers, which particularly highest within workers with lower educational attainment. Infectious diseases are still prevalent among migrants in Malaysia due to various interplay factors including their working sectors, country of origin, immunization status, type of settlement, impoverished living conditions, and language and cultural barriers that impeding access to health facilities.

[Elimination of infectious disease in China, past and future].

In the long history, infectious disease once caused huge disasters to human beings, not only resulting in serious impacts on public health, but even threatening socioeconomic development and national security. Since the founding of the People's Republic of China, China has attached great importance to the prevention and treatment of infectious disease and achieved remarkable achievements. This article mainly summarizes the historical progresses of the eradication of smallpox and the eliminations of polio, leprosy, filariasis, neonatal tetanus, blinding trachoma and malaria in China, and discusses the eliminations of the infectious diseases which can be conducted in the future.

O protagonismo da enfermagem nas doenças infecciosas e epidemias comunitárias no Brasil / The role of nursing in infectious diseases and community epidemics in Brazil / El papel de la enfermería en las enfermedades infecciosas y las epidemias comunitarias en Brasil

Introdução: A história da enfermagem está ligada ao pioneirismo no combate às doenças infecciosas. No Brasil, anteriormente à pandemia da Covid-19, doenças como a tuberculose e hanseníase já estavam presentes sendo a enfermagem referência na prevenção e assistência. Paradoxalmente, a profissão permaneceu bastante invisível e desvalorizada ao longo dos anos. Objetivo: Evidenciar a participação da enfermagem no enfrentamento às doenças infecciosas e epidemias comunitárias. Material e Método: Trata-se de uma revisão integrativa da literatura com análise temática. A busca foi realizada nas bases National Library of Medicine e Biblioteca Virtual em Saúde, entre maio e junho de 2020, nos idiomas português, inglês e espanhol. Não houve recorte temporal na busca de publicações. Resultados: A análise dos 19 artigos incluídos originou quatro categorias: "O Papel de Transformar", "O Papel de Atuar", "O Papel de Educar" e "O Papel de Formar". Nestas categorias, as ações de vigilância em saúde se destacaram, dentre elas as consultas de enfermagem, busca ativa, vacinação, visitas domiciliares, educação em saúde, participação política e educação profissional. Conclusão: Verifica-se que questões sanitárias corroboraram para o surgimento e para institucionalização da enfermagem enquanto profissão no Brasil, evidenciando a importância deste profissional no combate às doenças infecciosas e epidemias comunitárias.(AU)

Introduction: The history of nursing is linked to pioneering in the fight against infectious diseases. In Brazil, prior to the COVID-19 pandemic, diseases such as tuberculosis and leprosy were already present and nursing was a reference in prevention and care. Paradoxically, the profession has remained quite invisible and undervalued over the years. Objective: To highlight the participation of nursing in coping with infectious diseases and community epidemics. Material and Method: This is an integrative review of the literature with thematic analysis. The search was conducted in the National Library of Medicine and Virtual Health Library databases, between May and June 2020, in Portuguese, English and Spanish. There was no time cut in the search for publications. Results: The analysis of the 19 articles included originated four categories: "The Role of Transforming", "The Role of Acting", "The Role of Educating" and "The Role of Forming". In these categories, health surveillance actions stood out, among them nursing consultations, active search, vaccination, home visits, health education, political participation and professional education. Conclusion: It is verified that health issues corroborated the emergence and institutionalization of nursing as a profession in Brazil, highlighting the importance of this professional in the fight against infectious diseases and community epidemics.(AU)

Introducción: La historia de la enfermería está ligada al espíritu pionero en la lucha contra las enfermedades infecciosas. En Brasil, antes de la pandemia Covid-19, ya estaban presentes enfermedades como la tuberculosis y la lepra, siendo la enfermería un referente en prevención y atención. Paradójicamente, la profesión se ha mantenido bastante invisible y devaluada a lo largo de los años. Objetivo: Destacar la participación de la enfermería en la lucha contra las enfermedades infecciosas y las epidemias comunitarias. Material y Método: Se trata de una revisión bibliográfica integradora con análisis temático. La búsqueda se realizó en las bases de datos de la Biblioteca Nacional de Medicina y Biblioteca Virtual en Salud, entre mayo y junio de 2020, en portugués, inglés y español. No hubo cortes de tiempo en la búsqueda de publicaciones. Resultados: El análisis de los 19 artículos incluidos dio como resultado cuatro categorías: "El rol de transformar", "El rol de actuar", "El rol de educar" y "El rol de la formación". En estas categorías se destacaron las acciones de vigilancia en salud, entre ellas consultas de enfermería, búsqueda activa, vacunación, visitas domiciliarias, educación en salud, participación política y educación profesional. Conclusión: Parece que los problemas de salud se corroboraron para el surgimiento e institucionalización de la enfermería como profesión en Brasil, mostrando la importancia de este profesional en la lucha contra las enfermedades infecciosas y las epidemias comunitarias.(AU)

Insights from ancient DNA analysis of Egyptian human mummies: clues to disease and kinship.

The molecular Egyptology field started in the mid-eighties with the first publication on the ancient DNA (aDNA) analysis of an Egyptian mummy. Egypt has been a major interest for historians, archeologists, laymen as well as scientists. The aDNA research on Egyptian biological remains has been fueled by their abundance and relatively well-preserved states through artificial mummification and by the advanced analytical techniques. Early doubts of aDNA integrity within the Egyptian mummies and data authenticity were later abated with studies proving successfully authenticated aDNA retrieval. The current review tries to recapitulate the published studies presenting paleogenomic evidence of disease diagnosis and kinship establishment for the Egyptian human remains. Regarding disease diagnosis, the prevailing literature was on paleogenomic evidence of infectious diseases in the human remains. A series of reports presented evidence for the presence of tuberculosis and/or malaria. In addition, there were solitary reports of the presence of leprosy, diphtheria, bacteremia, toxoplasmosis, schistosomiasis and leishmaniasis. On the contrary, paleogenomic evidence of the presence of rare diseases was quite scarce and mentioned only in two articles. On the other hand, kinship analysis of Egyptian human remains, including that of Tutankhamen, was done using both mitochondrial DNA sequences and nuclear DNA markers, to establish family relationships in four studies. It is clear that the field of molecular Egyptology is still a largely unexplored territory. Nevertheless, the paleogenomic investigation of Egyptian remains could make significant contributions to biomedical sciences (e.g. elucidation of coevolution of human host-microbe interrelationship) as well as to evidence-based archeology.

Estratificación epidemiológica de enfermedades seleccionadas. Granma. 2018 / Epidemiological stratification of selected diseases. Granma. 2018

La estratificación es una estrategia útil para obtener un diagnóstico objetivo de acuerdo con el cual planificar las actividades de prevención y control de las distintas enfermedades. El objetivo fundamental del trabajo fue identificar el comportamiento territorial del riesgo absoluto de enfermedades transmisibles seleccionadas en la provincia. Se realizó la estratificación epidemiológica de 5 enfermedades seleccionadas (EDA, IRA, Tuberculosis, Meningoencefalitis viral y Lepra), utilizando para ello el método de riesgo absoluto, que consistió en la formación de diferentes estratos de riesgo: bajo, mediano y alto. Durante el año 2018 se clasificó como municipio de alto riesgo Bayamo; la distribución por municipios según número de entidades en alto riesgo pudimos constatar lo siguiente: Bayamo (5); Manzanillo (3); Cauto Cristo, Yara, Campechuela, Media Luna, Niquero, Buey Arriba y Guisa (2 cada uno); Jiguaní, Pilón y Bartolomé Masó (1 cada uno); Río Cauto (no se encuentra en alto riesgo para ninguna entidad); según las enfermedades seleccionadas, la distribución de los municipios que se encontraban en alto riesgo fue la siguiente: IRA, Tuberculosis, Meningoencefalitis viral y Lepra (4 municipios en cada una), EDA (3 municipios). La conformación de los estratos de riesgo según la metodología escogida garantiza a los jefes de programa el diseño de estrategias de intervención para cada una de las enfermedades analizadas, según el comportamiento de los factores asociados a las mismas y completar el proceso de diagnóstico-intervención-evaluación(AU)

Stratification is a useful strategy to obtain an objective diagnosis according to which to plan prevention and control activities for different diseases. The main objective of the work was to identify the territorial behavior of the absolute risk of selected communicable diseases in the province. Epidemiological stratification of 5 selected diseases (EDA, ARI, Tuberculosis, Viral Meningoencephalitis and Leprosy) was carried out, using the absolute risk method, which consisted of the formation of different risk strata: low, medium and high. During 2018 Bayamo was classified as a high risk municipality; the distribution by municipalities according to the number of high risk entities we could verify the following: Bayamo (5); Manzanillo (3); Cauto Cristo, Yara,Campechuela, Media Luna, Niquero, Buey Arriba and Guisa (2 each); Jiguaní, Pilón and Bartolomé Masó (1 each); Río Cauto (it is not at high risk for any entity); According to the selected diseases, the distribution of the municipalities that were at high risk was as follows: ARF, Tuberculosis, Viral Meningoencephalitis and Leprosy (4 municipalities in each), EDA (3 municipalities). The conformation of the risk strata according to the chosen methodology guarantees the program managers the design of intervention strategies for each one of the analyzed diseases, according to the behavior of the factors associated with them and completing the diagnostic-intervention process-evaluation(EU)

Doenças infecciosas e parasitárias no Brasil de 2010 a 2017: aspectos para vigilância em saúde / Infectious and parasitic diseases in Brazil, 2010 to 2017: considerations for surveillance / Enfermedades infecciosas y parasitarias en Brasil de 2010 a 2017: aspectos para la vigilancia sanitaria

RESUMO Objetivo. Apresentar um método para identificar áreas críticas relativas a doenças infecciosas e parasitárias selecionadas para fins de vigilância em saúde, analisando a sua associação a indicadores de pobreza no Brasil. Métodos. Foram mapeadas as taxas de incidência de dengue, doença de Chagas aguda, esquistossomose, hanseníase, hepatite A, leishmaniose tegumentar, leishmaniose visceral, leptospirose, malária e tuberculose. Foram realizadas análises para os anos de 2010 a 2017 a partir de um indicador síntese, calculado como a média dos coeficientes médios de incidência para cada agravo normalizada pela média e desvio padrão durante o período analisado. A estimativa da base populacional foi de 2014. Os coeficientes calculados foram estratificados para classificação dos municípios em criticidade muito alta, alta, média, baixa ou muito baixa conforme cada doença. Também foram selecionados indicadores de diferentes dimensões que expressassem desigualdades socioeconômicas e segregação espacial nos municípios brasileiros, sendo testada a sua associação às doenças em estudo. Resultados. O indicador mostrou que 40,5% dos municípios brasileiros apresentam alta criticidade, sobretudo nas regiões Norte, parte do Nordeste e Centro-Oeste. Os indicadores "proporção de pobreza", "lixo no entorno", "esgoto no entorno" e "famílias chefiadas por mulheres" podem aumentar a chance de a localidade apresentar maior criticidade para as doenças. O indicador "esgoto adequado" pode ser considerado potencial fator de proteção. Conclusões. A técnica utilizada foi adequada para orientar ações de vigilância no país e permite a articulação entre vigilâncias locais e demais setores para contornar os problemas de saúde causados por doenças infecciosas e parasitárias e fatores relacionados.(AU)

ABSTRACT Objective. To present a method to identify critical areas for selected infectious and parasitic diseases for the purpose of health surveillance and to analyze the association between these critical areas and poverty indicators in Brazil. Method. The following incidence rates were mapped: dengue, acute Chagas disease, schistosomiasis, Hansen's disease, hepatitis A, cutaneous leishmaniasis, visceral leishmaniasis, leptospirosis, malaria, and tuberculosis. The analyses were performed for the period from 2010 to 2017 based on a synthetic indicator calculated as the mean of mean incidence coefficients for each disorder, normalized by the mean and standard deviation during the period of analysis. A 2014 population estimate was used. The calculated coefficients were stratified for classification of municipalities into very high, high, medium, low, or very low criticality according to each disorder. Indicators expressing several socioeconomic dimensions and space segregation in Brazilian municipalities were also selected and tested regarding their association with the transmission of the diseases under study. Results. The indicator showed that 40.5% of Brazilian municipalities had high criticality for the diseases of interest, especially in the North, parts of the Northeast, and Midwest. Indicators "proportion of poverty," "garbage in surroundings," and "families headed by women" increased the chance of higher criticality for the diseases. The indicator "adequate sewer system" was a potential protection factor. Conclusions. The technique used was adequate to guide surveillance actions in the country and allows articulation between local surveillance efforts and other sectors to resolve health problems caused by infectious and parasitic diseases and associated factors.(AU)

RESUMEN Objetivo. Presentar un método para identificar áreas críticas relacionadas con ciertas enfermedades infecciosas y parasitarias con fines de vigilancia sanitaria y analizar su asociación con los indicadores de pobreza en Brasil. Métodos. Se cartografiaron las tasas de incidencia de dengue, enfermedad de Chagas aguda, esquistosomiasis, lepra, hepatitis A, leishmaniasis cutánea, leishmaniasis visceral, leptospirosis, malaria y tuberculosis. Se efectuaron análisis para los años 2010 a 2017 a partir de un indicador de síntesis, calculado como el promedio de los coeficientes de incidencia promedio para cada enfermedad, normalizado por la media y la desviación estándar durante el período analizado. La base de población estimada fue la de 2014. Los coeficientes calculados se estratificaron para clasificar los municipios según presentaran una situación crítica muy alta, alta, media, baja o muy baja para cada enfermedad. Se seleccionaron también indicadores de diferentes dimensiones que expresaran las desigualdades socioeconómicas y la segregación espacial en los municipios brasileños, y se evaluó su asociación con las enfermedades estudiadas. Resultados. El indicador demostró que el 40,5% de los municipios brasileños presentan una situación crítica alta, en especial en las regiones Norte y Centro-oeste y parte del Nordeste. Los indicadores "proporción de pobreza", "basura en los alrededores", "aguas servidas en los alrededores" y "familias encabezadas por mujeres" pueden aumentar la posibilidad de que la localidad presente una situación más crítica para las enfermedades. El indicador "red cloacal adecuada" puede considerarse un potencial factor de protección. Conclusiones. La técnica utilizada fue adecuada para orientar las acciones de vigilancia sanitaria en el país y permite la articulación entre la vigilancia local y otros sectores para evitar los problemas de salud causados por las enfermedades infecciosas y parasitarias y los factores relacionados.(AU)

[Study on infectious diseases in Guizhou during the Republic of China].

There are many infectious diseases in Guizhou Province during the Republican period, including cholera, smallpox, typhoid, typhus, dysentery, scarlet fever, diphtheria, epidemic cerebrospinal meningitis, recurrent fever, malaria, trachoma, acute conjunctivitis, skin diseases, venereal diseases, leprosy and so on. Natural and social factors together led to the prevalence of infectious diseases during that period. For example, natural factors mainly include Guizhou province's special geographical condition and its frequent flood disasters, and social factors such as the unhealthy lifestyle and low medical level have also caused bad effects. In general, infectious diseases during the Republican period have resulted in a large number of mortalities and great financial losses, hindering the development of Guizhou economic society at that time.

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.

Paleopathology of Human Infections: Old Bones, Antique Books, Ancient and Modern Molecules.

Paleopathology studies the traces of disease on human and animal remains from ancient times. Infectious diseases have been, for over a century, one of its main fields of interest. The applications of paleogenetics methods to microbial aDNA, that started in the 90s combined to the recent development of new sequencing techniques allowing 'paleogenomics' approaches, have completely renewed the issue of the infections in the past. These advances open up new challenges in the understanding of the evolution of human-pathogen relationships, integrated in "One Health" concept.In this perspective, an integrative multidisciplinary approach combining data from ancient texts and old bones to those of old molecules is of great interest for reconstructing the past of human infections. Despite some too optimistic prediction of their eradication in the late 20th century, some of these ancient human diseases, such as plague, leprosy or tuberculosis, are still present and continue their evolution at the beginning of this 21rst century. Better know the past to predict a part of the future of human diseases remains, more than ever, the motto of the paleopathological science.

Microbial Genomics of Ancient Plagues and Outbreaks.

The recent use of next-generation sequencing methods to investigate historical disease outbreaks has provided us with an unprecedented ability to address important and long-standing questions in epidemiology, pathogen evolution, and human history. In this review, we present major findings that illustrate how microbial genomics has provided new insights into the nature and etiology of infectious diseases of historical importance, such as plague, tuberculosis, and leprosy. Sequenced isolates collected from archaeological remains also provide evidence for the timing of historical evolutionary events as well as geographic spread of these pathogens. Elucidating the genomic basis of virulence in historical diseases can provide relevant information on how we can effectively understand the emergence and re-emergence of infectious diseases today and in the future.

Ilep: en el camino hacia un mundo sin lepra / No disponible

No disponible

Leprosy: a glossary.

Leprosy continues to afflict residents from a number of countries in Africa, South America, and southeast Asia, despite the marked reduction in the number of cases of leprosy worldwide, after the introduction of the multidrug regimens as recommended by the World Health Organization (WHO-MDT). With the increasing immigration of individuals from risk areas to Europe and the United States, knowledge of the basic concepts of leprosy would be helpful to clinicians caring for immigrants in nonendemic areas. We present a comprehensive, updated, and critical glossary of the most relevant terms related to leprosy.

Clinical aspects of leprosy.

Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. It mainly affects the peripheral nervous system, skin, and certain other tissues such as the reticulo-endothelial system, bones and joints, mucous membranes, eyes, testes, muscles, and adrenals. Leprosy clinical presentation varies from few to widespread lesions. In most patients, early leprosy presents as macular and hypopigmented lesions. This initial clinical presentation is known as indeterminate leprosy and occurs in individuals who have not developed cell-mediated immunity against M. leprae yet. The number of lesions depends on the genetically determined cellular immunity of the patient. Individuals presenting a vigorous cellular immune response and limited humoral immune responses to M. leprae, usually present few skin lesions. Without treatment, those patients tend to evolve into the polar tuberculoid or borderline tuberculoid form of leprosy. Due to the inability to mount an effective cellular-mediated response to M. leprae and the consequent hematogenous spread of the bacilli, some patients may present with numerous and symmetrically distributed hypochromic lesions. Without treatment these patients evolve to a nonresistant form of leprosy, polar lepromatous.

Sex bias in infectious disease epidemiology: patterns and processes.

BACKGROUND: Infectious disease incidence is often male-biased. Two main hypotheses have been proposed to explain this observation. The physiological hypothesis (PH) emphasizes differences in sex hormones and genetic architecture, while the behavioral hypothesis (BH) stresses gender-related differences in exposure. Surprisingly, the population-level predictions of these hypotheses are yet to be thoroughly tested in humans. METHODS AND FINDINGS: For ten major pathogens, we tested PH and BH predictions about incidence and exposure-prevalence patterns. Compulsory-notification records (Brazil, 2006-2009) were used to estimate age-stratified ♂:♀ incidence rate ratios for the general population and across selected sociological contrasts. Exposure-prevalence odds ratios were derived from 82 published surveys. We estimated summary effect-size measures using random-effects models; our analyses encompass ∼0.5 million cases of disease or exposure. We found that, after puberty, disease incidence is male-biased in cutaneous and visceral leishmaniasis, schistosomiasis, pulmonary tuberculosis, leptospirosis, meningococcal meningitis, and hepatitis A. Severe dengue is female-biased, and no clear pattern is evident for typhoid fever. In leprosy, milder tuberculoid forms are female-biased, whereas more severe lepromatous forms are male-biased. For most diseases, male bias emerges also during infancy, when behavior is unbiased but sex steroid levels transiently rise. Behavioral factors likely modulate male-female differences in some diseases (the leishmaniases, tuberculosis, leptospirosis, or schistosomiasis) and age classes; however, average exposure-prevalence is significantly sex-biased only for Schistosoma and Leptospira. CONCLUSIONS: Our results closely match some key PH predictions and contradict some crucial BH predictions, suggesting that gender-specific behavior plays an overall secondary role in generating sex bias. Physiological differences, including the crosstalk between sex hormones and immune effectors, thus emerge as the main candidate drivers of gender differences in infectious disease susceptibility.

[Leprosy, a pillar of human genetics of infectious diseases]. / La lèpre, pilier de la génétique des maladies infectieuses.

Despite a natural reservoir of Mycobacterium leprae limited to humans and free availability of an effective antibiotic treatment, more than 200,000 people develop leprosy each year. This disease remains a major cause of disability and social stigma worldwide. The cause of this constant incidence is currently unknown and indicates that important aspects of the complex relationship between the pathogen and its human host remain to be discovered. An important contribution of host genetics to susceptibility to leprosy has long been suggested to account for the considerable variability between individuals sustainably exposed to M. leprae. Given the inability to cultivate M. leprae in vitro and in the absence of relevant animal model, genetic epidemiology is the main strategy used to identify the genes and, consequently, the immunological pathways involved in protective immunity to M. leprae. Recent genome-wide studies have identified new pathophysiological pathways which importance is only beginning to be understood. In addition, the prism of human genetics placed leprosy at the crossroads of other common diseases such as Crohn's disease, asthma or myocardial infarction. Therefore, novel lights on the pathogenesis of many common diseases could eventually emerge from the detailed understanding of a disease of the shadows.

A qualitative exploration of social contact patterns relevant to airborne infectious diseases in northwest Bangladesh.

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions.

Prevalence of infectious diseases of immigrant workers receiving health examinations at Rajavithi Hospital.

BACKGROUND: There are rapidly increasing numbers of immigrant workers coming for jobs in Thailand. These immigrant workers often harbor some serious communicable diseases. OBJECTIVE: To describe the prevalence of infectious diseases in these immigrant workers. MATERIAL AND METHOD: This is a retrospective study of immigrant workers who presented for check-ups needed for work permits at Rajavithi Hospital during 1 January 2008 to 31 December 2010. They were examined for serious infectious disease including pulmonary TB, elephantiasis, leprosy, syphilis and malaria. Their health status was analyzed. RESULTS: A total of 102,090 immigrant workers were examined. The majority of cases were female (58.4%) and 94.3% of the population was under the age of 40. Workers from Burma constituted the most cases, (78.9%), followed by workers from Laos (14.0%) and Cambodia (7.0%). The prevalence of infectious diseases in all workers was 1,612.3 cases per 100,000 population. Patients with pulmonary TB, elephantiasis, leprosy, syphilis and malaria were 1,112.7, 7.8, 4.9, 465.3 and 21.5 cases per 100,000 population respectively. The prevalence of TB in Burmese, Lao and Cambodian workers was 1,119.3, 885.9 and 1,493.2 cases per 100,000 population respectively. The prevalence of syphilis in Burmese, Lao and Cambodian workers was 467.8, 258.1 and 851.2 cases per 100,000 population respectively. CONCLUSION: Immigrant workers with infectious diseases were 1,612.3 cases per 100,000 population. Those harboring these serious transmitted diseases may be an important factor in these diseases becoming widespread in Thailand.

Continuing challenge of infectious diseases in India.

In India, the range and burden of infectious diseases are enormous. The administrative responsibilities of the health system are shared between the central (federal) and state governments. Control of diseases and outbreaks is the responsibility of the central Ministry of Health, which lacks a formal public health department for this purpose. Tuberculosis, malaria, filariasis, visceral leishmaniasis, leprosy, HIV infection, and childhood cluster of vaccine-preventable diseases are given priority for control through centrally managed vertical programmes. Control of HIV infection and leprosy, but not of tuberculosis, seems to be on track. Early success of malaria control was not sustained, and visceral leishmaniasis prevalence has increased. Inadequate containment of the vector has resulted in recurrent outbreaks of dengue fever and re-emergence of Chikungunya virus disease and typhus fever. Other infectious diseases caused by faecally transmitted pathogens (enteric fevers, cholera, hepatitis A and E viruses) and zoonoses (rabies, leptospirosis, anthrax) are not in the process of being systematically controlled. Big gaps in the surveillance and response system for infectious diseases need to be addressed. Replication of the model of vertical single-disease control for all infectious diseases will not be efficient or viable. India needs to rethink and revise its health policy to broaden the agenda of disease control. A comprehensive review and redesign of the health system is needed urgently to ensure equity and quality in health care. We recommend the creation of a functional public health infrastructure that is shared between central and state governments, with professional leadership and a formally trained public health cadre of personnel who manage an integrated control mechanism of diseases in districts that includes infectious and non-infectious diseases, and injuries.

Infectious diseases of Afghan immigrants in the United States: review of published reports.

Infectious diseases of immigrants may differ from patients born and resident in the same country, especially if immigrants from Africa or Asia live in Europe or North America. Because the available information is limited published reports of infections of Afghan immigrants in the United States and other countries were analysed. Four reports from the US and 15 reports from other countries were identified [7, (46.7%) Pakistan, 5 (33.3%) Iran, 1 (6.7%) United Kingdom, 1 (6.7%) Germany, 1 (6.7%) Israel)]. Reports from the US were case reports or case series of infections with gastro-intestinal parasites and Mycobacterium tuberculosis (1, 25%), Echinococcus species (2, 50%), and Plasmodium vivax (1, 25%). Reports from other countries were case reports, case series, or surveys and investigated infections with Echinococcus species (2, 13%), Hepatitis B virus (HBV) (1, 6.7%), M. tuberculosis (6, 40%), P. falciparum (1, 6.7%), Leishmania tropica (3, 20%), Fasciola hepatica (1, 6.7%), and M. leprae (1, 6.7%). The reports suggest that Echinococcus species and L. tropica infections can be encountered in Afghan immigrants in the US, and the frequency of a positive PPD (purified protein derivative) response or HBsAg test was increased. An infectious diseases database specific for the country of residence readily available to clinicians treating Afghan patients outside of Afghanistan may be useful.