Control of paratuberculosis: who, why and how. A review of 48 countries.

Paratuberculosis, a chronic disease affecting ruminant livestock, is caused by Mycobacterium avium subsp. paratuberculosis (MAP). It has direct and indirect economic costs, impacts animal welfare and arouses public health concerns. In a survey of 48 countries we found paratuberculosis to be very common in livestock. In about half the countries more than 20% of herds and flocks were infected with MAP. Most countries had large ruminant populations (millions), several types of farmed ruminants, multiple husbandry systems and tens of thousands of individual farms, creating challenges for disease control. In addition, numerous species of free-living wildlife were infected. Paratuberculosis was notifiable in most countries, but formal control programs were present in only 22 countries. Generally, these were the more highly developed countries with advanced veterinary services. Of the countries without a formal control program for paratuberculosis, 76% were in South and Central America, Asia and Africa while 20% were in Europe. Control programs were justified most commonly on animal health grounds, but protecting market access and public health were other factors. Prevalence reduction was the major objective in most countries, but Norway and Sweden aimed to eradicate the disease, so surveillance and response were their major objectives. Government funding was involved in about two thirds of countries, but operations tended to be funded by farmers and their organizations and not by government alone. The majority of countries (60%) had voluntary control programs. Generally, programs were supported by incentives for joining, financial compensation and/or penalties for non-participation. Performance indicators, structure, leadership, practices and tools used in control programs are also presented. Securing funding for long-term control activities was a widespread problem. Control programs were reported to be successful in 16 (73%) of the 22 countries. Recommendations are made for future control programs, including a primary goal of establishing an international code for paratuberculosis, leading to universal acknowledgment of the principles and methods of control in relation to endemic and transboundary disease. An holistic approach across all ruminant livestock industries and long-term commitment is required for control of paratuberculosis.

A survey to assess the extent of public-private mix DOTS in the management of tuberculosis in Zambia.

BACKGROUND: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates. AIM: We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB. SETTING: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. METHODS: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities. RESULTS: Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications. CONCLUSION: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS).

[Foodborne illness report systems in China].

OBJECTIVE: To introduce the current foodborne illness report system in China. METHODS: Foodborne illness (food poisoning included) report system and food related unusual cases reported system were characterized by their report definitions, scopes and report procedures as well as their differences. RESULTS: From October, 2010 to June, 2012, there are 2961 centers of disease control and prevention and heath executive organizations at the different local levels registered in the foodborne illness (food poisoning included) report system and 1525 incidents were reported. There were 553 hospitals registered in the food related unusual cases reported system while only 38 cases reported. CONCLUSION: The foodborne illness report system has been set up in China and further efforts in capacities building are needed.

Genital chlamydia in southern New South Wales: an ecological analysis of testing and notification patterns 2004-2008.

OBJECTIVE: To identify demographic patterns for chlamydia testing rates on reported general practice (GP) visits and notification rates in residents of Greater Southern Area Health Service (GSAHS) for the period 2004-2008. DESIGN: Descriptive analysis of presentation and chlamydia-specific Medicare data and chlamydia notifications made to GSAHS Public Health Unit. SETTING: Rural and remote southern New South Wales. PARTICIPANTS: Residents of GSAHS who had a Medicare recorded visit to a GP and chlamydia pathology collected in the period July 2004 to June 2008, and those residents notified to the GSAHS Public Health Unit with a positive chlamydia test results. MAIN OUTCOME MEASURES: Age and gender trends for GP visits, chlamydia testing and chlamydia notifications. RESULTS: While chlamydia testing and notification rates increased over the review period, the percentage of chlamydia tests performed remained low. There was a greater increase in testing rates among women than men, and the highest were among women aged 15-24. Chlamydia notification rates increased across all age groups and were greater in women aged 15-24 than men of the same age group. CONCLUSION: The low proportion of tests performed to presentations (in conjunction with the high proportion of notifications to tests performed) reflects that chlamydia testing among providers is still being undertaken in a targeted approach rather than from a population-focused screening perspective. Further work with GPs is required to improve chlamydia screening rates, and ensure practice is consistent with national guidelines.

Under-reporting of HIV infection among cohorts of TB patients in the WHO European Region, 2003-2004.

SETTING: The World Health Organization (WHO) European Region, which includes 52 countries. OBJECTIVE: To assess an epidemiological data collection tool implemented in 2004 for recording human immunodeficiency virus (HIV) status among tuberculosis (TB) patients. DESIGN: Based on WHO estimates, the reported number of TB patients with HIV was compared with the number expected. The analysis included all forms of TB and was restricted to adults, wherever possible. The numbers of TB patients detected from HIV/acquired immune-deficiency syndrome (AIDS) programmes (NAPs) were also assessed. RESULTS: In 2003, 20 (38%) National TB Programmes (NTPs) reported 4602 (35%) HIV-infected TB cases of 13117 expected; in 2004, 23 (44%) NTPs reported 5902 (42%) cases of 13901 expected. In 2003, 47 (90%) NAPs reported 3575 (27%) TB cases as a new AIDS diagnosis, while in 2004, 40 (77%) NAPs reported 3901 (28%) TB cases. Those countries that did report, reported on average 60-65% of expected cases, irrespective of the kind of programme and the year. CONCLUSION: Most NTPs did not report TB cases with HIV infection. Overall, the number of cases reported in countries that reported data from either NTPs or NAPs was significantly lower than expected. Improved surveillance requires concerted efforts from both NTPs and NAPs.