The Potential of Surveillance Data for Dengue Risk Mapping: An Evaluation of Different Approaches in Cuba.

To better guide dengue prevention and control efforts, the use of routinely collected data to develop risk maps is proposed. For this purpose, dengue experts identified indicators representative of entomological, epidemiological and demographic risks, hereafter called components, by using surveillance data aggregated at the level of Consejos Populares (CPs) in two municipalities of Cuba (Santiago de Cuba and Cienfuegos) in the period of 2010-2015. Two vulnerability models (one with equally weighted components and one with data-derived weights using Principal Component Analysis), and three incidence-based risk models were built to construct risk maps. The correlation between the two vulnerability models was high (tau > 0.89). The single-component and multicomponent incidence-based models were also highly correlated (tau ≥ 0.9). However, the agreement between the vulnerability- and the incidence-based risk maps was below 0.6 in the setting with a prolonged history of dengue transmission. This may suggest that an incidence-based approach does not fully reflect the complexity of vulnerability for future transmission. The small difference between single- and multicomponent incidence maps indicates that in a setting with a narrow availability of data, simpler models can be used. Nevertheless, the generalized linear mixed multicomponent model provides information of covariate-adjusted and spatially smoothed relative risks of disease transmission, which can be important for the prospective evaluation of an intervention strategy. In conclusion, caution is needed when interpreting risk maps, as the results vary depending on the importance given to the components involved in disease transmission. The multicomponent vulnerability mapping needs to be prospectively validated based on an intervention trial targeting high-risk areas.

The additional benefit of residual spraying and insecticide-treated curtains for dengue control over current best practice in Cuba: Evaluation of disease incidence in a cluster randomized trial in a low burden setting with intensive routine control.

BACKGROUND: Aedes control interventions are considered the cornerstone of dengue control programmes, but there is scarce evidence on their effect on disease. We set-up a cluster randomized controlled trial in Santiago de Cuba to evaluate the entomological and epidemiological effectiveness of periodical intra- and peri-domiciliary residual insecticide (deltamethrin) treatment (RIT) and long lasting insecticide treated curtains (ITC). METHODOLOGY/PRINCIPAL FINDINGS: Sixty three clusters (around 250 households each) were randomly allocated to two intervention (RIT and ITC) and one control arm. Routine Aedes control activities (entomological surveillance, source reduction, selective adulticiding, health education) were applied in the whole study area. The outcome measures were clinical dengue case incidence and immature Aedes infestation. Effectiveness of tools was evaluated using a generalized linear regression model with a negative binomial link function. Despite significant reduction in Aedes indices (Rate Ratio (RR) 0.54 (95%CI 0.32-0.89) in the first month after RIT, the effect faded out over time and dengue incidence was not reduced. Overall, in this setting there was no protective effect of RIT or ITC over routine in the 17months intervention period, with for house index RR of 1.16 (95%CI 0.96-1.40) and 1.25 (95%CI 1.03-1.50) and for dengue incidence RR of 1.43 (95%CI 1.08-1.90) and 0.96 (95%CI 0.72-1.28) respectively. The monthly dengue incidence rate (IR) at cluster level was best explained by epidemic periods (Incidence Rate Ratio (IRR) 5.50 (95%CI 4.14-7.31)), the IR in bordering houseblocks (IRR 1.03 (95%CI 1.02-1.04)) and the IR pre-intervention (IRR 1.02 (95%CI 1.00-1.04)). CONCLUSIONS: Adding RIT to an intensive routine Aedes control programme has a transient effect on the already moderate low entomological infestation levels, while ITC did not have any effect. For both interventions, we didn't evidence impact on disease incidence. Further studies are needed to evaluate impact in settings with high Aedes infestation and arbovirus case load.

Polineuropatía en una persona viviendo con vih - sida / Polyneuropathy in a person living with HIV - AIDS

Se expone el caso clínico de un paciente de 31 años de edad, con virus de inmunodeficiencia humana desde hacía 4 años, que había comenzado a presentar fiebre de 39° C , dolor lumbar, calambre con dificultad para la marcha y sepsis urinaria. Los exámenes realizados confirmaron una lesión axonomielínica en fibras sensitivas dístales bilaterales, atribuibles a una polineuropatía axonal desmielinizante subaguda sensitiva. Se administraron 43 g/L de ozono por vía rectal en 20 sesiones, al término de las cuales disminuyó el dolor, desapareció la parestesia y mejoró la marcha, lo cual corroboró la efectividad del ozono como potente inmunomodulador y antimicrobiano, particularmente en el tratamiento de la mencionada enfermedad(AU)

The clinical case of a 31 year-old patient with human immunodeficiency virus for 4 years is reported, who had begun to present with fever of 39°C, lumbar pain, cramps with difficulty for walking and urinary sepsis. Examinations confirmed an axonomyelinic lesion in bilateral distal sensitive fibers attributable to a subacute sensitive demyelinating axonal polyneuropathy. 43 g/L ozone was administered via the rectal route in 20 sessions, at the end of which pain was relieved, paresthesia disappeared and walking improved, thus proving the effectiveness of the ozone as a strong immunomodulator and antimicrobial, particularly in the treatment of this condition(AU)

Polineuropatía en una persona viviendo con vih - sida / Polyneuropathy in a person living with HIV - AIDS

Se expone el caso clínico de un paciente de 31 años de edad, con virus de inmunodeficiencia humana desde hacía 4 años, que había comenzado a presentar fiebre de 39°C, dolor lumbar, calambre con dificultad para la marcha y sepsis urinaria. Los exámenes realizados confirmaron una lesión axonomielínica en fibras sensitivas dístales bilaterales, atribuibles a una polineuropatía axonal desmielinizante subaguda sensitiva. Se administraron 43 g/L de ozono por vía rectal en 20 sesiones, al término de las cuales disminuyó el dolor, desapareció la parestesia y mejoró la marcha, lo cual corroboró la efectividad del ozono como potente inmunomodulador y antimicrobiano, particularmente en el tratamiento de la mencionada enfermedad.

The clinical case of a 31 year-old patient with human immunodeficiency virus for 4 years is reported, who had begun to present with fever of 39°C, lumbar pain, cramps with difficulty for walking and urinary sepsis. Examinations confirmed an axonomyelinic lesion in bilateral distal sensitive fibers attributable to a subacute sensitive demyelinating axonal polyneuropathy. 43 g/L ozone was administered via the rectal route in 20 sessions, at the end of which pain was relieved, paresthesia disappeared and walking improved, thus proving the effectiveness of the ozone as a strong immunomodulator and antimicrobial, particularly in the treatment of this condition.