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1.
Infect Dis Poverty ; 9(1): 12, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32114979

RESUMEN

BACKGROUND: Around 2007, a nodding syndrome (NS) epidemic appeared in onchocerciasis-endemic districts of northern Uganda, where ivermectin mass distribution had never been implemented. This study evaluated the effect of community-directed treatment with ivermectin (CDTI) and ground larviciding of rivers initiated after 2009 and 2012 respectively, on the epidemiology of NS and other forms of epilepsy (OFE) in some districts of northern Uganda. METHODS: In 2012, a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts. In August 2017, we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data. In addition, two villages in Moyo district (where CDTI was ongoing since 1993) served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented. The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95% level of significance. RESULTS: A total of 2138 individuals in 390 households were interviewed. In the selected villages of Kitgum and Pader, there was no significant decrease in prevalence of NS and OFE between 2012 and 2017. However, the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100 000 persons per year (P = 0.002); that of NS decreased from 490 to 43 per 100 000 persons per year (P = 0.037); and for OFE from 675 to 87 per 100 000 persons per year (P = 0.024). The median age of affected persons (NS and OFE) shifted from 13.5 (IQR: 11.0-15.0) years in 2012 to 18.0 (IQR: 15.0-20.3) years in 2017; P <  0.001. The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%, similar to 4.5% in Kitgum and Pader. CONCLUSIONS: Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy, and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.


Asunto(s)
Epilepsia/epidemiología , Síndrome del Cabeceo/epidemiología , Oncocercosis/prevención & control , Adolescente , Animales , Antiparasitarios/uso terapéutico , Niño , Enfermedades Endémicas , Epilepsia/parasitología , Femenino , Humanos , Incidencia , Ivermectina/uso terapéutico , Masculino , Síndrome del Cabeceo/parasitología , Onchocerca volvulus , Oncocercosis/complicaciones , Oncocercosis/epidemiología , Prevalencia , Uganda/epidemiología , Adulto Joven
2.
Infect Dis Poverty ; 9(1): 26, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32160927

RESUMEN

BACKGROUND: Yaws is a chronic relapsing disease caused by Treponema pallidum subspecies pertunue, which can result in severe disability and deformities. Children below the age of 15 years in resource-poor communities are the most affected. Several non-specific factors facilitate the continuous transmission and resurgence of the disease. Endemic communities in rural Ghana continue to report cases despite the roll out of several intervention strategies in the past years. The objective of this study was to determine the factors associated with cutaneous ulcers among children in two yaws-endemic districts in Ghana. METHODS: A community-based unmatched 1:2 case-control study was conducted among children between 1 and 15 years. Data on socio-demographic, environmental and behavioral factors were collected using a structured questionnaire. Active case search and confirmation was done using the Dual Path Platform (DPP) Syphilis Screen and Confirm test kit. Data were analyzed using STATA 15. Logistic regression was done to determine the exposures that were associated with yaws infection at 0.05 significant level. RESULTS: Sixty-two cases and 124 controls were recruited for the study. The adjusted multivariable logistic regression model showed that yaws infection was more likely among individuals who reside in overcrowded compound houses (aOR = 25.42, 95% CI: 6.15-105.09) and with poor handwashing habits (aOR = 6.46, 95% CI: 1.89-22.04). Male (aOR = 4.15, 95% CI: 1.29-13.36) and increasing age (aOR = 5.90, 95% CI: 1.97-17.67) were also associated with yaws infection. CONCLUSIONS: Poor personal hygiene, overcrowding and lack of access to improved sanitary facilities are the factors that facilitate the transmission of yaws in the Awutu Senya West and Upper West Akyem districts. Yaws was also more common among males and school-aged children. Improving living conditions, access to good sanitary facilities and encouraging good personal hygiene practices should be core features of eradication programs in endemic communities.


Asunto(s)
Población Rural , Úlcera Cutánea/microbiología , Treponema pallidum/aislamiento & purificación , Buba , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Aglomeración , Enfermedades Endémicas , Femenino , Ghana/epidemiología , Humanos , Higiene , Lactante , Masculino , Vigilancia de la Población , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/epidemiología , Encuestas y Cuestionarios , Serodiagnóstico de la Sífilis , Buba/diagnóstico , Buba/epidemiología , Buba/prevención & control , Buba/transmisión
3.
Rev Bras Epidemiol ; 23: e200019, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159629

RESUMEN

OBJECTIVE: To characterize spatiotemporal patterns of operational indicators for leprosy control in the state of Bahia from 2001 to 2014. METHODS: This is a population-based ecological study, with spatial distribution and autocorrelation of operational indicators for leprosy control. RESULTS: From 2001 to 2007, 42.7% (n=178) of the municipalities presented a cure rate lower than 75%, increasing to 61.4% (n =291) from 2009 to 2014. Between 2001 and 2007, 32.5% (n=54) of the municipalities reported more than 10% of the total number of relapses in the state, increasing to 36.9% (n=75) between 2008 and 2014. From 2001 to 2014, 38% (n=159) of the municipalities presented an assessment index of disability grading at the time of diagnosis within the regular performance parameter. Between 2009 and 2014, the number of municipalities with a high incidence of grade 2 disability (G2D) at the time of diagnosis increased, reaching 55.3% (n=230) of the municipalities. Most municipalities in the state of Bahia showed poor performance in the implementation of planned actions for leprosy control, with little change or relative worsening in the patterns of operational indicators throughout the historical series. CONCLUSION: The operational context in Bahia indicates significant institutional vulnerability, leading to the need for expansion and qualification of the surveillance and health care network in the different regions and conditions analyzed in the public health system (Sistema Único de Saúde - SUS).


Asunto(s)
Personas con Discapacidad , Enfermedades Endémicas/estadística & datos numéricos , Lepra/prevención & control , Brasil/epidemiología , Ciudades , Estudios de Cohortes , Evaluación de la Discapacidad , Humanos , Incidencia , Lepra/epidemiología , Vigilancia de la Población , Características de la Residencia , Factores de Riesgo , Análisis Espacio-Temporal
4.
Exp Parasitol ; 210: 107847, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32004535

RESUMEN

Leishmaniasis is an infectious disease that has high endemicity and is among the six parasitic diseases of higher occurrence in the world. The current treatments are limited due to their toxicity, treatment resistance and high cost which have increased the search for new substances of natural origin for its therapy. Based on this, an in vitro biological and chemical investigation was carried out to evaluate the potential of Piper marginatum against Leishmania amazonesis. P. marginatum leaves were collected to obtain the essential oil (EO) and the ethanolic extract (CE). The chemical profile of the CE and fractions was obtained by 1H NMR. The analysis of the EO chemical composition was performed by GC-MS. EO, CE and fractions were submitted to antileishmanial and cytotoxicity assays against macrophages. The chromatographic profiles of EO, CE and fractions showed the presence of phenolic compounds and terpenoids, having 3,4-Methylenedioxypropiophenone as a major compound. All P. marginatum samples showed low toxicity to macrophages. The CE and the methanolic, hexane and ethyl acetate fractions had low cytotoxicity when compared to Pentamidine. All tested samples inhibited growth of L. amazonensis promastigotes. The antileishmanial activity of EO, CE and fractions were evaluated in macrophages infected with L. (L.) amazonensis and treated with the concentrations 1, 10 and 100 µg/mL for 48 h. All samples were active, but EO and CE showed superior activity against amastigote forms when compared to the promastigote forms of L. amazonensis. This work describes for the first time the antileishmanial activity of the species P. marginatum and its cytotoxicity against macrophages, suggesting that it can be an alternative source of natural products in the phytotherapeutic treatment of leishmaniasis.


Asunto(s)
Leishmania mexicana/efectos de los fármacos , Leishmaniasis Cutánea/tratamiento farmacológico , Aceites Volátiles/farmacología , Piper/química , Extractos Vegetales/farmacología , Animales , Brasil/epidemiología , Enfermedades Endémicas , Cromatografía de Gases y Espectrometría de Masas , Concentración 50 Inhibidora , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Cutánea/parasitología , Macrófagos/efectos de los fármacos , Macrófagos/parasitología , Espectroscopía de Resonancia Magnética , Ratones , Ratones Endogámicos BALB C , Enfermedades Desatendidas/tratamiento farmacológico , Enfermedades Desatendidas/epidemiología , Enfermedades Desatendidas/parasitología , Aceites Volátiles/química , Aceites Volátiles/aislamiento & purificación , Extractos Vegetales/química , Extractos Vegetales/aislamiento & purificación , Hojas de la Planta/química , Aceites Vegetales/química , Aceites Vegetales/aislamiento & purificación , Aceites Vegetales/farmacología
5.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-46937

RESUMEN

Folder que contém informações sobre a doença e as formas de prevenção, atendimento e orientações à saúde do viajante e da população que vivem nas áreas endêmicas.


Asunto(s)
Malaria , Salud del Viajero , Prevención de Enfermedades , Enfermedades Endémicas
6.
Am J Forensic Med Pathol ; 41(1): 48-51, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31977345

RESUMEN

Chikungunya is a mosquito-transmitted viral illness with clinical hallmarks of rash, fever, arthralgia, and myalgia. It is rarely fatal, although vulnerable populations, to include elderly, children, and those with multiple comorbid illnesses, are more susceptible to severe infection and death. There have been multiple areas of the world with periodic chikungunya epidemics. With increased immigration, foreign travel, epidemics, and global spread of the virus, it is prudent to consider chikungunya as a diagnosis both clinically and postmortem when a patient presents with rash, fevers, and arthralgia. We present a case of a patient with recent foreign travel, a rash, fever, and arthralgia with mosquito bites who succumbed to chikungunya viral infection with pneumonia. His diagnosis was established postmortem. A review of the literature is included in this report. This case stresses the delayed time to diagnose chikungunya with serologic testing and the importance of using reverse transcriptase-polymerase chain reaction to aid in rapid and accurate diagnosis and management.


Asunto(s)
Fiebre Chikungunya/diagnóstico , Enfermedad Relacionada con los Viajes , Artralgia/virología , Virus Chikungunya/genética , El Salvador , Enfermedades Endémicas , Exantema/patología , Exantema/virología , Patologia Forense , Humanos , Los Angeles , Pulmón/patología , Masculino , Persona de Mediana Edad , Neumonía Viral/etiología , Reacción en Cadena de la Polimerasa , Edema Pulmonar/patología , Edema Pulmonar/virología
7.
Rev Bras Parasitol Vet ; 28(4): 671-676, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800889

RESUMEN

Ticks of the Amblyomma cajennense complex present high infestation rates. These ticks transmit the bacterium Rickettsia rickettsii, which causes Brazilian Spotted Fever. For this reason, an integrated tick control system was adopted on a farm in the municipality of Itu, state of São Paulo. On this farm, which borders the Tietê river, domestic animals are in contact with populations of capybaras. Six locations were monitored and evaluated between the years of 2015 and 2017. During this work 1271 nymphs and adult ticks were caught, all of them from the Amblyomma sculptum species, except for a single individual from the Amblyomma dubitatum species. The integrated tick management reduced the overall infestation levels to zero. Adult tick population dropped in the first year of the study, while larvae population dropped in the second year. Nymph population dropped in both years, decreasing in higher numbers in the first year. The estimated mean infestation levels for all of the tick's life cycle forms in the six monitored spots did not reach one individual in the end of the study. Estimated mean infestation levels for nymphs in these places equaled zero.


Asunto(s)
Caballos/parasitología , Ixodidae/microbiología , Roedores/parasitología , Control de Ácaros y Garrapatas/métodos , Animales , Brasil , Enfermedades Endémicas , Granjas , Fiebre Maculosa de las Montañas Rocosas/transmisión , Población Rural
8.
N Engl J Med ; 381(23): 2209-2218, 2019 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-31800986

RESUMEN

BACKGROUND: Salmonella Typhi is a major cause of fever in children in low- and middle-income countries. A typhoid conjugate vaccine (TCV) that was recently prequalified by the World Health Organization was shown to be efficacious in a human challenge model, but data from efficacy trials in areas where typhoid is endemic are lacking. METHODS: In this phase 3, randomized, controlled trial in Lalitpur, Nepal, in which both the participants and observers were unaware of the trial-group assignments, we randomly assigned children who were between 9 months and 16 years of age, in a 1:1 ratio, to receive either a TCV or a capsular group A meningococcal conjugate vaccine (MenA) as a control. The primary outcome was typhoid fever confirmed by blood culture. We present the prespecified analysis of the primary and main secondary outcomes (including an immunogenicity subgroup); the 2-year trial follow-up is ongoing. RESULTS: A total of 10,005 participants received the TCV and 10,014 received the MenA vaccine. Blood culture-confirmed typhoid fever occurred in 7 participants who received TCV (79 cases per 100,000 person-years) and in 38 who received MenA vaccine (428 cases per 100,000 person-years) (vaccine efficacy, 81.6%; 95% confidence interval, 58.8 to 91.8; P<0.001). A total of 132 serious adverse events (61 in the TCV group and 71 in the MenA vaccine group) occurred in the first 6 months, and 1 event (pyrexia) was identified as being vaccine-related; the participant remained unaware of the trial-group assignment. Similar rates of adverse events were noted in the two trial groups; fever developed in 5.0% of participants in the TCV group and 5.4% in the MenA vaccine group in the first week after vaccination. In the immunogenicity subgroup, seroconversion (a Vi IgG level that at least quadrupled 28 days after vaccination) was 99% in the TCV group (677 of 683 participants) and 2% in the MenA vaccine group (8 of 380 participants). CONCLUSIONS: A single dose of TCV was immunogenic and effective in reducing S. Typhi bacteremia in children 9 months to 16 years of age. (Funded by the Bill and Melinda Gates Foundation; Current Controlled Trials number, ISRCTN43385161.).


Asunto(s)
Salmonella typhi/aislamiento & purificación , Fiebre Tifoidea/prevención & control , Vacunas Tifoides-Paratifoides/inmunología , Vacunas Conjugadas/inmunología , Adolescente , Niño , Preescolar , Método Doble Ciego , Enfermedades Endémicas/prevención & control , Femenino , Humanos , Incidencia , Lactante , Estimación de Kaplan-Meier , Masculino , Vacunas Meningococicas/efectos adversos , Vacunas Meningococicas/inmunología , Nepal/epidemiología , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/epidemiología , Vacunas Tifoides-Paratifoides/efectos adversos , Vacunas Conjugadas/efectos adversos
9.
PLoS Med ; 16(12): e1002992, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31834890

RESUMEN

BACKGROUND: To reduce the risk of drug-induced haemolysis, all patients should be tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDd) prior to prescribing primaquine (PQ)-based radical cure for the treatment of vivax malaria. This systematic review and individual patient meta-analysis assessed the utility of a qualitative lateral flow assay from Access Bio/CareStart (Somerset, NJ) (CareStart Screening test for G6PD deficiency) for the diagnosis of G6PDd compared to the gold standard spectrophotometry (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42019110994). METHODS AND FINDINGS: Articles published on PubMed between 1 January 2011 and 27 September 2019 were screened. Articles reporting performance of the standard CSG from venous or capillary blood samples collected prospectively and considering spectrophotometry as gold standard (using kits from Trinity Biotech PLC, Wicklow, Ireland) were included. Authors of articles fulfilling the inclusion criteria were contacted to contribute anonymized individual data. Minimal data requested were sex of the participant, CSG result, spectrophotometry result in U/gHb, and haemoglobin (Hb) reading. The adjusted male median (AMM) was calculated per site and defined as 100% G6PD activity. G6PDd was defined as an enzyme activity of less than 30%. Pooled estimates for sensitivity and specificity, unconditional negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated comparing CSG results to spectrophotometry using a random-effects bivariate model. Of 11 eligible published articles, individual data were available from 8 studies, 6 from Southeast Asia, 1 from Africa, and 1 from the Americas. A total of 5,815 individual participant data (IPD) were available, of which 5,777 results (99.3%) were considered for analysis, including data from 3,095 (53.6%) females. Overall, the CSG had a pooled sensitivity of 0.96 (95% CI 0.90-0.99) and a specificity of 0.95 (95% CI 0.92-0.96). When the prevalence of G6PDd was varied from 5% to 30%, the unconditional NPV was 0.99 (95% CI 0.94-1.00), with an LR+ and an LR- of 18.23 (95% CI 13.04-25.48) and 0.05 (95% CI 0.02-0.12), respectively. Performance was significantly better in males compared to females (p = 0.027) but did not differ significantly between samples collected from capillary or venous blood (p = 0.547). Limitations of the study include the lack of wide geographical representation of the included data and that the CSG results were generated under research conditions, and therefore may not reflect performance in routine settings. CONCLUSIONS: The CSG performed well at the 30% threshold. Its high NPV suggests that the test is suitable to guide PQ treatment, and the high LR+ and low LR- render the test suitable to confirm and exclude G6PDd. Further operational studies are needed to confirm the utility of the test in remote endemic settings.


Asunto(s)
Pruebas Diagnósticas de Rutina , Deficiencia de Glucosafosfato Deshidrogenasa/diagnóstico , Glucosafosfato Deshidrogenasa/genética , Primaquina/uso terapéutico , Pruebas Diagnósticas de Rutina/métodos , Enfermedades Endémicas , Femenino , Deficiencia de Glucosafosfato Deshidrogenasa/tratamiento farmacológico , Humanos , Malaria/tratamiento farmacológico , Malaria/epidemiología , Malaria Vivax/epidemiología , Masculino , Sistemas de Atención de Punto , Primaquina/efectos adversos , Sensibilidad y Especificidad
10.
Artículo en Inglés | MEDLINE | ID: mdl-31859842

RESUMEN

Hantavirus Cardiopulmonary Syndrome (HCPS) is an important emergent zoonosis associated with wild rodents in Brazil, where this viral infection in children is generally rare. We present HCPS in a child from the Pantanal Biome and a review of all reported pediatric cases in Mato Grosso State, an endemic area for HCPS in Brazil. The investigation used the Information System for Notifiable Diseases database (SINAN). A 12-year-old boy was hospitalized with fever and respiratory failure and hantavirus IgM and IgG antibodies were detected by ELISA in serum samples. During the period of 1999 to 2016, 32 HCPS pediatric cases confirmed by serology were reported to SINAN with a mortality rate of 34.4%. The possibility of hantavirus infection in children with acute febrile illness associated with respiratory failure should be considered mainly in recognized endemic areas as Mato Grosso State, contradicting a hypothesis that children are more protected from lung involvement.


Asunto(s)
Anticuerpos Antivirales/sangre , Síndrome Pulmonar por Hantavirus/epidemiología , Adolescente , Brasil/epidemiología , Niño , Enfermedades Endémicas , Ensayo de Inmunoadsorción Enzimática , Femenino , Síndrome Pulmonar por Hantavirus/diagnóstico , Humanos , Inmunoglobulina G/sangre , Masculino , Factores de Riesgo , Estudios Seroepidemiológicos
11.
N Engl J Med ; 381(26): 2519-2528, 2019 12 26.
Artículo en Inglés | MEDLINE | ID: mdl-31881138

RESUMEN

BACKGROUND: With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically. METHODS: We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection. RESULTS: All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings. CONCLUSIONS: These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.).


Asunto(s)
Control de Enfermedades Transmisibles , Esquistosomiasis Urinaria/prevención & control , Esquistosomiasis mansoni/prevención & control , África del Sur del Sahara/epidemiología , Animales , Antihelmínticos/uso terapéutico , Niño , Estudios Transversales , Enfermedades Endémicas/prevención & control , Humanos , Objetivos Organizacionales , Prevalencia , Schistosoma haematobium/aislamiento & purificación , Schistosoma mansoni/aislamiento & purificación , Esquistosomiasis Urinaria/tratamiento farmacológico , Esquistosomiasis Urinaria/epidemiología , Esquistosomiasis mansoni/tratamiento farmacológico , Esquistosomiasis mansoni/epidemiología , Organización Mundial de la Salud , Yemen/epidemiología
12.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud, LIS-bvsms | ID: lis-LISBR1.1-46895

RESUMEN

Risco de transmissão se restringe a terra indígena Yanomami na divisa com a Venezuela. Ações apoiadas pela Secretaria Especial de Saúde Indígena foram fundamentais no combate à doença.


Asunto(s)
Oncocercosis , Oncocercosis Ocular , Enfermedades Parasitarias , Simuliidae , Enfermedades Endémicas , Medicina Tropical
13.
N Engl J Med ; 381(21): 2009-2019, 2019 11 21.
Artículo en Inglés | MEDLINE | ID: mdl-31693803

RESUMEN

BACKGROUND: Dengue, a mosquito-borne viral disease, was designated a World Health Organization top 10 threat to global health in 2019. METHODS: We present primary efficacy data from part 1 of an ongoing phase 3 randomized trial of a tetravalent dengue vaccine candidate (TAK-003) in regions of Asia and Latin America in which the disease is endemic. Healthy children and adolescents 4 to 16 years of age were randomly assigned in a 2:1 ratio (stratified according to age category and region) to receive two doses of vaccine or placebo 3 months apart. Participants presenting with febrile illness were tested for virologically confirmed dengue by serotype-specific reverse-transcriptase polymerase chain reaction. The primary end point was overall vaccine efficacy in preventing virologically confirmed dengue caused by any dengue virus serotype. RESULTS: Of the 20,071 participants who were given at least one dose of vaccine or placebo (safety population), 19,021 (94.8%) received both injections and were included in the per-protocol analysis. The overall vaccine efficacy in the safety population was 80.9% (95% confidence interval [CI], 75.2 to 85.3; 78 cases per 13,380 [0.5 per 100 person-years] in the vaccine group vs. 199 cases per 6687 [2.5 per 100 person-years] in the placebo group). In the per-protocol analyses, vaccine efficacy was 80.2% (95% CI, 73.3 to 85.3; 61 cases of virologically confirmed dengue in the vaccine group vs. 149 cases in the placebo group), with 95.4% efficacy against dengue leading to hospitalization (95% CI, 88.4 to 98.2; 5 hospitalizations in the vaccine group vs. 53 hospitalizations in the placebo group). Planned exploratory analyses involving the 27.7% of the per-protocol population that was seronegative at baseline showed vaccine efficacy of 74.9% (95% CI, 57.0 to 85.4; 20 cases of virologically confirmed dengue in the vaccine group vs. 39 cases in the placebo group). Efficacy trends varied according to serotype. The incidence of serious adverse events was similar in the vaccine group and placebo group (3.1% and 3.8%, respectively). CONCLUSIONS: TAK-003 was efficacious against symptomatic dengue in countries in which the disease is endemic. (Funded by Takeda Vaccines; TIDES ClinicalTrials.gov number, NCT02747927.).


Asunto(s)
Vacunas contra el Dengue/inmunología , Virus del Dengue/inmunología , Dengue/prevención & control , Enfermedades Endémicas/prevención & control , Adolescente , Américas/epidemiología , Anticuerpos Neutralizantes/sangre , Anticuerpos Antivirales/sangre , Asia/epidemiología , Niño , Preescolar , Dengue/epidemiología , Dengue/inmunología , Vacunas contra el Dengue/efectos adversos , Virus del Dengue/aislamiento & purificación , Método Doble Ciego , Femenino , Humanos , Incidencia , Masculino , Serogrupo , Resultado del Tratamiento
14.
BMC Public Health ; 19(1): 1456, 2019 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-31694595

RESUMEN

BACKGROUND: Pesticides remain the mainstay for the control of agricultural pests and disease vectors. However, their indiscriminate use in agriculture has led to development of resistance to both crop pests and disease vectors. This threatens to undermine the success gained through the implementation of chemical based vector control programs. We investigated the practices of farmers with regard to pesticide usage in the vegetable growing areas and their impact on susceptibility status of An. gambiae s.l. METHODS: A stratified multistage sampling technique using the administrative structure of the Tanzanian districts as sampling frame was used. Wards, villages and then participants with farms where pesticides are applied were purposively recruited at different stages of the process, 100 participants were enrolled in the study. The same villages were used for mosquito larvae sampling from the farms and the surveys were complimented by the entomological study. Larvae were reared in the insectary and the emerging 2-3 days old female adults of Anopheles gambiae s.l were subjected to susceptibility test. RESULTS: Forty eight pesticides of different formulations were used for control of crop and Livestock pests. Pyrethroids were the mostly used class of pesticides (50%) while organophosphates and carbamates were of secondary importance. Over 80% of all farmers applied pesticides in mixed form. Susceptibility test results confirmed high phenotypic resistance among An. gambiae populations against DDT and the pyrethroids (Permethrin-0.75%, Cyfluthrin-0.15%, Deltametrin-0.05% and Lambdacyhalothrin-0.05%) with mortality rates 54, 61, 76 and 71%, respectively. Molecular analysis showed An. arabiensis as a dominant species (86%) while An. gambiae s.s constituted only 6%. The kdr genes were not detected in all of the specimens that survived insecticide exposures. CONCLUSION: The study found out that there is a common use of pyrethroids in farms, Livestocks as well as in public health. The study also reports high phenotypic resistance among An. gambiae s.l against most of the pyrethroids tested. The preponderance of pyrethroids in agriculture is of public health concern because this is the class of insecticides widely used in vector control programs and this calls for combined integrated pest and vector management (IPVM).


Asunto(s)
Agricultura/estadística & datos numéricos , Enfermedades Endémicas/prevención & control , Resistencia a los Insecticidas , Insecticidas/farmacología , Malaria/prevención & control , Mosquitos Vectores/efectos de los fármacos , Animales , Anopheles/efectos de los fármacos , Agricultores/estadística & datos numéricos , Humanos , Larva/efectos de los fármacos , Malaria/epidemiología , Tanzanía/epidemiología
15.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 519-521, 2019 Oct 14.
Artículo en Chino | MEDLINE | ID: mdl-31713383

RESUMEN

OBJECTIVE: To understand the epidemic trend of schistosomiasis in China from 2010 to 2017 so as to provide the scientific evidence for schistosomiasis elimination. METHODS: The information of schistosomiasis control nationwide from 2010 to 2017 was collected, including the endemic of population, status of livestock control, and Oncomelania hupensis snail control. Microsoft Excel was applied for datum management and analysis. RESULTS: From 2010 to 2017, the epidemic of schistosomiasis in China dropped significantly. The decreasing amplitude of estimated number of patients nationwide was 88.46%. Seventy-one acute schistosomiasis patients were reported and 12.68% (9/71) of them were imported. The decreasing rate of cultivated cattle was 50.09%, and the accumulative number of schistosome-infected cattle was 17 239, and the average positive rate of stool examinations decreased from 1.04% to 0.000 22%. The area with snails nationwide was 373 596.18 to 363 068.95 hm2, and the new detected area with snails was 46.71 to 1 346.73 hm2. The area with schistosome-infected snails was 171.68 hm2 in 2012 and it was 9.25 hm2 in 2013. In 72 key monitoring points of 7 endemic provinces, there were 17 schistosome positive points of water body in 2010 and 6 points in 2016. There were some high risk-factors related to schistosomiasis transmission including schisto-some-infected cattle, dogs, and field rats, and the field stools, and the pasture in the area with snails in schistosomiasis monitoring points. CONCLUSIONS: The endemic status of schistosomiasis in China has dropped significantly, and the transmission level is very low. However, the infectious source and risk factors in the endemic environments have not be eliminated. Therefore, the infectious source control, health education, snail control, and transmission monitoring should be strengthened, so as to promote the progress of schistosomiasis elimination.


Asunto(s)
Enfermedades Endémicas , Esquistosomiasis , Animales , Bovinos , China/epidemiología , Perros , Enfermedades Endémicas/estadística & datos numéricos , Heces , Humanos , Ratas , Schistosoma , Esquistosomiasis/epidemiología , Caracoles
16.
Rev Soc Bras Med Trop ; 52: e20190278, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31778421

RESUMEN

INTRODUCTION: Trypanosoma cruzi is the etiological agent of Chagas disease (CD), a zoonotic infection transmitted by triatomine bug vectors to human beings. Although the story of this parasitic infection was born in Brazil and here this has made major step forward information, the same cannot be said about the actual distribution of the triatomine vector in several areas of this country. The aim of this study was to assess the occurrence of triatomine species in an endemic region for CD in Northeastern Brazil. METHODS: A retrospective study was performed using data obtained from 2008 to 2017. All information was provided by the V Gerência Regional de Saúde of the state of Pernambuco. The spatial distribution of triatomine species was analyzed by drawing a map using the Quantum geographic information system. RESULTS: A total of 4,694 triatomine specimens (469.4 ± 221.2 per year) were collected during the period 2008-2017, with 94.5% (4,434/4,694) at the intradomicile and 5.5% (260/4,694) at peridomicile environment. Of all arthropods collected, 92.5% (4,340/4,694) and 7.5% (354/4,694) were adults and nymphs, respectively. The species most frequently detected were Panstrongylus lutzi (30.36%), Triatoma brasiliensis (26.12%), Triatoma pseudomaculata (22.43%), and Panstrongylus megistus (20.54%). CONCLUSIONS: These data contribute to a better understanding of the distribution of T. cruzi infection in the Northeastern region of Brazil. Preventive measures based on vector control should be implemented in the study area in order to reduce the burden this neglected tropical disease.


Asunto(s)
Distribución Animal , Insectos Vectores/clasificación , Triatominae/clasificación , Animales , Brasil , Enfermedad de Chagas/transmisión , Enfermedades Endémicas , Densidad de Población , Estudios Retrospectivos
17.
Global Health ; 15(1): 69, 2019 11 21.
Artículo en Inglés | MEDLINE | ID: mdl-31753038

RESUMEN

BACKGROUND: There is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors. METHODS: Data was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses. RESULTS: The knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work. CONCLUSION: The high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.


Asunto(s)
Creación de Capacidad/organización & administración , Enfermedades Endémicas/prevención & control , Política de Salud , Investigación sobre Servicios de Salud , Personal Administrativo/psicología , Personal Administrativo/estadística & datos numéricos , Adulto , Toma de Decisiones , Práctica Clínica Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Formulación de Políticas , Análisis de Sistemas
18.
Rev Bras Parasitol Vet ; 28(4): 790-796, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31691733

RESUMEN

The aim of this study was to investigate the occurrence of Leishmania spp. antibodies, and its association with feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV), in domestic cats from an area endemic for canine and human leishmaniasis in Rio Grande do Norte State, Brazil. Ninety-one cats were subjected to a complete clinical exam, and blood samples were collected. An epidemiological questionnaire was used to investigate the risk factors. IgG anti-Leishmania spp. antibodies were detected by immunofluorescence antibody test (IFAT), with a cut-off value of 1:40. Polymerase chain reaction (PCR) was performed to detect genetic material of Leishmania spp. in the blood samples. The presence of antibodies against FIV and antigens of FeLV was evaluated using an immunochromatographic test. Seropositivity for Leishmania spp., FIV, and FeLV was observed in 14/91 (15.38%), 26/91 (28.57%), and 3/91 (3.29%) cats, respectively. All samples gave negative results on PCR analysis. Based on these data, no significant statistical association was observed between seropositivity for Leishmania spp., and sex, age, presence of clinical signs, evaluated risk factors, and positivity for retroviruses. These findings demonstrated for the first time that cats from Mossoró, Rio Grande do Norte, are being exposed to this zoonosis and might be part of the epidemiological chain of transmission of visceral leishmaniasis.


Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Enfermedades de los Gatos/parasitología , Leishmaniasis/veterinaria , Animales , Brasil/epidemiología , Enfermedades de los Gatos/diagnóstico , Enfermedades de los Gatos/epidemiología , Gatos , Perros , Enfermedades Endémicas , Técnica del Anticuerpo Fluorescente Directa , Humanos , Virus de la Inmunodeficiencia Felina/inmunología , Leishmaniasis/diagnóstico , Leishmaniasis/epidemiología , Virus de la Leucemia Felina/inmunología , Reacción en Cadena de la Polimerasa , Factores de Riesgo
19.
Parasit Vectors ; 12(1): 476, 2019 Oct 14.
Artículo en Inglés | MEDLINE | ID: mdl-31610803

RESUMEN

BACKGROUND: Borrelia burgdorferi and Anaplasma phagocytophilum are tick-borne infections transmitted by Ixodes scapularis in the eastern USA; both agents cause disease in dogs and people. To characterize changes in seroprevalence over time, Cochran Armitage trend tests were used to evaluate percent positive test results for antibodies to B. burgdorferi and Anaplasma spp. in approximately 20 million canine tests from 2010-2017 in 25 states and 905 counties in the eastern USA. RESULTS: A significant decreasing trend in seroprevalence to B. burgdorferi was evident in eight states along the mid-Atlantic coast from Virginia to New Hampshire, and in Wisconsin. In contrast, a continued increasing trend was evident in five northeastern and Midwestern states where Lyme borreliosis is endemic or emerging, as well as in three southern states where endemicity has not yet been widely established. Similarly, seroprevalence to Anaplasma spp. showed a significant, although smaller, decreasing trend in five states along the mid-Atlantic coast from Virginia to Connecticut and Rhode Island, as well as in Minnesota and Wisconsin in the Midwest; despite the fact that those trends were significant they were weak. However, a strong increasing trend was evident in Massachusetts and three states in northern New England as well as in Pennsylvania. CONCLUSIONS: As expected, seroprevalence continued to increase in regions where Lyme borreliosis and anaplasmosis are more newly endemic. However, the declining seroprevalence evident in other areas was not anticipated. Although the reasons for the decreasing trends are not clear, our finding may reflect shifting ecologic factors that have resulted in decreased infection risk or the combined positive influence of canine vaccination, tick control, and routine testing of dogs in regions where these infections have long been endemic. Analysis of trends in canine test results for tick-borne infections continues to be a valuable tool to understand relative geographical and temporal risk for these zoonotic agents.


Asunto(s)
Anaplasma/inmunología , Anaplasmosis/epidemiología , Borrelia burgdorferi/inmunología , Enfermedades de los Perros/epidemiología , Ehrlichiosis/epidemiología , Enfermedad de Lyme/veterinaria , Anaplasma phagocytophilum/inmunología , Animales , Anticuerpos Antibacterianos/sangre , Enfermedades de los Perros/microbiología , Perros , Enfermedades Endémicas/estadística & datos numéricos , Enfermedades Endémicas/veterinaria , Enfermedad de Lyme/epidemiología , Estudios Seroepidemiológicos , Estados Unidos/epidemiología
20.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 410-413, 2019 Jul 29.
Artículo en Chino | MEDLINE | ID: mdl-31612677

RESUMEN

OBJECTIVE: To analyze the endemic sitaution of schistosomiasis based on geographic information system (GIS) in Wuhan City in 2017, so as to provide the reference for further schistosomiasis control activities. METHODS: According to the data of the annual report on the prevention and control of schistosomiasis in Wuhan City in 2017, the spatial database regarding the endemic situation of schistosomiasis was established and analyzed by ArcMap 10.2. RESULTS: The 593 schistosomiasis-endemic villages in Wuhan City were mainly located in the Yangtze River and its major tributaries. Kernel density analysis showed that the endemic villages of three regions with the highest density was located in the west of Caidian District (Zhuru Street), the east of Hannan District (Shamao Street) and the southwest corner of Xinzhou District (Yangluo Street). The sero-positive population was densely distributed in the West of Caidian District (Zhuru Street), which accounted for 34.23% of all seruo-positives in the city. There were 492 farming cattle fenced in Donggan Village in Hongbei Street of Caidian District. A higher density of the area with Oncomelania hupensis snails was located in the southwest region of Caidian District (Xiaosi Street), accounting for 31.22% of the total area with snails. In 2017, the re-emerging area with snails was 36.60 hm2. The high kernel density region with snails was located in Zhuru Street of Caidian District. The region with high density of living snails was located in the central region of Hannan District (Hongbei Production Brigade), the average density of living snails was 0.36 snails/0.1 m2. CONCLUSIONS: The endemic situation of schistosomiasis is at a low level in Wuhan City, and the spatial distribution is not uniform. In some local areas, the historical endemic situation of schistosomiasis is serious and the high risk factors are more concentrated. It is necessary to strengthen the surveillance of schistosomiasis.


Asunto(s)
Sistemas de Información Geográfica , Esquistosomiasis , Animales , Anticuerpos Antihelmínticos/sangre , China/epidemiología , Enfermedades Endémicas/estadística & datos numéricos , Humanos , Densidad de Población , Vigilancia de la Población , Factores de Riesgo , Esquistosomiasis/sangre , Esquistosomiasis/epidemiología , Caracoles
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