National spatial and temporal patterns of notified dengue cases, Colombia 2007-2010.

OBJECTIVES: To explore the variation in the spatial distribution of notified dengue cases in Colombia from January 2007 to December 2010 and examine associations between the disease and selected environmental risk factors. METHODS: Data on the number of notified dengue cases in Colombia were obtained from the National Institute of Health (Instituto Nacional de Salud - INS) for the period 1 January 2007 through 31 December 2010. Data on environmental factors were collected from the Worldclim website. A Bayesian spatio-temporal conditional autoregressive model was used to quantify the relationship between monthly dengue cases and temperature, precipitation and elevation. RESULTS: Monthly dengue counts decreased by 18% (95% credible interval (CrI): 17-19%) in 2008 and increased by 30% (95% CrI: 28-31%) and 326% (95% CrI: 322-331%) in 2009 and 2010, respectively, compared to 2007. Additionally, there was a significant, nonlinear effect of monthly average precipitation. CONCLUSIONS: The results highlight the role of environmental risk factors in determining the spatial of dengue and show how these factors can be used to develop and refine preventive approaches for dengue in Colombia.

Prevalence, incidence and determinants of herpes simplex virus type 2 infection among HIV-seronegative women at high-risk of HIV infection: a prospective study in Beira, Mozambique

To estimate the prevalence, incidence and determinants of herpes simplex type 2 (HSV-2) infection, and associations between HSV-2 and incident HIV infection, among women at higher risk for HIV infection in Beira, Mozambique. Methods: Between 2009 and 2012, 411 women aged 18-35 years at higher risk of HIV acquisition (defined as having had two or more sexual partners in the month prior to study enrollment) were enrolled and followed monthly for one year. At each study visit, they were counseled, interviewed, and tested for HSV-2 and HIV antibodies. Results: The HSV-2 prevalence at baseline was 60.6% (95% CI: 55.7% -65.4%). Increasing age (aOR = 2.94, 95% CI: 1.74-4.97, P<0.001 and aOR = 3.39, 95% CI: 1.58-7.29, P = 0.002 for age groups of 21-24 and 25-35 years old respectively), lower educational level (aOR = 1.81, 95% CI: 1.09-3.02, P = 0.022), working full time (aOR = 8.56, 95% CI: 1.01-72.53, P = 0.049) and having practiced oral sex (aOR = 3.02, 95% CI: 1.16-7.89, P = 0.024) were strongly associated with prevalent HSV-2 infection. Thirty one participants seroconverted for HSV-2 (20.5%; 95% CI: 14.4% -27.9%) and 22 for HIV during the study period. The frequency of vaginal sex with a casual partner using a condom in the last 7 days was independently associated with incident HSV-2 infection (aOR = 1.91, 95% CI: 1.05-3.47, P = 0.034). Positive HSV-2 serology at baseline was not significantly associated with risk of subsequent HIV seroconversion. Conclusions: Young women engaging in risky sexual behaviors in Beira had high prevalence and incidence of HSV-2 infection. Improved primary HSV-2 control strategies are urgently needed in Beira.

Clostridium difficile PCR ribotype 027: assessing the risks of further worldwide spread.

Highly virulent strains of Clostridium difficile have emerged since 2003, causing large outbreaks of severe, often fatal, colitis in North America and Europe. In 2008-10, virulent strains spread between continents, with the first reported cases of fluoroquinolone-resistant C difficile PCR ribotype 027 in three Asia-Pacific countries and Central America. We present a risk assessment framework for assessing risks of further worldwide spread of this pathogen. This framework first requires identification of potential vehicles of introduction, including international transfers of hospital patients, international tourism and migration, and trade in livestock, associated commodities, and foodstuffs. It then calls for assessment of the risks of pathogen release, of exposure of individuals if release happens, and of resulting outbreaks. Health departments in countries unaffected by outbreaks should assess the risk of introduction or reintroduction of C difficile PCR ribotype 027 using a structured risk-assessment approach.