Sensitivity, completeness and agreement of the tuberculosis electronic system in Ho Chi Minh City, Viet Nam.

Setting: Since 2011, tuberculosis (TB) clinics in Ho Chi Minh City (HCMC), Viet Nam, have been entering data from a paper-based TB treatment register into an electronic database known as VITIMES (Viet Nam TB Information Management Electronic System), which is currently used in parallel with the paper system. Objective: To evaluate the sensitivity, completeness and agreement of data in VITIMES with that of paper-based registers among TB patients co-infected with the human immunodeficiency virus (HIV) being treated for TB in HCMC. Design: This was a retrospective data review of all TB-HIV patients receiving anti-tuberculosis treatment in each of the 24 district TB clinics in HCMC in 2013. Data were abstracted from the paper-based TB treatment registers at district level and extracted electronically at the provincial level. Records were matched based on name, age and address. The sensitivity, completeness and agreement of the electronic data were compared with data from the paper system. Results: The findings showed that the electronic system had high sensitivity (99.2%), high completeness (87-99%) and high agreement (κ 0.78-0.97) for all variables. Conclusion: The results of this study suggest that data are being correctly entered into VITIMES and that patient data can be directly entered into VITIMES instead of having a parallel, paper-based system.

Contexte : Depuis 2011, les centres antituberculeux (TB) de Ho Chi Minh City (HCMC) ont entré les données émanant d'un registre papier de traitement de la TB dans une base de données électronique appelée VITIMES (Viet Nam TB Information Management Electronic System), qui est actuellement utilisée en parallèle au système papier.Objectif : Evaluer la sensibilité, l'exhaustivité et l'accord des données de VITIMES avec celles des registres papier parmi les patients TB co-infectés par le virus de l'immunodéficience humaine (VIH) et traités pour la TB à HCMC.Schéma : Cette étude est une revue rétrospective des données de tous les patients TB-VIH bénéficiant d'un traitement de TB dans chacun des 24 centres TB de district de HCMC en 2013. Les données ont été tirées du registre papier de traitement de la TB au niveau de chaque district et extraites électroniquement au niveau provincial. Les dossiers ont été appariés sur le nom, l'âge et l'adresse. La sensibilité, l'exhaustivité et l'accord des données ont été évalués par comparaison avec les données du système papier.Résultats : Les résultats ont montré que le système électronique avait une sensibilité élevée (99,2%), une exhaustivité élevée (87­99%) et un degré d'accord élevé (κ 0,78­0,97) pour toutes les variables.Conclusion : Les résultats de cette étude suggèrent que les données sont entrées correctement sur VITIMES et que les données des patients peuvent y être entrées directement au lieu d'avoir un système papier en parallèle.

Marco de referencia: Desde el 2011, en los consultorios de atención de la tuberculosis (TB) de la ciudad de Ho Chi Minh, los datos del registro de tuberculosis en papel se están ingresando en un formato informático denominado VITIMES (por Viet Nam TB Information Management Electronic System). En la actualidad se utilizan ambos sistemas en paralelo.Objetivo: Evaluar la sensibilidad, el carácter integral y la concordancia de los datos del sistema VITIMES con respecto a los registros en papel sobre los pacientes con diagnóstico de coinfección por el virus de la inmunodeficiencia humana (VIH) y el bacilo de la TB que reciben tratamiento antituberculoso en la ciudad de Ho Chi Minh.Método: Fue este un análisis retrospectivo de los datos de todos los pacientes coinfectados por el VIH y la TB que habían recibido tratamiento antituberculoso en cada uno de los 24 consultorios distritales en la ciudad en el 2013. Se extrajeron los datos de los registros de tratamiento de la TB mantenidos en papel a escala distrital y de los registros electrónicos a escala de la provincia. Se emparejaron los archivos a partir del nombre, la edad y la dirección. Se evaluó la sensibilidad, el carácter integral y la concordancia de los datos electrónicos con respecto a los datos del sistema en formato de papel.Resultados: Se observó que el sistema electrónico ofrecía una alta sensibilidad (99,2%) y un alto grado de integridad (de 87% a 99%), con una alta concordancia para todas las variables (κ de 0,78 a 0,97).Conclusión: Los resultados del presente estudio indican que los datos se han ingresado de manera correcta en el sistema VITIMES y que es posible captar la información directamente en este formato, sin conservar en paralelo el sistema en papel.

Antiretroviral therapy uptake among adult tuberculosis patients newly diagnosed with HIV in Nyanza Province, Kenya.

SETTING: In 2008, the Kenya tuberculosis (TB) program reported low (31%) antiretroviral therapy (ART) uptake among human immunodeficiency virus (HIV) infected TB patients. OBJECTIVE: To confirm ART coverage and identify factors associated with HIV clinic enrollment and ART initiation among TB patients. DESIGN: Retrospective chart abstraction of adult TB patients newly diagnosed with HIV and eligible for ART at 58 Nyanza Province TB clinics between October 2006 and April 2008. TB data were linked to HIV clinic data at 50 facilities that provided ART. Associations with HIV clinic enrollment and ART were evaluated. RESULTS: Among 1137 ART-eligible TB patient records sampled, 32% documented HIV clinic enrollment and 29% ART. Date fields were largely incomplete; 11% of the patient records included HIV testing dates and ≤1% had dates for cotrimoxazole prophylaxis, HIV clinic enrollment and ART initiation. Adding HIV clinic data increased HIV clinic enrollment and ART documentation to respectively 62% and 44%. Among TB patients in HIV care, female sex, older age group and baseline CD4 documentation were associated with ART initiation. CONCLUSION: Linking data increased documentation of HIV clinic enrollment and ART uptake. Continued efforts are required to improve the documentation of HIV service delivery, especially in TB clinics. Interventions to increase ART uptake are needed for younger patients and men.

Search for diphoton events with large missing transverse energy in 7 TeV proton-proton collisions with the ATLAS detector.

A search for diphoton events with large missing transverse energy is presented. The data were collected with the ATLAS detector in proton-proton collisions at √s=7 TeV at the CERN Large Hadron Collider and correspond to an integrated luminosity of 3.1 pb⁻¹. No excess of such events is observed above the standard model background prediction. In the context of a specific model with one universal extra dimension with compactification radius R and gravity-induced decays, values of 1/R<729 GeV are excluded at 95% C. L., providing the most sensitive limit on this model to date.

Piloting the use of personal digital assistants for tuberculosis and human immunodeficiency virus surveillance, Kenya, 2007.

SETTING: Improved documentation of human immunodeficiency virus (HIV) testing and care among tuberculosis (TB) patients is needed to strengthen TB-HIV programs. In 2007, Kenya piloted the use of personal digital assistants (PDAs) instead of paper registers to collect TB-HIV surveillance data from TB clinics. OBJECTIVE: To evaluate the acceptability, data quality and usefulness of PDAs. DESIGN: We interviewed four of 31 district coordinators who collected data in PDAs for patients initiating TB treatment from April to June 2007. In 10 of 93 clinics, we randomly selected patient records for comparison with corresponding records in paper registers or PDAs. Using Cochran-Mantel-Haenszel tests, we compared missing data proportions in paper registers with PDAs. We evaluated PDA usefulness by analyzing PDA data from all 93 clinics. RESULTS: PDAs were well accepted. Patient records were more frequently missing (28/97 vs. 1/112, P < 0.001) and data fields more frequently incomplete (148/1449 vs. 167/2331, P = 0.03) in PDAs compared with paper registers. PDAs, however, facilitated clinic-level analyses: 48/93 (52%) clinics were not reaching the targets of testing >or=80% of TB patients for HIV, and 8 (9%) clinics were providing <80% of TB-HIV co-infected patients with cotrimoxazole (CTX). CONCLUSION: PDAs had high rates of missing data but helped identify clinics that were undertesting for HIV or underprescribing CTX.

Search for new particles in two-jet final states in 7 TeV proton-proton collisions with the ATLAS detector at the LHC.

A search for new heavy particles manifested as resonances in two-jet final states is presented. The data were produced in 7 TeV proton-proton collisions by the LHC and correspond to an integrated luminosity of 315 nb⁻¹ collected by the ATLAS detector. No resonances were observed. Upper limits were set on the product of cross section and signal acceptance for excited-quark (q*) production as a function of q* mass. These exclude at the 95% C.L. the q* mass interval 0.30

Observation of a centrality-dependent dijet asymmetry in lead-lead collisions at sqrt[S(NN)] =2.76 TeV with the ATLAS detector at the LHC.

By using the ATLAS detector, observations have been made of a centrality-dependent dijet asymmetry in the collisions of lead ions at the Large Hadron Collider. In a sample of lead-lead events with a per-nucleon center of mass energy of 2.76 TeV, selected with a minimum bias trigger, jets are reconstructed in fine-grained, longitudinally segmented electromagnetic and hadronic calorimeters. The transverse energies of dijets in opposite hemispheres are observed to become systematically more unbalanced with increasing event centrality leading to a large number of events which contain highly asymmetric dijets. This is the first observation of an enhancement of events with such large dijet asymmetries, not observed in proton-proton collisions, which may point to an interpretation in terms of strong jet energy loss in a hot, dense medium.

Analysis of Salmonella enterica serotype Typhi pulsed-field gel electrophoresis patterns associated with international travel.

Typhoid fever is a significant cause of morbidity and mortality worldwide, causing an estimated 16 million cases and 600,000 deaths annually. Although overall rates of the disease have dramatically decreased in the United States, the number of travel-related infections has increased in recent decades. Drug resistance among Salmonella enterica serotype Typhi strains has emerged worldwide, making antimicrobial susceptibility testing an important function in public health laboratories. Pulsed-field gel electrophoresis (PFGE) subtyping of food-borne and waterborne pathogens has proven to be a valuable tool for the detection of outbreaks and laboratory-based surveillance. This retrospective study examined the distribution of PFGE patterns of S. enterica serotype Typhi isolates from patients with a history of international travel. Isolates were collected as part of a passive laboratory-based antimicrobial susceptibility surveillance study. Isolates were PFGE subtyped by using the restriction enzyme XbaI to restrict the total genomic DNA. Isolates indistinguishable with XbaI were further characterized using the restriction enzyme BlnI. A total of 139 isolates were typed, representing travel to 31 countries. Restriction fragment patterns consisted of 14 to 18 fragments ranging in size from 580 to 40 kbp. Seventy-nine unique PFGE patterns were generated using XbaI. Isolates from the same geographic region did not necessarily have similar PFGE patterns. Of the 139 isolates, 46 (33%) were resistant to more than one antimicrobial agent (multidrug resistant [MDR]). Twenty-seven (59%) of 46 MDR isolates had indistinguishable PFGE patterns with both XbaI and BlnI. It appears that MDR S. enterica serotype Typhi has emerged as a predominant clone in Southeast Asia and the Indian subcontinent.

Typhoid fever in travelers: who should be targeted for prevention?

To clarify indications for typhoid vaccination, we reviewed laboratory-confirmed cases of typhoid fever reported to the United States Centers for Disease Control and Prevention between 1994 and 1999. To estimate the risk of adverse events associated with typhoid vaccination, we reviewed reports to the Vaccine Adverse Event Reporting System for the same period. Acute Salmonella enterica serotype Typhi infection was reported for 1393 patients. Of these patients, recent travel was reported by 1027 (74%), only 36 (4%) of whom reported having received a vaccination. Six countries accounted for 76% of travel-associated cases (India [30%], Pakistan [13%], Mexico [12%], Bangladesh [8%], The Philippines [8%], and Haiti [5%]). For 626 travelers who traveled to a single country, the length of stay was

Antimicrobial-resistant bacterial diarrhea in rural western Kenya.

Bacterial diarrheal diseases cause substantial morbidity and mortality in sub-Saharan Africa, but data on the epidemiology and antimicrobial susceptibility patterns of enteric bacterial pathogens are limited. Between May 1997 and April 1998, a clinic-based surveillance for diarrheal disease was conducted in Asembo, a rural area in western Kenya. In total, 729 diarrheal specimens were collected, and 244 (33%) yielded >or=1 bacterial pathogen, as determined by standard culture techniques; 107 (44%) Shigella isolates, 73 (30%) Campylobacter isolates, 45 (18%) Vibrio cholerae O1 isolates, and 33 (14%) Salmonella isolates were identified. Shigella dysenteriae type 1 accounted for 22 (21%) of the Shigella isolates. Among 112 patients empirically treated with an antimicrobial agent and whose stool specimens yielded isolates on which resistance testing was done, 57 (51%) had isolates that were not susceptible to their antimicrobial treatment. Empiric treatment strategies for diarrheal disease in western Kenya need to be reevaluated, to improve clinical care.

Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic: rationale for integrating services.

BACKGROUND AND OBJECTIVES: Clients attending sexually transmitted disease (STD) clinics are at risk for multiple infections (e.g., STDs, HIV, and infectious viral hepatitis). Risk assessment and serosurveys can document the need for hepatitis screening and vaccination services. GOAL: To determine hepatitis C and B virus seroprevalence, identify predictive risk factors, and provide a rationale for integrating hepatitis services in an STD clinic. METHODS: During various periods in 1998, consecutive clients completed a self-administered risk assessment and were offered screening for markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection (HBV core antibody and anti-HCV [enzyme-linked immunosorbent assay 3.0, confirmed by recombinant immunoblot assay 2.0]). RESULTS: Sixteen percent of 300 clients tested for an anti-HBV core were positive, with injecting-drug users (IDUs) and men who have sex with men (MSM) having higher prevalences (50% and 37%, respectively). Of 615 clients tested for anti-HCV, 21 (3.4%) were positive. Injecting-drug users (n = 34) had a 38% anti-HCV prevalence compared with 1.1% for non-IDUs. Of 66 non-IDU MSM tested, none was HCV infected. IDUs had a high prevalence of past STDs (> 50%) and unsafe sexual behavior. CONCLUSIONS: Injecting drug users and MSM are at high risk for STDs, HIV, and hepatitis infections and could benefit from a "one-stop" STD clinic that included hepatitis prevention services.

Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise.

CONTEXT: Multidrug-resistant Salmonella serotype Typhi infections have been reported worldwide, but data on the incidence of resistant strains in the United States are lacking. OBJECTIVES: To determine the incidence of antimicrobial-resistant Salmonella Typhi infections and to identify risk factors for infection. DESIGN: Cross-sectional laboratory-based surveillance study. SETTING AND PARTICIPANTS: A total of 293 persons with symptomatic typhoid fever who had Salmonella Typhi isolates and epidemiological information submitted to US public health departments and laboratories from June 1, 1996, to May 31, 1997. MAIN OUTCOME MEASURES: Proportion of Salmonella Typhi isolates demonstrating resistance to 12 antimicrobial agents; patient epidemiological factors associated with drug-resistant infections. RESULTS: Median age was 21 years (range, 3 months to 84 years); 56% were male. Two hundred twenty-eight (80%) were hospitalized; 2 died. In the 6 weeks before illness onset, 81% of patients had traveled abroad. Seventy-four Salmonella Typhi isolates (25%) were resistant to 1 or more antimicrobial agent, and 51 (17%) were resistant to 5 or more agents, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant Salmonella Typhi [MDRST]). Although no resistance to ciprofloxacin or ceftriaxone was observed, 20 isolates (7%) were nalidixic acid-resistant (NARST). Patients with MDRST and NARST infections were more likely to report travel outside the United States, particularly to the Indian subcontinent (Bangladesh, India, and Pakistan) (odds ratio [OR], 29.3; 95% confidence interval [CI], 6.8-126.7; P<.001 and OR, 35.9; 95% CI, 3.4-377.3; P<.001, respectively). CONCLUSIONS: Our data suggest that ciprofloxacin and ceftriaxone are appropriate empirical therapy for suspected typhoid fever; however, resistance may be anticipated. Continued monitoring of antimicrobial resistance among Salmonella Typhi strains will help determine vaccination and treatment policies. JAMA. 2000;283:2668-2673.

An outbreak of Yersinia enterocolitica O:8 infections associated with pasteurized milk.

In October 1995, an outbreak of Yersinia enterocolitica O:8 infections occurred in the Upper Valley of Vermont and New Hampshire. Ten patients were identified, median age 9 years (range, 6 months-44 years). Three patients were hospitalized; 1 underwent an appendectomy. Consumption of bottled pasteurized milk from a local dairy was associated with illness (matched odds ratio undefined; lower 95% confidence interval, 1.9). No deficiencies in pasteurization procedures or equipment were detected. Y. enterocolitica O:8 was isolated from 1 raw-milk sample and from a fecal sample from 1 dairy pig. The route of contamination was not determined; this outbreak likely resulted from postpasteurization contamination of milk. Dairy pigs were the most likely source of contamination. Milk bottles were likely contaminated by rinsing with untreated well water prior to filling or by other environmental routes. Educating dairy owners about Y. enterocolitica and postpasteurization contamination is necessary to prevent further outbreaks.

Salmonella Thompson associated with improper handling of roast beef at a restaurant in Sioux Falls, South Dakota.

In October 1996, we investigated an outbreak of Salmonella serotype Thompson infections associated with Restaurant A in Sioux Falls, South Dakota, and conducted two cohort studies among persons who ate at luncheons catered by Restaurant A. Fifty-two Salmonella Thompson infections were identified between 29 September and 14 October 1996. Infections occurred among employees and patrons at Restaurant A and among attendees at three luncheons catered by the restaurant on 7 October. Roast beef cooked at Restaurant A was the only food item significantly associated with illness. Cooking times and storage temperatures for roast beef were inadequate to prevent multiplication of Salmonella, and the chefs were unaware of proper cooking and storage temperatures. We conclude that improper handling of roast beef probably caused this outbreak of Salmonella Thompson infections. Better knowledge of food safety practices by the cooking staff at Restaurant A, through required food safety education, might have prevented the outbreak.

An outbreak of Escherichia coli O157:H7 infections associated with leaf lettuce consumption.

In July 1995, 40 Montana residents were identified with laboratory-confirmed Escherichia coli O157:H7 infection; 52 residents had bloody diarrhea without laboratory confirmation. The median age of those with laboratory-confirmed cases was 42 years (range, 4- 86); 58% were female. Thirteen patients were hospitalized, and 1 developed hemolytic-uremic syndrome. A case-control study showed that 19 (70%) of 27 patients but only 8 (17%) of 46 controls reported eating purchased (not home-grown) leaf lettuce before illness (matched odds ratio, 25.3; 95% confidence interval, 3.9-1065.6). Pulsed-field gel electrophoresis identified a common strain among 22 of 23 isolates tested. Implicated lettuce was traced to two sources: a local Montana farm and six farms in Washington State that shipped under the same label. This outbreak highlights the increasing importance of fresh produce as a vehicle in foodborne illness. Sanitary growing and handling procedures are necessary to prevent these infections.

Are there national risk factors for epidemic cholera? The correlation between socioeconomic and demographic indices and cholera incidence in Latin America.

BACKGROUND: From 1991 through 1995, all Latin American countries maintained cholera surveillance systems to track the epidemic that entered the region through Peru in January 1991. These data were used to assess correlations between socioeconomic and demographic indices that might serve as national risk predictors for epidemic cholera in Latin America. METHODS: Correlations between country-specific cumulative cholera incidence rates from 1991 through 1995 and infant mortality, the Human Development Index [HDI] a numerical value based on life expectancy, education, and income), gross national product (GNP) per capita, and female literacy were tested using the Pearson correlation coefficient. RESULTS: A total of 1,339,834 cholera cases with a cumulative incidence rate of 183 per 100,000 population were reported from affected Western Hemisphere countries from 1991 through 1995. Infant mortality rates were the most strongly correlated with cumulative cholera incidence based on the Pearson correlation coefficient. The HDI had a less strong negative correlation with cumulative cholera incidence. The GNP per capita and female literacy rates were weakly and negatively correlated with cholera cumulative incidence rates. CONCLUSIONS: Infant mortality and possibly the HDI may be useful indirect indices of the risk of sustained transmission of cholera within a Latin American country. Cumulative cholera incidence is decreased particularly in countries with infant mortality below 40 per 1000 live births. The lack of reported cholera cases in Uruguay and the Caribbean may reflect a low risk for ongoing transmission, consistent with socioeconomic and demographic indices. Cholera surveillance remains an important instrument for determining cholera trends within individual countries and regions.

PIP: To track a cholera epidemic that entered Latin America through Peru in January 1991, the region maintained cholera surveillance systems from 1991 through 1995. The present study used the surveillance data to identify socioeconomic and demographic indices that might serve as national risk predictors for epidemic cholera in Latin America. A total of 1,339,834 cholera cases, with a cumulative incidence rate of 183/100,000 population, were reported in 1991-95 from 22 countries in the region. Use of the Pearson correlation coefficient indicated that infant mortality rates were most strongly associated with cumulative cholera incidence. Cumulative cholera incidence was decreased in countries with an infant mortality below 40/1000 live births. The Human Development Index had a less strong negative correlation with cholera incidence, but values under 0.720 may provide an additional estimator of risk. The gross national product per capita (above US$2000) and female literacy rates above 90% were weakly and negatively correlated with cholera cumulative incidence rates. The continued lack of cholera cases in the Caribbean, where most countries have socioeconomic and demographic indices that resemble the Latin American countries with lowest risk for cholera, provides tentative support for this framework.

An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group.

BACKGROUND: Cyclospora cayetanensis is a parasite that causes gastroenteritis. Until last year most of the documented cases of cyclosporiasis in North America were in overseas travelers. In 1996, a large outbreak of cyclosporiasis occurred in North America. We investigated this outbreak. METHODS: Health departments solicited information from clinicians and laboratories on cases of cyclosporiasis, which were then reported to the Centers for Disease Control and Prevention and to Health Canada. We conducted retrospective cohort studies for the cases associated with events (e.g., luncheons) and attempted to identify the sources of the implicated food. RESULTS: A total of 1465 cases of cyclosporiasis were reported by 20 states, the District of Columbia, and 2 provinces. Of these cases, 978 (66.8 percent) were laboratory confirmed and 725 (49.5 percent) were associated with 55 events that were held from May 3 through June 14. Raspberries were definitely served at 50 events and may have been served at 4 events. For 27 of the 41 events for which adequate data were available (65.8 percent), the associations between the consumption of berries (raspberries with or without other berries) and cyclosporiasis were statistically significant (P<0.05). For all 29 events for which there were good data, the raspberries definitely came from Guatemala (21 events, 72.4 percent) or may have come from Guatemala (8 events, 27.6 percent). As few as five Guatemalan farms could have accounted for the 25 events for which the raspberries could be traced to a single exporter per event. The mode of contamination of the raspberries remains unclear. CONCLUSIONS: This large outbreak of cyclosporiasis in North America in 1996 was associated with the consumption of Guatemalan raspberries. The outbreak illustrates the need to consider that a local cluster of foodborne illness may be part of a widespread outbreak and to pursue investigations to the source of the implicated vehicle.