National vaccine coverage trends and funding in Latin America and the Caribbean.

BACKGROUND: From 2006 to 2011 nearly 174,000 deaths were prevented in Latin America and the Caribbean through vaccination of children under five, which is widely attributed to the Expanded Program on Immunization (EPI). Despite near global adoption of EPI recommendations, vaccination coverage shows substantial variation across world regions. Causes for low immunizations within regions are multifaceted and include vaccination program costs. To date, publications regarding vaccine coverage across Latin America and the Caribbean are not readily available. This study aimed to: (1) compare vaccine coverage trends across nations within the region; and (2) assess whether national immunization program expenditures are correlated with vaccine coverage. METHODS: Coverage for nine vaccines were collected by nation using publicly available data from WHO. National immunization program expenditures for each country were collected from the World Bank Index. The proportion of countries achieving 90% coverage in the years 2013 and 2017 for each vaccine were compared. Pearson correlation coefficients were calculated to measure the relationship between financing variables and DTP3 coverage for 2017. RESULTS: In 2017, fewer Latin American and Caribbean nations were able to achieve 90% vaccine coverage for five vaccines compared to 2013. Mostly weak to moderate positive relationships were found between national immunization program expenditures and DTP3 coverage for 2017. Excluding Haiti, a weak negative relationship was found between total government expenditure on vaccines per infant and DTP3 coverage for 2017. Countries across Latin America and the Caribbean were largely self-reliant in funding vaccine expenditures. CONCLUSIONS: Fewer countries across Latin America and the Caribbean are currently achieving optimum national vaccine coverage and weak to moderate relationships between routine immunization and vaccine expenditures and coverage were observed. Additional factors contributing to national vaccine coverage should be concomitantly examined to implement strategies which optimize delivery of childhood immunizations.

Chagas Disease Prevalence in Colombia: A Meta-Analysis and Systematic Review.

BACKGROUND AND OBJECTIVES: Chagas disease is a major public health problem in Latin America. A neglected disease of poor and rural Latin American populations, it has now emerged in other regions and urban areas due to international migration. In Colombia, systematic data pertaining to the disease's magnitude in the general population and its distribution within regions are lacking. Our objective is to describe the prevalence of Chagas disease in Colombia through a meta-analysis and systematic review. MATERIALS AND METHODS: A comprehensive search using several electronic databases, gray literature, and reference lists of selected articles for population-based studies on Chagas disease prevalence in Colombia was performed between 1990 and 2017. Articles published in either English or Spanish were included. Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated for Chagas disease in the general population using a meta-analysis random-effects model. Subgroup analyses were performed to investigate potential sources of heterogeneity among studies. A sensitivity analysis was conducted to determine whether publication bias existed. RESULTS: Seventeen articles with relevant prevalence data were identified from a total of 1213 references. The initial pooled estimate of Chagas disease prevalence across studies for the entire period was 4.10% (95% CI: 2.23-7.41). After removing studies with large effect and small sample sizes, the pooled estimate was 1.67% (95% CI: 0.95-2.92). A high degree of heterogeneity in most pooled estimates was observed, even after subgroup analysis. The Orinoquía region, rural areas, males, and persons aged ≥15 years yielded the highest pooled prevalence. INTERPRETATION AND CONCLUSION: Higher prevalence was observed in select regions, rural areas, and older teenagers and adults. Additional population-based studies within Colombia are recommended to provide more stable and reliable estimates and identify high-risk areas and groups.

Outbreak of Tattoo-associated Nontuberculous Mycobacterial Skin Infections.

BACKGROUND: On 29 April 2015, the Florida Department of Health in Miami-Dade County (DOH Miami-Dade) was notified by a local dermatologist of 3 patients with suspected nontuberculous mycobacterial (NTM) infection after receiving tattoos at a local tattoo studio. METHODS: DOH Miami-Dade conducted interviews and offered testing, described below, to tattoo studio clients reporting rashes. Culture of clinical isolates and identification were performed at the Florida Bureau of Public Health Laboratories. Characterization of NTM was performed by the Centers for Disease Control and Prevention and the US Food and Drug Administration (FDA), respectively. Whole-genome sequencing (WGS) and single-nucleotide polymorphism (SNP) analyses were used to construct a phylogeny among 21 Mycobacterium isolates at the FDA. RESULTS: Thirty-eight of 226 interviewed clients were identified as outbreak-associated cases. Multivariate logistic regression revealed that individuals who reported gray tattoo ink in their tattoos were 8.2 times as likely to report a rash (95% confidence interval, 3.1-22.1). Multiple NTM species were identified in clinical and environmental specimens. Phylogenetic results from environmental samples and skin biopsies indicated that 2 Mycobacterium fortuitum isolates (graywash ink and a skin biopsy) and 11 Mycobacterium abscessus isolates (5 from the implicated bottle of graywash tattoo ink, 2 from tap water, and 4 from skin biopsies) were indistinguishable. In addition, Mycobacterium chelonae was isolated from 5 unopened bottles of graywash ink provided by 2 other tattoo studios in Miami-Dade County. CONCLUSIONS: WGS and SNP analyses identified the tap water and the bottle of graywash tattoo ink as the sources of the NTM infections.

Epidemiology of Pediatric Zika Virus Infections.

BACKGROUND AND OBJECTIVE: In July 2016, local transmission of Zika virus (ZIKV) was announced in Miami-Dade County, Florida. In this report, we describe the epidemiology of pediatric ZIKV infections in locally acquired and travel-associated cases. METHODS: All children aged 1 to 17 years tested for ZIKV between October 1, 2015, and March 29, 2017, were included. SAS 9.4 was used to analyze age, sex, race and/or ethnicity, origin of exposure, onset date, affiliation with a household cluster, clinical symptoms, hospitalizations, viremia, viruria, and antibody detection in specimens. RESULTS: Among 478 confirmed ZIKV cases in Miami-Dade County, 33 (6.9%) occurred in children (1-17 years). Twenty-seven (82.3%) cases were travel-associated. The median age of a pediatric Zika case patient was 11 years. Seventeen (51.5%) case patients were boys, and 23 (69.9%) were Hispanic. Among 31 symptomatic cases, all reported having rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.6%) reported arthralgia. Sixteen (48.5%) cases reported 2 of 4 and 8 (24.2%) reported 3 of 4 main symptoms. CONCLUSIONS: This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.

The Impact of Red Light Cameras on Crashes Within Miami-Dade County, Florida.

OBJECTIVE: To determine the safety effect of red light camera (RLC) programs, this study attempted to estimate its impact on collisions within Miami-Dade County, Florida Methods: A before-after evaluation using a comparison group along with traffic control correction was employed. Twenty signalized intersections with RLCs that began enforcement on January 1, 2011, were matched to 2 comparison sites located at least 2 miles from camera sites to minimize spillover effect. An empirical Bayes analysis was used to account for potential regression to the mean effects. An index of effectiveness along with 95% confidence intervals were calculated based on the comparison between the estimated and actual number of crashes in the after period. RESULTS: During the first year, RLC sites experienced a marginal decrease in right angle/turn collisions (-3%), a significant increase in rear-end collisions (+40%), and significant decreases in all injury (-19%) and RLR-related injury collisions (-24%). An increase in right angle/turning (+14%) and rear-end (+51%) collisions at the RLC sites was observed after 2 years despite camera enforcement. A significant reduction in RLR-related injury crashes (-17%), however, was still observed after 2 years. A nonsignificant decline in all injury collisions (-12%) was also noted. CONCLUSIONS: RLCs showed a benefit in reducing RLR-related injury collisions at camera sites after enforcement commenced, yet its tradeoff was a large increase in rear-end collisions. There was inconclusive evidence whether RLCs affected right angle/turning and all injury collisions. Statutory changes in crash reporting during the second year of camera enforcement affected the incidence of right angle and rear-end collisions; nevertheless, a "novelty effect" could not be ruled out. Future research should consider events such as low frequencies of severe injury/fatal collisions and changes in crash reporting requirements when conducting RLC analyses.

The effectiveness of red light cameras in the United States-a literature review.

OBJECTIVE: To examine the available scientific evidence based on peer-reviewed publications concerning the effectiveness of red light cameras (RLCs) within the U.S. traffic system. METHODS: Relevant literature published prior to December 2012 was retrieved from the PubMed, Medline, and Engineering Index databases using free-text term queries. Jurisdictions with either a fixed number of RLCs studied or area wide programs within the United States were included. RLC studies with additional interventions were excluded. Nine RLC studies were extracted and grouped into 3 categories based on outcome measures: violations, crashes, and injuries/fatalities. RESULTS: All 9 studies reviewed showed significant reductions in the frequency/rate of violations, crashes, and injuries at intersections after RLC implementation. RLC interventions appear to decrease violations, crashes, and injuries at intersections. CONCLUSIONS: Despite limited peer-reviewed publications available in the literature, it appears that RLCs decrease violations, crashes, and injuries at intersections. Some studies, however, contained methodological shortcomings. Therefore, the apparent effectiveness should be confirmed with stronger methodological approaches. Although spillover effects appeared to be evident, many of the jurisdictions examined were small in area. Thus, it is unknown whether spillover resulting from RLCs would have similar effects in large metropolitan areas. To determine the full public health impact of RLC programs, crashes, injuries, and fatalities should be considered as primary outcomes of interest. To accomplish this requires a clear definition of which types of crashes will be included for RLC studies. Lastly, it is unknown whether RLCs would be effective in reducing crashes resulting from distracted or alcohol-impaired drivers. Future studies should examine the effects of RLCs by exclusively analyzing these crash types.

Alert system to detect possible school-based outbreaks of influenza-like illness.

To evaluate the usefulness of school absentee data in identifying outbreaks as part of syndromic surveillance, we examined data collected from public schools in Miami-Dade County, Florida, USA. An innovative automated alert system captured information about school-specific absenteeism to detect and provide real-time notification of possible outbreaks of influenza-like illness.

Innovative uses for syndromic surveillance.

To determine if expanded queries can be used to identify specific reportable diseases/conditions not detected by using automated syndrome categories, we developed new categories to use with the Electronic Surveillance System for the Early Notification of Community Based Epidemics. Results suggest innovative queries can enhance clinicians' compliance with reportable disease requirements.