Chikungunya in the western hemisphere: a review of the 2014 epidemic, the potential long-term impact, and research opportunities

OBJECTIVE: The objective of this paper is to present a comprehensive review of the impact of the recent chikungunya virus outbreaks in island nations, including the Caribbean, and explore the potential for further study of the epidemiology and pathogen-host interactions of this emerging virus. DESIGN AND METHODS: We conducted a review of the current literature and data on multiple facets of chikungunya including: acute disease outbreaks, epidemiological and clinical data, comparisons of diagnostic techniques, and virologic strains. RESULTS: Outbreaks of chikungunya (CHIKV) on island nations have seen high attack rates with corresponding increased morbidity and mortality. Severe, persistent and relapsing arthritis and tenosynovitis is common among chikungunya patients. CONCLUSION: Comprehensive surveillance of chikungunya virus is required by the linking of epidemiologic, molecular and immunologic data with information on ecological patterns and vector prevalence if the incidence of chikungunya is to be reduced and prevented. More data on the disease spectrum and persistence in the Caribbean nations, the viral strain, and the incidence rates are sorely needed. Because CHIK can only be prevented by preventing mosquito bites, more research needs to be done locally in Caribbean nations to determine the optimal strategies of Aedes vector control and public health education with subsequent behavior change.

The current prevalence and potential elimination of the soil transmitted helminth’s from Grenada

OBJECTIVE: This study formed part of a soil transmitted helminth elimination program in Grenada. The study assessed the prevalence of soil transmitted helminths (STH’s) in Grenadian primary school children. DESIGN AND METHODS: A longitudinal study was carried out on students attending 39 out of all 54 (72.2%) primary schools in Grenada, Carriacou and Petite Martinique between March 2013 and December 2014. The schools were randomly selected for inclusion in the study. Zinc Sulphate Floatation with centrifugation and Microscopy was used to assess the prevalence of STH’s in stool samples from Grenadian primary school children. RESULTS: The overall prevalence of STH was 1.3% (95% CI= 0.54-2.72). In 4 of the 8 parishes the prevalence was 0%. The highest prevalence was 3.9% (0.48-13.46) in St. Patrick. The STH identified were Ancylostoma duodenale, Ascaris lumbricoides and Trichuris trichuria. CONCLUSION: The prevalence of STH’s in the initial survey was 1.3%. This low prevalence indicates that the elimination program which utilizes a multi pronged approach including targeted chemotherapy and education may be feasible.

A retrospective case series study of the seroprevalence of Human T Lymphocyte Virus 1 and 2 from the General hospital Laboratory in Grenada

OBJECTIVE: HTLV-1 is a human retrovirus that causes adult T-cell Leukemia/Lymphoma (ATL) and some other conditions – HTLV-associated myelopathy (tropical spastic paraparesis, a multiple sclerosis-like disease), uveitis, infective dermatitis and some “auto immune” diseases. While the Caribbean has been identified as an HTLV-1 endemic area, there are no published studies on HTLV-1 from Grenada. The objective of this study was to anonymously review the General Hospital laboratory records to investigate the seroprevalence of HTLV-1 and 2 in Grenada. DESIGN AND METHODS: This was a retrospective study of the records from the General Hospital Laboratory in Grenada, where ELISA serologically positive results for HTLV 1 and 2 were recorded as a percentage of the total number of tests performed between the years 1998 - 2013. The Diasoren rapid ELISA serological test was used. RESULTS: During the 16 year review period (1998-2013) a total of 2,346 (4.7%: 95% CI: 4.5% to 4.9%) out of 49,782 patients were identified as HTLV-1 and 2 positive. Females with a median age of 34 years comprised 70% of positive cases whilst the median age for males was 43 years. The rate in Grenada has been steadily declining since 1998 and appears to be leveling off at about 3.7%. CONCLUSION: The current seroprevalence of HTLV 1 and 2 in Grenada is lower than that reported in 1991 in Jamaica (5%). The rate found is still unacceptably high and additional studies are required to determine the health consequences of HTLV-1 infection. Additionally appropriate public health programs should be applied to help reduce transmission.

Short and long term knowledge of the transmission and prevention of soil transmitted helminths in primary schoolchildren assessed using Turning Point Technologies

OBJECTIVE: This study formed part of a soil transmitted helminth (STH) elimination program in Grenada. This study assessed the short and long term knowledge of primary school children on the transmission and prevention of STH using Turning Point Technologies. DESIGN AND METHODS: A longitudinal study was carried out on schoolchildren attending 39 out of all 54 (72.2%) primary schools from Grenada, Carriacou and Petite Martinique between March and November 2014. The schools were randomly selected for inclusion in the study. Turning Point Technology was used to assess the knowledge and administer the subsequent intervention to all students. The Pre, immediate-Post and long-term Post intervention (seven months later) data was analyzed using Chi Square. RESULTS: A total of 962 students participated in March 2014 and 805 students participated in October 2014. There was no significant (p< 0.05) inter school difference in the answering of questions. This displayed a ubiquitous knowledge transfer across the primary schools. There was a significant improvement in knowledge post turning point intervention, which was maintained at 7-months post-intervention. CONCLUSION: The advantages of using turning point technologies to impart this knowledge where class responses appear instantly, anonymously and can be used for immediate discussion were numerous. These include inter alia, active engaged participation.

Attitude, behavior and practice of primary school students with regard to soil transmitted helminths in Grenada

OBJECTIVE: To identify the attitude, behaviour and practice of parents, guardians and adolescents associated with Soil Transmitted Helminth’s (STH’s). DESIGN AND METHODS: A questionnaire was completed by 811 parents /guardians. The questionnaire posed questions on the socio economic, attitudes, behavior and practices of primary school students with regard to factors that could contribute to the transmission of STH’s in Grenada. RESULTS: 534 (66%) parents/guardian reported that their children regularly washed their hands before eating, 690 (85%) had an inside water supply, 465 (57%) had indoor toilets. Also, 579 (71%) said that their children never played around outdoor latrines and 326 (40%) said their children always wore shoes outdoors. 732 (90%) of the parents/guardians reported that vegetables and fruits were always washed before cooking and 662 (82%) said that their children had previously received de-worming medication. CONCLUSION: Practical recommendations such as in-house sanitation facilities and hand washing programs can be made. This will enable limited resources to be used more efficiently to combat the problem of transmission of STH’s.