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1.
PLoS One ; 15(8): e0237913, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817630

RESUMO

BACKGROUND: In November 2016, the Kenya National Vaccines and Immunization Programme conducted an assessment of missed opportunities for vaccination (MOV) using the World Health Organization (WHO) MOV methodology. A MOV includes any contact with health services during which an eligible individual does not receive all the vaccine doses for which he or she is eligible. METHODS: The MOV assessment in Kenya was conducted in 10 geographically diverse counties, comprising exit interviews with caregivers and knowledge, attitudes, and practices (KAP) surveys with health workers. On the survey dates, which covered a 4-day period in November 2016, all health workers and caregivers visiting the selected health facilities with children <24 months of age were eligible to participate. Health facilities (n = 4 per county) were purposively selected by size, location, ownership, and performance. We calculated the proportion of MOV among children eligible for vaccination and with documented vaccination histories (i.e., from a home-based record or health facility register), and stratified MOV by age and reason for visit. Timeliness of vaccine doses was also calculated. RESULTS: We conducted 677 age-eligible children exit interviews and 376 health worker KAP surveys. Of the 558 children with documented vaccination histories, 33% were visiting the health facility for a vaccination visit and 67% were for other reasons. A MOV was seen in 75% (244/324) of children eligible for vaccination with documented vaccination histories, with 57% (186/324) receiving no vaccinations. This included 55% of children visiting for a vaccination visit and 93% visiting for non-vaccination visits. Timeliness for multi-dose vaccine series doses decreased with subsequent doses. Among health workers, 25% (74/291) were unable to correctly identify the national vaccination schedule for vaccines administered during the first year of life. Among health workers who reported administering vaccines as part of their daily work, 39% (55/142) reported that they did not always have the materials they needed for patients seeking immunization services, such as vaccines, syringes, and vaccination recording documents. CONCLUSIONS: The MOV assessment in Kenya highlighted areas of improvement that could reduce MOV. The results suggest several interventions including standardizing health worker practices, implementing an orientation package for all health workers, and developing a stock management module to reduce stock-outs of vaccines and vaccination-related supplies. To improve vaccination coverage and equity in all counties in Kenya, interventions to reduce MOV should be considered as part of an overall immunization service improvement plan.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde , Vacinação/normas , Vacinas/uso terapêutico , Cuidadores/psicologia , Criança , Pré-Escolar , Agentes Comunitários de Saúde , Feminino , Instalações de Saúde , Pessoal de Saúde/psicologia , Humanos , Programas de Imunização/normas , Esquemas de Imunização , Lactente , Entrevistas como Assunto , Quênia/epidemiologia , Masculino , Inquéritos e Questionários , Cobertura Vacinal/normas , Organização Mundial da Saúde
2.
BMC Infect Dis ; 20(1): 611, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811467

RESUMO

BACKGROUND: The poliovirus has been targeted for eradication since 1988. Kenya reported its last case of indigenous Wild Poliovirus (WPV) in 1984 but suffered from an outbreak of circulating Vaccine-derived Poliovirus type 2 (cVDPV2) in 2018. We aimed to describe Kenya's polio surveillance performance 2016-2018 using WHO recommended polio surveillance standards. METHODS: Retrospective secondary data analysis was conducted using Kenyan AFP surveillance case-based database from 2016 to 2018. Analyses were carried out using Epi-Info statistical software (version 7) and mapping was done using Quantum Geographic Information System (GIS) (version 3.4.1). RESULTS: Kenya reported 1706 cases of AFP from 2016 to 2018. None of the cases were confirmed as poliomyelitis. However, 23 (1.35%) were classified as polio compatible. Children under 5 years accounted for 1085 (63.6%) cases, 937 (55.0%) cases were boys, and 1503 (88.1%) cases had received three or more doses of Oral Polio Vaccine (OPV). AFP detection rate substantially increased over the years; however, the prolonged health workers strike in 2017 negatively affected key surveillance activities. The mean Non-Polio (NP-AFP) rate during the study period was 2.87/ 100,000 children under 15 years, and two adequate specimens were collected for 1512 (88.6%) AFP cases. Cumulatively, 31 (66.0%) counties surpassed target for both WHO recommended AFP quality indicators. CONCLUSIONS: The performance of Kenya's AFP surveillance system surpassed the minimum WHO recommended targets for both non-polio AFP rate and stool adequacy during the period studied. In order to strengthen the country's polio free status, health worker's awareness on AFP surveillance and active case search should be strengthened in least performing counties to improve case detection. Similar analyses should be done at the sub-county level to uncover underperformance that might have been hidden by county level analysis.


Assuntos
Surtos de Doenças/prevenção & controle , Monitoramento Epidemiológico , Paralisia/epidemiologia , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Poliovirus/imunologia , Adolescente , Criança , Pré-Escolar , Fezes/virologia , Feminino , Sistemas de Informação Geográfica , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Paralisia/virologia , Vacina Antipólio Oral/efeitos adversos , Vigilância da População , Estudos Retrospectivos , Software
3.
BMC Public Health ; 20(1): 1110, 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664859

RESUMO

BACKGROUND: In 1988, the 41st World Health Assembly (WHA) marked the launch of the Global Polio Eradication Initiative (GPEI) for the eradication of polio. A key component of the GPEI has been the development and deployment of a skilled workforce to implement eradication activities. In 1989, the Stop Transmission of Polio (STOP) was initiated to address skilled human resource gaps and strengthen poliovirus surveillance. This paper describes the role of the STOP 52 team in technical capacity building and health system strengthening in the implementation of polio eradication strategies in Kenya following the outbreak of Circulating Vaccine-derived Poliovirus type 2 (cVDPV2). METHODS: Overview of the STOP program, deployment, and the modality of support are described. Descriptive analysis was conducted using data collected by the STOP 52 team during integrated supportive supervisory visits conducted from July 2018 to September 2019. Analyses were carried out using Epi-Info statistical software (Version 7.0) and maps were developed using Quantum Geographic Information System (Q-GIS) (version 3.12.0). RESULTS: The STOP 52 team supportively supervised 870 health facilities on Expanded Program on Immunization (EPI), and Acute Flaccid Paralysis (AFP) and other Vaccine-Preventable Diseases (VPDs) surveillance in 16 (34.1%) of the 47 counties during the study period. AFP surveillance was conducted in all health facilities supervised leading to the detection and investigation of 11 unreported AFP cases. The STOP 52 team, as part of the outbreak response, provided technical support to five successive rounds of polio Supplementary Immunization Activities (SIAs) conducted during the study period. Moreover, in addressing programmatic data needs, the STOP 52 Data Manager played a valuable role in enhancing the quality and use of data for evidence-based planning and decision-making. The STOP 52 team contributed to the development of operational plans, guidelines and training manuals, and participated in the delivery of various Training of Trainers (TOT) and On-the-Job Training (OJT) on EPI, AFP and other VPDs surveillance including data management. CONCLUSION: The STOP 52 team has contributed to polio eradication efforts in Kenya by enhancing AFP and other VPDs surveillance, supporting polio SIAs, strengthening EPI, use of quality EPI, AFP and other VPDs data, and capacity building of Frontline Health Workers (FLWs). The use of Open Data Kit (ODK) technology during supportive supervision, and AFP and other VPDs surveillance was found to be advantageous. A national STOP program should be modeled to produce a homegrown workforce to ensure the availability of more sustainable technical support for polio eradication efforts in Kenya and possibly other polio-affected countries.


Assuntos
Erradicação de Doenças/organização & administração , Surtos de Doenças/prevenção & controle , Promoção da Saúde/métodos , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Poliomielite/prevenção & controle , Vacinação/estatística & dados numéricos , Países em Desenvolvimento , Erradicação de Doenças/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Humanos , Quênia , Vigilância da População
4.
PLoS One ; 15(3): e0230783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226039

RESUMO

BACKGROUND: In 2016, Kenya conducted a study of missed opportunities for vaccination (MOV)-when eligible children have contact with the health system but are not fully vaccinated-to explore some of the reasons for persistent low vaccination coverage. This paper details the qualitative findings from that assessment. METHODS: Using the World Health Organization MOV methodology, teams conducted focus group discussions among caregivers and health workers and in-depth interviews of key informants in 10 counties in Kenya. Caregivers of children <24 months of age visiting the selected health facilities on the day of the assessment were requested to participate in focus group discussions. Health workers were purposively sampled to capture a broad range of perspectives. Key informants were selected based on their perceived insight on immunization services at the county, sub-county, or health facility level. RESULTS: Six focus group discussions with caregivers, eight focus group discussions with health workers, and 35 in-depth interviews with key informants were completed. In general, caregivers had positive attitudes toward healthcare and vaccination services, but expressed a desire for increased education surrounding vaccination. In order to standardize vaccination checks at all health facility visits, health workers and key informants emphasized the need for additional trainings for all staff members on immunization. Health workers and key informants also highlighted the negative impact of significant understaffing in health facilities, and the persistent challenge of stock-outs of vaccines and vaccination-related supplies. CONCLUSIONS: Identified factors that could contribute to MOV include a lack of knowledge surrounding vaccination among caregivers and health workers, inadequate number of health workers, and stock-outs of vaccines or vaccination-related materials. In addition, vaccination checks outside of vaccination visits lacked consistency, leading to MOV in non-vaccinating departments. Qualitative assessments could provide a starting point for understanding and developing interventions to address MOV in other countries.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Agentes Comunitários de Saúde/psicologia , Feminino , Humanos , Quênia , Masculino , Vacinação/psicologia
5.
PLoS One ; 13(8): e0201538, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30071060

RESUMO

BACKGROUND: Home-based records (HBRs), which take many forms, serve as an important tool for frontline health workers by providing a standardized patient history vital to making informed decisions about the need for immunization services. There are increasing concerns around HBRs with recording areas that are functionally irrelevant because records are incomplete or not up-to-date. The aim of this report was to describe HBR ownership and report on the utilization of selected recording areas in HBRs across selected study communities in Kenya. METHODS: The Kenya Missed Opportunities for Vaccination Assessment utilized a mixed-methods approach that included exit interviews, using a standardized questionnaire, among a convenience sample of caregivers of children aged <24 months attending a health facility during November 2016 as well as interviews of health staff and facility administrators. In addition to the exit interview data, we analysed data obtained from a review of available HBRs from the children. RESULTS: A total of 677 children were identified with a valid date of birth and who were aged <24 months. A HBR was in hand and reviewed for three-quarters of the children. Nearly one-third (n = 41) of those without a HBR in hand at the visit noted that they did not know the importance of bringing the document with them. Roughly two-thirds (n = 443) of caregivers noted they were asked by clinic staff to see the HBR during the clinic visit. Across the 516 reviewed HBRs, recording areas were most commonly identified for the child's demographic information (80% of HBRs) and vaccination history (82%) with information marked in >90% of records. Recording areas were less frequently available for child early eye / vision problems (61%), growth monitoring (74%) and vitamin A (76%); with information marked in 33%, 88% and 60% of records, respectively. CONCLUSIONS: Critical to the reduction of missed opportunities for vaccination, the HBR's importance must be emphasized and the document must be requested by health workers at every health encounter. Health workers must not only ensure that all children receive a HBR and counsel caregivers of its importance, but they must also ensure that all sections of the record are legibly completed to ensure continuity of care. Programmes are encouraged to periodically review and critically assess the HBR to determine whether the document's design and content areas are optimal to end user needs.


Assuntos
Registros de Saúde Pessoal , Programas de Imunização/métodos , Inquéritos e Questionários , Feminino , Humanos , Lactente , Recém-Nascido , Quênia , Masculino
6.
PLoS One ; 13(7): e0199786, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29965975

RESUMO

INTRODUCTION: To achieve measles elimination, two doses of measles-containing vaccine (MCV) are provided through routine immunization services or vaccination campaigns. In May 2016, Kenya conducted a measles-rubella (MR) vaccination campaign targeting 19 million children aged 9 months-14 years, with a goal of achieving ≥95% coverage. We conducted a post-campaign cluster survey to estimate national coverage and classify coverage in Kenya's 47 counties. METHODS: The stratified multi-stage cluster survey included data from 20,011 children in 8,253 households sampled using the recently revised World Health Organization coverage survey methodology (2015). Point estimates and 95% confidence intervals (95% CI) of national campaign coverage were calculated, accounting for study design. County vaccination coverage was classified as 'pass,' 'fail,' or 'intermediate,' using one-sided hypothesis tests against a 95% threshold. RESULTS: Estimated national MR campaign coverage was 95% (95% CI: 94%-96%). Coverage differed significantly (p < 0.05) by child's school attendance, mother's education, household wealth, and other factors. In classifying coverage, 20 counties passed (≥95%), two failed (<95%), and 25 were intermediate (unable to classify either way). Reported campaign awareness among caretakers was 92%. After the 2016 MR campaign, an estimated 93% (95% CI: 92%-94%) of children aged 9 months to 14 years had received ≥2 MCV doses; 6% (95% CI: 6%-7%) had 1 MCV dose; and 0.7% (95% CI: 0.6%-0.9%) remained unvaccinated. CONCLUSIONS: Kenya reached the MR campaign target of 95% vaccination coverage, representing a substantial achievement towards increasing population immunity. High campaign awareness reflected the comprehensive social mobilization strategy implemented in Kenya and supports the importance of including strong communications platforms in future vaccination campaigns. In counties with sub-optimal MR campaign coverage, further efforts are needed to increase MCV coverage to achieve the national goal of measles elimination by 2020.


Assuntos
Programas de Imunização/estatística & dados numéricos , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Vacina contra Rubéola/administração & dosagem , Rubéola (Sarampo Alemão)/prevenção & controle , Vacinação/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Programas de Imunização/classificação , Lactente , Quênia/epidemiologia , Masculino , Sarampo/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Inquéritos e Questionários , Organização Mundial da Saúde
7.
Pan Afr Med J ; 31: 65, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31007812

RESUMO

INTRODUCTION: Measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination. METHODS: We reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years. RESULTS: The coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year. CONCLUSION: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains.


Assuntos
Erradicação de Doenças , Programas de Imunização , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Quênia/epidemiologia , Masculino , Sarampo/epidemiologia , Vírus do Sarampo/imunologia , Vigilância da População , Vacinação/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos
8.
Artigo em Inglês | AIM (África) | ID: biblio-1268544

RESUMO

Introduction: measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.Methods: we reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.Results: the coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.Conclusion: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains


Assuntos
Quênia , Vacina contra Sarampo/administração & dosagem , Sarampo/diagnóstico , Sarampo/epidemiologia , Sarampo/prevenção & controle
9.
PLoS One ; 12(8): e0181777, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28763454

RESUMO

As of 2015, only 12 countries in the World Health Organization's AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya's efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival.


Assuntos
Serviços de Saúde da Criança/organização & administração , Política de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Adulto , Saúde da Criança , Mortalidade da Criança , Pré-Escolar , Feminino , Grupos Focais , Infecções por HIV/prevenção & controle , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Quênia , Masculino , Serviços de Saúde Materna/organização & administração , Neonatologia/organização & administração , Obstetrícia/organização & administração , Gravidez , População Rural , População Urbana , Adulto Jovem
10.
J Infect Dis ; 210 Suppl 1: S85-90, 2014 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-25316880

RESUMO

BACKGROUND: Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process. METHODS: Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance. RESULTS: Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. CONCLUSIONS: Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.


Assuntos
Surtos de Doenças , Monitoramento Epidemiológico , Paralisia/epidemiologia , Paralisia/prevenção & controle , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Vacinas contra Poliovirus/administração & dosagem , Adolescente , Animais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Masculino , Vacinas contra Poliovirus/provisão & distribuição , Vacinação/estatística & dados numéricos
11.
Am J Trop Med Hyg ; 78(2): 333-7, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18256441

RESUMO

An outbreak of Chikungunya virus (CHIKV) disease associated with high fever and severe protracted arthralgias was detected in Lamu, Kenya, peaking in July 2004. At least 1,300 cases were documented. We conducted a seroprevalence study to define the magnitude of transmission on Lamu Island. We conducted a systematic cross-sectional survey. We administered questionnaires and tested 288 sera from Lamu residents for IgM and IgG antibodies to CHIKV. Chikungunya virus infection (seropositivity) was defined as a person with IgG and/or IgM antibodies to CHIKV. IgM antibodies to CHIKV were detected in 18% (53/288) and IgG antibodies in 72% (206/288); IgM and/or IgG antibodies were present in 75% (215/288). The seroprevalence findings suggested that the outbreak was widespread, affecting 75% of the Lamu population; extrapolating the findings to the entire population, 13,500 (95% CI, 12,458-14328) were affected. Vector control strategies are needed to control the spread of this mosquito-borne infection.


Assuntos
Infecções por Alphavirus/epidemiologia , Anticorpos Antivirais/sangue , Vírus Chikungunya/imunologia , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Alphavirus/sangue , Vírus Chikungunya/isolamento & purificação , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos
12.
Am J Trop Med Hyg ; 78(1): 77-82, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18187788

RESUMO

From January to April 2005, an epidemic of chikungunya virus (CHIKV) illness occurred in the Union of Comoros. Entomological studies were undertaken during the peak of the outbreak, from March 11 to March 31, aimed at identifying the primary vector(s) involved in transmission so that appropriate public health measures could be implemented. Adult mosquitoes were collected by backpack aspiration and human landing collection in homes and neighborhoods of clinically ill patients. Water-holding containers were inspected for presence of mosquito larvae. Adult mosquitoes were analyzed by RT-PCR and cultivation in cells for the presence of CHIK virus and/or nucleic acid. A total of 2,326 mosquitoes were collected and processed in 199 pools. The collection consisted of 62.8% Aedes aegypti, 25.5% Culex species, and 10.7% Aedes simpsoni complex, Eretmapodites spp and Anopheles spp. Seven mosquito pools were found to be positive for CHIKV RNA and 1 isolate was obtained. The single CHIKV mosquito isolate was from a pool of Aedes aegypti and the minimum infection rate (MIR) for this species was 4.0, suggesting that Ae. aegypti was the principal vector responsible for the outbreak. This was supported by high container (31.1%), household (68%), and Breteau (126) indices, with discarded tires (58.8%) and small cooking and water storage vessels (31.1%) registering the highest container indices.


Assuntos
Infecções por Alphavirus/epidemiologia , Infecções por Alphavirus/transmissão , Vírus Chikungunya/isolamento & purificação , Culicidae/virologia , Surtos de Doenças , Insetos Vetores/virologia , Infecções por Alphavirus/etiologia , Infecções por Alphavirus/virologia , Animais , Vírus Chikungunya/genética , Comores/epidemiologia , Feminino , Humanos , Larva/virologia , Masculino , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa
13.
Am J Trop Med Hyg ; 76(6): 1189-93, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17556634

RESUMO

An outbreak of Chikungunya virus (CHIKV) illness associated with high fever combined with prolonged and severe arthralgias occurred on Grande Comore Island from January through May 2005; 5,202 cases were reported. A seroprevalence study was conducted to define the extent of transmission on the island. We conducted a cross-sectional survey using a multistage sampling technique. A total of 481 households were sampled. In each household, one resident was selected randomly for interview and blood collection. We administered questionnaires and tested 331 sera for CHIKV-specific IgM and IgG antibodies by capture enzyme-linked immunosorbent assay. Infection with CHIKV infection (seropositivity) was defined as presence of IgG and/or IgM antibodies to CHIKV. A total of 331 (69%) of 481 survey participants consented to blood collection. Antibodies to CHIKV were detected in 63% of sera; IgM antibodies were found in 60% of specimens and IgG antibodies were detected in 27% of specimens. Extrapolation of the findings to the entire Grande Comore population suggested that nearly 215,000 people were infected with CHIKV during the outbreak. A total of 79% of the seropositive persons were hospitalized or stayed at home in bed for a mean of 6 days (range = 1-30 days); 52% missed work or school for a mean of 7 days (range = 1-40 days). The findings suggest that CHIKV was broadly transmitted during the outbreak with a high attack rate. Although not fatal during this outbreak, CHIKV infection caused significant morbidity and decreased economic productivity.


Assuntos
Infecções por Alphavirus/epidemiologia , Vírus Chikungunya/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Alphavirus/imunologia , Infecções por Alphavirus/virologia , Criança , Pré-Escolar , Comores/epidemiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos
14.
Am J Trop Med Hyg ; 76(3): 405-7, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17360859

RESUMO

Epidemics of chikungunya fever, an Aedes spp.-borne viral disease, affected hundreds of thousands of people in western Indian Ocean islands and India during 2005-2006. The initial outbreaks occurred in coastal Kenya (Lamu, then Mombasa) in 2004. We investigated eco-climatic conditions associated with chikungunya fever emergence along coastal Kenya using epidemiologic investigations and satellite data. Unusually dry, warm conditions preceded the outbreaks, including the driest since 1998 for some of the coastal regions. Infrequent replenishment of domestic water stores and elevated temperatures may have facilitated Chikungunya virus transmission. These results suggest that drought-affected populations may be at heightened risk for chikungunya fever, and underscore the need for safe water storage during drought relief operations.


Assuntos
Infecções por Alphavirus/etiologia , Vírus Chikungunya , Desastres , Infecções por Alphavirus/epidemiologia , Surtos de Doenças , Humanos , Quênia/epidemiologia , Fatores de Tempo
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