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2.
BMC Infect Dis ; 21(1): 202, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622264

RESUMO

BACKGROUND: Persistence of cholera outbreaks in developing countries calls for concern and more targeted intervention measures for long-term control. This research undertook spatial analysis of cholera incidence in Nigeria over a seventeen-year period to determine the existence of regional hotspots and predictors. METHODS: A cross-sectional study design was used for the research. Cholera data for each of the thirty-six states and the federal capital territory (FCT) were obtained from the Nigeria Centre for Disease Control (NCDC) of the Federal Ministry of Health, Nigeria. Socioeconomic data including proportion of households using solid waste disposal (unapproved dumpsite, refuse burying, refuse burning, public dumpsite, and refuse collectors), water sources (pipe borne water, well, borehole, rain water, surface waters and water vendors), sewage disposal (water closet, pit latrines, bucket/pan, public toilet and nearby bush/stream), living in a single room and earning less than minimum wage (18,000 naira) were obtained from National Population Commission. On the other hand, proportion of illiterate adults (15 years and above) and poor people; and population density were obtained from National Bureau of Statistics. Each socioeconomic data was obtained at state level. Cholera patterns were analysed at state level using Global Moran's I while specific locations of cholera clusters were determined using Local Moran's I. Stepwise multiple regression was used to determine socioeconomic predictors of cholera incidence. RESULTS: Local Moran's I revealed significant cluster patterns in 1999, 2001, 2002, 2009 and 2010 in Adamawa, Gombe, Katsina, Bauchi, Borno, Yobe, and Kano states. Households using surface water was the significant predictor (23%) of the observed spatial variations in cholera incidence. CONCLUSIONS: Persistence of cholera outbreaks in some north east and north western states calls for more targeted, long-term and effective intervention measures especially on provision of safe sources of water supply by government and other stakeholders.


Assuntos
Cólera/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Adulto , Estudos Transversais , Humanos , Incidência , Nigéria/epidemiologia , Fatores Socioeconômicos , Análise Espacial , Abastecimento de Água
4.
J Med Microbiol ; 70(2)2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33416465

RESUMO

Cholera is a severe diarrhoeal disease that spreads rapidly and affects millions of people each year, resulting in tens of thousands of deaths. The disease is caused by Vibrio cholerae O1 and is characterized by watery diarrhoea that can be lethal if not properly treated. Cholera had not been reported in South America from the late 1800s until 1991, when it was introduced in Peru, wreaking havoc in one of the biggest epidemics reported to date. Within a year, the disease had spread to most of the Latin American region, resulting in millions of cases and thousands of deaths in all affected countries. Despite its aggressive entry, cholera virtually disappeared from the continent after 1999. The progression of the entire epidemic was well documented, making it an ideal model to understand cholera dynamics. In this review, we highlight how the synergy of socioeconomic, political and ecological factors led to the emergence, rapid spread and eventual disappearance of cholera in Latin America. We discuss how measures implemented during the cholera epidemic drastically changed its course and continental dynamics. Finally, we synthesize our findings and highlight potential lessons that can be learned for efficient and standardized cholera management programmes during future outbreaks in non-endemic areas.


Assuntos
Cólera/epidemiologia , Controle de Doenças Transmissíveis/métodos , Vibrio cholerae O1/isolamento & purificação , Cólera/patologia , Mudança Climática , Epidemias , Humanos , América Latina/epidemiologia , Política , Fatores Socioeconômicos , América do Sul/epidemiologia , Vibrio cholerae O1/imunologia
5.
BMC Med ; 18(1): 397, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33317544

RESUMO

BACKGROUND: Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. METHODS: We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. RESULTS: Seventy-six outbreaks from 34 countries were included. Median delays spanned 1-2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5-5), detection (5 days, IQR 5-6), investigation (7 days, IQR 5.8-13.3), response (10 days, IQR 7-18), and confirmation (11 days, IQR 7-16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5-9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7-61.0, p = 0.03). CONCLUSIONS: From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.


Assuntos
Cólera/diagnóstico , Cólera/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Diagnóstico Precoce , Epidemias , Controle de Infecções/métodos , Conflitos Armados/estatística & dados numéricos , Cólera/prevenção & controle , Cólera/terapia , Simulação por Computador , Diagnóstico Tardio/estatística & dados numéricos , Surtos de Doenças/história , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Intervenção Médica Precoce/métodos , Intervenção Médica Precoce/normas , Epidemias/história , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , História do Século XX , História do Século XXI , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Modelos Estatísticos , Vigilância da População/métodos , Tempo de Reação , Refugiados/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos
6.
PLoS Negl Trop Dis ; 14(12): e0008959, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33362241

RESUMO

Vibrio cholerae causes the fatal cholera diarrhea. Chironomids (Diptera; Chironomidae) are abundant in freshwater aquatic habitats and estuaries and are natural reservoirs of V. cholerae. Until now, only the non-O1/O139 serogroups of V. cholerae were identified in chironomids. Here, we explored whether chironomids are natural reservoirs of V. cholerae O1/O139 serogroups, which are associated with cholera endemics and pandemics. All four life stages of chironomids were sampled from two rivers, and a laboratory culture in Pune, India, and from a pond in Israel. In total, we analyzed 223 chironomid samples. The presence of V. cholerae O1/O139 serogroups was verified using molecular tools. Nine chironomid species were identified; of them, Chironomus circumdatus was the most abundant. The presence of V. cholerae serogroup O1 and the cholera toxin genes were detected in samples from all chironomid species. However, serogroup O139 was detected in only two chironomid species. Besides PCR to detect specific genes, a metagenomic analysis that was performed in three selected C. ramosus larvae, identified a list of virulence genes associated with V. cholerae. The findings provide evidence that chironomids are natural reservoirs of toxigenic V. cholerae O1/O139. Chironomid populations and V. cholerae show biannual peak patterns. A similar pattern is found for cholera epidemics in the Bengal Delta region. Thus, we hypothesize that monitoring chironomids in endemic areas of the disease may provide a novel tool for predicting and preventing cholera epidemics. Moreover, serogroup O139 was detected only in two chironomid species that have a restricted distribution in the Indian subcontinent, possibly explaining why the distribution of the O139 serogroup is limited.


Assuntos
Chironomidae/microbiologia , Toxina da Cólera/genética , Cólera/epidemiologia , Reservatórios de Doenças/microbiologia , Pandemias , Vibrio cholerae/genética , Animais , Cólera/microbiologia , Ecossistema , Feminino , Água Doce , Humanos , Índia/epidemiologia , Israel/epidemiologia , Reação em Cadeia da Polimerase , Rios , Vibrio cholerae/patogenicidade , Virulência/genética
7.
Artigo em Inglês | MEDLINE | ID: mdl-33333823

RESUMO

Oceanic and coastal ecosystems have undergone complex environmental changes in recent years, amid a context of climate change. These changes are also reflected in the dynamics of water-borne diseases as some of the causative agents of these illnesses are ubiquitous in the aquatic environment and their survival rates are impacted by changes in climatic conditions. Previous studies have established strong relationships between essential climate variables and the coastal distribution and seasonal dynamics of the bacteria Vibrio cholerae, pathogenic types of which are responsible for human cholera disease. In this study we provide a novel exploration of the potential of a machine learning approach to forecast environmental cholera risk in coastal India, home to more than 200 million inhabitants, utilising atmospheric, terrestrial and oceanic satellite-derived essential climate variables. A Random Forest classifier model is developed, trained and tested on a cholera outbreak dataset over the period 2010-2018 for districts along coastal India. The random forest classifier model has an Accuracy of 0.99, an F1 Score of 0.942 and a Sensitivity score of 0.895, meaning that 89.5% of outbreaks are correctly identified. Spatio-temporal patterns emerged in terms of the model's performance based on seasons and coastal locations. Further analysis of the specific contribution of each Essential Climate Variable to the model outputs shows that chlorophyll-a concentration, sea surface salinity and land surface temperature are the strongest predictors of the cholera outbreaks in the dataset used. The study reveals promising potential of the use of random forest classifiers and remotely-sensed essential climate variables for the development of environmental cholera-risk applications. Further exploration of the present random forest model and associated essential climate variables is encouraged on cholera surveillance datasets in other coastal areas affected by the disease to determine the model's transferability potential and applicative value for cholera forecasting systems.


Assuntos
Cólera , Cólera/epidemiologia , Ecossistema , Humanos , Índia/epidemiologia , Aprendizado de Máquina , Oceanos e Mares
8.
Nat Commun ; 11(1): 4918, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004800

RESUMO

In order to control and eradicate epidemic cholera, we need to understand how epidemics begin, how they spread, and how they decline and eventually end. This requires extensive sampling of epidemic disease over time, alongside the background of endemic disease that may exist concurrently with the epidemic. The unique circumstances surrounding the Argentinian cholera epidemic of 1992-1998 presented an opportunity to do this. Here, we use 490 Argentinian V. cholerae genome sequences to characterise the variation within, and between, epidemic and endemic V. cholerae. We show that, during the 1992-1998 cholera epidemic, the invariant epidemic clone co-existed alongside highly diverse members of the Vibrio cholerae species in Argentina, and we contrast the clonality of epidemic V. cholerae with the background diversity of local endemic bacteria. Our findings refine and add nuance to our genomic definitions of epidemic and endemic cholera, and are of direct relevance to controlling current and future cholera epidemics.


Assuntos
Cólera/microbiologia , Doenças Endêmicas/prevenção & controle , Genoma Bacteriano/genética , Pandemias/prevenção & controle , Vibrio cholerae/genética , Argentina/epidemiologia , Cólera/epidemiologia , Cólera/prevenção & controle , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , História do Século XIX , História do Século XX , Humanos , Anotação de Sequência Molecular , Pandemias/história , Filogenia , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNA , Vibrio cholerae/isolamento & purificação , Vibrio cholerae/patogenicidade
9.
BMC Infect Dis ; 20(1): 741, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036564

RESUMO

BACKGROUND: Cholera remains a major global health challenge. Uvira, in the Democratic Republic of the Congo (DRC), has had endemic cholera since the 1970's and has been implicated as a possible point of origin for national outbreaks. A previous study among this population, reported a case confirmation rate of 40% by rapid diagnostic test (RDT) among patients at the Uvira Cholera Treatment Centre (CTC). This study considers the prevalence and diversity of 15 enteric pathogens in suspected cholera cases seeking treatment at the Uvira CTC. METHODS: We used the Luminex xTAG® multiplex PCR to test for 15 enteric pathogens, including toxigenic strains of V. cholerae in rectal swabs preserved on Whatman FTA Elute cards. Results were interpreted on MAGPIX® and analyzed on the xTAG® Data Analysis Software. Prevalence of enteric pathogens were calculated and pathogen diversity was modelled with a Poisson regression. RESULTS: Among 269 enrolled CTC patients, PCR detected the presence of toxigenic Vibrio cholerae in 38% (103/269) of the patients, which were considered to be cholera cases. These strains were detected as the sole pathogen in 36% (37/103) of these cases. Almost half (45%) of all study participants carried multiple enteric pathogens (two or more). Enterotoxigenic Escherichia coli (36%) and Cryptosporidium (28%) were the other most common pathogens identified amongst all participants. No pathogen was detected in 16.4% of study participants. Mean number of pathogens was highest amongst boys and girls aged 1-15 years and lowest in women aged 16-81 years. Ninety-three percent of toxigenic V. cholerae strains detected by PCR were found in patients having tested positive for V. cholerae O1 by RDT. CONCLUSIONS: Our study supports previous results from DRC and other cholera endemic areas in sub-Sahara Africa with less than half of CTC admissions positive for cholera by PCR. More research is required to determine the causes of severe acute diarrhea in these low-resource, endemic areas to optimize treatment measures. TRIAL REGISTRATION: This study is part of the impact evaluation study entitled: "Impact Evaluation of Urban Water Supply Improvements on Cholera and Other Diarrheal Diseases in Uvira, Democratic Republic of Congo" registered on 10 October 2016 at clinicaltrials.gov Identification number: NCT02928341 .


Assuntos
Cólera/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/epidemiologia , Surtos de Doenças , Escherichia coli Enterotoxigênica/genética , Infecções por Escherichia coli/epidemiologia , Vibrio cholerae/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Cólera/microbiologia , Criptosporidiose/parasitologia , República Democrática do Congo/epidemiologia , Testes Diagnósticos de Rotina , Diarreia/microbiologia , Doenças Endêmicas , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Prevalência , Microbiologia da Água , Adulto Jovem
10.
Nat Commun ; 11(1): 5347, 2020 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-33093464

RESUMO

In 1970, the seventh pandemic of cholera (7 P) reached both Africa and Europe. Between 1970 and 2011, several European countries reported cholera outbreaks of a few to more than 2,000 cases. We report here a whole-genome analysis of 1,324 7 P V. cholerae El Tor (7 PET) isolates, including 172 from autochthonous sporadic or outbreak cholera cases occurring between 1970 and 2011 in Europe, providing insight into the spatial and temporal spread of this pathogen across Europe. In this work, we show that the 7 PET lineage was introduced at least eight times into two main regions: Eastern and Southern Europe. Greater recurrence of the disease was observed in Eastern Europe, where it persisted until 2011. It was introduced into this region from Southern Asia, often circulating regionally in the countries bordering the Black Sea, and in the Middle East before reaching Eastern Africa on several occasions. In Southern Europe, the disease was mostly seen in individual countries during the 1970s and was imported from North and West Africa, except in 1994, when cholera was imported into Albania and Italy from the Black Sea region. These results shed light on the geographic course of cholera during the seventh pandemic and highlight the role of humans in its global dissemination.


Assuntos
Cólera/história , Pandemias/história , Cólera/epidemiologia , Cólera/microbiologia , Farmacorresistência Bacteriana/genética , Europa (Continente)/epidemiologia , Evolução Molecular , Genoma Bacteriano , Genômica , História do Século XX , História do Século XXI , Migração Humana/história , Humanos , Filogenia , Ribotipagem , Análise Espaço-Temporal , Vibrio cholerae/classificação , Vibrio cholerae/genética , Vibrio cholerae/isolamento & purificação
11.
Postgrad Med J ; 96(1140): 633-638, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32907877

RESUMO

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.


Assuntos
Infecções por Coronavirus/epidemiologia , Ética Médica/história , Alocação de Recursos para a Atenção à Saúde/ética , Hospitais/história , Pandemias/história , Pneumonia Viral/epidemiologia , Quarentena/história , Betacoronavirus , Cólera/epidemiologia , Cólera/história , Mão de Obra em Saúde , Juramento Hipocrático , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , Humanos , Hanseníase/epidemiologia , Hanseníase/história , Peste/epidemiologia , Peste/história , Alocação de Recursos , Estados Unidos/epidemiologia
12.
PLoS One ; 15(9): e0238438, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881972

RESUMO

Vibrio cholerae is a natural inhabitant of aquatic ecosystems worldwide, typically residing in coastal or brackish water. While more than 200 serogroups have been identified, only serogroups O1 and O139 have been associated with epidemic cholera. However, infections other than cholera can be caused by nonepidemic, non-O1/non-O139 V. cholerae strains, including gastroenteritis and extraintestinal infections. While V. cholerae can also survive in freshwater, that is typically only observed in regions of the world where cholera is endemic. We recently isolated V. cholerae from several locations in lakes and rivers in northwest Ohio. These isolates were all found to be non-O1/non-O139 V. cholerae strains, that would not cause cholera. However, these isolates contained a variety of virulence genes, including ctxA, rtxA, rtxC, hlyA, and ompU. Therefore, it is possible that some of these isolates have the potential to cause gastroenteritis or other infections in humans. We also investigated the relative motility of the isolates and their ability to form biofilms as this is important for V. cholerae survival in the environment. We identified one isolate that forms very robust biofilms, up to 4x that of our laboratory strains. Finally, we investigated the susceptibility of these isolates to a panel of antibiotics. We found that many of the isolates showed decreased susceptibility to some of the antibiotics tested, which could be of concern. While we do not know if these isolates are pathogenic to humans, increased surveillance to better understand the public health risk to the local community should be considered.


Assuntos
Água Doce/microbiologia , Vibrio cholerae/genética , Proteínas de Bactérias/genética , Cólera/epidemiologia , Ecossistema , Humanos , Ohio/epidemiologia , Reação em Cadeia da Polimerase , Vibrio cholerae/isolamento & purificação , Vibrio cholerae/metabolismo , Virulência/genética , Fatores de Virulência/genética , Microbiologia da Água
13.
Arch Iran Med ; 23(8): 578-581, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32894975

RESUMO

In the past two centuries, several fatal infectious outbreaks have arisen in Iran. Presented here is a brief historical account of four fatal epidemics including cholera, plague, Spanish influenza of 1918 and smallpox between1796 and 1979. The lessons from these outbreaks could be helpful for better combatting other deadly epidemics including the present-day disastrous COVID-19 pandemic.


Assuntos
Cólera/história , Controle de Doenças Transmissíveis/história , Epidemias/história , Influenza Pandêmica, 1918-1919/história , Peste/história , Varíola/história , Cólera/epidemiologia , Cólera/prevenção & controle , Epidemias/prevenção & controle , História do Século XIX , História do Século XX , Humanos , Irã (Geográfico)/epidemiologia , Peste/epidemiologia , Peste/prevenção & controle , Varíola/epidemiologia , Varíola/prevenção & controle
14.
PLoS Negl Trop Dis ; 14(8): e0008661, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32866145

RESUMO

Household spraying is a commonly implemented, yet an under-researched, cholera response intervention where a response team sprays surfaces in cholera patients' houses with chlorine. We conducted mixed-methods evaluations of three household spraying programs in the Democratic Republic of Congo and Haiti, including 18 key informant interviews, 14 household surveys and observations, and 418 surface samples collected before spraying, 30 minutes and 24 hours after spraying. The surfaces consistently most contaminated with Vibrio cholerae were food preparation areas, near the patient's bed and the latrine. Effectiveness varied between programs, with statistically significant reductions in V. cholerae concentrations 30 minutes after spraying in two programs. Surface contamination after 24 hours was variable between households and programs. Program challenges included difficulty locating households, transportation and funding limitations, and reaching households quickly after case presentation (disinfection occurred 2-6 days after reported cholera onset). Program advantages included the concurrent deployment of hygiene promotion activities. Further research is indicated on perception, recontamination, cost-effectiveness, viable but nonculturable V. cholerae, and epidemiological coverage. We recommend that, if spraying is implemented, spraying agents should: disinfect surfaces systematically until wet using 0.2/2.0% chlorine solution, including kitchen spaces, patients' beds, and latrines; arrive at households quickly; and, concurrently deploy hygiene promotion activities.


Assuntos
Cólera/epidemiologia , Cólera/prevenção & controle , Desinfecção/métodos , Características da Família , Cloro , Congo/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Haiti/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Inquéritos e Questionários , Toaletes , Vibrio cholerae
15.
PLoS Negl Trop Dis ; 14(8): e0008406, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32776919

RESUMO

We hypothesized that Cholera (Vibrio cholerae) that appeared along Lake Kivu in the African Rift in the seventies, might be controlled by volcano-tectonic activity, which, by increasing surface water and groundwater salinity and temperature, may partly rule the water characteristics of Lake Kivu and promote V. cholerae proliferation. Volcanic activity (assessed weekly by the SO2 flux of Nyiragongo volcano plume over the 2007-2012 period) is highly positively correlated with the water conductivity, salinity and temperature of the Kivu lake. Over the 2007-2012 period, these three parameters were highly positively correlated with the temporal dynamics of cholera cases in the Katana health zone that border the lake. Meteorological variables (air temperature and rainfall), and the other water characteristics (namely pH and dissolved oxygen concentration in lake water) were unrelated to cholera dynamics over the same period. Over the 2016-2018 period, we sampled weekly lake water salinity and conductivity, and twice a month vibrio occurrence in lake water and fish. The abundance of V. cholerae in the lake was positively correlated with lake salinity, temperature, and the number of cholera cases in the population of the Katana health zone. V. cholerae abundance in fishes was positively correlated with V. cholerae abundance in lake water, suggesting that their consumption directly contaminate humans. The activity of the volcano, by controlling the physico-chemical characteristics of Lake Kivu, is therefore a major determinant of the presence of the bacillus in the lake. SO2 fluxes in the volcano plume can be used as a tool to predict epidemic risks.


Assuntos
Cólera/epidemiologia , Lagos/química , Lagos/microbiologia , Erupções Vulcânicas/efeitos adversos , Animais , República Democrática do Congo/epidemiologia , Condutividade Elétrica , Peixes/microbiologia , Humanos , Concentração de Íons de Hidrogênio , Oxigênio/análise , Ruanda , Salinidade , Dióxido de Enxofre/análise , Temperatura , Vibrio , Microbiologia da Água
16.
Artigo em Inglês | MEDLINE | ID: mdl-32781601

RESUMO

Distribution, investigation, surveillance and control (DISC) of cholera outbreaks in endemic/non-endemic regions has been a concerted approach towards the management of the causal pathogen. Relevant organization, government, health systems and the public have implemented several steps towards controlling the menace, yet pathogen continues to occur with diverse phenotypes/genotypes of high clinical and epidemiological relevance. The study determines antibiotic susceptibility/resistance pattern of Vibrio cholerae isolates retrieved from six domestic water sources between March and August 2018. Serological and molecular typing methods (polymerase chain reaction or PCR) were used to confirm the isolates identity. Antibiotic susceptibility testing was conducted using six commonly employed antibiotics of V. cholerae according to the recommendation of Clinical Laboratory Standard and European Committee for Antimicrobial Susceptibility Testing with other relevant antibiotics of investigative epidemiology and infection control, employing both disc diffusion test and PCR gene detection. Samples presumptive counts ranged between 1.10 to 7.91 log10 CFU/mL. Amongst the 759 presumptive isolates retrieved, sixty-one were confirmed as V. cholerae which were further serogrouped as Non-O1/Non-O139 V. cholerae. Various V. cholerae resistant phenotypes/genoytypes were detected vis: carbapenemase (CR-Vc; 31.1%/5.3%). New Delhi Metallobetalactamase (NDM-1-Vc; 23.0%/42.5%), extended spectrum betalactamase (ESBL-Vc; 42.6%/blaTEM:86,7%), chloramphenicol resistance (62.3%/Flor: 46.2%}, tetracycline resistance (70.5%/46.7%), AmpC resistance (21.0 (34.4%/56.7%)) and various other resistant genotypes/phenotypes. It was observed that more than 50% of the confirmed V. cholerae isolates possess resistance to two or more antibiotic classes/groups with multiple antibiotic resistance index (MARI) ranging from 0.031 to 0.5. This observation provides necessary information and updates for surveillance, planning and implementation of control strategies for cholera. It would also encourage decision making, formulation of policy by the government and cholera control authorities.


Assuntos
Antibacterianos/farmacologia , Cólera/tratamento farmacológico , Cólera/prevenção & controle , Vibrio cholerae/efeitos dos fármacos , Vibrio cholerae/isolamento & purificação , Cólera/epidemiologia , Resistência Microbiana a Medicamentos , Humanos , Controle de Infecções , Testes de Sensibilidade Microbiana/métodos , Reação em Cadeia da Polimerase , Vibrio cholerae/genética , Abastecimento de Água
18.
Eur J Health Econ ; 21(9): 1329-1350, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32789780

RESUMO

Pandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2014. We screened titles and abstracts of papers, and subsequently examined remaining full-text papers. Data were extracted according to a pre-constructed protocol. We included 34 studies of which the majority evaluated interventions related to the H1N1 outbreak in a high-income setting. Most interventions concerned pharmaceuticals. Included costs and benefits, as well as the methods applied, varied substantially between studies. Most studies used a short time horizon and did not include future costs and benefits. We found substantial variation in the included elements and methods used. Policymakers need to be aware of this and the bias toward high-income countries and pharmaceutical interventions, which hampers generalizability. More standardization of included elements, methodology, and reporting would improve economic evaluations and their usefulness for policy.


Assuntos
Cólera/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Epidemias/economia , Viroses/epidemiologia , Cólera/economia , Cólera/terapia , Controle de Doenças Transmissíveis/economia , Análise Custo-Benefício , Humanos , Pandemias , Viroses/economia , Viroses/terapia
19.
Lancet Glob Health ; 8(8): e1081-e1089, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710864

RESUMO

BACKGROUND: Cholera was introduced into Haiti in 2010. Since then, more than 820 000 cases and nearly 10 000 deaths have been reported. Oral cholera vaccine (OCV) is safe and effective, but has not been seen as a primary tool for cholera elimination due to a limited period of protection and constrained supplies. Regionally, epidemic cholera is contained to the island of Hispaniola, and the lowest numbers of cases since the epidemic began were reported in 2019. Hence, Haiti may represent a unique opportunity to eliminate cholera with OCV. METHODS: In this modelling study, we assessed the probability of elimination, time to elimination, and percentage of cases averted with OCV campaign scenarios in Haiti through simulations from four modelling teams. For a 10-year period from January 19, 2019, to Jan 13, 2029, we compared a no vaccination scenario with five OCV campaign scenarios that differed in geographical scope, coverage, and rollout duration. Teams used weekly department-level reports of suspected cholera cases from the Haiti Ministry of Public Health and Population to calibrate the models and used common vaccine-related assumptions, but other model features were determined independently. FINDINGS: Among campaigns with the same vaccination coverage (70% fully vaccinated), the median probability of elimination after 5 years was 0-18% for no vaccination, 0-33% for 2-year campaigns focused in the two departments with the highest historical incidence, 0-72% for three-department campaigns, and 35-100% for nationwide campaigns. Two-department campaigns averted a median of 12-58% of infections, three-department campaigns averted 29-80% of infections, and national campaigns averted 58-95% of infections. Extending the national campaign to a 5-year rollout (compared to a 2-year rollout), reduced the probability of elimination to 0-95% and the proportion of cases averted to 37-86%. INTERPRETATION: Models suggest that the probability of achieving zero transmission of Vibrio cholerae in Haiti with current methods of control is low, and that bolder action is needed to promote elimination of cholera from the region. Large-scale cholera vaccination campaigns in Haiti would offer the opportunity to synchronise nationwide immunity, providing near-term population protection while improvements to water and sanitation promote long-term cholera elimination. FUNDING: Bill & Melinda Gates Foundation, Global Good Fund, Institute for Disease Modeling, Swiss National Science Foundation, and US National Institutes of Health.


Assuntos
Vacinas contra Cólera/administração & dosagem , Cólera/prevenção & controle , Erradicação de Doenças/métodos , Programas de Imunização , Administração Oral , Cólera/epidemiologia , Haiti/epidemiologia , Humanos , Incidência , Modelos Biológicos , Vacinação/estatística & dados numéricos
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