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2.
Pan Afr Med J ; 33(Suppl 2): 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31402968

RESUMO

Introduction: in spite of the efforts and resources committed by the division of infectious disease and epidemiology (DIDE) of the national public health institute of Liberia (NPHIL)/Ministry of health to strengthening integrated disease surveillance and response (IDSR) across the country, quality data management system remains a challenge to the Liberia NPHIL/MoH (Ministry of health), with incomplete and inconsistent data constantly being reported at different levels of the surveillance system. As part of the monitoring and evaluation strategy for IDSR continuous improvement, data quality assessment (DQA) of the IDSR system to identify successes and gaps in the disease surveillance information system (DSIS) with the aim of ensuring data accuracy, reliability and credibility of generated data at all levels of the health system; and to inform an operational plan to address data quality needs for IDSR activities is required. Methods: multi-stage cluster sampling that included stage 1: simple random sample (SRS) of five counties, stage 2: simple random sample of two districts and stage 3: simple random sample of three health facilities was employed during the study pilot assessment done in Montserrado County with Liberia institute of bio medical research (LIBR) inclusive. A total of thirty (30) facilities was targeted, twenty nine (29) of the facilities were successfully audited: one hospital, two health centers, twenty clinics and respondents included: health facility surveillance focal persons (HFSFP), zonal surveillance officers (ZSOs), district surveillance officers (DSOs) and County surveillance officers (CSOs). Results: the assessment revealed that data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the subnational level. The findings indicated the following: 23% (7/29) of health facilities having dedicated phone for reporting, 20% (6/29) reported no cell phone network, 17% (5/29) reported daily access to internet, 56.6% (17/29) reported a consistent supply of electricity, and no facility reported access to functional laptop. It was also established that 40% of health facilities have experienced a stock out of laboratory specimens packaging supplies in the past year. About half of the surveyed health facilities delivered specimens through riders and were assisted by the DSOs. There was a large variety in the reported packaging process, with many staff unable to give clear processes. The findings during the exercise also indicated that 91% of health facility staff were mentored on data quality check and data management including the importance of the timeliness and completeness of reporting through supportive supervision and mentorship; 65% of the health facility assessed received supervision on IDSR core performance indicator; and 58% of the health facility officer in charge gave feedback to the community level. Conclusion: public health is a data-intensive field which needs high-quality data and authoritative information to support public health assessment, decision-making and to assure the health of communities. Data quality assessment is important for public health. In this review completeness, accuracy, and timeliness were the three most-assessed attributes. Quantitative data quality assessment primarily used descriptive surveys and data audits, while qualitative data quality assessment methods include primarily interviews, questionnaires administration, documentation reviews and field observations. We found that data-use and data-process have not been given adequate attention, although they were equally important factors which determine the quality of data. Other limitations of the previous studies were inconsistency in the definition of the attributes of data quality, failure to address data users' concerns and a lack of triangulation of mixed methods for data quality assessment. The reliability and validity of the data quality assessment were rarely reported. These gaps suggest that in the future, data quality assessment for public health needs to consider equally the three dimensions of data quality, data use and data process. Measuring the perceptions of end users or consumers towards data quality will enrich our understanding of data quality issues. Data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the sub national level.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Vigilância em Saúde Pública/métodos , Saúde Pública , Análise por Conglomerados , Comunicação , Confiabilidade dos Dados , Instalações de Saúde/estatística & dados numéricos , Humanos , Libéria/epidemiologia , Projetos Piloto , Reprodutibilidade dos Testes , Risco , Inquéritos e Questionários
3.
Prev Vet Med ; 169: 104710, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31311633

RESUMO

Porcine epidemic diarrhea (PED) is an emerging and/or re-emerging disease of pigs in several countries, with high morbidity and mortality in suckling piglets. Farms affected with PED perform various intervention practices to control and/or eliminate the PED virus. The objectives of the present study were to assess the effect of biosecurity measures and intervention practices to control PED on time to absence of clinical signs (TAC) and number of dead suckling piglets during TAC. A questionnaire was administered to 120-PED affected farms located across Japan between 2013, when the first case was reported in Japan, and 2014. Farms were asked to provide information on farm characteristics and internal or external biosecurity measures during PED outbreak, as well as on intervention practices to control PED. The TAC was defined as the number of days from the date that clinical PED signs appeared to the date that clinical PED signs disappeared. The number of dead piglets per sow (DP/S) was calculated as the number of dead suckling piglets during TAC divided by the sow inventory. Regarding the effect of biosecurity measures during PED outbreak on TAC and DP/S, longer TAC was observed in Actinobacillus pleuropneumoniae-positive farms and farms outsourcing pig transport to the slaughterhouse (p <  0.05). In addition, farms with divided truck entrances had lower DP/S than those without divided entrances (p <  0.05).Regarding the effect of intervention practices to control PED on TAC and DP/S, farms that performed feedback at 2 weeks or later after PED outbreak had longer TAC and higher DP/S than other farms (p <  0.05). Farms that fixed the hours staff worked in farrowing barn had lower DP/S than the other farms (p <  0.05). In conclusion, variables associated with long TAC were Actinobacillus pleuropneumoniae -positive farms, farms outsourcing pig transport to the slaughterhouse, and farms performing feedback at 2 week or later after PED outbreak. Additionally, those associated with high DP/S were farms without divided entrances, farms without a fixed hours worked in the barn, and farms that performed feedback at 2 week or later after PED outbreak.


Assuntos
Infecções por Coronavirus/veterinária , Doenças dos Suínos/mortalidade , Doenças dos Suínos/prevenção & controle , Criação de Animais Domésticos , Animais , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/veterinária , Japão/epidemiologia , Análise Multivariada , Vírus da Diarreia Epidêmica Suína , Fatores de Risco , Inquéritos e Questionários , Suínos , Doenças dos Suínos/epidemiologia , Tempo
4.
Epidemiol Mikrobiol Imunol ; 68(1): 40-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31181951

RESUMO

A decontamination process plays a key role in management of biological incidents. While decontamination of surfaces and buildings located in the hot zone can be usually postponed until an agent is confirmed and an adequate planning phase is established, personnel wearing personal protective equipment must be decontaminated prior to their final exit from the hot zone. Because CBRN units require the shortest possible duration of this procedure, many factors must be considered, including concentration of biological agents, precleaning, disinfectant formulae, its concentration and spectrum of efficacy, contact time, external conditions (temperature, pH, relative humidity, soil load), technical assets used for decontamination, decontaminated surface (compatibility, pores), and staff performance. Experimental tests with surrogates of biological agents are thus necessary to identify above-mentioned points. Once an optimal decontamination procedure is recognized, a field rehearsal must follow and the method using a surrogate must be implemented into a training process of CBRN units.


Assuntos
Controle de Doenças Transmissíveis/métodos , Descontaminação , Meio Ambiente , Microbiologia Industrial/métodos , Fatores Biológicos , Desinfetantes , Humanos
5.
Malar J ; 18(1): 190, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170984

RESUMO

Mozambique has historically been one of the countries with the highest malaria burden in the world. Starting in the 1960s, malaria control efforts were intensified in the southern region of the country, especially in Maputo city and Maputo province, to aid regional initiatives aimed to eliminate malaria in South Africa and eSwatini. Despite significant reductions in malaria prevalence, elimination was never achieved. Following the World Health Organization's renewed vision of a malaria-free-world, and considering the achievements from the past, the Mozambican National Malaria Control Programme (NMCP) embarked on the development and implementation of a strategic plan to accelerate from malaria control to malaria elimination in southern Mozambique. An initial partnership, supported by the Bill and Melinda Gates Foundation and the La Caixa Foundation, led to the creation of the Mozambican Alliance Towards the Elimination of Malaria (MALTEM) and the Malaria Technical and Advisory Committee (MTAC) to promote national ownership and partner coordination to work towards the goal of malaria elimination in local and cross-border initiatives. Surveillance systems to generate epidemiological and entomological intelligence to inform the malaria control strategies were strengthened, and an impact and feasibility assessment of various interventions aimed to interrupt malaria transmission were conducted in Magude district (Maputo Province) through the "Magude Project". The primary aim of this project was to generate evidence to inform malaria elimination strategies for southern Mozambique. The goal of malaria elimination in areas of low transmission intensity is now included in the national malaria strategic plan for 2017-22 and the NMCP and its partners have started to work towards this goal while evidence continues to be generated to move the national elimination agenda forward.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Erradicação de Doenças/organização & administração , Transmissão de Doença Infecciosa/prevenção & controle , Malária/epidemiologia , Malária/prevenção & controle , Financiamento de Capital , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Política de Saúde , Humanos , Controle de Mosquitos/economia , Controle de Mosquitos/métodos , Controle de Mosquitos/organização & administração , Moçambique/epidemiologia
6.
BMC Infect Dis ; 19(1): 517, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185927

RESUMO

BACKGROUND: Although Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+. METHODS: Data were used in two deterministic models simulating a cohort of 2000 HIV+ pregnant women. A decision tree model simulated the number of averted infants infections and QALY acquired for infants in the PMTCT period for Options B and B+. The minimum cost was calculated. A Markov decision model simulated the number of maternal life year gained and serodiscordant partner infections averted in the ten years after PMTCT for Option B or B+. ICER per life year gained was calculated. Deterministic sensitivity analyses were conducted. RESULTS: If fully implemented, Option B and Option B+ averted 1016.85 infections and acquired 588,01.02 QALYs.The cost of Option B was US$1,229,338.47, the cost of Option B+ was 1,176,128.63. However, when Options B and B+ were compared over ten years, Option B+ not only improved mothers'ten-year survival from 69.7 to 89.2%, saving more than 3890 life-years, but also averted 3068 HIV infections between serodiscordant partners. Option B+ yielded a favourable ICER of $32.99per QALY acquired in infants and $5149per life year gained in mothers. A 1% MTCT rate, a 90% coverage rate and a 20-year horizon could decrease the ICER per QALY acquired in children and LY gained in mothers. CONCLUSIONS: Option B+ is a cost-effective treatment for comprehensive HIV prevention for infants and serodiscordant partners and life-long treatment for mothers in Yunnan province, China. Option B+ could be implemented in Yunnan province, especially as the goals of elimination mother-to-child transmission of HIV and "90-90-90" achieved, Option B+ would be more attractive.


Assuntos
Controle de Doenças Transmissíveis , Infecções por HIV , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Complicações Infecciosas na Gravidez/economia , Complicações Infecciosas na Gravidez/terapia , Planos Governamentais de Saúde , Síndrome de Imunodeficiência Adquirida/economia , Síndrome de Imunodeficiência Adquirida/terapia , Síndrome de Imunodeficiência Adquirida/transmissão , Adulto , China/epidemiologia , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Análise Custo-Benefício , Árvores de Decisões , Feminino , HIV , Infecções por HIV/economia , Infecções por HIV/terapia , Infecções por HIV/transmissão , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/economia , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Masculino , Modelos Econométricos , Mães/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Planos Governamentais de Saúde/economia , Planos Governamentais de Saúde/organização & administração , Planos Governamentais de Saúde/normas , Resultado do Tratamento , Adulto Jovem
7.
Infect Dis Poverty ; 8(1): 40, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138293

RESUMO

BACKGROUND: In 2017, the Centre for Global Health (CGH) at the University of Oslo in collaboration with the Coalition for Epidemic Preparedness Innovations (CEPI) and the Norwegian Agency for Development Cooperation (Norad) held a meeting to discuss together with leading figures in disease control, research and development the issue of neglected tropical diseases and emerging/re-emerging infectious diseases. This commentary has taken up this discussion and the conclusions drawn at this meeting to make a case for the opportunity the Sustainable Development Goals (SDGs) provide in highlighting the interconnectedness of factors that are relevant in the successful fight against neglected tropical diseases (NTDs) and emerging infectious diseases (EIDS). MAIN BODY: Despite NTDs being endemic and EIDS being epidemic, in order to prevent both disease groups effectively, it is important to appreciate that they share essential health determining factors, namely: neglect, poverty, a lack of access to clean water and sanitation facilities and an absence of or severely limited provision of healthcare as well as in many cases a zoonotic nature. Instead of looking to "simple disease management" for the answer, the SDGs help to understand the interplay of multiple priority areas and thereby help to promote a more holistic approach to addressing these two disease groups. CONCLUSIONS: Their commonalities mean that the Global Health community should leverage opportunities and efforts in the prevention and elimination of both NTDs and EIDs. Doing so using a One Health approach is considered to offer a "public health best-buy". Concrete solutions are proposed.


Assuntos
Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis Emergentes , Doenças Negligenciadas , Prática de Saúde Pública , Animais , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/prevenção & controle , Congressos como Assunto , Saúde Global , Política de Saúde , Humanos , Relações Interinstitucionais , Internacionalidade , Área Carente de Assistência Médica , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Noruega , Pobreza , Saneamento , Medicina Tropical , Organização Mundial da Saúde
8.
Infect Dis Poverty ; 8(1): 36, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31130141

RESUMO

BACKGROUND: Drylands, which are among the biosphere's most naturally limiting and environmentally variable ecosystems, constitute three-quarters of the African continent. As a result, environmental sustainability and human development along with vector-borne disease (VBD) control historically have been especially challenging in Africa, particularly in the sub-Saharan and Sahelian drylands. Here, the VBD burden, food insecurity, environmental degradation, and social vulnerability are particularly severe. Changing climate can exacerbate the legion of environmental health threats in Africa, the social dimensions of which are now part of the international development agenda. Accordingly, the need to better understand the dynamics and complex coupling of populations and environments as exemplified by drylands is increasingly recognized as critical to the design of more sustainable interventions. MAIN BODY: This scoping review examines the challenge of vector-borne disease control in drylands with a focus on Africa, and the dramatic, ongoing environmental and social changes taking place. Dryland societies persisted and even flourished in the past despite changing climates, extreme and unpredictable weather, and marginal conditions for agriculture. Yet intrusive forces largely out of the control of traditional dryland societies, along with the negative impacts of globalization, have contributed to the erosion of dryland's cultural and natural resources. This has led to the loss of resilience underlying the adaptive capacity formerly widely exhibited among dryland societies. A growing body of evidence from studies of environmental and natural resource management demonstrates how, in light of dryland system's inherent complexity, these factors and top-down interventions can impede sustainable development and vector-borne disease control. Strengthening adaptive capacity through community-based, participatory methods that build on local knowledge and are tailored to local ecological conditions, hold the best promise of reversing current trends. CONCLUSIONS: A significant opportunity exists to simultaneously address the increasing threat of vector-borne diseases and climate change through methods aimed at strengthening adaptive capacity. The integrative framework and methods based on social-ecological systems and resilience theory offers a novel set of tools that allow multiple threats and sources of vulnerability to be addressed in combination. Integration of recent advances in vector borne disease ecology and wider deployment of these tools could help reverse the negative social and environmental trends currently seen in African drylands.


Assuntos
Mudança Climática , Clima Desértico , Ecossistema , Doenças Parasitárias/prevenção & controle , Doenças Parasitárias/transmissão , África/epidemiologia , Agricultura , Animais , Controle de Doenças Transmissíveis/métodos , Vetores de Doenças , Humanos , Insetos Vetores/parasitologia , Fatores de Risco , População Rural , Fatores Socioeconômicos
9.
Top Antivir Med ; 27(1): 8-25, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31136999

RESUMO

At the 2019 Conference on Retroviruses and Opportunistic Infections (CROI), a plan for ending the HIV epidemic in the United States was presented. More rapid HIV diagnosis and treatment is a key component needed nationwide. In international settings, substantial scale up of HIV testing and treatment has led to substantial declines in HIV incidence. U=U (undetectable equals untransmittable) is a powerful concept that can reduce stigma and encourage engagement in testing and care, but raises a number of clinical questions. HIV testing remains a gateway to HIV prevention and treatment, and innovative testing strategies, including HIV self-testing, show promise. Opioid overdose deaths are on the rise, highlighting the need for comprehensive prevention efforts. Molecular data are being used to identify rapidly growing clusters of infections for intervention. Rates of sexually transmitted infections have increased substantially in recent years. A new preexposure prophylaxis (PrEP) combination, tenofovir alafenamide/emtricitabine (FTC), was demonstrated to be non inferior to tenofovir disoproxil fumarate/FTC, with improved bone and renal safety. PrEP uptake is increasing globally, but use is lower in several populations, including African Americans, cis- and transgender women, and youth. Same-day PrEP initiations are a promising approach to increasing access, but PrEP discontinuations remain a challenge.


Assuntos
Antirretrovirais/uso terapêutico , Controle de Doenças Transmissíveis/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Epidemias/prevenção & controle , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/métodos , Controle de Doenças Transmissíveis/organização & administração , Testes Diagnósticos de Rotina/métodos , Gerenciamento Clínico , Saúde Global , Humanos , Programas de Rastreamento/métodos
10.
Cochrane Database Syst Rev ; 5: CD012688, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31120132

RESUMO

BACKGROUND: Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are used to control malaria vectors. Both strategies use insecticides to kill mosquitoes that bite and rest indoors. For ITNs, the World Health Organization (WHO) only recommended pyrethroids until 2018, but mosquito vectors are becoming resistant to this insecticide. For IRS, a range of insecticides are recommended. Adding IRS to ITNs may improve control, simply because two interventions may be better than one; it may improve malaria control where ITNs are failing due to pyrethroid resistance; and it may slow the emergence and spread of pyrethroid resistance. OBJECTIVES: To summarize the effect on malaria of additionally implementing IRS, using non-pyrethroid-like or pyrethroid-like insecticides, in communities currently using ITNs. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; LILACS; the WHO International Clinical Trials Registry Platform; ClinicalTrials.gov; and the ISRCTN registry up to 18 March 2019. SELECTION CRITERIA: Cluster-randomized controlled trials (cRCTs), interrupted time series (ITS), or controlled before-and-after studies (CBAs) comparing IRS plus ITNs with ITNs alone. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility, analyzed risk of bias, and extracted data. We used risk ratio (RR) and 95% confidence intervals (CI). We stratified by type of insecticide: 'non-pyrethroid-like', as this could improve malaria control better than adding IRS insecticides that have the same way of working as the insecticide on ITNs ('pyrethroid-like'). We used subgroup analysis of ITN usage in the trials to explore heterogeneity. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: Six cRCTs (eight comparisons) met our inclusion criteria conducted since 2008 in sub-Saharan Africa. Malaria transmission in all sites was from mosquitoes belonging to the Anopheles gambiae s.l. complex species; two trials in Benin and Tanzania also reported the vector Anopheles funestus. Three trials used insecticide with targets different to pyrethroids (two used bendiocarb and one used pirimiphos-methyl); two trials used dichloro-diphenyl-trichlorethane (DDT), an insecticide with the same target as pyrethroids; and one trial used both types of insecticide (pyrethroid deltamethrin in the first year, switching to bendiocarb for the second-year). ITN usage was greater than 50% in three trials, and less than 50% in the remainder.Indoor residual spraying using 'non-pyrethroid-like' insecticides Adding IRS with a non-pyrethroid-like insecticide had mixed results. Overall, we do not know if the addition of IRS impacted on malaria incidence (rate ratio 0.93, 95% CI 0.46 to 1.86; 2 cRCTs, 566 child-years; very low-certainty evidence); it may have reduced malaria parasite prevalence (0.67, 95% CI 0.35 to 1.28; 5 comparisons from 4 cRCTs, 10,440 participants; low-certainty evidence); and it may have reduced the prevalence of anaemia (RR CI 0.46, 95% 0.18 to 1.20; 3 comparisons from 2 cRCTs, 2026 participants; low-certainty evidence). Three trials reported the impact on EIR, with variable results; overall, we do not know if IRS had any effect on the EIR in communities using ITNs (very low-certainty evidence). Trials also reported the adult mosquito density and the sporozoite rate, but we could not summarize or pool these entomological outcomes due to unreported data. ITN usage did not explain the variation in malaria outcomes between different studies. One trial reported no effect on malaria incidence or parasite prevalence in the first year, when the insecticide used for IRS had the same target as pyrethroids, but showed an effect on both outcomes in the second year, when the insecticide was replaced by one with a different target.Two trials measured the prevalence of pyrethroid resistance before and after IRS being introduced: no difference was detected, but these data are limited.Indoor residual spraying using 'pyrethroid-like' insecticidesAdding IRS using a pyrethroid-like insecticide did not appear to markedly alter malaria incidence (rate ratio 1.07, 95% CI 0.80 to 1.43; 2 cRCTs, 15,717 child-years; moderate-certainty evidence), parasite prevalence (RR 1.11, 95% CI 0.86 to 1.44; 3 cRCTs, 10,820 participants; moderate-certainty evidence), or anaemia prevalence (RR 1.12, 95% CI 0.89 to 1.40; 1 cRCT, 4186 participants; low-certainty evidence). Data on the entomological inoculation rate (EIR) were limited, and therefore we do not know if IRS had any effect on the EIR in communities using ITNs (very low-certainty evidence). AUTHORS' CONCLUSIONS: Four trials have evaluated adding IRS using 'non-pyrethroid-like' insecticides in communities using ITNs. Some of these trials showed effects, and others did not. Three trials have evaluated adding IRS using 'pyrethroid-like' insecticides in communities using ITNs, and these studies did not detect an additional effect of the IRS. Given the wide geographical variety of malaria endemicities, transmission patterns, and insecticide resistance, we need to be cautious with inferences to policy from the limited number of trials conducted to date, and to develop relevant further research to inform decisions.


Assuntos
Mosquiteiros Tratados com Inseticida , Inseticidas/administração & dosagem , Malária/prevenção & controle , Controle de Mosquitos/métodos , Controle de Doenças Transmissíveis/métodos , Humanos
11.
N Z Vet J ; 67(5): 219-227, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31104579

RESUMO

Eradicating bovine viral diarrhoea (BVD) from cattle populations requires a clear approach for determining the epidemiological status of individual herds and implementing the appropriate control measures to ensure the transmission cycle is cost-effectively broken. This is particularly important in countries such as New Zealand where there is currently no coordinated national programme and the herd-level decisions to control BVD are left to the discretion of individual farmers and veterinarians. To ensure greater consistency in the information being delivered by different stakeholders, we review the epidemiology of BVD in the context of New Zealand pastoral production systems and provides a series of simplified recommendations for the future control of BVD in beef and dairy herds. Based on analysis of BVD test accession data from commercial diagnostic laboratories, it has been estimated that 40.6% of dairy herds and 45.6% of beef herds tested had positive results for antibodies to BVD virus. While BVD continues to remain widespread and under voluntary control in New Zealand, it is recommended that herds test all individual mixed-age cows and replacement heifers for BVD virus or antigen and remove persistently infected animals from the breeding population. All new breeding animals that have entered the herd either through purchase or birth should also be tested for BVD virus. Biosecurity risks should be managed by reducing contacts with other herds and implementing targeted vaccination programmes. All individual purchased cattle should be tested and confirmed negative for BVD virus before being moved onto the buyer's property, even if the herd of origin had a negative antibody-based screening test. Herds should continue annual antigen or virus testing of all calves as soon as possible after birth to identify any persistently infected animals.


Assuntos
Criação de Animais Domésticos/métodos , Doença das Mucosas por Vírus da Diarreia Viral Bovina/diagnóstico , Doença das Mucosas por Vírus da Diarreia Viral Bovina/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Animais , Anticorpos Antivirais , Doença das Mucosas por Vírus da Diarreia Viral Bovina/epidemiologia , Doença das Mucosas por Vírus da Diarreia Viral Bovina/transmissão , Bovinos , Vírus da Diarreia Viral Bovina/isolamento & purificação , Ensaio de Imunoadsorção Enzimática/veterinária , Feminino , Masculino , Nova Zelândia/epidemiologia , Gravidez , Vacinas Virais/uso terapêutico
12.
J Vector Borne Dis ; 56(1): 15-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31070161

RESUMO

The global fight against malaria requires continual development of new tools. Collaborations in India have played a key role in MMV's partnerships to discover, develop and deliver new medicines. Over the last decade, India has become a focal point of global medicinal chemistry, and combined with investments in basic science, this has led to the discovery of new potential drugs. India also brings significant experience to drug development, in clinical trials, but also in formulation and manufacturing. Finally, innovative new approaches in case management have streamlined impact at the level of communities and the patients.


Assuntos
Controle de Doenças Transmissíveis/tendências , Malária/tratamento farmacológico , Malária/prevenção & controle , Antimaláricos/uso terapêutico , Controle de Doenças Transmissíveis/métodos , Descoberta de Drogas/estatística & dados numéricos , Descoberta de Drogas/tendências , Saúde Global , Humanos , Índia/epidemiologia , Vacinas Antimaláricas
13.
N Engl J Med ; 381(4): 373-383, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31141654

RESUMO

The international response to the evolving Ebola epidemic in eastern Democratic Republic of Congo (DRC) has had interim successes while facing ongoing difficulties. The outbreak has occurred in an area of intractable conflict among multiple armed groups at a time of contentious national elections. Despite porous international borders and considerable population movement, however, transmission has been confined to North Kivu and Ituri provinces. Factors potentially contributing to this containment include conduct of about 55 million screenings, surveillance of contacts (12,591 under surveillance currently), testing of 280 samples per day, provision of safe and dignified burials for most deaths, vaccination of high-risk people (112,485 vaccinated as of May 7, 2019), and medical treatment including four investigational therapies. Major challenges remain. Since late February 2019, a sharp rise in cases and increased transmission have been observed. These coincide with organized attacks by armed groups targeting response teams, deteriorating security, and the population's increasing distrust of the response effort. The risk of local and regional spread remains high given the high proportion of deaths occurring outside treatment facilities, relatively low proportions of new patients who were known contacts, ongoing nosocomial transmission, and persistent delays in detection and reporting. Stopping this epidemic will require the alignment of the principal political and armed groups in eastern DRC in support of the response.


Assuntos
Epidemias/estatística & dados numéricos , Doença pelo Vírus Ebola/epidemiologia , Conflitos Armados , Controle de Doenças Transmissíveis/métodos , Busca de Comunicante , República Democrática do Congo/epidemiologia , Vacinas contra Ebola , Educação em Saúde , Doença pelo Vírus Ebola/prevenção & controle , Humanos , Vigilância da População
15.
Prev Vet Med ; 166: 1-7, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935500

RESUMO

Influenza A virus (IAV) infection is a recognized cause of acute respiratory disease in pigs that can culminate in the decline of performance due to increasing feed conversion and costs of antimicrobial drugs to control secondary infections. Biosecurity practices are the key to prevent transmission of highly contagious agents. The aim of this study was to assess the effect of biosecurity practices on IAV seroprevalence through a cross-sectional study carried out in 404 sows from 21 herds. An indirect ELISA was used to detect antibodies against a nucleoprotein of IAV. To evaluate IAV subtypes (H1N1pdm09, H1N2 and H3N2), all samples positive by ELISA were tested using the hemagglutination inhibition assay (HI). Prevalence ratios (PR) estimates were calculated using multivariate Poisson regression accounted with survey weights. Sixty-four percent (261/404) of sows were positive in the rNP-ELISA and the estimated prevalence was 63.9% (95% CI 55%-73%). All farms had at least one seropositive sow; the frequency of IAV subtypes found in seropositive sows was 51.9% for H1N1pdm09, 38.1% for codetection H1N1pdm09 and H1N2, 8.6% for H1N2, and 0.6% for codetection H1N1pdm09 and H3N2, and 19 herds presented coinfection of H1N1 pdm09 and H1N2. Variables significantly associated with IAV seroprevalence found in the final model were 'bird-proof net' (PR = 0.75; 95% CI: 0.65-0.86) and 'gilt acclimatization unit' (PR = 0.57, 95% CI: 0.50-0.66), showing a protective effect against IAV seroprevalence, and 'external replacement', which had a positive effect on IAV seroprevalence (PR = 1.38, 95% CI: 1.17-1.64). This study suggests that preventing contact among wild species and swine and using an adaptation area for animals before entry into the herd can be strategies to control the influenza virus in breeding herds.


Assuntos
Controle de Doenças Transmissíveis/métodos , Vírus da Influenza A/fisiologia , Infecções por Orthomyxoviridae/veterinária , Doenças dos Suínos/epidemiologia , Animais , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por Orthomyxoviridae/epidemiologia , Infecções por Orthomyxoviridae/prevenção & controle , Infecções por Orthomyxoviridae/virologia , Prevalência , Estudos Soroepidemiológicos , Sus scrofa , Suínos , Doenças dos Suínos/prevenção & controle , Doenças dos Suínos/virologia
16.
Prev Vet Med ; 166: 21-27, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935502

RESUMO

In the late summer of 2011, a sudden rise in incidence of fever, drop in milk production and diarrhoea was observed in dairy cows in the eastern region of the Netherlands and in north-western Germany. In the autumn of 2011, a novel orthobunyavirus was identified by metagenomic analyses in samples from acutely diseased cows on a farm near the German city of Schmallenberg, and was thereafter named Schmallenberg virus (SBV). Due to the novelty of the virus, there was an immediate need for knowledge regarding the epidemiological characteristics of SBV-infections to inform surveillance and control strategies. A rapid assessment of the spread and impact of an emerging disease supports decision-makers on allocation of resources. This paper reviews the disease mitigation activities during and after the SBV epidemic in the Netherlands, to illustrate the phases in surveillance when a new (vector-borne) pathogen emerges in a country or region. Immediate and short-term disease mitigation activities that were initiated after SBV was identified are discussed in detail, as well as ways to enhance future surveillance (e.g. by syndromic surveillance) and preparedness for similar disease outbreaks. By doing so, lessons learnt from the SBV epidemic will also improve surveillance for other emerging diseases in cattle.


Assuntos
Infecções por Bunyaviridae/veterinária , Doenças dos Bovinos/epidemiologia , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/veterinária , Vigilância de Evento Sentinela/veterinária , Animais , Infecções por Bunyaviridae/epidemiologia , Infecções por Bunyaviridae/prevenção & controle , Infecções por Bunyaviridae/virologia , Bovinos , Doenças dos Bovinos/prevenção & controle , Doenças dos Bovinos/virologia , Surtos de Doenças/prevenção & controle , Feminino , Países Baixos/epidemiologia , Orthobunyavirus/fisiologia , Vigilância da População/métodos
17.
Prev Vet Med ; 166: 78-85, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935508

RESUMO

The objective of this study was to evaluate and compare different combinations of intervention strategies for contagious or opportunistic subclinical and clinical intramammary infections (IMI). We simulated two different Danish dairy cattle herds with ten different intervention strategies focusing on cow-specific treatment or culling, including three baseline strategies without subclinical interventions. In one herd, the main causative pathogen of IMI was Staphylococcus (S.) aureus. In the other herd, Streptococcus (St.) agalactiae was the main causative agent. For both herds, we investigated costs and effectiveness of all ten intervention strategies. Intervention strategies consisted of measures against clinical and subclinical IMI, with baselines given by purely clinical intervention strategies. Our results showed that strategies including subclinical interventions were more cost-effective than the respective baseline strategies. Increase in income and reduction of IMI cases came at the cost of increased antibiotic usage and an increased culling rate in relation to IMI. However, there were differences between the herds. In the St. agalactiae herd, the clinical intervention strategy did not seem to have a big impact on income and number of cases. However, intervention strategies which included cow-specific clinical interventions led to a higher income and lower number of cases in the S. aureus herd. The results show that intervention strategies including interventions against contagious or opportunistic clinical and subclinical IMI can be highly cost-effective, but should be herd-specific.


Assuntos
Controle de Doenças Transmissíveis/métodos , Indústria de Laticínios , Mastite Bovina/prevenção & controle , Infecções Estafilocócicas/veterinária , Infecções Estreptocócicas/veterinária , Animais , Infecções Assintomáticas/economia , Bovinos , Dinamarca , Feminino , Mastite Bovina/economia , Mastite Bovina/microbiologia , Infecções Oportunistas/economia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/prevenção & controle , Infecções Oportunistas/veterinária , Infecções Estafilocócicas/economia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/fisiologia , Infecções Estreptocócicas/economia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae/fisiologia
18.
Malar J ; 18(1): 122, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961603

RESUMO

BACKGROUND: A core set of intervention and treatment options are recommended by the World Health Organization for use against falciparum malaria. These are treatment, long-lasting insecticide-treated bed nets, indoor residual spraying, and chemoprevention options. Both domestic and foreign aid funding for these tools is limited. When faced with budget restrictions, the introduction and scale-up of intervention and treatment options must be prioritized. METHODS: Estimates of the cost and impact of different interventions were combined with a mathematical model of malaria transmission to estimate the most cost-effective prioritization of interventions. The incremental cost effectiveness ratio was used to select between scaling coverage of current interventions or the introduction of an additional intervention tool. RESULTS: Prevention, in the form of vector control, is highly cost effective and scale-up is prioritized in all scenarios. Prevention reduces malaria burden and therefore allows treatment to be implemented in a more cost-effective manner by reducing the strain on the health system. The chemoprevention measures (seasonal malaria chemoprevention and intermittent preventive treatment in infants) are additional tools that, provided sufficient funding, are implemented alongside treatment scale-up. Future tools, such as RTS,S vaccine, have impact in areas of higher transmission but were introduced later than core interventions. CONCLUSIONS: In a programme that is budget restricted, it is essential that investment in available tools be effectively prioritized to maximize impact for a given investment. The cornerstones of malaria control: vector control and treatment, remain vital, but questions of when to scale and when to introduce other interventions must be rigorously assessed. This quantitative analysis considers the scale-up or core interventions to inform decision making in this area.


Assuntos
Controle de Doenças Transmissíveis/economia , Análise Custo-Benefício , Erradicação de Doenças/economia , Malária Falciparum/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Erradicação de Doenças/métodos , Humanos , Modelos Teóricos
19.
Infect Dis Poverty ; 8(1): 26, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999956

RESUMO

BACKGROUND: Asia is a region that is rapidly urbanising. While overall urban health is above rural health standards, there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk. With a focus on vaccine preventable disease and immunisation coverage, this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy, with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region. The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund (UNICEF)  on the topic of immunisation and related health services for the urban poor in Cambodia, Indonesia, Mongolia, Myanmar, the Philippines, and Vietnam. MAIN BODY: Although overall urban coverage is higher than rural coverage in selected countries of Asia, there are also wide disparities in coverage between socio economic groups within urban areas. Consistent with these coverage gaps, there is emerging evidence of outbreaks of vaccine preventable diseases in urban areas. In response to this elevated public health risk, there have been some promising innovations in operational strategy in urban settings, although most of these initiatives are project related and externally funded. Critical issues for attention for urban health services access include reaching consensus on accountability for management and resourcing of the strategy, and inclusion of an urban poor approach within the planning and budgeting procedures of Ministries of Health and local governments. Advancement of local partnership and community engagement strategies to inform operational approaches for socially marginalised populations are also urgently required. Such developments will be reliant on development of municipal models of primary health care that have clear delegations of authority, adequate resources and institutional capabilities to implement. CONCLUSIONS: The development of urban health systems and immunisation strategy is required regionally and nationally, to respond to rapid demographic change, social transition, and increased epidemiological risk.


Assuntos
Controle de Doenças Transmissíveis/métodos , Acesso aos Serviços de Saúde , Programas de Imunização , Vacinação/métodos , Ásia , Pré-Escolar , Surtos de Doenças/prevenção & controle , Feminino , Disparidades em Assistência à Saúde , Humanos , Lactente , Masculino , Estudos de Casos Organizacionais , Pobreza , Administração em Saúde Pública , Prática de Saúde Pública , Nações Unidas , População Urbana
20.
Prev Vet Med ; 167: 128-136, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31027714

RESUMO

Brazil is the fourth largest producer and exporter of pork in the world, but has never reported yet the occurrence of some economically important diseases such as porcine reproductive and respiratory syndrome (PRRS) and porcine epidemic diarrhea (PED). Most of the swine farms in Brazil are characterized by intensive production being part of large integrated companies, where biosecurity practices help to prevent the introduction and spread of disease-causing infectious agents. The assessment of biosecurity in farms is not straightforward because of the large number of practices that constitute an on-farm biosecurity program. It is therefore necessary to combine the measurement of several parameters in order to characterize the level of biosecurity on a given farm. Thus, the objective of the study was to develop a biosecurity score to estimate the biosecurity level (theta or θ) in swine farms using the item response theory (IRT) and explore the relationship between the scores and independent variables. The IRT is a latent trait method extensively used in other fields, and offers the advantage to quantify the latent trait, here the biosecurity level, and to identify the practices that discriminate the farms avoiding the use of extensive questionnaires and redundant questions. In this study, 604 farms were evaluated in the main swine production regions of the state of Rio Grande do Sul, Brazil. Thirty-five practices were considered in order to quantify the biosecurity level on a given farm. After a recursive process 14 practices were selected to compose the biosecurity score to estimate the biosecurity level (θ). The variables identified with greater capacity of distinguishing the farms as to their biosecurity level were if the farm has 'feed bin outside of the barn limit (external feed loading)', has 'perimetral fence around the farm or barn', and if 'transit of trucks inside the farm is prohibited'. The biosecurity level was associated with some independent variables, e.g. the farm operation type, the integrated company and some owner characteristics. In addition, the results demonstrated that biosecurity practices related to management (internal biosecurity) are adopted with higher frequency compared to segregation and sanitation practices (external biosecurity). The IRT model proved useful and valid to estimate the biosecurity level in swine farms. Moreover, the biosecurity score described here has a relatively low number of items, which makes the application of this tool easier and faster compared to other previously described biosecurity assessment.


Assuntos
Criação de Animais Domésticos/métodos , Doenças dos Suínos/prevenção & controle , Animais , Brasil/epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Fazendas , Fatores de Risco , Suínos , Doenças dos Suínos/epidemiologia
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