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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-LISBR1.1-46937

RESUMO

Folder que contém informações sobre a doença e as formas de prevenção, atendimento e orientações à saúde do viajante e da população que vivem nas áreas endêmicas.


Assuntos
Malária , Saúde do Viajante , Prevenção de Doenças , Doenças Endêmicas
2.
Rev Bras Parasitol Vet ; 28(4): 671-676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800889

RESUMO

Ticks of the Amblyomma cajennense complex present high infestation rates. These ticks transmit the bacterium Rickettsia rickettsii, which causes Brazilian Spotted Fever. For this reason, an integrated tick control system was adopted on a farm in the municipality of Itu, state of São Paulo. On this farm, which borders the Tietê river, domestic animals are in contact with populations of capybaras. Six locations were monitored and evaluated between the years of 2015 and 2017. During this work 1271 nymphs and adult ticks were caught, all of them from the Amblyomma sculptum species, except for a single individual from the Amblyomma dubitatum species. The integrated tick management reduced the overall infestation levels to zero. Adult tick population dropped in the first year of the study, while larvae population dropped in the second year. Nymph population dropped in both years, decreasing in higher numbers in the first year. The estimated mean infestation levels for all of the tick's life cycle forms in the six monitored spots did not reach one individual in the end of the study. Estimated mean infestation levels for nymphs in these places equaled zero.


Assuntos
Cavalos/parasitologia , Ixodidae/microbiologia , Roedores/parasitologia , Controle de Ácaros e Carrapatos/métodos , Animais , Brasil , Doenças Endêmicas , Fazendas , Febre Maculosa das Montanhas Rochosas/transmissão , População Rural
3.
N Engl J Med ; 381(23): 2209-2218, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31800986

RESUMO

BACKGROUND: Salmonella Typhi is a major cause of fever in children in low- and middle-income countries. A typhoid conjugate vaccine (TCV) that was recently prequalified by the World Health Organization was shown to be efficacious in a human challenge model, but data from efficacy trials in areas where typhoid is endemic are lacking. METHODS: In this phase 3, randomized, controlled trial in Lalitpur, Nepal, in which both the participants and observers were unaware of the trial-group assignments, we randomly assigned children who were between 9 months and 16 years of age, in a 1:1 ratio, to receive either a TCV or a capsular group A meningococcal conjugate vaccine (MenA) as a control. The primary outcome was typhoid fever confirmed by blood culture. We present the prespecified analysis of the primary and main secondary outcomes (including an immunogenicity subgroup); the 2-year trial follow-up is ongoing. RESULTS: A total of 10,005 participants received the TCV and 10,014 received the MenA vaccine. Blood culture-confirmed typhoid fever occurred in 7 participants who received TCV (79 cases per 100,000 person-years) and in 38 who received MenA vaccine (428 cases per 100,000 person-years) (vaccine efficacy, 81.6%; 95% confidence interval, 58.8 to 91.8; P<0.001). A total of 132 serious adverse events (61 in the TCV group and 71 in the MenA vaccine group) occurred in the first 6 months, and 1 event (pyrexia) was identified as being vaccine-related; the participant remained unaware of the trial-group assignment. Similar rates of adverse events were noted in the two trial groups; fever developed in 5.0% of participants in the TCV group and 5.4% in the MenA vaccine group in the first week after vaccination. In the immunogenicity subgroup, seroconversion (a Vi IgG level that at least quadrupled 28 days after vaccination) was 99% in the TCV group (677 of 683 participants) and 2% in the MenA vaccine group (8 of 380 participants). CONCLUSIONS: A single dose of TCV was immunogenic and effective in reducing S. Typhi bacteremia in children 9 months to 16 years of age. (Funded by the Bill and Melinda Gates Foundation; Current Controlled Trials number, ISRCTN43385161.).


Assuntos
Salmonella typhi/isolamento & purificação , Febre Tifoide/prevenção & controle , Vacinas Tíficas-Paratíficas/imunologia , Vacinas Conjugadas/imunologia , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Doenças Endêmicas/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Estimativa de Kaplan-Meier , Masculino , Vacinas Meningocócicas/efeitos adversos , Vacinas Meningocócicas/imunologia , Nepal/epidemiologia , Febre Tifoide/diagnóstico , Febre Tifoide/epidemiologia , Vacinas Tíficas-Paratíficas/efeitos adversos , Vacinas Conjugadas/efeitos adversos
4.
Artigo em Inglês | MEDLINE | ID: mdl-31859842

RESUMO

Hantavirus Cardiopulmonary Syndrome (HCPS) is an important emergent zoonosis associated with wild rodents in Brazil, where this viral infection in children is generally rare. We present HCPS in a child from the Pantanal Biome and a review of all reported pediatric cases in Mato Grosso State, an endemic area for HCPS in Brazil. The investigation used the Information System for Notifiable Diseases database (SINAN). A 12-year-old boy was hospitalized with fever and respiratory failure and hantavirus IgM and IgG antibodies were detected by ELISA in serum samples. During the period of 1999 to 2016, 32 HCPS pediatric cases confirmed by serology were reported to SINAN with a mortality rate of 34.4%. The possibility of hantavirus infection in children with acute febrile illness associated with respiratory failure should be considered mainly in recognized endemic areas as Mato Grosso State, contradicting a hypothesis that children are more protected from lung involvement.


Assuntos
Anticorpos Antivirais/sangue , Síndrome Pulmonar por Hantavirus/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Feminino , Síndrome Pulmonar por Hantavirus/diagnóstico , Humanos , Imunoglobulina G/sangue , Masculino , Fatores de Risco , Estudos Soroepidemiológicos
5.
N Engl J Med ; 381(26): 2519-2528, 2019 12 26.
Artigo em Inglês | MEDLINE | ID: mdl-31881138

RESUMO

BACKGROUND: With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically. METHODS: We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection. RESULTS: All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings. CONCLUSIONS: These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.).


Assuntos
Controle de Doenças Transmissíveis , Esquistossomose Urinária/prevenção & controle , Esquistossomose mansoni/prevenção & controle , África ao Sul do Saara/epidemiologia , Animais , Anti-Helmínticos/uso terapêutico , Criança , Estudos Transversais , Doenças Endêmicas/prevenção & controle , Humanos , Objetivos Organizacionais , Prevalência , Schistosoma haematobium/isolamento & purificação , Schistosoma mansoni/isolamento & purificação , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose Urinária/epidemiologia , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Organização Mundial da Saúde , Iêmen/epidemiologia
6.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46895

RESUMO

Risco de transmissão se restringe a terra indígena Yanomami na divisa com a Venezuela. Ações apoiadas pela Secretaria Especial de Saúde Indígena foram fundamentais no combate à doença.


Assuntos
Oncocercose , Oncocercose Ocular , Doenças Parasitárias , Simuliidae , Doenças Endêmicas , Medicina Tropical
7.
Global Health ; 15(1): 69, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31753038

RESUMO

BACKGROUND: There is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors. METHODS: Data was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses. RESULTS: The knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work. CONCLUSION: The high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.


Assuntos
Fortalecimento Institucional/organização & administração , Doenças Endêmicas/prevenção & controle , Política de Saúde , Pesquisa sobre Serviços de Saúde , Pessoal Administrativo/psicologia , Pessoal Administrativo/estatística & dados numéricos , Adulto , Tomada de Decisões , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Formulação de Políticas , Análise de Sistemas
8.
Rev Bras Parasitol Vet ; 28(4): 790-796, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31691733

RESUMO

The aim of this study was to investigate the occurrence of Leishmania spp. antibodies, and its association with feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV), in domestic cats from an area endemic for canine and human leishmaniasis in Rio Grande do Norte State, Brazil. Ninety-one cats were subjected to a complete clinical exam, and blood samples were collected. An epidemiological questionnaire was used to investigate the risk factors. IgG anti-Leishmania spp. antibodies were detected by immunofluorescence antibody test (IFAT), with a cut-off value of 1:40. Polymerase chain reaction (PCR) was performed to detect genetic material of Leishmania spp. in the blood samples. The presence of antibodies against FIV and antigens of FeLV was evaluated using an immunochromatographic test. Seropositivity for Leishmania spp., FIV, and FeLV was observed in 14/91 (15.38%), 26/91 (28.57%), and 3/91 (3.29%) cats, respectively. All samples gave negative results on PCR analysis. Based on these data, no significant statistical association was observed between seropositivity for Leishmania spp., and sex, age, presence of clinical signs, evaluated risk factors, and positivity for retroviruses. These findings demonstrated for the first time that cats from Mossoró, Rio Grande do Norte, are being exposed to this zoonosis and might be part of the epidemiological chain of transmission of visceral leishmaniasis.


Assuntos
Anticorpos Antiprotozoários/sangue , Doenças do Gato/parasitologia , Leishmaniose/veterinária , Animais , Brasil/epidemiologia , Doenças do Gato/diagnóstico , Doenças do Gato/epidemiologia , Gatos , Cães , Doenças Endêmicas , Técnica Direta de Fluorescência para Anticorpo , Humanos , Vírus da Imunodeficiência Felina/imunologia , Leishmaniose/diagnóstico , Leishmaniose/epidemiologia , Vírus da Leucemia Felina/imunologia , Reação em Cadeia da Polimerase , Fatores de Risco
9.
N Engl J Med ; 381(21): 2009-2019, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31693803

RESUMO

BACKGROUND: Dengue, a mosquito-borne viral disease, was designated a World Health Organization top 10 threat to global health in 2019. METHODS: We present primary efficacy data from part 1 of an ongoing phase 3 randomized trial of a tetravalent dengue vaccine candidate (TAK-003) in regions of Asia and Latin America in which the disease is endemic. Healthy children and adolescents 4 to 16 years of age were randomly assigned in a 2:1 ratio (stratified according to age category and region) to receive two doses of vaccine or placebo 3 months apart. Participants presenting with febrile illness were tested for virologically confirmed dengue by serotype-specific reverse-transcriptase polymerase chain reaction. The primary end point was overall vaccine efficacy in preventing virologically confirmed dengue caused by any dengue virus serotype. RESULTS: Of the 20,071 participants who were given at least one dose of vaccine or placebo (safety population), 19,021 (94.8%) received both injections and were included in the per-protocol analysis. The overall vaccine efficacy in the safety population was 80.9% (95% confidence interval [CI], 75.2 to 85.3; 78 cases per 13,380 [0.5 per 100 person-years] in the vaccine group vs. 199 cases per 6687 [2.5 per 100 person-years] in the placebo group). In the per-protocol analyses, vaccine efficacy was 80.2% (95% CI, 73.3 to 85.3; 61 cases of virologically confirmed dengue in the vaccine group vs. 149 cases in the placebo group), with 95.4% efficacy against dengue leading to hospitalization (95% CI, 88.4 to 98.2; 5 hospitalizations in the vaccine group vs. 53 hospitalizations in the placebo group). Planned exploratory analyses involving the 27.7% of the per-protocol population that was seronegative at baseline showed vaccine efficacy of 74.9% (95% CI, 57.0 to 85.4; 20 cases of virologically confirmed dengue in the vaccine group vs. 39 cases in the placebo group). Efficacy trends varied according to serotype. The incidence of serious adverse events was similar in the vaccine group and placebo group (3.1% and 3.8%, respectively). CONCLUSIONS: TAK-003 was efficacious against symptomatic dengue in countries in which the disease is endemic. (Funded by Takeda Vaccines; TIDES ClinicalTrials.gov number, NCT02747927.).


Assuntos
Vacinas contra Dengue/imunologia , Vírus da Dengue/imunologia , Dengue/prevenção & controle , Doenças Endêmicas/prevenção & controle , Adolescente , Américas/epidemiologia , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Ásia/epidemiologia , Criança , Pré-Escolar , Dengue/epidemiologia , Dengue/imunologia , Vacinas contra Dengue/efeitos adversos , Vírus da Dengue/isolamento & purificação , Método Duplo-Cego , Feminino , Humanos , Incidência , Masculino , Sorogrupo , Resultado do Tratamento
10.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 519-521, 2019 Oct 14.
Artigo em Chinês | MEDLINE | ID: mdl-31713383

RESUMO

OBJECTIVE: To understand the epidemic trend of schistosomiasis in China from 2010 to 2017 so as to provide the scientific evidence for schistosomiasis elimination. METHODS: The information of schistosomiasis control nationwide from 2010 to 2017 was collected, including the endemic of population, status of livestock control, and Oncomelania hupensis snail control. Microsoft Excel was applied for datum management and analysis. RESULTS: From 2010 to 2017, the epidemic of schistosomiasis in China dropped significantly. The decreasing amplitude of estimated number of patients nationwide was 88.46%. Seventy-one acute schistosomiasis patients were reported and 12.68% (9/71) of them were imported. The decreasing rate of cultivated cattle was 50.09%, and the accumulative number of schistosome-infected cattle was 17 239, and the average positive rate of stool examinations decreased from 1.04% to 0.000 22%. The area with snails nationwide was 373 596.18 to 363 068.95 hm2, and the new detected area with snails was 46.71 to 1 346.73 hm2. The area with schistosome-infected snails was 171.68 hm2 in 2012 and it was 9.25 hm2 in 2013. In 72 key monitoring points of 7 endemic provinces, there were 17 schistosome positive points of water body in 2010 and 6 points in 2016. There were some high risk-factors related to schistosomiasis transmission including schisto-some-infected cattle, dogs, and field rats, and the field stools, and the pasture in the area with snails in schistosomiasis monitoring points. CONCLUSIONS: The endemic status of schistosomiasis in China has dropped significantly, and the transmission level is very low. However, the infectious source and risk factors in the endemic environments have not be eliminated. Therefore, the infectious source control, health education, snail control, and transmission monitoring should be strengthened, so as to promote the progress of schistosomiasis elimination.


Assuntos
Doenças Endêmicas , Esquistossomose , Animais , Bovinos , China/epidemiologia , Cães , Doenças Endêmicas/estatística & dados numéricos , Fezes , Humanos , Ratos , Schistosoma , Esquistossomose/epidemiologia , Caramujos
11.
Rev Soc Bras Med Trop ; 52: e20190278, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778421

RESUMO

INTRODUCTION: Trypanosoma cruzi is the etiological agent of Chagas disease (CD), a zoonotic infection transmitted by triatomine bug vectors to human beings. Although the story of this parasitic infection was born in Brazil and here this has made major step forward information, the same cannot be said about the actual distribution of the triatomine vector in several areas of this country. The aim of this study was to assess the occurrence of triatomine species in an endemic region for CD in Northeastern Brazil. METHODS: A retrospective study was performed using data obtained from 2008 to 2017. All information was provided by the V Gerência Regional de Saúde of the state of Pernambuco. The spatial distribution of triatomine species was analyzed by drawing a map using the Quantum geographic information system. RESULTS: A total of 4,694 triatomine specimens (469.4 ± 221.2 per year) were collected during the period 2008-2017, with 94.5% (4,434/4,694) at the intradomicile and 5.5% (260/4,694) at peridomicile environment. Of all arthropods collected, 92.5% (4,340/4,694) and 7.5% (354/4,694) were adults and nymphs, respectively. The species most frequently detected were Panstrongylus lutzi (30.36%), Triatoma brasiliensis (26.12%), Triatoma pseudomaculata (22.43%), and Panstrongylus megistus (20.54%). CONCLUSIONS: These data contribute to a better understanding of the distribution of T. cruzi infection in the Northeastern region of Brazil. Preventive measures based on vector control should be implemented in the study area in order to reduce the burden this neglected tropical disease.


Assuntos
Distribuição Animal , Insetos Vetores/classificação , Triatominae/classificação , Animais , Brasil , Doença de Chagas/transmissão , Doenças Endêmicas , Densidade Demográfica , Estudos Retrospectivos
12.
BMC Public Health ; 19(1): 1456, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694595

RESUMO

BACKGROUND: Pesticides remain the mainstay for the control of agricultural pests and disease vectors. However, their indiscriminate use in agriculture has led to development of resistance to both crop pests and disease vectors. This threatens to undermine the success gained through the implementation of chemical based vector control programs. We investigated the practices of farmers with regard to pesticide usage in the vegetable growing areas and their impact on susceptibility status of An. gambiae s.l. METHODS: A stratified multistage sampling technique using the administrative structure of the Tanzanian districts as sampling frame was used. Wards, villages and then participants with farms where pesticides are applied were purposively recruited at different stages of the process, 100 participants were enrolled in the study. The same villages were used for mosquito larvae sampling from the farms and the surveys were complimented by the entomological study. Larvae were reared in the insectary and the emerging 2-3 days old female adults of Anopheles gambiae s.l were subjected to susceptibility test. RESULTS: Forty eight pesticides of different formulations were used for control of crop and Livestock pests. Pyrethroids were the mostly used class of pesticides (50%) while organophosphates and carbamates were of secondary importance. Over 80% of all farmers applied pesticides in mixed form. Susceptibility test results confirmed high phenotypic resistance among An. gambiae populations against DDT and the pyrethroids (Permethrin-0.75%, Cyfluthrin-0.15%, Deltametrin-0.05% and Lambdacyhalothrin-0.05%) with mortality rates 54, 61, 76 and 71%, respectively. Molecular analysis showed An. arabiensis as a dominant species (86%) while An. gambiae s.s constituted only 6%. The kdr genes were not detected in all of the specimens that survived insecticide exposures. CONCLUSION: The study found out that there is a common use of pyrethroids in farms, Livestocks as well as in public health. The study also reports high phenotypic resistance among An. gambiae s.l against most of the pyrethroids tested. The preponderance of pyrethroids in agriculture is of public health concern because this is the class of insecticides widely used in vector control programs and this calls for combined integrated pest and vector management (IPVM).


Assuntos
Agricultura/estatística & dados numéricos , Doenças Endêmicas/prevenção & controle , Resistência a Inseticidas , Inseticidas/farmacologia , Malária/prevenção & controle , Mosquitos Vetores/efeitos dos fármacos , Animais , Anopheles/efeitos dos fármacos , Fazendeiros/estatística & dados numéricos , Humanos , Larva/efeitos dos fármacos , Malária/epidemiologia , Tanzânia/epidemiologia
13.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(4): 410-413, 2019 Jul 29.
Artigo em Chinês | MEDLINE | ID: mdl-31612677

RESUMO

OBJECTIVE: To analyze the endemic sitaution of schistosomiasis based on geographic information system (GIS) in Wuhan City in 2017, so as to provide the reference for further schistosomiasis control activities. METHODS: According to the data of the annual report on the prevention and control of schistosomiasis in Wuhan City in 2017, the spatial database regarding the endemic situation of schistosomiasis was established and analyzed by ArcMap 10.2. RESULTS: The 593 schistosomiasis-endemic villages in Wuhan City were mainly located in the Yangtze River and its major tributaries. Kernel density analysis showed that the endemic villages of three regions with the highest density was located in the west of Caidian District (Zhuru Street), the east of Hannan District (Shamao Street) and the southwest corner of Xinzhou District (Yangluo Street). The sero-positive population was densely distributed in the West of Caidian District (Zhuru Street), which accounted for 34.23% of all seruo-positives in the city. There were 492 farming cattle fenced in Donggan Village in Hongbei Street of Caidian District. A higher density of the area with Oncomelania hupensis snails was located in the southwest region of Caidian District (Xiaosi Street), accounting for 31.22% of the total area with snails. In 2017, the re-emerging area with snails was 36.60 hm2. The high kernel density region with snails was located in Zhuru Street of Caidian District. The region with high density of living snails was located in the central region of Hannan District (Hongbei Production Brigade), the average density of living snails was 0.36 snails/0.1 m2. CONCLUSIONS: The endemic situation of schistosomiasis is at a low level in Wuhan City, and the spatial distribution is not uniform. In some local areas, the historical endemic situation of schistosomiasis is serious and the high risk factors are more concentrated. It is necessary to strengthen the surveillance of schistosomiasis.


Assuntos
Sistemas de Informação Geográfica , Esquistossomose , Animais , Anticorpos Anti-Helmínticos/sangue , China/epidemiologia , Doenças Endêmicas/estatística & dados numéricos , Humanos , Densidade Demográfica , Vigilância da População , Fatores de Risco , Esquistossomose/sangue , Esquistossomose/epidemiologia , Caramujos
14.
BMC Infect Dis ; 19(1): 855, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619180

RESUMO

BACKGROUND: Cutaneous leishmaniasis is one of the neglected tropical diseases in the Ethiopian highlands and studies on assessment of knowledge, attitude and practice of the community in endemic areas are scanty. The study aimed to assess the knowledge, attitude towards cutaneous leishmaniasis and treatment seeking practices in people living in the endemic highlands areas in the Northwest, Ethiopia and to provide evidence-based information to guide development of appropriate interventions to reduce the impact of cutaneous leishmaniasis on communities. METHODS: Quantitative cross-sectional study was conducted in cutaneous leishmaniasis endemic districts (woredas) using a semi structured questionnaire. Households were randomly selected according to probability proportional to size of households in each enumeration area. Systematic random sampling of eligible households was based on the number of households recorded during listing of households. Descriptive statistics was used to describe numerical data, organise and summarise the data in a manner that gave meaning to the numerical form. Frequency tables were used to show descriptive analysis and regression analysis was used to determine correlation between variables. RESULTS: Majority of respondents 321(78.7%) lived in rural areas, age ranged between 18 and 85 years and most were farmers. Illiteracy was high (47.6%) among respondents and majority 358(87.8%) had seen patients with CL. Less than quarter (21.6%) had heard about sand flies and knowledge on the peak transmission period was low (46.3%). About 192 (47.1%) of the respondents indicated disfiguring lesions were the major clinical presentations, less than half 55(27.5%) of urban residents believed CL was treatable compared to 145(72.5%) of rural residents (P < 0.001). Traditional medicines were indicated as best treatment option by 209(51.2%) compared to 114(27.9%) for modern treatment. Major factors influencing treatment options included accessibility to treatment facilities, distance and short duration of treatment. Participants expressed negative experiential attitude and perceived control towards modern treatment because of inaccessibility and distance from where modern treatment is provided. CONCLUSION: Priority should be given to primary prevention and appropriate awareness campaigns on lesion recognition. Information on modern treatment should be intensified.


Assuntos
Doenças Endêmicas , Conhecimentos, Atitudes e Prática em Saúde , Leishmaniose Cutânea/epidemiologia , Doenças Negligenciadas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etiópia/epidemiologia , Humanos , Pessoa de Meia-Idade , Adulto Jovem
16.
BMC Infect Dis ; 19(1): 830, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590648

RESUMO

BACKGROUND: Many gaps in the burden of resistant pathogens exist in endemic areas of low- and middle-income economies, especially those endemic for carbapenem resistance. The aim of this study is to evaluate risk factors for carbapenem-resistance, to estimate the association between carbapenem-resistance and all-cause 30-day mortality and to examine whether mortality is mediated by inappropriate therapy. METHODS: A case-control and a cohort study were conducted in one tertiary-care hospital in Medellín, Colombia from 2014 to 2015. Phenotypic and genotypic characterization of isolates was performed. In the case-control study, cases were defined as patients infected with carbapenem-resistant K. pneumoniae (CRKP) and controls as patients infected with carbapenem-susceptible K. pneumoniae (CSKP). A risk factor analysis was conducted using logistic regression models. In the cohort study, the exposed group was defined as patients infected with CRKP and the non-exposed group as patients infected with CSKP. A survival analysis using an accelerated failure time model with a lognormal distribution was performed to estimate the association between carbapenem resistance and all-cause 30-day-mortality and to examine whether mortality is mediated by inappropriate therapy. RESULTS: A total of 338 patients were enrolled; 49 were infected with CRKP and 289 with CSKP. Among CRKP isolates CG258 (n = 29), ST25 (n = 5) and ST307 (n = 4) were detected. Of importance, every day of meropenem (OR 1.18, 95%CI 1.10-1.28) and cefepime (OR 1.22, 95%CI 1.03-1.49) use increase the risk of carbapenem resistance. Additional risk factors were previous use of ciprofloxacin (OR 2.37, 95%CI 1.00-5.35) and urinary catheter (OR 2.60, 95%CI 1.25-5.37). Furthermore, a significant lower survival time was estimated for patients infected with CRKP compared to CSKP (Relative Times 0.44, 95%CI 0.24-0.82). The strength of association was reduced when appropriate therapy was included in the model (RT = 0.81 95%CI 0.48-1.37). CONCLUSION: Short antibiotic courses had the potential to reduce the selection and transmission of CRKP. A high burden in mortality occurred in patients infected with CRKP in a KPC endemic setting and CRKP leads to increased mortality via inappropriate antibiotic treatment. Furthermore, dissemination of recognized hypervirulent clones could add to the list of challenges for antibiotic resistance control.


Assuntos
Antibacterianos/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos , Doenças Endêmicas , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/genética , Meropeném/uso terapêutico , Idoso , Antibacterianos/efeitos adversos , Estudos de Casos e Controles , Cefepima/efeitos adversos , Cefepima/uso terapêutico , Ciprofloxacino/efeitos adversos , Ciprofloxacino/uso terapêutico , Colômbia , Farmacorresistência Bacteriana Múltipla , Feminino , Genótipo , Humanos , Estimativa de Kaplan-Meier , Klebsiella pneumoniae/isolamento & purificação , Modelos Logísticos , Masculino , Meropeném/efeitos adversos , Pessoa de Meia-Idade , Fenótipo , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Cateteres Urinários/efeitos adversos
17.
BMC Infect Dis ; 19(1): 832, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590657

RESUMO

BACKGROUND: Intestinal schistosomiasis is highly endemic in Tanzania and mass drug administration (MDA) using praziquantel is the mainstay of the control program. However, the MDA program covers only school aged children and does not include neither adult individuals nor other public health measures. The Ijinga schistosomiasis project examines the impact of an intensified treatment protocol with praziquantel MDA in combination with additional public health interventions. It aims to investigate the feasibility of eliminating intestinal schistosomiasis in a highly endemic African setting using an integrated community-based approach. In preparation of this project, we report about baseline data on S.mansoni prevalence, intensity of infection, related hepatosplenic morbidities and their associated factors. METHODS: A cross sectional study was conducted among 930 individuals aged 1-95 years living at Ijinga Island, north-western Tanzania in September 2016. Single stool and urine samples were collected from each study participant and processed using Kato Katz (KK) technique and point-of-care Circulating Cathodic (POC-CCA) antigen test for detection of S.mansoni eggs and antigen respectively. Ultrasonographical examination for S.mansoni hepatosplenic morbidities was done to all participants. For statistical analyses Fisher's exact test, chi-square test, student-t-test, ANOVA and linear regression were used where applicable. RESULTS: Overall based on KK technique and POC-CCA test, 68.9% (95%CI: 65.8-71.8) and 94.5% (95%CI: 92.8-95.8) were infected with S.mansoni. The overall geometrical mean eggs per gram (GMepg) of faeces was 85.7epg (95%CI: 77.5-94.8). A total of 27.1, 31.2 and 51.9% of the study participants had periportal fibrosis (PPF-grade C-F), splenomegaly and hepatomegaly. Risk factors for PPF were being male (aRR = 1.08, 95%CI: 1.02-1.16, P < 0.01), belong to the age group 16-25 years (aRR = 1.23, 95%CI: 105-1.44, P < 0.01), 26-35 years (aRR = 1.42, 95%CI: 1.21-1.67, P < 0.001), 36-45 years (aRR = 1.56, 95%CI:1.31-1.84, P < 0.001) and ≥ 46 years (aRR = 1.64, 95%CI:1.41-1.92, P < 0.001). The length of the left liver lobe was associated with being female (P < 0.03), belong to the age group 1-5 years (P < 0.013), 6-15 years (P < 0.04) and S.mansoni intensity of infection (P < 0.034). Male sex (aRR = 1.15, 95%CI:1.06-1.24, P < 0.001) and belonging to the age groups 16-25 years (aRR = 1.27, 95%CI:1.05-1.54, P < 0.02) or 26-35 years (aRR = 1.32, 95%CI:108-1.61, P < 0.01) were associated with splenomegaly. CONCLUSION: Schistosoma mansoni infection and its related morbidities (hepatomegaly, splenomegaly, periportal fibrosis) are common in the study area. Age, sex and intensity of infection were associated with periportal fibrosis. The prevalence of S.mansoni was above 50% in each age group and based on the observed prevalence, we recommend MDA to the entire community.


Assuntos
Anti-Helmínticos/uso terapêutico , Hepatomegalia/epidemiologia , Cirrose Hepática/epidemiologia , Praziquantel/uso terapêutico , Schistosoma mansoni/imunologia , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Esplenomegalia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Estudos Transversais , Doenças Endêmicas , Fezes/parasitologia , Feminino , Humanos , Lactente , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Morbidade , Testes Imediatos , Prevalência , Fatores de Risco , Esquistossomose mansoni/urina , Testes Sorológicos , Tanzânia/epidemiologia , Adulto Jovem
18.
Rev Bras Parasitol Vet ; 28(4): 569-573, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576976

RESUMO

Phlebotomines of the genus Lutzomyia are important vector for species of Leishmania, the etiological agent of leishmaniasis. The aim of this study was to assess the diversity of sandflies in an endemic area for Visceral Leishmaniasis (VL). Sampling was performed in four localities on the coast of the municipality of Goiana, state of Pernambuco, Northeastern Brazil. Specimens were collected monthly on three consecutive nights, from November 2017 to October 2018. CDC light traps were installed at a height of 1.5 m above the ground, in two ecotypes (i.e. tree and animal facility), both in peridomestic areas. A total of 5,205 sandflies were collected, among which the species Lutzomyia longipalpis (99.85%; 5,197/5,205) was the most common, followed by Lutzomyia evandroi (0.13%; 07/5,205) and Lutzomyia whitmani (0.02%; 01/5,205). Specimens of L. longipalpis were collected throughout the study period and most of them were found near to the animal facilities. The findings from this research indicate that vectors for Leishmania infantum are present in the study area throughout the year, along with occurrences of vectors relating to Cutaneous Leishmaniasis (CL). Preventive vector control measures need to be implemented in Goiana to reduce the risk of infection for the human and animal populations.


Assuntos
Insetos Vetores/classificação , Psychodidae/classificação , Animais , Brasil , Doenças Endêmicas , Feminino , Leishmaniose Visceral/transmissão , Masculino , Densidade Demográfica , Estações do Ano
19.
N Engl J Med ; 381(14): 1347-1357, 2019 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-31577876

RESUMO

BACKGROUND: The World Health Organization has set ambitious targets for the global elimination of tuberculosis. However, these targets will not be achieved at the current rate of progress. METHODS: We performed a cluster-randomized, controlled trial in Ca Mau Province, Vietnam, to evaluate the effectiveness of active community-wide screening, as compared with standard passive case detection alone, for reducing the prevalence of tuberculosis. Persons 15 years of age or older who resided in 60 intervention clusters (subcommunes) were screened for pulmonary tuberculosis, regardless of symptoms, annually for 3 years, beginning in 2014, by means of rapid nucleic acid amplification testing of spontaneously expectorated sputum samples. Active screening was not performed in the 60 control clusters in the first 3 years. The primary outcome, measured in the fourth year, was the prevalence of microbiologically confirmed pulmonary tuberculosis among persons 15 years of age or older. The secondary outcome was the prevalence of tuberculosis infection, as assessed by an interferon gamma release assay in the fourth year, among children born in 2012. RESULTS: In the fourth-year prevalence survey, we tested 42,150 participants in the intervention group and 41,680 participants in the control group. A total of 53 participants in the intervention group (126 per 100,000 population) and 94 participants in the control group (226 per 100,000) had pulmonary tuberculosis, as confirmed by a positive nucleic acid amplification test for Mycobacterium tuberculosis (prevalence ratio, 0.56; 95% confidence interval [CI], 0.40 to 0.78; P<0.001). The prevalence of tuberculosis infection in children born in 2012 was 3.3% in the intervention group and 2.6% in the control group (prevalence ratio, 1.29; 95% CI, 0.70 to 2.36; P = 0.42). CONCLUSIONS: Three years of community-wide screening in persons 15 years of age or older who resided in Ca Mau Province, Vietnam, resulted in a lower prevalence of pulmonary tuberculosis in the fourth year than standard passive case detection alone. (Funded by the Australian National Health and Medical Research Council; ACT3 Australian New Zealand Clinical Trials Registry number, ACTRN12614000372684.).


Assuntos
Doenças Endêmicas/prevenção & controle , Programas de Rastreamento/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Criança , Serviços de Saúde Comunitária , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Mycobacterium tuberculosis/genética , Técnicas de Amplificação de Ácido Nucleico , Prevalência , Escarro/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/prevenção & controle , Vietnã/epidemiologia , Adulto Jovem
20.
Parasit Vectors ; 12(1): 476, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610803

RESUMO

BACKGROUND: Borrelia burgdorferi and Anaplasma phagocytophilum are tick-borne infections transmitted by Ixodes scapularis in the eastern USA; both agents cause disease in dogs and people. To characterize changes in seroprevalence over time, Cochran Armitage trend tests were used to evaluate percent positive test results for antibodies to B. burgdorferi and Anaplasma spp. in approximately 20 million canine tests from 2010-2017 in 25 states and 905 counties in the eastern USA. RESULTS: A significant decreasing trend in seroprevalence to B. burgdorferi was evident in eight states along the mid-Atlantic coast from Virginia to New Hampshire, and in Wisconsin. In contrast, a continued increasing trend was evident in five northeastern and Midwestern states where Lyme borreliosis is endemic or emerging, as well as in three southern states where endemicity has not yet been widely established. Similarly, seroprevalence to Anaplasma spp. showed a significant, although smaller, decreasing trend in five states along the mid-Atlantic coast from Virginia to Connecticut and Rhode Island, as well as in Minnesota and Wisconsin in the Midwest; despite the fact that those trends were significant they were weak. However, a strong increasing trend was evident in Massachusetts and three states in northern New England as well as in Pennsylvania. CONCLUSIONS: As expected, seroprevalence continued to increase in regions where Lyme borreliosis and anaplasmosis are more newly endemic. However, the declining seroprevalence evident in other areas was not anticipated. Although the reasons for the decreasing trends are not clear, our finding may reflect shifting ecologic factors that have resulted in decreased infection risk or the combined positive influence of canine vaccination, tick control, and routine testing of dogs in regions where these infections have long been endemic. Analysis of trends in canine test results for tick-borne infections continues to be a valuable tool to understand relative geographical and temporal risk for these zoonotic agents.


Assuntos
Anaplasma/imunologia , Anaplasmose/epidemiologia , Borrelia burgdorferi/imunologia , Doenças do Cão/epidemiologia , Ehrlichiose/epidemiologia , Doença de Lyme/veterinária , Anaplasma phagocytophilum/imunologia , Animais , Anticorpos Antibacterianos/sangue , Doenças do Cão/microbiologia , Cães , Doenças Endêmicas/estatística & dados numéricos , Doenças Endêmicas/veterinária , Doença de Lyme/epidemiologia , Estudos Soroepidemiológicos , Estados Unidos/epidemiologia
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