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1.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(2): 113-118, 2020 Mar 18.
Artigo em Chinês | MEDLINE | ID: mdl-32458598

RESUMO

Currently, the local transmission of coronavirus disease 2019 (COVID-19) has been effectively contained in China; however, the epidemic situation of this highly infectious disease is more and more serious outside of China. Importation of COVID-19 cases from other countries and territories is therefore becoming a new challenge for the control of COVID-19 in China. Malaria was once widely epidemic in China. Nevertheless, the local transmission of this parasitic disease has been interrupted in China since the launch of the national malaria elimination programme in 2010, and great successes have been achieved in the management of appropriately 3 thousand malaria cases imported from other countries and territories annually. Hereby, the epidemiological characteristics and current epidemic situation of COVID-19 in China were analyzed and compared with malaria. Based on the successful experiences from the management of overseas imported malaria in China, the strategy and countermeasures for COVID-19 control were proposed, so as to provide insights into the response to the importation of COVID-19 from other countries and territories and the consolidation of the control achievements in China.


Assuntos
Doenças Transmissíveis Importadas/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Erradicação de Doenças/métodos , Malária/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
2.
Science ; 368(6489): 401-405, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32193361

RESUMO

Although there have been no cases of serotype 2 wild poliovirus for more than 20 years, transmission of serotype 2 vaccine-derived poliovirus (VDPV2) and associated paralytic cases in several continents represent a threat to eradication. The withdrawal of the serotype 2 component of oral poliovirus vaccine (OPV2) was implemented in April 2016 to stop VDPV2 emergence and secure eradication of all serotype 2 poliovirus. Globally, children born after this date have limited immunity to prevent transmission. Using a statistical model, we estimated the emergence date and source of VDPV2s detected between May 2016 and November 2019. Outbreak response campaigns with monovalent OPV2 are the only available method to induce immunity to prevent transmission. Yet our analysis shows that using monovalent OPV2 is generating more paralytic VDPV2 outbreaks with the potential for establishing endemic transmission. A novel OPV2, for which two candidates are currently in clinical trials, is urgently required, together with a contingency strategy if this vaccine does not materialize or perform as anticipated.


Assuntos
Erradicação de Doenças/métodos , Surtos de Doenças/prevenção & controle , Saúde Global , Poliomielite/epidemiologia , Poliomielite/etiologia , Vacina Antipólio Oral/efeitos adversos , Poliovirus/imunologia , Humanos , Poliomielite/prevenção & controle , Poliomielite/transmissão , Suspensão de Tratamento
3.
BMC Infect Dis ; 20(1): 181, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32106819

RESUMO

BACKGROUND: Hepatitis C virus is one of the leading causes of chronic liver disease and liver-related deaths worldwide. The estimated prevalence of chronic hepatitis C viral infection among the general Belgian population was 0.57% (n = 64,000) in 2015. Although Belgium has had a 'Hepatitis C Plan' since 2014, elimination efforts are unclear. This study employs the best available data and modelling estimates to define the burden of hepatitis C viral infection among key subgroups in Belgium, identify information gaps and propose potential approaches to screening, linkage to care and treatment, and cure. METHODS: We examined the peer-reviewed and grey literature since 2012 for data on the prevalence of hepatitis C viral infection in Belgium in key subgroups identified by national experts and in the literature. Ultimately, this research is primarily based on data provided by the key stakeholders themselves due to a lack of reliable data in the literature. Based on this, we modelled the treatment rates required to reach elimination of hepatitis C in several subgroups. RESULTS: Eleven potential subgroups were identified. There were no data available for two subgroups: generational cohorts and men who have sex with men. In six subgroups, fewer than 3000 people were reported or estimated to have hepatitis C infection. Migrants and people who inject drugs were the most affected subgroups, and children were the least affected subgroup. Only two subgroups are on target to achieve elimination by 2030: patients living with haemophilia and transplant recipients. CONCLUSIONS: Removing Belgian treatment reimbursement restrictions in January 2019 was a big step towards eliminating HCV. In addition, increasing surveillance, including with a national registry, treatment prescription by other health-care providers and availability of treatment in local pharmacies are central to improving the current situation and getting on track to reach the 2030 WHO hepatitis C elimination targets in Belgium.


Assuntos
Erradicação de Doenças/métodos , Hepatite C/prevenção & controle , Adolescente , Adulto , Antivirais/uso terapêutico , Bélgica , Criança , Pré-Escolar , Política de Saúde , Hemofilia A/complicações , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Homossexualidade Masculina , Humanos , Lactente , Masculino , Modelos Teóricos , Prisioneiros , Sistema de Registros , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transplantes , Adulto Jovem
5.
PLoS Genet ; 16(2): e1008576, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32053607

RESUMO

Although Plasmodium vivax parasites are the predominant cause of malaria outside of sub-Saharan Africa, they not always prioritised by elimination programmes. P. vivax is resilient and poses challenges through its ability to re-emerge from dormancy in the human liver. With observed growing drug-resistance and the increasing reports of life-threatening infections, new tools to inform elimination efforts are needed. In order to halt transmission, we need to better understand the dynamics of transmission, the movement of parasites, and the reservoirs of infection in order to design targeted interventions. The use of molecular genetics and epidemiology for tracking and studying malaria parasite populations has been applied successfully in P. falciparum species and here we sought to develop a molecular genetic tool for P. vivax. By assembling the largest set of P. vivax whole genome sequences (n = 433) spanning 17 countries, and applying a machine learning approach, we created a 71 SNP barcode with high predictive ability to identify geographic origin (91.4%). Further, due to the inclusion of markers for within population variability, the barcode may also distinguish local transmission networks. By using P. vivax data from a low-transmission setting in Malaysia, we demonstrate the potential ability to infer outbreak events. By characterising the barcoding SNP genotypes in P. vivax DNA sourced from UK travellers (n = 132) to ten malaria endemic countries predominantly not used in the barcode construction, we correctly predicted the geographic region of infection origin. Overall, the 71 SNP barcode outperforms previously published genotyping methods and when rolled-out within new portable platforms, is likely to be an invaluable tool for informing targeted interventions towards elimination of this resilient human malaria.


Assuntos
Surtos de Doenças/prevenção & controle , Genoma de Protozoário/genética , Técnicas de Genotipagem/métodos , Malária Vivax/transmissão , Plasmodium vivax/genética , África Oriental , Ásia , Conjuntos de Dados como Assunto , Erradicação de Doenças/métodos , Marcadores Genéticos/genética , Genótipo , Geografia , Humanos , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , Metadados , Repetições de Microssatélites/genética , Plasmodium vivax/isolamento & purificação , Polimorfismo de Nucleotídeo Único/genética , Valor Preditivo dos Testes , América do Sul , Doença Relacionada a Viagens , Reino Unido , Sequenciamento Completo do Genoma
8.
Acta Trop ; 201: 105214, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31600519

RESUMO

Human hookworm, a soil-transmitted helminth (STH) infection caused by either Necator americanus or Anclystoma duodenale, is a major cause of morbidity globally and predominantly affects the world's poorest populations. Transmitted primarily by larval invasion of exposed skin, the adults inhabit the host small intestine, where they consume host blood. The resultant chronic iron deficiency anemia can lead to stunted growth and cognitive deficits in children, reduced work capacity in adults, and a variety of pregnancy complications. Historically, successful STH elimination has only been achieved in regions with concomitant significant economic growth. Since 2001, control of the STHs has been attempted via single-dose mass deworming of at-risk school-aged and preschool-aged children within STH-endemic countries, with the goal of morbidity reduction. Research questioning this strategy has grown in recent years, and current studies are evaluating the effectiveness of novel deworming strategies, including multidrug regimens and expansion of deworming to entire communities. While footwear campaigns may be associated with reduced odds of hookworm infection, the evidence supporting the impact of water, sanitation, and hygiene (WASH) interventions upon hookworm is mixed. Progress towards a human hookworm vaccine continues, with promising results from recent Phase 1 trials and several others ongoing. Integrated STH control programs, which combine mass deworming with WASH interventions, are relatively unstudied but may be a promising advancement. Whether interruption of STH transmission can be achieved apart from significant economic growth remains unanswered, but likely the implementation of intensive, integrated control programs will be necessary to achieve that goal.


Assuntos
Erradicação de Doenças/métodos , Erradicação de Doenças/tendências , Helmintíase/prevenção & controle , Infecções por Uncinaria/prevenção & controle , Saneamento/métodos , Animais , Previsões , Helmintíase/epidemiologia , Infecções por Uncinaria/epidemiologia , Humanos
9.
BMC Infect Dis ; 19(1): 1019, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791253

RESUMO

BACKGROUND: Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. METHODS: We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. RESULTS: Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). CONCLUSIONS: Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.


Assuntos
Erradicação de Doenças , Hepatite C/prevenção & controle , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Adulto , Antivirais/economia , Antivirais/uso terapêutico , Estudos de Coortes , Análise Custo-Benefício , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Erradicação de Doenças/economia , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Usuários de Drogas/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Hepatite C/economia , Hepatite C/epidemiologia , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/prevenção & controle , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Vigilância da População/métodos , Anos de Vida Ajustados por Qualidade de Vida , Minorias Sexuais e de Gênero/estatística & dados numéricos
10.
Parasit Vectors ; 12(1): 574, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801631

RESUMO

BACKGROUND: Onchocerciasis is a priority neglected tropical disease targeted for elimination by 2025. The standard strategy to combat onchocerciasis is annual Community-Directed Treatment with ivermectin (CDTi). Yet, high prevalence rates and transmission persist following > 12 rounds in South-West Cameroon. Challenges include programme coverage, adherence to, and acceptability of ivermectin in an area of Loa loa co-endemicity. Loiasis patients harbouring heavy infections are at risk of potentially fatal serious adverse events following CDTi. Alternative strategies are therefore needed to achieve onchocerciasis elimination where CDTi effectiveness is suboptimal. METHODS/DESIGN: We designed an implementation study to evaluate integrating World Health Organisation-endorsed alternative strategies for the elimination of onchocerciasis, namely test-and-treat with the macrofilaricide, doxycycline (TTd), and ground larviciding for suppression of blackfly vectors with the organophosphate temephos. A community-based controlled before-after intervention study will be conducted among > 2000 participants in 20 intervention (Meme River Basin) and 10 control (Indian River Basin) communities. The primary outcome measure is O. volvulus prevalence at follow-up 18-months post-treatment. The study involves four inter-disciplinary components: parasitology, entomology, applied social sciences and health economics. Onchocerciasis skin infection will be diagnosed by skin biopsy and Loa loa infection will be diagnosed by parasitological examination of finger-prick blood samples. A simultaneous clinical skin disease assessment will be made. Eligible skin-snip-positive individuals will be offered directly-observed treatment for 5 weeks with 100 mg/day doxycycline. Transmission assessments of onchocerciasis in the communities will be collected post-human landing catch of the local biting blackfly vector prior to ground larviciding with temephos every week (0.3 l/m3) until biting rate falls below 5/person/day. Qualitative research, including in-depth interviews and focus-group discussions will be used to assess acceptability and feasibility of the implemented alternative strategies among intervention recipients and providers. Health economics will assess the cost-effectiveness of the implemented interventions. CONCLUSIONS: Using a multidisciplinary approach, we aim to assess the effectiveness of TTd, alone or in combination with ground larviciding, following a single intervention round and scrutinise the acceptability and feasibility of implementing at scale in similar hotspots of onchocerciasis infection, to accelerate onchocerciasis elimination.


Assuntos
Anti-Helmínticos/uso terapêutico , Erradicação de Doenças/métodos , Doxiciclina/uso terapêutico , Inseticidas , Oncocercose/tratamento farmacológico , Simuliidae/parasitologia , Temefós , Animais , Camarões , Erradicação de Doenças/organização & administração , Estudos de Viabilidade , Implementação de Plano de Saúde , Humanos , Ivermectina/uso terapêutico , Loíase/epidemiologia , Onchocerca/efeitos dos fármacos , Oncocercose/diagnóstico , Oncocercose/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Prevalência , Saúde Pública/métodos , Organização Mundial da Saúde
11.
PLoS One ; 14(12): e0226513, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841530

RESUMO

INTRODUCTION: In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country's National Verification Committee (NVC) through an annual status update (ASU). OBJECTIVE: By analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process. METHODS: A total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013-2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs). RESULTS: From 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians. CONCLUSIONS: The review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019-2023 as a technical aid to facilitate the achievement of disease elimination goals.


Assuntos
Erradicação de Doenças/tendências , Sarampo/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Sarampo/epidemiologia , Vacina contra Sarampo/uso terapêutico , Pessoa de Meia-Idade , Vigilância da População , Gravidez , Indicadores de Qualidade em Assistência à Saúde , Rubéola (Sarampo Alemão)/epidemiologia , Vacinação/métodos , Vacinação/tendências , Cobertura Vacinal/métodos , Cobertura Vacinal/tendências , Organização Mundial da Saúde , Adulto Jovem
12.
Acta Vet Hung ; 67(4): 529-542, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31842600

RESUMO

Eradication of porcine reproductive and respiratory syndrome virus (PRRSV) from the pig population of Hungary started in 2014 on the basis of the territorial principle. In order to reach this goal it was crucial to render each fattening unit free of this disease, since fattening units play a significant role in spreading the virus all over the country. In 2015, 188 out of 307 large-scale fattening farms (61.2%) kept PRRS-positive animals. The main source of infection of these farms was the import of PRRS-infected fattening pigs. The following methods were used during the eradication from 2017: (1) Only pigs coming from PRRS-free farms were allowed to be used for fattening in Hungary; (2) Quarantine of all herds for 60 days; (3) PCR test for PRRS 48 hours after the arrival of the prefattening animals; (4) Serological test for PRRS at the end of the quarantine period. If any diagnostic test gave even one positive result and the result was confirmed by another test, the stock had to be sold for slaughter within 15 days or placed outside Hungary, so that the infected stock would not compromise the PRRS status of that area. PRRSV eradication on large-scale fattening units applying all-in/all-out operation was relatively simple, using the depopulation-repopulation method. On permanently operating farms, the infected herd was sold from time to time, without having to be repopulated until the last delivery. After cleaning, disinfection and restocking, the repopulation was done with PRRS-free animals. As the eradication progressed over the years, a ban on the import of infected fattening pigs was imposed. As a consequence of these measures, by the end of 2018, Hungarian large-scale fattening farms became free of PRRS. Maintaining the national-level PRRS-free status of large-scale pig fattening units contributes to eliminating a significant cost factor from the Hungarian pork production industry, and opens the way for a significant reduction in antibiotic consumption as well.


Assuntos
Criação de Animais Domésticos/métodos , Erradicação de Doenças/métodos , Síndrome Respiratória e Reprodutiva Suína/prevenção & controle , Animais , Hungria , Síndrome Respiratória e Reprodutiva Suína/virologia , Vírus da Síndrome Respiratória e Reprodutiva Suína/fisiologia , Suínos
14.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 522-524, 2019 Aug 09.
Artigo em Chinês | MEDLINE | ID: mdl-31713384

RESUMO

OBJECTIVE: To understand the strategy of schistosomiasis elimination and its effects in Jinhu County, Jiangsu Province. METHODS: The data of schistosomiasis control in Jinhu County at different stages from 1970 to 2017 were collected and analyzed. RESULTS: From 1970 to 2017, there were three stages of schistosomiasis control, including transmission control, transmission interruption, and monitoring and elimination stages in Jinhu County. The main measures included Oncomelania hupensis snail control, infectious source control, and health education. A total of area of 290 691.78 hm2 was detected in Jinhu County, and the area with snails was 3 420.98 hm2. There were 8 729.37 hm2 area with snails was controlled. Since 2014, no O. hupensis snails were found. A total of 525 377 person-times were examined for schistosomiasis, with 2 815 schistosomiasis patients identified, and 2 844 person-times were treated by chemotherapy. In addition, 977 cases received the expand chemotherapy. Since 1990, no local schistosome-infected persons were found. In 2017, the awareness rate of schistosomiasis control knowledge and the correct rate of health behavior were increased by 54.59% and 14.23% respectively compared with those in 1992. CONCLUSIONS: The comprehensive schistosomiasis control measures implemented in Jinhu County at different periods have achieved remarkable outputs and accelerated the schistosomiasis elimination process. However, the precise control measures should be implemented in the future to consolidate the prevention and control achievements.


Assuntos
Erradicação de Doenças , Esquistossomose , Animais , Anti-Helmínticos/uso terapêutico , Conscientização , China , Erradicação de Doenças/métodos , Erradicação de Doenças/estatística & dados numéricos , Erradicação de Doenças/tendências , Comportamentos Relacionados com a Saúde , Humanos , Schistosoma/fisiologia , Esquistossomose/tratamento farmacológico , Esquistossomose/prevenção & controle , Caramujos/fisiologia
15.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 543-545, 2019 Jan 05.
Artigo em Chinês | MEDLINE | ID: mdl-31713391

RESUMO

OBJECTIVE: To understand the laboratory technicians' abilities in blood slide making and reading in 10 prefectures of Yunnan Province which have passed the provincial malaria elimination evaluation, so as to provide the evidence for improving the malaria elimination surveillance and parasite examination. METHODS: Thirty negative blood slides were randomly sampled to evaluate coating, dyeing and clean quality and reading results, and 4 laboratory technicians were sampled to evaluate their reading abilities from each prefecture level and its 2 subordinate counties (districts) respectively, and then the results were analyzed. RESULTS: A total of 869 negative blood samples were evaluated. The coincidence rate was 100%. The proportions of good coating, dyeing and clean quality were 96.09%, 91.71% and 96.89%, respectively. Totally 576 blood slides were used to evaluate the reading ability. The number of correct reading was 505, and the correct rate was 87.67%. Among them, the Plasmodium vivax correct reading rate was 87.76%, the P. falciparum correct reading rate was 87.50%, and the correct reading rate of mixed infections was 47.62%. The laboratory technicians' ability to the mixed infections was significantly lower than the ability to the others (χ2 = 37.169, P < 0.05), however, in the laboratory technicians' abilities, there was no significant difference among the center (s) for disease control and prevention, general hospitals and township hospitals (χ2 = 2.782, P > 0.05), and the prefecture, county and township levels (χ2 = 0.358, P > 0.05) . CONCLUSIONS: The 10 prefectures have passed the provincial evaluation in blood slide making and microscopic examination skill indicators requested, but the medical and public health institutions at all levels still should further improve their laboratory technicians' abilities in blood slide making and microscopic examination skills.


Assuntos
Técnicas e Procedimentos Diagnósticos , Erradicação de Doenças , Malária , China/epidemiologia , Técnicas e Procedimentos Diagnósticos/normas , Erradicação de Doenças/métodos , Humanos , Malária/sangue , Malária/diagnóstico , Malária/epidemiologia , Microscopia , Reprodutibilidade dos Testes
16.
Prev Vet Med ; 173: 104800, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31704560

RESUMO

In spite of the efforts invested to eradicate bovine tuberculosis (bTB) in cattle, the disease is still present in several developed countries, including Spain. Among the factors related with disease persistence in high prevalence areas, the lack of sensitivity of the screening test for detection of infected herds [single intradermal tuberculin (SIT) test] can play a major role. Here, a scenario tree model mimicking the diagnostic test scheme in place in the region of Castilla y Leon (Spain) was developed to estimate the probability of detecting bTB in an infected-non detected officially tuberculosis free (OTF) herd (herd sensitivity, HSe). In order to do so the probability of detecting at least one positive animal in the SIT test with/without post-mortem (detection of lesions and culture) confirmation in an infected herd was estimated using Monte Carlo simulation through @RISK (Palisade Co, NY, USA). Uncertainty on the accuracy of the diagnostic tests was introduced in the model using distributions based on the literature. The performance of the model was evaluated by comparing the predicted number of SIT/post-mortem positive animals in infected herds with those observed in newly detected bTB-infected herds in the region in 2011-2015. The estimated HSe of the SIT test was 76.2% (95% probability interval: 19.8-97.6). According to the model, bTB infection would be then confirmed through culture in 65.3% (95% PI: 50.0-82.3) of the herds detected through the SIT test, so that overall the proportion of infected-non detected OTF herds in which the infection could be confirmed after the initial SIT test was 49.6% (95% PI: 9.75-80.3). The predicted HSe of both SIT test and culture was directly correlated with herd size. Results from the model suggest a moderate but highly variable HSe of the current surveillance system in place for bTB detection in OTF herds located in high prevalence areas, that could be maximized by performing multiple tests within a year as indicated in the Spanish eradication program (with a median SIT HSe of 87% when two consecutive tests were considered). In addition, these results highlight the usefulness of performing subsequent SIT tests to rule out infection in SIT-positive herds even when the causative agent cannot be isolated.


Assuntos
Doenças dos Bovinos/prevenção & controle , Erradicação de Doenças/métodos , Tuberculose Bovina/prevenção & controle , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Monitoramento Epidemiológico/veterinária , Prevalência , Fatores de Risco , Espanha/epidemiologia , Teste Tuberculínico/veterinária , Tuberculose Bovina/epidemiologia
17.
Gastroenterol. hepatol. (Ed. impr.) ; 42(9): 579-592, nov. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187928

RESUMO

La Asociación Española para el Estudio del Hígado (AEEH) está convencida de que la eliminación de la hepatitisC en España es posible siempre y cuando seamos capaces de emplear los recursos y las herramientas necesarias para la misma. Este documento refleja la posición de la AEEH respecto a la eliminación del virus de la hepatitisC (VHC), estableciendo una amplia serie de recomendaciones que se pueden agrupar en cinco categorías: 1)cribado del VHC en función de la edad, de la existencia de factores de riesgo clásicos de adquisición de la infección, búsqueda activa de pacientes diagnosticados con anterioridad y desarrollo de estrategias de microeliminación en poblaciones vulnerables; 2)simplificación del diagnóstico del VHC (diagnóstico en un solo paso y diagnóstico en el punto de atención del paciente); 3)simplificación del tratamiento de los pacientes y mejora de los circuitos asistenciales; 4)medidas de política sanitaria, y, finalmente, 5)establecimiento de indicadores de eliminación del VHC


The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitisC virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1)Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of micro-elimination strategies in vulnerable populations; 2)Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3)Simplification of patient treatment and improvement of care circuits; 4)Health policy measures, and, finally, 5)Establishment of HCV elimination indicators


Assuntos
Humanos , Erradicação de Doenças/métodos , Hepacivirus/isolamento & purificação , Hepatite C/prevenção & controle , Fatores Etários , Erradicação de Doenças/organização & administração , Diagnóstico Precoce , Hepatite C/diagnóstico , Hepatite C/etiologia , Hepatite C/terapia , Seleção de Pacientes , Fatores de Risco , Espanha , Qualidade da Assistência à Saúde , Melhoria de Qualidade
18.
Expert Rev Anti Infect Ther ; 17(10): 763-773, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31578079

RESUMO

Introduction: Hepatitis C virus (HCV) infection is a major global health concern on the rise, prompting unprecedented efforts by the World Health Organization (WHO) to eliminate this epidemic by 2030. Being the country with the largest HCV-infected population in the world, China has been faced with a general lack of awareness for HCV, low treatment uptake and subpar collaborations among healthcare providers and stakeholders. Areas covered: This review discusses the epidemiological situations of HCV infection and the challenges in HCV management in China. This review also explores micro-elimination strategies in China, identifying potential sub-populations for concerted efforts in eliminating HCV. As DAAs are increasingly recognized as a more effective alternative to traditional regimens, the cost-effectiveness and budget impacts of bringing more DAAs into the reimbursement lists are also addressed. Several small-scale targeted literature searches were conducted in PubMed for various topics covered in the article, and hand searching was performed to fill any data gaps. More recent data were used wherever possible. Expert opinion: Considering the unique socioeconomical landscape of China, micro-elimination strategies might be more effective and should be targeted at high-risk populations. Varying regional needs in HCV care across the country necessitate decentralized approaches in research and policy-making.


Assuntos
Antivirais/administração & dosagem , Erradicação de Doenças/métodos , Hepatite C/prevenção & controle , China , Análise Custo-Benefício , Saúde Global , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Humanos , Fatores de Risco , Fatores Socioeconômicos , Organização Mundial da Saúde
20.
Gastroenterol Hepatol ; 42(9): 579-592, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31594683

RESUMO

The Spanish Association for the Study of the Liver (AEEH) is convinced that the elimination of hepatitisC virus (HCV) in Spain is possible as long as we are able to use the resources and tools necessary for it. This document reflects the position of the AEEH regarding the elimination of HCV, establishing a wide range of recommendations that can be grouped into five categories: 1)Screening of HCV according to age, of the existence of classic acquisition risk factors of infection, active search of previously diagnosed patients and development of micro-elimination strategies in vulnerable populations; 2)Simplification of HCV diagnosis (one-step diagnosis and diagnosis at the point of patient care); 3)Simplification of patient treatment and improvement of care circuits; 4)Health policy measures, and, finally, 5)Establishment of HCV elimination indicators.


Assuntos
Erradicação de Doenças/métodos , Hepacivirus/isolamento & purificação , Hepatite C/prevenção & controle , Fatores Etários , Erradicação de Doenças/organização & administração , Diagnóstico Precoce , Hepatite C/diagnóstico , Hepatite C/etiologia , Hepatite C/terapia , Humanos , Seleção de Pacientes , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Fatores de Risco , Espanha
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