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1.
MMWR Morb Mortal Wkly Rep ; 68(40): 893-896, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600181

RESUMO

During January 1-October 1, 2019, a total of 1,249 measles cases and 22 measles outbreaks were reported in the United States. This represents the most U.S. cases reported in a single year since 1992 (1), and the second highest number of reported outbreaks annually since measles was declared eliminated* in the United States in 2000 (2). Measles is an acute febrile rash illness with an attack rate of approximately 90% in susceptible household contacts (3). Domestic outbreaks can occur when travelers contract measles outside the United States and subsequently transmit infection to unvaccinated persons they expose in the United States. Among the 1,249 measles cases reported in 2019, 1,163 (93%) were associated with the 22 outbreaks, 1,107 (89%) were in patients who were unvaccinated or had an unknown vaccination status, and 119 (10%) measles patients were hospitalized. Closely related outbreaks in New York City (NYC) and New York State (NYS; excluding NYC), with ongoing transmission for nearly 1 year in large and close-knit Orthodox Jewish communities, accounted for 934 (75%) cases during 2019 and threatened the elimination status of measles in the United States. Robust responses in NYC and NYS were effective in controlling transmission before the 1-year mark; however, continued vigilance for additional cases within these communities is essential to determine whether elimination has been sustained. Collaboration between public health authorities and undervaccinated communities is important for preventing outbreaks and limiting transmission. The combination of maintenance of high national vaccination coverage with measles, mumps, and rubella vaccine (MMR) and rapid implementation of measles control measures remains the cornerstone for preventing widespread measles transmission (4).


Assuntos
Surtos de Doenças/estatística & dados numéricos , Sarampo/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Sarampo/prevenção & controle , Vacina contra Sarampo-Caxumba-Rubéola/administração & dosagem , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos , Adulto Jovem
4.
BMC Public Health ; 19(1): 937, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296198

RESUMO

BACKGROUND: Various neglected tropical diseases show spatially changing seasonality at small areas. This phenomenon has received little scientific attention so far. Our study contributes to advancing the understanding of its drivers. This study focuses on the effects of the seasonality of increasing social contacts on the incidence proportions at multiple district level of the childhood hand-foot-mouth disease in Da Nang city, Viet Nam from 2012 to 2016. METHODS: We decomposed the nonstationary time series of the incidence proportions for the nine spatial-temporal (S-T) strata in the study area, where S indicates the spatial and T the temporal stratum. The long-term trends and the seasonality are presented by the Fourier series. To study the effects of the monthly average ambient temperature and the period of preschooling, we developed a spatial-temporal autoregressive model. RESULTS: Seasonality of childhood hand-foot-mouth disease incidence proportions shows two peaks in all spatial strata annually: large peaks synchronously in April and small ones asynchronously during the preschooling period. The peaks of the average temperature are asynchronous with the seasonal peaks of the childhood hand-foot-mouth disease incidence proportions in the period between January and May, with the negative values of the regression coefficients for all spatial strata, respectively: [Formula: see text]. The increasingly cumulative preschooling period and the seasonal component of the incidence proportions are negatively correlated in the period between August and December, with the negative values of the regression coefficients for all temporal strata, respectively: [Formula: see text]. CONCLUSIONS: The study shows that social contact amongst children under five years of age is the important driving factor of the dynamics of the childhood hand-foot-mouth disease outbreaks in the study area. The preschooling season when children's contact with each other increases stimulates the geographical variation of the seasonality of childhood hand-foot-mouth disease infections at small areas in the study area.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Doença de Mão, Pé e Boca/epidemiologia , Estações do Ano , Pré-Escolar , Cidades , Feminino , Humanos , Incidência , Lactente , Masculino , Análise Espaço-Temporal , Vietnã/epidemiologia
5.
BMC Infect Dis ; 19(1): 592, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286917

RESUMO

BACKGROUND: Norovirus (NoV) is recognized as a leading cause of acute gastroenteritis (AGE) outbreaks in settings globally. Studies have shown that employees played an important role in the transmission mode during some NoV outbreaks. This study aimed to investigate the prevalence of NoV infection and duration of NoV shedding among employees during NoV outbreaks, as well as factors affecting shedding duration. METHODS: Specimens and epidemiological data were collected from employees who were suspected of being involved in the transmission or with AGE symptoms during NoV outbreaks in Xuhui District, Shanghai, from 2015 to 2017. Specimens were detected using real-time RT-PCR to determine whether or not employees had become infected with NoV. Specimens were collected every 3-7 days from NoV-infected employees until specimens became negative for NoV. RESULTS: A total of 421 employees were sampled from 49 NoV outbreaks, and nearly 90% of them (377/421) were asymptomatic. Symptomatic employees showed significantly higher prevalence of NoV infection than asymptomatic ones (70.5% vs. 17.0%, P < 0.01). The average duration of NoV shedding was 6.9 days (95% confidence interval: 6.1-7.7 days) among 88 NoV-infected individuals, and was significantly longer in symptomatic individuals than in asymptomatic ones (9.8 days vs. 5.6 days, P < 0.01). In Cox proportional-hazards model, after adjusting age and gender, symptoms was the only factor associated with duration of NoV shedding. CONCLUSIONS: Compared with asymptomatic employees, symptomatic employees had higher prevalence of NoV infection and longer durations of NoV shedding. Since NoV shedding duration among NoV-infected employees tends to be longer than their isolation time during outbreaks, reinforcement of hygiene practices among these employees is especially necessary to reduce the risk of virus secondary transmissions after their return to work.


Assuntos
Infecções por Caliciviridae , Surtos de Doenças/estatística & dados numéricos , Gastroenterite , Norovirus/genética , Adulto , Canal Anal/virologia , Infecções Assintomáticas/epidemiologia , Infecções por Caliciviridae/diagnóstico , Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , China/epidemiologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , RNA Viral/análise , RNA Viral/genética , Reação em Cadeia da Polimerase em Tempo Real
6.
MMWR Morb Mortal Wkly Rep ; 68(27): 608-614, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31295232

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM), a serious paralytic illness, was first recognized as a distinct condition in 2014, when cases were reported concurrent with a large U.S. outbreak of severe respiratory illness caused by enterovirus D-68 (EV-D68). Since 2014, nationwide outbreaks of AFM have occurred every 2 years in the United States; the cause for the recent change in the epidemiology of AFM in the United States, including the occurrence of outbreaks and a biennial periodicity since 2014, is under investigation. This report updates clinical, laboratory, and outcome data for cases reported to CDC during 2018. METHODS: Clinical data and specimens from persons in the United States who met the clinical criterion for AFM (acute onset of flaccid limb weakness) with onset in 2018 were submitted to CDC for classification of the illnesses as confirmed, probable, or non-AFM cases. Enterovirus/rhinovirus (EV/RV) testing was performed on available specimens from persons meeting the clinical criterion. Descriptive analyses, laboratory results, and indicators of early recognition and reporting are summarized. RESULTS: From January through December 2018, among 374 reported cases of AFM, 233 (62%) (from 41 states) were classified as confirmed, 26 (7%) as probable, and 115 (31%) as non-AFM cases. Median ages of patients with confirmed, probable, and non-AFM cases were 5.3, 2.9, and 8.8 years, respectively. Laboratory testing identified multiple EV/RV types, primarily in respiratory and stool specimens, in 44% of confirmed cases. Among confirmed cases, the interval from onset of limb weakness until specimen collection ranged from 2 to 7 days, depending on specimen type. Interval from onset of limb weakness until reporting to CDC during 2018 ranged from 18 to 36 days, with confirmed and probable cases reported earlier than non-AFM cases. CONCLUSION: Identification of risk factors leading to outbreaks of AFM remains a public health priority. Prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention recommendations.


Assuntos
Viroses do Sistema Nervoso Central/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Mielite/epidemiologia , Doenças Neuromusculares/epidemiologia , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Centers for Disease Control and Prevention (U.S.) , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estações do Ano , Estados Unidos/epidemiologia , Adulto Jovem
7.
Parasit Vectors ; 12(1): 359, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340851

RESUMO

BACKGROUND: An outbreak of leishmaniasis caused by Leishmania infantum was declared in the southwest of the Madrid region (Spain) in June 2009. This provided a unique opportunity to compare the management of visceral leishmaniasis (VL) in immunocompetent adults (IC-VL), patients with HIV (HIV-VL) and patients receiving immunosuppressants (IS-VL). METHODS: A cohort of adults with VL, all admitted to the Hospital Universitario de Fuenlabrada between June 2009 and June 2018, were monitored in this observational study, recording their personal, epidemiological, analytical, diagnostic, treatment and outcome variables. RESULTS: The study population was made up of 111 patients with VL (10% HIV-VL, 14% IS-VL, 76% IC-VL). Seventy-one percent of the patients were male; the mean age was 45 years (55 years for the IS-VL patients, P = 0.017). Fifty-four percent of the IC-VL patients were of sub-Saharan origin (P = 0.001). Fever was experienced by 98% of the IC-VL patients vs 73% of the LV-HIV patients (P = 0.003). Plasma ferritin was > 1000 ng/ml in 77% of the IC-VL patients vs 17% of the LV-HIV patients (P = 0.007). Forty-two percent of patients fulfilled the criteria for haemophagocytic lymphohistiocytosis. RDT (rK39-ICT) serological analysis returned sensitivity and specificity values of 45% and 99%, respectively, and ELISA/iIFAT returned 96% and 89%, respectively, with no differences in this respect between patient groups. Fourteen (13.0%) patients with VL experienced treatment failure, eight of whom were in the IC-VL group. Treatment with < 21 mg/kg (total) liposomal amphotericin B (LAB) was associated with treatment failure in the IC-VL patients [P = 0.002 (OR: 14.7; 95% CI: 2.6-83.3)]. CONCLUSIONS: IS-VL was more common than HIV-VL; the lack of experience in dealing with IS-VL is a challenge that needs to be met. The clinical features of the patients in all groups were similar, although the HIV-VL patients experienced less fever and had lower plasma ferritin concentrations. RDT (rK39-ICT) analysis returned a good specificity value but a much poorer sensitivity value than reported in other scenarios. The patients with HIV-VL, IS-VL and IC-VL returned similar serological results. Current guidelines for treatment seem appropriate, but the doses of LAB required to treat patients with HIV-VL and IS-VL are poorly defined.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Infecções por HIV/parasitologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Adulto , Idoso , Antígenos de Protozoários/imunologia , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Coinfecção/parasitologia , Coinfecção/virologia , Diagnóstico Tardio , Surtos de Doenças/prevenção & controle , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Imunocompetência , Imunossupressores/uso terapêutico , Leishmania infantum , Leishmaniose Visceral/tratamento farmacológico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Parasit Vectors ; 12(1): 344, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300061

RESUMO

BACKGROUND: In 2015-2016, Zika virus (ZIKV) caused serious epidemics in Brazil. The key epidemiological parameters and spatial heterogeneity of ZIKV epidemics in different states in Brazil remain unclear. Early prediction of the final epidemic (or outbreak) size for ZIKV outbreaks is crucial for public health decision-making and mitigation planning. We investigated the spatial heterogeneity in the epidemiological features of ZIKV across eight different Brazilian states by using simple non-linear growth models. RESULTS: We fitted three different models to the weekly reported ZIKV cases in eight different states and obtained an R2 larger than 0.995. The estimated average values of basic reproduction numbers from different states varied from 2.07 to 3.41, with a mean of 2.77. The estimated turning points of the epidemics also varied across different states. The estimation of turning points nevertheless is stable and real-time. The forecast of the final epidemic size (attack rate) is reasonably accurate, shortly after the turning point. The knowledge of the epidemic turning point is crucial for accurate real-time projection of the outbreak. CONCLUSIONS: Our simple models fitted the epidemic reasonably well and thus revealed the spatial heterogeneity in the epidemiological features across Brazilian states. The knowledge of the epidemic turning point is crucial for real-time projection of the outbreak size. Our real-time estimation framework is able to yield a reliable prediction of the final epidemic size.


Assuntos
Sistemas de Computação , Surtos de Doenças/estatística & dados numéricos , Modelos Teóricos , Infecção por Zika virus/epidemiologia , Número Básico de Reprodução , Brasil/epidemiologia , Epidemias/prevenção & controle , Epidemias/estatística & dados numéricos , Humanos , Incidência , Saúde Pública , Zika virus , Infecção por Zika virus/transmissão
9.
MMWR Morb Mortal Wkly Rep ; 68(28): 627-630, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31318854

RESUMO

In October 2017, the Nebraska Department of Health and Human Services (NDHHS) was notified by a local health department of a gastrointestinal illness outbreak among attendees of a wedding reception at facility A, an event center. Shortly thereafter, state and local public health officials began receiving reports of similar gastrointestinal illness among attendees of subsequent facility A events. An investigation was initiated to identify cases, establish the cause, assess possible transmission routes, and provide control recommendations. Overall, 159 cases consistent with norovirus infection (three confirmed and 156 probable) were identified among employees of facility A and attendees of nine facility A events during October 27-November 18, 2017. The investigation revealed a public vomiting episode at the facility on October 27 and at least one employee involved with preparing and serving food who returned to work <24 hours after symptom resolution, suggesting that a combination of contaminated environmental surfaces and infected food handlers likely sustained the outbreak. Recommendations regarding sanitation and excluding ill employees were communicated to facility A management. However, facility A performed minimal environmental cleaning and did not exclude ill employees. Consequently, transmission continued. To prevent persistent norovirus outbreaks in similar settings, public health officials should ensure that involved facilities implement a comprehensive prevention strategy as early as possible that includes extensive sanitation and strict exclusion of ill food handlers for at least 48 hours after symptom resolution (1).


Assuntos
Infecções por Caliciviridae/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Logradouros Públicos , Infecções por Caliciviridae/prevenção & controle , Surtos de Doenças/prevenção & controle , Fezes/virologia , Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Gastroenterite/virologia , Genótipo , Humanos , Nebraska/epidemiologia , Norovirus/genética , Norovirus/isolamento & purificação , Prática de Saúde Pública
11.
MMWR Morb Mortal Wkly Rep ; 68(29): 642-646, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31344023

RESUMO

The number of wild poliovirus (WPV) cases in Nigeria decreased from 1,122 in 2006 to six WPV type 1 (WPV1) in 2014 (1). During August 2014-July 2016, no WPV cases were detected; during August-September 2016, four cases were reported in Borno State. An insurgency in northeastern Nigeria had resulted in 468,800 children aged <5 years deprived of health services in Borno by 2016. Military activities in mid-2016 freed isolated families to travel to camps, where the four WPV1 cases were detected. Oral poliovirus vaccine (OPV) campaigns were intensified during August 2016-December 2017; since October 2016, no WPV has been detected (2). Vaccination activities in insurgent-held areas are conducted by security forces; however, 60,000 unvaccinated children remain in unreached settlements. Since 2018, circulating vaccine-derived poliovirus type 2 (cVDPV2) has emerged and spread from Nigeria to Niger and Cameroon; outbreak responses to date have not interrupted transmission. This report describes progress in Nigeria polio eradication activities during January 2018-May 2019 and updates the previous report (2). Interruption of cVDPV2 transmission in Nigeria will need increased efforts to improve campaign quality and include insurgent-held areas. Progress in surveillance and immunization activities will continue to be reviewed, potentially allowing certification of interruption of WPV transmission in Africa in 2020.


Assuntos
Erradicação de Doenças , Surtos de Doenças/prevenção & controle , Poliomielite/prevenção & controle , Vigilância da População , Adolescente , Criança , Pré-Escolar , Surtos de Doenças/estatística & dados numéricos , Humanos , Programas de Imunização , Lactente , Nigéria/epidemiologia , Poliomielite/epidemiologia , Poliovirus/genética , Poliovirus/isolamento & purificação , Vacinas contra Poliovirus/administração & dosagem , Avaliação de Programas e Projetos de Saúde , Sorogrupo , Violência
13.
Glob Health Action ; 12(1): 1552652, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154985

RESUMO

Background: Digital traces are rapidly used for health monitoring purposes in recent years. This approach is growing as the consequence of increased use of mobile phone, Internet, and machine learning. Many studies reported the use of Google Trends data as a potential data source to assist traditional surveillance systems. The rise of Internet penetration (54.7%) and the huge utilization of Google (98%) indicate the potential use of Google Trends in Indonesia. No study was performed to measure the correlation between country wide official dengue reports and Google Trends data in Indonesia. Objective: This study aims to measure the correlation between Google Trends data on dengue fever and the Indonesian national surveillance report. Methods: This research was a quantitative study using time series data (2012-2016). Two sets of data were analyzed using Moving Average analysis in Microsoft Excel. Pearson and Time lag correlations were also used to measure the correlation between those data. Results: Moving Average analysis showed that Google Trends data have a linear time series pattern with official dengue report. Pearson correlation indicated high correlation for three defined search terms with R-value range from 0.921 to 0.937 (p ≤ 0.05, overall period) which showed increasing trend in epidemic periods (2015-2016). Time lag correlation also indicated that Google Trends data can potentially be used for an early warning system and novel tool to monitor public reaction before the increase of dengue cases and during the outbreak. Conclusions: Google Trends data have a linear time series pattern and statistically correlated with annual official dengue reports. Identification of information-seeking behavior is needed to support the use of Google Trends for disease surveillance in Indonesia.


Assuntos
Dengue/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Epidemias/estatística & dados numéricos , Vigilância da População/métodos , Mídias Sociais/estatística & dados numéricos , Mídias Sociais/tendências , Telefone Celular , Previsões , Humanos , Indonésia/epidemiologia , Internet
14.
Glob Health Action ; 12(1): 1553283, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154987

RESUMO

Background: Leptospirosis is an important public health problem in Sri Lanka. Most people become infected by contact with leptospires in soil and in surface water. Survival of leptospires in the environment depends upon the moisture in soil, humidity, temperature and surface water. Leptospires are spread by flood water and waterways. Therefore, the weather of an area influences the leptospirosis incidence of that area. Objectives: To find out the correlations between the leptospirosis incidence in the district of Kandy, Sri Lanka, and local weather variables and then to explore the utility of the findings. Methods: We gathered data on reported leptospirosis cases in the Kandy district and mid-year population data and calculated weekly incidences for 2006 to 2015. Daily weather data from Katugastota weather station was obtained and converted into weekly data. We plotted time series graphs and observed the correlation between six aggregated weather parameters and leptospirosis incidence. Those weather parameters were rainfall, the count of wet days per week, days with rainfall >100 mm per week, minimum temperature, average temperature and average humidity. Then we looked for correlations between leptospirosis incidence and those weather parameters by performing the wavelet analysis. Results: Our wavelet analysis results show peaks of wet days per week, days with rainfall >100 mm per week, minimum temperature, average temperature and average humidity respectively after 2, 3, 13, 20 and 1 week lags were followed by peaks of leptospirosis incidence. Nadirs (troughs) of rainfall after a week were followed by nadirs of leptospirosis incidence. Conclusions: All weather parameters studied are correlated with local leptospirosis incidence and the climate in Kandy is conducive for leptospirosis transmission. Leptospirosis incidence in the Kandy district is high compared to the national and global incidence. Therefore, leptospirosis preventive work in Kandy deserves more attention, especially during months with favorable weather for leptospirosis transmission. Video abstract Read the transcript Watch the video on Vimeo.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Umidade , Leptospirose/epidemiologia , Temperatura Ambiente , Tempo (Meteorologia) , Humanos , Incidência , Sri Lanka/epidemiologia
15.
MMWR Morb Mortal Wkly Rep ; 68(25): 568-572, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31246941

RESUMO

Cryptosporidium is a parasite that causes cryptosporidiosis, a profuse, watery diarrhea that can last up to 3 weeks in immunocompetent patients and can lead to life-threatening malnutrition and wasting in immunocompromised patients.* Fecal-oral transmission can occur by ingestion of contaminated recreational water, drinking water, or food, or through contact with infected persons or animals. For the period 2009-2017, public health officials from 40 states and Puerto Rico voluntarily reported 444 cryptosporidiosis outbreaks resulting in 7,465 cases. Exposure to treated recreational water (e.g., in pools and water playgrounds) was associated with 156 (35.1%) outbreaks resulting in 4,232 (56.7%) cases. Other predominant outbreak exposures included contact with cattle (65 outbreaks; 14.6%) and contact with infected persons in child care settings (57; 12.8%). The annual number of reported cryptosporidiosis outbreaks overall increased an average of approximately 13% per year over time. Reversing this trend will require dissemination of prevention messages to discourage swimming or attending child care while ill with diarrhea and encourage hand washing after contact with animals. Prevention and control measures can be optimized by improving understanding of Cryptosporidium transmission through regular analysis of systematically collected epidemiologic and molecular characterization data.


Assuntos
Criptosporidiose/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Animais , Bovinos , Doenças dos Bovinos/microbiologia , Creches , Pré-Escolar , Criptosporidiose/transmissão , Cryptosporidium/isolamento & purificação , Diarreia/microbiologia , Humanos , Lactente , Piscinas , Estados Unidos/epidemiologia , Microbiologia da Água
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 731-738, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238628

RESUMO

Due to the continuous improvement on HIV surveillance system and the diversity of data sources, various methodologies on estimation and projection of HIV/AIDS present greater contribution in exploring the natural history and related burden of HIV in the future. Different kinds of methods have been developed by professionals, both at home and abroad. This paper reviews the rationale, requirement, application, strength and limitation of the related methodologies that have been widely used in this field, to provide reference and evidence for the application and selection of related methodologies in the future.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Epidemias , Infecções por HIV/epidemiologia , China/epidemiologia , Previsões/métodos , Humanos , Prevalência
17.
Mem Inst Oswaldo Cruz ; 114: e180569, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31166479

RESUMO

BACKGROUND: Currently, there is an increasing global interest for the study of how infectious diseases could be linked to climate and weather variability. The Chagas disease was described in 1909 by Carlos Chagas, and is caused by the flagellate protozoan Trypanosoma cruzi. The Chagas disease is considered one of the biggest concerns in public health in Latin America. In Chile, the main vectors involved in the transmission of T. cruzi are arthropods of the Triatominae subfamily. Moreover, another main transmission way is through of vectors by fecal-urine way, however, oral way also has been described among others transmission form. OBJECTIVES: In order to get understand outbreaks of Chagas-disease, we search for possible relationships between the frequency of cases in the Chilean population and atmospheric oscillations. METHODS: We explored the two most important atmospheric oscillations in the Southern Hemisphere: southern oscillation index (SOI) and Antarctic oscillation (AAO), during the available years with official data. Because the number of migrant people born outside from Chile increasing significantively between 2014 and 2018, we used for the analysis two different periods from data available official data: (i) 2001 to 2014, (ii) 2001 to 2017. FINDINGS: For both periods we observed a significant and positive relation between AAO one year before. However, for the 2001 to 2014 period positive SOI one year before, which is related with La Niña phases, was the more important variable. MAIN CONCLUSIONS: The Chagas disease frequency per year in Chile was found to depend mainly on SOI in previous year, whose values can be determined one year in advance. Therefore, it is possible to partially forecast annual frequency patterns. This could have important applications in public health strategies and for allocating resources for the management of the disease.


Assuntos
Atmosfera , Doença de Chagas/epidemiologia , Mudança Climática , Surtos de Doenças/estatística & dados numéricos , Doença de Chagas/transmissão , Chile/epidemiologia , Humanos , Valores de Referência , Fatores de Tempo
18.
BMC Infect Dis ; 19(1): 516, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185939

RESUMO

BACKGROUND: A cholera outbreak started on 29 February in Bwikhonge Sub-county, Bulambuli District in Eastern Uganda. Local public health authorities implemented initial control measures. However, in late March, cases sharply increased in Bwikhonge Sub-county. We investigated the outbreak to determine its scope and mode of transmission, and to inform control measures. METHODS: We defined a suspected case as sudden onset of watery diarrhea from 1 March 2016 onwards in a resident of Bulambuli District. A confirmed case was a suspected case with positive stool culture for V. cholerae. We conducted descriptive epidemiologic analysis of the cases to inform the hypothesis on mode of transmission. To test the hypothesis, we conducted a case-control study involving 100 suspected case-patients and 100 asymptomatic controls, individually-matched by residence village and age. We collected seven water samples for laboratory testing. RESULTS: We identified 108 suspected cases (attack rate: 1.3%, 108/8404), including 7 confirmed cases. The case-control study revealed that 78% (78/100) of case-patients compared with 51% (51/100) of control-persons usually collected drinking water from the nearby Cheptui River (ORMH = 7.8, 95% CI = 2.7-22); conversely, 35% (35/100) of case-patients compared with 54% (54/100) of control-persons usually collected drinking water from borehole pumps (ORMH = 0.31, 95% CI = 0.13-0.65). The index case in Bwikhonge Sub-county had onset on 29 February but the outbreak had been on-going in the neighbouring sub-counties in the previous 3 months. V. cholera was isolated in 2 of the 7 river water samples collected from different locations. CONCLUSIONS: We concluded that this cholera outbreak was caused by drinking contaminated water from Cheptui River. We recommended boiling and/or treating drinking water, improved sanitation, distribution of chlorine tablets to the affected villages, and as a long-term solution, construction of more borehole pumps. After implementing preventive measures, the number of cases declined and completely stopped after 6th April.


Assuntos
Cólera/epidemiologia , Cólera/etiologia , Surtos de Doenças , Água Potável/microbiologia , Rios/microbiologia , Poluição da Água , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/microbiologia , Surtos de Doenças/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Saneamento , Uganda/epidemiologia , Vibrio cholerae/isolamento & purificação , Poluição da Água/efeitos adversos , Adulto Jovem
19.
BMC Public Health ; 19(1): 484, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046711

RESUMO

BACKGROUND: Globally in 2015 about 214 million malaria cases and 438,000 deaths were reported with 75% were from Sub-Saharan Africa. Malaria transmission in Ethiopia is unstable, and outbreaks are considered public health emergencies. Understanding the trigger for outbreaks in low-transmission areas can help facilitate malaria elimination. On July 8th malaria outbreak was reported from Laelay Adyabo district. The objective was to investigate the magnitude and associated factors with malaria outbreak. METHODS: We defined a case as confirmed malaria using microscopy or a rapid diagnostic test for Plasmodium parasites in a resident of Laelay-Adyabo District from July 9-28, 2017. We identified cases by reviewing health facility records and conducted a case-control study using randomly-selected cases from a line list, and two neighborhood controls per case. A pretested semi-structured questionnaire adapted from WHO malaria guidelines was used to collect data from case-patients and controls. We calculated crude (COR) and adjusted (AOR) odds ratios to identify factors associated with malaria. RESULT: A total of 145 confirmed malaria cases (57.9% males) were identified with village attack rate (AR) of 12.1/1000. The AR was higher among males than females (14.1 verses 10.1/1000), children aged 5-14 years (12.9/1000), and in Zelazle Kebelle (13.6/1000 population). Wearing protective clothing (AOR = 0.27, 95% CI 0.11-0.66), having good knowledge of malaria transmission (AOR = 0.25, 95% CI 0.08-0.75), having waste collection material at home (AOR = 0.25 95% CI 0.11-0.61), availability of mosquito breeding sites around home (AOR = 9.08, 95% CI 3.6-22.93), and staying outdoor overnight (AOR = 3.7, 95% CI 1.44-9.56) were independently associated with malaria. CONCLUSION: The overall attack rate for malaria during this outbreak was high affecting > 1% of the population. Wearing protective clothing at night, knowing about malaria transmission, having mosquito breeding sites around the home, staying outdoors overnight, and having waste collection material in their house were predictors of the infection. Laelay Adyabo district health office should provide health education on malaria transmission and prevention measures and how to clear mosquito breeding sites.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Malária/epidemiologia , Medição de Risco/estatística & dados numéricos , Adolescente , Adulto , Animais , Estudos de Casos e Controles , Criança , Pré-Escolar , Culicidae , Surtos de Doenças/prevenção & controle , Etiópia/epidemiologia , Feminino , Educação em Saúde/organização & administração , Humanos , Incidência , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Roupa de Proteção , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-31110836

RESUMO

Introduction: In April 2016, the Department of Health in Zamboanga Peninsula reported an increase in the number of acute gastroenteritis cases reported from Zamboanga City. An epidemiologic investigation was conducted to verify the existence of an outbreak, determine source/mode of transmission and recommend control measures. Methods: A line list of cases was compiled from the 11 hospitals within Zamboanga City and a case-series study was conducted. Suspected cases were any persons from Zamboanga City who had three or more episodes of acute diarrhoea within 24 hours from 15 March to 29 May 2016. Confirmed cases were suspected cases with active symptoms during the investigation who had a stool sample collected with rotavirus detected. Water samples were also collected for viral detection. Results: There were 2936 suspected cases with 22 deaths (case fatality rate: 0.75%), an age range of 8 days to 89 years (median: 2 years), with those aged less than 5 years the most affected age group (1903/2936, 65%). The majority were males (1549/2936, 53%). From the 138 active case patients included in the case-series study, the majority reported contact with a family member who had diarrhoea (89/138, 64%) and using water refilling stations as their major source of drinking-water (88/134, 64%). Of the 93 stool specimens collected, 56 (60%) were positive for rotavirus. Five samples from water refilling stations where case patients reported collecting drinking-water were all positive for rotavirus. Discussion: Strict regulation of water refilling stations and boiling drinking-water in households were implemented, immediately controlling the outbreak. After complying with all the requirements set by the Department of Health, a water safety certificate was awarded to Zamboanga City in September 2018.


Assuntos
Água Potável/normas , Água Potável/virologia , Infecções por Rotavirus/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Água Potável/efeitos adversos , Fezes/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Filipinas/epidemiologia , Reação em Cadeia da Polimerase/métodos , Vigilância da População/métodos , Fatores de Risco , Rotavirus/patogenicidade , Infecções por Rotavirus/epidemiologia
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