Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23
Filtrar
1.
Emerg Infect Dis ; 23(13)2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29155658

RESUMO

More than ever, competent field epidemiologists are needed worldwide. As known, new, and resurgent communicable diseases increase their global impact, the International Health Regulations and the Global Health Security Agenda call for sufficient field epidemiologic capacity in every country to rapidly detect, respond to, and contain public health emergencies, thereby ensuring global health security. To build this capacity, for >35 years the US Centers for Disease Control and Prevention has worked with countries around the globe to develop Field Epidemiology Training Programs (FETPs). FETP trainees conduct surveillance activities and outbreak investigations in service to ministry of health programs to prevent and control infectious diseases of global health importance such as polio, cholera, tuberculosis, HIV/AIDS, malaria, and emerging zoonotic infectious diseases. FETP graduates often rise to positions of leadership to direct such programs. By training competent epidemiologists to manage public health events locally and support public health systems nationally, health security is enhanced globally.


Assuntos
Fortalecimento Institucional , Epidemiologia/educação , Saúde Global/educação , Vigilância em Saúde Pública , Saúde Pública/educação , Centers for Disease Control and Prevention, U.S. , Surtos de Doenças , Métodos Epidemiológicos , Epidemiologia/organização & administração , Humanos , Avaliação de Resultados em Cuidados de Saúde , Administração em Saúde Pública , Vigilância em Saúde Pública/métodos , Estados Unidos , Recursos Humanos
2.
Int J Infect Dis ; 146: 107141, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38901728

RESUMO

OBJECTIVES: In Sindh Province, Pakistan, confirmed Crimean-Congo haemorrhagic fever (CCHF) increased from zero in 2008 to 16 in 2015-2016. To counter this increase, in 2016, we initiated structured CCHF surveillance to improve estimates of risk factors for CCHF in Sindh and to identify potential interventions. METHODS: Beginning in 2016, all referral hospitals in Sindh reported all CCHF cases to surveillance agents. We used laboratory-confirmed cases from CCHF surveillance from 2016 to 2020 to compute incidence rates and in a case-control study to quantify risk factors for CCHF. RESULTS: For the 5 years, CCHF incidence was 4.2 per million for the Sindh capital, Karachi, (68 cases) and 0.4 per million elsewhere. Each year, the onset of new cases peaked during the 13 days during and after the 3-day Eid-al-Adha festival, when Muslims sacrificed livestock, accounting for 38% of cases. In Karachi, livestock for Eid were purchased at a seasonal livestock market that concentrated up to 700,000 livestock. CCHF cases were most common (44%) among the general population that had visited livestock markets (odds ratio = 102). CONCLUSIONS: Urban CCHF in Sindh province is associated with the general public's exposure to livestock markets in addition to high-risk occupations.


Assuntos
Vírus da Febre Hemorrágica da Crimeia-Congo , Febre Hemorrágica da Crimeia , Febre Hemorrágica da Crimeia/epidemiologia , Paquistão/epidemiologia , Humanos , Fatores de Risco , Masculino , Estudos de Casos e Controles , Feminino , Pessoa de Meia-Idade , Adulto , Incidência , Animais , Adolescente , Adulto Jovem , Idoso , Criança , Gado/virologia , Pré-Escolar
3.
Emerg Infect Dis ; 19(9)2013.
Artigo em Inglês | MEDLINE | ID: mdl-23968983

RESUMO

In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0-0.71). The source case-passenger was not identified. Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.


Assuntos
Aeronaves , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/prevenção & controle , Máscaras , Viagem , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças , Feminino , Humanos , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
4.
PLoS One ; 18(12): e0295915, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38100505

RESUMO

When assessing multiple exposures in epidemiologic studies, epidemiologists often use multivariable regression models with main effects only to control for confounding. This method can mask the true effects of individual exposures, potentially leading to wrong conclusions. We revisited a simple, practical, and often overlooked approach to untangle effects of the exposures of interest, in which the combinations of all levels of the exposures of interest are recoded into a single, multicategory variable. One category, usually the absence of all exposures of interest, is selected as the common reference group (CRG). All other categories representing individual and joint exposures are then compared to the CRG using indicator variables in a regression model or in a 2×2 contingency table analysis. Using real data examples, we showed that using the CRG analysis results in estimates of individual and joint effects that are mutually comparable and free of each other's confounding effects, yielding a clear, accurate, intuitive, and simple summarization of epidemiologic study findings involving multiple exposures of interest.


Assuntos
Projetos de Pesquisa , Estudos Epidemiológicos
5.
J Acquir Immune Defic Syndr ; 89(2): 121-128, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34723928

RESUMO

BACKGROUND: From April to June 2019, a total of 909 new HIV infections were identified in Larkana, Pakistan; 86% was children younger than 15 years. To identify the possible transmission links in this outbreak, a case-control study was conducted in June 2019. METHODS: For cases, we selected a systematic random sample of 100 HIV-positive children from the screening list. We chose 2 age-matched and sex-matched controls from the neighborhood of each HIV-positive case. All selected children were tested using the World Health Organization-approved rapid diagnosis test algorithm. We interviewed the parents of each selected child about previous exposures to parenteral treatment and compared exposures of case and control children using conditional logistic regression. RESULTS: The ages of the selected children ranged from 1 month to 10 years. More than 90% of both HIV+ and HIV- children had received outpatient health care from MBBS-qualified private physicians. Eighty-three percent of HIV+ children versus 46% of HIV- children had received health care from one private physician [adjusted odds ratio (aOR) = 29, 95% confidence interval (95% CI): 10 to 79]. Intravenous infusions during the last outpatient visit were reported by 29% of case versus 7% of controls (aOR 57, 95% CI: 2.9 to >1000), whereas no case children and 17% of control children had received only intramuscular injections (aOR 0, 95% CI: 0 to 41). Among cases, 94% had been given infusions through a drip set compared with 85% of control children (aOR = 7.7, 95% CI: 2.3 to 26). Infusions had been administered with reused IV drip sets in 70% of cases compared with 8% of controls (aOR = 197, 95% CI: 16 to 2400). DISCUSSION: Private physicians reusing intravenous drip sets to treat outpatients seen in private practice were responsible for this HIV epidemic. Mapping and regulation of private practitioners were suggested.


Assuntos
Epidemias , Infecções por HIV , Estudos de Casos e Controles , Criança , Surtos de Doenças , Infecções por HIV/epidemiologia , Humanos , Lactente , Paquistão/epidemiologia
6.
Clin Infect Dis ; 53(4): 326-33, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21810744

RESUMO

BACKGROUND: Glucocorticoids increase the risk of developing critical disease from viral infections. However, primary care practitioners in China use them as antipyretics, potentially exposing hundreds of millions to this risk. METHODS: We enrolled all patients with confirmed pandemic influenza A (pH1N1) virus infection aged ≥3 years with available medical records at 4 Shenyang City hospitals from 20 October to 30 November 2009. A critical patient was any confirmed, hospitalized pH1N1 patient who developed ≥1 of the following: death, respiratory failure, septic shock, failure or insufficiency of ≥2 nonpulmonary organs, mechanical ventilation, or ICU admission. In a retrospective cohort study, we evaluated the risk of developing critical illness in relation to early (≤72 hours of influenza-like illness [ILI] onset) glucocorticoids treatment. RESULTS: Of the 83 hospitalized case-patients, 46% developed critical illness, 17% died, and 37% recovered and were discharged. Critically ill and other patients did not differ by underlying conditions and severity, median temperature at first clinic visit, and other measured risk factors. Of 17 patients who received early glucocorticoid treatment, 71% subsequently developed critical disease compared with 39% of 66 patients who received late (>72 hours) or no glucocorticoid treatment (RR(M-H) = 1.8, 95% CI = 1.2-2.8, after adjusting for 2 summary variables; ie, presence of underlying diseases and presence of underlying risk factors). Proportional hazards modeling showed that use of glucocorticoids tripled the hazard of developing critical disease (hazard ratio [HR] = 2.9, 95% CI = 1.3-6.2, after adjusting for the same summary variables). CONCLUSIONS: Early use of parenteral glucocorticoids therapy for fever reduction and pneumonia prevention increases the risk for critical disease or death from pH1N1 infection. We recommend that guidelines on glucocorticoid use be established and enforced.


Assuntos
Glucocorticoides/administração & dosagem , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Pandemias/estatística & dados numéricos , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , China/epidemiologia , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Feminino , Febre/tratamento farmacológico , Glucocorticoides/efeitos adversos , Hospitalização , Humanos , Influenza Humana/mortalidade , Estimativa de Kaplan-Meier , Masculino , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Pneumonia Viral/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco
7.
Health Secur ; 18(S1): S113-S118, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32004135

RESUMO

The World Health Organization monitoring and evaluation framework for the International Health Regulations (IHR, 2005) describes the targets for the Joint External Evaluation (JEE) indicators. For workforce development, the JEE defines the optimal target for attaining and complying with the IHR (2005) as 1 trained field epidemiologist (or equivalent) per 200,000 population. We explain the derivation and use of the current field epidemiology workforce development target and identify the limitations and lessons learned in applying it to various countries' public health systems. This article also proposes a way forward for improvements and implementation of this workforce development target.


Assuntos
Surtos de Doenças/prevenção & controle , Epidemiologistas , Mão de Obra em Saúde/normas , Monitoramento Epidemiológico , Saúde Global , Humanos , Regulamento Sanitário Internacional , Administração em Saúde Pública
9.
Medicine (Baltimore) ; 95(11): e3046, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26986125

RESUMO

Previous observational studies have reported protective effects of hand-washing in reducing upper respiratory infections, little is known about the associations between hand-washing and good hygienic habits and seasonal influenza infection. We conducted a case-control study to test whether the risk of influenza transmission associated with self-reported hand-washing and unhealthy hygienic habits among residents in Fujian Province, southeastern China.Laboratory confirmed seasonal influenza cases were consecutively included in the study as case-patients (n = 100). For each case, we selected 1 control person matched for age and city of residence. Telephone interview was used to collect information on hand-washing and hygienic habits. The associations were analyzed using conditional logistic regression. Compared with the poorest hand-washing score of 0 to 3, odds ratios of influenza infection decreased progressively from 0.26 to 0.029 as hand-washing score increased from 4 to the maximum of 9 (P < 0.001). Compared with the poorest hygienic habit score of 0 to 2, odds ratios of influenza infection decreased from 0.10 to 0.015 with improving score of hygienic habits (P < 0.001). Independent protective factors against influenza infection included good hygienic habits, higher hand-washing score, providing soap or hand cleaner beside the hand-washing basin, and receiving influenza vaccine. Regular hand-washing and good hygienic habits were associated with a reduced risk of influenza infection. These findings support the general recommendation for nonpharmaceutical interventions against influenza.


Assuntos
Desinfecção das Mãos , Higiene , Influenza Humana/prevenção & controle , Estudos de Casos e Controles , Cidades , Humanos , Vacinas contra Influenza , Influenza Humana/transmissão , Fatores de Risco
10.
Am J Trop Med Hyg ; 72(5): 612-5, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15891137

RESUMO

Epizootics of encephalitis in El Salvador killed 203 equines between November 2001 and April 2003. During an investigation of the outbreaks, 18 (25%) of 73 serum samples collected from stablemates of deceased animals in 2003 had antibodies to West Nile virus. Ten of these infections were confirmed by plaque reduction neutralization tests, suggesting West Nile virus has extended its range and spread to Central America.


Assuntos
Surtos de Doenças/veterinária , Doenças dos Cavalos/virologia , Febre do Nilo Ocidental/veterinária , Animais , El Salvador/epidemiologia , Ensaio de Imunoadsorção Enzimática/veterinária , Doenças dos Cavalos/epidemiologia , Cavalos , Humanos , Estações do Ano , Febre do Nilo Ocidental/epidemiologia
11.
Pediatr Infect Dis J ; 33(9): 966-70, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24577041

RESUMO

BACKGROUND: There has been a high mortality and morbidity rate of critical and fatal patients from hand, foot and mouth disease (HFMD) in China in recent. Causes for development of critical and fatal disease remain unclear. METHODS: We performed a case-control study to assess the association between use of drugs and development of critical disease and death from HFMD. RESULTS: We found that glucocorticoids treatment was associated with a greater incidence of severe HFMD, whereas andrographolides treatment was associated with a protective effect when they are used for treatment within 48 hours after onset or before being diagnosed as critical. CONCLUSIONS: We recommend that glucocorticoids should not be used for mild HFMD and andrographolides should undergo clinical trials for treatment of enterovirus 71 infections.


Assuntos
Glucocorticoides/efeitos adversos , Doença de Mão, Pé e Boca/tratamento farmacológico , Doença de Mão, Pé e Boca/mortalidade , Antivirais/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , China/epidemiologia , Estado Terminal , Diterpenos/uso terapêutico , Feminino , Glucocorticoides/administração & dosagem , Humanos , Lactente , Masculino , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
12.
Am J Trop Med Hyg ; 88(5): 923-8, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23509116

RESUMO

We investigated a cluster of five cases of severe pneumonia from one village in Yunnan Province, China. We searched for severe pneumonia in the village and hospitals. We interviewed patients and family members about exposures. We tested acute and convalescent sera for antigen and antibody of severe acute respiratory syndrome, avian influenza, and plague. The only common exposure of the five patients was riding together in the enclosed cab of a truck for 1.5 hours while taking the first patient to the hospital. Seroconversion to plague F1 antigen confirmed plague in three survivors. Unfamiliarity of clinicians with plague and lack of sputum examination, blood culture, or postmortem examination delayed the diagnosis. No plague cases occurred among family and village contacts and health care workers. High infectivity in this cluster was limited to a crowded, poorly ventilated truck.


Assuntos
Anticorpos Antibacterianos/sangue , Proteínas de Bactérias/imunologia , Veículos Automotores , Peste/epidemiologia , Yersinia pestis/imunologia , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peste/diagnóstico , Peste/mortalidade , Peste/transmissão , Adulto Jovem
14.
PLoS One ; 7(6): e38712, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22745677

RESUMO

BACKGROUND: Clusters of sudden unexplained death (SUD) in Yunnan Province, China, have been linked to eating Trogia venenata mushrooms. We evaluated the toxic effect of this mushroom on mice. METHODS: We prepared extracts of fresh T. venenata and Laccaria vinaceoavellanea mushrooms collected from the environs of a village that had SUD. We randomly allocated mice into treatment groups and administered mushroom extracts at doses ranging from 500 to 3500 mg/kg and water (control) via a gavage needle. We observed mice for mortality for 7 days after a 3500 mg/kg dose and for 24 hours after doses from 500 to 3000 mg/kg. We determined biochemical markers from serum two hours after a 2000 mg/kg dose. RESULTS: Ten mice fed T. venenata extract (3500 mg/kg) died by five hours whereas all control mice (L. vinaceoavellanea extract and water) survived the seven-day observation period. All mice died by five hours after exposure to single doses of T. venenata extract ranging from 1500 to 3000 mg/kg, while the four mice exposed to a 500 mg/kg dose all survived. Mice fed 2000 mg/kg of T. venenata extract developed profound hypoglycemia (median= 0.66 mmol/L) two hours after exposure. DISCUSSION: Hypoglycemia and death within hours of exposure, a pattern unique among mushroom toxicity, characterize T. venenata poisoning.


Assuntos
Agaricales/química , Hipoglicemia/induzido quimicamente , Intoxicação Alimentar por Cogumelos/mortalidade , Intoxicação Alimentar por Cogumelos/fisiopatologia , Animais , Feminino , Masculino , Camundongos , Intoxicação Alimentar por Cogumelos/sangue
15.
PLoS One ; 7(5): e35894, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22615743

RESUMO

INTRODUCTION: Since the late 1970's, time-space clusters of sudden unexplained death (SUD) in northwest Yunnan, China have alarmed the public and health authorities. From 2006-2009, we initiated enhanced surveillance for SUD to identify a cause, and we warned villagers to avoid eating unfamiliar mushrooms. METHODS: We established surveillance for SUD, defined as follows: sudden onset of serious, unexplained physical impairment followed by death in <24 hours. A mild case was onset of any illness in a member of the family or close socially related group of a SUD victim within 1 week of a SUD. We interviewed witnesses of SUD and mild case-persons to identify exposures to potentially toxic substances. We tested blood from mild cases, villagers, and for standard biochemical, enzyme, and electrolyte markers of disease. RESULTS: We identified 33 SUD, a 73% decline from 2002-2005, distributed among 21 villages of 11 counties. We found a previously undescribed mushroom, Trogia venenata, was eaten by 5 of 7 families with SUD clusters compared to 0 of 31 other control-families from the same villages. In T. venenata-exposed persons SUD was characterized by sudden loss of consciousness during normal activities. This mushroom grew nearby 75% of 61 villages that had time-space SUD clusters from 1975 to 2009 compared to 17% of 18 villages with only single SUD (p<0.001, Fisher's exact test). DISCUSSION: Epidemiologic data has implicated T. venenata as a probable cause of clusters of SUD in northwestern Yunnan Province. Warnings to villagers about eating this mushroom should continue.


Assuntos
Intoxicação Alimentar por Cogumelos/mortalidade , População Rural , China/epidemiologia , Análise por Conglomerados , Humanos , Intoxicação Alimentar por Cogumelos/epidemiologia , Vigilância da População
16.
Pediatr Infect Dis J ; 30(9): 745-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21587095

RESUMO

INTRODUCTION: Between October 1 and December 10, 2006, Bao'an, China had a 5-fold increase in acute rotavirus gastroenteritis (ARGE) cases compared with the same time in 2005. To identify the risk factors for ARGE during this outbreak, we conducted a case-control study among children ≤ 24 months old from the most heavily affected area. METHODS: We defined an ARGE case as diarrhea, with group A rotavirus antigen detected from fecal samples by the enzyme-linked immunosorbent assay test. In the case-control study, 86 confirmed ARGE cases were identified. We enrolled 98 healthy control children matched by age. We administered questionnaires about exposures through telephone interviews. RESULTS: Of 8 general exposure types, we identified the following as being associated with ARGE: visiting outpatient services of hospital X, odds ratio (OR) = 7.1 (95% confidence interval [CI], 2.2-26); contact with other children with diarrhea, OR = 2.1 (95% CI, 1.1-3.7); and hand-washing before eating, OR = 0.48 (95% CI, 0.27-0.82). After improvements in the outpatient department of hospital X, ARGE incidence in the community during the ARGE transmission season (October through December) decreased from 4.3/10000 in 2006 to 1.4/10000 in 2009. CONCLUSIONS: Outpatient services in hospital X may have contributed to the transmission of ARGE and improvements in infection control practices in this setting were associated a marked decrease incidence of ARGE in this community.


Assuntos
Diarreia/epidemiologia , Diarreia/virologia , Surtos de Doenças , Pacientes Ambulatoriais , Infecções por Rotavirus/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , China/epidemiologia , Feminino , Hospitais , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Características de Residência , Fatores de Risco , Infecções por Rotavirus/transmissão , Infecções por Rotavirus/virologia
17.
Pediatrics ; 127(4): e898-904, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21422083

RESUMO

BACKGROUND: Hygiene and social distancing are recommended control measures for hand, foot, and mouth disease (HFMD) and herpangina. However, empirical data to support this recommendation are limited. METHODS: During an outbreak of HFMD and herpangina due to infection by the human enterovirus 71, we defined a case as a vesicular papular rash on the hands, feet, buttocks, or oral mucosa and onset from April 30 to June 26, 2008. We selected 176 HFMD and herpangina case-children and a stratified random sample of 201 asymptomatic control-children; frequency matched according to residency status. We administered a questionnaire to the parents about their children's exposures and hygienic behaviors. RESULTS: Risk factors for HFMD and herpangina included playing with neighborhood children (odds ratio [OR]: 11 [95% confidence interval (CI): 6.2-17]), visiting an outpatient clinic for another reason ≤ 1 week before onset (OR: 20 [95% CI: 5.0-88]), and community exposures to crowded places (OR: 7.3 [95% CI: 4.1-13]). By using a score summarizing responses to 4 hand-washing questions, we found that 50% of the case-children and 2.5% of control-children had a poor score of 1 to 3, whereas 12% of the case-children and 78% of control-children had a good score of ≥ 7 (OR: 0.00069 [95% CI: 0.0022-0.022]) after we adjusted for residency, age, and community exposures by using logistic regression. CONCLUSIONS: Hand-washing by preschool-aged children and their caregivers had a significant protective effect against community-acquired HFMD and herpangina from the human enterovirus 71 infection.


Assuntos
Surtos de Doenças , Desinfecção das Mãos , Doença de Mão, Pé e Boca/prevenção & controle , Doença de Mão, Pé e Boca/transmissão , Herpangina/prevenção & controle , Herpangina/transmissão , Instituições de Assistência Ambulatorial , Estudos de Casos e Controles , Criança , Pré-Escolar , China , Análise por Conglomerados , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Infecções Comunitárias Adquiridas/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Estudos Transversais , Aglomeração , Surtos de Doenças/estatística & dados numéricos , Desinfecção , Feminino , Doença de Mão, Pé e Boca/epidemiologia , Comportamentos Relacionados com a Saúde , Educação em Saúde , Herpangina/epidemiologia , Humanos , Incidência , Lactente , Masculino , Razão de Chances , Jogos e Brinquedos , Características de Residência , Fatores de Risco
18.
J Clin Oncol ; 29(13): 1765-70, 2011 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-21422429

RESUMO

PURPOSE: The production and administration of drugs used intrathecally requires special care to prevent contamination with neurotoxic agents. In 2007, we investigated a widespread outbreak of paraplegia and paraparesis among Chinese patients who received intrathecal drugs to identify the presumed contaminant and its source to prevent further cases. PATIENTS AND METHODS: We defined a case as onset from January 1 to October 31, 2007, of bilateral flaccid paraparesis or paraplegia or retention and incontinence of stool or urine, in a patient receiving intrathecal drugs. Using a retrospective cohort approach, we selected 12 hospitals from all hospitals that had reported cases. In these hospitals, we identified all 448 patients (including 107 cases) who received intrathecal chemotherapy or chemoprophylaxis in 2007. We calculated attack rates and Mantel-Haenszel adjusted risk ratios for intrathecal drug type and lot. RESULTS: All 12 hospitals used intrathecal methotrexate or cytarabine produced by one pharmaceutical plant. Only two lots of each drug were associated with cases. Lot-specific attack rates ranged from 42% to 100% (risk ratio, ∞; lower confidence bounds, 1.8 to 7.3). Vincristine production had immediately preceded production of the implicated lots on the same equipment. By using ultra performance liquid chromatography, we detected vincristine (0.28 to 18 µg) in unused vials from implicated lots of methotrexate and cytarabine. CONCLUSION: Trace amounts of vincristine that contaminated intrathecal drugs caused a large outbreak of severe neurologic damage. Vincristine and other neurotoxic drugs should not be produced on any equipment that is also used for producing drugs that are to be administered intrathecally.


Assuntos
Citarabina/administração & dosagem , Contaminação de Medicamentos , Metotrexato/administração & dosagem , Paraparesia/induzido quimicamente , Paraplegia/induzido quimicamente , Vincristina/intoxicação , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , China , Citarabina/química , Composição de Medicamentos/instrumentação , Contaminação de Equipamentos , Feminino , Humanos , Lactente , Masculino , Metotrexato/química , Vincristina/administração & dosagem , Vincristina/análise
19.
Pediatr Infect Dis J ; 29(6): 524-9, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20104199

RESUMO

BACKGROUND: Human enterovirus 71 (HEV71) causes outbreaks of life-threatening diseases throughout the world. The genesis of these severe diseases is unknown. METHODS: During an outbreak of HEV71 infection, we investigated risk factors for critical illness. We developed a modified pediatric index of mortality (mPIM) incorporating heart rate, temperature, white blood cell count, respiratory rate, chest infiltrates, skin color, reflexes, responsiveness, and mobility. We calculated the mPIM for 103 patients (22 deaths) using complete scoring criteria in the medical record. In a case-control study, we compared cases (mPIM > or =10 or death) with controls (mPIM = 0-9) by drugs received within 96 hours after onset of fever, initial temperature, age, and nutritional anthropometry. RESULTS: About 66% (68/103) of the patients with an mPIM score (28 cases and 40 controls) had data on initial exposures. About 50% of the 28 cases and 18% of the 40 controls received an injection to treat fever during the first 96 hours after onset (Odds ratio [OR] = 7.0, 95% confidence interval [CI]: 1.8-28). Injections containing exclusively glucocorticoids (OR = 4.8, 95% CI: 1.2-21) or pyrazolones (OR = 4.1, 95% CI: 0.91-19, P = 0.047) were risk factors for severe HEV71 infection. About 25% of cases and 5% of controls received both drugs parenterally while 7% of cases and 30% of controls received neither (OR = 21, 95% CI: 1.8-305). Conversely, cases and controls had identical average initial temperature, and did not differ significantly by age, sex, nutritional measurements, use of other drugs, or timeliness of medical care received. CONCLUSION: Fever treatment with glucocorticoids and/or pyrazolones is a risk factor for life-threatening HEV71 infection.


Assuntos
Enterovirus Humano A/isolamento & purificação , Infecções por Enterovirus/induzido quimicamente , Febre/tratamento farmacológico , Glucocorticoides/efeitos adversos , Pirazolonas/efeitos adversos , Doença Aguda , Criança , Pré-Escolar , China , Surtos de Doenças , Infecções por Enterovirus/virologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Lactente , Masculino , Pirazolonas/uso terapêutico , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas
20.
Int J Infect Dis ; 13(5): 537-42, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19269204

RESUMO

BACKGROUND: We investigated an outbreak of gluteal abscesses following intramuscular (IM) injections given at a clinic in rural China to identify the causative agent, source, and method of exposure. METHODS: We defined a case as an abscess that appeared at the site of an injection given since June 1, 2006. We compared case rates by injection route, medication, and diluents. We reviewed injection practices, and cultured abscesses and environmental sites for mycobacteria. RESULTS: From October through December 2006, 5.8% (n=35) of 604 persons who had received injections at the clinic developed a case. All 35 cases occurred in 184 patients (attack rate=19.0%) who had received IM injections with various drugs that had been mixed with normal saline (NS); risk ratio=infinity; p<0.0001. No cases occurred in the absence of NS exposure. We identified Mycobacterium abscessus from eight abscesses and from the clinic water supply, and observed the inappropriate reuse of a 16-gauge needle left in the rubber septum of 100 ml multiple-dose bottles of NS in the clinic. Fourteen percent (n=527) of the 3887 registered residents of this village had been treated with IM drugs over a three-month period, often for minor illnesses. CONCLUSIONS: This outbreak of M. abscessus occurred from exposure to extrinsically contaminated NS through improper injection practices. Frequent treatment of minor illnesses with IM injections of antibiotics was likely an important contributing factor to the size of this outbreak.


Assuntos
Contaminação de Equipamentos , Infecções por Mycobacterium não Tuberculosas , Micobactérias não Tuberculosas/isolamento & purificação , Pele/microbiologia , Cloreto de Sódio , Abscesso/epidemiologia , Abscesso/microbiologia , Instituições de Assistência Ambulatorial , China/epidemiologia , Surtos de Doenças , Humanos , Injeções Intramusculares/efeitos adversos , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/classificação , População Rural , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/microbiologia , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/efeitos adversos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA