Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020-2021.

Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020-October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.

Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021-2023.

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.

Novel species of Triatoma (Hemiptera: Reduviidae) identified in a case of vectorial transmission of Chagas disease in northern Belize.

Chagas disease is a leading cause of non-ischemic cardiomyopathy in endemic regions of Central and South America. In Belize, Triatoma dimidiata sensu lato has been identified as the predominate taxon but vectorial transmission of Chagas disease is considered to be rare in the country. We recently identified an acute case of vector-borne Chagas disease in the northern region of Belize. Here we present a subsequent investigation of triatomines collected around the case-patient's home. We identified yet undescribed species, closely related to Triatoma huehuetenanguensis vector by molecular systematics methods occurring in the peridomestic environment. The identification of a T. cruzi-positive, novel species of Triatoma in Belize indicates an increased risk of transmission to humans in the region and warrants expanded surveillance and further investigation.

Diagnosis of Acute Chagas Disease in a Belizean Child with Evidence of a Multiclonal Trypanosoma cruzi Infection.

In January 2020, we instituted acute febrile illness surveillance in 11 hospitals and clinics across Belize. Within 3 months, we diagnosed an acute case of Chagas disease by polymerase chain reaction in a 7-year-old child in the northern part of the country. Phylogenetic analyses of the parasite from the acute blood specimen revealed a multiclonal Trypanosoma cruzi infection, including parasites from the TcII (25.0% of haplotypes), TcIV (2.5% of haplotypes), and TcV (72.5% of haplotypes) discrete typing units. The family reported no history of travel, and three Triatoma species vectors were found within the home. The child's mother was seronegative for antibodies to T. cruzi, ruling out congenital transmission. Convalescent blood samples documented seroconversion and confirmed acute infection. The child was successfully treated with nifurtimox. This is the first known diagnosed case of acute Chagas infection in Belize, highlighting the need for further investigation and public health prevention measures.

Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020.

The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission.

Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19.

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices-for example, hand hygiene-are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

Prevalence and Risk Factors for Chronic Kidney Disease in Belize: A Population-based Survey.

Background: Health resources supporting dialysis and chronic kidney disease (CKD) patients are limited in Central America, and little information about the prevalence and risk factors for CKD in this region is available. Methods: The Survey of Risk Factors for Chronic Kidney Disease was a population-based cross-sectional study conducted throughout Belize in 2017. The study aimed to assess the prevalence and risk factors for CKD via structured questionnaires and clinical measurements in Belizeans aged 20-55 years. A two-stage stratified sampling technique was applied. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1·73 m2 or the presence of proteinuria. Findings: A total of 7,506 adults with a mean age of 34·6 years old completed the survey; 53·2% were women. The overall CKD prevalence was 13·7%. Women had a higher CKD prevalence than men (14·8% vs. 12·5%), and the overall awareness of CKD was low (3·7%). The prevalences of stage 1, 2, 3a, 3b, 4, and 5 CKD were 2·85%, 2·93%, 6·59%, 1·10%, 0·18%, and 0·06%, respectively. Older age, female sex, Mestizo/Hispanic ethnicity, diabetes, hypertension, hypercholesterolaemia, and obesity were identified as independent risk factors for CKD. Interpretation: The prevalence of CKD was 13·7% in Belizeans aged 20-55 years. The study confirms the high burden of CKD in Belize and provides important epidemiological information for Central America. Case management systems and surveillance programmes targeting high-risk populations are crucial for ameliorating the burden of CKD. Funding: Capacity Building Project for the Prevention and Control of Chronic Renal Failure in Belize.

Ethnic and Gender Disparities in Premature Adult Mortality in Belize 2008-2010.

BACKGROUND: Data on disparities in mortality within low and middle income countries are limited, with little published data from the Caribbean or Central America. Our aim was to investigate disparities in overall and cause specific premature adult mortality in the multi-ethnic middle income country of Belize. METHODS: Mortality data from Belize 2008-2010 classified using the International Classification of Diseases 10 and the 2010 census stratified by age and ethnicity were used to calculate age, sex, and ethnic specific mortality rates for those 15-59 years, and life table analysis was used to estimate the probability of death between the ages of 15 and 59 (45q15). RESULTS: The probability of death among those aged 15 to 59 years was 18.1% (women 13.5%, men 22.7%). Creole and Garifuna ethnic groups have three times the 45q15 probability of death compared to Mayan and Mestizo groups (Creole 31.2%, Garifuna 31.1%, Mayan 10.2%, Mestizo 12.0%). This pattern of ethnic disparity existed in both sexes but was greater in men. The probability of death from injuries was 14.8% among Creole men, more than twice the rate of other ethnicities and peaks among young Creole men. These deaths are dominated by homicides and unspecified deaths involving firearms. CONCLUSIONS: Marked disparities in mortality between ethnic groups exist in this Central American/Caribbean country, from rates that are typical of high-income countries to those of low-income countries. The pattern of these extreme differences likely suggests that they reflect underlying social determinants rooted in the country's colonial past.

La fasciolasis hepática humana en Camagüey 1999 / Hepatic fascioliasis in Camagüey 1999

Se realizó un estudio transversal descriptivo y observacional para caracterizar la infestación por Fasciola hepática en 25 pacientes ingresados en el Hospital Manuel Ascunce Domenech durante el período de enero a mayo de 1999 procedentes del Municipio Esmeralda, Camagüey. Se confeccionó un cuestionario cuyos datos se codificaron manualmente y se procesaron en una microcomputadora IBM compatible, utilizando el paquete de programas estadísticos MICROSTAT.Los pacientes más afectados se ubicaron entre los 51-60 años de edad (7 para el 28 por ciento) Los síntomas más frecuentes fueron la astenia y el dolor abdominal en hemiabdomen superior con el 84 por ciento y 80 por ciento respectivamente, mientras que la fiebre fue el principal signo (88 por ciento). El 48 por ciento de los casos fue ingresado con el diagnóstico inicial de Síndrome Febril prolongado de Eosinofilia.La eosinofilia se presentó en los 25 pacientes (100 por ciento), mientras que el examen parasitológico de las heces, el inmunodiagnóstico y la eritrosedimentación acelerada tuvieron prevalencia mayor que del 90 por ciento. El 100 por ciento de los casos egresó vivo y solo una quinta parte tuvo complicaciones(AU)

Hipertensión arterial maligna: su incidencia en un quinquenio / Malignant arterial hypertension behavior in a quinquennium

Se realizó un estudio descriptivo para caracterizar la hipertensión arterial maligna en el Hospital "Manuel Ascunce Domenech" de Camagüey, durante un quinquenio. El universo ascendió a 38 enfermos cuyos datos se procesaron en una microcomputadora utilizando el programa Microstad. Los hombres representaron el 65.7 por ciento del universo, el principal grupo de edad fue de 48 a 67 años en el que se ubicó el 50 por ciento. La hiperuricemia, la diabetes mellitus, la hiperlipoproteinemia y la cardiopatía isquémica fueron los antecedentes personales más frecuentes. En el 55.3 por ciento predominó la hipertensión severa, mediando un período de 6 a 10 años (44.7 por ciento) para el diagnóstico de la hipertensión maligna. Las principales lesiones de órganos diana fueron la insuficiencia renal, la microproteinuria, el infarto cerebral aterotrombótico, el ataque transitorio de isquemia, la hipertrofia ventricular izquierda y el infarto cardíaco(AU)

Hipertensión arterial maligna. su incidencia en un quinquenio / Malignant arterial hypertension behavior in a quinquennium

Se realizó un estudio descriptivo para caracterizar la hipertensión arterial maligna en el Hospital Manuel Ascunce Domenech de Camagüey, durante un quinquenio. El universo ascendió a 38 enfermos cuyos datos se procesaron en una microcomputadora utilizando el programa Microstad. Los hombres representaron el 65, 7 % del universo, el principal grupo de edad fue de 48 a 67 años en el que se ubicó el 50 %. La hiperuricemia, la diabetes mellitus, la hiperlipoproteinemia y la cardiopatía isquémica fueron los antecedentes personales más frecuentes. En el 55.3 % predominó la hipertensión severa, mediando un período de 6 a 10 años (44, 7 %) para el diagnóstico de la hipertensión maligna. Las principales lesiones de órganos diana fueron la insuficiencia renal, la microproteinuria, el infarto cerebral aterotrombótico, el ataque transitorio de isquemia, la hipertrofia ventricular izquierda y el infarto cardíaco.

A descriptive study was performed for characterizingg malignant arterial hypertensión at Manuel Ascunce Domenech, during a que quinquenium. The study universe raised to 38 nursed whose data were processed in a PC using MICROSTAT program. Men represented 65, 7 % of the universe, the main age group was 48 to 67 years in which 50 % was located. Hyperuricemia, diabetes mellitus, hyperliproteinemia and ischemic cardiopathy were the most frequent personal antecendents; in 55, 3 % prevailed severe hypertension, mediating a period from 6 to 10 years (44, 7 %) for the diagnosis of malignant hypertension . The main lesions of target organs were renal failure, microproteinuria, atherotrombotic cerebral infarction, transient ischemic stroke, letf ventricular hypertrophy and cardiac infartion.

Fasciolasis con hematoma hepático: presentación de tres casos / Fascioliasis with hepatic hematoma

Se presentó un paciente con infestación por Fasciola hepática y Strongyloides stercoralis, comentamos la rareza de esta asociación y las características clínicas de ambas parasitosis, haciendo énfasis en la estrongiloidosis(AU)

Fasciolasis con hematoma hepático. Presentación de tres casos / Fascioliasis with hepatic hematoma. Presentation of three cases

Se realiza la presentación de tres pacientes con fasciolasis hepática con hematoma subcapsular del hígado ingresados en el Hospital Clínico Quirúrgico Docente Manuel Ascunce Domenech de Camagüey durante los meses de mayo hasta agosto de 1999 con el objetivo de describir los principales hallazgos del diagnóstico. Fue común en estos enfermos la procedencia del Municipio Esmeralda, hábitos alimentarios (ingestión de berro), la pérdida de peso, el dolor en hipocondrio derecho, astenia, fiebre y hepatomegalia dolorosa. Los principales resultados de laboratorio fueron: eosinofilia, huevos de Fasciola Hepática en heces fecales, coproantígeno de Fasciola positivo y eritrosedimentación acelerada. Se anexan tres figuras con resultado histológico y tomográfico de cada paciente. La evolución en todos los casos fue favorable.

Three patients suffering hepatic fasciolasis with liver subcapsular hematoma admitted at "Manuel Ascunce Domenench"Hospital of Camagüey from May to August 1999 were studied with the aim of describing the main diagnostic findings, data were manually processed. Patients came from Esmeralda municipality, they had commmon alimentary habits (ingestion of water cress), losing water cress), asthenia, fever and painful hepatomegalia. The main laboratory results were: eosinophilia, eggs of hepatic fasciola in strools, copro antigen of positive fasciola and acelerated eritrosedimentation Figures, histologic and thomographic results of each patien are included. All cases successfully evolved.