First reported enterovirus D68 infection in pediatric patients from the Caribbean region: evidence of spread from the U.S. outbreak / Primeros casos notificados en el Caribe de infección por enterovirus D68 en pacientes pediátricos: pruebas de la propagación del brote de los Estados Unidos

ABSTRACT The 2014 enterovirus D68 (EV-D68) outbreak in the United States raised concerns about the introduction of the virus in the Caribbean region. The objective of this study was to provide rapid evidence of the introduction of EV-D68 strains in the Caribbean region during the 2014 outbreak in the United States, using a relatively simple phylogenetic approach. From October 2014 to May 2015, four EV-D68 cases from two countries (Bermuda and Dominica) were detected at the regional referral laboratory at the Caribbean Public Health Agency (Port of Spain, Trinidad and Tobago) based on molecular testing of respiratory specimens. All cases were children presenting to hospitals with moderate respiratory distress. No cases of acute flaccid paralysis were detected. Phylogenetic analysis of the Caribbean strains showed more than 99% similarity with the 2014 U.S.-outbreak strain, providing evidence of the introduction and circulation of the virus in the region.(AU)

RESUMEN El brote de enterovirus D68 (EV-D68) registrado en el 2014 en los Estados Unidos suscitó preocupación acerca de la introducción del virus en el Caribe. El objetivo de este estudio fue aportar pruebas rápidas, mediante la adopción de un enfoque filogénico relativamente sencillo, de que durante ese brote ingresaron en el Caribe cepas del EV-D68. Entre octubre del 2014 y mayo del 2015, el laboratorio regional de referencia ubicado en el Organismo de Salud Pública del Caribe (Puerto España, Trinidad y Tabago) detectó cuatro casos de EV-D68 provenientes de dos países (Bermudas y Dominica) mediante el análisis molecular de muestras respiratorias. Todos los casos correspondían a niños que acudieron al hospital con dificultad respiratoria moderada. No se detectó ningún caso de parálisis flácida aguda. El análisis filogénico de las cepas encontradas en el Caribe demostró una semejanza superior al 99 % con la cepa responsable del brote del 2014 en los Estados Unidos, lo que demuestra la introducción y la circulación del virus en la región.(AU)

Health status of the elderly in the Marigot Health District, Dominica

The health status and the prevalence of hypertension, diabetes mellitus, glaucoma and visual disorders of 123 elderly people (56 men, 67 women) in the Marigot Health District, Dominica, were assessed by means of four questionnaires; collection of data from their medical records; physical examination, measurement of blood pressure, visual acuity and intra-ocular pressure (IOP); and testing for glucosuria. The overall health status was good, but 20were dependent on care. 74were independent in the activities in daily life, with only moderate limitations in activities. The health status decreased considerably in those over 75 years of age. There were slight perceived differences in health status between men and women. About 40of the study population were known to be hypertensive, and another 13had an elevated blood pressure on examination. Diabetes mellitus was present in 15. 20had a visual acuity of 0.1 or below, and 10had an elevated IOP. During the study, a considerable number of new cases of hypertension, diabetes mellitus and elevated IOP were diagnosed. 50of the study population who were on medication used this more than as prescribed. This study indicates a high prevalence of the secondary complications of hypertension, diabetes mellitus, cataract, glaucoma and osteo-arthritis that cause disability and dependency in the elderly population. Education, diagnosis at an early stage and appropriate treatment of these disorders may prevent or delay their development. We sugggest the development of a programme oriented approach of primary health care for the elderly to support this.

The use of capture-recapture methods to monitor diabetes in Dominica, West Indies

The aim of this project was to evaluate the utility of capture-recapture (CR) estimation methodology, together with easily accessible sources of information, for monitoring the frequency of diabetes mellitus in a developing country. On the Caribbean island of Dominica, from July 1995 through July 1996, the names were collected of all individuals who were listed in at least one of three sources as having been diagnosed with diabetes during 1995. The sources were the membership list of the Dominica Diabetic Association, a register of patients in seven regional health centers, and clinic records of the Princess Margaret Hospital, which is the main hospital on the island. Capture-recapture techniques were used to estimate the number of Dominicans with diagnosed diabetes who were missed by all three sources of information and to evaluate dependencies among the sources. An ascertainment-corrected prevalence estimate of diagnosed diabetes was then calculated. The three sources identified a total of 1 945 different individuals. When this number was compared with the ascertainment -corrected estimate obtained with CR methodology (2 688), it appeared to represent only 72.3% of the true prevalence of diagnosed diabetes. Most of the under-ascertainment by the data sources was due to cases that were missed in the urban area of the island. This approach to disease monitoring may be useful for other Caribbean countries. However, standardized procedures for collecting and reporting prevalence and morbidity data are needed to maximize its accuracy and cost-effectiveness.

El propósito de este trabajo fue evaluar la utilidad de la metodología de estimación por captura y recaptura (CR), aplicada junto con fuentes de información fácilmente accesibles, para monitorear la frecuencia de diabetes mellitus en un país en desarrollo. En la isla caribeña de Dominica, se recogieron de julio de 1995 a julio de 1996 los nombres de todas las personas que figuraban como mínimo en una de tres fuentes diferentes por haber recibido un diagnóstico de diabetes en el transcurso de 1995. Las fuentes fueron la lista de miembros de la Asociación de Diabetes de Dominica, un registro de los pacientes atendidos en siete centros de salud regionales y las fichas clínicas del Hospital Princess Margaret, que es el más importante de la isla. Se aplicaron técnicas de CR para estimar el número de dominicanos con diabetes diagnosticada que no fueron detectados por ninguna de las tres fuentes, y para evaluar las discrepancias entre las distintas fuentes. Se procedió a calcular la prevalencia estimada de diabetes diagnosticada, corrigiéndola según los datos obtenidos. Las tres fuentes identificaron a un total de 1 945 individuos diferentes. Cuando se comparó con la estimación corregida que se obtuvo por el método de CR (2 688), se observó que esta cifra representaba solamente 72,3% de la verdadera prevalencia de diabetes diagnosticada. La mayor parte de la subdetección en las fuentes de datos correspondió a casos que no fueron captados en la zona urbana de la isla. Esta forma de monitorear la enfermedad podría resultar útil en otros países caribeños. No obstante, hacen falta procedimientos estandarizados de recolección y notificación de datos sobre prevalencia y morbilidad para lograr que este enfoque rinda al máximo en exactitud y costo-efectividad.