A case report of Japanese encephalitis in Paracelis, Mountain Province, the Philippines

@#On 12 September 2022, a 10-year-old female in Paracelis municipality, Mountain Province, the Philippines, without travel history outside the municipality, experienced acute onset of fever and a change in mental status with disorientation, an altered level of consciousness and new onset of seizures. She was hospitalized at the district hospital from 1 to 3 October 2022, before being transferred to the regional hospital. As diphtheria was originally suspected, the investigation team reviewed records and reports and interviewed key informants to gather additional information and organize case finding and contact tracing. The patient’s condition was laboratory-confirmed for Japanese encephalitis virus infection. An environmental survey was carried out at the patient's residence to check for the presence of vectors and contributing factors. Exemplifying inadequate vaccination coverage for Japanese encephalitis virus in Mountain Province, the patient had not been vaccinated against the disease. It is recommended that vaccination campaigns be immediately implemented in the affected area and the surveillance system be strengthened for early detection and prompt response to the emergence of cases and outbreaks. Overall, the investigation highlighted the importance of strong surveillance and response systems for early detection and control of diseases, such as Japanese encephalitis virus. It also underscores the need for comprehensive vaccination programmes to prevent outbreaks and protect vulnerable populations.

Atenção à saúde dos parceiros sexuais de adolescentes com sífilis gestacional e seus filhos: uma revisão integrativa / Health care of sexual partners of adolescents with gestational syphilis and their children: an integrative review

Resumo A sífilis gestacional (SG) em adolescentes é um desafio para a saúde pública brasileira, com elevadas taxas de incidência. A testagem, diagnóstico e tratamento dos parceiros sexuais é indispensável para interromper a cadeia de transmissão, mas desde 2017 deixou de ser critério para o tratamento adequado da gestante. Buscamos analisar e sintetizar o conhecimento produzido sobre a atenção à saúde de parceiros sexuais de adolescentes com SG no Brasil. Realizamos uma revisão integrativa nas bases de dados BVS, SciELO e PubMed, selecionando artigos que abordavam SG e/ou sífilis congênita (SC) em adolescentes de 15 a 19 anos e que incluíam informações sobre os parceiros sexuais. Quarenta e um artigos foram analisados compreensivamente com auxílio do software WebQDA e classificados em duas categorias: (a) Abordagem dos parceiros sexuais no pré-natal, e (b) Papel dos parceiros sexuais no ciclo de transmissão da SG e da SC. Os estudos evidenciam que a abordagem do parceiro é deficitária, com ausência de dados sobre o perfil sociodemográfico e informações sobre testagem e tratamento. No âmbito da atenção primária à saúde não se encontram estudos que abordem fatores inerentes ao contexto de vulnerabilidade dos parceiros sexuais em relação ao enfrentamento da sífilis.

Abstract Gestational syphilis (GS) in adolescents is a challenge for Brazilian public health, with high incidence rates. Testing, diagnosis and treatment of sexual partners is essential to interrupt the chain of transmission, but since 2017 it is no longer a criterion for the proper treatment of pregnant women. We sought to analyze and synthesize the knowledge produced about the health care of sexual partners of adolescents with GS in Brazil. We carried out a systematic review in the BVS, SciELO and PubMed databases, selecting articles that addressed GS and/or congenital syphilis (CS) in adolescents aged 15 to 19 years and that included information about sexual partners. Forty-one articles were comprehensively analyzed using the WebQDA software and classified into two categories: a) Approach to sexual partners during prenatal care, and b) The role of sexual partners in the transmission cycle of GS and CS. The studies show that the partner's approach is deficient, with a lack of data on the sociodemographic profile and information on testing and treatment. In the context of Primary Health Care, there are no studies that address factors inherent to the context of vulnerability of sexual partners in relation to coping with syphilis.

The use of individual tracking programs in public health: a bioethics dilemma / El uso de programas de cribado individual en salud pública: un dilema bioético / O uso de programas de rastreamento individual na saúde pública: um dilema da bioética

ABSTRACT Objective: to understand the bioethical perspectives on mobile tracking device use. Methods: theoretical study based on action research, carried out with eight graduate students from a public university. A focus group was used, with a thematic content analysis methodology with a codebook structure, approved by the Research Ethics Committee. Results: from the analysis, there was a concern about using devices after the pandemic ended. Using or not the device, rights inherent to humans, legislation and effectiveness of methods deepen interpretations, moving participants from a personalistic conception of the topic to a vision focused on professional implications about the methods. Final considerations: the debate on the impact of using technological devices on health, especially those that imply restriction of rights that refer to individuals' private life, involves a discussion of a professional nature, in addition to requirement for clear rules on the topic.

RESUMEN Objetivo: comprender las perspectivas bioéticas sobre el uso de dispositivos móviles de seguimiento. Métodos: estudio teórico basado en la investigación acción, realizado con ocho estudiantes de posgrado de una universidad pública. Se utilizó un grupo focal, con metodología de análisis de contenido temático con estructura de libro de códigos, aprobada por el Comité de Ética en Investigación. Resultados: del análisis surgió la preocupación por el uso de dispositivos una vez terminada la pandemia. El uso o no del dispositivo, los derechos inherentes a la persona humana, la legislación y la eficacia de los métodos profundizan las interpretaciones, trasladando a los participantes de una concepción personalista del tema a una visión centrada en las implicaciones profesionales de los métodos. Consideraciones finales: el debate sobre el impacto del uso de dispositivos tecnológicos en la salud, especialmente aquellos que implican restricción de derechos que se refieren a la vida privada de las personas, implica una discusión profesional, además de la exigencia de reglas claras sobre el tema.

RESUMO Objetivo: compreender as perspectivas bioéticas no uso de dispositivos móveis de rastreamento. Métodos: estudo teórico fundamentado através de pesquisa-ação, realizado com oito pós-graduandos de uma universidade pública. Utilizou-se grupo focal, com metodologia de análise de conteúdo temática com estrutura de codebook, aprovado pelo Comitê de Ética em Pesquisa. Resultados: a partir da análise, constatou-se uma preocupação sobre o uso dos dispositivos findada a pandemia. O uso ou não do dispositivo, direitos inerentes à pessoa humana, legislação e efetividade dos métodos aprofundam interpretações, passando os participantes de uma concepção personalista do tema a uma visão voltada a implicações profissionais sobre os métodos. Considerações finais: o debate sobre o impacto do uso de dispositivos tecnológicos na saúde, em especial os que impliquem restrição de direitos que se referem à vida privada do indivíduo, passa por uma discussão de caráter profissional, além da exigência de claro regramento sobre o tema.

Monitoramento de contatos de pacientes com tuberculose por agentes comunitários de saúde / Monitoreo de contactos de pacientes con tuberculosis por agentes comunitarios de salud / Monitoring contacts of tuberculosis patients by community health workers

Resumo Objetivo Analisar o monitoramento de contatos de pacientes com tuberculose (TB) na perspectiva de Agentes Comunitários de Saúde (ACS). Métodos Estudo descritivo, transversal e qualitativo, com ACS de oito Unidades Básicas de Saúde da Supervisão Técnica de Saúde Casa Verde/Cachoerinha/Limão do Município de São Paulo, SP. Foram realizadas entrevistas semiestruturadas de junho a julho de 2021. A Vigilância à Saúde constituiu o referencial conceitual e os depoimentos foram submetidos a análise de conteúdo. Resultados Os ACS (51) tinham um tempo médio de atuação de 7,4 anos e 169 famílias sob sua responsabilidade; referiram já ter tido casos de TB na microárea de atuação (68,7%) e algum treinamento em relação à doença (70,6%). Em geral, o monitoramento de contatos não era conhecido pelos participantes, que também não reconheciam essa atividade como uma tarefa de sua responsabilidade. Várias dificuldades foram identificadas na rotina de trabalho, incluindo: resistência dos contatos em ser avaliados em consulta e realizar os exames solicitados, aceitar a possibilidade de ter TB, não conseguir acessar os contatos, dentre outras. Conclusão O desconhecimento da necessidade de monitorar os contatos pode fragilizar a detecção precoce de casos novos de Tuberculose e a Infecção Latente por Tuberculose, e contribuir para a manutenção da transmissão da doença. Dada a importância dos ACS para essa prática, e considerando que são um importante elo entre a comunidade e a equipe de saúde, recomenda-se sua devida instrumentalização para a identificação precoce de novos casos de TB e para o monitoramento adequado dos contatos.

Resumen Objetivo Analizar el monitoreo de contactos de pacientes con tuberculosis (TB) bajo la perspectiva de agentes comunitarios de salud (ACS). Métodos Estudio descriptivo, transversal y cualitativo, con ACS de ocho Unidades Básicas de Salud de la Supervisión Técnica de Salud Casa Verde/Cachoerinha/Limão del municipio de São Paulo, estado de São Paulo. Se realizaron entrevistas semiestructuradas de junio a julio de 2021. La Vigilancia de la Salud constituyó el marco conceptual y los testimonios fueron sometidos al análisis de contenido. Resultados Los ACS (51) contaban con un tiempo promedio de actuación de 7,4 años y 169 familias bajo su responsabilidad. Declararon haber tenido casos de TB en su microárea de actuación (68,7 %) y alguna capacitación relacionada con la enfermedad (70,6 %). En general, los participantes no conocían el monitoreo de contactos y tampoco reconocían esa actividad como una tarea bajo su responsabilidad. Se identificaron varias dificultades en la rutina de trabajo: resistencia de los contactos a ser evaluados en consulta y realizar los exámenes solicitados, aceptar la posibilidad de tener TB, no poder acceder a los contactos, entre otras. Conclusión La falta de conocimiento de la necesidad de monitorear los contactos puede debilitar la detección temprana de nuevos casos de tuberculosis y de infección por tuberculosis latente, lo que contribuye a mantener la transmisión de la enfermedad. Dada la importancia de los ACS para esta práctica y considerando que son un importante eslabón entre la comunidad y el equipo de salud, se recomienda que sean debidamente preparados para la identificación temprana de nuevos casos de TB y para el monitoreo adecuado de los contactos.

Abstract Objective To analyze the monitoring of contacts of tuberculosis (TB) patients from the perspective of Community Health Workers (CHWs). Methods This was a descriptive, cross-sectional, qualitative study with CHWs from eight Primary Care Center in the Casa Verde/Cachoerinha/Limão Technical Health Supervision in the city of São Paulo, SP. Semi-structured interviews were conducted from June to July 2021. Health Surveillance was the conceptual framework and the statements were subjected to content analysis. Results The CHWs (51) had an average working time of 7.4 years and 169 families under their responsibility; they reported having already had cases of TB in the micro-area they worked in (68.7%) and had some training in the disease (70.6%). In general, the monitoring of contacts was not known by the participants, who also did not recognize this activity as a task for which they were responsible. Several difficulties were identified in the work routine, including: contacts' resistance to being assessed at appointments and carrying out the tests requested, accepting the possibility of having TB, not being able to access contacts, among others. Conclusion Ignorance of the need to monitor contacts can weaken the early detection of new cases of tuberculosis and latent tuberculosis infection, and contribute to maintaining the transmission of the disease. Given the importance of CHWs for this practice, and considering that they are an important link between the community and the health team, it is recommended that they be properly trained for the early identification of new TB cases and for the proper monitoring of contacts.

Prevalencia de infección tuberculosa latente e incidencia de viraje tuberculínico en contactos escolares mayores de 5 años en la Ciudad Autónoma de Buenos Aires / Prevalence of latent tuberculosis infection and incidence of tuberculin conversion among school contacts older than 5 years in the City of Buenos Aires

Introducción. La tuberculosis continúa siendo un problema frecuente en contextos de vulnerabilidad socioeconómica. El objetivo principal fue establecer la prevalencia de infección latente y viraje tuberculínico en contactos escolares de casos de tuberculosis. Población y métodos. En un área programática del sur de la ciudad, se evaluó la prevalencia de infección y viraje tuberculínico de 691 niñas, niños y adolescentes utilizando la prueba cutánea de tuberculina. Se investigó la asociación entre pérdida de seguimiento por parte del equipo de salud y características demográficas, escolares y asistencia inicial, y se describió el grado de adherencia cuando la quimioprofilaxis con isoniacida fue indicada. Resultados. Según las definiciones consideradas, la prevalencia de infección latente fue entre el 3,4 % (IC95 %: 2,3-5,2) y el 11,6 % (IC95 %: 9,3-14,4) de los 610 contactos con al menos una prueba cutánea aplicada. La incidencia de viraje tuberculínico se encontró entre el 0,3 % y el 6,8 % de los 294 evaluados. La edad mayor de 18 años, la mayor prevalencia de necesidades básicas insatisfechas en la comuna escolar, la pertenencia al turno escolar vespertino, la negatividad en la baciloscopia del caso índice y la ausencia de aplicación de la prueba cutánea inicial se asociaron con pérdida de seguimiento del contacto. Conclusiones. La incidencia de viraje tuberculínico en contactos escolares fue baja. La adherencia a isoniacida continúa siendo limitada. Se identificaron factores asociados con la pérdida de seguimiento de contactos que podrían orientar estrategias necesarias para mejorar este proceso.

Introduction. Tuberculosis continues to be a common problem in settings of socioeconomic vulnerability. Our primary objective was to establish the prevalence of latent infection and tuberculin conversion among school contacts of tuberculosis cases. Population and methods. In a programmatic area in the south of the City of Buenos Aires, the prevalence of latent infection and tuberculin conversion was assessed in 691 children and adolescents using the tuberculin skin test. The association between loss to follow-up by the health care team and the demographic, school, and baseline care characteristics was studied, and the level of adherence when isoniazid chemoprophylaxis was indicated was described. Results. According to established definitions, the prevalence of latent infection was between 3.4% (95% confidence interval [CI]: 2.3­5.2) and 11.6% (95% CI: 9.3­14.4) in the 610 contacts with at least one skin test. The incidence of tuberculin conversion was between 0.3% and 6.8% in the 294 assessed participants. Age older than 18 years, a higher prevalence of unmet basic needs in the school district, attending the afternoon school shift, negative sputum smear results in the index case, and absence of baseline skin test were associated with contact lost to follow-up. Conclusions. The incidence of tuberculin conversion among school contacts was low. Adherence to isoniazid treatment remains limited. Factors associated with loss of contact tracing were identified, which may guide strategies necessary to improve this process.

ML Flow serological test: complementary tool in leprosy

Abstract Background The evaluation of household contacts of leprosy cases allows the early diagnosis of new cases. Objective To associate the results of the ML Flow test with the clinical characteristics of leprosy cases and to verify their positivity in household contacts, in addition to describing the epidemiological profile of both. Methods Prospective study with patients diagnosed over the course of one year (n = 26), without prior treatment, and their household contacts (n = 44) in six municipalities in northwestern São Paulo, Brazil. Results There was a predominance of men among the leprosy cases, of 61.5% (16/26); 77% (20/26) were over 35 years old; 86.4% (22/26) were multibacillary; 61.5% (16/26) had a positive bacilloscopy; and 65.4% (17/26) had no physical disability. The ML Flow test was positive in 53.8% (14/26) of the leprosy cases and was associated with those who had a positive bacilloscopy and were diagnosed as multibacillary (p-value <0.05). Among the household contacts, 52.3% (23/44) were women and aged over 35 years; 81.8% (36/44) had been vaccinated with BCG ‒ Bacillus Calmette-Guérin. The ML Flow test was positive in 27.3% (12/44) of household contacts, all of whom lived with multibacillary cases; seven lived with positive bacilloscopy cases and six with consanguineous cases. Study limitations Difficulty in convincing the contacts to undergo the evaluation and collection of the clinical sample. Conclusion The ML Flow test, when positive in household contacts, can help the identification of cases that require more attention by the health team, as it indicates a predisposition to disease development, especially when they are household contacts of multibacillary cases, with positive bacilloscopy and consanguineous. The ML Flow test also helps in the correct clinical classification of the leprosy cases.

Contact tracing of health care workers as a part of health system strengthening: lessons learnt from field experience

Health care workers (HCWs) are the frontline workers working tirelessly during the pandemic of coronavirus disease-2019 (COVID-19). The same HCW, after duty, is exposed to his/ her community which again increases the risk of infection. Hence, with an increased risk of exposure, we cannot afford to lose our frontline workers due to sickness or more. In the absence of any definitive antiviral treatment, unclear modes of transmission, burnout working hours, fatigue, societal stigma related to disease etc., a HCW is exposed to psychological distress and many a time develops an anxiety/panic condition which can increase the chances of work-place error and thus can increase the likelihood of infection. In this article, we have shared our experience with contact tracing among HCWs, what we have learned in the past two years, and proposed a way forward.

A study of the socio demographic and obstetric factors in pregnant women with COVID-19 infection at a tertiary care hospital, Kollam, Kerala, India

Background: The first wave of the COVID-19 pandemic took the world to task. Pregnant women needed care without actually knowing if the treatment schedules outside of pregnancy could be extrapolated to the pregnant state. Obstetric protocols were adhered to as far as was feasible, yet world over there was an increase in cesarean section rates. The so-called alpha variant that we saw at the time appeared to infect pregnant women too with equal frequency but they fared well. The issues regarding infectivity and the use of personal protective equipment (PPE) assumed mammoth dimensions. The objectives of this paper were to explore the demographic data and the epidemiological risk factors and study the symptomatology, severity and course of COVID-19 in pregnancy.Methods: This was an observational study conducted on all the COVID-19 positive pregnant women admitted to the department of obstetrics and gynecology at the designated COVID hospital for the district - Government Medical College Kollam - for a period of 6 months from October 2020 to March 2021. These women were studied with respect to their socio demographic details and their Obstetric risk factors and performance. Data was collected and analyzed using statistical package for the social sciences (SPSS) software.Results: 377 antenatal COVID-19 positive women were admitted and analyzed during the study period. Nulliparous women (48.5%%) in the age group 20 to 30 years (74.28%) formed the major group. Third trimester and near date admissions were the majority (48.80%). Most women (79.31%) were asymptomatic. Most common symptoms were fever in 35% and flu like upper respiratory symptoms (20%). Breathlessness and lung involvement was seen in 2.91%. Contact tracing revealed a travel history or contact with infected persons at 15.64%. However, 84.8% had no contact history. All antenatal women were tested at admission and reverse transcriptase-polymerase chain reaction (RTPCR) was done in 73.21%. Rapid antigen and nucleic acid amplification test (NAAT) detected the rest. 46% had some co morbidity gestational diabetes mellitus (GDM), gestational hypertension, thyroid disease and anemia were the common co morbidities detected. The presence of GDM in 24.14% of the study population is noteworthy.Conclusions: Pregnancy being an immune compromised state, unpredictable outcomes are possible with COVID-19 infection. Asymptomatic patients too can experience complications. Frequent hospital and lab visits could be a source of infection. The growing incidence of GDM in the midst of the COVID-19 pandemic is a point for concern.

COVID-19 clusters in Malaysia: characteristics, detection methods and modes of early transmission

@#Objective: Effective prevention and control measures are essential to contain outbreaks of infectious diseases, such as coronavirus disease (COVID-19). Understanding the characteristics of case clusters can contribute to determining which prevention and control measures are needed. This study describes the characteristics of COVID-19 case clusters in Malaysia, the method used to detect a cluster’s index case and the mode of early transmission, using the seven cluster categories applied in Malaysia. Methods: This cross-sectional study collected publicly available data on COVID-19 clusters occurring in Malaysia from 1 March 2020 to 31 May 2021. The characteristics of cases were described by category, and their associations with several outcomes were analysed. Descriptive analyses were performed to explore the method used to detect the index case and the mode of early transmission, according to cluster category. Results: A total of 2188 clusters were identified. The workplace cluster category had the largest proportion of clusters (51.5%, 1126/2188 clusters), while the custodial settings category had the largest median cluster size (178 cases per cluster) and longest median duration of cluster (51 days). The high-risk groups category had the highest mortality. There were significant differences in cluster size, duration and rate of detection across the categories. Targeted screening was most commonly used to detect index cases, especially in custodial settings, and in imported and workplace clusters. Household–social and social–workplace contacts were the most common modes of early transmission across most categories. Discussion: Targeted screening might effectively reduce the size and duration of COVID-19 clusters. Measures to prevent and control COVID-19 outbreaks should be continually adjusted based on ongoing assessments of the unique context of each cluster.

Challenges of contact tracing during COVID-19 pandemic response in a tertiary hospital in Northwestern Nigeria

Background: Contact tracing is a traditional pillar of infectious disease control, especially for illnesses involving direct transmission from person to person, such as COVID-19. Several challenges have arisen from COVID-19 contact tracing activities, particularly in low-resource settings. These include refusal of positive clients to disclose their close contacts, difficulties in conducting risk assessment for contacts traced, among others. Objectives: To explore the activities and identify challenges of contact tracing during COVID -19 pandemic response in a tertiary hospital in Northwestern Nigeria from May, 2020 to March, 2021. Methodology: Amixed method approach was done with quantitative secondary data analysis of COVID-19 contacts traced, and qualitative assessment through Key Informant Interviews (KII) of Ahmadu Bello University Teaching Hospital staff involved in COVID-19 outbreak response during the period. Results: Atotal of 2,249 clients were tested for COVID-19, of which 925 (41.1%) were healthcare workers. The identified challenges included problems with contact identification, delay in notification of results, refusal to disclose contacts by cases, contacts refusing to allow risk assessment, and health workers being overwhelmed by the task of contact tracing. Conclusion: Challenges identified include refusal of cases to disclose their contacts, overwhelming number of contacts, and delay in notification of results. There is need to institute contact tracing protocols to mandate cases to disclose their contacts, train more manpower to reduce the burden of contact tracing, and improve the notification of results.

Father-Daughter Duo: How Unmasking Leprosy in Father Helped in Leprosy Diagnosis in the Daughter - A Case Report

In highly endemic countries like India, where tuberculosis (TB) and leprosy infection may coexist, screening the other disease before initiating treatment is important to prevent Rifampicin resistance since both diseases are treated with and sensitive to Rifampicin. Here, we report a leprosy case involving the unmasking of leprosy in a treated patient with Pulmonary TB. In this case, a high index of suspicion of Erythema Nodosum Leprosum (ENL) in a patient with no history of leprosy disease or treatment with anti-leprosy drugs was observed. He, however, had a history of taking anti-tuberculous medicine 1.5 years earlier. This case report also acknowledges the physician’s prompt referral of this patient to a dermatologist. Taking a detailed family history and screening helped us diagnose leprosy in the patient’s daughter. It also emphasises the atypical presentation of leprosy, which (although described in textbooks) is being reported here.

Social school contacts of multibacillary leprosy cases in children living in the hyperendemic region of the Midwest of Brazil

Abstract Objective: To analyze the prevalence of Mycobacterium leprae detection and the associated factors among social contacts in the school environment of multibacillary cases living in a hyperendemic municipality of the state of Mato Grosso. Methods: Cross-sectional study with 236 social contacts of multibacillary leprosy from public schools and residents in Cuiabá (Mato Grosso) in 2018. The sources of information were interviews and nasal swab tests for molecular analysis by polymerase chain reaction - PCR. For the prevalence ratio estimates, crude and adjusted analyses were performed using robust Poisson regression and their respective confidence intervals (95% CI). The ArcGIS 9.1 software was used for the geographic distribution analyses. Results: The prevalence of detection of M. leprae in social contacts was 14%. A total of 63.6% of the schools surveyed had 5.1% to 50% of the social contacts of leprosy with positive PCR. The analysis of the geographic distribution in the neighborhoods showed a high prevalence of infection, being higher than 50% in some localities. The highest proportion of positive results occurred in the northern region of the city and from a precarious socioeconomic class. Conclusion: The results showed a high prevalence of detection of M. leprae among social contacts in areas with poor socioeconomic conditions. In these regions, there is a greater risk of

Caracterización de factores clínicos-epidemiológicos en la incidencia de lepra

Introducción: La meta mundial para la eliminación de la lepra, es su detección temprana, lo que requiere un abordaje integral, saber los diversos factores que pueden favorecer su adquisición, para así desarrollar estrategias que contribuyan a su erradicación. Objetivo: Caracterizar los factores clínico-epidemiológicos en la incidencia de lepra del municipio Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, transversal, retrospectivo cuyo universo de trabajo estuvo constituido por todos los pacientes con diagnóstico de lepra en el municipio Camagüey, durante el período de estudio. Las variables estudiadas fueron: formas clínicas según clasificación de Madrid, edad, sexo, primeros síntomas y signos, localización de las lesiones, baciloscopia, modo de detección, fuente de infección y situación del enfermo en relación al foco. La información obtenida fue procesada mediante el paquete estadístico SPSS v21. Los métodos empleados fueron estadística descriptiva de distribución de frecuencias absolutas y relativas. Los resultados del estudio se expusieron en tablas y gráficos. Resultados: La lepra dimorfa fue la de mayor incidencia, prevaleció el grupo de edad entre los 60 y más años con predominio del sexo masculino, más de la mitad de los enfermos presentaron manchas anestésicas como primer síntoma y baciloscopia codificación cero. El modo de detección más relevante fue espontáneo, la fuente de infección la ignorada y en la situación del enfermo en relación al foco prevaleció el caso índice. Conclusiones: Los resultados del estudio evidencian que se hace necesario incrementar la capacitación del personal de la salud y profundizar en las labores de búsqueda de casos.

Introduction: The global goal for the elimination of leprosy is its early detection, which requires a comprehensive approach, knowing the various factors that can favor its acquisition, to develop strategies that contribute to its eradication. Objective: To characterize the clinical-epidemiological factors in the incidence of leprosy in the Camagüey municipality. Methods: A retrospective cross-sectional descriptive observational study was carried out, whose work universe consisted of all the patients with a diagnosis of leprosy in the Camagüey municipality, during the studied period. The variables studied were: clinical forms according to Madrid classification, age, sex, first symptoms and signs, location of the lesions, bacilloscopy, mode of detection, source of infection, and situation of the patient about the focus. The information obtained was processed using the statistical package SPSS v21. The methods used were descriptive statistics of the distribution of absolute and relative frequencies. The results of the study were presented in tables and graphs. Results: Dimorphic leprosy was the one with the highest incidence, the age group between 60 and older prevailed with a predominance of males, more than half of the patients presented anesthetic spots as the first symptom, and smear coding was zero. The most relevant detection mode was spontaneous, the source of infection was ignored, and the index case prevailed in the patient's situation in relation to the outbreak. Conclusions: The results of this study show that it is necessary to increase the training of health personnel and deepen the search for cases.

Household outbreak of sporotrichosis: towards the One Health approach

ABSTRACT Although sporotrichosis requires a broad approach for control, few reports have described the relationship between the index case and secondary contacts. In the present work, we report an outbreak involving a woman, a dog, and two cats from the same household environment, including the clinical and epidemiological aspects and outcomes, and discuss the importance of a One Health approach to face this neglected disease. The joint efforts of professionals such as veterinarians and physicians are essential for early diagnosis and surveillance, which contributes to the rapid identification and control of zoonotic sporotrichosis outbreaks.

Tuberculosis infantil en Chile: ¿de dónde provienen los casos? / Childhood tuberculosis in Chile: where do the cases come from?

La tuberculosis es la principal causa de muerte por un agente infeccioso a nivel mundial y se estima que un 6% de los casos nuevos corresponde a tuberculosis infantil. La presencia de tuberculosis en niños es una señal de la existencia de transmisión del agente en la comunidad. Esta investigación busca describir las características epidemiológicas de la tuberculosis infantil en Chile entre 2011 y 2020. METODOLOGÍA: estudio descriptivo de los casos de tuberculosis infantil registrados en Chile entre los años 2011 y 2020. RESULTADOS: se registraron 544 casos de tuberculosis en menores de 15 años en el período analizado, con una tasa de incidencia anual entre 1,1 y 2,2 casos por 100.000. Se observa un importante aumento de casos en los últimos tres años, especialmente en el grupo de menores de 5 años. 63,2% corresponden a tuberculosis pulmonar, y de ellos 62,3% fueron confirmados por bacteriología. La mayoría de los casos no presenta comorbilidades que impliquen inmunosupresión y la incidencia de meningitis tuberculosa en menores de 5 años es baja. La proporción de contactos es de 29% y la de extranjeros de 17%, ambas variables en aumento en los últimos años. CONCLUSIÓN: La tuberculosis en niños sigue siendo un problema de salud poco frecuente en Chile. Sin embargo, su aumento en los últimos años debe alertar sobre un incremento de la transmisión comunitaria de la enfermedad, por lo que se debe reforzar la detección oportuna de casos contagiantes, la investigación de contactos y el tratamiento preventivo.

Tuberculosis is the leading cause of death from a single infectious agent worldwide and it is estimated that 6% of new cases are children. Childhood tuberculosis reflects ongoing transmission within communities. This study aims to describe the epidemiological characteristics of childhood tuberculosis in Chile between 2011 and 2020. METHODOLOGY: descriptive study of the cases of tuberculosis under 15 years-old registered in Chile from 2011 to 2020. RESULTS: 544 cases were registered in the period analyzed, with an annual incidence rate between 1.1 and 2.2 cases per 100,000. A significant increase in cases is observed in the last three years, especially in the group under 5 years-old. 63.2% correspond to pulmonary tuberculosis, and among them 62.3% are confirmed by bacteriology. Most of the cases do not have comorbidities and the incidence of tuberculous meningitis in children under 5 years is low. Contacts are 29% of the cases and foreigners are 17%, both percentages are increasing in the last years. CONCLUSION: Childhood tuberculosis remains a low frequency health problem in Chile. However, its increase in recent years implies an increase in the community transmission. Active case finding, contact tracing and preventive treatment should be reinforced.

¿Cuál es el efecto de añadir estrategias de trazabilidad digitales a trazabilidad manual en contexto de brotes de enfermedades infecciosas como COVID-19?: síntesis rápida de evidencia / What is the effect of adding digital traceability strategies to manual traceability in the context of infectious disease outbreaks such as COVID-19?: rapid evidence of synthesis

ANTECEDENTES Y OBJETIVO La trazabilidad de contactos rápida y oportuna ha sido considerada clave para controlar la transmisión del SARS-CoV-2. Sin embargo, la efectividad de los métodos manuales o tradicionales de trazabilidad han sido cuestionados, y en su lugar o a modo complementario, distintas soluciones digitales se han desarrollado con el fin de facilitar la gestión, notificación y seguimiento de contactos y casos. En este contexto la Coordinación Nacional de Testeo Trazabilidad y Aislamiento solicita una síntesis de evidencia con el objetivo de evaluar la efectividad del uso complementario de sistemas digitales a los métodos manuales de trazabilidad. METODOLOGÍA Se buscaron revisiones sistemáticas en las bases de datos Embase y Medline a través de Ovid, y Epistemonikos, con fecha 25 de agosto de 2021. Además, se construyó una matriz de evidencia con el objetivo de encontrar literatura adicional. Se utiliza la metodología GRADE. Criterios de inclusión: sistemas de trazabilidad digital como softwares, plataformas o apps móviles; artículos que evaluaron trazabilidad manual complementada con sistemas digitales. Criterios de exclusión: dispositivos portátiles, enfermedades que no se enmarcaron en contexto de brote, artículos sobre "vigilancia epidemiológica" que no especifican sobre trazabilidad de contactos y que no evalúan la intervención. RESULTADOS Se recuperaron 5 revisiones sistemáticas, de las cuales se obtuvieron los siguientes resultados: -La evidencia de efecto disponible tiene certeza baja a muy baja, por lo que es muy probable que los resultados observados varíen con la publicación de nuevos y mejores estudios, a saber: • La inclusión de aplicaciones móviles automatizadas de trazabilidad podría reducir la transmisión de la enfermedad y aumentar el número de contactos en cuarentena por cada caso COVID-19. • El uso de sistemas digitales semi-automatizados podría aumentar el número de contactos identificados, y disminuir el tiempo hasta notificación o cuarentena, el tiempo laboral asociado y el número de personas encargadas de esta tarea. -La implementación de estas tecnologías requiere de una evaluación sobre impactos en equidad, costos, nivel de implementación (conectividad local y capacitación) y percepción de los usuarios.

Tuberculin skin test in close contacts in case of school tuberculosis outbreak / 中国学校卫生

Objective@#To evaluate the role of tuberculin skin test prified protein derivative (PPD) in defining the screening scope of close contacts of tuberculosis cases in disposal of tuberculosis outbreak in schools.@*Methods@#In a senior middle school in August 2019, 1 553 students of the grade two were tested by PPD because of a school tuberculosis outbreak. PPD results were compared to grade one students without any association with this tuberculosis epidemic, who were also tested by PPD when beginning school. Potential association between PPD distribution characteristics and tuberculosis case distribution were analyzed.@*Results@#Twenty nine grade two students were diagnozed as tuberculosis infection, seven of which were PPD positive, and with the same MIRU-VNTR genotype. In grade one, 0.1 % (1/796) student showed strong PPD positive, 34.3% (273/796) student showed positive. For grade two students, significant higher rate of strong PPD positive [5.9% (45/757)], and PPD positive [52.0% (394/757)] were observed ( χ 2=45.71, 49.90, P <0.01). Proportion of strong PPD positive in the first floor of the teaching building ( 19.4 %), where tuberculosis cases clustered, was significantly higher than that in other floors ( χ 2=89.81, P <0.01); Number of strong PPD positive students increased with TB cases in each floor of the teaching building ( r =0.99, P <0.01). Proportion of strong PPD positive and PPD positive in floors of the dormitory, where TB cases lived, was significantly higher than in other floors ( χ 2=49.4, 64.9 , P <0.01). Number of strong PPD positive and PPD positive students increased with TB cases in each floor of the teaching building ( r =0.84, 0.56, P <0.01).@*Conclusion@#Strong PPD positive rate well reflects tuberculosis infection of close contacts, and is recommended for defining the scope of screening.

Risk of developing tuberculosis in T-cell spot test of tuberculosis infection positive close contacts of tuberculosis patients in Shanghai: a prospective observational study / 中华传染病杂志

Objective:To investigate the risk and temporal characteristics of tuberculosis (TB) in persons with latent tuberculosis infection (LTBI) among close contacts of TB patients in Shanghai.Methods:This was a prospective observational study, the study subjects were the close contacts of TB patients who tested positive for Mycobacterium tuberculosis infection by T-cell spot test of tuberculosis infection (T-SPOT.TB) among the registered population in seven districts of Shanghai from 2009 to 2010. Questionnaire interview was applied to investigate the basic information and contact history.The LTBI cases during nine consecutive years were identified through the TB registration and reporting system.Cumulative incidence rate and incidence density of TB in tuberculosis-infected close contacts were estimated. Chi-square test was used to compare the incidence rate among different sex and age groups. Results:In total, 376 pulmonary TB patients and their 982 close contacts were enrolled in the baseline survey from 2009 to 2010. Of them, 287 close contacts were tested positive for Mycobacterium tuberculosis infection by T-SPOT.TB.The median age of persons with LTBI at the time of survey was 54 years old, and 36.6%(105/287) were male. By the end of December 2019, five new TB cases were detected among the 287 close contacts with LTBI. The two-year and five-year cumulative incidence were 0.35% and 1.05%, respectively. The nine-year cumulative incidence was 1.74%(95% confidence interval 0.57%-4.02%). The median duration for TB occurrence was 3.67 years. The incidence density of TB was 1.875/1 000 person-years with a total of 2 666.75 observation person-years. There were no significant differences in the nine-year cumulative incidence of TB among close contacts with LTBI by age and sex ( χ2=0.600, <0.001, respectively, both P>0.05). Conclusion:The occurrence of TB among close contacts with LTBI is concentrated in the first five years after TB contact.

Industry and workplace characteristics associated with the downloading of a COVID-19 contact tracing app in Japan: a nation-wide cross-sectional study

BACKGROUND@#To combat coronavirus disease 2019 (COVID-19), many countries have used contact tracing apps, including Japan's voluntary-use contact-confirming application (COCOA). The current study aimed to identify industry and workplace characteristics associated with the downloading of this COVID-19 contact tracing app.@*METHODS@#This cross-sectional study of full-time workers used an online survey. Multiple logistic regression analysis was used to evaluate the associations of industry and workplace characteristics with contact tracing app use.@*RESULTS@#Of the 27,036 participants, 25.1% had downloaded the COCOA. Workers in the public service (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] 1.14-1.45) and information technology (aOR = 1.38, 95% CI 1.20-1.58) industries were more likely to use the app than were those in the manufacturing industry. In contrast, app usage was less common among workers in the retail and wholesale (aOR = 0.87, 95% CI 0.76-0.99) and food/beverage (aOR = 0.81, 95% CI 0.70-0.94) industries, but further adjustment for company size attenuated these associations. Workers at larger companies were more likely to use the app. Compared with permanent employees, the odds of using the app were higher for managers and civil servants but lower for those who were self-employed.@*CONCLUSIONS@#Downloading of COCOA among Japanese workers was insufficient; thus, the mitigating effect of COCOA on the COVID-19 pandemic is considered to be limited. One possible reason for the under-implementation of the contact tracing app in the retail and wholesale and food/beverage industries is small company size, as suggested by the fully adjusted model results. An awareness campaign should be conducted to promote the widespread use of the contact tracing app in these industries.

Utility of early diagnosis, contact tracing and stakeholder engagement in outbreak response in three COVID-19 outbreak settings in Ghana

Objective: To describe how early case detection, testing and contact tracing measures were deployed by stakeholders in response to the COVID-19 outbreak in Ghana ­ using three outbreak scenarios. Design: A descriptive assessment of three case studies of COVID-19 outbreaks within three settings that occurred in Ghana from March 13 till the end of June 2020. Setting: A construction camp, a factory and a training institution in Ghana. Participants: Staff of a construction camp, a factory, workers and students of a training institution. Interventions: We described and compared the three COVID-19 outbreak scenarios in Ghana, highlighting identification and diagnosis of cases, testing, contact tracing and stakeholder engagement for each scenario. We also outlined the challenges and lessons learnt in the management of these scenarios. Main outcome measures: Approach used for diagnosis, testing, contact tracing and stakeholder engagement. Results: Index cases of the training institution and construction camp were screened the same day of reporting symptoms, whiles the factory index case required a second visit before the screening. All index cases were tested with RTPCR. The training institution followed and tested all contacts, and an enhanced contact tracing approach was conducted for staff of the other two sites. Multi-sectorial engagement and collaboration with stakeholders enabled effective handling of the outbreak response in all sites. Conclusion: Comparing all three settings, early diagnosis and prompt actions taken through multi-sectorial collaborations played a major role in controlling the outbreak. Engaging stakeholders in the COVID-19 response is an effective way to mitigate the challenges in responding to the pandemic.