Fostering Prevention and Care Delivery Services Capability on HIV Pandemic and Ebola Outbreak Symbiosis in Africa

Human immunodeficiency virus (HIV) and the re-emerging Ebola virus disease (EVD) are closely intertwined and remain a persistent public health threat and global challenge. Their origin and rapid transmission and spread have similar boundaries and share overlapping impact characteristics; including related symptoms and other interactions. The controversies and global threat of these viruses require rapid response policy and evidence-based implementation findings. The constraints and dual burden inflicted by Ebola and HIV infections are highly characterized by similar socio-demographics; socio-economic and political factors. EVD has similar effects and burdens to HIV infection. This study seeks to understand EVD in the context of HIV epidemic despite the challenges in developing an effective vaccine against HIV and EVD. Our findings show that early understanding; prevention and treatment of these diseases a global health threat mainly in Africa is important and valuable. The lessons learned so far from HIV and Ebola epidemics are crucial in health programming and execution of rapid response interventions and continued vigilance against EVD before it become another worldwide health menace. Therefore; the current regional West Africa EVD requires strengthening healthcare systems and building preparedness and response capacity. Importantly; appropriate community participation; health education and resilience coupled with deployment of effective novel diagnostic approaches in early warning and surveillance of threats and emerging diseases. Therefore; there is an urgent need to develop novel key strategies are crucial in curbing the constant viral resurgence; persistence transmission dynamics and spread; as well in accelerating Ebola vaccines regimen (immunization) development and national implementation plans in achieving sustained control; and eventual elimination

Measles Case-based Surveillance and Outbreak Response in Nigeria; An Update for Clinicians and Public Health Professionals

The Federal Ministry of Health recommendations for response during measles epidemics in Nigeria previously focused on case management using antibiotics and Vitamin. A supplements and did not include outbreak response immunization (ORI) campaigns. However; with the revision of the existing national technical guideline on measles case based surveillance and outbreak response in Nigeria in 2012 in line with the World Health Organization recommendation on response to measles outbreak in measles mortality reduction settings; there is a need to update members of the Nigerian public health community on these revisions to ensure appropriate implementation and compliance. This article therefore seeks to provide clinicians and other public health professionals in Nigeria with updates on recent developments in measles case-based surveillance and outbreak response in Nigeria

Molecular epidemiology of Vibrio cholerae causing outbreaks & sporadic cholera in northern India.

Background & objectives: Several outbreaks of cholera have been reported in Chandigarh region during a span of seven years from 2002-2008. The genetic characteristics of Vibrio cholerae isolates obtained during these outbreaks have not been adequately studied. The aim of this study was to do molecular typing of V. cholerae isolated from the sporadic and outbreak cases by pulsed-field gel electrophoresis (PFGE), Rep-PCR and ribotyping. Methods: Fifty representative isolates of V. cholerae from outbreak as well as sporadic cases were subjected to molecular typing by PFGE, 173 isolates (163 clinical and 10 environmental) were typed by rep-PCR and ribotyping. Ribotyping was done by determination of rRNA restriction pattern of BglI restriction digestion and hybridization with 7.2 kb rRNA probe of pKK3535 plasmid using DIG DNA labelling and detection kit. Universal VC1 primer was used for rep-PCR. Results: PFGE generated 15 pulsotypes, of which four matched the published pulsotypes and there were 11 new pulsotypes. PFGE was the most discriminatory method that could differentiate between isolates belonging to single ribotype. Pulsotype P1 corresponding to known pulsotype H1 was the major pulsotype till 2003. Pulsotype P3 corresponding to known pulsotype L emerged in 2004. The 2007 outbreaks in Punjab and Haryana were caused by P5 though P1 and P3 were isolated from the sporadic cases from the same region. The 2008 outbreak was caused by pulsotypes P6 and P7. Ribotype IV was the most predominant followed by RIII. This ribotype was not isolated after 2003 and ribotype IV became the most predominant 2004 onwards. Of the two unknown ribotypes (UNI and UN2), UNI was more common (27 isolates). Rep-PCR was the least discriminatory and divided all clinical isolates into four major profiles. The dendrogram analysis of PFGE revealed similarity of some clinical isolates with environmental isolates indicating the genetic relatedness. Interpretation & conclusion: Our findings showed that Rep-PCR was least discriminatory method. Ribotyping was a reliable and reproducible method. Ribotype IV was predominant ribotype followed by RIII. A total of 15 pulsotypes were generated and 11 of these were not reported earlier. Genetic relatedness was shown by clinical and environmental isolates which needs to be confirmed in future studies.

Evaluation of a rapid dipstick test for identifying cholera cases during the outbreak.

Background & objectives: Intermittent cholera outbreaks are major problem in many of the states of India. It is essential to identify cholera at the earliest for timely mobilization of public health responses and to abort the outbreaks. The present study was a part of a diarrhoeal outbreak investigation in Secunderabad, India, during May 2009 where the usefulness of Crystal VC rapid dipstick kit was assessed for detecting the aetiologic agent of the outbreak. Methods: Stool specimens were collected from 15 hospitalized patients with acute watery diarrhoea and analyzed for detection of cholera vibrios using Crystal VC rapid dipstick kit and the usefulness of the kit was determined by comparative analysis of the same set of specimens using both microbiological and real-time PCR (RT-PCR) based assays. Results: Detection of Vibrio cholerae O1 from 10 of 15 specimens was recorded using dipstick assay. Microbiological methods detected V. cholerae O1 positivity among 11 specimens. However, RT-PCR based assay showed all 15 specimens positive for the presence of V. cholerae O1. In addition, the same assay showed that the pathogen load in the dipstick as well as RT-PCR positive specimens ranged from 106 colony forming units (cfu)/ml or more. Interpretation & conclusions: Crystal VC kit had the potential to identify cholera cases in 10 min in field conditions without having good laboratory support. Therefore, dipstick kit may be considered as cholera detecting tool in diarrhoeal outbreak investigations. Specimens from clinically typical cholera cases, if negative by dipstick, should be reanalyzed by culture based methods.

Trends of major disease outbreaks in the African region, 2003­2007

Background: Communicable disease outbreaks cause millions of deaths throughout Sub-Saharan Africa each year. Most of the diseases causing epidemics in the region have been nearly eradicated or brought under control in other parts of the world. In recent years, considerable effort has been directed toward public health initiatives and strategies with a potential for significant impact in the fight against infectious diseases. In 1998, the World Health Organization African Regional Office (WHO/AFRO) launched the Integrated Disease Surveillance and Response (IDSR) strategy aimed at mitigating the impact of communicable diseases, including epidemic-prone diseases, through improving surveillance, laboratory confirmation and appropriate and timely public health interventions. Over the past decade, WHO and its partners have been providing technical and financial resources to African countries to strengthen epidemic preparedness and response (EPR) activities. Methods: This review examined the major epidemics reported to WHO/AFRO from 2003 to 2007. we conduct a review of documents and reports obtained from WHO/AFRO, WHO inter-country team, and partners and held meeting and discussions with key stakeholders to elicit the experiences of local, regional and international efforts against these epidemics to evaluate the lessons learned and to stimulate discussion on the future course for enhancing EPR. Results: The most commonly reported epidemic outbreaks in Africa include: cholera, dysentery, malaria and hemorrhagic fevers (e.g. Ebola, Rift Valley fever, Crimean-Congo fever and yellow fever). The cyclic meningococcal meningitis outbreak that affects countries along the /meningitis belt. (spanning Sub-Saharan Africa from Senegal and The Gambia to Kenya and Ethiopia) accounts for other major epidemics in the region. The reporting of disease outbreaks to WHO/AFRO has improved since the launch of the IDSR strategy in 1998. Although the epidemic trends for cholera showed a decline in case fatality rate (CFR) suggesting improvement in detection and quality of response by the health sector, the number of countries affected has increased. Major epidemic diseases continue to occur in most countries in the region. Among the major challenges to overcome are: poor coordination of EPR, weak public health infrastructure, lack of trained workers and inconsistent supply of diagnostic, treatment and prevention commodities.Conclusions: To successfully reduce the levels of morbidity and mortality resulting from epidemic outbreaks, urgent and long-term investments are needed to strengthen capacities for early detection and timely and effective response. Effective advocacy, collaboration and resource mobilization efforts involving local health officials, governments and the international community are critically needed to reduce the heavy burden of disease outbreaks on African populations

Epidemics in Bahrain from 1966 to 2003. an historical perspective [part III]

The Kingdom of Bahrain is an archipelago of 33 islands located in the Arabian Gulf. In the final article in a three part series, the authors enumerate epidemics between 1966 and 2003. During this period, the Public Health Department continued to expand and refine its various sections. Immunization programmes have been a major part of the preventive health services. Epidemics of poliomyelitis, cholera, typhoid fever, paratyphoid fever, meningococcal meningitis, measles, and aseptic meningitis were reported. The rapid influx of workers into Bahrain in the mid 1970s caused a massive transfer of enteropathogens and resulted in an upsurge of enteric diseases in 1978

Leptospirose: reflexöes sobre o espectro grave / Leptospirosis: observations on the severe spectrum

Säo estudados 30 enfermeiros com espectro grave de leptospirose, retirados de um total de 69 observados no Hospital dos Servidores do Estado, durante surto epidêmico conseqüente as chuvas torrenciais e enchentes ocorridas no Rio de Janeiro e "Grande Rio" em 1988. As formas graves foram definidas pela presença de icterícia e de insuficiência renal aguda. Distúrbios hemorrágicos, cardiovasculares, respiratórios, neurológicos e metabólicos foram outros achado clínicos importantes neste grupo. A heterogeneidade de evoluçäo clínica permitiu-nos a caracterizaçäo de três subgrupos: 1) evoluçöes para o óbito; 2) recuperaçöes com evoluçäo arrastada e tormentosa; e 3) formas brandas, dialisadas ou näo. Dez enfermos cursaram com anúria, 15 com oligúria e dois com poliúria. A mortalidade foi maior nos que tiveram anúria. Dos 30 estudados, 13 apresentaram arritmias cardíacas, 8/20 tiveram alteraçöes de ondas T e, em 5/20, houve alteraçöes de segmento ST. Dos dois casos necropsiados, ambos tinham miocardite. O estudo ecocardiográfico näo demonstrou alteraçöes significativas. Treze tiveram alteraçöes hemorrágicas e, entre os 10 com hemorragia digestiva, cinco (50%) faleceram. Foi assinalada plaquetopenia entre 12 entre 22 estudados. Dois casos fatais mostraram padräo radiológico de angústia respiratória, porém a morte näo pode ser atribuída exclusivamente ao envolvimento pulmonar, porque havia concomitância de lesöes graves em outros setores. Os dois casos necropsiados mostraram broncopneumonial hemorragica bilateral. As principais alteraçöes neurológicas descritas foram torpor, convulsöes e coma. Oito dos 30 enfermos tiveram infecçäo hospitalar, como conseqüência da própria gravidade do espectro e da utilizaçäo de terapêuticas invasivas (broncopneumonia, infecçäo urinária, sepsis, parotidite e contaminaçäo de catéter de bexiga e de hemodiálise). Houve concordância entre prognóstico pior e maior número de órgäos acometidos; nos que tiveram evoluçäo fatal, o acometimento foi de 4,3% de órgäos (4 a 6 órgäos). Houve ainda relaçäo direta entre o tipo de evoluçäo, mortalidade e faixa etária. Dez doentes tiveram evoluçäo fatal (33,3%) de mortalidade

Conjuntivite hemorrágica aguda causada pela variante do coxsackievirus A24, em Belém, Pará, Brasil, 1987 / Acute hemorrhagic conjunctivitis caused by a variant of coxsackievirus A24, in Belém, Pará, Brazil, 1987

Durante um surto de conjuntivite hemorrágica aguda (CHA), ocorrido em Belém, Pará, Brasil, em 1987, foi feita investigaçäo etiológica clínica e laboratorial, atendidos 83 pacientes e colhidos espécimes da conjuntiva, orofaringe e soro. Na linhagem celular HEP-2 obteve-se 73 isolamentos de um enterovirus posteriormente identificado pelo Centers for Disease Control (CDC), Atlanta, Georgia, USA, como sendo uma variante do coxsackievirus A24. Em 56 pares de soro foram realizados testes de neutralizaçäo para o EV70 e para a cepa isolada, tendo havido 57%(32) de conversäo sorológica para essa última

Microsporum gypseum: relato de surto de infecçäo e isolamento do solo / Microsporum gypseum: report of an outbreak of infection and isolation from the soil

Descreve-se um surto (sete casos) de tinha da pele glabra ocasionado pelo Microsporum gypseum, caracterizando a fonte da infecçäo. Discute-se a raridade desta micose comparada a freqüência com que este dermatófito geofílico é encontrado no solo

Brote de infección por Serratia Marcescens / Oubreak of infection by Serratia Marcescens

Dada la aparición de un brote de infección por Serratia marcescens en las Unidades de Ciudados Especializados de un Sanatorio de la ciudad de Posadas; se realizó una investigación epidemiológica del brote, que permitió evaluar la importancia del mismo, detectar factores de riesgo y algunaos de los probables mecanismos de transmisión de la infección. Entre el 28 de mayo y el 23 de junio de 1986, ocurrió un brote de infección de Serratia marcescens en pacientes internados en los sectores de Unidad Coronaria y Terapia Intensiva. Dada las características de las cepas aisladas se analizaron las soluciones antisépticas y parenterales y sus envases (18), arrojando resultados negativos en todos los casos, excepto en un envase que contenía un desinfectante derivado del amonio cuaternario (marca DG 6) donde se aisló la misma cepa con idéntico antibiótico-tipo. Se implementaron las medidas tendientes a limitar el brote y evitar nuevos casosñ cambio en la técnica de manejo de soluciones antisépticas, extremar cuidados de técnica aséptica en el manejo de estos pacientes y fundamentalmente cambios en la conducta de quienes manejan estos enfermos. Se destaca como fundamental las medidas de higiene y lavado de manos en la prevencion de la Infección Nosocomial

An outbreak of american cutaneous leishmaniasis (Leishmania braziliensis braziliensis) in a periurban area of Rio de Janeiro city, Brazil: clinical and epidemiological studies

De julho de 1984 a setembro de 1986, 105 casos de leishmaniose cutânea foram estudados numa localidade situada na imediata vizinhança da área urbanizada da regiäo metropolitana da cidade do Rio de Janeiro. A ocupaçäo do sítio deu-se aproximadamente há 20 anos, mas os primeiros casos foram registrados somente seis meses antes do início de nosso estudo. Os casos eram quase que exclusivamente cutâneos, da forma clínica ulcerada com um e seis meses de evoluçäo. O teste de Montenegro foi positivo em todos os casos e anticorpos antileishmania foram detectados por imunofluorescência indireta em 74,3% dos pacientes. A demonstraçäo do parasito foi obtida em 69,5%. Animais domésticos infectados foram facilmente encontrados: 32% dos cäes examinados e 30,8% dos equinos mostravam presença de leishmânia em lesöes ulceradas. Parasitos isolados, tanto de casos humanos como de cäes e equinos, foram imulogicamente caracterizados e identificados com L. b. braziliensis. Da populaçäo de flebotomíneos encontrados 73% eram de Lutzomyia intermedia capturados principalmente com iscas humanas e de animais domésticos. Nossas observaçöes sugerem que esta é uma área de estabelecimento recente da infecçäo por L. b. braziliensis e que a transmissäo ocorre provavelmente tanto no peridomicílio como no interior das habitaçöes

Intoxicaçäo alimentar por queijo Minas contaminado com Staphylococcus aureus / Food-poisoning from Minas-type cheese, contamined with Staphylococcus aureus

Relata-se surto de intoxicaçäo alimentar ocorrido em julho de 1987, na cidade de Ouro Preto, MG (Brasil). O alimento causador foi um queijo Minas, contaminado por Staphylococcus aureus ao nivel de 9,3 x 10**7 UFG/g. Detectaram-se cepas produtoras de enterotoxinas do tipo A, B, D e E. A amostra analisada revelou contaminaçäo por coliformes fecais acima de 1,1 x 10**5/g (NMP), mas näo continha Salmonella. Devido aos sintomas característicos e a elevada contaminaçäo, concluiu-se que o Staphylococcus aureus foi o patogênico responsável pelo surto.

Brote epidémico por Serratia marcescens en un servicio de neonatología / Epidemic outoreank by Serratia marcescens in a neonatal care unit

Serratia marcecens, ha sido considerada responsable de epidemias en recién nacidos (RN). En este estudio se describen las características de un brote por este microorganismo, el cual se presentó entre febrero y abril de 1987 en un servicio de neonatología. Se detectaron 23 pacientes con septicemia, 14 de estos desarrollaron meningoencefalitis; otras localizaciones de infección fueron: flebitis, neumonía, conjuntivitis, abscesos dérmicos y onfalitis. Fallecieron 15 pacientes. Durante la investigación epidemiológica no fue posible encontrar una fuente ambiental común para explicar el brote; sin embargo, S. marcecens se aisló de punta de catéter, sondas nasogástricas, así como de cultivos de manos lo que hizo sospechar que la vía de transmisión de paciente a paciente fue a través de las manos del personal. El tracto gastrointestinal y respiratorio de los propios niños infectados resultó ser el reservorio más importante. Las medidas efectivas para el control de la epidemia y la interrupción de la diseminación de paciente a paciente fueron el lavado de manos adecuado, la antisepsia y el aislamiento de los R colonizados e infectados. Esta investigación demuestra que S. marcescens es un agente potencialmente paógeno que puede ser responsable de infecciones graves en el RN particularmente cuando se relajan las medidas de control epidemiológico

Casos de dengue en las Américas; 1986 a 1987 / Cases of dengue in the Americas 1986 to 1987

En este trabajo se proporciona información sobre el número de casos de dengue que se presentaron en los países de la región de las Américas durante el periodo comprendido de 1986 a 1987. Se incluyen algunos datos del número de casos de dengue notificados hasta marzo de 1988

A human food poisoning outbreak in Rio de Janeiro caused by sausage contaminated with enterotoxigenic clostridium perfringens type A

Em janeiro de 1987, 13 pessoas apresentaram cólicas abdominais e diarréia após o consumo de 30 a 70 gramas de uma linguiça preparada com sangue bovinmo (chouriço). O surto ocorreu em Pertrópolis, no Rio de Janeiro, onde a linguiça foi vendida em um açougue e consumida no lar ou em um bar-lanchonete desta cidade. É possível que outras pessoas também tenham consumido o alimento e apresentado a sintomatologia cujo tempo de incubaçäo e duraçäo foram compatíveis com os atribuídos a C. perfringens tipo A. Foi feito um estudo microbiológico de dois tipos suspeitos de linguiça bem como das fezes de três indivíduos que apresentaram sintomas. Outros 14 indivíduos responderam a um questionário fornecendo dados pessoais e epidemiológicos relacionados ao surto. Nas amostras de fezes o número de C. perfringens enterotoxigênico variou de 4,3 x 10 a 1,8 x 10 e na de chouriço foi de 6,8x 10 por grama. No chouriço o número de mesófilos por grama foi 1,1 x 10, sendo 7,4 x 10 bacilos Gram negativos e 2,0 x 10 Staphylococcus sp. Näo foram encontrados microrganismos dos gêneros Salmonella e Shigella nem Staphylococcus aureus ou Bacillus cereus. As amostras enterotoxigênicas de C. perfringens isoladas do chouriço e das fezes apresentaram identidade sorológica e termo-resistência. Os resultados encontrados sugerem que o surto tenha sido causado por C. perfringens tipo A

Estudio de la serie cronológica del sarampión / Study of a measles time-series

Se analiza la serie cronológica correspondiente a los casos notificados de sarampión expresada en años para el período de 1962 a 1982, y en meses para el período de 1974 a 1982. Se aplica la prueba basada en el número de rachas, para decimar si la serie se comporta como una sucesión aleatoria de alguna población estable o si depende del tiempo. Se estima la variación estacional con la utilización de diferentes métodos. Se estima la tendencia, al suponer que ésta sigue una línea recta, y se aplica el método de los mínimos cuadrados. Se hacen predicciones del número de casos de sarampión para cada mes del año 1983, sobre la base de las estimaciones de la variación estacional y la tendencia. Se comparan estas predicciones, para los meses de enero a agosto de 1983, con el número de casos notificados en estos meses, y se obtiene una concordancia aceptable