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Malaria is long known as a deadly vector borne infection, caused by five parasite species of the coccidian genus Plasmodia that are present in as many as 85 countries. Despite significant progresses have been achieved to control the infection by early diagnosis and artemisinin combination treatment, insecticide-treated nets and indoor residual spraying, malaria still represents a major public health issue in many endemic low-income countries. New diagnostic tools of higher sensitivity and specificity are now available for use in endemic countries to better guide diagnosis and treatment. In particular, highly sensitive rapid antigenic tests are now available and the loop-mediated isothermal amplification is a very promising and highly sensitive diagnostic tool. After 2015, decreasing morbidity and mortality trends have been stagnating because of limited funding, emergence of parasite and vector resistance to drugs and insecticides respectively and, recently, by the disrupting effect of COVID-19 pandemic. The incomplete knowledge of the complex immunity of malaria infection has slowed the development of an effective vaccine. However, in 2021, the RTS-S vaccine, however of suboptimal protective efficacy, has been made available for routine use in children above 5 months of age. Population movements has increased the chance of observing imported malaria in non-endemic areas, where malaria competent vectors may still exist.
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SESSION TITLE: Occupational and Environmental Lung Disease Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Chlorine gas is a pulmonary irritant with pungent odor that damages the respiratory tract. Chlorine gas exposure occurs in industrial or household exposures,Chlorine gas has two forms either a liquid or gas, toxicity of chlorine gas depends on the dose and duration of exposure. Chlorine gas used in manufacturing products like paper, insecticides, Chlorine is used to treat bottled and swiming pool water. CASE PRESENTATION: A 37 Y.O Male, no PMH presents with progressive dyspnea for three days worse with activity,decreases with rest, denied cough fever or chest pain he is vaccinated for COVID,no smoking history. The patient worked at a chlorine gas factory in the Dominican Republic for 15 years. Exam: Vitals: BP 124/72 mmHg. HR 100 BPM. RR 21 BPM. SpO2 84%. General: acute distress. Heart: normal S1, S2. RRR. Lung: wheeze bilaterally. Abdomen: Soft. Musculoskeletal: no pitting edema. he was placed on 6 LPM NC saturation improved to 90%. CBC and Chemistry were unremarkable, he was started on steroid, breathing treatment with antibiotics. ABG showed hypoxemia. he was placed on Venturi mask and his saturation improved to 95%.CTA was negative for PE. EKG, troponin were unremarkable. A proBNP normal. The antibiotics were discontinued because of a negative workup. A TTE study was normal. HRCT scan of the chest, showed atelectasis and infiltrates of lower lobes. No interstitial fibrosis.A PFT showed obstructive airway disease. He was discharged on oral and inhaled steroids.Hi new onset obstructive airway could be due to chlorine gas exposure. DISCUSSION: Chlorine gas causes cellular injury through oxidative damage but further damage results from activation and recruitment of inflammatory cells with subsequent release of oxidants and proteolytic enzymes. Humans can detect chlorine gas odor at a concentration between 0.1-0.3 ppm. At 1-3 ppm,it causes irritation of oral,eye mucosal membranes. At 30-40 ppm causes cough, chest pain, and SOB. At 40-60 ppm, toxic pneumonitis and pulmonary edema and can be fatal at 430 ppm concentration or higher within thirty minutes. Chronic exposure to chlorine gas lead to chest pain, cough, sore throat, hemoptysis, recurrent asthma. Physical exam findings include tachypnea cyanosis, wheezing, intercostal retractions, decreased breath sounds. Pulmonary function tests may reveal obstructive lung function disease. Chronic exposure to a low level was found to be associated with an increased risk of asthma in swimmers. CONCLUSIONS: Chlorine exposure results in direct chemical toxicity to the airways with acute airways obstruction or airways hyperreactivity, presentation varies from acute overwhelming intoxication with acute lung injury and or death, occupational exposure increase the likelihood of chronic bronchitis or isolated wheezing attacks. Treatment for chlorine exposure is largely supportive. Reference #1: 1- Center of disease control and prevention website/emergency preparedness and response/ https://emergency.cdc.gov/agent/chlorine/basics/facts.asp Reference #2: 2- C- Morim A, Guldner GT. Chlorine Gas Toxicity. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537213/. Reference #3: A- Gummin DD, Mowry JB, Beuhler MC, et al. 2020 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021;59(12):1282-1501. doi:10.1080/15563650.2021.1989785 DISCLOSURES: No relevant relationships by Abdallah Khashan No relevant relationships by Samer Talib no disclosure on file for Matthew Yotsuya;
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Speed read WHO draws list of 25 countries targeting malaria elimination by 2025 Eight countries were certified malaria-free last year despite COVID-19 But disruptions to health services during the pandemic could threaten progress The World Health Organization (WHO) says it has identified 25 countries with the potential to stamp out malaria in the next five years, despite the added burden of COVID-19 and antimalarial drug resistance. “No matter what burden of malaria you have in your country, there’s a path that can be walked and the end stage of that path will be eliminating malaria,” Pedro Alonso, director, WHO Global Malaria Programme Last year alone eight countries reported zero indigenous cases of malaria, “a remarkable achievement in view of the ongoing global COVID-19 pandemic,” the report says. About one third of countries around the world reported disruptions in malaria prevention, diagnosis and treatment services during the first quarter of 2021, a survey by the organisation found, while lockdowns and restrictions on movement led to delays in the delivery of insecticide-treated mosquito nets and indoor insecticide spraying campaigns.
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Malaria is long known as a deadly vector borne infection, caused by five parasite species of the coccidian genus Plasmodia that are present in as many as 85 countries. Despite significant progresses have been achieved to control the infection by early diagnosis and artemisinin combination treatment, insecticide-treated nets and indoor residual spraying, malaria still represents a major public health issue in many endemic low-income countries. New diagnostic tools of higher sensitivity and specificity are now available for use in endemic countries to better guide diagnosis and treatment. In particular, highly sensitive rapid antigenic tests are now available and the loop-mediated isothermal amplification is a very promising and highly sensitive diagnostic tool. After 2015, decreasing morbidity and mortality trends have been stagnating because of limited funding, emergence of parasite and vector resistance to drugs and insecticides respectively and, recently, by the disrupting effect of COVID-19 pandemic. The incomplete knowledge of the complex immunity of malaria infection has slowed the development of an effective vaccine. However, in 2021, the RTS-S vaccine, however of suboptimal protective efficacy, has been made available for routine use in children above 5 months of age. Population movements has increased the chance of observing imported malaria in non-endemic areas, where malaria competent vectors may still exist.
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BACKGROUND: Drums and cisterns are ubiquitous water storages in Indonesian households, seldom being drained and left open to create access for the rainwater, providing a favorable breeding site for dengue vector. The bigger the container, the more it produces immature mosquitoes that are soon to be mature, increasing the entomological indices and raising the potency of cases in the area. Previous studies revealed that the net covering the reservoir was able to effectively protect the water from mosquito oviposition;therefore, a modification of the net was made. AIM: The aim of this study is to discover whether the net as a cover for water containers is effective in reducing the entomological indices in dengue-endemic areas. METHODS: The quasi-experimental study with pretest and posttest control group design, involved 3 intervention and 3 control clusters, 150 houses which have 672 water-holding containers with 116 large containers were intervened with non-insecticide tulle nets for 3 months. The larval presence data were performed by larval survey. RESULTS: It revealed that net reduced the container index (CI) in intervened large containers 18%–84% as well as the environment entomological indices in general in study areas: CI decreased 75%–79%, house index decreased 65%–70%, and Breteau index decreased 75.5%–78.7%, while Free Larva Index rose 73.7%–88%. CONCLUSIONS: The nets had lowered the CI in the intervened large container and affected the entomological indices of the surrounding environment, by blocking the mosquitos-water contact and preventing the young mosquitos that had developed in the containers from flying out.
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Background: Emergency physicians must be updated about the variations in poisoning pattern during Covid19 pandemic. Limited data exist on the incidence and characteristics of patients presenting with poisoning in Indian Emergency Departments (ED) during the COVID 19 pandemic. Hence, we aimed to explore the impact of Covid19 pandemic on poisoning cases presenting to the ED. Methods: This cross-sectional retrospective study was conducted on poisoning patients presenting to ED during the pandemic period (April 1-October 30, 2020 (period 2)), and a matching period before the pandemic (September 1,2019 to March 31, 2020 (period 1)). The rate of prevalence and clinical profile were compared between period 1 and 2 using appropriate statistical test. Results: A total of 111 (periods 1 = 57, and periods 2 = 54) cases were analysed. Poisoning prevalence rates had slightly increased by 2.7% before the pandemic (51.33%) in comparison to during the pandemic (48.6%) period (p=0.3). Females were predominant in both periods, and the mean age of 32.5 years. The predominant (57%) patient age group was 15-34 years. 36.9% (n=41) patients consumed multiple poisons, 19.8% (n=22) consumed paracetamol, and 14.4% (n=16) patients consumed psychiatric medications. Before lockdown, 27.02% (n=30) patients presented within 3 hours ingestion, and 21.6% (n=24) presented after 3 hours ingestion (p=0.12). A significant delay in arrival of poisoning cases during lockdown (p= 0.12) with increased hospital admission (p=0.03) was observed. A psychiatric disorder was observed in 36.03% cases. Majority of the cases were admitted in the ICU, and 0.9%(n=1) death was recorded. Conclusions: This is the first Indian study that describes the incidence of poisoning cases and their pattern during the COVID 19pandemic period, study revealed that increased mental health crisis in low resource settings in rural Kerala affects predominantly young population. Study implies the importance of priming the mental health care professionals to initiate their mental health screening programmes.
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Background: After the first case of COVID-19 being announced in China in December 2019, various diagnostic technologies have been developed at unprecedented pace with the aim of providing a basis for accurate clinical intervention. However, some assays including CRISPR-based diagnostics and loop-mediated isothermal amplification (LAMP) have been less explored. As new COVID-19 technologies emerge, there is need for them to be assessed, validated and improved upon. Moreover, there is paucity of data on the essential factors governing the selection of an appropriate diagnostic approach within the correct timeframe. Myths and origin of SARS-CoV-2 remain to be controversial. Consequently, this review aims at exploring the current COVID-19 diagnostic technologies, performance evaluation, principles, suitability, specificity, sensitivity, successes and challenges of the technologies for laboratory and bedside testing. Main Body: To date, there exist more publications on COVID-19 diagnostics as compared to the Zika virus. The SARS-CoV-2 virus genome profiles were readily available by 31st of December 2019. This was attributed to the fast-paced sharing of the epidemiological and diagnostics data of COVID-19. Timely profiling of the virus genome accelerated the development of diagnostic technologies. Furthermore, the rapid publication of studies that evaluated several diagnostic methods available provided baseline information on how the various technologies work and paved way for development of novel technologies. Conclusion: Up to date, RT-PCR is the most preferred as compared to the other assays. This is despite the repeated false negatives reported in many of the study findings. Considering that COVID-19 has caused devastating effects on the economy, healthcare systems, agriculture and culture, timely and accurate detection of the virus is paramount in the provision of targeted therapy hence reducing chances of drug resistance, increased treatment costs and morbidity. However, information on the origin of SARS-CoV-2 still remains elusive. Furthermore, knowledge and perception of the patients toward management of SARS-CoV-2 are also paramount to proper diagnosis and management of the pandemic. Future implications of the misperceptions are that they may lead to increased non-compliance to SARS-CoV-2-related World Health Organization (WHO) policies and guidelines.
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Understanding how multiple insecticide resistance mechanisms occur in malaria vectors is essential for efficient vector control. This study aimed at assessing the evolution of metabolic mechanisms and Kdr L995F/S resistance alleles in Anopheles gambiae s.l. from North Cameroon, following long-lasting insecticidal nets (LLINs) distribution in 2011. Female An. gambiae s.l. emerging from larvae collected in Ouro-Housso/Kanadi, Be-Centre, and Bala in 2011 and 2015, were tested for susceptibility to deltamethrin + piperonyl butoxide (PBO) or SSS-tributyl-phosphoro-thrithioate (DEF) synergists, using the World Health Organization's standard protocol. The Kdr L995F/S alleles were genotyped using Hot Ligation Oligonucleotide Assay. Tested mosquitoes identified using PCR-RFLP were composed of An. arabiensis (68.5%), An. coluzzii (25.5%) and An. gambiae (6%) species. From 2011 to 2015, metabolic resistance increased in Ouro-Housso/Kanadi (up to 89.5% mortality to deltametnrin+synergists in 2015 versus <65% in 2011; p < 0.02), while it decreased in Be-Centre and Bala (>95% mortality in 2011 versus 42-94% in 2015; p < 0.001). Conversely, the Kdr L995F allelic frequencies slightly decreased in Ouro-Housso/Kanadi (from 50% to 46%, p > 0.9), while significantly increasing in Be-Centre and Bala (from 0-13% to 18-36%, p < 0.02). These data revealed two evolutionary trends of deltamethrin resistance mechanisms; non-pyrethroid vector control tools should supplement LLINs in North Cameroon.
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The World Health Organization (WHO) World Malaria Report 2021 < https://www.who.int/publications/i/item/9789240040496 > estimates that there were 241 million malaria cases, including 627,000 deaths, worldwide in 2020, which represents around 14 million more cases, and 69,000 more deaths, than 2019. Approximately two-thirds of these additional deaths were linked to disruptions in the provision of malaria prevention, diagnosis and treatment during the COVID-19 pandemic. Sub-Saharan Africa continues to carry the heaviest malaria burden, accounting for about 95% of all cases and 96% of all deaths in 2020, with around 80% of deaths in the region among children under five years old. Since 2015, the baseline date for the WHO's global malaria strategy, registered increases in malaria deaths were reported in 24 countries. In the 11 countries that carry the highest burden of malaria worldwide, cases increased from 150 million in 2015 to 163 million cases in 2020, and malaria deaths increased from 390,000 to 444,600 over that same period. As in previous years, the report includes an up-to-date assessment on the burden of malaria at global, regional, and country levels, and tracks investment in malaria programmes and research, as well as detailing progress across the four intervention areas of prevention, diagnosis, treatment and surveillance. There are also dedicated chapters on malaria elimination and key threats, such as insecticide and drug resistance.
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BACKGROUND: The use of data in targeting malaria control efforts is essential for optimal use of resources. This work provides a practical mechanism for prioritizing geographic areas for insecticide-treated net (ITN) distribution campaigns in settings with limited resources. METHODS: A GIS-based weighted approach was adopted to categorize and rank administrative units based on data that can be applied in various country contexts where Plasmodium falciparum transmission is reported. Malaria intervention and risk factors were used to rank local government areas (LGAs) in Nigeria for prioritization during mass ITN distribution campaigns. Each factor was assigned a unique weight that was obtained through application of the analytic hierarchy process (AHP). The weight was then multiplied by a value based on natural groupings inherent in the data, or the presence or absence of a given intervention. Risk scores for each factor were then summated to generate a composite unique risk score for each LGA. This risk score was translated into a prioritization map which ranks each LGA from low to high priority in terms of timing of ITN distributions. RESULTS: A case study using data from Nigeria showed that a major component that influenced the prioritization scheme was ITN access. Sensitivity analysis results indicate that changes to the methodology used to quantify ITN access did not modify outputs substantially. Some 120 LGAs were categorized as 'extremely high' or 'high' priority when a spatially interpolated ITN access layer was used. When prioritization scores were calculated using DHS-reported state level ITN access, 108 (90.0%) of the 120 LGAs were also categorized as being extremely high or high priority. The geospatial heterogeneity found among input risk factors suggests that a range of variables and covariates should be considered when using data to inform ITN distributions. CONCLUSION: The authors provide a tool for prioritizing regions in terms of timing of ITN distributions. It serves as a base upon which a wider range of vector control interventions could be targeted. Its value added can be found in its potential for application in multiple country contexts, expediated timeframe for producing outputs, and its use of systematically collected malaria indicators in informing prioritization.
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Insecticide-Treated Bednets/statistics & numerical data , Mosquito Control/methods , Public Health/statistics & numerical data , Spatial Analysis , Child, Preschool , Emergencies , Humans , Infant , NigeriaABSTRACT
Monitoring local mosquito populations for insecticide resistance is critical for effective vector-borne disease control. However, widely used phenotypic assays, which are designed to monitor the emergence and spread of insecticide resistance (technical resistance), do not translate well to the efficacy of vector control products to suppress mosquito numbers in the field (practical resistance). This is because standard testing conditions such as environmental conditions, exposure dose, and type of substrate differ dramatically from those experienced by mosquitoes under field conditions. In addition, field mosquitoes have considerably different physiological characteristics such as age and blood-feeding status. Beyond this, indirect impacts of insecticide resistance and/or exposure on mosquito longevity, pathogen development, host-seeking behavior, and blood-feeding success impact disease transmission. Given the limited number of active ingredients currently available and the observed discordance between resistance and disease transmission, we conclude that additional testing guidelines are needed to determine practical resistance-the efficacy of vector control tools under relevant local conditions- in order to obtain programmatic impact.
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Culicidae , Insecticide Resistance , Insecticides , Mosquito Control , Mosquito Vectors , Vector Borne Diseases/prevention & control , Animals , Guidelines as TopicABSTRACT
BACKGROUND: The pandemic of the coronavirus disease 2019 (COVID-19) has caused substantial disruptions to health services in the low and middle-income countries with a high burden of other diseases, such as malaria in sub-Saharan Africa. The aim of this study is to assess the impact of COVID-19 pandemic on malaria transmission potential in malaria-endemic countries in Africa. METHODS: We present a data-driven method to quantify the extent to which the COVID-19 pandemic, as well as various non-pharmaceutical interventions (NPIs), could lead to the change of malaria transmission potential in 2020. First, we adopt a particle Markov Chain Monte Carlo method to estimate epidemiological parameters in each country by fitting the time series of the cumulative number of reported COVID-19 cases. Then, we simulate the epidemic dynamics of COVID-19 under two groups of NPIs: (1) contact restriction and social distancing, and (2) early identification and isolation of cases. Based on the simulated epidemic curves, we quantify the impact of COVID-19 epidemic and NPIs on the distribution of insecticide-treated nets (ITNs). Finally, by treating the total number of ITNs available in each country in 2020, we evaluate the negative effects of COVID-19 pandemic on malaria transmission potential based on the notion of vectorial capacity. RESULTS: We conduct case studies in four malaria-endemic countries, Ethiopia, Nigeria, Tanzania, and Zambia, in Africa. The epidemiological parameters (i.e., the basic reproduction number [Formula: see text] and the duration of infection [Formula: see text]) of COVID-19 in each country are estimated as follows: Ethiopia ([Formula: see text], [Formula: see text]), Nigeria ([Formula: see text], [Formula: see text]), Tanzania ([Formula: see text], [Formula: see text]), and Zambia ([Formula: see text], [Formula: see text]). Based on the estimated epidemiological parameters, the epidemic curves simulated under various NPIs indicated that the earlier the interventions are implemented, the better the epidemic is controlled. Moreover, the effect of combined NPIs is better than contact restriction and social distancing only. By treating the total number of ITNs available in each country in 2020 as a baseline, our results show that even with stringent NPIs, malaria transmission potential will remain higher than expected in the second half of 2020. CONCLUSIONS: By quantifying the impact of various NPI response to the COVID-19 pandemic on malaria transmission potential, this study provides a way to jointly address the syndemic between COVID-19 and malaria in malaria-endemic countries in Africa. The results suggest that the early intervention of COVID-19 can effectively reduce the scale of the epidemic and mitigate its impact on malaria transmission potential.
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COVID-19/epidemiology , COVID-19/therapy , Malaria/epidemiology , Malaria/therapy , COVID-19/transmission , COVID-19/virology , Ethiopia/epidemiology , Humans , Malaria/transmission , Markov Chains , Nigeria/epidemiology , Pandemics , SARS-CoV-2/isolation & purification , Syndemic , Tanzania/epidemiology , Zambia/epidemiologyABSTRACT
Biocidal active chemicals have potential health risks associated with exposure to retail biocide products such as disinfectants for COVID-19. Reliable exposure assessment was investigated to understand the exposure pattern of biocidal products used by occupational workers in their place of occupation, multi-use facilities, and general facilities. The interview-survey approach was taken to obtain the database about several subcategories of twelve occupational groups, the use pattern, and the exposure information of non-human hygiene disinfectant and insecticide products in workplaces. Furthermore, we investigated valuable exposure factors, e.g., the patterns of use, exposure routes, and quantifying potential hazardous chemical intake, on biocidal active ingredients. We focused on biocidal active-ingredient exposure from products used by twelve occupational worker groups. The 685 non-human hygiene disinfectants and 763 insecticides identified contained 152 and 97 different active-ingredient chemicals, respectively. The toxicity values and clinical health effects of total twelve ingredient chemicals were determined through a brief overview of toxicity studies aimed at estimating human health risks. To estimate actual exposure amounts divided by twelve occupational groups, the time spent to apply the products was investigated from the beginning to end of the product use. This study investigated the exposure assessment of occupational exposure to biocidal products used in workplaces, multi-use facilities, and general facilities. Furthermore, this study provides valuable information on occupational exposure that may be useful to conduct accurate exposure assessment and to manage products used for quarantine in general facilities.
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Disinfectants/adverse effects , Insecticides/adverse effects , Occupational Exposure , Occupational Health , COVID-19 , Humans , Occupations , Pandemics , Risk AssessmentABSTRACT
Here we tell the story of ivermectin, describing its anthelmintic and insecticidal actions and recent studies that have sought to reposition ivermectin for the treatment of other diseases that are not caused by helminth and insect parasites. The standard theory of its anthelmintic and insecticidal mode of action is that it is a selective positive allosteric modulator of glutamate-gated chloride channels found in nematodes and insects. At higher concentrations, ivermectin also acts as an allosteric modulator of ion channels found in host central nervous systems. In addition, in tissue culture, at concentrations higher than anthelmintic concentrations, ivermectin shows antiviral, antimalarial, antimetabolic, and anticancer effects. Caution is required before extrapolating from these preliminary repositioning experiments to clinical use, particularly for Covid-19 treatment, because of the high concentrations of ivermectin used in tissue-culture experiments.