Classical RS1 and environmental RS1 elements in Vibrio cholerae O1 El Tor strains harbouring a tandem repeat of CTX prophage: revisiting Mozambique in 2005.

Currently, Vibrio cholerae O1 serogroup biotype El Tor strains producing classical type cholera toxin (altered strains or El Tor variants) are prevalent in Asia and in Mozambique. Mozambican strains collected in 2004 contained a tandem repeat of CTX prophage on the small chromosome and each CTX prophage harboured the classical rstR and classical ctxB. We found that the majority of the strains collected in 2005 in Mozambique contained extra elements on the large chromosome in addition to the tandem repeat of CTX prophage on the small chromosome. New type RS1 elements RS1(cla) and RS1(env), and a CTX(env) with rstR(env) and the classical ctxB were identified on the large chromosome of the Mozambican isolates collected in 2005.

Characteristics of a pandemic clone of O3 : K6 and O4 : K68 Vibrio parahaemolyticus isolated in Beira, Mozambique.

The genetic characteristics of Vibrio parahaemolyticus strains isolated in 2004 and 2005 in Mozambique were assessed in this study to determine whether the pandemic clone of V. parahaemolyticus O3 : K6 and O4 : K68 serotypes has spread to Mozambique. Fifty-eight V. parahaemolyticus strains isolated from hospitalized diarrhoea patients in Beira, Mozambique, were serotyped for O : K antigens and genotyped for toxR, tdh and trh genes. A group-specific PCR, a PCR that detects the presence of ORF8 of the filamentous phage f237, arbitrarily primed PCR, PFGE and multilocus sequence typing were performed to determine the pandemic status of the strains and their ancestry. All strains of serovars O3 : K6 (n=38) and O4 : K68 (n=4) were identified as a pandemic clonal group by these analyses. These strains are closely related to the pandemic reference strains of O3 : K6 and O4 : K68, which emerged in Asia in 1996 and were later found globally. The pandemic serotypes O3 : K6 and O4 : K68 including reference strains grouped into a single cluster indicating emergence from a common ancestor. The O3 : K58 (n=8), O4 : K13 (n=6), O3 : KUT (n=1) and O8 : K41 (n=1) strains showed unique characteristics different from the pandemic clone.

Is HIV infection associated with an increased risk for cholera? Findings from a case-control study in Mozambique.

OBJECTIVE: As residents of sub-Saharan Africa are at high risk for HIV and cholera, it is biologically plausible that immune suppression caused by HIV infection predisposes to cholera. Our aim was to assess the potential association between both diseases. METHODS: We conducted a case-control study in Beira, Mozambique, a high-risk area for HIV and cholera. Between 1 January 2005 and 30 June 2006, experienced counsellors invited 132 suspected cholera cases and 528 age- and sex-matched controls to an HIV counselling and testing centre. RESULTS: Forty (30%) of the invited cases and 127 (24%) of the invited controls came for HIV testing. No significant differences in demographic and socio-economic baseline characteristics were detected between participants and non-participants. Twenty five of 167 (15%) individuals who underwent testing were found HIV-positive. The probability of a positive HIV-test was highest in participants between 40 and 49 years; 6 of 14 (43%) tested HIV-positive. Nine of 40 (23%) cholera cases were found to be HIV-infected compared with 16 of 127 (13%) controls (adjusted odds ratio 2.6; 95% CI 0.9-7.5; P = 0.08). DISCUSSION: The findings suggest that in a cholera-endemic area, HIV infection is associated with an increased risk for cholera. More research in HIV endemic settings is needed to confirm the findings and to explore the effect of HIV-related immunosuppression on the transmission of cholera.

Seven years of regional malaria control collaboration--Mozambique, South Africa, and Swaziland.

The Lubombo Spatial Development Initiative is a joint development program between the governments of Mozambique, Swaziland, and South Africa, which includes malaria control as a core component of the initiative. Vector control through indoor residual spraying (IRS) was incrementally introduced in southern Mozambique between November 2000 and February 2004. Surveillance to monitor its impact was conducted by annual cross-sectional surveys to assess the prevalence of Plasmodium falciparum infection, entomologic monitoring, and malaria case notification in neighboring South Africa and Swaziland. In southern Mozambique, there was a significant reduction in P. falciparum prevalence after the implementation of IRS, with an overall relative risk of 0.74 for each intervention year (P < 0.001), ranging from 0.66 after the first year to 0.93 after the fifth intervention year. Substantial reductions in notified malaria cases were reported in South Africa and Swaziland over the same period. The success of the program in reducing malaria transmission throughout the target area provides a strong argument for investment in regional malaria control.

Private demand for cholera vaccines in Beira, Mozambique.

In the summer of 2005, we interviewed 996 randomly selected respondents in Beira, Mozambique concerning their willingness and ability to pay for cholera vaccine for themselves and for other household members. Respondents were told that two doses of the vaccine would be required 2 weeks apart, and that the cholera vaccine would offer excellent protection against infection for the first year following vaccination, and some protection during the second and third year after a person is vaccinated. This research was carried out in order to learn more about private demand for vaccines in a cholera-endemic area. We asked two types of valuation questions: (1) a discrete-price offer for a vaccine that could be purchased for household members and (2) a payment card designed to assess uncertainty in the respondent's demand for a vaccine for self-protection. We estimate average household willingness to pay (WTP) for cholera vaccines in Beira to be 2005 US$ 8.45. This estimate of household WTP represents the perceived private economic benefits to a household--six persons on average--of giving all members free cholera vaccines.

Genetic characterization of human immunodeficiency virus type 1 from Beira, Mozambique.

In this report, we examined the genetic diversity of HIV-1 strains circulating in the city of Beira, the second largest metropolitan area in Mozambique. A total of 131 blood samples, collected between August and October 2003 from antiretroviral-naïve individuals, were characterized with a combined approach consisting of heteroduplex mobility assay (HMA) subtyping for gag (n=74) and/or env (n=117) genes, and DNA sequence analysis of proviral env (C2V3C3, n=52), LTR (n=30) and/or pol (n=43) genomic regions. Aside from the identification, by bootscanning analysis, of a viral strain with a C/A1 mosaic C2V3C3 structure, classified as subtype A by env HMA, phylogenetic inference studies of the sequence data demonstrated the circulation of genetically diverse subtype C viruses, predominantly of the R5 type. Inspection of the LTR sequences revealed a pattern of structural and regulatory elements typical of subtype C, with 63.3% of the viruses showing three NF-kappaB binding sites. Analysis of the predicted protease sequences enabled us to detect a single primary mutation (I84V, n=1) associated with resistance to protease inhibitors (PI), while secondary mutations were highly prevalent, some of them in combinations which may confer PI resistance. Although an unexpectedly high rate (11.6%) of reverse transcriptase key mutations (V75A, K103N, Y181C, M184I, or P236L) was detected in the sequences analyzed, our data suggest the non-epidemic circulation of resistant viruses, and the absence of multi-class drug resistant viral strains.

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique.

We conducted a study to assess the feasibility and the potential vaccine coverage of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban endemic neighbourhood of Beira, Mozambique. The campaign was conducted from December 2003 to January 2004. Overall 98,152 doses were administered, and vaccine coverage of the target population was 58.6% and 53.6% for the first and second rounds, respectively. The direct cost of the campaign, which excludes the price of the vaccine, amounted to slightly over 90,000 dollars, resulting in the cost per fully vaccinated person of 2.09 dollars, which is relatively high. However, in endemic settings where outbreaks are likely to occur, integrating cholera vaccination into the routine activities of the public health system could reduce such costs.

Pandemic serovars (O3:K6 and O4:K68) of Vibrio parahaemolyticus associated with diarrhea in Mozambique: spread of the pandemic into the African continent.

Forty-two episodes of Vibrio parahaemolyticus infections were detected in Beira, Mozambique, from January to May 2004. The majority of the isolates (81%) belonged to the pandemic serovars (O3:K6 and O4:K68) of V. parahaemolyticus. The pandemic serovars were positive by group-specific PCR (GS-PCR) and a PCR specific for open reading frame ORF8 (ORF8-PCR), which are molecular markers of the pandemic clone, and were positive for tdh but negative for trh. The remaining 19% of the strains also possessed the tdh gene but were GS-PCR and ORF8-PCR negative and did not belong to the pandemic serovars. Patients with V. parahaemolyticus infection were older (mean age, 27 years) than patients infected by other diarrheal agents (mean age, 21 years). Ten percent of diarrhea patients from whom no V. parahaemolyticus was cultured were severely dehydrated, but none of the V. parahaemolyticus cases were severely dehydrated. This is the first report of the isolation of pandemic strains of V. parahaemolyticus in sub-Saharan Africa and clearly indicates that the pandemic of V. parahaemolyticus has spread into the African continent.

Effectiveness of mass oral cholera vaccination in Beira, Mozambique.

BACKGROUND: New-generation, orally administered cholera vaccines offer the promise of improved control of cholera in sub-Saharan Africa. However, the high prevalence of human immunodeficiency virus (HIV) infection in many cholera-affected African populations has raised doubts about the level of protection possible with vaccination. We evaluated a mass immunization program with recombinant cholera-toxin B subunit, killed whole-cell (rBS-WC) oral cholera vaccine in Beira, Mozambique, a city where the seroprevalence of HIV is 20 to 30 percent. METHODS: From December 2003 to January 2004, we undertook mass immunization of nonpregnant persons at least two years of age, using a two-dose regimen of rBS-WC vaccine in Esturro, Beira (population 21,818). We then assessed vaccine protection in a case-control study during an outbreak of El Tor Ogawa cholera in Beira between January and May 2004. To estimate the level of vaccine protection, antecedent rates of vaccination were compared between persons with culture-confirmed cholera severe enough to have prompted them to seek treatment and age- and sex-matched neighborhood controls without treated diarrhea. RESULTS: We assessed the effectiveness of the vaccine in 43 persons with cholera and 172 controls. Receipt of one or more doses of rBS-WC vaccine was associated with 78 percent protection (95 percent confidence interval, 39 to 92 percent; P=0.004). The vaccine was equally effective in children younger than five years of age and in older persons. A concurrently conducted case-control study designed to detect bias compared persons with treated, noncholeraic diarrhea and controls without diarrhea in the same population and found no protection associated with receipt of the rBS-WC vaccine. CONCLUSIONS: The rBS-WC vaccine was highly effective against clinically significant cholera in an urban sub-Saharan African population with a high prevalence of HIV infection.

The cost and cost-effectiveness of malaria vector control by residual insecticide house-spraying in southern Mozambique: a rural and urban analysis.

OBJECTIVES: To compare two separately funded, but operationally similar, residual household-spraying (RHS) initiatives; one rural and one peri-urban in southern Mozambique. METHODS: The rural programme is a regional project involving the participation and co-ordination of organizations across three countries in southern Africa and is focussed on control in an area in Mozambique of 7552 km2. The second programme focuses on spraying a peri-urban community within a 10-km radius around MOZAL, an aluminium smelter plant of area 410 km2. An ingredients approach was used to derive unit costs for both the rural and peri-urban spraying programmes using detail retrospective cost data and effectiveness indicators. RESULTS: The economic cost per person covered per year using Carbamates for indoor residual spraying (IRS) in the rural area, excluding the costs of project management and monitoring and surveillance was $3.48 and in the peri-urban area, $2.16. The financial costs per person covered in the rural area and peri-urban area per year were $3.86 and $2.41, respectively. The economic costs per person covered were respectively increased by 39% and 31% when project management and monitoring and surveillance were included. The main driving forces behind the costs of delivering RHS are twofold: the population covered and insecticide used. Computed economic and financial costs are presented for all four insecticide families available for use in RHS. CONCLUSIONS: The results from both these initiatives, especially the rural area, should be interpreted as conservative cost estimates as they exclude the additional health gains that the newly introduced programmes have had on malaria rates in the neighbouring areas of South Africa and Swaziland. Both these initiatives show that introducing an IRS programme can deliver a reduction in malaria-related suffering providing financial support, political will, collaborative management and training and community involvement are in place.

Manual de vigilância epidemiológica para o nível distrital / Manual of epidemiological surveillance for the district level

O Manual do Vigilância Epidemiológica para é Nível Distrital" de que agora se publica o primeiro volume é um instrumento de trabalho a usar no quotidiano pelos trabalhadores de saúde que lidam com 3 níveis primário e secundário de prevenção. Pretende-se que primeiro que tudo fosse um documento formativo que transmite-se aos seus utilizadores as bases teóricas para o manuseamento da epidemiologia. Depois há todo um conjunto de informações sobre os procedimentos a cumprir no campo da vigilância epidemiológica. Desta forma vai permitir que não apenas médicos, mas outros trabalhadores de saúde mesmo de nível básico tenha m acesso a um conjunto de informações e regras necessárias ao desenvolvimento do seu trabalho. Vai permitir sobretudo, se bem utilizado melhorar a qualidade do trabalho realizado no dia a dia e introduzir no sistema de informações de saúde, informação epidemiológica muito mais fiável e operativa, útil para quem a produz e para outros níveis de decisão.

Epidemiologia da cólera em Moçambique no período de 1973-1992 / Cholera epidemiology in Mozambique: period 1973-1992

Descreve os resultados de estudo epidemiológico da evoluçäo da cólera em Moçambique no período de 1973 a 1992, objetivando analisar a influência dos fatores socioeconômicos e ecológicos, de um país em guerra, na propagaçäo da doença. Utiliza informaçöes relativas à incidência e letalidade da cólera, relacionando-as com a taxa de crescimento médio anual da populaçäo das cidades e precipitaçäo pluvial. Analisa também o abastecimento de àgua potável, o saneamento do meio e higiene alimentar. Encontrou-se uma taxa elevada de crescimento médio anual da populaçäo nos centros urbanos, tendo uma correlaçäo linear direta com a incidência da coléra. A seca ocorrida em 1991-1992 também exerceu papel importante no aumento e propagaçäo da doença. A cólera tem tido padräo endêmico-epidêmico, determinado por: a) crescimento populacional urbano descontrolado, provocado pela guerra, b) reduçäo da qualidade das condiçöes higiênico-sanitárias nos centros urbanos; c) comercializaçäo de produtos alimentares sem o devido controle sanitário; d) a seca

Quantificacao dos indicadores prioritarios de prevencao do HIV/SIDA; nos jovens; nas provincias do centro; Maputo Cidade e provincia-Ronda 2000: relatorioLorna M. F. Gujral et al

"A Vigilancia Epidemiologia de segunda geracao do HIV propoe como principio fundamental; a combinacao de varios metodos de recolha de dados; com particular enfase para os comportamentais; como forma de melhorar a compreensao sobre a dinamica das DTS e alteracoes na tendencia da prevalencia do HIV; descrever os padroes de risco relacionados com a transmissao das DTS/HIV e tambem; obter informacao com vista ao delineamento de estrategias de controle. E neste contexto que em Junho de 2000; a vigilancia comportamental e introduzida no pais pela primeira vez; nas areas de saude dos Postos Sentinela (PS) que funcionavam para a vigilancia biologica do HIV; com o objectivo de quantificar 4 Indicadores Prioritarios de Prevencao (IPP); nomeadamente: (i) a idade media de inicio da actividade sexual; (ii) o numero de parceiros ocasionais nos ultimos 6 meses; (iii) a frequencia do uso do preservativo na ultima relacao sexual ocasional e (iv) a prevalencia de DTS reportada em jovens de ambos sexos; nas provincias de Zambezia; Tete; Manica; Sofala; Maputo Cidade e Provincia. Para tal; realizou-se um estudo descritivo; transversal; que constou de um questionario anonimo; com perguntas nao relacionaveis; pre-codificadas; administrado por entrevista aos jovens no seu local de residencia. Atraves da amostragem por conglomerados e com base no metodo de probabilidade proporcional ao tamanho; identificaram-se 30 conglomerados nos bairros (area urbana) ou vilas e aldeias (area rural) servidos por estes PS; para a seleccao de 7 jovens com idades compreendidos entre os 15-24 anos e recolha de informacao; sobre variaveis de base; socio-economicas e dos IPP em estudo. Os dados foram introduzidos e analisados no programa EPIINFO 6.04c. Os aspectos eticos inerentes a este tipo de estudo foram respeitados. Foram estudados 2111 jovens; sendo 51.8 por cento do sexo masculino e 48.2 por cento do feminino. A sua media de idades era de 19.1 anos; a maioria dos jovens eram solteiros (68.4 por cento); estudantes (37.1 por cento) ou camponeses (20.6 por cento); no tocante a situacao socio-economica; apenas 6.1 por cento nao possuia nenhum tipo de carencia; enquanto que 50.4 por cento possuiam ""carencias elevadas""; 82.3 por cento dos entrevistados ja tinha experiencia sexual. A idade media de inicio da actividade sexual foi de 15.7 anos (amplitude: 7-24 anos); sendo esta mais precoce para os jovens da Zambezia (15.1 anos) e mais tardia em Manica (16.3 anos). Verificou-se que os jovens do sexo masculino; em media iniciavam mais cedo (15.4 anos) do que as raparigas (16.1 anos). Pouco mais de metade dos jovens (58.7 por cento) afirmaram terem sido fieis ao(a) seu/sua parceiro(a) regular nos ultimos 6 meses; os restantes 242 (13.9 por cento) e 475 (27.3 por cento) reportaram 1 parceiro e parceiros multiplos; respectivamente. Destes; 77.8 por cento (558) eram do sexo masculino e 22.2 por cento (159) do feminino. Sobre a sua relacao com o(a) ultimo(a) parceiro(a); 284 jovens reportaram parceiros(as) ocasionais; apenas 42.6 por cento (121) usaram o preservativo nesta relacao; sob influencia do genero (9.9 por cento de raparigas e 90.1 por cento de rapazes). Dos jovens sexualmente activos; so 70 por cento responderam as questoes referentes as DTS; destes; 523 (47 por cento) reportaram antecedentes; igualmente sob influencia do genero (29.1 por cento para os jovens e 99.6 por cento para os jovens); as provincias com mais casos foram Maputo Cidade (62.8 por cento) e Manica (57.6 por cento); constratando com Tete (28.7 por cento) e Sofala (38.9 por cento). Com base nos resultados obtidos; recomenda-se que: (i) as campanhas de Educacao Informacao e Comunicacao sobre o HIV/SIDA prossigam; envolvendo criancas e jovens no processo de concepcao de mensagens relacionadas com a prevencao; avaliacao do risco pessoal; poder de negociacao do uso do preservativo e adiamento do inicio da actividade sexual; (ii) se expanda a actividade de divulgacao do uso do preservativo e a distribuicao gratuita do mesmo; para alem das unidades sanitarias; centros de atendimento do adolescente a outros locais de aglomeracao de jovens; nomeadamente; recintos desportivos; clubes nocturnos; (iii) se intensifique a sensibilizacao dos jovens e seus parceiros com vista a procura dos servicos de saude sempre que tiverem sinais e/ou sintomas de DTS; para que sejam tratados precocemente; (iv) haja uma actividade de sensibilizacao e formacao dos lideres comunitarios (incluindo os tradicionais); religiosos e os praticantes de medicina tradicional para que possam orientar os jovens e esclarece-los sobre questoes relacionadas com a transmissao; prevencao das DTS/HIV/SIDA; (v) se envolvam pessoas; vivendo com HIV/SIDA; de preferencia jovens do mesmo grupo etario; nas actividades anteriormente citadas; como forma de promocao de atitudes e praticas que contribuam para a melhoria da qualidade de vida"

Quantificacao dos indicadores prioritarios de prevencao do HIV/SIDA; nos jovens; nas provincias do Norte; Gaza e Inhambane-ronda 2001: relatorioLorna M. F. Gujral et al

A vigilancia epidemiologica de segunda geracao do HIV propoe como principio fundamental; a combinacao de varios metodos de recolha de dados; com particular enfase para os comportamentais; como forma de melhorar a compreensao sobre a dinamica das DTS e alteracoes na tendencia da prevalencia do HIV; descrever os padroes de risco relacionados com a transmissao das DTS/HIV e tambem; obter informacao com vista ao delineamento de estrategias de controle. E neste contexto que em Julho de 2000; a vigilancia comportamental e introduzida no pais pela primeira vez; nas areas de saude dos Postos Sentinela (PS) que funcionavam para a vigilancia biologica do HIV; com objectivo de quantificar 4 indicadores prioritarios de prevencao (IPP); o presente estudo abrangeu as provincias que nao foram incluidas no primeiro e teve os mesmos objectivos; nomeadamente: (I) a mediana de idade de inicio da actividade sexual; (II) o numero de parceiros ocasionais nos ultimos seis meses; (III) a frequencia do uso do preservativo na ultima relacao sexual ocasional e (IV) a prevalencia de DTS reportada em jovens de ambos sexos; nas provincias de Niassa; Cabo Delgado; Nampula; Gaza e Inhambane(...)

Analise epidemiologica da vigilancia epidemiologica das doencas tranmissiveis; Mocambique-1981-2001

Com a presente edicao pretende-se dar a conhecer o perfil epidemiologico de algumas patologias; com especial realce para aquelas que maior morbi-mortalidade causam na populacao mocambicana. Toda a informacao recolhida e analizada deve ser vista com algum cuidado e com espirito critico; pois a base deste trabalho traduz ao mesmo tempo; toda uma serie de transformacoes e ideias que atingiram as diversas fases por que passou a implementacao do Sistema de Informacao do pais; e neste caso concreto; este sub-sistema de doencas transmissiveis