ABSTRACT
Over 35,000 cases of Japanese encephalitis (JE) are reported worldwide each year. Culex tritaeniorhynchus is the primary vector of the JE virus, while wading birds are natural reservoirs and swine amplifying hosts. As part of a JE risk analysis, the ecological niche modeling programme, Maxent, was used to develop a predictive model for the distribution of Cx. tritaeniorhynchus in the Republic of Korea, using mosquito collection data, temperature, precipitation, elevation, land cover and the normalized difference vegetation index (NDVI). The resulting probability maps from the model were consistent with the known environmental limitations of the mosquito with low probabilities predicted for forest covered mountains. July minimum temperature and land cover were the most important variables in the model. Elevation, summer NDVI (July-September), precipitation in July, summer minimum temperature (May-August) and maximum temperature for fall and winter months also contributed to the model. Comparison of the Cx. tritaeniorhynchus model to the distribution of JE cases in the Republic of Korea from 2001 to 2009 showed that cases among a highly vaccinated Korean population were located in high-probability areas for Cx. tritaeniorhynchus. No recent JE cases were reported from the eastern coastline, where higher probabilities of mosquitoes were predicted, but where only small numbers of pigs are raised. The geographical distribution of reported JE cases corresponded closely with the predicted high-probability areas for Cx. tritaeniorhynchus, making the map a useful tool for health risk analysis that could be used for planning preventive public health measures.
Subject(s)
Culex , Encephalitis, Japanese/epidemiology , Animals , Area Under Curve , Birds , Climate , Disease Models, Animal , Disease Reservoirs , Encephalitis, Japanese/diagnosis , Epidemiologic Methods , Geography , Humans , Models, Statistical , Probability , ROC Curve , Republic of Korea/epidemiology , Risk Assessment , SwineABSTRACT
Carrion's disease is caused by infection with the alpha-proteobacterium Bartonella bacilliformis. Distribution of the disease is considered coincident with the distribution of its known vector, the sand fly Lutzomyia verrucarum. Recent epidemics of B. bacilliformis infections associated with atypical symptomatology in nonendemic regions have raised questions regarding the historic and present distribution of this bacterium and the scope of disease that infection causes. Phylogenetic relationships and genomic diversity of 18 B. bacilliformis isolates (10 isolates from a region where Carrion's disease is epidemic, Cuzco, Peru, and 8 isolates from a region where Carrion's disease is endemic, Caraz, Peru) were assessed using genomic data generated by infrequent restriction site PCR and gene sequence analysis of the flagellin gltA and ialB genes. A population genetic analysis of the genomic diversity suggests that what was once considered an epidemic region of Peru did not result from the recent introduction of B. bacilliformis.
Subject(s)
Bartonella Infections/epidemiology , Bartonella bacilliformis/genetics , Genetics, Population/methods , Bartonella bacilliformis/classification , Bartonella bacilliformis/isolation & purification , DNA Fingerprinting/methods , DNA, Bacterial/genetics , DNA, Bacterial/isolation & purification , Geography , Humans , Peru/epidemiology , Phylogeny , Polymerase Chain Reaction/methodsABSTRACT
The authors sought to explore gender differences among patients with physical symptoms who came to see internists. The women were younger, more likely to report stress, endorsed more "other, currently bothersome" symptoms, were more likely to have a mental disorder, and were less likely to be satisfied with their care. The men were slower to improve, but there was no difference between the sexes after 3 months. There were no differences in the number, type, duration, or severity of symptoms or in the expectation of care, costs of visits, intervention received, use of health care services, or likelihood of being considered difficult by their physician. The gender of the clinician had no effect on any outcome.
Subject(s)
Psychophysiologic Disorders/epidemiology , Somatoform Disorders/epidemiology , Adult , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Comorbidity , Cross-Sectional Studies , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Follow-Up Studies , Humans , Male , Maryland/epidemiology , Middle Aged , Primary Health Care/statistics & numerical data , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Psychophysiologic Disorders/therapy , Remission, Spontaneous , Sex Factors , Sick Role , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Somatoform Disorders/therapyABSTRACT
Bartonella bacilliformis has caused debilitating illness since pre-Incan times, but relatively little is known about its epidemiology. A population-based, prospective cohort investigation was conducted in a Peruvian community with endemic bartonellosis. By use of house-to-house and hospital surveillance methods, cohort participants were monitored for evidence of bartonellosis. Of 690 participants, 0.5% had asymptomatic bacteremia at study initiation. After 2 years of follow-up, the incidence of infection was 12.7/100 person-years. The highest rates were in children <5 years old, and there was a linear decrease in incidence with increasing age. Seventy percent of cases were clustered in 18% of households. Age and bartonellosis in a family member were the best predictors of B. bacilliformis infection. There were multiple clinical presentations and significant subclinical infection. A cost-effective control strategy should include vector control and surveillance efforts focused on children and clusters of households with highest endemicity.
