ABSTRACT
Military global influenza surveillance began in 1976 as an Air Force program. In 1997, the Department of Defense (DoD) Global Emerging Infections Surveillance and Response System expanded the program to include all services. Also included were local residents in areas where DoD overseas research activities operated. This new, worldwide DoD surveillance infrastructure provides valuable information and can respond quickly to outbreaks. This was demonstrated during the current influenza season when a suspected outbreak was reported in Panama. In less than 3 weeks, specimens were collected, transported, and cultured, and isolates were subtyped and sent to the Centers for Disease Control and Prevention for further studies. This influenza surveillance initiative combines viral isolation, antigenic characterization, and molecular sequencing with clinical and public health management of information. The information obtained is shared with the Centers for Disease Control and Prevention and the World Health Organization and has contributed to important decisions in influenza vaccine composition.
Subject(s)
Influenza, Human/epidemiology , Military Medicine/organization & administration , Population Surveillance , Global Health , Government Agencies , Humans , Influenza Vaccines , Population Surveillance/methods , United StatesABSTRACT
SETTING: Two private hospitals, one in the capital city and one in the eastern rainforest of Ecuador. OBJECTIVE: To document the prevalence of anti-tuberculosis drug resistance in Ecuador in patients who had not received prior treatment and in those who had. DESIGN: Drug resistance was determined using the proportion method with solid medium on the first isolate of Mycobacterium tuberculosis from all patients who attended the two hospitals between 1989 and 1996. Documentation of prior treatment was obtained by patient interview. RESULTS: Resistance was identified in 39 of 161 patients (24%) who had had no prior treatment. Resistance was 14.2% to isoniazid, 11.8% to rifampin and 8.7% to both (multidrug-resistant tuberculosis). Among 60 patients who had received prior treatment, 18 (30%) were resistant to isoniazid, and 14 (23.3%) to rifampin, while multidrug resistance was seen in 10 (16.7%). CONCLUSION: In these populations the prevalence of resistance both in patients with no prior treatment and in patients with prior treatment was ominously high. The initial treatment regimens and patient management in Ecuador should be re-evaluated in an effort to prevent further increases in drug resistance.
Subject(s)
Antitubercular Agents/pharmacology , Mycobacterium tuberculosis/drug effects , Tuberculosis, Multidrug-Resistant/epidemiology , Tuberculosis, Pulmonary/epidemiology , Ambulatory Care Facilities , Antitubercular Agents/therapeutic use , Developing Countries , Ecuador/epidemiology , Female , Humans , Male , Microbial Sensitivity Tests , Mycobacterium tuberculosis/isolation & purification , Prevalence , Rural Population , Tuberculosis, Multidrug-Resistant/drug therapy , Tuberculosis, Pulmonary/drug therapy , Urban PopulationABSTRACT
The prevalence of strongyloidiasis among American veterans of the Vietnam and other wars was evaluated by testing several groups of veterans for serum IgG antibodies against Strongyloides stercoralis antigens, using an enzyme-linked immunosorbent assay. Of 493 Vietnam veterans, eight (1.6%) were seropositive. Of 60 patients with abdominal symptoms and/or elevated eosinophilia (greater than 0.08 [greater than 8%]) admitted to the Cincinnati Veterans Administration Medical Center, 12 (5%) were seropositive. Of 147 residents of a Veterans Administration-operated nursing home, six (4%) were seropositive. All infected patients in the latter two groups were World War II veterans. The usefulness of the enzyme-linked immunosorbent assay as a screening tool for at-risk groups is suggested by the finding that S stercoralis larvae were demonstrated in most seropositive patients when a sufficient number of fresh stools were examined.
Subject(s)
Strongyloidiasis/epidemiology , Veterans , Warfare , Adult , Aged , Aged, 80 and over , Enzyme-Linked Immunosorbent Assay , Eosinophils , Epidemiologic Methods , Humans , Immunoglobulin G/analysis , Leukocyte Count , Male , Middle Aged , Strongyloidiasis/diagnosis , Strongyloidiasis/parasitology , VietnamABSTRACT
Parasite-specific humoral and cellular immune responses were evaluated in in nine immunosuppressed patients with Strongyloides stercoralis infection. Four patients had the disseminated form of the disease, and five had serious manifestations without evidence of hyperinfection. All patients had high levels of immunoglobulin G (IgG) antibodies directed against S. stercoralis larval antigens as detected by the enzyme-linked immunosorbent assay. Seven patients had both elevated total serum IgE and parasite-specific IgE antibodies detected by a modified radioimmunoassay. The hyperinfected patients differed significantly from the nonhyperinfected group in total and specific IgE levels and peripheral eosinophilia but not in specific IgG levels. None of the patients tested exhibited significant in vitro lymphoproliferative responses to parasite antigens. Our results indicated that the possibility of a protective role of IgE and eosinophils in strongyloidiasis deserves further investigation. In addition, we suggest that the enzyme-linked immunosorbent assay for specific IgG antibodies may have an important place in the diagnosis of strongyloidiasis in immunocompetent as well as in immunocompromised patients.
