Risk factors of cholera transmission in rural areas in Haiti.

Cholera, present in Haiti since October 2010, persisted in early 2014 in several places, each with its own particular epidemiological characteristics. The scarcity of fresh water probably contributed to the spread of the disease in some rural areas. Population gatherings in places without an access to either safe water or sanitation infrastructure were another factor. Outreach activities of hygiene promotion and improving access to chlorinated water had positive results. The disappearance of choléra in areas where effective preventive actions were conducted supports the conclusion that its transmission is predominantly interhuman, without the sustainable installation of the pathogenic Vibrio in the Haitian environment. These actions must be modulated according to the various areas.

[Response to the cholera epidemic at Port au Prince (Haiti) in December 2010]. / Les réponses a l'epidémie de choléra a Port-au-Prince (Haïti) en décembre 2010.

Cholera, that had been present in rural areas north of Port-au-Prince, Haiti since October 2010, reached the urban area in November. Due to the novelty of the disease in this region, to the lack of health care, clean water, and waste disposal facilities, and to the extensive damage caused by the earthquake on January 12, 2010, that left a large victim population living in camps, a large-scale health disaster was feared. However, after two months, the disease appeared to be relatively well-controlled and treated with a fatality rate of less than 1% in the urban area. Actions implemented by the Ministry of Health long with its efforts to coordinate the intervention of the many humanitarian partners played a role in this outcome.

[Observations during basic care after the earthquake in Port-au-Prince, Haiti on January 12, 2010]. / Soins de base après le tremblement de terre de Port-au-Prince du 12 janvier 2010.

Provision of basic health care to earthquake victims in camps in Haiti indicated that the population was in relatively good health. It also allowed early detection of possible epidemic outbreak.

[Chagas disease in a rural area of Northeast Brazil]. / La maladie de Chagas dans une zone rurale du Nord-Est du Brésil.

A serological and medical survey on Chagas disease was carried out between December 1997 and June 2000 in four villages of the semi-arid rural Northeast Brazil. The average human serological prevalence rate of 11.8% was strongly linked with age: 1.1% for people under 25, 13.7% for people aged of 26 to 49, 29.5% for people aged of 50+. The clinical form was indeterminate for 57% of the infected population, cardiac for 35%, digestive or mixed for 8%. The infected patients under 55 received at home an etiologic treatment with benznidazol. The survey confirms the drastic reduction of Trypanosoma cruzi transmission during the last decades, especially since 25 years. This situation is the result jointly of the antivectorial activities, improvement of education level and changes in the way of life. However Chagas disease is still a serious problem, especially for numerous middle-aged infected adults. The situation could be improved by increasing the serologic screening in the field as well as the counselling and the treatment of the patients.

[American cutaneous leishmaniasis in the sugar cane-producing area of Pernambuco, North-East Brazil]. / La leishmaniose tégumentaire américaine dans la région sucrière du Pernambouc, Nord-Est du Brésil.

The cases of American cutaneous leishmaniasis reported here were observed between 1995 and 1998 in outpatients at a health clinic in the sugar cane-producing region in the south of Pernambuco State (Brazil), in which the disease is known to be endemic. Two hundred thirty eight cases were reported, equivalent to about ten cases per thousand patients. The disease affected patients of all ages, with a slight male predominance. The lesions were generally single and located on the legs. They were successfully treated with Glucantime. Vectors of the disease, sandflies of the genus Lutzomyia, were captured in and around homes, particularly in stables. This field work demonstrates the extent of a long-standing endemic that can be effectively treated within motivated health structures.

[Intestinal parasite infections and schistosomiasis in a poor urban area, in townships of the sugar cane belt and in villages of the semi-arid area of North-East Brazil]. / Parasitoses intestinales et schistosomose en milieu urbain, en région semi-aride du Nord-Est du Brésil.

We determined the prevalence of intestinal parasite infections between 1993 and 1998 in the populations of a poor quarter of Recife (Pernambuco), in two townships in the sugar cane belt and in three villages of the semi-arid area far from the coast. Intestinal schistosomiasis was present in the sugar-growing area but was not observed in the populations inland that use dams to provide irrigation and fishing. Ascaris was very common in the city and the sugar cane belt and large numbers of hookworms were observed, especially in the sugar-growing area. These nematodes were very rare in the semi-arid area. This distribution probably results from both climatic conditions and human behavior. The high frequency of Amoeba cysts demonstrates that the peasants, farmers and fisherman living in these areas have poor hygiene practices. There are probably many, complex relationships between education, income, lifestyle and intestinal parasite infections.

[Occurrence of snail vectors of schistosomiasis in a dam of the semi-arid region of Pernambuco State, Brazil]. / Registro de ocorrência de vetores da esquistossomose mansônica em açude do Sertão de Pernambuco.

The semi-arid region of Pernambuco state is not an endemic or focal area for schistosomiasis. The present work registers the occurrence of Biomphalaria straminea in a local dam with favorable chemical-physical characteristics to the proliferation of these mollusks. This observation gets the attention for the possibility of the introduction of the disease in this semi-arid region due to the growing multiplication of these dams.

[Management of AIDS during traditional hospitalization and at outpatient clinics in Recife (Brazil)]. / Prise en charge du sida en hospitalisations traditionnelle et de jour à Recife (Brésil).

The management of 50 AIDS patients by traditional hospital admission (25 cases) and outpatient clinics (25 cases) was studied between August and November 1995 in the Department of Infectious and Parasitic Diseases of the Federal University Hospital. The most costly items of expenditure were hospital services and consumable materials. Comparison of costs was complicated by differences in clinical status of the patients in the two groups. The choice of treatment was much more dependent on clinical status than on sociodemographic factors. Traditional hospital admission tended to be associated with the poorest patients. The rationalization of care based on cost-benefit analysis requires much future work.

[Tuberculosis among the Amerindian population of the upper Rio Negro region] / A situação da tuberculose na população indígena do alto rio Negro (Estado do Amazonas, Brasil)

The presence of tuberculosis in the upper Rio Negro region (Brazil) dates to the early 20th century. A retrospective survey of medical records in two clinics (one from 1977 and the other from 1990) showed 699 cases, with an extremely high annual incidence rate of over two per thousand, predominantly pulmonary cases, and distribution of the disease among all age groups. Data on compliance with outpatient treatment are not reliable. In the present context of deteriorating environmental and socioeconomic conditions among Indians, tuberculosis incidence may increase. Control of this disease could be enhanced by improving living conditions and health services for indigenous peoples.

[Acquired immunodeficiency syndrome in Brazil and the State of Ceará]. / Le syndrome d'immunodéficience acquise au Brésil et dans l'Etat du Ceará.

Since February 1998, a total of 129,000 cases of acquired immune deficiency syndrome have been reported in Brazil. The cumulative frequency of the disease is 82 per 100,000 which makes Brazil one of the countries moderately affected. There are considerable differences between regions in the frequency of cases, from 25 per 100,000 in the north and north east to 152 per 100,000 in the south east. Sexual intercourse is still the predominant means of transmission. Transmission in the early years of the epidemic was mostly between homosexuals and bisexuals, but transmission via heterosexual intercourse is increasing. The contribution made by intravenous drug use differs between the regions, and is particularly large in the mid-south region. A pilot project in the city of Fortaleza has shown that it is possible to successfully integrate the diagnosis of STD and AIDS in health care units at an intermediate level. This appears to be an appropriate strategy for the integration of STD treatment into primary health care in Ceará State. The non-uniform pattern of development of this epidemic must be taken into account in epidemiological analyses of AIDS in Brazil.

Acquired immune deficiency syndrome in brazil and the state of cear

Since February 1998, a total of 129,000 cases of acquired immune deficiency syndrome have been reported in Brazil. The cumulative frequency of the disease is 82 per 100,000, which makes Brazil one of the countries moderatly affected. There are considerable differences between regions in the frequency of cases, from 25 per 100,000 in the north and north east to 152 per 100,000 in the south east. Sexual intercourse is still the predominant means of transmission. Transmission in the early years of the epidemic was mostly between homosexuals and bisexuals, but transmission via heterosexual intercourse is increasing. The contribution made by intravenous drug use differs between the regions, and is particularly large in the mid-south region. A pilot project in the city of Fortaleza has shown that it is possible to successfully integrate the diagnosis of STD and AIDS in health care units at an intermediate level. This appears to be an appropriate strategy for the integration of STD treatment into primary health care in Ceara State. The non-uniform pattern of development of this epidemic must be taken into account in epidemiological analyses of AIDS in Brazil.