Epidemiological Investigation of a Diarrhea Outbreak in the South Pacific Island Nation of Tuvalu During a Severe La Niña-Associated Drought Emergency in 2011.

The association between heavy rainfall and an increased risk of diarrhea has been well established but less is known about the effect of drought on diarrhea transmission. In 2011, the Pacific island nation of Tuvalu experienced a concurrent severe La Niña-associated drought and large diarrhea outbreak. We conducted a field investigation in Tuvalu to identify factors that contributed to epidemic transmission in the context of a drought emergency. Peak case numbers coincided with the nadir of recorded monthly rainfall, the lowest recorded since 1930. Independent factors associated with increased risk of diarrhea were households with water tank levels below 20% (odds ratio [OR] = 2.31; 95% confidence interval = 1.16-4.60) and decreased handwashing frequency (OR = 3.00 [1.48-6.08]). The resolution of the outbreak occurred after implementation of a hygiene promotion campaign, despite persistent drought and limited water access. These findings are potentially important given projections that future climate change will cause more frequent and severe droughts.

Dermatological disorders in Tuvalu between 2009 and 2012.

There is a distinct lack of knowledge on the prevalence of skin disorders in Tuvalu. The aim of the current study was to assess the prevalence of cutaneous diseases and to evaluate access dermatological care in Tuvalu. Cutaneous disorders in the people of Tuvalu between 2009 and 2012 were examined. The most common skin conditions were eczema/dermatitis, superficial fungal infections, impetigo, carbuncles, furuncles, folliculitis, acne, scabies, warts and keloids. Infrequent skin conditions included infectious granulomatous disease, albinism, actinic keratosis, skin cancer, cutaneous lupus erythematosus and mammary Paget's disease, which required medical attention. This is the first epidemiological report on skin disorders in the southwest Pacific Island, Tuvalu.

A multicenter evaluation of diagnostic tools to define endpoints for programs to eliminate bancroftian filariasis.

Successful mass drug administration (MDA) campaigns have brought several countries near the point of Lymphatic Filariasis (LF) elimination. A diagnostic tool is needed to determine when the prevalence levels have decreased to a point that MDA campaigns can be discontinued without the threat of recrudescence. A six-country study was conducted assessing the performance of seven diagnostic tests, including tests for microfilariae (blood smear, PCR), parasite antigen (ICT, Og4C3) and antifilarial antibody (Bm14, PanLF, Urine SXP). One community survey and one school survey were performed in each country. A total of 8,513 people from the six countries participated in the study, 6,443 through community surveys and 2,070 through school surveys. Specimens from these participants were used to conduct 49,585 diagnostic tests. Each test was seen to have both positive and negative attributes, but overall, the ICT test was found to be 76% sensitive at detecting microfilaremia and 93% specific at identifying individuals negative for both microfilariae and antifilarial antibody; the Og4C3 test was 87% sensitive and 95% specific. We conclude, however, that the ICT should be the primary tool recommended for decision-making about stopping MDAs. As a point-of-care diagnostic, the ICT is relatively inexpensive, requires no laboratory equipment, has satisfactory sensitivity and specificity and can be processed in 10 minutes-qualities consistent with programmatic use. Og4C3 provides a satisfactory laboratory-based diagnostic alternative.