Mapping the international health regulations monitoring and evaluation framework: an expert consultation, triangulation crosswalk and quantitative analysis.

The International Health Regulations Monitoring and Evaluation Framework (IHRMEF) includes four components regularly conducted by States Parties to measure the current status of International Health Regulations (IHR) 2005 core capacities and provide recommendations for strengthening these capacities. However, the four components are conducted independently of one another and have no systematic referral to each other before, during or after each process, despite being largely conducted by the same team, country and support organisations. This analysis sets out to identify ways in which IHRMEF components could work more synergistically to effectively measure the status of IHR core capacities, taking into account the country's priority risks. We developed a methodology to allow these independent components to communicate with each other, including expert consultation, a qualitative crosswalk analysis and a country-level quantitative analysis. The demonstrated results act as a proof of concept and illustrate a methodology to provide benefits across all four components before, during and after implementation.

Towards the elimination of dog-mediated rabies: development and application of an evidence-based management tool.

BACKGROUND: International organizations advocate for the elimination of dog-mediated rabies, but there is only limited guidance on interpreting surveillance data for managing elimination programmes. With the regional programme in Latin America approaching elimination of dog-mediated rabies, we aimed to develop a tool to evaluate the programme's performance and generate locally-tailored rabies control programme management guidance to overcome remaining obstacles. METHODS: We developed and validated a robust algorithm to classify progress towards rabies elimination within sub-national administrative units, which we applied to surveillance data from Brazil and Mexico. The method combines criteria that are easy to understand, including logistic regression analysis of case detection time series, assessment of rabies virus variants, and of incursion risk. Subjecting the algorithm to robustness testing, we further employed simulated data sub-sampled at differing levels of case detection to assess the algorithm's performance and sensitivity to surveillance quality. RESULTS: Our tool demonstrated clear epidemiological transitions in Mexico and Brazil: most states progressed rapidly towards elimination, but a few regressed due to incursions and control lapses. In 2015, dog-mediated rabies continued to circulate in the poorest states, with foci remaining in only 1 of 32 states in Mexico, and 2 of 27 in Brazil, posing incursion risks to the wider region. The classification tool was robust in determining epidemiological status irrespective of most levels of surveillance quality. In endemic settings, surveillance would need to detect less than 2.5% of all circulating cases to result in misclassification, whereas in settings where incursions become the main source of cases the threshold detection level for correct classification should not be less than 5%. CONCLUSION: Our tool provides guidance on how to progress effectively towards elimination targets and tailor strategies to local epidemiological situations, while revealing insights into rabies dynamics. Post-campaign assessments of dog vaccination coverage in endemic states, and enhanced surveillance to verify and maintain freedom in states threatened by incursions were identified as priorities to catalyze progress towards elimination. Our finding suggests genomic surveillance should become increasingly valuable during the endgame for discriminating circulating variants and pinpointing sources of incursions.

Comparison of molecular tests for the diagnosis of malaria in Honduras.

BACKGROUND: Honduras is a tropical country with more than 70% of its population living at risk of being infected with either Plasmodium vivax or Plasmodium falciparum. Laboratory diagnosis is a very important factor for adequate treatment and management of malaria. In Honduras, malaria is diagnosed by both, microscopy and rapid diagnostic tests and to date, no molecular methods have been implemented for routine diagnosis. However, since mixed infections, and asymptomatic and low-parasitaemic cases are difficult to detect by light microscopy alone, identifying appropriate molecular tools for diagnostic applications in Honduras deserves further study. The present study investigated the utility of different molecular tests for the diagnosis of malaria in Honduras. METHODS: A total of 138 blood samples collected as part of a clinical trial to assess the efficacy of chloroquine were used: 69 microscopically confirmed P. falciparum positive samples obtained on the day of enrollment and 69 follow-up samples obtained 28 days after chloroquine treatment and shown to be malaria negative by microscopy. Sensitivity and specificity of microscopy was compared to an 18 s ribosomal RNA gene-based nested PCR, two single-PCR reactions designed to detect Plasmodium falciparum infections, one single-PCR to detect Plasmodium vivax infections, and one multiplex one-step PCR reaction to detect both parasite species. RESULTS: Of the 69 microscopically positive P. falciparum samples, 68 were confirmed to be P. falciparum-positive by two of the molecular tests used. The one sample not detected as P. falciparum by any of the molecular tests was shown to be P. vivax-positive by a reference molecular test indicating a misdiagnosis by microscopy. The reference molecular test detected five cases of P. vivax/P. falciparum mixed infections, which were not recognized by microscopy as mixed infections. Only two of these mixed infections were recognized by a multiplex test while a P. vivax-specific polymerase chain reaction (PCR) detected three of them. In addition, one of the day 28 samples, previously determined to be malaria negative by microscopy, was shown to be P. vivax-positive by three of the molecular tests specific for this parasite. CONCLUSIONS: Molecular tests are valuable tools for the confirmation of Plasmodium species and in detecting mixed infections in malaria endemic regions.

Impact of long-term treatment of onchocerciasis with ivermectin in Ecuador: potential for elimination of infection.

BACKGROUND: Onchocerciasis is a leading cause of blindness worldwide, hence elimination of the infection is an important health priority. Community-based treatment programs with ivermectin form the basis of control programs for the disease in Latin America. The long-term administration of ivermectin could eliminate Onchocerca volvulus infection from endemic areas in Latin America. METHODS: A strategy of annual to twice-annual treatments with ivermectin has been used for onchocerciasis in endemic communities in Ecuador for up to 14 years. The impact of ivermectin treatment on ocular morbidity, and O. volvulus infection and transmission was monitored in seven sentinel communities. RESULTS: Over the period 1990-2003, high rates of treatment coverage of the eligible population were maintained in endemic communities (mean 85.2% per treatment round). Ivermectin reduced the prevalence of anterior segment disease of the eye to 0% in sentinel communities and had a major impact on the prevalence and transmission of infection, with possible elimination of infection in some foci. CONCLUSION: The distribution of ivermectin in endemic communities in Ecuador might have eliminated ocular morbidity and significant progress has been made towards elimination of the infection. A strategy of more frequent treatments with ivermectin may be required in communities where the infection persists to achieve the objective of elimination of the infection from Ecuador. The elimination of the infection from an endemic country in Latin America would be a major public health achievement and could stimulate the implementation of elimination strategies in other endemic countries.

Paragonimiasis pulmonar en el Río Canande, Provincia de Esmeraldas / Pulmonary Paragonimiasis in the Canande River, Esmerald Province

Se estudiaron 137 muestras de esputo de adultos que habitan en un área endémica para paragonimiasis en laprovincia de Esmeraldas. En 10 individuos (7.11 por ciento) se observaron huevos de Paragonimus mexicanus en el esputo...

Estudios comparativos clínicos y epidemiológicos de la oncocercosis entre dos grupos raciales del área hiperendémica de Ecuador / Comparative clinical and epidemiological studies between 2 racial groups in the hyperendemic area of onchocercosis in Ecuador

Se evaluó la importancia de los factores raciales en la epidemiología y las manifestaciones clínicas de la oncocercosis en la raza negra y la raza indígena Chachi, dos grupos étnicos diferentes del área hiperendémica del foco oncocercótico ecuatoriano. Los Chachi presentaron una significativa mayor densidad de microfilarias en la piel. De los negros, 72,2 por ciento presentaron lesiones oncocercóticas en la piel comparado con 56,4 por ciento en los Chachi. Se encontró mayor prevalencia de nódulos palpables en los Chachi (51,4 por ciento vs. 43,0 por ciento). La presencia de microfilarias en la cámara anterior del ojo fue más frecuente en los Chachi (51,9 por ciento vs. 34,2 por ciento), pero se evidenció una mayor prevalencia de corioretinitis y atrofia del nervio óptico en los negros (17,6 por ciento vs 11,2 por ciento y 8,5 por ciento vs. 0,5 por ciento, respectivamente)

Evaluación del ribósido de alpurinol contra la leishmaniasis cutánea ecuatoriana / Evaluation of allopurinol-riboside therapy against Ecuatorian cutaneous leishmaniasis

Se realizó un randomizado de 75 pacientes con leishmaniasis cutánea ecuatoriano con el fin de determinar el índice terapéutico de una nueva droga oral antileishmania, el ribósido de alopurinol más probenecid. Este agente fue evaluado comparándolo con controles positivos que se trataron con pentostam y con testigos no tratados. Las medidas de las lesiones disminuyeron rápidamente durante la terapia, lo que permitió determinar el porcentaje de cicatrización en los diferentes grupos. En el día 70 se realizó la evaluación de la curación de los pacientes en los diferentes grupos, obteniéndose: alopurinol (1.500 mg/6 h) más probenecid (500 mg/6 h) por 28 días, dió una curación con lesiones cicatrizadas en 10 (45,5 por ciento) de los 22 pacientes. Con pentostam (20 mg Sb/kg/día, IM por 20 días) se obtuvo una curación en 28 pacientes siendo esto de 100 por ciento de cicatrización. El grupo de no tratamiento presentó un porcentaje muy elevado de curación espontánea en 9 (75,0 por ciento) de los 12 pacientes. Todos los pacientes con tratamiento fallido o recidivas recibieron posteriormente tratamiento con pentostam. Este estudio sugiere que le ribósido de alopurinol más probenecid no es una droga con mayor eficacia contra la leishmaniasis cutánea ecuatoriana

El pian en la provincia de Esmeraldas, Ecuador / Yaws in the Province of Esmeraldas, Ecuador

Se realizó un estudio epidemiológico, clínico y serológico del pian en la cuenca del río Santiago, cantón Eloy Alfaro, provincia de Esmeraldas, el cual demostró una prevalencia del 11,3 por ciento con lesiones dérmicas activas y una seropositividad del 94,9 por ciento. El área del río Santiago era hiperendémica para el pian (prevalencia 17,9 por ciento seropositividad 98,0 por ciento), mientras que el río Zapatillo era mesoendémico y los ríos Cayapas y Onzole, hipoendémicos. Se encontró evidencia del pian, activa y latente, solamente en la raza negra. La mayor incidencia de las lesiones clínicas (55,8 por ciento) se encontró en los niños de 5-12 años de edad, localizándose el porcentaje superior en las piernas (64,2 por ciento). Los papilomas fueron las lesiones más frecuentes (55,4 por ciento). Se administró tratamiento masivo con penicilina benzatínica, según las normas de OMS, en todas las comunidades positivas para esta enfermedad