Stratifying the potential local transmission of Zika in municipalities of Antioquia, Colombia.

OBJECTIVE: To stratify and understand the potential transmission processes of Zika virus in Colombia, in order to effectively address the efforts on surveillance and disease control. METHODS: We compare R0 of Zika for municipalities based on data from the regional surveillance system of Antioquia, Colombia. The basic reproduction number (R0 ) and its 95% confidence intervals were estimated from an SIR model with implicit vector dynamics, in terms of recovered individuals in each time unit, using an approximate solution. These parameters were estimated fitting the solution of the model to the daily cumulative frequency of each Zika case according to symptoms onset date relative to the index case reported to the local surveillance system. RESULTS: R0 was estimated for 20 municipalities with a median of 30 000 inhabitants, all located less than 2200 m above sea level. The reported cases ranged from 17 to 347 between these municipalities within 4 months (January to April of 2016). The results suggest that 15 municipalities had a high transmission potential (R0  > 1), whereas in five municipality transmissions were potentially not sustaining (R0  < 1), although the upper bound of the confidence interval of the R0 for 3 of these 5 was greater than one, indicating the possibility of an outbreak later on. CONCLUSION: The study identified high-risk municipalities (R0  > 1) and provide a technique to optimise surveillance and control of Zika. Health authorities should promote the collection, analysis, modelling and sharing of anonymous data onto individual cases to estimate R0 .

[Microgeographic and temporal genetic changes of Aedes aegypti from Medellín, Colombia]. / Cambios genéticos temporales y microgeográficos de Aedes aegypti en Medellín, Colombia.

INTRODUCTION: Aedes aegypti populations may experience changes in abundance and genetic diversity in addition to changes in their evolutionary capability to respond to vector control. The knowledge on the changes in genetic variation on a spatio-temporal scale improves the epidemiological understanding of dengue and supports the appropriate and timely design of vector control strategies. OBJECTIVE: To assess the genetic changes, diversity and gene flow in six microgeographical populations of Ae. aegypti in Medellín for different epidemiological periods of dengue. MATERIALS AND METHODS: A total of 255 specimens from six different neighborhoods in Medellín were used to assess variations in the CO1 mtDNA haplotype composition, diversity and genetic differentiation for an epidemic period (2010) and an endemic period (2012). RESULTS: Two groups of highly differentiated haplotypes were present in both periods, and a high-frequency haplotype was assessed for all neighborhoods. The highest haplotype diversity was recorded in 2012, but the maximum nucleotide diversity was recorded in 2010. No significant correlation between genetic and geographic distances was observed. CONCLUSIONS: The genetic composition of Ae. aegypti varies over time without a predictable pattern. In addition, the presence of a high-frequency haplotype in both periods could indicate a persistent variation adapted to vector control. However, the simultaneous movement of highly differentiated CO1 haplotypes compatible with multiple introductions suggests that different gene pools would be suitable for transmission. These results are consistent with mosquito dispersion due to human activities, which would enable the rapid spread of the virus during epidemics in Medellin.

Cambios genéticos temporales y microgeográficos de Aedes aegypti en Medellín, Colombia / Microgeographic and temporal genetic changes of Aedes aegypti from Medellín, Colombia

Introducción. Las poblaciones de Aedes aegypti pueden experimentar cambios en cuanto a su abundancia y diversidad genética y, con ello, su potencial evolutivo para responder al control vectorial. El conocimiento de los cambios en la variación genética a escala espacio-temporal, permite entender mejor la epidemiología del dengue y contribuye al diseño adecuado y oportuno de estrategias antivectoriales. Objetivo. Evaluar los cambios genéticos, la diversidad y el flujo génico en seis poblaciones microgeográficas de Ae. aegypti en Medellín en diferentes períodos epidemiológicos del dengue. Materiales y métodos. En 255 especímenes provenientes de seis barrios de Medellín, se evaluó la variación en la composición de los haplotipos mtDNA CO1 , así como la diversidad y la diferenciación genética en un período epidémico (2010) y en otro endémico (2012). Resultados. Se detectaron dos grupos de haplotipos muy diferenciados entre sí en ambos períodos, al igual que un haplotipo de alta frecuencia presente en todos los barrios. La mayor diversidad de haplotipos se registró en el 2012, pero la mayor diversidad de nucleótidos se presentó en el 2010. No se observó correlación significativa entre las distancias genéticas y geográficas. Conclusión. La composición genética de Ae. aegypti varía temporalmente sin un patrón predecible. La presencia de un haplotipo de gran frecuencia en ambos períodos podría ser indicio de una variación persistente adaptada al control vectorial. Sin embargo, la circulación simultánea de haplotipos CO1 muy diferenciados y compatibles con múltiples introducciones, sugiere que diversos acervos genéticos serían aptos para la transmisión. Estos resultados son compatibles con la dispersión del mosquito por efecto de actividades antrópicas, lo cual posibilitaría la diseminación rápida del virus durante epidemias en Medellín.

Introduction: Aedes aegypti populations may experience changes in abundance and genetic diversity in addition to changes in their evolutionary capability to respond to vector control. The knowledge on the changes in genetic variation on a spatio-temporal scale improves the epidemiological understanding of dengue and supports the appropriate and timely design of vector control strategies. Objective: To assess the genetic changes, diversity and gene flow in six microgeographical populations of Ae. aegypti in Medellín for different epidemiological periods of dengue. Materials and methods: A total of 255 specimens from six different neighborhoods in Medellín were used to assess variations in the CO1 mtDNA haplotype composition, diversity and genetic differentiation for an epidemic period (2010) and an endemic period (2012). Results: Two groups of highly differentiated haplotypes were present in both periods, and a high-frequency haplotype was assessed for all neighborhoods. The highest haplotype diversity was recorded in 2012, but the maximum nucleotide diversity was recorded in 2010. No significant correlation between genetic and geographic distances was observed. Conclusions: The genetic composition of Ae. aegypti varies over time without a predictable pattern. In addition, the presence of a high-frequency haplotype in both periods could indicate a persistent variation adapted to vector control. However, the simultaneous movement of highly differentiated CO1 haplotypes compatible with multiple introductions suggests that different gene pools would be suitable for transmission. These results are consistent with mosquito dispersion due to human activities, which would enable the rapid spread of the virus during epidemics in Medellin.

Enfermedad de Darier-White / Darier-White disease

La disqueratosis folicular (enfermedad de Darier-White) es un trastorno infrecuente autosómico dominante en el que se produce una queratinización alterada de la piel, uñas y mucosas, con una pérdida de adhesión entre las células de la epidermis. Se caracteriza clínicamente por la presencia de lesiones pápulo-queratósicas persistentes, principalmente foliculares que predominan en zonas seborreicas. Se presenta el caso de un paciente de 30 años de edad y se realiza una revisión de la literatura

Dyskeratosis follicularis (Darier-White disease) is a rare autosomal dominant transmitted disease due to an alteration of keratinization in epidermis, nails and mucosas, with a loss of adhesion between epidermal cells. It is characterized clinically by persistent follicular keratotic papule, which mainly appears in seborrheic areas. We present the case of a 30-year old male and a review of the literature

Modelling entomological-climatic interactions of Plasmodium falciparum malaria transmission in two Colombian endemic-regions: contributions to a National Malaria Early Warning System.

BACKGROUND: Malaria has recently re-emerged as a public health burden in Colombia. Although the problem seems to be climate-driven, there remain significant gaps of knowledge in the understanding of the complexity of malaria transmission, which have motivated attempts to develop a comprehensive model. METHODS: The mathematical tool was applied to represent Plasmodium falciparum malaria transmission in two endemic-areas. Entomological exogenous variables were estimated through field campaigns and laboratory experiments. Availability of breeding places was included towards representing fluctuations in vector densities. Diverse scenarios, sensitivity analyses and instabilities cases were considered during experimentation-validation process. RESULTS: Correlation coefficients and mean square errors between observed and modelled incidences reached 0.897-0.668 (P > 0.95) and 0.0002-0.0005, respectively. Temperature became the most relevant climatic parameter driving the final incidence. Accordingly, malaria outbreaks are possible during the favourable epochs following the onset of El Niño warm events. Sporogonic and gonotrophic cycles showed to be the entomological key-variables controlling the transmission potential of mosquitoes' population. Simulation results also showed that seasonality of vector density becomes an important factor towards understanding disease transmission. CONCLUSION: The model constitutes a promising tool to deepen the understanding of the multiple interactions related to malaria transmission conducive to outbreaks. In the foreseeable future it could be implemented as a tool to diagnose possible dynamical patterns of malaria incidence under several scenarios, as well as a decision-making tool for the early detection and control of outbreaks. The model will be also able to be merged with forecasts of El Niño events to provide a National Malaria Early Warning System.

Laboratory estimation of the effects of increasing temperatures on the duration of gonotrophic cycle of Anopheles albimanus (Diptera: Culicidae).

The increase of malaria transmission in the Pacific Coast of Colombia during the occurrence of El Niño warm event has been found not to be linked to increases in the density of the vector Anopheles albimanus, but to other temperature-sensitive variables such as longevity, duration of the gonotrophic cycle or the sporogonic period of Plasmodium. The present study estimated the effects of temperature on duration of the gonotrophic cycle and on maturation of the ovaries of An. albimanus. Blood fed adult mosquitoes were exposed to temperatures of 24, 27, and 30 degrees C, held individually in oviposition cages and assessed at 12 h intervals. At 24, 27, and 30 degrees C the mean development time of the oocytes was 91.2 h (95% C.I.: 86.5-96), 66.2 h (61.5-70.8), and 73.1 h (64-82.3), respectively. The mean duration of the gonotrophic cycle for these three temperatures was 88.4 h (81.88-94.9), 75 h (71.4-78.7), and 69.1 h (64.6-73.6) respectively. These findings indicate that both parameters in An. albimanus are reduced when temperatures rose from 24 to 30 degrees C, in a nonlinear manner. According to these results the increase in malaria transmission during El Niño in Colombia could be associated with a shortening of the gonotrophic cycle in malaria vectors, which could enhance the frequency of man-vector contact, affecting the incidence of the disease.

Laboratory estimation of the effects of increasing temperatures on the duration of gonotrophic cycle of Anopheles albimanus (Diptera: Culicidae)

The increase of malaria transmission in the Pacific Coast of Colombia during the occurrence of El Niño warm event has been found not to be linked to increases in the density of the vector Anopheles albimanus, but to other temperature-sensitive variables such as longevity, duration of the gonotrophic cycle or the sporogonic period of Plasmodium. The present study estimated the effects of temperature on duration of the gonotrophic cycle and on maturation of the ovaries of An. albimanus. Blood fed adult mosquitoes were exposed to temperatures of 24, 27, and 30ºC, held individually in oviposition cages and assessed at 12 h intervals. At 24, 27, and 30ºC the mean development time of the oocytes was 91.2 h (95 percent C.I.: 86.5-96), 66.2 h (61.5-70.8), and 73.1 h (64-82.3), respectively. The mean duration of the gonotrophic cycle for these three temperatures was 88.4 h (81.88-94.9), 75 h (71.4-78.7), and 69.1 h (64.6-73.6) respectively. These findings indicate that both parameters in An. albimanus are reduced when temperatures rose from 24 to 30ºC, in a nonlinear manner. According to these results the increase in malaria transmission during El Niño in Colombia could be associated with a shortening of the gonotrophic cycle in malaria vectors, which could enhance the frequency of man-vector contact, affecting the incidence of the disease.