Epidemiological scenarios for human rabies exposure notified in Colombia during ten years: A challenge to implement surveillance actions with a differential approach on vulnerable populations.

Based on notified cases of human rabies exposure and human deaths by rabies to Colombia public health surveillance system between 2007 and 2016, we conducted a spatiotemporal analysis to identify epidemiological scenarios of high human rabies exposure due to dogs, cats, bats, or farm animals (n = 666,411 cases). The incidence rate of human rabies exposures was analyzed by using geographical information system (spatiotemporal distribution and Cluster and Outlier Analysis (Anselin Local Moran's I)) data for all Colombian cities. The incidence rate of human rabies exposures due to dogs and cats showed an increasing trend, while aggression due bats and farm animals fluctuated throughout the analyzed period. Human deaths by rabies transmitted by cat and bat occurred in the Andean and Orinoquia regions, which had urban and rural scenarios. The urban scenario showed the highest exposure to human rabies due to cats and dogs in cities characterized with high human population density and greater economic development. In contrary, the highest human rabies exposure in the rural scenario was observed due to contact of mucosa or injured skin with the infected saliva of farm animals with the rabies virus, principally among workers in the agroforestry area. The inequality scenario showed some outlier cities with high human rabies exposure due to farm animals principally in the Pacific region (characterized by the highest poverty rates in Colombia), being Afro-descendant and indigenous population the most exposed. The highest exposure due to bats bite was observed among indigenous people residing in cities of the Amazon region as a dispersed population (Amazonian scenario). None of the high exposure scenarios were related to human deaths by rabies due to dogs aggression. The identified scenarios can help develop better surveillance systems with a differential approach to the vulnerable population and strengthening them in areas with rabies viral circulation.

Neuroimaging findings using transfontanellar ultrasound in newborns with microcephaly: a possible association with congenital Zika virus infection.

OBJECTIVE: The objective of this study is to determine the main neuroimaging findings of microcephalic newborns with possible Zika virus (ZIKV) intrauterine infection using transfontanellar cranial ultrasound. METHODS: We performed a retrospective study to describe the main neuroimaging findings in newborns with microcephaly and possible association with congenital ZIKV infection. Microcephaly was defined in the postnatal period using transfontanellar cranial examination which was performed using both two- (2D) and three-dimensional (3D) ultrasound. RESULTS: One hundred and fifty newborns with microcephaly were identified during the study period. The mean ± (standard deviation - SD) of cephalic perimeter was 28.5 ± 4.2 cm (range, 25-38 cm). Transfontanellar neuroimaging patterns detected cerebral calcifications, neuronal migrational abnormalities, dysgenesis of the corpus callosum, and cerebellar atrophy in 34.9%, 31.1%, 26%, and 16.2%, respectively. Hydrocephalus was seen in 28% of overall newborns. A history of maculopapular rash was present in almost half of the mothers (46.1%). CONCLUSION: Neuroimaging patterns by means of transfontanellar ultrasound are accurate and diagnostic investigations of brain pathology in newborns affected by microcephaly and possible intrauterine ZIKV infection.