Identification of TB space-time clusters and hotspots in Ouest département, Haiti, 2011-2016.

BACKGROUND: Haiti has the highest incidence rate of TB in the Western Hemisphere, with an estimated 170 cases per 100,000 in 2019. Since 2010, control efforts have focused on targeted case-finding activities in urban areas, implementation of rapid molecular diagnostics at high-volume TB centers, and improved reporting. TB analyses are rarely focused on lower geographic units; thus, the major goal was to determine if there were focal areas of TB transmission from 2011 to 2016 at operational geographic levels useful for the National TB Control Program (PNLT). METHODS: We created a geocoder to locate TB cases at the smallest geographic level. Kulldorff's space-time permutation scan, Anselin Moran's I, and Getis-Ord Gi* statistics were used to determine the spatial distribution and clusters of TB. RESULTS: With 91% of cases linked using the geocoder, TB clusters were identified each year. Getis-Ord Gi* analysis revealed 14 distinct spatial clusters of high incidences in the Port-au-Prince metropolitan area. One hundred retrospective space-time clusters were detected. CONCLUSION: Our study confirms the presence of TB hotspots in the Ouest département, with most clusters in the Port-au-Prince metropolitan area. Results will help the PNLT and its partners better design case-finding strategies for these areas.

CONTEXTE: Haïti a le taux d'incidence le plus élevé de TB de l'hémisphère Ouest avec un nombre de cas estimé à 170 par 100 000 en 2019. Depuis 2010, les efforts de contrôle se sont focalisés sur des activités de recherche ciblée des cas dans les zones urbaines, la mise en œuvre de diagnostic moléculaire rapide dans des centres TB de grand volume et de meilleurs rapports. Les analyses TB sont rarement focalisées sur les unités géographiques; le but principal était de déterminer s'il existait des zones focales de transmission de la TB de 2011 à 2016 à des niveaux géographiques opérationnels utiles pour le Programme national de Lutte contre la TB (PNLT). MÉTHODES: Nous avons créé géocodeur pour localiser les cas de TB au plus petit niveau géographique. Le scan de permutation espace-temps de Kulldorff's, Anselin Moran's I et les statistiques de Getis-Ord Gi* ont été utilisés pour déterminer la distribution spatiale et les clusters de TB. RÉSULTATS: Avec 91% des cas liés avec le géocodeur, les clusters de TB ont été identifiés chaque année. L'analyse Getis-Ord Gi* a révélé 14 clusters spatiaux distincts d'incidence élevée dans la zone métropolitaine de Port-au-Prince. Cent clusters rétrospectifs espacetemps ont été détectés. CONCLUSION: Notre étude confirme la présence de hotspots TB dans la département Ouest, la majorité des clusters étant situés dans la zone métropolitaine de Port-au-Prince. Les résultats aideront le PNLT et ses partenaires à mieux affiner leurs stratégies de recherche des cas dans ces zones.

Knowledge, attitudes and practices regarding rabies risk in community members and healthcare professionals: Pétionville, Haiti, 2013.

Haiti has the highest human rabies burden in the Western Hemisphere. There is no published literature describing the public's perceptions of rabies in Haiti, information that is critical to developing effective interventions and government policies. We conducted a knowledge, attitudes and practices survey of 550 community members and 116 health professionals in Pétionville, Haiti in 2013 to understand the perception of rabies in these populations. The majority of respondents (85%) knew that dogs were the primary reservoir for rabies, yet only 1% were aware that bats and mongooses could transmit rabies. Animal bites were recognized as a mechanism of rabies transmission by 77% of the population and 76% were aware that the disease could be prevented by vaccination. Of 172 persons reporting a bite, only 37% sought medical treatment. The annual bite incidence rate in respondents was 0·9%. Only 31% of bite victims reported that they started the rabies vaccination series. Only 38% of respondents reported that their dog had been vaccinated against rabies. The majority of medical professionals recognized that dogs were the main reservoir for rabies (98%), but only 28% reported bats and 14% reported mongooses as posing a risk for rabies infection. Bites were reported as a mechanism of rabies transmission by 73% of respondents; exposure to saliva was reported by 20%. Thirty-four percent of medical professionals reported they would wash a bite wound with soap and water and 2·8% specifically mentioned rabies vaccination as a component of post-bite treatment. The majority of healthcare professionals recommended some form of rabies assessment for biting animals; 68·9% recommended a 14-day observation period, 60·4% recommended a veterinary consultation, and 13·2% recommended checking the vaccination status of the animal. Fewer than 15% of healthcare professionals had ever received training on rabies prevention and 77% did not know where to go to procure rabies vaccine for bite victims. Both study populations had a high level of knowledge about the primary reservoir for rabies and the mode of transmission. However, there is a need to improve the level of knowledge regarding the importance of seeking medical care for dog bites and additional training on rabies prevention for healthcare professionals. Distribution channels for rabies vaccines should be evaluated, as the majority of healthcare providers did not know where rabies vaccines could be obtained. Canine rabies vaccination is the primary intervention for rabies control programmes, yet most owned dogs in this population were not vaccinated.