The Health Impact of Rabies in Haiti and Recent Developments on the Path Toward Elimination, 2010-2015.

Haiti, a Caribbean country of 10.5 million people, is estimated to have the highest burden of canine-mediated human rabies deaths in the Western Hemisphere, and one of the highest rates of human rabies deaths in the world. Haiti is also the poorest country in the Western Hemisphere and has numerous economic and health priorities that compete for rabies-control resources. As a result, primary rabies-control actions, including canine vaccination programs, surveillance systems for human and animal rabies, and appropriate postbite treatment, have not been fully implemented at a national scale. After the 2010 earthquake that further hindered the development of public health program infrastructure and services, the U.S. Centers for Disease Control and Prevention worked with the Ministry of Public Health and Population and key health development partners (including the Pan-American Health Organization) to provide technical expertise and funding for general disease surveillance systems, laboratory capacity, and selected disease control programs; including rabies. In 2011, a cross-ministerial rabies consortium was convened with participation from multiple international rabies experts to develop a strategy for successful rabies control in Haiti. The consortium focused on seven pillars: 1) enhancement of laboratory diagnostic capacity, 2) development of comprehensive animal surveillance system, 3) development of comprehensive human rabies surveillance system, 4) educational outreach, 5) sustainable human rabies biologics supply, 6) achievement of sustained canine vaccination rates of ≥ 70%, and 7) finalization of a national rabies control strategy. From 2010 until 2015, Haiti has seen improvements in the program infrastructure for canine rabies control. The greatest improvements were seen in the area of animal rabies surveillance, in support of which an internationally recognized rabies laboratory was developed thereby leading to an 18-fold increase in the detection of rabid animals. Canine rabies vaccination practices also improved, from a 2010 level of approximately 12% to a 2015 dog population coverage level estimated to be 45%. Rabies vaccine coverage is still below the goal of 70%, however, the positive trend is encouraging. Gaps exist in the capacity to conduct national surveillance for human rabies cases and access to human rabies vaccine is lacking in many parts of the country. However, control has improved over the past 5 years as a result of the efforts of Haiti's health and agriculture sectors with assistance from multiple international organizations. Haiti is well situated to eliminate canine-mediated human rabies deaths in the near future and should serve as a great example to many developing countries struggling with similar barriers and limitations.

Early prenatal diagnosis of oculoauriculofrontonasal syndrome by three-dimensional ultrasound.

Oculoauriculofrontonasal syndrome is a rare developmental field defect that represents an abnormal morphogenesis of the frontonasal eminence. It consists of features of both oculoauriculovertebral spectrum and frontonasal malformation. A few cases in the literature have described this syndrome, but to the best of our knowledge the present case is the first early prenatal diagnosis of this severe condition using three-dimensional ultrasonography.

A performance-dependent adjustment of the retention interval in a delayed non-matching-to-position paradigm differentiates effects of amnestic drugs in rats.

Operant delayed non-matching-to-position (delayed non-matching-to-position) tasks have been widely used as tests of working memory in rats, but have suffered some loss in sensitivity to differentiating selective mnemonic from non-mnemonic deficits due to floor and ceiling effects. To circumvent this problem, a novel delayed non-matching-to-position was developed in which the retention interval was adjusted on a trial-by-trial basis to hold performance accuracy at an intermediate value. The present study assessed the effects of three amnestic drugs in this delayed non-matching-to-position. Rats were administered (i.p.) NMDA receptor antagonist ((5R,10S)-(+)-5-Methyl-10, 11-dihydro-5H-dibenzo[a,d,] cyclohepten-5,10-imine (Dizocilpine or MK-801), muscarinic receptor antagonist (-)-scopolamine hydrobromide (scopolamine), or cannabinoid receptor agonist ((R)-(+)-[2, 3-Dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1, 4-benzoxazin-6-yl]-1-naphthalenylmethanone) (WIN 55, 212-2). At high doses, both MK-801 (0.12-0.25 mg/kg) and scopolamine (0.25 mg/kg) produced deficits not selective to working memory. At low doses, scopolamine (0.06-0.12 mg/kg) and MK-801 (0.06 mg/kg) produced no deficits in any mnemonic or secondary measures. WIN 55, 212-2 produced deficits at 2.0 mg/kg that were consistent with a specific impairment of working memory. Using this particular delayed non-matching-to-position revealed that consistent changes in performance accuracy at the short retention interval were evident for scopolamine and MK-801, at times in the absence of changes in response tendency, which are consistent with an interpretation that these drugs produce general deficits in reference or procedural memory. In contrast, cannabinoid-induced deficits in choice accuracy support previous reports of delay-dependent deficits. Together, these data suggest that this delayed non-matching-to-position task is able to differentiate deficit patterns of amnestic drugs, and isolate the effects of motivational side effects of drugs from working memory measurement.

Specificity of memory measures in an adjusting delayed nonmatching-to-position task for rats.

While the delayed nonmatching-to-position (DNMTP) behavioral paradigm has often been used by neuroscientists to assess working memory in rats, its measure of working memory is compromised by floor and ceiling effects. Specifically, these floor and ceiling effects undermine the ability to detect a significant interaction in a two-factor repeated-measures ANOVA, which is required in order to conclude that impaired performance has resulted from disrupted working memory and not from a change in another psychological process (i.e. that the impairment is 'specific' to working memory). The present study was conducted to evaluate if these limitations could be overcome in a DNMTP by adjusting the length of time that the rat was required to remember (the 'delay') so as to avoid the floor and ceiling. The general procedure for two experiments presented subjects with trials where there was either a minimal (1 s) delay or a longer delay of varying length, with the goal of maintaining nonmatch-to-position accuracy near 75%. The procedure was such, that if the average accuracy was at or above 75%, then the next trial would be a long-delay trial. If it were below 75%, then the next trial would be a 1 s delay trial. In the first experiment, the subjects were presented with trials where the value of the longer delay was systematically varied between-sessions. This was done to simulate the faster rate of forgetting found in persons with amnesia. DNMTP accuracy diminished at the longer delay but not the short delay as the second interval was lengthened. However, other measures, including accuracy at the 1 s delay, discrimination accuracy during the sample phase, and the number of trials completed per session, did not change. This experiment suggested that this DNMTP could precisely measure small changes in the rate of forgetting. In a second experiment, a potential non-mnemonic confound, the level of motivation, was directly manipulated by giving the water-restricted subjects access to water immediately prior to the start of the session. The number of trials completed per session diminished, but the accuracy at both the 1 s and the longer delays did not change. These results indicated that the measures of working memory in this DNMTP were insensitive to changes in motivation. Together, these experiments confirmed that adjusting the delay in the DNMTP improves the validity of the measures in this task.

Oral rehydration program evaluation by quality assurance sampling in rural Haiti.

An oral rehydration program in rural Haiti was evaluated by quality assurance sampling. The quality assurance sampling method and its application are described. The indicators measured were knowledge of the oral rehydration salts packet, knowledge of preparation of the solution from the packet, oral rehydration therapy use, and knowledge of preparation of the solution from salt and sugar. Coverages of the first two indicators were adequate, coverages of the latter two were inadequate. The method is a useful low-cost approach to evaluation of program coverage.

[Epidemiological study of intestinal helminthiasis in the island of Tortuga (Haiti). I. Prevalence of trichocephalosis, ascaridiasis and necatoriasis studied from elimination of eggs in the stools]. / Etude épidémiologique des helminthiases intestinales à l'île de la Tortue (Haiti) I. Prévalence de la trichocéphalose, de l'ascaridiose et de la nécatorose d'après l'élimination des oeufs dans les selles.

An epidemiological survey is conducted by spot-checks over about 10% of the population of Tortuga Island in order to estimate the prevalence of intestinal helminthiasis in that region of the Republic of Haïti, by researching the presence of eggs in faeces. Population sample is representative of the whole of the island's population excepting the 0-4 years old group whose faeces are difficult to obtain. Faeces are examined through the Kato method, a very simple, quick and remarkably accurate procedure. Trichuriasis and ascariasis, which are transmitted in the area around the house, affect mainly children, but also adults. Women seem to be more often infested than men by Ascaris lumbricoides. Necatoriasis, the farmer's disease, hits primarily young men and elderly women who spend most time in the fields. It is observed in inland villages where people are engaged in agricultural production, with a higher incidence if they are located in a not so sloping zone.

[Epidemiological study of intestinal helminthiasis in the island of Tortuga (Haiti). II. Evaluation of the parasite count by means of the Kato method]. / Etude épidémiologique des helminthiases intestinales à l'île de la Tortue (Haiti). 2. Evaluation de la charge parasitaire par la méthode de Kato.

Results of the numbering of T. trichiura, A. lumbricoides et N. americanus eggs found in the stool, taken from a representative sample of the population of Tortuga island, shows the importance of parasital load borne by people attacked by the parasites. Those who produce the greatest number of eggs for a gram of faeces are young children. For adults, the evolution of the parasital load follow that of the prevalence, for each Nematodes, with an increase of the average number of eggs of A. lumbricoides per gram of faeces for adults aged 30 to 44, and of the average number of N. amercanus per gram of faeces for adults aged 45 to 59. Moreover women adults show a higher number of parasites than men. Farmers from villages within the interior of the island who are more often attacked than those from the coast, also bear a parasital load which is twice as high. Victims less than 5 years old and more than 30, particularly women, whose faeces are richest in eggs, seem to present the greatest danger for the transmission of ascaridiosis and necatorosis in Toruga Island.