COVID-19 and Substance Use Disorder: Study Protocol for the International Society of Addiction Medicine Practice and Policy Interest Group Global Survey.

INTRODUCTION: As one of the major health problems in the present century, the COVID-19 pandemic affected all parts of the global communities and the health of substance users are potentially at a greater risk of harm. This global study has been designed and conducted by the International Society of Addiction Medicine Practice and Policy Interest Group (ISAM-PPIG) to understand better the health related issues of people with Substance Use Disorders (SUD) as well as responses of the relevant health care systems during the pandemic. METHODS: This is a cross-sectional study using convenient sampling. The data gathering was carried out with two follow-up stages each two months apart through an online conducted survey prepared using Google platform. The survey started by emergence of COVID-19 as a pandemic in March 2020 and respondents were followed till September 2020 when most of the initial lockdowns by most countries are supposed to be reopened. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. The results will be published in relevant peer reviewing journals and communicated with different international stakeholders.

Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO).

Very little evidence has been reported in literature regarding the misuse of substances in rural areas. Despite the common perception of rural communities as a protective and risk-mitigating environment, the scientific literature demonstrated the existence of many risk factors in rural communities. The Drug Prevention and Health Branch (DHB) of the United Nations Office on Drugs and Crime (UNODC), and the World Health Organization (WHO), in June 2016, organized a meeting of experts in treatment and prevention of SUDs in rural settings. The content presented during the meeting and the related discussion have provided materials for the preparation of an outline document, which is the basis to create a technical tool on SUDs prevention and treatment in rural settings. The UNODC framework for interventions in rural settings is a technical tool aimed to assist policy makers and managers at the national level. This paper is a report on UNODC/WHO efforts to improve the clinical conditions of people affected by SUDs and living in rural areas. The purpose of this article is to draw attention on a severe clinical and social problem in a reality forgotten by everyone.

United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet.

Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created Treatnet, a network of 20 drug dependence treatment resource centers around the world. Treatnet's primary goal is to promote the use of effective addiction treatment practices. Phase I of this project included (1) selecting and establishing a network of geographically distributed centers; (2) conducting a capacity-building program consisting of a training needs assessment, development of training packages, and the training of 2 trainers per center in 1 content area each; and (3) creating good-practice documents. Data on the training activities conducted by the trainers during their first 6 months in the field are presented. Plans for Phase II of the Treatnet project are also discussed.

Fetal risk associated with rubella vaccination during pregnancy.

BACKGROUND: Costa Rica implemented a nationwide measles-rubella vaccination campaign among men and women (15-39 years old) in May 2001. A protocol was developed to follow-up the vaccinated women who were unknowingly pregnant, to determine the risk of congenital rubella syndrome (CRS) or congenital rubella infection only associated with the administration of the rubella vaccine RA27/3 during pregnancy. METHODS: To classify the prevaccination maternal immune status, a serum sample was taken at the initial evaluation to detect IgM and IgG rubella antibodies (enzyme-linked immunosorbent assay). All pregnancies were followed up and all newborns were evaluated. A cord serum sample of their children was taken at birth. We calculated odds ratio, OR (95% confidence interval, 95% CI) associated with miscarriage, stillbirth, prematurity, low birth weight, and the presence of defects compatible with CRS. RESULTS: The prevaccination immune status was established in 797 women and 1191 mother and child pairs were analyzed. Adjusted OR for miscarriage (OR = 0.60, 95% CI = 0.26-1.39), stillbirth (OR = 1.32, 95% CI = 0.10-16.81), prematurity (OR = 0.25, 95% CI = 0.03-2.39), low birth weight (OR = 0.25, 95% CI = 0.03-2.23) and defects compatible with CRS (OR = 1.09, 95% CI = 0.34-3.54) showed no association between immune and susceptible maternal status. There were no cases of CRS and no children were IgM positive. CONCLUSIONS: No adverse pregnancy outcome such as miscarriages or CRS was documented in women who were vaccinated and unknowingly pregnant. These results support RA27/3 rubella vaccine safety.

[Using surveys of schoolchildren to evaluate coverage with and opportunity for vaccination in Costa Rica]. / Uso de encuestas en escolares para la evaluación de la cobertura y oportunidad de la vacunación en Costa Rica.

OBJECTIVE: To identify differences in the level of coverage of and opportunity for vaccination among schoolchildren in three areas in Costa Rica with different characteristics: an urban area (with the highest level of socioeconomic development of the three areas), a rural area (with a medium level of socioeconomic development), and a border area (a rural area in northern Costa Rica, on the border with Nicaragua, with the lowest level of socioeconomic development and the highest proportion of foreign immigrants). METHODOLOGY: Following selection of schools by proportional probability, surveys were used with children chosen at random from the first and second grades of elementary schools in the three areas: urban (961 students), rural (544 students), and border (811 students). The data on the vaccines that had been administered were obtained from the children's vaccination cards. Differences among the three areas were evaluated: (1) in the coverage with BCG; with three doses of diphtheria-tetanuspertussis vaccine (DTP3); with three doses of oral polio vaccine (OPV3); with the first dose of measles-mumps-rubella vaccine (MMR1); and with the second dose of MMR vaccine (MMR2) and (2) in the "opportunity" for the children having received DTP1 + OPV1 before 3 months of age, DTP3 + OPV3 before 7 months of age, and DTP4 + OPV4 + MMR1 before 24 months of age. RESULTS: Out of all the students who had been selected, 80% of them in the urban area had a vaccination card, 73% did in the rural area, and 72% did in the border area (P < 0.05). The coverage levels for BCG, DTP3, and OPV3 were each over 95% in both the urban area and the rural area; however, the coverage levels were significantly lower (P < 0.05) in the border area: BCG, 83%; OPV3, 88%; and DTP3, 88%. Coverage with MMR1 and MMR2 was similar in the three areas. The percentage of schoolchildren with two or more doses of measles vaccine was 98% in the urban area, 92% in the rural area, and 85% in the border area (P < 0.05). In terms of opportunity, 90% of the children had received DTP1 + OPV1 before 3 months of age in the urban area, 89% had in the rural area, and 80% had in the border area (P < 0.05). The percentage of application of the complete basic schedule (DTP4 + OPV4 + MMR1) before 24 months of age was 93% in the urban area, 95% in the rural area, and 84% in the border area (P < 0.05). CONCLUSIONS: The border area had lower coverage of and opportunity for the basic schedule of vaccines, except for MMR. Follow-up campaigns for measles eradication have increased the coverage of the initial and booster doses in all three areas, but the increase has been greatest in the urban area. A greater effort should be made to identify children with an incomplete schedule of vaccinations, with priority going to areas that have a high proportion of immigrants.

Uso de encuestas en escolares para la evaluación de la cobertura y oportunidad de la vacunación en Costa Rica / Using surveys of schoolchildren to evaluate coverage with and opportunity for vaccination in Costa Rica

OBJETIVO: Identificar diferencias en el nivel de cobertura y en la oportunidad de la vacunación de escolares residentes en tres tipos de zonas de Costa Rica: urbana, rural y fronteriza (rural de la frontera norte del país). MÉTODOS: Mediante encuesta, previa selección de escuelas por probabilidad proporcional, se reunió al azar a alumnos de primero y segundo grados de enseñanza primaria de tres zonas: urbana (n = 961), rural (n = 544) y fronteriza (n = 811). Los datos de las vacunas aplicadas se obtuvieron del carné (cartilla) de vacunación. Se evaluaron las diferencias en la cobertura con BCG, DPT3, VOP3, SRP1 y SRP2 y en la oportunidad de la administración de DPT1 + VOP1 antes de los 3 meses, de DPT3 + VOP3 antes de los 7 meses y de DPT4 + VOP4 + SRP1 antes de los 24 meses de edad, entre las tres zonas. RESULTADOS: Del total de alumnos seleccionados, 80 por ciento presentaron carné de vacunación en la zona urbana, 73 por ciento en la rural y 72 por ciento en la fronteriza (P <0.05). Las coberturas con BCG, DPT3, VOP3 fueron >95 por ciento en las zonas urbana y rural, y se encontraron cifras significativamente menores (P <0,05) en la zona fronteriza: BCG, 83 por ciento, VOP3, 88 por ciento y DPT3, 88 por ciento. La cobertura con SRP1 y SRP2 fue similar en las tres zonas. El porcentaje de escolares con dos o más dosis de sarampión fue: 98 por ciento en la zona urbana, 92 por ciento en la rural y 85 por ciento en la fronteriza (P <0,05). Una proporción de 90 por ciento recibió DPT1 y VOP1 antes de los tres meses de edad en la zona urbana, 89 por ciento en la rural y 80 por ciento en la fronteriza (P <0,05). El porcentaje de aplicación del esquema básico completo (DPT4 + VOP4 + SRP1) antes de los 24 meses fue: 93 por ciento en la zona urbana, 95 por ciento en la rural y 84 por ciento (P <0,05) en la fronteriza. CONCLUSIONES: La zona fronteriza mostró menor cobertura y oportunidad en la aplicación de vacunas del esquema básico, con excepción de SRP. La realización de campañas de seguimiento para la erradicación del sarampión ha elevado las coberturas con la SRP1 y el refuerzo de sarampión en todas las zonas, pero el incremento ha sido mayor en la urbana. Debe hacerse un mayor esfuerzo por identificar a niños con esquemas incompletos, principalmente en zonas de alta migración.

Human rabies: a reemerging disease in Costa Rica?

Two human rabies cases caused by a bat-associated virus variant were identified in September 2001 in Costa Rica, after a 31-year absence of the disease in humans. Both patients lived in a rural area where cattle had a high risk for bat bites, but neither person had a definitive history of being bitten by a rabid animal. Characterization of the rabies viruses from the patients showed that the reservoir was the hematophagous Vampire Bat, Desmodus rotundus, and that a sick cat was the vector.

Confirmación serológica de la rubéola en Costa Rica, 1998-1999 / Serological confirmation of rubella in Costa Rica 1998-1999

Se presenta la experiencia del Centro Nacional de Referencia (CNDR) del INCIENSA en relación con el brote de rubéola reportado en Costa Rica en 1998-1999 y la participación del laboratorio dentro del Sistema Nacional de Vigilancia para esta enfermedad. Esto, en un contexto internacional en donde la lucha contra la rubéola, y el síndrome de rubéola congénita (SRC), se definen como una prioridad de salud pública en las Américas y por supuesto en Costa Rica. El análisis correlacionó la información epidemiológica disponible por notificación obligatoria en el Departamento de Vigilancia Epidemiológica del Ministerio de Salud con los resultados de las muestras procesadas que refirieron los establecimientos del salud de todo el país al CDR, entre el 1 de enero de 1998 y el 31 de diciembre de 1999 como parte del Programa Nacional de Vigilancia de Enfermedades Febriles Eruptivas (EFEs). La confirmación diagnóstica se realizó mediante la determinación de anticuerpos IgM antisarampión, rubéola y dengue. Durante el período de estudio el Sistema de Notificación Obligatoria registró un total de 1559 casos de rubéola de los cuales el 40 por ciento (n=623) fue confirmado por el laboratorio. El 50 por ciento de los casos pertenecían a la Región Central Sur, el 24 por ciento a la Región Central Norte y el 26 por ciento se distribuyó en el resto de las regiones del país. El 61 por ciento de la población afectada tenía entre 15 y 44 años.(RESUMEN TRUNCADO)

Evaluación del sistema de vigilancia epidemiológico del dengue utilizando como indicador la aplicación de la definición de caso sospechoso, Costa Rica 1998 / Evaluation of epidemiology system for dengue using as indicating the application of the definition of suspicious case, Costa Rica, 1998

Se analizó la sensibilidad del sistema de vigilancia para detectar casos de dengue, mediante la aplicación de la definición de caso en tres regiones de Costa Rica que durante el año 1998 presentaron diferente actividad de esta enfermedad. El propósito es fortalecer el sistema de notificación ogligatoria que permita la detección precoz de los casos sospechosos para lograr la intervención oportuna y eficaz en el control de esta enfermedad. Para ello, se realizó un estudio observacional de tipo analítico, enfocado desde la perspectiva de la demanda de los análisis del laboratorio. Los datos corresponden a 377 registros seleccionados aleatoriamente de la base de datos de 1998 del Centro de Referencia de Dengue (CDRD) del Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA). Los resultados demostraron que el sistema basado en la vigilancia clínica de los casos sospechosos, no es sensible ni se relacionó con el comportamiento epidemiológico de la enfermedad. El mismo no detectó ni el 50 por ciento de los casos positivos, dejando gente infectada que mantiene el ciclo mientras existió entre un 16 y 46 por ciento de pacientes que desencadenaron acciones sin ameritarlas. Esto permite concluir que el personal médico que atiende al enfermo describe en el expediente el cuadro clínico y sospecha dengue porque indica pruebas para descartar esta patología, pero no lo anota como diagnóstico presuntivo. Por esta situacón no se genera la boleta de notificación obligatoria y, por lo tanto, no se activa oportunamente el sistema de vigilancia. Este es el primer estudio que analiza la sensibilidad del sistema de vigilancia de dengue y específicamente aplicado en relación con la activdad de la enfermedad.

The sensitivity of the National Surveillance Program to detect dengue cases was investigated in Costa Rica by evaluating the application of the case definition in three different health regions showing activity for dengue en 1998. The study was aimed to strengthen the Obligatory Notification System in order to achieve a timely detection of suspicious cases and an efficient outbreak control. The investigation corresponds to an observational analytical study from the perspective of the laboratory test demand. Data included 377 registers randomly selected from the data base of the National Reference Center for Dengue of the Costa Rican Institute for Investigation and Training in Nutrition and Health (INCIENSA). Data were processed in two stages: firstly, a descriptive statistics of the variables and, secondly, an univariate analysis of the results to define the sensitivity, specificity and predictive value of the case definition for dengue were carried out. Results showed that the system based on the clinical surveillance of the dengue suspicious cases is neither sensitive nor has connection with the epidemiological profile of the disease. The system showed to be unable to detect Iess than 50% of the positive cases causing that infected people maintain the cycle of the disease while between 16 and 46 % of patients receive the effects of control actions that are not required. Finally, data showed that clinicians attending the patients describe the clinical picture and guess about the possibility of dengue (even prescribing the necessity of serology test for dengue) but do not indicate it as the presumptive diagnose. As a consequence, the obligatory notification form is not filled out and the surveillance system does not receive a timely notification to activate the control actions. This is the first study aimed to analyze the national surveillance system for dengue in Costa Rica in association with the activity of the disease.