DengueTools: innovative tools and strategies for the surveillance and control of dengue

Dengue fever is a mosquito-borne viral disease estimated to cause about 230 million infections worldwide every year, of which 25,000 are fatal. Global incidence has risen rapidly in recent decades with some 3.6 billion people, over half of the world's population, now at risk, mainly in urban centres of the tropics and subtropics. Demographic and societal changes, in particular urbanization, globalization, and increased international travel, are major contributors to the rise in incidence and geographic expansion of dengue infections. Major research gaps continue to hamper the control of dengue. The European Commission launched a call under the 7th Framework Programme with the title of 'Comprehensive control of Dengue fever under changing climatic conditions'. Fourteen partners from several countries in Europe, Asia, and South America formed a consortium named 'DengueTools' to respond to the call to achieve better diagnosis, surveillance, prevention, and predictive models and improve our understanding of the spread of dengue to previously uninfected regions (including Europe) in the context of globalization and climate change.The consortium comprises 12 work packages to address a set of research questions in three areas:Research area 1: Develop a comprehensive early warning and surveillance system that has predictive capability for epidemic dengue and benefits from novel tools for laboratory diagnosis and vector monitoring.Research area 2: Develop novel strategies to prevent dengue in children.Research area 3: Understand and predict the risk of global spread of dengue, in particular the risk of introduction and establishment in Europe, within the context of parameters of vectorial capacity, global mobility, and climate change.In this paper, we report on the rationale and specific study objectives of 'DengueTools'. DengueTools is funded under the Health theme of the Seventh Framework Programme of the European Community, Grant Agreement Number: 282589 Dengue Tools.

Evidence for a smooth onset of deformation in the neutron-rich Kr isotopes

The neutron-rich nuclei 94,96Kr were studied via projectile Coulomb excitation at the REX-ISOLDE facility at CERN. Level energies of the first excited 2(+) states and their absolute E2 transition strengths to the ground state are determined and discussed in the context of the E(2(1)(+)) and B(E2;2(1)(+)→0(1)(+)) systematics of the krypton chain. Contrary to previously published results no sudden onset of deformation is observed. This experimental result is supported by a new proton-neutron interacting boson model calculation based on the constrained Hartree-Fock-Bogoliubov approach using the microscopic Gogny-D1M energy density functional.

Development of a SYBR green I based RT-PCR assay for yellow fever virus: application in assessment of YFV infection in Aedes aegypti

BACKGROUND

Yellow Fever virus (YFV) is an important arboviral pathogen in much of sub-Saharan Africa and the tropical Americas. It is the prototype member of the genus Flavivirus and is transmitted primarily by Aedes (Stegomyia) mosquitoes. The incidence of human infections in endemic areas has risen in recent years. Prompt and dependable identification of YFV is a critical component of response to suspect cases.

RESULTS

We developed a one-step SYBR Green I-based real-time quantitative RT-PCR (qRT-PCR) assay targeting the 5'NTR and capsid-gene junction--for rapid detection and quantification of YFV. The detection limit was 1 PFU/mL, 10-fold more sensitive than conventional RT-PCR, and there was no cross-reactivity with closely related flaviviruses or with alphaviruses. Viral load in samples was determined by standard curve plotted from cycle threshold (Ct) values and virus concentration. The efficacy of the assay in mosquitoes was assessed with spiked samples. The utility of the assay for screening of pooled mosquitoes was also confirmed. Replication of a Cameroon isolate of YFV in Ae. aegypti revealed a marked variation in susceptibility among different colonies at different days post infection (pi).

CONCLUSIONS

The SYBR Green-1 based qRT-PCR assay is a faster, simpler, more sensitive and less expensive procedure for detection and quantification of YFV than other currently used methods.

Warfarin therapeutic monitoring: is 70% time in the therapeutic range the best we can do?

WHAT IS KNOWN AND OBJECTIVE

Warfarin, an oral anticoagulant, which has been in clinical use for over sixty years, remains a challenge for clinicians to utilize, given the multiplicity of items which can limit its efficacy. Our objective is to review the evidence and comment on whether INR control can be better than has been currently reported in various studies.

COMMENT

The duration of time a patient's international normalized ratio (INR) is maintained within the therapeutic range (time in the therapeutic range, TTR) for his or her particular indication for the drug impacts the effectiveness and safety of warfarin therapy. Maintaining a therapeutic INR while on warfarin is difficult, and numerous studies employing various strategies confirm the challenge, but not the impossibility of achieving a TTR above 70%.

WHAT IS NEW AND CONCLUSION

Maintaining a therapeutic INR requires a dedicated multi-faceted approach. With diligence, skill and various therapeutic strategies, a TTR >70% can be achieved.

Abstract P138: Quality Improvment Strategy for Better Control of Warfarin Anticoagulaton in Outpatients

Introduction: Warfarin is currently the only effective oral anticoagulant for thromboembolic prophylaxis in patients at high risk for stroke or other thromboembolic complications. Maintaining a therapeutic level of anticoagulation as measured by the International Normalized Ratio (INR) can be challenging, due to genetic differences in drug metabolism, multiple drug interactions, and variations in dietary vitamin K intake. We designed a program to improve our ability to keep our patients' INR within the therapeutic range.

Methods: We established a baseline degree of INR control in the fall of 2007, measuring the INR for 50 sequential patients who required warfarin therapy for at least one month for each of our 5 physicians; therapeutic range was 2-3 for most indications, or 2.5-3.5 for mechanical valves. We then instituted an INR improvement program, making certain our office gave directions for subsequent warfarin dosing and the next INR testing directly to the patient only; reviewing all drugs and potential interactions at each contact; reviewing potential dietary and alcohol consumption issues at each contact; and utilizing a standard dosing protocol for any dose changes. We reassessed the degree of INR control 6 months later and 18 months later in a similar cohort, measuring 50 sequential patients for each of our 5 physicians.

Results: At our most recent survey, the average age of our patients was 73.7 and 43% (108 of 250) were female. The indication for anticoagulation was atrial fibrillation in 81.6% (204 of 250), mechanical heart valve in 11.2% (28 of 250), and other indications in 7.2% (18 of 250). The percentage of patients within their therapeutic range was 62.4% (156 of 250) at the baseline survey, 66.0% (165 of 250) at the second survey, and 65.6% (164 of 250) at the most recent survey, p=0.42 comparing first to second, p=0.45 comparing first to third, and p=0.92 comparing second to third, none significantly different.

Conclusion: Achieving and maintaining a therapeutic INR with warfarin dosing even with an aggressive quality improvement program is a continuing therapeutic challenge. More effective management strategies or alternative anticoagulants which may be simpler to manage remain a high priority.

16+ spin-gap isomer in 96Cd

A β-decaying high-spin isomer in (96)Cd, with a half-life T(1/2)=0.29(-0.10)(+0.11) s, has been established in a stopped beam rare isotope spectroscopic investigations at GSI (RISING) experiment. The nuclei were produced using the fragmentation of a primary beam of (124)Xe on a (9)Be target. From the half-life and the observed γ decays in the daughter nucleus, (96)Ag, we conclude that the β-decaying state is the long predicted 16(+) "spin-gap" isomer. Shell-model calculations, using the Gross-Frenkel interaction and the πν(p(1/2),g(9/2)) model space, show that the isoscalar component of the neutron-proton interaction is essential to explain the origin of the isomer. Core excitations across the N=Z=50 gaps and the Gamow-Teller strength, B(GT) distributions have been studied via large-scale shell-model calculations using the πν(g,d,s) model space to compare with the experimental B(GT) value obtained from the half-life of the isomer.

Discovery of the shape coexisting 0+ state in 32 Mg by a two neutron transfer reaction

The "island of inversion" nucleus 32 Mg has been studied by a (t, p) two neutron transfer reaction in inverse kinematics at REX-ISOLDE. The shape coexistent excited 0+ state in 32 Mg has been identified by the characteristic angular distribution of the protons of the Δ L=0 transfer. The excitation energy of 1058 keV is much lower than predicted by any theoretical model. The low γ-ray intensity observed for the decay of this 0+ state indicates a lifetime of more than 10 ns. Deduced spectroscopic amplitudes are compared with occupation numbers from shell-model calculations.

Community involvement in the development and feedback about a colorectal cancer screening media campaign in Ohio Appalachia

A community needs assessment focused on colorectal cancer (CRC) screening knowledge, behaviors, and barriers was completed in one Ohio Appalachia county. A CRC screening media campaign was developed based on the findings from the needs assessment and feedback was obtained about the media campaign. The survey was completed by 170 self-reported average-risk adults. In a multivariate model, the CRC screening rate was higher for participants who had received a doctor's recommendation (OR = 6.09) and had adequate CRC knowledge (OR = 2.88), and it was lower among participants employed full-time (OR = 0.23). Having health insurance (OR = 4.20) and being married (OR = 2.58) was associated with having received a doctor's recommendation for screening. Campaign feedback using a second survey completed by self-reported average-risk adults (n = 61) revealed that 69% recognized the campaign image and message, with a billboard being the most cited source. This study highlights the importance of involving community members in the development of CRC screening programs to reduce cancer disparities in Appalachia.

The standardised freight container: vector of vectors and vector-borne diseases

The standardised freight container was one of the most important innovations of the 20th Century. Containerised cargoes travel from their point of origin to their destination by ship, road and rail as part of a single journey, without unpacking. This simple concept is the key element in cheap, rapid transport by land and sea, and has led to a phenomenal growth in global trade. Likewise, containerised air cargo has led to a remarkable increase in the inter-continental transportation of goods, particularly perishable items such as flowers, fresh vegetables and live animals. In both cases, containerisation offers great advantages in speed and security, but reduces the opportunity to inspect cargoes in transit. An inevitable consequence is the globalisation of undesirable species of animals, plants and pathogens. Moreover, cheap passenger flights offer worldwide travel for viral and parasitic pathogens in infected humans. The continued emergence of exotic pests, vectors and pathogens throughout the world is an unavoidable consequence of these advances in transportation technology.

Mosquito (Diptera: Culicidae) fauna in an area endemic for West Nile virus

Mosquito collections with CDC light traps using dry ice and pigeon-baited traps were carried out in south Moravia (Czech Republic) from April to October in 2007 and 2008 at two study sites. In 2007, 11 two-day captures were carried out in two-week intervals, and 1,490 female mosquitoes of nine species were caught. In 2008, 15 two-day trappings of mosquitoes were carried out: 6,778 females of 22 species of mosquitoes were trapped. The results showed marked differences in abundance and species composition of mosquitoes between both study sites and between the trapping methods. In the floodplain forest ecosystem of the Soutok study area, Aedes vexans predominated. The species composition in the Nesyt study site was more varied and the most common species was Culex pipiens. At the latter study site, Anopheles hyrcanus (var. pseudopictus) and Uranotaenia unguiculata, mosquito species with largely southern Eurasian distribution, were repeatedly demonstrated. The largest capture of mosquitoes was in traps with CO2 placed at a height 1 m above the ground. The capture of mosquitoes in the pigeon-baited traps as well as in the traps with CO2 placed in the canopy of trees was markedly lower in both study sites, with the predominant species being Culex pipiens.

Low West Nile virus circulation in wild birds in an area of recurring outbreaks in Southern France

West Nile virus (WNV) has a history of irregular but recurrent epizootics in countries of Mediterranean and of Central and Eastern Europe. We have investigated the temporal enzootic activity of WNV in free-ranging birds over a 3-year period in an area with sporadic occurrences of WNV outbreaks in Southern France. We conducted an intensive serologic survey on several wild bird populations (>4000 serum samples collected from 3300 birds) selected as potential indicators of the WNV circulation. WNV antibodies were detected by seroneutralization and/or plaque reduction neutralization in house sparrows, black-billed magpies, and scops owls, but these species appeared to be insufficient indicators of WNV circulation. Overall seroprevalence was low (<1%), including in birds that had been potentially exposed to the virus during recent outbreaks. However, the detection of a seroconversion in one bird, as well as the detection of seropositive birds in all years of our monitoring, including juveniles, indicate a constant annual circulation of WNV at a low level, including in years without any detectable emergence of WN fever in horses or humans.

Yellow fever and dengue: a threat to Europe?

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalization of vectors and vector-borne diseases. The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced. The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

West Nile virus in Europe: understanding the present to gauge the future

The appearance of West Nile virus in New York in 1999 and the unprecedented panzootic that followed, have stimulated a major research effort in the western hemisphere and a new interest in the presence of this virus in the Old World. This review considers current understanding of the natural history of this pathogen, with particular regard to transmission in Europe.

Yellow fever and dengue: a threat to Europe?

The introduction and rapidly expanding range of Aedes albopictus in Europe is an iconic example of the growing risk of the globalisation of vectors and vector-borne diseases. The history of yellow fever and dengue in temperate regions confirms that transmission of both diseases could recur, particularly if Ae. aegypti, a more effective vector, were to be re-introduced. The article is a broad overview of the natural history and epidemiology of both diseases in the context of these risks.

West Nile virus in Europe: understanding the present to gauge the future

The appearance of West Nile virus in New York in 1999 and the unprecedented panzootic that followed, have stimulated a major research effort in the western hemisphere and a new interest in the presence of this virus in the Old World. This review considers current understanding of the natural history of this pathogen, with particular regard to transmission in Europe.

Presence of the mosquito Anopheles hyrcanus in South Moravia, Czech Republic

During a survey of mosquitoes in the South Moravian lowland area, the mosquito Anopheles hyrcanus (Pallas) (Diptera: Culicidae) was found breeding in an ancient fishpond (Nesyt). It is not clear whether this southern Palaearctic species, a known vector of malaria in Asia which has not been recorded in the Czech Republic until this year, has gone undetected in the past or whether it has recently moved into the region as a result of climate change.

Dispersal and survival of male and female Aedes albopictus (Diptera: Culicidae) on Réunion Island

Mouse-baited traps were used to assess the longevity and dispersal of male and female Aedes albopictus by mark-release-recapture at two sites on La Réunion Island. Recapture rate was high, and mosquitoes of both sexes appeared up to 23 d after release. A daily survival probability of approximately 0.95 for males and females, far higher than expected, was estimated from these results. There was evidence that both sexes prefer to follow corridors of vegetation rather than crossing open spaces. Populations of wild mosquitoes had parous and insemination rates indicative of a young population. These results are relevant to future attempts to control this species by sterile insect technology.

Adaptation of the BG-Sentinel trap to capture male and female Aedes albopictus mosquitoes

In recent years, the remarkable spread of Aedes albopictus (Skuse) (Diptera: Culicidae) throughout the world has drawn attention to this hitherto poorly studied species, particularly after its role in outbreaks of chikungunya fever in the western Indian Ocean and in Italy. Variants of sterile insect technique (SIT), including the release of transgenic males with a dominant lethal gene (RIDL), have been proposed in the search for new and innovative methods of control. Knowledge of male dispersal, mating behaviour and longevity will be critical to the success of this approach. We present an effective and practical method for trapping both male and female Ae. albopictus using a mouse-baited BG-Sentinel trap.

Family history of cancer predicts Papanicolaou screening behavior for African American and white women

BACKGROUND

Understanding women's motivations for getting Papanicolaou (Pap) screening has the potential to impact cancer disparities. This study examined whether having a family history of cancer was a predictor for Pap screening.

METHODS

By using the National Health Interview Survey 2000 Cancer Control and Family modules, we identified a subsample (n=15,509) of African American (n=2774) and white women (n=12,735) unaffected by cancer, with and without a family history of cancer. Data were analyzed using logistic regression models.

RESULTS

African American and white women with a positive family history of cancer were 42% (P<.0001) more likely to have had a recent Papanicolaou (Pap) test than their counterparts without a family history of cancer. Among African American women, those with a positive family history of cancer were 53% more likely to have had a recent Pap test, whereas among white women those with a positive family history of cancer were 41% more likely to have received a Pap test. African American women with a family history of cancer were more likely to have had a recent Pap test than white women with or without a family history of cancer.

CONCLUSIONS

This study presents a unique perspective on Pap screening behavior. Having an immediate family member with any cancer statistically predicted having a recent Pap test for both African American and white women. Because these results demonstrated that regardless of the cancer type, having an immediate affected family member is a motivator for cervical cancer screening behavior, healthcare providers managing cancer treatment patients have a teachable opportunity that extends beyond the patient.