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Duque MP, Naser AM, dos Santos GR, O’Driscoll M, Paul KK, Rahman M, Alam MS, Al-Amin HM, Rahman MZ, Hossain ME, Paul RC, Luby SP, Cauchemez S, Vanhomwegen J, Gurley ES, Salje H. Informing an investment case for Japanese encephalitis vaccine introduction in Bangladesh. SCIENCE ADVANCES 2024; 10:eadp1657. [PMID: 39121225 PMCID: PMC11313847 DOI: 10.1126/sciadv.adp1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/08/2024] [Indexed: 08/11/2024]
Abstract
Japanese encephalitis virus (JEV) is a major threat to human health. Bangladesh is considering introducing a JEV vaccine; however, the investment case is hampered by a limited understanding of key aspects of JEV ecology. We conducted a seroprevalence study in a high-incidence region using an assay that limits cross-reactivity with dengue virus. We also trapped mosquitoes and collected information about potential host species. We used mathematical models to recover risk factors for infection and underlying probabilities of severe disease and death. We observed 19.0% [95% confidence interval (CI):17.1 to 21.1] of JEV antibodies. On average, 0.7% (95% CI: 0.2 to 2.0) of the susceptible population gets infected yearly, with pig proximity being the main human infection risk factor. Our traps captured 10 different mosquito species that have been linked with JEV transmission. We estimated that 1 in 1000 infections results in severe disease, 1 in 10,000 results in death, and 76% of severe cases are missed by surveillance.
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Affiliation(s)
- Mariana Perez Duque
- Pathogen Dynamics Group, Department of Genetics, University of Cambridge, Cambridge, UK
| | - Abu M. Naser
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | | | - Megan O’Driscoll
- Pathogen Dynamics Group, Department of Genetics, University of Cambridge, Cambridge, UK
| | - Kishor K. Paul
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Mahmudur Rahman
- Institute for Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mohammad S. Alam
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Hasan M. Al-Amin
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of the Environment, The University of Queensland, Brisbane, QLD, Australia
| | - Mohammed Z. Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad E. Hossain
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Repon C. Paul
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, UMR 2000 CNRS, Paris, France
| | | | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henrik Salje
- Pathogen Dynamics Group, Department of Genetics, University of Cambridge, Cambridge, UK
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Bhaumik S, Habib AG, Santra V. Strategic priorities for accelerating action to reduce the burden of snakebite. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002866. [PMID: 38315692 PMCID: PMC10843099 DOI: 10.1371/journal.pgph.0002866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Soumyadeep Bhaumik
- Injury Division, George Institute for Global Health, New Delhi, India
- Meta-research and Evidence Synthesis Unit, Health Systems Science, George Institute for Global Health, Sydney, Australia
| | - Abdulrazaq G. Habib
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Science, Bayero University, Kano, Nigeria
| | - Vishal Santra
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal, India
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Haider MS, Youngkong S, Thavorncharoensap M, Thokala P. Priority setting of vaccine introduction in Bangladesh: a multicriteria decision analysis study. BMJ Open 2022; 12:e054219. [PMID: 35228286 PMCID: PMC8886403 DOI: 10.1136/bmjopen-2021-054219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To prioritise vaccines for introduction in Bangladesh. METHODS Multicriteria decision analysis (MCDA) process was used to prioritise potential vaccines for introduction in Bangladesh. A set of criteria were identified, weighted and assigned scores by relevant stakeholders (n=14) during workshop A. The performance matrix of the data of vaccines against the criteria set was constructed and validated with the experts (n=6) in workshop B. The vaccines were ranked and appraised by another group of stakeholders (n=10) in workshop C, and the final workshop D involved the dissemination of the findings to decision-makers (n=28). RESULTS Five criteria including incidence rate, case fatality rate, vaccine efficacy, size of the population at risk and type of population at risk were used quantitatively to evaluate and to score the vaccines. Two other criteria, cost-effectiveness and outbreak potentiality, were considered qualitatively. On deliberation, the Japanese encephalitis (JE) vaccine was ranked top to be recommended for introduction in Bangladesh. CONCLUSIONS Based on the MCDA results, JE vaccine is planned to be recommended to the decision-makers for introduction into the national vaccine benefit package. The policymakers support the use of systematic evidence-based decision-making processes such as MCDA for vaccine introduction in Bangladesh, and to prioritise health interventions in the country.
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Affiliation(s)
- Mohammad Sabbir Haider
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Directorate General of Health Services, Government of Bangladesh Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment (MUHTA) Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Praveen Thokala
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Moore SM. The current burden of Japanese encephalitis and the estimated impacts of vaccination: Combining estimates of the spatial distribution and transmission intensity of a zoonotic pathogen. PLoS Negl Trop Dis 2021; 15:e0009385. [PMID: 34644296 PMCID: PMC8544850 DOI: 10.1371/journal.pntd.0009385] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/25/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
Japanese encephalitis virus (JEV) is a major cause of neurological disability in Asia and causes thousands of severe encephalitis cases and deaths each year. Although Japanese encephalitis (JE) is a WHO reportable disease, cases and deaths are significantly underreported and the true burden of the disease is not well understood in most endemic countries. Here, we first conducted a spatial analysis of the risk factors associated with JE to identify the areas suitable for sustained JEV transmission and the size of the population living in at-risk areas. We then estimated the force of infection (FOI) for JE-endemic countries from age-specific incidence data. Estimates of the susceptible population size and the current FOI were then used to estimate the JE burden from 2010 to 2019, as well as the impact of vaccination. Overall, 1,543.1 million (range: 1,292.6-2,019.9 million) people were estimated to live in areas suitable for endemic JEV transmission, which represents only 37.7% (range: 31.6-53.5%) of the over four billion people living in countries with endemic JEV transmission. Based on the baseline number of people at risk of infection, there were an estimated 56,847 (95% CI: 18,003-184,525) JE cases and 20,642 (95% CI: 2,252-77,204) deaths in 2019. Estimated incidence declined from 81,258 (95% CI: 25,437-273,640) cases and 29,520 (95% CI: 3,334-112,498) deaths in 2010, largely due to increases in vaccination coverage which have prevented an estimated 314,793 (95% CI: 94,566-1,049,645) cases and 114,946 (95% CI: 11,421-431,224) deaths over the past decade. India had the largest estimated JE burden in 2019, followed by Bangladesh and China. From 2010-2019, we estimate that vaccination had the largest absolute impact in China, with 204,734 (95% CI: 74,419-664,871) cases and 74,893 (95% CI: 8,989-286,239) deaths prevented, while Taiwan (91.2%) and Malaysia (80.1%) had the largest percent reductions in JE burden due to vaccination. Our estimates of the size of at-risk populations and current JE incidence highlight countries where increasing vaccination coverage could have the largest impact on reducing their JE burden. Japanese encephalitis is a vector-transmitted, zoonotic disease that is endemic throughout a large portion of Asia. Vaccination has significantly reduced the JE burden in several formerly high-burden countries, but vaccination coverage remains limited in several other countries with high JE burdens. A better understanding of both the spatial distribution and the magnitude of the burden in endemic countries is critical for future disease prevention efforts. To estimate the number of people living in areas within Asia suitable for JEV transmission we conducted a spatial analysis of the risk factors associated with JE. We estimate that over one billion people live in areas suitable for local JEV transmission. We then combined these population-at-risk estimates with estimates of the force of infection (FOI) to model the national-level burden of JE (annual cases and deaths) over the past decade. Increases in vaccination coverage have reduced JE incidence from over 80,000 cases in 2010 to fewer than 57,000 cases in 2019. We estimate that vaccination has prevented almost 315,000 cases and 115,000 deaths in the past decade. Our results also call attention to the countries, and high-risk areas within countries, where increases in vaccination coverage are most needed.
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Affiliation(s)
- Sean M. Moore
- Department of Biological Sciences and Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
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Chowdhury S, Aleem MA, Khan MSI, Hossain ME, Ghosh S, Rahman MZ. Major zoonotic diseases of public health importance in Bangladesh. Vet Med Sci 2021; 7:1199-1210. [PMID: 33650812 PMCID: PMC8013274 DOI: 10.1002/vms3.465] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/01/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022] Open
Abstract
Zoonotic diseases cause repeated outbreaks in humans globally. The majority of emerging infections in humans are zoonotic. COVID‐19 is an ideal example of a recently identified emerging zoonotic disease, causing a global pandemic. Anthropogenic factors such as modernisation of agriculture and livestock farming, wildlife hunting, the destruction of wild animal habitats, mixing wild and domestic animals, wildlife trading, changing food habits and urbanisation could drive the emergence of zoonotic diseases in humans. Since 2001, Bangladesh has been reporting many emerging zoonotic disease outbreaks such as nipah, highly pathogenic avian influenza, pandemic H1N1, and COVID‐19. There are many other potential zoonotic pathogens such as Ebola, Middle East respiratory syndrome coronavirus, Kyasanur forest disease virus and Crimean–Congo haemorrhagic fever that may emerge in the future. However, we have a limited understanding of zoonotic diseases’ overall risk in humans and associated factors that drive the emergence of zoonotic pathogens. This narrative review summarised the major emerging, re‐emerging, neglected and other potential zoonotic diseases in Bangladesh and their associated risk factors. Nipah virus and Bacillus anthracis caused repeated outbreaks in humans. More than 300 human cases with Nipah virus infection were reported since the first outbreak in 2001. The highly pathogenic avian influenza virus (H5N1) caused more than 550 outbreaks in poultry, and eight human cases were reported so far since 2007. People of Bangladesh are frequently exposed to zoonotic pathogens due to close interaction with domestic and peri‐domestic animals. The rapidly changing intensified animal–human–ecosystem interfaces and risky practices increase the risk of zoonotic disease transmission. The narrative review's findings are useful to draw attention to the risk and emergence of zoonotic diseases to public health policymakers in Bangladesh and the application of one‐health approach to address this public health threat.
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Affiliation(s)
- Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad A Aleem
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Md Shafiqul I Khan
- Department of Food Microbiology, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Mohammad Enayet Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Ghosh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Z Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Hospital-based surveillance for Japanese encephalitis in Bangladesh, 2007-2016: Implications for introduction of immunization. Int J Infect Dis 2020; 99:69-74. [PMID: 32721530 PMCID: PMC7566160 DOI: 10.1016/j.ijid.2020.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 11/26/2022] Open
Abstract
Japanese encephalitis (JE) is largely preventable through vaccination. Several JE vaccines prequalified by World Health Organization are available. Hospital-based surveillance were conducted in Bangladesh to describe JE epidemiology. JE cases were identified each year, among all age groups, and from a widespread geographical area. Routine childhood immunization program or mass vaccination need to be examined.
Background Japanese encephalitis (JE) virus is recognized as a major cause of encephalitis in Bangladesh. The World Health Organization (WHO) recommends human immunization as the most effective means to control JE. Several WHO-prequalified vaccines are available to prevent JE but no vaccination program has been implemented in Bangladesh. Methods We conducted hospital-based surveillance for acute meningitis-encephalitis syndrome (AMES) to describe JE epidemiology and help inform policy decisions about possible immunization strategies for Bangladesh. Results During 2007–2016, a total of 6543 AMES patients were identified at four tertiary hospitals. Of the 6525 patients tested, 548 (8%) were classified as JE cases. These 548 patients resided in 36 (56%) out of 64 districts of Bangladesh, with the highest proportion of JE cases among AMES patients (12% and 7%) presenting at two hospitals in the northwestern part of the country. The median age of JE cases was 30 years, and 193 (35%) were aged ≤15 years. The majority of JE cases (80%) were identified from July through November. Conclusions Surveillance results suggest that JE continues to be an important cause of meningo-encephalitis in Bangladesh. Immunization strategies including JE vaccine introduction into the routine childhood immunization program or mass vaccination in certain age groups or geographic areas need to be examined, taking into consideration the cost-effectiveness ratio of the approach and potential for decreasing disease burden.
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Hopkins H, Bassat Q, Chandler CI, Crump JA, Feasey NA, Ferrand RA, Kranzer K, Lalloo DG, Mayxay M, Newton PN, Mabey D. Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia. BMJ Open 2020; 10:e035632. [PMID: 32699131 PMCID: PMC7375419 DOI: 10.1136/bmjopen-2019-035632] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Fever commonly leads to healthcare seeking and hospital admission in sub-Saharan Africa and Asia. There is only limited guidance for clinicians managing non-malarial fevers, which often results in inappropriate treatment for patients. Furthermore, there is little evidence for estimates of disease burden, or to guide empirical therapy, control measures, resource allocation, prioritisation of clinical diagnostics or antimicrobial stewardship. The Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) study seeks to address these information gaps. METHODS AND ANALYSIS FIEBRE investigates febrile illness in paediatric and adult outpatients and inpatients using standardised clinical, laboratory and social science protocols over a minimum 12-month period at five sites in sub-Saharan Africa and Southeastern and Southern Asia. Patients presenting with fever are enrolled and provide clinical data, pharyngeal swabs and a venous blood sample; selected participants also provide a urine sample. Laboratory assessments target infections that are treatable and/or preventable. Selected point-of-care tests, as well as blood and urine cultures and antimicrobial susceptibility testing, are performed on site. On day 28, patients provide a second venous blood sample for serology and information on clinical outcome. Further diagnostic assays are performed at international reference laboratories. Blood and pharyngeal samples from matched community controls enable calculation of AFs, and surveys of treatment seeking allow estimation of the incidence of common infections. Additional assays detect markers that may differentiate bacterial from non-bacterial causes of illness and/or prognosticate illness severity. Social science research on antimicrobial use will inform future recommendations for fever case management. Residual samples from participants are stored for future use. ETHICS AND DISSEMINATION Ethics approval was obtained from all relevant institutional and national committees; written informed consent is obtained from all participants or parents/guardians. Final results will be shared with participating communities, and in open-access journals and other scientific fora. Study documents are available online (https://doi.org/10.17037/PUBS.04652739).
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Affiliation(s)
- Heidi Hopkins
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Pg. Lluís Companys 23, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Clare Ir Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Nicholas A Feasey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rashida A Ferrand
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- National and Supranational Reference Center for Mycobacteria, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
| | | | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Paul N Newton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - David Mabey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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8
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Hegde ST, Salje H, Sazzad HMS, Hossain MJ, Rahman M, Daszak P, Klena JD, Nichol ST, Luby SP, Gurley ES. Using healthcare-seeking behaviour to estimate the number of Nipah outbreaks missed by hospital-based surveillance in Bangladesh. Int J Epidemiol 2020; 48:1219-1227. [PMID: 30977803 DOI: 10.1093/ije/dyz057] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Understanding the true burden of emergent diseases is critical for assessing public-health impact. However, surveillance often relies on hospital systems that only capture a minority of cases. We use the example of Nipah-virus infection in Bangladesh, which has a high case-fatality ratio and frequent person-to-person transmission, to demonstrate how healthcare-seeking data can estimate true burden. METHODS We fit logistic-regression models to data from a population-based, healthcare-seeking study of encephalitis cases to characterize the impact of distance and mortality on attending one of three surveillance hospital sites. The resulting estimates of detection probabilities, as a function of distance and outcome, are applied to all observed Nipah outbreaks between 2007 and 2014 to estimate the true burden. RESULTS The probability of attending a surveillance hospital fell from 82% for people with fatal encephalitis living 10 km away from a surveillance hospital to 54% at 50 km away. The odds of attending a surveillance hospital are 3.2 (95% confidence interval: 1.6, 6.6) times greater for patients who eventually died (i.e. who were more severely ill) compared with those who survived. Using these probabilities, we estimated that 119 Nipah outbreaks (95% confidence interval: 103, 140)-an average of 15 outbreaks per Nipah season-occurred during 2007-14; 62 (52%) were detected. CONCLUSIONS Our findings suggest hospital-based surveillance missed nearly half of all Nipah outbreaks. This analytical method allowed us to estimate the underlying burden of disease, which is important for emerging diseases where healthcare access may be limited.
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Affiliation(s)
- Sonia T Hegde
- Johns Hopkins University, Baltimore, Maryland, USA.,Global Disease Detection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henrik Salje
- Johns Hopkins University, Baltimore, Maryland, USA.,Institut Pasteur, Paris, France
| | - Hossain M S Sazzad
- International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh.,University of New South Wales, Sydney, New South Wales, Australia
| | - M Jahangir Hossain
- International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | | | - John D Klena
- Viral Special Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart T Nichol
- Viral Special Pathogens, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen P Luby
- Global Disease Detection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Stanford University, Palo Alto, California, USA
| | - Emily S Gurley
- Johns Hopkins University, Baltimore, Maryland, USA.,International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
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9
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Sazzad HMS. A trial for post-exposure prophylaxis against henipaviruses. THE LANCET. INFECTIOUS DISEASES 2020; 20:387-388. [PMID: 32027841 DOI: 10.1016/s1473-3099(19)30687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Hossain M S Sazzad
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; icddr,b, Dhaka, Bangladesh.
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10
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Andrews JR, Barkume C, Yu AT, Saha SK, Qamar FN, Garrett D, Luby SP. Integrating Facility-Based Surveillance With Healthcare Utilization Surveys to Estimate Enteric Fever Incidence: Methods and Challenges. J Infect Dis 2019; 218:S268-S276. [PMID: 30184162 PMCID: PMC6226762 DOI: 10.1093/infdis/jiy494] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/16/2018] [Indexed: 11/15/2022] Open
Abstract
Cohort studies and facility-based sentinel surveillance are common approaches to characterizing infectious disease burden, but present trade-offs; cohort studies are resource-intensive and may alter disease natural history, while sentinel surveillance underestimates incidence in the population. Hybrid surveillance, whereby facility-based surveillance is paired with a community-based healthcare utilization assessment, represents an alternative approach to generating population-based disease incidence estimates with moderate resource investments. Here, we discuss this method in the context of the Surveillance for Enteric Fever in Asia Project (SEAP) study. We describe how data are collected and utilized to adjust enteric fever incidence for blood culture sensitivity, facility-based enrollment, and healthcare seeking, incorporating uncertainty in these parameters in the uncertainty around incidence estimates. We illustrate how selection of surveillance sites and their coverage may influence precision and bias, and we identify approaches in the study design and analysis to minimize and control for these biases. Rigorously designed hybrid surveillance systems can be an efficient approach to generating population-based incidence estimates for infectious diseases.
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Affiliation(s)
- Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Caitlin Barkume
- Typhoid Programs, Sabin Vaccine Institute, Washington, District of Columbia
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Samir K Saha
- Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Farah N Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Denise Garrett
- Typhoid Programs, Sabin Vaccine Institute, Washington, District of Columbia
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
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11
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Paul RC, Gidding HF, Nazneen A, Banik KC, Sumon SA, Paul KK, Luby SP, Gurley ES, Hayen A. A Low-Cost, Community Knowledge Approach to Estimate Maternal and Jaundice-Associated Mortality in Rural Bangladesh. Am J Trop Med Hyg 2019; 99:1633-1638. [PMID: 30298803 DOI: 10.4269/ajtmh.17-0974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the absence of a civil registration system, a house-to-house survey is often used to estimate cause-specific mortality in low- and middle-income countries. However, house-to-house surveys are resource and time intensive. We applied a low-cost community knowledge approach to identify maternal deaths from any cause and jaundice-associated deaths among persons aged ≥ 14 years, and stillbirths and neonatal deaths in mothers with jaundice during pregnancy in five rural communities in Bangladesh. We estimated the method's sensitivity and cost savings compared with a house-to-house survey. In the five communities with a total of 125,570 population, we identified 13 maternal deaths, 60 deaths among persons aged ≥ 14 years associated with jaundice, five neonatal deaths, and four stillbirths born to a mother with jaundice during pregnancy over the 3-year period before the survey using the community knowledge approach. The sensitivity of community knowledge method in identifying target deaths ranged from 80% for neonatal deaths to 100% for stillbirths and maternal deaths. The community knowledge approach required 36% of the staff time to undertake compared with the house-to-house survey. The community knowledge approach was less expensive but highly sensitive in identifying maternal and jaundice-associated mortality, as well as all-cause adult mortality in rural settings in Bangladesh. This method can be applied in rural settings of other low- and middle-income countries and, in conjunction with hospital-based hepatitis diagnoses, used to monitor the impact of programs to reduce the burden of cause-specific hepatitis mortality, a current World Health Organization priority.
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Affiliation(s)
- Repon C Paul
- School of Public Health and Community Medicine, UNSW Medicine, Sydney, Australia.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Heather F Gidding
- School of Public Health and Community Medicine, UNSW Medicine, Sydney, Australia
| | - Arifa Nazneen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kajal C Banik
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shariful A Sumon
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kishor K Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California
| | - Emily S Gurley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Andrew Hayen
- Australian Centre for Public and Population Health, Research, University of Technology Sydney, Sydney, Australia
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12
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Carugati M, Biggs HM, Maze MJ, Stoddard RA, Cash-Goldwasser S, Hertz JT, Halliday JEB, Saganda W, Lwezaula BF, Kazwala RR, Cleaveland S, Maro VP, Rubach MP, Crump JA. Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014. Trans R Soc Trop Med Hyg 2019; 112:136-143. [PMID: 29697848 PMCID: PMC5961162 DOI: 10.1093/trstmh/try033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Brucellosis causes substantial morbidity among humans and their livestock. There are few robust estimates of the incidence of brucellosis in sub-Saharan Africa. Using cases identified through sentinel hospital surveillance and health care utilization data, we estimated the incidence of brucellosis in Moshi Urban and Moshi Rural Districts, Kilimanjaro Region, Tanzania, for the periods 2007–2008 and 2012–2014. Methods Cases were identified among febrile patients at two sentinel hospitals and were defined as having either a 4-fold increase in Brucella microscopic agglutination test titres between acute and convalescent serum or a blood culture positive for Brucella spp. Findings from a health care utilization survey were used to estimate multipliers to account for cases not seen at sentinel hospitals. Results Of 585 patients enrolled in the period 2007–2008, 13 (2.2%) had brucellosis. Among 1095 patients enrolled in the period 2012–2014, 32 (2.9%) had brucellosis. We estimated an incidence (range based on sensitivity analysis) of brucellosis of 35 (range 32–93) cases per 100 000 persons annually in the period 2007–2008 and 33 (range 30–89) cases per 100 000 persons annually in the period 2012–2014. Conclusions We found a moderate incidence of brucellosis in northern Tanzania, suggesting that the disease is endemic and an important human health problem in this area.
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Affiliation(s)
- Manuela Carugati
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases, San Gerardo Hospital, Monza, Italy
| | - Holly M Biggs
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Michael J Maze
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Robyn A Stoddard
- Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, GA, USA
| | - Shama Cash-Goldwasser
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jo E B Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | | | | | - Sarah Cleaveland
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Matthew P Rubach
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - John A Crump
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.,Centre for International Health, University of Otago, Dunedin, New Zealand.,Duke Global Health Institute, Duke University, Durham, NC, USA.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
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13
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Salje H, Paul KK, Paul R, Rodriguez-Barraquer I, Rahman Z, Alam MS, Rahman M, Al-Amin HM, Heffelfinger J, Gurley E. Nationally-representative serostudy of dengue in Bangladesh allows generalizable disease burden estimates. eLife 2019; 8:42869. [PMID: 30958263 PMCID: PMC6513551 DOI: 10.7554/elife.42869] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/04/2019] [Indexed: 01/08/2023] Open
Abstract
Serostudies are needed to answer generalizable questions on disease risk. However, recruitment is usually biased by age or location. We present a nationally-representative study for dengue from 70 communities in Bangladesh. We collected data on risk factors, trapped mosquitoes and tested serum for IgG. Out of 5866 individuals, 24% had evidence of historic infection, ranging from 3% in the north to >80% in Dhaka. Being male (aOR:1.8, [95%CI:1.5–2.0]) and recent travel (aOR:1.3, [1.1–1.8]) were linked to seropositivity. We estimate that 40 million [34.3–47.2] people have been infected nationally, with 2.4 million ([1.3–4.5]) annual infections. Had we visited only 20 communities, seropositivity estimates would have ranged from 13% to 37%, highlighting the lack of representativeness generated by small numbers of communities. Our findings have implications for both the design of serosurveys and tackling dengue in Bangladesh. Dengue is a mosquito-borne virus that infects millions of people each year. Often the countries most affected by the virus, such as Bangladesh, do not have the resources needed to tackle the disease. For resources sent to these countries to have the greatest impact, it is important to know which areas are most affected, and which subsets of the population are most at risk. A way to gather this information is to test for dengue virus antibodies a protein produced by the immune system in response to the infection in the blood of individuals. However, previous efforts to use these tests to understand dengue risk in communities have generally only been done in single locations, typically a major city, and the findings of these tests are unlikely to be applicable to the wider population. Now, Salje et al. have visited 70 different communities from all around Bangladesh and used these tests on blood samples collected from over 5,000 individuals from a range of age-groups. From these measurements it was estimated that an average 2.4 million people are infected with dengue each year in Bangladesh, with major cities, such as Dhaka, experiencing more concentrated levels. The exposure to dengue outside major cities was much lower, and men, who tend to travel more, were found to be at greater risk of infection. Salje et al. also showed that using a small number of communities to estimate national levels of infection led to misleading results. This highlights the danger of using information collected from a limited number of places to represent the effects of a disease on the wider population. Public health agencies in Bangladesh will be able to use this information to tackle dengue more effectively, focusing on the areas and the populations most affected by the disease. In addition, the design and analytical approaches used in this study could be applied to other countries, and to different diseases.
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Affiliation(s)
- Henrik Salje
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Kishor Kumar Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Repon Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Shafiul Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahmadur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Hasan Mohammad Al-Amin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - James Heffelfinger
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, United States
| | - Emily Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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14
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Abstract
PURPOSE OF REVIEW We examine the present global burden of Japanese encephalitis (JE) in endemic populations, summarize published cases in travelers since 2009, examine current guidelines for vaccination for international travelers, and consider challenges in prevention of this vector-borne disease. RECENT FINDINGS We identified 11 JE cases in travelers that were published in peer-reviewed literature since 2009. JE incidence in endemic countries appears to be declining but the number of JE cases reported to the World Health Organization (WHO) varied from estimates derived from other published reports based on serosurveys or sentinel surveillance. Current JE vaccines appear to be safe and are not associated with delayed hypersensitivity in contrast to the older mouse brain vaccine. Given differences between WHO-reported cases and local surveillance data, future research on true incidence is needed. Regular assessment will inform JE risk in travelers. National and international guidelines on JE vaccination varied; we suggest areas for improvement.
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15
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Estimation of the Burden of Serious Human Fungal Infections in Malaysia. J Fungi (Basel) 2018; 4:jof4010038. [PMID: 29562712 PMCID: PMC5872341 DOI: 10.3390/jof4010038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/07/2018] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
Abstract
Fungal infections (mycoses) are likely to occur more frequently as ever-increasingly sophisticated healthcare systems create greater risk factors. There is a paucity of systematic data on the incidence and prevalence of human fungal infections in Malaysia. We conducted a comprehensive study to estimate the burden of serious fungal infections in Malaysia. Our study showed that recurrent vaginal candidiasis (>4 episodes/year) was the most common of all cases with a diagnosis of candidiasis (n = 501,138). Oesophageal candidiasis (n = 5850) was most predominant among individuals with HIV infection. Candidemia incidence (n = 1533) was estimated in hospitalized individuals, some receiving treatment for cancer (n = 1073), and was detected also in individuals admitted to intensive care units (ICU) (n = 460). In adults with asthma, allergic bronchopulmonary aspergillosis (ABPA) was the second most common respiratory mycoses noticed (n = 30,062) along with severe asthma with fungal sensitization (n = 39,628). Invasive aspergillosis was estimated in 184 cases undergoing anti-cancer treatment and 834 ICU cases. Cryptococcal meningitis was diagnosed in 700 subjects with HIV/AIDS and Pneumocystis jirovecii pneumonitis (PCP) in 1286 subjects with underlying HIV disease. The present study indicates that at least 590,214 of the Malaysian population (1.93%) is affected by a serious fungal infection annually. This problem is serious enough to warrant the further epidemiological studies to estimate the burden of human fungal infections in Malaysia.
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16
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Ahmed M, Abedin J, Alam KF, Al Mamun A, Paul RC, Rahman M, Iuliano AD, Sturm-Ramirez K, Parashar U, Luby SP, Gurley ES. Incidence of Acute Diarrhea-Associated Death among Children < 5 Years of Age in Bangladesh, 2010-12. Am J Trop Med Hyg 2018; 98:281-286. [PMID: 29141756 DOI: 10.4269/ajtmh.17-0384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Although acute diarrheal deaths have declined globally among children < 5 years, it may still contribute to childhood mortality as an underlying or contributing cause. The aim of this project was to estimate the incidence of acute diarrhea-associated deaths, regardless of primary cause, among children < 5 years in Bangladesh during 2010-12. We conducted a survey in 20 unions (administrative units) within the catchment areas of 10 tertiary hospitals in Bangladesh. Through social networks, our field team identified households where children < 5 years were reported to have died during 2010-12. Trained data collectors interviewed caregivers of the deceased children and recorded illness symptoms, health care seeking, and other information using an abbreviated international verbal autopsy questionnaire. We classified the deceased based upon the presence of diarrhea before death. We identified 880 deaths, of which 36 (4%) died after the development of acute diarrhea, 17 (2%) had diarrhea-only in the illness preceding death, and 19 (53%) had cough or difficulty breathing in addition to diarrhea. The estimated annual incidence of all-cause mortality in the unions < 13.6 km of the tertiary hospitals was 26 (95% confidence interval [CI] 16-37) per 1,000 live births compared with the mortality rate of 37 (95% CI 26-49) per 1,000 live births in the unions located ≥ 13.6 km. Diarrhea contributes to childhood death at a higher proportion than when considering it only as the sole underlying cause of death. These data support the use of interventions aimed at preventing acute diarrhea, especially available vaccinations for common etiologies, such as rotavirus.
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Affiliation(s)
- Makhdum Ahmed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (icddr,b).,The University of Texas MD Anderson Cancer Center, Houston, Texas.,The University of Texas Health Science Center at Houston, Houston, Texas
| | - Jaynal Abedin
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (icddr,b)
| | - Kazi Faisal Alam
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (icddr,b)
| | - Abdullah Al Mamun
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (icddr,b)
| | - Repon C Paul
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (icddr,b)
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Emily S Gurley
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh (icddr,b)
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17
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Ahmed M, Aleem MA, Roguski K, Abedin J, Islam A, Alam KF, Gurley ES, Rahman M, Azziz‐Baumgartner E, Homaira N, Sturm‐Ramirez K, Danielle Iuliano A. Estimates of seasonal influenza-associated mortality in Bangladesh, 2010-2012. Influenza Other Respir Viruses 2018; 12:65-71. [PMID: 29197174 PMCID: PMC5818342 DOI: 10.1111/irv.12490] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Seasonal influenza-associated mortality estimates help identify the burden of disease and assess the value of public health interventions such as annual influenza immunization. Vital registration is limited in Bangladesh making it difficult to estimate seasonal influenza mortality. OBJECTIVES Our study aimed to estimate seasonal influenza-associated mortality rates for 2010-2012 in Bangladesh. METHODS We conducted surveillance among hospitalized patients with severe acute respiratory illness (SARI) for persons aged ≥5 years and severe pneumonia for children <5 years in 11 sites across Bangladesh. We defined the catchment areas of these sites and conducted a community survey in 22 randomly selected unions (administrative units) within the catchment areas to identify respiratory deaths. We multiplied the proportion of influenza-positive patients at our surveillance sites by the age-specific number of respiratory deaths identified to estimate seasonal influenza-associated mortality. RESULTS Among 4221 surveillance case-patients, 553 (13%) were positive for influenza viruses. Concurrently, we identified 1191 persons who died within 2 weeks of developing an acute respiratory illness within the catchment areas of the surveillance hospitals. In 2010-2011, the estimated influenza-associated mortality rate was 6 (95% CI 4-9) per 100 000 for children <5 years and 41 (95% CI 35-47) per 100 000 for persons >60 years. During 2011-2012, the estimated influenza-associated mortality rate was 13 (95% CI 10-16) per 100 000 among children <5 years and 88 (95% CI 79-98) per 100 000 among persons aged >60 years. CONCLUSIONS We identified a substantial burden of influenza-associated deaths in Bangladesh suggesting that the introduction of prevention and control measures including seasonal vaccination should be considered by local public health decision-makers.
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Affiliation(s)
- Makhdum Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
- The University of Texas Health Science Center at HoustonHoustonTXUSA
- The University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Mohammad Abdul Aleem
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | | | - Jaynal Abedin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Ariful Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Kazi Faisal Alam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Emily S. Gurley
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR)DhakaBangladesh
| | | | - Nusrat Homaira
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b)DhakaBangladeshUSA
- School of Women's and Children's HealthThe University of New South Wales (UNSW)SydneyNSWAustralia
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18
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Nikolay B, Salje H, Sturm-Ramirez K, Azziz-Baumgartner E, Homaira N, Ahmed M, Iuliano AD, Paul RC, Rahman M, Hossain MJ, Luby SP, Cauchemez S, Gurley ES. Evaluating Hospital-Based Surveillance for Outbreak Detection in Bangladesh: Analysis of Healthcare Utilization Data. PLoS Med 2017; 14:e1002218. [PMID: 28095468 PMCID: PMC5240927 DOI: 10.1371/journal.pmed.1002218] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/09/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The International Health Regulations outline core requirements to ensure the detection of public health threats of international concern. Assessing the capacity of surveillance systems to detect these threats is crucial for evaluating a country's ability to meet these requirements. METHODS AND FINDINGS We propose a framework to evaluate the sensitivity and representativeness of hospital-based surveillance and apply it to severe neurological infectious diseases and fatal respiratory infectious diseases in Bangladesh. We identified cases in selected communities within surveillance hospital catchment areas using key informant and house-to-house surveys and ascertained where cases had sought care. We estimated the probability of surveillance detecting different sized outbreaks by distance from the surveillance hospital and compared characteristics of cases identified in the community and cases attending surveillance hospitals. We estimated that surveillance detected 26% (95% CI 18%-33%) of severe neurological disease cases and 18% (95% CI 16%-21%) of fatal respiratory disease cases residing at 10 km distance from a surveillance hospital. Detection probabilities decreased markedly with distance. The probability of detecting small outbreaks (three cases) dropped below 50% at distances greater than 26 km for severe neurological disease and at distances greater than 7 km for fatal respiratory disease. Characteristics of cases attending surveillance hospitals were largely representative of all cases; however, neurological disease cases aged <5 y or from the lowest socioeconomic group and fatal respiratory disease cases aged ≥60 y were underrepresented. Our estimates of outbreak detection rely on suspected cases that attend a surveillance hospital receiving laboratory confirmation of disease and being reported to the surveillance system. The extent to which this occurs will depend on disease characteristics (e.g., severity and symptom specificity) and surveillance resources. CONCLUSION We present a new approach to evaluating the sensitivity and representativeness of hospital-based surveillance, making it possible to predict its ability to detect emerging threats.
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Affiliation(s)
- Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, URA3012, Paris, France
- Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France
| | - Henrik Salje
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, URA3012, Paris, France
- Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Katharine Sturm-Ramirez
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nusrat Homaira
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Makhdum Ahmed
- School of Public Health, University of Texas Health Science Center, Houston, Texas, United States of America
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - A. Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Repon C. Paul
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Stephen P. Luby
- Infectious Diseases Division, Stanford University, Stanford, California, United States of America
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
- Centre National de la Recherche Scientifique, URA3012, Paris, France
- Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France
| | - Emily S. Gurley
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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19
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Maze MJ, Biggs HM, Rubach MP, Galloway RL, Cash-Goldwasser S, Allan KJ, Halliday JEB, Hertz JT, Saganda W, Lwezaula BF, Cleaveland S, Mmbaga BT, Maro VP, Crump JA. Comparison of the Estimated Incidence of Acute Leptospirosis in the Kilimanjaro Region of Tanzania between 2007-08 and 2012-14. PLoS Negl Trop Dis 2016; 10:e0005165. [PMID: 27911902 PMCID: PMC5135036 DOI: 10.1371/journal.pntd.0005165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022] Open
Abstract
Background The sole report of annual leptospirosis incidence in continental Africa of 75–102 cases per 100,000 population is from a study performed in August 2007 through September 2008 in the Kilimanjaro Region of Tanzania. To evaluate the stability of this estimate over time, we estimated the incidence of acute leptospirosis in Kilimanjaro Region, northern Tanzania for the time period 2012–2014. Methodology and Principal Findings Leptospirosis cases were identified among febrile patients at two sentinel hospitals in the Kilimanjaro Region. Leptospirosis was diagnosed by serum microscopic agglutination testing using a panel of 20 Leptospira serovars belonging to 17 separate serogroups. Serum was taken at enrolment and patients were asked to return 4–6 weeks later to provide convalescent serum. Confirmed cases required a 4-fold rise in titre and probable cases required a single titre of ≥800. Findings from a healthcare utilisation survey were used to estimate multipliers to adjust for cases not seen at sentinel hospitals. We identified 19 (1.7%) confirmed or probable cases among 1,115 patients who presented with a febrile illness. Of cases, the predominant reactive serogroups were Australis 8 (42.1%), Sejroe 3 (15.8%), Grippotyphosa 2 (10.5%), Icterohaemorrhagiae 2 (10.5%), Pyrogenes 2 (10.5%), Djasiman 1 (5.3%), Tarassovi 1 (5.3%). We estimated that the annual incidence of leptospirosis was 11–18 cases per 100,000 population. This was a significantly lower incidence than 2007–08 (p<0.001). Conclusions We estimated a much lower incidence of acute leptospirosis than previously, with a notable absence of cases due to the previously predominant serogroup Mini. Our findings indicate a dynamic epidemiology of leptospirosis in this area and highlight the value of multi-year surveillance to understand leptospirosis epidemiology. Leptospirosis is an infectious disease that causes a fever. It can be severe or fatal. Understanding how many people get leptospirosis helps to determine priorities in allocating resources for disease diagnosis, treatment, and prevention. There are few data about leptospirosis incidence in sub-Saharan African countries. The only mainland estimate is from northern Tanzania for the years 2007–08. To see if leptospirosis incidence had changed since 2007–08, we measured leptospirosis incidence in the same location in 2012–2014. To do this, we systematically approached people at two hospitals in the Kilimanjaro Region and tested them for leptospirosis. We adjusted the number of identified cases of leptospirosis found at the hospitals to account for people with fever who did not come to hospital for testing and care. We also adjusted for imperfect testing methods. We found that the number of people who developed leptospirosis annually had dropped from 75–102 cases per 100,000 people during 2007–08 to 11–18 cases per 100,000 people during 2012–14. Also, the subtype of leptospirosis responsible for the most cases during 2007–08 was not present during 2012–14. The number of people developing leptospirosis was not stable, highlighting the value of measuring how commonly leptospirosis occurs over several years.
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Affiliation(s)
- Michael J. Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- * E-mail:
| | - Holly M. Biggs
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Matthew P. Rubach
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Renee L. Galloway
- Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia, United States of America
| | - Shama Cash-Goldwasser
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Kathryn J. Allan
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jo E. B. Halliday
- Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Julian T. Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | | | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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20
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Beardsley J, Denning DW, Chau NV, Yen NTB, Crump JA, Day JN. Estimating the burden of fungal disease in Vietnam. Mycoses 2016; 58 Suppl 5:101-6. [PMID: 26449514 PMCID: PMC4606745 DOI: 10.1111/myc.12382] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/14/2015] [Accepted: 05/02/2015] [Indexed: 12/18/2022]
Abstract
Data regarding the prevalence of fungal infections in Vietnam are limited yet they are likely to occur more frequently as increasingly sophisticated healthcare creates more iatrogenic risk factors. In this study, we sought to estimate baseline incidence and prevalence of selected serious fungal infections for the year 2012. We made estimates with a previously described actuarial method, using reports on the incidence and prevalence of various established risk factors for fungal infections from Vietnam, or similar environments, supplemented by personal communications. Global data were used if local data were unavailable. We estimated 2 352 748 episodes of serious fungal infection occurred in Vietnam in 2012. Frequent conditions included recurrent vaginal candidiasis (3893/100 000 women annually), tinea capitis (457/100 000 annually) and chronic pulmonary aspergillosis (61/100 000/5 year period). We estimated 140 cases of cryptococcal meningitis, 206 of penicilliosis and 608 of Pneumocystis jirovecii pneumonia. This is the first summary of Vietnamese fungal infections. The majority of severe disease is due to Aspergillus species, driven by the high prevalence of pulmonary tuberculosis. The AIDS epidemic highlights opportunistic infections, such as penicilliosis and cryptococcosis, which may complicate immunosuppressive treatments. These estimates provide a useful indication of disease prevalence to inform future research and resource allocation but should be verified by further epidemiological approaches.
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Affiliation(s)
- J Beardsley
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - D W Denning
- The National Aspergillosis Centre, The University of Manchester, Manchester, UK
| | - N V Chau
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - N T B Yen
- Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - J A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J N Day
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Wellcome Trust Intermediate Fellow, London, UK
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21
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Morales I, Salje H, Saha S, Gurley ES. Seasonal Distribution and Climatic Correlates of Dengue Disease in Dhaka, Bangladesh. Am J Trop Med Hyg 2016; 94:1359-61. [PMID: 27114293 DOI: 10.4269/ajtmh.15-0846] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/12/2016] [Indexed: 11/07/2022] Open
Abstract
Dengue has been regularly reported in Dhaka, Bangladesh, since a large outbreak in 2000. However, to date, we have limited information on the seasonal distribution of dengue disease and how case distribution correlates with climate. Here, we analyzed dengue cases detected at a private diagnostic facility in Dhaka during 2010-2014. We calculated Pearson cross-correlation coefficients to examine the relationship between the timing of cases and both rainfall and temperature. There were 2,334 cases diagnosed during the study period with 76% over the age of 15 years. Cases were reported in every month of the study; however, 90% of cases occurred between June and November. Increases in rainfall were correlated with increases in cases 2 months later (correlation of 0.7). The large proportion of adult cases is consistent with substantial population susceptibility and suggests Dhaka remains at risk for outbreaks. Although cases occurred year-round, public health preparedness should be focused during peak months.
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Affiliation(s)
- Ivonne Morales
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Henrik Salje
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Samir Saha
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | - Emily S Gurley
- Section on Membrane and Cellular Biophysics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; Department of Microbiology, Popular Diagnostic Centre, Dhaka, Bangladesh; International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
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22
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Lord JS, Al-Amin HM, Chakma S, Alam MS, Gurley ES, Pulliam JRC. Sampling Design Influences the Observed Dominance of Culex tritaeniorhynchus: Considerations for Future Studies of Japanese Encephalitis Virus Transmission. PLoS Negl Trop Dis 2016; 10:e0004249. [PMID: 26726881 PMCID: PMC4699645 DOI: 10.1371/journal.pntd.0004249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022] Open
Abstract
Mosquito sampling during Japanese encephalitis virus (JEV)-associated studies, particularly in India, has usually been conducted via aspirators or light traps to catch mosquitoes around cattle, which are dead-end hosts for JEV. High numbers of Culex tritaeniorhynchus, relative to other species, have often been caught during these studies. Less frequently, studies have involved sampling outdoor resting mosquitoes. We aimed to compare the relative abundance of mosquito species between these two previously used mosquito sampling methods. From September to December 2013 entomological surveys were undertaken in eight villages in a Japanese encephalitis (JE) endemic area of Bangladesh. Light traps were used to collect active mosquitoes in households, and resting boxes and a Bina Pani Das hop cage were used near oviposition sites to collect resting mosquitoes. Numbers of humans and domestic animals present in households where light traps were set were recorded. In five villages Cx. tritaeniorhynchus was more likely to be selected from light trap samples near hosts than resting collection samples near oviposition sites, according to log odds ratio tests. The opposite was true for Cx. pseudovishnui and Armigeres subalbatus, which can also transmit JEV. Culex tritaeniorhynchus constituted 59% of the mosquitoes sampled from households with cattle, 28% from households without cattle and 17% in resting collections. In contrast Cx. pseudovishnui constituted 5.4% of the sample from households with cattle, 16% from households with no cattle and 27% from resting collections, while Ar. subalbatus constituted 0.15%, 0.38%, and 8.4% of these samples respectively. These observations may be due to differences in timing of biting activity, host preference and host-seeking strategy rather than differences in population density. We suggest that future studies aiming to implicate vector species in transmission of JEV should consider focusing catches around hosts able to transmit JEV. The relative numbers of individuals of each mosquito species in an area are important to estimate when identifying species that contribute the most to vector-borne pathogen transmission. However, methods to sample mosquitoes and enumerate the number of individuals collected often vary in their catch efficacy between species. For example, species that take a bloodmeal during daylight hours are less likely to be caught using a light trap than a species that feeds predominantly at night. Similarly, sampling near a mammalian host will more likely collect mosquitoes with a preference for mammals than those with a preference for birds. In this study we compare sampling methods for assessing the relative abundance of mosquito species that may be involved in Japanese encephalitis virus (JEV) transmission. Collections near cattle- a species unable to transmit JEV- have been influential in implicating Cx. tritaeniorhynchus as the primary vector of JEV in South Asia, due to the high number of individuals of this species caught relative to other species. Indeed, this mosquito constituted the majority of the mosquitoes collected by light traps in households with cattle in this study. However, other species were more common when sampling households without cattle or resting mosquitoes near oviposition sites. We propose that methods used to sample mosquitoes in studies aiming to implicate species in JEV transmission in South Asia be reconsidered given that there are other mosquito species that are able to transmit JEV, and these species may be underrepresented when sampling using light traps near cattle.
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Affiliation(s)
- Jennifer S. Lord
- Vector Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | | | - Sumit Chakma
- Centre for Communicable Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh
| | | | - Emily S. Gurley
- Centre for Communicable Diseases, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Juliet R. C. Pulliam
- Department of Biology, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
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23
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Nahar N, Uddin M, Gurley ES, Jahangir Hossain M, Sultana R, Luby SP. Cultural and Economic Motivation of Pig Raising Practices in Bangladesh. ECOHEALTH 2015; 12:611-620. [PMID: 26122206 PMCID: PMC4696915 DOI: 10.1007/s10393-015-1046-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/29/2015] [Accepted: 06/11/2015] [Indexed: 06/04/2023]
Abstract
The interactions that pig raisers in Bangladesh have with their pigs could increase the risk of zoonotic disease transmission. Since raising pigs is a cultural taboo to Muslims, we aimed at understanding the motivation for raising pigs and resulting practices that could pose the risk of transmitting disease from pigs to humans in Bangladesh, a predominantly Muslim country. These understandings could help identify acceptable strategies to reduce the risk of disease transmission from pigs to people. To achieve this objective, we conducted 34 in-depth interviews among pig herders and backyard pig raisers in eight districts of Bangladesh. Informants explained that pig raising is an old tradition, embedded in cultural and religious beliefs and practices, the primary livelihood of pig herders, and a supplemental income of backyard pig raisers. To secure additional income, pig raisers sell feces, liver, bile, and other pig parts often used as traditional medicine. Pig raisers have limited economic ability to change the current practices that may put them at risk of exposure to diseases from their pigs. An intervention that improves their financial situation and reduces the risk of zoonotic disease may be of interest to pig raisers.
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Affiliation(s)
- Nazmun Nahar
- icddr,b, GPO Box 128, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Main Uddin
- icddr,b, GPO Box 128, Mohakhali, Dhaka, 1212, Bangladesh
| | - Emily S Gurley
- icddr,b, GPO Box 128, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Rebeca Sultana
- icddr,b, GPO Box 128, Mohakhali, Dhaka, 1212, Bangladesh
| | - Stephen P Luby
- icddr,b, GPO Box 128, Mohakhali, Dhaka, 1212, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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24
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Incidence of severe diarrhoea due to Vibrio cholerae in the catchment area of six surveillance hospitals in Bangladesh. Epidemiol Infect 2015; 144:927-39. [PMID: 26391481 DOI: 10.1017/s0950268815002174] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cholera is an important public health problem in Bangladesh. Interventions to prevent cholera depend on their cost-effectiveness which in turn depends on cholera incidence. Hospital-based diarrhoeal disease surveillance has been ongoing in six Bangladeshi hospitals where a systematic proportion of patients admitted with diarrhoea were enrolled and tested for Vibrio cholerae. However, incidence calculation using only hospital data underestimates the real disease burden because many ill persons seek treatment elsewhere. We conducted a healthcare utilization survey in the catchment areas of surveillance hospitals to estimate the proportion of severe diarrhoeal cases that were admitted to surveillance hospitals and estimated the population-based incidence of severe diarrhoea due to V. cholerae by combining both hospital surveillance and catchment area survey data. The estimated incidence of severe diarrhoea due to cholera ranged from 0.3 to 4.9/1000 population in the catchment area of surveillance hospitals. In children aged <5 years, incidence ranged from 1.0 to 11.0/1000 children. Diarrhoeal deaths were most common in the Chhatak Hospital's catchment area (18.5/100 000 population). This study provides a credible estimate of the incidence of severe diarrhoea due to cholera in Bangladesh, which can be used to assess the cost-effectiveness of cholera prevention activities.
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25
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Luby SP, Saha S, Andrews JR. Towards sustainable public health surveillance for enteric fever. Vaccine 2015; 33 Suppl 3:C3-7. [PMID: 25912287 DOI: 10.1016/j.vaccine.2015.02.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
Enteric fever that results from infection by the typhoidal Salmonellas (Salmonella Typhi and Salmonella Paratyphi A, B and C) is a life-threatening preventable illness. Surveillance of enteric fever is important to understand current burden of disease, to track changes in human health burden from increasing antimicrobial resistance and to assess the impact of efforts to reduce disease burden. Since enteric fever occurs predominantly in low income communities, expensive surveillance is not sustainable. Traditional hospital-based surveillance does not estimate population burden and intensive community-based cohort studies do not capture the severe disease that is crucial to policy decisions. While cohort studies have been considered the gold standard for incidence estimates, the resources required to conduct them are great; as a consequence, estimates of enteric fever burden have been highly geographically and temporally restricted. A hybrid approach combining laboratory diagnosis that is already being conducted in healthcare centers with community-based surveillance of health care facility use offers a low-cost, sustainable approach to generate policy relevant data.
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Affiliation(s)
- Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States.
| | - Samir Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Jason R Andrews
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
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26
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Wang H, Liang G. Epidemiology of Japanese encephalitis: past, present, and future prospects. Ther Clin Risk Manag 2015; 11:435-48. [PMID: 25848290 PMCID: PMC4373597 DOI: 10.2147/tcrm.s51168] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Japanese encephalitis (JE) is one of severe viral encephalitis that affects individuals in Asia, western Pacific countries, and northern Australia. Although 67,900 JE cases have been estimated among 24 JE epidemic countries annually, only 10,426 have been reported in 2011. With the establishment of JE surveillance and vaccine use in some countries, the JE incidence rate has decreased; however, serious outbreaks still occur. Understanding JE epidemics and identifying the circulating JE virus genotypes will improve JE prevention and control. This review summarizes the current epidemiology data in these countries.
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Affiliation(s)
- Huanyu Wang
- State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Department of Viral Encephalitis, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing People's Republic of China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
| | - Guodong Liang
- State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Department of Viral Encephalitis, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing People's Republic of China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
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27
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Cavallaro KF, Sandhu HS, Hyde TB, Johnson BW, Fischer M, Mayer LW, Clark TA, Pallansch MA, Yin Z, Zuo S, Hadler SC, Diorditsa S, Hasan ASMM, Bose AS, Dietz V. Expansion of syndromic vaccine preventable disease surveillance to include bacterial meningitis and Japanese encephalitis: evaluation of adapting polio and measles laboratory networks in Bangladesh, China and India, 2007-2008. Vaccine 2015; 33:1168-75. [PMID: 25597940 PMCID: PMC4830482 DOI: 10.1016/j.vaccine.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/30/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surveillance for acute flaccid paralysis with laboratory confirmation has been a key strategy in the global polio eradication initiative, and the laboratory platform established for polio testing has been expanded in many countries to include surveillance for cases of febrile rash illness to identify measles and rubella cases. Vaccine-preventable disease surveillance is essential to detect outbreaks, define disease burden, guide vaccination strategies and assess immunization impact. Vaccines now exist to prevent Japanese encephalitis (JE) and some etiologies of bacterial meningitis. METHODS We evaluated the feasibility of expanding polio-measles surveillance and laboratory networks to detect bacterial meningitis and JE, using surveillance for acute meningitis-encephalitis syndrome in Bangladesh and China and acute encephalitis syndrome in India. We developed nine syndromic surveillance performance indicators based on international surveillance guidelines and calculated scores using supervisory visit reports, annual reports, and case-based surveillance data. RESULTS Scores, variable by country and targeted disease, were highest for the presence of national guidelines, sustainability, training, availability of JE laboratory resources, and effectiveness of using polio-measles networks for JE surveillance. Scores for effectiveness of building on polio-measles networks for bacterial meningitis surveillance and specimen referral were the lowest, because of differences in specimens and techniques. CONCLUSIONS Polio-measles surveillance and laboratory networks provided useful infrastructure for establishing syndromic surveillance and building capacity for JE diagnosis, but were less applicable for bacterial meningitis. Laboratory-supported surveillance for vaccine-preventable bacterial diseases will require substantial technical and financial support to enhance local diagnostic capacity.
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Affiliation(s)
- Kathleen F Cavallaro
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Hardeep S Sandhu
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terri B Hyde
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara W Johnson
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc Fischer
- Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leonard W Mayer
- Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas A Clark
- Division of Bacterial Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A Pallansch
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuyan Zuo
- World Health Organization, Beijing, People's Republic of China
| | | | | | | | - Anindya S Bose
- National Polio Surveillance Project, World Health Organization, New Delhi, India
| | - Vance Dietz
- Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, USA
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28
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Chowdhury S, Khan SU, Crameri G, Epstein JH, Broder CC, Islam A, Peel AJ, Barr J, Daszak P, Wang LF, Luby SP. Serological evidence of henipavirus exposure in cattle, goats and pigs in Bangladesh. PLoS Negl Trop Dis 2014; 8:e3302. [PMID: 25412358 PMCID: PMC4238985 DOI: 10.1371/journal.pntd.0003302] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022] Open
Abstract
Background Nipah virus (NiV) is an emerging disease that causes severe encephalitis and respiratory illness in humans. Pigs were identified as an intermediate host for NiV transmission in Malaysia. In Bangladesh, NiV has caused recognized human outbreaks since 2001 and three outbreak investigations identified an epidemiological association between close contact with sick or dead animals and human illness. Methodology We examined cattle and goats reared around Pteropus bat roosts in human NiV outbreak areas. We also tested pig sera collected under another study focused on Japanese encephalitis. Principal Findings We detected antibodies against NiV glycoprotein in 26 (6.5%) cattle, 17 (4.3%) goats and 138 (44.2%) pigs by a Luminex-based multiplexed microsphere assay; however, these antibodies did not neutralize NiV. Cattle and goats with NiVsG antibodies were more likely to have a history of feeding on fruits partially eaten by bats or birds (PR = 3.1, 95% CI 1.6–5.7) and drinking palmyra palm juice (PR = 3.9, 95% CI 1.5–10.2). Conclusions This difference in test results may be due to the exposure of animals to one or more novel viruses with antigenic similarity to NiV. Further research may identify a novel organism of public health importance. Nipah virus (NiV), is an emerging disease that causes severe encephalitis and respiratory illness in humans. Pigs were identified as an intermediate host for NiV transmission in Malaysia, and in Bangladesh three NiV outbreak investigations since 2001 identified an epidemiological association between close contact with sick or dead animals and human illness. We collected samples from cattle and goats reared around Pteropus bat roosts in human NiV outbreak areas in Bangladesh, and tested pig sera collected for a Japanese encephalitis study. We detected antibodies against NiV glycoprotein in 26 (6.5%) cattle, 17 (4.3%) goats and 138 (44.2%) pigs by a Luminex-based multiplexed microsphere assay, but none were virus neutralizing. There may have been exposure of Luminex positive animals to one or more novel viruses with antigenic similarity to NiV. Further research may identify a novel organism of public health importance.
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Affiliation(s)
- Sukanta Chowdhury
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- * E-mail:
| | - Salah Uddin Khan
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Gary Crameri
- CSIRO Australian Animal Health Laboratory (AAHL), Geelong, Victoria, Australia
| | | | | | - Ausraful Islam
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Alison J. Peel
- Environmental Futures Research Institute, Griffith University, Nathan, Queensland, Australia
| | - Jennifer Barr
- CSIRO Australian Animal Health Laboratory (AAHL), Geelong, Victoria, Australia
| | - Peter Daszak
- EcoHealth Alliance, New York, New York, United States of America
| | - Lin-Fa Wang
- CSIRO Australian Animal Health Laboratory (AAHL), Geelong, Victoria, Australia
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore
| | - Stephen P. Luby
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Stanford University, Stanford, California, United States of America
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29
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Abdelwahab J, Dietz V, Eggers R, Maher C, Olaniran M, Sandhu H, Vandelaer J. Strengthening the partnership between routine immunization and the global polio eradication initiative to achieve eradication and assure sustainability. J Infect Dis 2014; 210 Suppl 1:S498-503. [PMID: 25316872 PMCID: PMC10617671 DOI: 10.1093/infdis/jiu041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the number of polio endemic countries has declined from 125 to 3 in 2013. Despite this remarkable achievement, ongoing circulation of wild poliovirus in polio-endemic countries and the increase in the number of circulating vaccine-derived poliovirus cases, especially those caused by type 2, is a cause for concern. The Polio Eradication and Endgame Strategic Plan 2013-2018 (PEESP) was developed and includes 4 objectives: detection and interruption of poliovirus transmission, containment and certification, legacy planning, and a renewed emphasis on strengthening routine immunization (RI) programs. This is critical for the phased withdrawal of oral poliovirus vaccine, beginning with the type 2 component, and the introduction of a single dose of inactivated polio vaccine into RI programs. This objective has inspired renewed consideration of how the GPEI and RI programs can mutually benefit one another, how the infrastructure from the GPEI can be used to strengthen RI, and how a strengthened RI can facilitate polio eradication. The PEESP is the first GPEI strategic plan that places strong and clear emphasis on the necessity of improving RI to achieve and sustain global polio eradication.
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Affiliation(s)
| | - Vance Dietz
- Global Immunization Division, CDC, Atlanta, Georgia
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30
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Khan SU, Salje H, Hannan A, Islam MA, Bhuyan AAM, Islam MA, Rahman MZ, Nahar N, Hossain MJ, Luby SP, Gurley ES. Dynamics of Japanese encephalitis virus transmission among pigs in Northwest Bangladesh and the potential impact of pig vaccination. PLoS Negl Trop Dis 2014; 8:e3166. [PMID: 25255286 PMCID: PMC4177832 DOI: 10.1371/journal.pntd.0003166] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/04/2014] [Indexed: 11/19/2022] Open
Abstract
Background Japanese encephalitis (JE) virus infection can cause severe disease in humans, resulting in death or permanent neurologic deficits among survivors. Studies indicate that the incidence of JE is high in northwestern Bangladesh. Pigs are amplifying hosts for JE virus (JEV) and a potentially important source of virus in the environment. The objectives of this study were to describe the transmission dynamics of JEV among pigs in northwestern Bangladesh and estimate the potential impact of vaccination to reduce incidence among pigs. Methodology/Principal Findings We conducted a comprehensive census of pigs in three JE endemic districts and tested a sample of them for evidence of previous JEV infection. We built a compartmental model to describe JEV transmission dynamics in this region and to estimate the potential impact of pig vaccination. We identified 11,364 pigs in the study area. Previous JEV infection was identified in 30% of pigs with no spatial differences in the proportion of pigs that were seropositive across the study area. We estimated that JEV infects 20% of susceptible pigs each year and the basic reproductive number among pigs was 1.2. The model suggest that vaccinating 50% of pigs each year resulted in an estimated 82% reduction in annual incidence in pigs. Conclusions/Significance The widespread distribution of historic JEV infection in pigs suggests they may play an important role in virus transmission in this area. Future studies are required to understand the contribution of pig infections to JE risk in humans and the potential impact of pig vaccination on human disease. Japanese encephalitis (JE) virus infection can cause severe neurological disease in man. More JE cases are seen in northwestern districts in Bangladesh. Pigs are the most common amplifying host of the virus and can act as a potential environmental source. We conducted a comprehensive census of pigs in three JE endemic districts and tested a sample of them for evidence of previous JEV infection. We built a compartmental model to describe JEV transmission dynamics in this region and to estimate the potential impact of pig vaccination. We identified 11,364 pigs in our study area, mostly raised in backyards. About 30% of the pigs had evidence of previous JE virus infection. Our model suggests that vaccinating 50% of pigs each year resulted in an estimated 82% reduction in annual incidence in pigs. Pigs in northwestern Bangladesh may play a significant role in JE virus transmission. JE incidence may be substantially reduced through reasonable pig vaccination coverage.
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Affiliation(s)
- Salah Uddin Khan
- Centre for Communicable Diseases, i,cddr,b, Dhaka, Bangladesh
- College of Public Health and Health Professions - Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - A. Hannan
- Department of Livestock Services, Ministry of Fisheries and Livestock, Dhaka, Bangladesh
| | | | | | | | - M. Ziaur Rahman
- Centre for Communicable Diseases, i,cddr,b, Dhaka, Bangladesh
| | - Nazmun Nahar
- Centre for Communicable Diseases, i,cddr,b, Dhaka, Bangladesh
| | | | - Stephen P. Luby
- Centre for Communicable Diseases, i,cddr,b, Dhaka, Bangladesh
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily S. Gurley
- Centre for Communicable Diseases, i,cddr,b, Dhaka, Bangladesh
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Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania. PLoS Negl Trop Dis 2013; 7:e2589. [PMID: 24340122 PMCID: PMC3855074 DOI: 10.1371/journal.pntd.0002589] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 10/31/2013] [Indexed: 01/22/2023] Open
Abstract
Background The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania. Methodology/Principal Findings We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14%) of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75–102 cases per 100,000 persons annually. Conclusions/Significance We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings. Leptospirosis is a zoonotic infection that occurs worldwide and is caused by a spirochete, Leptospira spp. The incidence of leptospirosis is unknown in most of sub-Saharan Africa, including Tanzania. Incidence estimates are important in prioritizing resources for disease prevention and control. In this study, we calculated leptospirosis incidence in 2 districts in the Kilimanjaro Region of Tanzania using a multiplier method. We used responses from a population-based survey that asked where participants and their household members would seek health care in the event of fever along with the number of leptospirosis cases found at 2 hospitals under surveillance to calculate estimated incidence. We calculated a high incidence of leptospirosis in the study area that was previously unrecognized. This has important implications for prioritizing further research and consideration of public health control measures for leptospirosis in Tanzania.
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Homaira N, Luby SP, Alamgir ASM, Islam K, Paul R, Abedin J, Rahman M, Azim T, Podder G, Sohel BM, Brooks A, Fry AM, Widdowson MA, Bresee J, Rahman M, Azziz-Baumgartner E. Influenza-associated mortality in 2009 in four sentinel sites in Bangladesh. Bull World Health Organ 2012; 90:272-8. [PMID: 22511823 DOI: 10.2471/blt.11.095653] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 11/30/2011] [Accepted: 01/19/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate influenza-associated mortality in Bangladesh in 2009. METHODS In four hospitals in Bangladesh, respiratory samples were collected twice a month throughout 2009 from inpatients aged < 5 years with severe pneumonia and from older inpatients with severe acute respiratory infection. The samples were tested for influenza virus ribonucleic acid (RNA) using polymerase chain reaction. The deaths in 2009 in five randomly selected unions (the smallest administrative units in Bangladesh) in each hospital's catchment area were then investigated using formal records and informal group discussions. The deaths of those who had reportedly died within 14 days of suddenly developing fever with cough and/or a sore throat were assumed to be influenza-associated. The rate of such deaths in 2009 in each of the catchment areas was then estimated from the number of apparently influenza-associated deaths in the sampled unions, the proportion of the sampled inpatients in the local hospital who tested positive for influenza virus RNA, and the estimated number of residents of the sampled unions. FINDINGS Of the 2500 people known to have died in 2009 in all 20 study unions, 346 (14%) reportedly had fever with cough and/or sore throat within 14 days of their deaths. The estimated mean annual influenza-associated mortality in these unions was 11 per 100,000 population: 1.5, 4.0 and 125 deaths per 100,000 among those aged < 5, 5-59 and > 59 years, respectively. CONCLUSION The highest burden of influenza-associated mortality in Bangladesh in 2009 was among the elderly.
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Affiliation(s)
- Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh, Saheed Tajuddin Ahmed Sarani, Mohakhalai, Dhaka-1212, Bangladesh.
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Campbell GL, Hills SL, Fischer M, Jacobson JA, Hoke CH, Hombach JM, Marfin AA, Solomon T, Tsai TF, Tsu VD, Ginsburg AS. Estimated global incidence of Japanese encephalitis: a systematic review. Bull World Health Organ 2011; 89:766-74, 774A-774E. [PMID: 22084515 PMCID: PMC3209971 DOI: 10.2471/blt.10.085233] [Citation(s) in RCA: 660] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 06/17/2011] [Accepted: 07/10/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To update the estimated global incidence of Japanese encephalitis (JE) using recent data for the purpose of guiding prevention and control efforts. METHODS Thirty-two areas endemic for JE in 24 Asian and Western Pacific countries were sorted into 10 incidence groups on the basis of published data and expert opinion. Population-based surveillance studies using laboratory-confirmed cases were sought for each incidence group by a computerized search of the scientific literature. When no eligible studies existed for a particular incidence group, incidence data were extrapolated from related groups. FINDINGS A total of 12 eligible studies representing 7 of 10 incidence groups in 24 JE-endemic countries were identified. Approximately 67,900 JE cases typically occur annually (overall incidence: 1.8 per 100,000), of which only about 10% are reported to the World Health Organization. Approximately 33,900 (50%) of these cases occur in China (excluding Taiwan) and approximately 51,000 (75%) occur in children aged 0-14 years (incidence: 5.4 per 100,000). Approximately 55,000 (81%) cases occur in areas with well established or developing JE vaccination programmes, while approximately 12,900 (19%) occur in areas with minimal or no JE vaccination programmes. CONCLUSION Recent data allowed us to refine the estimate of the global incidence of JE, which remains substantial despite improvements in vaccination coverage. More and better incidence studies in selected countries, particularly China and India, are needed to further refine these estimates.
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Affiliation(s)
| | - Susan L Hills
- Centers for Disease Control and Prevention, Fort Collins, USA
| | - Marc Fischer
- Centers for Disease Control and Prevention, Fort Collins, USA
| | | | - Charles H Hoke
- Pharmaceutical Systems Project Management Office, US Army Medical Material Development Activity, Fort Detrick, USA
| | - Joachim M Hombach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Anthony A Marfin
- Washington State Department of Health, Communicable Disease Epidemiology, Shoreline, USA
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England
| | | | - Vivien D Tsu
- Program for Appropriate Technology in Health (PATH), PO Box 900922, Seattle, WA, 98109, USA
| | - Amy S Ginsburg
- Program for Appropriate Technology in Health (PATH), PO Box 900922, Seattle, WA, 98109, USA
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