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Li X, Snow RW, Lindblade K, Noor AM, Steketee R, Rabinovich R, Gopinath D, Gasimov E, Alonso PL. Border malaria: defining the problem to address the challenge of malaria elimination. Malar J 2023; 22:239. [PMID: 37605226 PMCID: PMC10440889 DOI: 10.1186/s12936-023-04675-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023] Open
Abstract
Border malaria is frequently cited as an obstacle to malaria elimination and sometimes used as a justification for the failure of elimination. Numerous border or cross-border meetings and elimination initiatives have been convened to address this bottleneck to elimination. In this Perspective, border malaria is defined as malaria transmission, or the potential for transmission, across or along shared land borders between countries where at least one of them has ongoing malaria transmission. Border malaria is distinct from malaria importation, which can occur anywhere and in any country. The authors' analysis shows that the remaining transmission foci of malaria-eliminating countries tend to occur in the vicinity of international land borders that they share with neighbouring endemic countries. The reasons why international land borders often represent the last mile in malaria elimination are complex. The authors argue that the often higher intrinsic transmission potential, the neglect of investment and development, the constant risk of malaria importation due to cross-border movement, the challenges of implementing interventions in complex environments and uncoordinated action in a cross-border shared transmission focus all contribute to the difficulties of malaria elimination in border areas. Border malaria reflects the limitations of the current tools and interventions for malaria elimination and implies the need for social cohesion, basic health services, community economic conditions, and policy dialogue and coordination to achieve the expected impact of malaria interventions. Given the uniqueness of each border and the complex and multifaceted nature of border malaria, a situation analysis to define and characterize the determinants of transmission is essential to inform a problem-solving mindset and develop appropriate strategies to eliminate malaria in these areas.
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Affiliation(s)
- Xiaohong Li
- Global Malaria Programme, World Health Organization, Geneva, Switzerland.
| | - Robert W Snow
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Kim Lindblade
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Abdisalan M Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Deyer Gopinath
- World Health Organization Country Office, Bangkok, Thailand
| | - Elkhan Gasimov
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Pedro L Alonso
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Yukich JO, Lindblade K, Kolaczinski J. Receptivity to malaria: meaning and measurement. Malar J 2022; 21:145. [PMID: 35527264 PMCID: PMC9080212 DOI: 10.1186/s12936-022-04155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 04/07/2022] [Indexed: 01/13/2023] Open
Abstract
"Receptivity" to malaria is a construct developed during the Global Malaria Eradication Programme (GMEP) era. It has been defined in varied ways and no consistent, quantitative definition has emerged over the intervening decades. Despite the lack of consistency in defining this construct, the idea that some areas are more likely to sustain malaria transmission than others has remained important in decision-making in malaria control, planning for malaria elimination and guiding activities during the prevention of re-establishment (POR) period. This manuscript examines current advances in methods of measurement. In the context of a decades long decline in global malaria transmission and an increasing number of countries seeking to eliminate malaria, understanding and measuring malaria receptivity has acquired new relevance.
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Affiliation(s)
- Joshua O. Yukich
- grid.265219.b0000 0001 2217 8588Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Kim Lindblade
- grid.3575.40000000121633745Global Malaria Programme, World Health Organization, Geneva, CH USA
| | - Jan Kolaczinski
- grid.3575.40000000121633745Global Malaria Programme, World Health Organization, Geneva, CH USA
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Mitchell RM, Zhou Z, Sheth M, Sergent S, Frace M, Nayak V, Hu B, Gimnig J, Ter Kuile F, Lindblade K, Slutsker L, Hamel MJ, Desai M, Otieno K, Kariuki S, Vigfusson Y, Shi YP. Development of a new barcode-based, multiplex-PCR, next-generation-sequencing assay and data processing and analytical pipeline for multiplicity of infection detection of Plasmodium falciparum. Malar J 2021; 20:92. [PMID: 33593329 PMCID: PMC7885407 DOI: 10.1186/s12936-021-03624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Simultaneous infection with multiple malaria parasite strains is common in high transmission areas. Quantifying the number of strains per host, or the multiplicity of infection (MOI), provides additional parasite indices for assessing transmission levels but it is challenging to measure accurately with current tools. This paper presents new laboratory and analytical methods for estimating the MOI of Plasmodium falciparum. METHODS Based on 24 single nucleotide polymorphisms (SNPs) previously identified as stable, unlinked targets across 12 of the 14 chromosomes within P. falciparum genome, three multiplex PCRs of short target regions and subsequent next generation sequencing (NGS) of the amplicons were developed. A bioinformatics pipeline including B4Screening pathway removed spurious amplicons to ensure consistent frequency calls at each SNP location, compiled amplicons by SNP site diversity, and performed algorithmic haplotype and strain reconstruction. The pipeline was validated by 108 samples generated from cultured-laboratory strain mixtures in different proportions and concentrations, with and without pre-amplification, and using whole blood and dried blood spots (DBS). The pipeline was applied to 273 smear-positive samples from surveys conducted in western Kenya, then providing results into StrainRecon Thresholding for Infection Multiplicity (STIM), a novel MOI estimator. RESULTS The 24 barcode SNPs were successfully identified uniformly across the 12 chromosomes of P. falciparum in a sample using the pipeline. Pre-amplification and parasite concentration, while non-linearly associated with SNP read depth, did not influence the SNP frequency calls. Based on consistent SNP frequency calls at targeted locations, the algorithmic strain reconstruction for each laboratory-mixed sample had 98.5% accuracy in dominant strains. STIM detected up to 5 strains in field samples from western Kenya and showed declining MOI over time (q < 0.02), from 4.32 strains per infected person in 1996 to 4.01, 3.56 and 3.35 in 2001, 2007 and 2012, and a reduction in the proportion of samples with 5 strains from 57% in 1996 to 18% in 2012. CONCLUSION The combined approach of new multiplex PCRs and NGS, the unique bioinformatics pipeline and STIM could identify 24 barcode SNPs of P. falciparum correctly and consistently. The methodology could be applied to field samples to reliably measure temporal changes in MOI.
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Affiliation(s)
- Rebecca M Mitchell
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
- Department of Computer Science, Emory University, Atlanta, USA
- School of Nursing, Emory University, Atlanta, USA
| | - Zhiyong Zhou
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Mili Sheth
- Biotechnology Core Facility Branch, Division of Scientific Resources, CDC, Atlanta, USA
| | - Sheila Sergent
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Michael Frace
- Biotechnology Core Facility Branch, Division of Scientific Resources, CDC, Atlanta, USA
| | - Vishal Nayak
- Office of Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - Bin Hu
- Office of Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, USA
| | - John Gimnig
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | - Kim Lindblade
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Laurence Slutsker
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Mary J Hamel
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Meghna Desai
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Ymir Vigfusson
- Department of Computer Science, Emory University, Atlanta, USA.
| | - Ya Ping Shi
- Division of Parasitic Diseases, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, USA.
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Hegde S, Benoit SR, Arvelo W, Lindblade K, López B, McCracken JP, Bernart C, Roldan A, Bryan JP. Burden of laboratory-confirmed shigellosis infections in Guatemala 2007-2012: results from a population-based surveillance system. BMC Public Health 2019; 19:474. [PMID: 32326929 PMCID: PMC6696707 DOI: 10.1186/s12889-019-6780-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We describe the epidemiology and antimicrobial susceptibility patterns of culture-confirmed Shigella infections in facility-based surveillance sites in Guatemala. Current studies using quantitative molecular diagnostics suggest Shigella may contribute most to the global diarrheal disease burden. Since identification of Shigella requires culturing techniques using stool specimens and few laboratories in Guatemala routinely culture for this pathogen, little is known about the true burden of Shigella in Guatemala or, importantly, the antimicrobial resistance patterns. METHODS Clinical, epidemiological, and laboratory data were collected on 5399 patients with acute diarrhea (≥3 loose stools in 24 h) from June 2007-August 2012. Multidrug resistance (MDR) was defined as resistance to ampicillin and trimethoprim/sulfamethoxazole. RESULTS Five percent (261) of stool specimens yielded Shigella spp. The annual incidence of laboratory-confirmed infections ranged from 5.0 to 24.1 per 100,000 persons in Santa Rosa and 0.3 to 6.2 per 100,000 in Quetzaltenango; 58% of cases occurred in children < 5 years of age. Thirty patients were hospitalized; one patient died. Oral rehydration or intravenous solution was used to treat 72% of hospitalized and 15% of ambulatory cases. Fifty-nine percent of cases were S. flexneri and 51% of cases were MDR. CONCLUSIONS Shigella is an important cause of bacterial diarrhea in children and prevalence of MDR highlights the importance of appropriate treatment regimens. This study demonstrates that strengthening laboratory capacity in Guatemala can help determine causes which can lead to prevention of diarrheal diseases, particularly in children. Such capacity building is also critical for rapid detection and control of public health threats at their source and therefore for global health security.
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Affiliation(s)
- Sonia Hegde
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Johns Hopkins University, Baltimore, MD, USA.
| | | | - Wences Arvelo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim Lindblade
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beatriz López
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - John P McCracken
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Aleida Roldan
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Joe P Bryan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tomczyk S, McCracken JP, Contreras CL, Lopez MR, Bernart C, Moir JC, Escobar K, Reyes L, Arvelo W, Lindblade K, Peruski L, Bryan JP, Verani JR. Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala. BMC Public Health 2019; 19:499. [PMID: 31053069 PMCID: PMC6498661 DOI: 10.1186/s12889-019-6824-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. Methods We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician’s discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. Results Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. Conclusions Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.
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Affiliation(s)
- Sara Tomczyk
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Carmen Lucia Contreras
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Quetzaltenango Health Area, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Kenneth Escobar
- Western Regional Hospital San Juan de Dios, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Lisette Reyes
- Santa Rosa Health Area, Ministry of Public Health and Social Welfare, Cuilapa, Guatemala
| | - Wences Arvelo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kim Lindblade
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Joe P Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
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Mzilahowa T, Chiumia M, Mbewe RB, Uzalili VT, Luka-Banda M, Kutengule A, Mathanga DP, Ali D, Chiphwanya J, Zoya J, Mulenga S, Dodoli W, Bergeson-Lockwood J, Troell P, Oyugi J, Lindblade K, Gimnig JE. Increasing insecticide resistance in Anopheles funestus and Anopheles arabiensis in Malawi, 2011-2015. Malar J 2016; 15:563. [PMID: 27876046 PMCID: PMC5120501 DOI: 10.1186/s12936-016-1610-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Susceptibility of principal Anopheles malaria vectors to common insecticides was monitored over a 5-year period across Malawi to inform and guide the national malaria control programme. METHODS Adult blood-fed Anopheles spp. and larvae were collected from multiple sites in sixteen districts across the country between 2011 and 2015. First generation (F1) progeny aged 2-5 days old were tested for susceptibility, using standard WHO procedures, against pyrethroids (permethrin and deltamethrin), carbamates (bendiocarb and propoxur), organophosphates (malathion and pirimiphos-methyl) and an organochlorine (DDT). RESULTS Mortality of Anopheles funestus to deltamethrin, permethrin, bendiocarb and propoxur declined significantly over the 5-year (2011-2015) monitoring period. There was wide variation in susceptibility to DDT but it was not associated with time. In contrast, An. funestus exhibited 100% mortality to the organophosphates (malathion and pirimiphos-methyl) at all sites tested. There was reduced mortality of Anopheles arabiensis to deltamethrin over time though this was not statistically significant. However, mortality of An. arabiensis exposed to permethrin declined significantly over time. Anopheles arabiensis exposed to DDT were more likely to be killed if there was high ITN coverage in the mosquito collection area the previous year. There were no other associations between mosquito mortality in a bioassay and ITN coverage or IRS implementation. Mortality of An. funestus from four sites exposed to deltamethrin alone ranged from 2 to 31% and from 41 to 94% when pre-exposed to the synergist piperonyl butoxide followed by deltamethrin. For permethrin alone, mortality ranged from 2 to 13% while mortality ranged from 63 to 100% when pre-exposed to PBO. CONCLUSION Pyrethroid resistance was detected in An. funestus and An. arabiensis populations across Malawi and has worsened over the last 5 years. New insecticides and control strategies are urgently needed to reduce the burden of malaria in Malawi.
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Affiliation(s)
- Themba Mzilahowa
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi.
| | - Martin Chiumia
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi
| | - Rex B Mbewe
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi
| | - Veronica T Uzalili
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi
| | - Madalitso Luka-Banda
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi
| | - Anna Kutengule
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi
| | - Don P Mathanga
- Malaria Alert Centre, Malawi College of Medicine, Chichiri, P/Bag 360, Blantyre 3, Malawi
| | - Doreen Ali
- Community Health Services Unit, National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - John Chiphwanya
- Community Health Services Unit, National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - John Zoya
- Community Health Services Unit, National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Shadreck Mulenga
- Community Health Services Unit, National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | | | - Peter Troell
- President's Malaria Initiative, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Jessica Oyugi
- Division of Parasitic Diseases and Malaria, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Kim Lindblade
- Division of Parasitic Diseases and Malaria, Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - John E Gimnig
- Division of Parasitic Diseases and Malaria, Centers for Diseases Control and Prevention, Atlanta, GA, USA
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Wortham JM, Gray J, Verani J, Contreras CL, Bernart C, Moscoso F, Moir JC, Reyes Marroquin EL, Castellan R, Arvelo W, Lindblade K, McCracken JP. Using Standardized Interpretation of Chest Radiographs to Identify Adults with Bacterial Pneumonia--Guatemala, 2007-2012. PLoS One 2015. [PMID: 26207918 PMCID: PMC4514878 DOI: 10.1371/journal.pone.0133257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Bacterial pneumonia is a leading cause of illness and death worldwide, but quantifying its burden is difficult due to insensitive diagnostics. Although World Health Organization (WHO) protocol standardizes pediatric chest radiograph (CXR) interpretation for epidemiologic studies of bacterial pneumonia, its validity in adults is unknown. Methods Patients (age ≥15 years) admitted with respiratory infections to two Guatemalan hospitals between November 2007 and March 2012 had urine and nasopharyngeal/oropharyngeal (NP/OP) swabs collected; blood cultures and CXR were also performed at physician clinical discretion. ‘Any bacterial infection’ was defined as a positive urine pneumococcal antigen test, isolation of a bacterial pneumonia pathogen from blood culture, or detection of an atypical bacterial pathogen by polymerase chain reaction (PCR) of nasopharyngeal/oropharyngeal (NP/OP) specimens. ‘Viral infection’ was defined as detection of viral pathogens by PCR of NP/OP specimens. CXRs were interpreted according to the WHO protocol as having ‘endpoint consolidation’, ‘other infiltrate’, or ‘normal’ findings. We examined associations between bacterial and viral infections and endpoint consolidation. Findings Urine antigen and/or blood culture results were available for 721 patients with CXR interpretations; of these, 385 (53%) had endpoint consolidation and 253 (35%) had other infiltrate. Any bacterial infection was detected in 119 (17%) patients, including 106 (89%) pneumococcal infections. Any bacterial infection (Diagnostic Odds Ratio [DOR] = 2.9; 95% confidence Interval (CI): 1.3–7.9) and pneumococcal infection (DOR = 3.4; 95% CI: 1.5–10.0) were associated with ‘endpoint consolidation’, but not ‘other infiltrate’ (DOR = 1.7; 95% CI: 0.7–4.9, and 1.7; 95% CI: 0.7–4.9 respectively). Viral infection was not significantly associated with ‘endpoint consolidation’, ‘other infiltrate,’ or ‘normal’ findings. Interpretation ‘Endpoint consolidation’ was associated with ‘any bacterial infection,’ specifically pneumococcal infection. Therefore, endpoint consolidation may be a useful surrogate for studies measuring the impact of interventions, such as conjugate vaccines, against bacterial pneumonia.
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Affiliation(s)
- Jonathan M. Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Jennifer Gray
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Jennifer Verani
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Chris Bernart
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
| | | | | | - Wences Arvelo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kim Lindblade
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Patel JC, Taylor SM, Juliao PC, Parobek CM, Janko M, Gonzalez LD, Ortiz L, Padilla N, Tshefu AK, Emch M, Udhayakumar V, Lindblade K, Meshnick SR. Genetic Evidence of Importation of Drug-Resistant Plasmodium falciparum to Guatemala from the Democratic Republic of the Congo. Emerg Infect Dis 2015; 20:932-40. [PMID: 24856348 PMCID: PMC4036788 DOI: 10.3201/eid2006.131204] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Molecular markers and population genetics were effective tracking tools. Imported malaria threatens control and elimination efforts in countries that have low rates of transmission. In 2010, an outbreak of Plasmodium falciparum malaria was reported among United Nations peacekeeping soldiers from Guatemala who had recently returned from the Democratic Republic of the Congo (DRC). Epidemiologic evidence suggested that the soldiers were infected in the DRC, but local transmission could not be ruled out in all cases. We used population genetic analyses of neutral microsatellites to determine the outbreak source. Genetic relatedness was compared among parasites found in samples from the soldiers and parasite populations collected in the DRC and Guatemala; parasites identified in the soldiers were more closely related to those from the DRC. A phylogenetic clustering analysis confirms this identification with >99.9% confidence. Thus, results support the hypothesis that the soldiers likely imported malaria from the DRC. This study demonstrates the utility of molecular genotyping in outbreak investigations.
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Nyenswah T, Fahnbulleh M, Massaquoi M, Nagbe T, Bawo L, Falla JD, Kohar H, Gasasira A, Nabeth P, Yett S, Gergonne B, Casey S, Espinosa B, McCoy A, Feldman H, Hensley L, Baily M, Fields B, Lo T, Lindblade K, Mott J, Boulanger L, Christie A, Wang S, Montgomery J, Mahoney F. Ebola epidemic--Liberia, March-October 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1082-6. [PMID: 25412068 PMCID: PMC5779504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
On March 21, 2014, the Guinea Ministry of Health reported the outbreak of an illness characterized by fever, severe diarrhea, vomiting and a high fatality rate (59%), leading to the first known epidemic of Ebola virus disease (Ebola) in West Africa and the largest and longest Ebola epidemic in history. As of November 2, Liberia had reported the largest number of cases (6,525) and deaths (2,697) among the three affected countries of West Africa with ongoing transmission (Guinea, Liberia, and Sierra Leone). The response strategy in Liberia has included management of the epidemic through an incident management system (IMS) in which the activities of all partners are coordinated. Within the IMS, key strategies for epidemic control include surveillance, case investigation, laboratory confirmation, contact tracing, safe transportation of persons with suspected Ebola, isolation, infection control within the health care system, community engagement, and safe burial. This report provides a brief overview of the progression of the epidemic in Liberia and summarizes the interventions implemented.
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Affiliation(s)
| | | | | | | | - Luke Bawo
- Ministry of Health and Social Welfare, Liberia
| | | | - Henry Kohar
- Ministry of Health and Social Welfare, Liberia
| | | | | | | | | | | | | | | | | | | | - Mark Baily
- US Army Medical Research Institute of Infectious Diseases
| | | | | | | | | | | | | | | | | | - Frank Mahoney
- CDC,Corresponding author: Frank Mahoney, , 404-718-6833
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Benoit SR, Lopez B, Arvelo W, Henao O, Parsons MB, Reyes L, Moir JC, Lindblade K. Burden of laboratory-confirmed Campylobacter infections in Guatemala 2008-2012: results from a facility-based surveillance system. J Epidemiol Glob Health 2014; 4:51-9. [PMID: 24534336 PMCID: PMC4666523 DOI: 10.1016/j.jegh.2013.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/02/2013] [Accepted: 10/06/2013] [Indexed: 10/30/2022] Open
Abstract
INTRODUCTION Campylobacteriosis is one of the leading causes of gastroenteritis worldwide. This study describes the epidemiology of laboratory-confirmed Campylobacter diarrheal infections in two facility-based surveillance sites in Guatemala. METHODS Clinical, epidemiologic, and laboratory data were collected on patients presenting with acute diarrhea from select healthcare facilities in the departments of Santa Rosa and Quetzaltenango, Guatemala, from January 2008 through August 2012. Stool specimens were cultured for Campylobacter and antimicrobial susceptibility testing was performed on a subset of isolates. Multidrug resistance (MDR) was defined as resistance to ≥3 antimicrobial classes. RESULTS Campylobacter was isolated from 306 (6.0%) of 5137 stool specimens collected. For children <5 years of age, annual incidence was as high as 1288.8 per 100,000 children in Santa Rosa and 185.5 per 100,000 children in Quetzaltenango. Among 224 ambulatory care patients with Campylobacter, 169 (75.5%) received metronidazole or trimethoprim-sulfamethoxazole, and 152 (66.7%) received or were prescribed oral rehydration therapy. Antimicrobial susceptibilities were tested in 96 isolates; 57 (59.4%) were resistant to ciprofloxacin and 12 (12.5%) were MDR. CONCLUSION Campylobacter was a major cause of diarrhea in children in two departments in Guatemala; antimicrobial resistance was high, and treatment regimens in the ambulatory setting which included metronidazole and trimethoprim-sulfamethoxazole and lacked oral rehydration were sub-optimal.
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Affiliation(s)
- Stephen R Benoit
- Global Disease Detection Program, Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, GA, USA.
| | - Beatriz Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Wences Arvelo
- Global Disease Detection Program, Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, GA, USA
| | - Olga Henao
- Division of Foodborne, Waterborne and Environmental Diseases, National Center For Emerging & Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Michele B Parsons
- Division of Foodborne, Waterborne and Environmental Diseases, National Center For Emerging & Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Lissette Reyes
- Ministry of Public Health and Welfare, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Ministry of Public Health and Welfare, Guatemala City, Guatemala
| | - Kim Lindblade
- Global Disease Detection Program, Division of Global Disease Detection and Emergency Response, Center for Global Health, CDC, Atlanta, GA, USA
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11
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Fischer Langley G, McCracken J, Arvelo W, Estevez A, Villarruel G, Prill M, Iwane M, Gray J, Moscoso F, Reyes L, Moir JC, Ortiz J, Lindblade K. The epidemiology and clinical characteristics of young children hospitalized with respiratory syncytial virus infections in Guatemala (2007-2010). Pediatr Infect Dis J 2013; 32:629-35. [PMID: 23380666 PMCID: PMC10942251 DOI: 10.1097/inf.0b013e318289e3bc] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There have been few population-based studies from Central America on respiratory syncytial virus (RSV) infections in young children. We report population-based incidence rates and describe epidemiological and clinical characteristics of children <5 years old hospitalized with RSV infections in Guatemala. METHODS Prospective, active hospital-based surveillance for acute respiratory infections in children <5 years old was conducted at 3 hospitals in Guatemala from November 2007 through July 2010. RSV hospitalization rates were calculated for areas where the catchment population could be defined. Comparisons were made between children who were RSV-positive and RSV-negative. RESULTS RSV was detected in 549 (25%) of enrolled children. Overall, annual rates of RSV hospitalizations ranged from 5.9 to 45.9 and 2.0 to 13.7 per 1000 children <1 year old and <5 years old, respectively, but varied by location and calendar year. Rates generally decreased with age--children <6 months had rates up to 30 times higher than older children, but children >12 months old still had rates up to 5.5 per 1000 per year and accounted for 42% of deaths. Children with RSV infections were more likely to have signs of respiratory distress (85% versus 63%, P < 0.001) compared with those without RSV infections, but case fatality ratios were similar (3-4%). CONCLUSIONS The large burden and severity of RSV infections in young Guatemalan children is similar in magnitude and age distribution to RSV disease burdens found in other developing countries and suggests that this population would benefit from prevention strategies, including vaccines against RSV that are currently under development.
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Affiliation(s)
- Gayle Fischer Langley
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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12
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Odhiambo FO, Laserson KF, Sewe M, Hamel MJ, Feikin DR, Adazu K, Ogwang S, Obor D, Amek N, Bayoh N, Ombok M, Lindblade K, Desai M, ter Kuile F, Phillips-Howard P, van Eijk AM, Rosen D, Hightower A, Ofware P, Muttai H, Nahlen B, DeCock K, Slutsker L, Breiman RF, Vulule JM. Profile: The KEMRI/CDC Health and Demographic Surveillance System--Western Kenya. Int J Epidemiol 2012; 41:977-87. [DOI: 10.1093/ije/dys108] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Troyo A, Álvarez D, Taylor L, Abdalla G, Calderón-Arguedas Ó, Zambrano ML, Dasch GA, Lindblade K, Hun L, Eremeeva ME, Estévez A. Rickettsia felis in Ctenocephalides felis from Guatemala and Costa Rica. Am J Trop Med Hyg 2012; 86:1054-6. [PMID: 22665618 DOI: 10.4269/ajtmh.2012.11-0742] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rickettsia felis is an emerging human pathogen associated primarily with the cat flea Ctenocephalides felis. In this study, we investigated the presence of Rickettsia felis in C. felis from Guatemala and Costa Rica. Ctenocephalides felis were collected directly from dogs and cats, and analyzed by polymerase chain reaction for Rickettsia-specific fragments of 17-kDa protein, OmpA, and citrate synthase genes. Rickettsia DNA was detected in 64% (55 of 86) and 58% (47 of 81) of flea pools in Guatemala and Costa Rica, respectively. Sequencing of gltA fragments identified R. felis genotype URRWXCal(2) in samples from both countries, and genotype Rf2125 in Costa Rica. This is the first report of R. felis in Guatemala and of genotype Rf2125 in Costa Rica. The extensive presence of this pathogen in countries of Central America stresses the need for increased awareness and diagnosis.
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Affiliation(s)
- Adriana Troyo
- Departamento de Parasitología, Centro de Investigación en Enfermedades Tropicales, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
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14
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Gray J, Arvelo W, McCracken J, Lopez B, Lessa FC, Kitchel B, Wong B, Reyes L, Lindblade K. An outbreak of Klebsiella pneumoniae late-onset sepsis in a neonatal intensive care unit in Guatemala. Am J Infect Control 2012; 40:516-20. [PMID: 22854378 DOI: 10.1016/j.ajic.2012.02.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gram-negative bloodstream infections are an important cause of neonatal mortality. In October 2009, we investigated a Klebsiella spp outbreak in a neonatal intensive care unit in Guatemala. METHODS Probable cases were defined as a Klebsiella spp isolated from blood in neonates aged <28 days in the neonatal intensive care unit between October 1 and November 10, 2009; confirmed cases were identified as Klebsiella pneumoniae. Clinical data were abstracted from medical charts. K pneumoniae isolates were genotyped by pulsed-field gel electrophoresis (PFGE) and tested for antimicrobial susceptibility. Infection control practices were inspected. RESULTS There were 14 confirmed cases. The median age at onset of infection was 3 days (range, 2-8 days). Nine patients died (64%). K pneumoniae isolates were resistant to multiple antimicrobials. PFGE revealed 2 distinct clusters. Breaches in infection control procedures included inappropriate intravenous solution use and inadequate hand hygiene and contact precautions. CONCLUSIONS We report a K pneumoniae outbreak with high neonatal mortality in Guatemala. PFGE clustering suggested a common source possibly related to reuse of a single-use intravenous medication or solution. The risk for K pneumoniae bloodstream infections in neonates in low-resource settings where sharing of solutions is common needs to be emphasized.
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15
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Bai Y, Kosoy M, Recuenco S, Alvarez D, Moran D, Turmelle A, Ellison J, Garcia DL, Estevez A, Lindblade K, Rupprecht C. Bartonella spp. in Bats, Guatemala. Emerg Infect Dis 2012; 17:1269-72. [PMID: 21762584 PMCID: PMC3381397 DOI: 10.3201/eid1707.101867] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To better understand the role of bats as reservoirs of Bartonella spp., we estimated Bartonella spp. prevalence and genetic diversity in bats in Guatemala during 2009. We found prevalence of 33% and identified 21 genetic variants of 13 phylogroups. Vampire bat–associated Bartonella spp. may cause undiagnosed illnesses in humans.
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Affiliation(s)
- Ying Bai
- Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.
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16
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Gatei W, Kariuki S, Hawley W, ter Kuile F, Terlouw D, Phillips-Howard P, Nahlen B, Gimnig J, Lindblade K, Walker E, Hamel M, Crawford S, Williamson J, Slutsker L, Shi YP. Effects of transmission reduction by insecticide-treated bed nets (ITNs) on parasite genetics population structure: I. The genetic diversity of Plasmodium falciparum parasites by microsatellite markers in western Kenya. Malar J 2010; 9:353. [PMID: 21134282 PMCID: PMC3004940 DOI: 10.1186/1475-2875-9-353] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 12/06/2010] [Indexed: 11/13/2022] Open
Abstract
Background Insecticide-treated bed nets (ITNs) reduce malaria transmission and are an important prevention tool. However, there are still information gaps on how the reduction in malaria transmission by ITNs affects parasite genetics population structure. This study examined the relationship between transmission reduction from ITN use and the population genetic diversity of Plasmodium falciparum in an area of high ITN coverage in western Kenya. Methods Parasite genetic diversity was assessed by scoring eight single copy neutral multilocus microsatellite (MS) markers in samples collected from P. falciparum-infected children (< five years) before introduction of ITNs (1996, baseline, n = 69) and five years after intervention (2001, follow-up, n = 74). Results There were no significant changes in overall high mixed infections and unbiased expected heterozygosity between baseline (%MA = 94% and He = 0.75) and follow up (%MA = 95% and He = 0.79) years. However, locus specific analysis detected significant differences for some individual loci between the two time points. Pfg377 loci, a gametocyte-specific MS marker showed significant increase in mixed infections and He in the follow up survey (%MA = 53% and He = 0.57) compared to the baseline (%MA = 30% and He = 0.29). An opposite trend was observed in the erythrocyte binding protein (EBP) MS marker. There was moderate genetic differentiation at the Pfg377 and TAA60 loci (FST = 0.117 and 0.137 respectively) between the baseline and post-ITN parasite populations. Further analysis revealed linkage disequilibrium (LD) of the microsatellites in the baseline (14 significant pair-wise tests and ISA = 0.016) that was broken in the follow up parasite population (6 significant pairs and ISA = 0.0003). The locus specific change in He, the moderate population differentiation and break in LD between the baseline and follow up years suggest an underlying change in population sub-structure despite the stability in the overall genetic diversity and multiple infection levels. Conclusions The results from this study suggest that although P. falciparum population maintained an overall stability in genetic diversity after five years of high ITN coverage, there was significant locus specific change associated with gametocytes, marking these for further investigation.
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Affiliation(s)
- Wangeci Gatei
- Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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17
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Odhiambo FO, Hamel MJ, Williamson J, Lindblade K, ter Kuile FO, Peterson E, Otieno P, Kariuki S, Vulule J, Slutsker L, Newman RD. Intermittent preventive treatment in infants for the prevention of malaria in rural Western kenya: a randomized, double-blind placebo-controlled trial. PLoS One 2010; 5:e10016. [PMID: 20368815 PMCID: PMC2848869 DOI: 10.1371/journal.pone.0010016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 03/09/2010] [Indexed: 11/26/2022] Open
Abstract
Background Intermittent preventive treatment in infants (IPTi) with sulphadoxine-pyrimethamine (SP) for the prevention of malaria has shown promising results in six trials. However, resistance to SP is rising and alternative drug combinations need to be evaluated to better understand the role of treatment versus prophylactic effects. Methods Between March 2004 and March 2008, in an area of western Kenya with year round malaria transmission with high seasonal intensity and high usage of insecticide-treated nets, we conducted a randomized, double-blind placebo-controlled trial with SP plus 3 days of artesunate (SP-AS3), 3 days of amodiaquine-artesunate (AQ3-AS3), or 3 days of short-acting chlorproguanil-dapsone (CD3) administered at routine expanded programme of immunization visits (10 weeks, 14 weeks and 9 months). Principal Findings 1,365 subjects were included in the analysis. The incidence of first or only episode of clinical malaria during the first year of life (primary endpoint) was 0.98 episodes/person-year in the placebo group, 0.74 in the SP-AS3 group, 0.76 in the AQ3-AS3 group, and 0.82 in the CD3 group. The protective efficacy (PE) and 95% confidence intervals against the primary endpoint were: 25.7% (6.3, 41.1); 25.9% (6.8, 41.0); and 16.3% (−5.2, 33.5) in the SP-AS3, AQ3-AS3, and CD3 groups, respectively. The PEs for moderate-to-severe anaemia were: 27.5% (−6.9, 50.8); 23.1% (−11.9, 47.2); and 11.4% (−28.6, 39.0). The duration of the protective effect remained significant for up to 5 to 8 weeks for SP-AS3 and AQ3-AS3. There was no evidence for a sustained beneficial or rebound effect in the second year of life. All regimens were well tolerated. Conclusions These results support the view that IPTi with long-acting regimens provide protection against clinical malaria for up to 8 weeks even in the presence of high ITN coverage, and that the prophylactic rather than the treatment effect of IPTi appears central to its protective efficacy. Trial Registration ClinicalTrials.gov NCT00111163
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Affiliation(s)
- Frank O Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
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Cortes J, Arvelo W, lopez B, Reyes L, Gordillo B, Parashar U, Lindblade K. The epidemiology of rotavirus disease among children <5 years of age - Santa Rosa, Guatemala, 2007-2009. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
In order to assess the individual risk of acquiring sexually transmitted diseases (STDs), both characteristics of the partnership and the individual should be considered. Partnership characteristics have been used as risk markers for STD transmission but their distribution has not been well described. Using a self-administered questionnaire, we collected information on the partnership characteristics of the 4 most recent sexual partners of the members of 9 university women's social organizations at the University of Michigan. Respondents were asked to report the setting of the first meeting of partners, the length of the presexual relationship, condom use at the first sexual encounter and the total number of sexual encounters within that partnership. We graphically analyse changes in these partnership characteristics with respect to partnership order. As the number of sexual partners increased the women in this population were more likely to report partnership characteristics associated with an increased risk of acquiring an STD. In addition, partnership characteristics varied with the order of the partnership, implying that no single partnership is representative of all others.
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Affiliation(s)
- K Lindblade
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor 48109-2029
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