Targeted surveillance of raccoon rabies in Québec,Canada

Data from wildlife disease surveillance programs are used to inform implementation of disease control (e.g., vaccination, population reduction) in space and time. We developed an approach to increase detection of raccoon rabies in raccoons (Procyon lotor) and skunks (Mephitis mephitis) of Québec, Canada, and we examined the implications of using this approach for targeted surveillance. First we modeled the probability of a rabid animal relative to environmental characteristics of sampling locations. Rabid animals were more likely to be found in low-lying flat landscapes that had higher proportions of corn-forest edge habitat and hay agriculture, and that were within 20 km of one or more known rabies cases. From the model, we created 2 complementary risk maps to identify areas where rabid animals were most likely to be sampled. One map accounted for habitat and known rabies case locations, and can be used to define an infection zone from which surveillance can be targeted along the periphery to determine if disease is continuing to spread. The other map only accounted for habitat and can be used to locate areas most likely to contain rabid animals when the disease is present. In a further analysis we compared the 2 most successful methods for detecting raccoon rabies in Québec, given the disease was present. Government trapping operations (active surveillance) detected more cases in the short-term, but citizen notification (passive and enhanced) was more effective after 12 trapping days from which the initial rabies case was found. Our approach can benefit wildlife and public health agencies wanting to assess the disease status of regions by targeting surveillance to habitats most likely to contain infected animals and by defining the duration over which sampling methods are effective. © 2011 The Wildlife Society.     

Adolescent sexuality and the HIV epidemic in Yaoundé, Cameroon

Adolescents are the focus of many interventions that aim to prevent HIV transmission. In order for these interventions to be effective, it is essential to understand adolescents' sexual behaviour. Using data collected in Yaoundé, Cameroon, in 1997, the study analysed risk exposure and HIV prevalence among 426 men and 510 women aged 15-24. Although risky behaviours seem to be more prevalent among young men, their HIV prevalence remains under 1%. In contrast, HIV prevalence is high among young women (7.5%), even those who report having had few sexual partners. Mixing patterns among sexual partners, and especially the age difference between men and women, do not seem to be sufficient to explain the large male-female discrepancy in HIV prevalence that is evident in these data. The results are therefore probably due to a greater susceptibility to infection of young women than men. This study highlights the necessity of reinforcing prevention campaigns among youth and fighting the obstacles that continue to impede the use of condoms in this population.     

The Chikungunya epidemic on La Réunion Island in 2005-2006: a cost-of-illness study

Background

This study was conducted to assess the impact of chikungunya on health costs during the epidemic that occurred on La Réunion in 2005–2006.

Methodology/Principal Findings

From data collected from health agencies, the additional costs incurred by chikungunya in terms of consultations, drug consumption and absence from work were determined by a comparison with the expected costs outside the epidemic period. The cost of hospitalization was estimated from data provided by the national hospitalization database for short-term care by considering all hospital stays in which the ICD-10 code A92.0 appeared. A cost-of-illness study was conducted from the perspective of the third-party payer. Direct medical costs per outpatient and inpatient case were evaluated. The costs were estimated in Euros at 2006 values. Additional reimbursements for consultations with general practitioners and drugs were estimated as €12.4 million (range: €7.7 million–€17.1 million) and €5 million (€1.9 million–€8.1 million), respectively, while the cost of hospitalization for chikungunya was estimated to be €8.5 million (€5.8 million–€8.7 million). Productivity costs were estimated as €17.4 million (€6 million–€28.9 million). The medical cost of the chikungunya epidemic was estimated as €43.9 million, 60% due to direct medical costs and 40% to indirect costs (€26.5 million and €17.4 million, respectively). The direct medical cost was assessed as €90 for each outpatient and €2,000 for each inpatient.

Conclusions/Significance

The medical management of chikungunya during the epidemic on La Réunion Island was associated with an important economic burden. The estimated cost of the reported disease can be used to evaluate the cost/efficacy and cost/benefit ratios for prevention and control programmes of emerging arboviruses.     

Trends in rates of multiple vascular disruption defects, Atlanta, 1968-1989: is there evidence of a cocaine teratogenic epidemic?

Research suggests that, perhaps through mechanisms initiated by vasoconstriction and leading to vessel thrombosis or embolism, cocaine causes vascular disruption defects, and that frequent cocaine use during early pregnancy could disrupt multiple organ systems in the fetus. We hypothesized that if cocaine is an important cause of multiple vascular disruption defects, a rising prevalence of cocaine use by mothers during pregnancy should be accompanied by rising rates of these defects in their offspring. Using data from the Metropolitan Atlanta Congenital Defects Program, we identified all infants born in Atlanta from 1968 through 1989 who had nonsyndromic, provisional vascular disruption defects affecting more than one organ system: 61 infants (78%) had gastrointestinal and genitourinary defects, 7 (9%) had gastrointestinal and abdominal wall defects, 2 (3%) had gastrointestinal and limb reduction defects, 2 (3%) had limb reduction and abdominal wall defects, 2 (3%) had central nervous system and gastrointestinal defects, 2 (3%) had genitourinary and limb reduction defects, 1 (1%) had genitourinary and abdominal wall defects, and 1 (1%) had central nervous system and genitourinary defects. The prevalence of Atlanta infants with more than one vascular disruption defect is 0.13 per 1,000 live births. Chi-square analysis for trends showed no increase in prevalence during the study period. Our data are from one of the first population-based studies in which trends for defects potentially caused by maternal cocaine use are examined; the results of our study show no significant change in the prevalence of multiple vascular disruption defects over time.(ABSTRACT TRUNCATED AT 250 WORDS)     

Historical, social and epidemiological roots of tuberculosis in Bogotá, Colombia

Understanding the current epidemiologic dynamic of tuberculosis (TB) in any society requires a holistic approach. In the current paper, the history and behavior of the TB is summarized for Bogotá, Colombia. In prehispanic periods the occurrence of TB was low. During the Conquest and the Colony periods, a moderate increase of pulmonary and abdominal TB was observed. In the 1870s, a great increase in cases of pulmonary TB was associated with the accelerated urbanization process. Since the 1920s, the occurrence of pulmonary TB shifted to the status of an endemic disease. After 1920, its occurrence was relatively steady until the 1970s, when its occurence greatly decreased. More recently, however, an increase in case numbers has been observed. The occurrence of TB in each period is associated with clearly defined social and environmental phenomena.     

Overview and evaluation of 15 years of Creutzfeldt-Jakob disease surveillance in Belgium, 1998-2012

Background

In 1998, following the detection of variant Creutzfeldt-Jakob disease (vCJD) in the UK, Belgium installed a surveillance system for Creutzfeldt-Jakob disease (CJD). The objectives of this system were to identify vCJD cases and detect increases in CJD incidence. Diagnostic confirmation of CJD is based on autopsy after referral by neurologists. Reference centres perform autopsies and report to the surveillance system. The aim of this study was to assess whether the system met its objectives and to assess its acceptability.

Methods

For 1999–2010, we linked surveillance data with hospital discharge data. We calculated the proportion of CJD suspected patients who died in hospitals and were captured by the surveillance system. We surveyed stakeholders on knowledge of the surveillance system, referral practices and acceptability. We compared proportions using the chi-square test and investigated variables associated with capture using a multivariable logistic regression model.

Results

On average 60 % of hospitalised patients who died with suspected CJD were captured by the surveillance system. This proportion did not significantly differ over the years (p?=?0.1). The odds of capture significantly decreased with every 1 year increase in age (OR?=?0.95, 95 % CI 0.92–0.98, p?=?0.001). Eleven percent of surveyed neurologists would not refer suspect vCJD cases for autopsy, nor contact a reference centre for diagnostic support. Sixty-one percent of surveyed neurologists were not familiar with the surveillance system. Awareness of the existence of the system did not impact referral behaviour (p?=?0.18). CJD and vCJD surveillance were considered important by the majority of stakeholders.

Conclusions

Although 40 % of the suspect CJD cases were not referred for autopsy, our data suggest that the Belgian CJD surveillance system meets one of its main objectives: it can detect changes in CJD incidence. However, we do not have sufficient evidence to conclude that the system meets its second objective of detecting vCJD cases arising in Belgium. Although not well known, the system was considered acceptable by its stakeholders.

     

Retrospective Study of the Epidemiology and Clinical Manifestations of Cryptococcus gattii Infections in Colombia from 1997–2011

Background

Cryptococcosis due to Cryptococcus gattii is endemic in various parts of the world, affecting mostly immunocompetent patients. A national surveillance study of cryptococcosis, including demographical, clinical and microbiological data, has been ongoing since 1997 in Colombia, to provide insights into the epidemiology of this mycosis.

Methodology/Principal Findings

From 1,209 surveys analyzed between 1997–2011, 45 cases caused by C. gattii were reported (prevalence 3.7%; annual incidence 0.07 cases/million inhabitants/year). Norte de Santander had the highest incidence (0.81 cases/million/year), representing 33.3% of all cases. The male: female ratio was 3.3∶1. Mean age at diagnosis was 41±16 years. No specific risk factors were identified in 91.1% of patients. HIV infection was reported in 6.7% of patients, autoimmune disease and steroids use in 2.2%. Clinical features included headache (80.5%), nausea/vomiting (56.1%) and neurological derangements (48.8%). Chest radiographs were taken in 21 (46.7%) cases, with abnormal findings in 7 (33.3%). Cranial CT scans were obtained in 15 (33.3%) cases, with abnormalities detected in 10 (66.7%). Treatment was well documented in 30 cases, with most receiving amphotericin B. Direct sample examination was positive in 97.7% cases. Antigen detection was positive for all CSF specimens and for 75% of serum samples. C. gattii was recovered from CSF (93.3%) and respiratory specimens (6.6%). Serotype was determined in 42 isolates; 36 isolates were serotype B (85.7%), while 6 were C (14.3%). The breakdowns of molecular types were VGII (55.6%), VGIII (31.1%) and VGI (13.3%). Among 44 strains, 16 MLST sequence types (ST) were identified, 11 of them newly reported.

Conclusions/Significance

The results of this passive surveillance study demonstrate that cryptococcosis caused by C. gattii has a low prevalence in Colombia, with the exception of Norte de Santander. The predominance of molecular type VGII is of concern considering its association with high virulence and the potential to evolve into outbreaks.     

Characterisation of virulence genes in methicillin susceptible and resistant Staphylococcus aureus isolates from a paediatric population in a university hospital of Medellín, Colombia

Virulence and antibiotic resistance are significant determinants of the types of infections caused by Staphylococcus aureus and paediatric groups remain among the most commonly affected populations. The goal of this study was to characterise virulence genes of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains isolated from a paediatric population of a Colombian University Hospital during 2009. Sixty MSSA and MRSA isolates were obtained from paediatric patients between zero-14 years. We identified the genes encoding virulence factors, which included Panton-Valentine leucocidine (PVL), staphylococcal enterotoxins A-E, exfoliative toxins A and B and toxic shock syndrome toxin 1. Typing of the staphylococcal chromosome cassette mec (SCCmec) was performed in MRSA strains. The virulence genes were more diverse and frequent in MSSA than in MRSA isolates (83% vs. 73%). MRSA strains harboured SCCmec types IVc (60%), I (30%), IVa (7%) and V (3%). SCCmec type IVc isolates frequently carried the PVL encoding genes and harboured virulence determinants resembling susceptible strains while SCCmec type I isolates were often negative. PVL was not exclusive to skin and soft tissue infections. As previously suggested, these differences in the distribution of virulence factor genes may be due to the fitness cost associated with methicillin resistance.     

Outbreak of Rocky Mountain spotted fever in Córdoba, Colombia

Rocky Mountain spotted fever (RMSF) is a tick-borne disease caused by the obligate intracellular bacterium Rickettsia rickettsii. Although RMSF was first reported in Colombia in 1937, it remains a neglected disease. Herein, we describe the investigation of a large cluster of cases of spotted fever rickettsiosis in a new area of Colombia.     

Food habits of Puma concolor (Carnivora: Felidae) in the Parque Nacional Natural Puracé, Colombia

Neotropical puma (Puma concolor) diet is scarcely known, in particular that of mountain dwelling individuals from Northern South America. This is the first study on pumas from the paramo and the first puma diet analysis for Colombia. The puma diet was studied from 2007 to 2009 in the Puracé National Park in the South Colombian Andes. Paramos are unique neotropical high altitude ecosystems which store and regulate water, and are currently threatened by agricultural expansion and climate change. Seven latrines were monitored for three years and scat collected, washed and dried. Items in scat such as hair, bones, claws and others were separated. Hairs were inspected by microscopy and compared to voucher hair museum specimens. Bone fragments, claws and teeth were also compared to museum collections and identified wherever possible. Additionally, six cameras were set along game trails to document puma and potential prey presence in the area. Food items from five species were identified in 60 puma scats; Northern Pudu (Pudu mephistophiles) was the most important prey in their diet. A total of 354 camera trap-nights photographed a male and female puma, Northern pudu and Spectacled bear (Tremarctos ornatus). The main conclusion suggests a strong dependence of puma on the threatened and mysterious Northern Pudu in paramo habitats. This behavior might reflect restricted prey availability in the high Andes mountains of Colombia, and highlights the plasticity in the puma diet. Conservation actions in the paramo should thus, focus on focal wild species, and in particularly those that show a relationship, such as the one evidenced here with the dependence of puma on Northern Pudu. These findings contribute to increase the little known ecology of Andean puma populations and the species as a whole in Colombia. Baseline data on puma prey populations in different ecosystems throughout their range, is critical to understand the regional requirements for survival, and design conservation actions, to follow and evaluate the need for particular protected areas along their geographical gradients.     

Discourses,Power Negotiations and Indigenous Political Organization in Forest Partnerships: The Case of Selva de Matavén,Colombia

While much research on forest partnerships hitherto has been focused mainly on the drivers behind their formation, the kind of actors and deals involved, and the factors that promote or hinder their success, much less attention has been paid to the dynamic relationships and processes inherent in these partnerships. Based on the study of a partnership process in an indigenous reservation in Colombian Amazonia covering a variety of projects, this paper seeks to fill part of this lacuna by analyzing the partnership as a dynamic ‘discursive battlefield,’ in which objectives and actions are being constantly negotiated. Actors in the Matavén partnership strategically incorporate discursive elements in order to pursue their own interests while also endorsing those that ensure the continuation of collaboration. We conclude that discourses are embedded in partnership micro-politics. On the one hand, discursive shifts occur as a reflection of power balances at given moments. On the other hand, discourses constitute indispensable resources with the potential to both enhance individual actor’s negotiating power and to create opportunities for compromise. Within an ongoing discursive tension between ‘conservation’ and ‘indigenous autonomy,’ flexible notions such as ‘territorial ordering’ prove to be successful in allowing space for manoeuvre and granting conceptual coherence to shifts occurring ‘on the ground.’     

First Report of Lutzomyia França in the department of Guainía, Amazonian Colombia, and of Brumptomyia mesai Sherlock (Diptera: Psychodidae) in the Colombian Caribbean Coast

This is the first record of the presence of the medically important genus Lutzomyia Fran?a in the Department of Guainía, Colombia. Sand flies were collected biting humans in the surroundings of the urban area of the Municipality of Inírida. Three Lutzomyia species were taxonomically identified as L. davisi (Root), L. olmeca bicolor Fairchild & Theodor, and L. antunesi (Coutinho). Additionally, Brumptomyia mesai Sherlock is cited for the first time in the Caribbean Coast of Colombia based on specimens collected with a modified CDC light trap in the Reserva Forestal Protectora Serranía de Coraza y Montes de María, Department of Sucre.     

A dynamic,multi‐level analysis of recent immunization trends in Colombia

Abstract

During 1985–91, Latin American ministries of health carried out the ultimately successful Regional Polio Eradication Initiative. Unprecedented vaccine coverage levels were attained through a combination of mass campaigns, house‐to‐house vaccinations, and improvements in routine immunization services. Little is known, however, about the effects of these interventions on immunization demand; whether they reached so‐called high‐risk households and, if so, whether program effects were sufficient to offset the household risk factors. This paper examines the probability and timing of full immunization over this period in one case country, Colombia. Information on the immunization status of 3,609 vaccine‐eligible children born 1985–90 was extracted from Colombia's 1990 Demographic and Health Survey. Annual immunization coverage estimates from the Colombian Ministry of Health for 1985–90 for 148 sample municipios were appended to each child record, along with household‐level data. Initial non‐parametric regressions showed that five of six observed risk factors negatively influenced full immunization probability. Multivariate logit models showed that parents who had already lost a child were significantly less likely to obtain immunization cards (a proxy for exposure to the routine immunization program), despite rising cardholdership rates over the period. Among 1,376 immunization cardholders, waiting times to full immunization fell monotonically over the period. Local program coverage of 80 per cent or higher and prior use of prenatal services both increased the probability of full immunization. However, three of five maternal occupational categories decreased the probability, as did three of six observed household risk factors. The results show that demand for routine immunizations rose over the period, that only the highest‐risk households were not exposed to the routine program, and that routine program participation partially offset negative risk factor effects on the probability of full immunization. While targeted PHC interventions may increase health production by recruiting high‐risk households into the routine PHC services, further health production increases will require more intensive follow‐up of such households through routine PHC services.     

Secular trends of HPV genotypes in invasive cervical cancer in Cali,Colombia 1950–1999

Aim To estimate relative contribution and time trends of HPV types in cervical cancer in Cali, Colombia over a 50 years’ period.MethodsParaffin blocks of 736 cervical cancer histological confirmed cases were retrieved from the pathology laboratory at Hospital Universitario del Valle (Cali, Colombia) and HPV genotyped using SPF10-PCR/DEIA/LiPA25 (version 1) assay. Marginal effect of age and year of diagnosis in secular trends of HPV type prevalence among HPV+ cases were assessed by robust Poisson regression analysis.Results64.7% (95%CI: 59.9–69.2) of squamous cell carcinomas (SCCs) were attributed to HPV 16 and 18, 78.2% (95%CI: 74–82) to HPV 16, 18, 31, 33 and 45 and 84.8% (95%CI: 81–88.1) to HPV 16, 18, 31, 33, 45, 52 and 58 while ninety-three percent of adenocarcinomas (ADCs) were attributed to HPV 16, 18 and 45 only. The prevalence of specific HPV types did not change over the 50-year period. A significant downward trend of prevalence ratios of HPV16 (​P = 0.017) and α7 but HPV 18 (i.e., HPV 39, 45, 68, 70, ​P = 0.024) with increasing age at diagnosis was observed. In contrast, the prevalence ratio to other HPV genotypes of α9 but HPV 16 genotypes (i.e., HPV 31, 33, 35, 52, 58, 67, ​P = 0.002) increased with increasing age at diagnosis.ConclusionNo changes were observed in the relative contribution of HPV types in cervical cancer in Cali, Colombia during the 50 years. In this population, an HPV vaccine including the HPV 16, 18, 31, 33, 45, 52 and 58 genotypes may have the potential to prevent ∼85% and 93% of SCC and ADC cases respectively.     

Efficacy of amodiaquine and sulfadoxine/pyrimethamine in the treatment of malaria not complicated by Plasmodium falciparum in Nariño,Colombia, 1999-2002

The resurgence and spread of antimalarial drug resistance is one of the causes of the worldwide increase of malaria. In Colombia, uncomplicated Plasmodium falciparum malaria has been treated with a combination of amodiaquine (AQ) and sulfadoxine/pyrimethamine (SP) since 2000. The efficacy of these two antimalarials was evaluated after the implementation of the new malaria treatment scheme. In the municipalities of El Charco and Tumaco (Nari?o) on the Pacific Coast region, the standard PAHO protocol was used to evaluate antimalarial efficacy in areas of low to moderate malaria transmission. Patients were randomly allocated to treatment regime in two cities of Nari?o, El Charco (n = 48) and Tumaco (n = 50). After 14 days none of El Charco patients presented therapeutic failure to either antimalarial. However, in Tumaco after 28 days, 12 of 24 (95% CI: 30.6-69.4) patients presented AQ treatment failure while 4 of 26 (95% CI: 5.1-33.1) patients had SP treatment failure. The high level of AQ treatment failure in Tumaco was unexpected because it had been introduced only recently as an antimalarial treatment in Colombia. The results suggest that the use of the current dose of AQ in combination with SP will be therapeutically useful for less time than expected. Use of combined therapies is a key strategy to delay antimalarial resistance. Unfortunately, its success depends on the efficacy of antimalarial drugs individually.