Accurate Epidemiological Information Research Articles

La enfermedad fúngica: el acoso y derribo del más débil

Fungal diseases encompass a wide range of conditions, from superficial skin infections to potentially life-threatening systemic diseases. The burden of severe fungal diseases is considerable, with millions of cases annually and high mortality rates. However, accurate epidemiological information is lacking due to limited surveillance. Their diagnosis and treatment present significant challenges, especially in resource-limited settings. Globally, there is a notable shortage of specialists experienced in fungal diseases. This scarcity contributes to delays in diagnosis and empirical treatment, with the consequences that this entails for the patient. The integration of artificial intelligence into medical practice promises to improve the diagnosis and management of fungal diseases. However, careful validation and training of algorithms are essential to ensure their effectiveness and equity. In conclusion, we call on relevant institutions to recognize the need for public funding for a project whose sole aim is to ensure that fungal diseases are incorporated into the realm of equal opportunities and rights, rather than remaining hidden and relegated to elitist institutions where professionals have the knowledge and tools to diagnose and treat them.

Investigation of the Epidemiological Situation of Malta Fever in the Cities under Mashhad University of Medical Sciences during the years 2016 to 2022

Background Management of Malta fever disease requires policy-making and accurate epidemiological statistics and information. Aim The present study was conducted to determine the epidemiological status of Malta fever. Materials and Methods This study is of the secondary data analysis type, which was conducted using the recorded data of patients with brucellosis in the health center of Mashhad City from 2016 to 2022. Data related to 12,714 cases of brucellosis were analyzed using R software and Chi-2, Pearson, and independent t-statistical tests. Results The average age of the patients was 33.18 ± 18.81 years. About 87% of disease cases were related to rural areas and 13% to urban areas. The average annual incidence of the disease was 287 cases per 100,000 population at risk of the disease. The highest incidence rate was in 2020, and the lowest incidence rate was in 2016. The most cases of disease were related to the first three months of the year, and the least cases were related to the last three months of the year. Most cases of the disease were related to housewives, cattle breeders, and farmers. Conclusion The incidence of the disease increased from the beginning of the study to 2020 and decreased from 2020 to the end of the study. Health policymakers should integrate medicine, ecology, and education for the prevention and control of brucellosis. This holistic strategy recognizes the interconnectedness of human, animal, and environmental health, emphasizing the need for collaborative efforts across sectors to address the multifaceted nature of the disease.

A data-driven epidemic model with human mobility and vaccination protection for COVID-19 prediction

Epidemiological models allow for quantifying the dynamic characteristics of large-scale outbreaks. However, capturing detailed and accurate epidemiological information often requires consideration of multiple kinetic mechanisms and parameters. Due to the uncertainty of pandemic evolution, such as pathogen variation, host immune response and changes in mitigation strategies, the parameter evaluation and state prediction of complex epidemiological models are challenging. Here, we develop a data-driven epidemic model with a generalized SEIR mechanistic structure that includes new compartments, human mobility and vaccination protection. To address the issue of model complexity, we embed the epidemiological model dynamics into physics-informed neural networks (PINN), taking the observed series of time instances as direct input of the network to simultaneously infer unknown parameters and unobserved dynamics of the underlying model. Using actual data during the COVID-19 outbreak in Australia, Israel, and Switzerland, our model framework demonstrates satisfactory performance in multi-step ahead predictions compared to several benchmark models. Moreover, our model infers time-varying parameters such as transmission rates, hospitalization ratios, and effective reproduction numbers, as well as calculates the latent period and asymptomatic infection count, which are typically unreported in public data. Finally, we employ the proposed data-driven model to analyze the impact of different mitigation strategies on COVID-19.

Historical and modern views on the problem of prostatolithiasis

In the literature review the authors present data on the history of the development of diagnostics and treatment of patients with prostatolithiasis and basic information about the most effective methods of treatment of this urological nosology. Prostatolithiasis is one of the most common diseases of the prostate in which, due to various etiological factors, stones are formed in the parenchyma of the prostate gland. Due to the lack of a single diagnostic algorithm, there is no accurate epidemiological information on the prevalence of prostate stones. According to various authors, this figure starts from 7.35 % and reaches 88.6 %. Depending on the localization, prostate stones are divided into endogenous, exogenous and mixed. Asymptomatic course, polyetiological pathogenesis, frequent recurrences of the inflammatory process in the prostate gland with the subsequent appearance of symptoms of the lower urinary tract, sclerosis of the prostate and bladder neck determine the extremely important role of this pathology. Prostatolithiasis, due to its specific clinical course, continues to be one of the most poorly studied problems in men of active working age, as well as in elderly men.

Outpatient purchasing patterns of hydroxychloroquine and ivermectin in the USA and Canada during the COVID-19 pandemic: an interrupted time series analysis from 2016 to 2021.

Hydroxychloroquine and ivermectin received widespread attention after initial studies suggested that they were effective against COVID-19. However, several of these studies were later discredited. We explored the impact of scientific articles, public announcements and social media posts on hydroxychloroquine and ivermectin purchases in the USA and Canada during the COVID-19 pandemic. We conducted a retrospective, population-based time series analysis of retail hydroxychloroquine and ivermectin purchases in the USA and Canada from February 2016 through to December 2021, using IQVIA's Multinational Integrated Data Analysis database. We fitted the purchasing rates with interventional autoregressive integrated moving average models. We used Google Trends to identify the most influential interventions to include in the models. There were significant pulse increases in hydroxychloroquine purchases in March 2020 in both the USA (P < 0.0001) and Canada (P < 0.0001). For ivermectin, there were no significant changes in April 2020 in either the USA (P = 0.41) or Canada (P = 0.16); however, significant pulse increases occurred from December 2020 to January 2021 in both the USA (P = 0.0006) and Canada (P < 0.0001), as well as significant ramp increases from April to August 2021 in both the USA (P < 0.0001) and Canada (P = 0.02). The increases in ivermectin purchases were larger in the USA than in Canada. Increases in hydroxychloroquine and ivermectin purchasing rates aligned with controversial scientific articles and social media posts. This highlights the importance of scientific integrity and disseminating accurate epidemiologic information during pandemics.

Improving the accuracy of clinical interpretation of serological testing for the diagnosis of acute hepatitis a infection.

Hepatitis A (HA) remains a common infection globally that results in a self-limiting hepatitis with gastrointestinal and systemic symptoms. Direct detection of the virus in blood or stool is often not possible once symptomatic. Serological testing is frequently performed to investigate abnormal liver function tests - and interpretation of equivocal and low-level positive anti-hepatitis A virus (HAV) IgM is difficult even in the context of accurate epidemiological and clinical information. The aim of this project was to characterise the association between low-level reactive anti-HAV IgM results and clinical disease. Anti-HAV serology results recorded over 22 months were analysed. Equivocal and positive Architect anti-HAV IgM results were matched with available clinical and demographical data to identify confirmed and probable cases of acute HAV infection. Reactive anti-HAV IgM results were recorded for 88/7661 (1.15%) samples. Using clinical and laboratory data, 35 patients were confirmed to have acute HAV infection. Acute HA was associated with a mean Architect anti-HAV IgM value of 9.4 (SD 6.8-12.0). Cases of HA had a mean peak ALT value of 1920 (SD 682-3158). All confirmed cases (35/35) of acute HAV were associated with at least one clinical indicator, with 28/31 cases (90%) having a documented jaundice. All 35 (100%) cases of acute HAV infection had anti-HAV IgM > 4.0. A diagnosis other than acute HA was identified in 7/11 (63.6%) of low-level reactive anti-HAV IgM results (clinical data unavailable for further 4/11, 36.3%). Where clinical information was available, acute HA was excluded in all 31 patients with equivocal or low-level reactive anti-HAV IgM results. The accuracy of reports sent out to the clinician showed room for improvement. An interpretive algorithm is proposed including a clinically significant cut-off value for anti-HAV IgM.

Basketball vs. Hockey-The Changing Face of Sport-Related Injuries in Canada.

To characterize and compare the incidence of basketball-related, soccer-related, and hockey-related injuries over a 10-year period. Cohort analysis of sport-related injuries using multiple Ontario healthcare databases. Emergency department visits in Ontario, Canada. Any patient who sustained musculoskeletal injuries sustained while playing basketball, soccer, or hockey between 2006 and 2017 were identified. Sport of injury, age, sex, rurality index, marginalization status, and comorbidity score. Annual Incidence Density Rates of injury were calculated for each sport, and significance of trends was analyzed by assessing overlap of 95% confidence intervals. One lakhs eighty five thousand eighty hundred sixty-eight patients (median age: 16 years, interquartile range 13-26) received treatment for sport-related injuries (basketball = 55 468; soccer = 67 021; and hockey = 63 379). The incidence of basketball-related and soccer-related injuries increased from 3.4 (3.3-3.5) to 5.6 (5.5-5.7) and 4.4 (4.3-4.5) to 4.9 (4.8-5) per 10 000 person years, respectively, whereas the incidence of hockey-related injuries decreased from 4.7 (4.6-4.8) to 3.7 (3.6-3.8). Patients with basketball injuries were more marginalized (3.01 ± 0.74) compared with patients with soccer and hockey injuries (2.90 ± 0.75 and 2.72 ± 0.69, respectively). Accurate regional epidemiologic information regarding sports injuries can be used to guide policy development for municipal planning and sport program development. The trends and demographic patterns described highlight general and sport-specific injury patterns in Ontario. Populations with the highest incidence of injury, most notably adolescents and men older than 50, may represent an appropriate population for injury risk prevention.

Patients with Cystic Echinococcosis: Evaluation of Clinical and Biological Features of Cysts

Objective: The main purpose of the study was to evaluate CE patients in a versatile way with the most commonly used diagnostic methods. In addition, we also investigated correlation between diagnostic parameters and CE cyst properties. Materials and Methods: A total 45 patients had an active or transitional CE cysts according to the WHO-IWGE classification and they have received percutaneous treatment for CE cysts. Serological analyses, molecular characterization of E.granulosus s.l. and direct examination of hydatid material were perfomed. Results: A total of 58 CE cysts were recorded and 34 of 58 hydatid cysts were identified as CE1, 14 as CE2, 2 as CE3a and 8 as CE3b. Direct examination, 30 of 58 hydatid cysts were found to be positive regarding protoscolex. According to serological tests, 37 of 45 patients had positive ELISA results. Most of the isolates (56/58) were identified as E.granulosus sensu stricto (G1-G3 genotypes) and two of them were characterized as E. canadensis (G6/7 genotypes). On the other hand, it is confirmed that serodiagnosis has been influenced by certain cyst characteristics. Conclusion: CE patients should be evaluated using many diagnostic approaches to accurate epidemiological information and to adopt proper clinical management.

Prevalence and incidence of neuromuscular conditions in the UK between 2000 and 2019: A retrospective study using primary care data.

In the UK, large-scale electronic primary care datasets can provide up-to-date, accurate epidemiological information on rarer diseases, where specialist diagnoses from hospital discharges and clinic letters are generally well recorded and electronically searchable. Current estimates of the number of people living with neuromuscular disease (NMD) have largely been based on secondary care data sources and lacked direct denominators. To estimate trends in the recording of neuromuscular disease in UK primary care between 2000-2019. The Clinical Practice Research Datalink (CPRD) database was searched electronically to estimate incidence and prevalence rates (per 100,000) for a range of NMDs in each year. To compare trends over time, rates were age standardised to the most recent CPRD population (2019). Approximately 13 million patients were actively registered in each year. By 2019, 28,230 active patients had ever received a NMD diagnosis (223.6), which was higher among males (239.0) than females (208.3). The most common classifications were Guillain-Barre syndrome (40.1), myasthenia gravis (33.7), muscular dystrophy (29.5), Charcot-Marie-Tooth (29.5) and inflammatory myopathies (25.0). Since 2000, overall prevalence grew by 63%, with the largest increases seen at older ages (≥65-years). However, overall incidence remained constant, though myasthenia gravis incidence has risen steadily since 2008, while new cases of muscular dystrophy fell over the same period. Lifetime recording of many NMDs on primary care records exceed current estimates of people living with these conditions; these are important data for health service and care planning. Temporal trends suggest this number is steadily increasing, and while this may partially be due to better recording, it cannot be simply explained by new cases, as incidence remained constant. The increase in prevalence among older ages suggests increases in life expectancy among those living with NMDs may have occurred.

Knowledge, attitudes, and practices regarding COVID-19 among pharmacists partnering with community residents: A national survey in Japan.

BackgroundCommunity pharmacists play an important role in reducing COVID-19-related secondary health problems. However, the knowledge, attitudes, and practices (KAP) regarding COVID-19 among pharmacists in Japan have not yet been elucidated.MethodsWe conducted a web-based questionnaire survey among 1,137 pharmacists working in health support pharmacies (HSPs) in Japan. These pharmacists are responsible for providing health consultations to community residents. We assessed COVID-19-related KAP among pharmacists and compared the results for two age groups: ≤49 years and ≥50 years. We used multiple regression analysis to examine which factors influence KAP scores regarding COVID-19.ResultsFrom among the 2,141 HSPs in Japan, a total of 1,137 pharmacists, each representing a different HSP, responded to the survey. The results indicated that since the beginning of the COVID-19 pandemic, pharmacists have been providing consultations about COVID-19 to local residents, covering topics such as “Effective infection prevention methods” (60.6%) and “What the COVID-19 pandemic would be” (48.8%). Importantly, 73.5% of the pharmacists felt they “did not have enough information about COVID-19.” The main information resources about COVID-19 were Internet (91.2%) and television (78.9%). Across all respondents, the mean knowledge score (4.17/10) was lower than the mean scores for attitudes (7.26/10) and practices (5.79/10). Multiple regression analysis showed that having enough information about COVID-19 was a factor strongly associated with total KAP scores (p<0.001; 95% confidence interval, −1.344 to −0.540).ConclusionsPharmacists working in community pharmacies provide residents with information related to COVID-19. In this role as a health partner, these pharmacists need a way to strengthen and expand their knowledge, and moreover, their ability to support community residents. Learning more about the available academic and scientific information, as well as having access to accurate epidemiological information, can offer a means of reaching these goals.

Human dirofilariosis in the 21st century: A scoping review of clinical cases reported in the literature.

Human dirofilariosis is a clinical entity caused by infection with nematode species of the genus Dirofilaria. The traditional picture depicts the disease as a sporadic event associated with the presence of a single immature worm causing a nodular lesion. With the aim to reassess this paradigm, establishing a more accurate picture of the disease and homogenize criteria, a scoping review was conducted by searching, screening and analysing published clinical cases of human dirofilariosis worldwide during the 21st century. After extracting data from 305 publications containing 576 case reports, results showed that human dirofilariosis is currently caused by five Dirofilaria species (mainly D. repens). Maturation was not uncommon, since 42.95% of the parasites recovered were described as mature worms, most of them females, 26.42% of which contained micofilariae in the uterus. Moreover, six microfilaremic cases have been described. The predominant clinical manifestation was the presence of a worm encapsulated within a nodule, but there is a considerable variety of accompanying symptoms depending on anatomical location and type of dirofilariosis. Parasites/nodules were found in 71 different anatomical locations, being the traditional nomenclature of human dirofilariosis unable to properly cover this complex situation. Delay in seeking medical assistance (patient perception) and the frequency of wrong clinical suspicions (doctor knowledge), strongly influenced clinical management. The initial suspicion in cases of subcutaneous and pulmonary dirofilariosis is predominantly a tumour, while in the ocular dirofilariosis a parasite (but not directly Dirofilaria) is mostly suspected. Surgery is usually applied, regardless of the use of non-invasive techniques during preoperative management and although its use is still limited, molecular approach is the most accurate technique to establish a species-level diagnosis. Accurate epidemiological, parasitological and clinical information while handling and reporting human clinical cases is a need for physicians and researchers to improve and standardize the clinical management of human dirofilariosis.

Landscape analysis of healthcare policy: the instrumental role of governance in HIV/AIDS services integration framework

IntroductionLow and middle-income countries HIV/AIDS interventions are yet to achieve the desired levels of health outcome due to lack of effectiveness and efficiency in programming, a challenge associated with resource limitations, fragmented services, complexities in population and disease characteristics including political landscape. The objective of this study was to establish the instrumental role of governance in the implementation of HIV/AIDS services integration policy framework, with focus on organization structure, participation in decision making, collaboration, stakeholder engagement, political commitment as study variables.MethodsUsing a mixed method design, a total number of 30 health workers, 5 county AIDS services coordinators (CASCOs), 8 sub-CASCOs and 3 representatives of inter coordinating committee were interviewed in compliance with ethical protocols. Multi-stage sampling techniques was used to select counties in Kenya, health institutions and respondents. Quantitative and qualitative data was generated by administering semi structured questionnaire and key informant interview guide.ResultsGenerated from excel sheet and NVivo software indicate that organization structures existed and clarity and ease of work varied across the different levels of care. Collaboration efforts, however varied, created synergy in policy framework implementation and political commitment complemented the various leadership actions for successful implementation of integration policy framework.ConclusionGovernance role is indispensable in the implementation of health policy framework. Policy makers need accurate epidemiological and demographic information to implement contextualized policy framework necessary for sustained improvement in health outcomes.

Rapid and Accurate Species Identification of Mitis Group Streptococci Using the MinION Nanopore Sequencer.

Differentiation between mitis group streptococci (MGS) bacteria in routine laboratory tests has become important for obtaining accurate epidemiological information on the characteristics of MGS and understanding their clinical significance. The most reliable method of MGS species identification is multilocus sequence analysis (MLSA) with seven house-keeping genes; however, because this method is time-consuming, it is deemed unsuitable for use in most clinical laboratories. In this study, we established a scheme for identifying 12 species of MGS (S. pneumoniae, S. pseudopneumoniae, S. mitis, S. oralis, S. peroris, S. infantis, S. australis, S. parasanguinis, S. sinensis, S. sanguinis, S. gordonii, and S. cristatus) using the MinION nanopore sequencer (Oxford Nanopore Technologies, Oxford, UK) with the taxonomic aligner “What's in My Pot?” (WIMP; Oxford Nanopore's cloud-based analysis platform) and Kraken2 pipeline with the custom database adjusted for MGS species identification. The identities of the species in reference genomes (n = 514), clinical isolates (n = 31), and reference strains (n = 4) were confirmed via MLSA. The nanopore simulation reads were generated from reference genomes, and the optimal cut-off values for MGS species identification were determined. For 31 clinical isolates (S. pneumoniae = 8, S. mitis = 17 and S. oralis = 6) and 4 reference strains (S. pneumoniae = 1, S. mitis = 1, S. oralis = 1, and S. pseudopneumoniae = 1), a sequence library was constructed via a Rapid Barcoding Sequencing Kit for multiplex and real-time MinION sequencing. The optimal cut-off values for the identification of MGS species for analysis by WIMP and Kraken2 pipeline were determined. The workflow using Kraken2 pipeline with a custom database identified all 12 species of MGS, and WIMP identified 8 MGS bacteria except S. infantis, S. australis, S. peroris, and S. sinensis. The results obtained by MinION with WIMP and Kraken2 pipeline were consistent with the MGS species identified by MLSA analysis. The practical advantage of whole genome analysis using the MinION nanopore sequencer is that it can aid in MGS surveillance. We concluded that MinION sequencing with the taxonomic aligner enables accurate MGS species identification and could contribute to further epidemiological surveys.

Spatial distribution of the relative risk of Zika virus disease in Colombia during the 2015-2016 epidemic from a Bayesian approach.

ObjectiveTo determine the spatial distribution of the risk of Zika virus disease in each region of Colombia during the 2015–2016 epidemic.MethodsAn ecological study was designed to estimate the risks for each Colombian region using first‐order neighbors, covariate effects, and three adjacent periods of time (beginning, development, and end of the epidemic) to analyze the spatial distribution of the disease based on a Bayesian hierarchical model.ResultsSpatial distribution of the estimated risks of Zika virus disease showed that it increased in a strip that crosses the central area of the country from west to east. Analysis of the three time periods showed greater risk of the disease in the central and southern zones—Arauca and Santander—where the increase in risk was four times higher during the peak phase compared with the initial phase of the outbreak.ConclusionIn the identified high‐risk areas, integrated surveillance systems for Zika virus disease and its complications must be strengthened to provide up‐to‐date and accurate epidemiological information. This information would allow those involved in policy and decision making to identify new outbreaks and risk clusters, enabling more focused and accurate measures to target at‐risk populations.

Exanthema after travel abroad

ZusammenfassungAngesichts der Globalisierung und der damit verbundenen Warentransporte sowie einer zunehmenden Reisetätigkeit auch in der deutschen Bevölkerung häufen sich importierte Infektionen mit subtropischen und tropischen Erregern. Differenzialdiagnostisch kommt bei akutem Fieber mit Allgemeinsymptomen und Exanthem eine Reihe von Erkrankungen in Betracht. Neben Morphe und Verteilung des Exanthems sind genaue Angaben über den Reiseverlauf und epidemiologische Angaben über länderspezifische Risiken auf dem Weg zur richtigen Diagnose hilfreich. Dieser Beitrag gibt eine Übersicht über die häufigsten Exantheme bei Reiserückkehrer*innen, ihre Begleitsymptome, Methoden zur Diagnosesicherung und Therapie- bzw. Präventionsstrategien.

Achieving the targets of sustainable development goals (2030 agenda) for congenital disorders in Asia: Bottlenecks and interventions.

The United Nations General Assembly adopted the 2030 Agenda for Sustainable Development in November 2015 which included a set of 17 measurable "sustainable development goals" (SDGs). The SDGs included targets to end preventable deaths of newborns and children under 5 years of age by 2030, universal health care coverage, reduction of premature mortality from noncommunicable diseases (NCDs) by 33% as well as support the development and research for medicines for both communicable and NCDs. Although some successes were achieved in combating communicable diseases and improved childhood mortality rates, health systems in Asia are generally characterized by lack of accurate epidemiological information on congenital disorders, lack of human and financial resources, and inadequate focus on public health strategies to ensure targeted interventions, low level knowledge on congenital disorders amongst the community and healthcare providers and the ethical dilemma of managing rare congenital disorders in an environment of low national health expenditures. These bottlenecks must be addressed systematically and interventions such as the use of innovative epidemiological tools to overcome lack of data, increased efforts to standardize rare disease nomenclature and classification and renewed interest in birth defects registries by countries in the region must be considered. Targeted curative and public health approaches currently used in thalassaemia and neural tube defects may be used for other congenital disorders in Asian countries. The implementation of congenital disorders-related research, prevention, care, and treatment delivery services must be integrated into existing health systems in order to be effective to achieve the targets of SDG2030.

Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data.

BackgroundHyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends.MethodsWe extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation.ResultsThe total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend <0.01). In contrast, the hospitalization rate per 1,000 diabetes cases showed a decreasing trend (P for trend <0.01) during this period. The mortality rate per 1,000 diabetes cases also showed a decreasing trend (P for trend <0.0001). However, no distinct linear trend in the case-related fatality rate at <60 days over the last decade was observed. The predicted number of annual claims of hyperglycemic crisis will increase by 2030.ConclusionThe number of hyperglycemic crisis hospitalizations in Korea increased in the last decade, although the hospitalization rate per 1,000 diabetes cases and mortality rate decreased. Also, the predicted number of annual claims will increase in the future. Thus, it is necessary to establish long-term healthcare policies to prevent hyperglycemic crisis.

Paediatric poisoning in rural Sri Lanka: an epidemiological study

BackgroundAcute paediatric poisoning is a common public health concern for both developed and developing countries. The type of agent and underlying cause differ depending on the social, cultural, economic and educational background. The objectives of this study were to identify the incidence and pattern of paediatric poisoning in a rural district in Sri Lanka and establish whether tertiary referral hospital data are a useful surrogate for estimating district level epidemiology of paediatric poisoning.MethodsA subset of epidemiological data were obtained from March 2011 to February 2013 from a randomized controlled trial (SLCTR/2010/008) conducted in 45 hospitals in Kurunegala district.ResultsThe age adjusted annual incidence of all cause of acute poisoning in children aged 1 to 12 years in the study area was 60.4 per 100,000. The incidence of poisoning of younger age group (1 to 6 years; 76 per 100,000) was significantly higher than older age group (7 to 12 years; 41 per 100,000) (p = 0.0001) in Kurunegala district. The annual incidence rate of paediatric admissions due to deliberate self-poisoning is 18 per 100,000 population. This study also established that admission data from primary hospitals provided the most accurate epidemiological information on paediatric poisoning.ConclusionsIn rural districts of Sri Lanka, acute paediatric poisoning cases were less frequent and less severe compared to adult poisoning cases (426–446 per 100,000 population). The incidence of poisoning was significantly higher among young children with compared to old children. In this study, deliberate self-poisoning among older children was more frequently seen than in other comparable countries. Because most of the admissions are directed to and managed by primary hospitals, data from referral hospitals alone cannot be used to represent the true incidence of acute poisoning within a district. The data set from all the primary hospitals (n = 44) yielded more accurate poisoning incidence amongst a paediatric population.

Molecular Epidemiology of Brucella abortus in Northern Ireland—1991 to 2012

BackgroundBrucellosis is the most common bacterial zoonoses worldwide. Bovine brucellosis caused by Brucella abortus has far reaching animal health and economic impacts at both the local and national levels. Alongside traditional veterinary epidemiology, the use of molecular typing has recently been applied to inform on bacterial population structure and identify epidemiologically-linked cases of infection. Multi-locus variable number tandem repeat VNTR analysis (MLVA) was used to investigate the molecular epidemiology of a well-characterised Brucella abortus epidemic in Northern Ireland involving 387 herds between 1991 and 2012.ResultsMLVA identified 98 unique B. abortus genotypes from disclosing isolates in the 387 herds involved in the epidemic. Clustering algorithms revealed the relatedness of many of these genotypes. Combined with epidemiological information on chronology of infection and geographic location, these genotype data helped to identify 7 clonal complexes which underpinned the outbreak over the defined period. Hyper-variability of some VNTR loci both within herds and individual animals led to detection of multiple genotypes associated with single outbreaks. However with dense sampling, these genotypes could still be associated with specific clonal complexes thereby permitting inference of epidemiological links. MLVA- based epidemiological monitoring data were congruent with an independent classical veterinary epidemiology study carried out in the same territory.ConclusionsMLVA is a useful tool in ongoing disease surveillance of B. abortus outbreaks, especially when combined with accurate epidemiological information on disease tracings, geographical clustering of cases and chronology of infection.

Urban Malaria: Understanding its Epidemiology, Ecology, and Transmission Across Seven Diverse ICEMR Network Sites.

A major public health question is whether urbanization will transform malaria from a rural to an urban disease. However, differences about definitions of urban settings, urban malaria, and whether malaria control should differ between rural and urban areas complicate both the analysis of available data and the development of intervention strategies. This report examines the approach of the International Centers of Excellence for Malaria Research (ICEMR) to urban malaria in Brazil, Colombia, India (Chennai and Goa), Malawi, Senegal, and Uganda. Its major theme is the need to determine whether cases diagnosed in urban areas were imported from surrounding rural areas or resulted from transmission within the urban area. If infections are being acquired within urban areas, malaria control measures must be targeted within those urban areas to be effective. Conversely, if malaria cases are being imported from rural areas, control measures must be directed at vectors, breeding sites, and infected humans in those rural areas. Similar interventions must be directed differently if infections were acquired within urban areas. The hypothesis underlying the ICEMR approach to urban malaria is that optimal control of urban malaria depends on accurate epidemiologic and entomologic information about transmission.