Active Case Search Research Articles

Epidemiology of SARS-CoV-2 Infection in Karnataka State, South India: Transmission Dynamics of Symptomatic vs. Asymptomatic Infections

Background: In this report, we describe the epidemiology of SARS-CoV-2 infection, specifically examining how the symptomatic persons drove the transmission in the state of Karnataka, India, during the lockdown phase.Methods: The study included all the cases reported from March 8 to May 31, 2020 in the state. Any person with history of international or domestic travel from high burden states, those presenting with Influenza-like or Severe Acute Respiratory Illness and high-risk contacts of COVID19 cases, who were SARS-CoV-2 RT-PCR positive were included. Detailed analysis based on contact tracing data available from line-list of the state surveillance unit was performed using cluster analysis software package.Findings: Amongst the 3404 COVID-19 positive cases, 3096 (91%) were asymptomatic while 308 (9%) were symptomatic. Majority of the asymptomatic cases were in the age range of 16-50 years while symptomatic cases were between 31-65 years. Most of those affected were males. Cluster analysis of 822 cases indicated that the secondary attack rate, size of the cluster (dispersion) and occurrence of overt clinical illness is significantly higher when the index case in a cluster was symptomatic compared to an asymptomatic.Interpretation: Our findings indicate that both asymptomatic and symptomatic SARS-CoV-2 cases transmit the infection; however, the main driving force behind the spread of infection within the state was significantly higher from symptomatic cases. This has major implications for policies related to testing. Active search for symptomatic cases, subjecting them to testing and treatment should be prioritized for containing the spread of COVID-19. Funding: The study is funded by an Intermediate Fellowship of the Wellcome Trust-DBT India Alliance (Clinical and Public Health Research Fellowship) to Giridhara R Babu, Grant number: IA/CPHI/14/1/501499.Declaration of Interests: GRB and DAJ are employees of Indian Institute of Public Health, Bengaluru, Public Health Foundation of India and their employer had no say in the design of the study or the decision to publish. All other authors are employees of either state government (PD, PKBG) or NIMHANS (Central government). The employers had no role in the design of the study or the decision to publish. The authors declare that they do not have any other financial or non-financial relationships that could present a conflict of interest.Ethics Approval Statement: This is to certify that the study entitled "Epidemiology of SARS-CoV-2 Infection in Karnataka State, South India: Transmission Dynamics of Symptomatic vs. Asymptomatic Infections" was reviewed and approved by the NIMHANS Institutional Ethics Committee (Basic and Neurosciences) in its 24th meeting held on 3rd June 2020 (Ref No.NIMHANS/IEC/2020-21)

Influenza A (H1N1)pdm09 outbreak of unknown source in a Ghanaian senior high school

BackgroundInfluenza is an acute viral respiratory tract infection caused by influenza virus and transmitted from person to person. Though usually seasonal in temperate climates, influenza occurs throughout the year in the tropics with outbreaks occurring at irregular intervals. On February 6, 2018, a number of students from a Senior High School (SHS) in Accra reported to a district hospital with cough, fever and other respiratory symptoms. An influenza-like illness (ILI) outbreak was suspected. We investigated to determine the magnitude and source of the outbreak and implement control and preventive measures.MethodsWe interviewed health workers, staff and students of the school as well as case-patients and reviewed health records to collect data on demographic characteristics, signs and symptoms, date of illness onset and outcome. We defined ILI case as “any person in the SHS with fever (measured axillary temperature of ≥ 37.5 °C or history of fever) and cough with or without sore throat or runny nose from January 21 to February 26, 2018”. We conducted active case search to identify more cases and took oropharyngeal samples for laboratory testing. We performed descriptive and inferential analysis by calculating attack rate ratios (ARR) and their exact 95% confidence intervals (CI).ResultsOf the 3160 students, 104 case-patients were recorded from January 25, 2018 to February 13, 2018 (overall attack rate of 3.3%). Mean age of case-patients was 16.1 (±2.3) years with males constituting 71.2% (74/104). Sex specific attack rates were 5.6% (74/1331) and 1.6% (30/1829) for males and females respectively. Compared to females, males were 3.4 times as likely to be ill [ARR =3.4, 95%CI = (2.23–5.15)]. Nine oropharyngeal samples from 17 suspected case-patients tested positive for influenza A (H1N1)pdm09.ConclusionOutbreak of influenza A (H1N1)pdm09 occurred in a SHS in Accra from January to February, 2018. Even though source of the outbreak could not be determined, prompt case management and health education on hand and personal hygiene as non-pharmacological factors probably contributed to the outbreak control. The outbreak ended with a scheduled mid-term break. This underscores the need for more evidence on the effect of school closure in influenza outbreak control.

Ferraz de Vasconcelos syphilis: epidemiological profile, investigation and evolution of cases

Abstract The increased incidence of syphilis in Brazil can be explained by multiple reasons: increased reports of acquired syphilis, increased coverage of rapid tests in pregnant women provided by the Brazilian Ministry of Health, reduced condom use, inadequate treatment of patients and partners. In Ferraz de Vasconcelos, a city in the metropolitan region of São Paulo, an increasing elevation in syphilis cases in healthcare services and in the epidemiological surveillance system. In 2017, the city reported 148 cases from which 27 cases were congenital syphilis, with one death. The purpose of the survey was to evaluate the cases reported and describe the main sociodemographic, epidemiological, clinical, and syphilis investigation. A high incidence of syphilis in adults, pregnant women, and congenital syphilis was recorded with a detection rate of 45.0 per 100,000 in habitants and 12.4 and 9.3 per 1,000 live births, respectively. These rates reflect failures in the diagnosis, treatment, and follow-up of cases. Syphilis in adults was obtained in this study in a higher incidence in men 54.1%.Being 49.4% between brown and black people. It is noteworthy that more than 97% of the pregnant women reported with syphilis underwent prenatal care; however, 36.1% of them started from the second trimester, only 88.9% were given treatment, and 66.7% with record of healing. In addition, only in 27.8% pregnant women, the sexual partner underwent the specific treatment. Regarding congenital syphilis, only 81.5% newborns were given proper treatment and only 55.6% underwent laboratory investigation of cerebrospinal fluid. It is evident that these results expose the weaknesses of the municipal healthcare system. Greater coordination among services can contribute to early diagnosis and active search of cases. The epidemiological bulletin containing data from this study may enhance the organization of syphilis prevention, planning, and surveillance actions in the city. Key messages The increased incidence of syphilis in Brazil can be explained by multiple reasons: increased coverage of rapid tests on people, reduced condom use, inadequate treatment of patients and partners. Greater coordination among services can contribute to early diagnosis and active search of cases.

An epidemiological analysis of Acute Flaccid Paralysis (AFP)\xa0surveillance in Kenya, 2016 to 2018

BackgroundThe poliovirus has been targeted for eradication since 1988. Kenya reported its last case of indigenous Wild Poliovirus (WPV) in 1984 but suffered from an outbreak of circulating Vaccine-derived Poliovirus type 2 (cVDPV2) in 2018. We aimed to describe Kenya’s polio surveillance performance 2016–2018 using WHO recommended polio surveillance standards.MethodsRetrospective secondary data analysis was conducted using Kenyan AFP surveillance case-based database from 2016 to 2018. Analyses were carried out using Epi-Info statistical software (version 7) and mapping was done using Quantum Geographic Information System (GIS) (version 3.4.1).ResultsKenya reported 1706 cases of AFP from 2016 to 2018. None of the cases were confirmed as poliomyelitis. However, 23 (1.35%) were classified as polio compatible. Children under 5 years accounted for 1085 (63.6%) cases, 937 (55.0%) cases were boys, and 1503 (88.1%) cases had received three or more doses of Oral Polio Vaccine (OPV). AFP detection rate substantially increased over the years; however, the prolonged health workers strike in 2017 negatively affected key surveillance activities. The mean Non-Polio (NP-AFP) rate during the study period was 2.87/ 100,000 children under 15 years, and two adequate specimens were collected for 1512 (88.6%) AFP cases. Cumulatively, 31 (66.0%) counties surpassed target for both WHO recommended AFP quality indicators.ConclusionsThe performance of Kenya’s AFP surveillance system surpassed the minimum WHO recommended targets for both non-polio AFP rate and stool adequacy during the period studied. In order to strengthen the country’s polio free status, health worker’s awareness on AFP surveillance and active case search should be strengthened in least performing counties to improve case detection. Similar analyses should be done at the sub-county level to uncover underperformance that might have been hidden by county level analysis.

Identificação de doenças genéticas na Atenção Primária à Saúde

Problema: Embora individualmente raras, somadas, as doenças genéticas têm prevalência global estimada de 31,5 a 73,0 por 1.000 indivíduos. Além disto, doenças genéticas e defeitos congênitos representam a segunda causa de mortalidade infantil no Brasil. Diante deste cenário, foi instituída a Política Nacional de Atenção Integral às Pessoas com Doenças Raras no Sistema Único de Saúde. Esta política prevê funções específicas para Atenção Primária à Saúde (APS) que incluem diagnóstico precoce e mapeamento de pessoas com ou sob-risco de desenvolver doenças genéticas raras e/ou defeitos congênitos para encaminhamento regulado. Essa experiência objetivou colaborar com o desenvolvimento de métodos para o reconhecimento de indivíduos com ou sob-risco de desenvolver doenças genéticas na APS. Métodos: Através de visitas domiciliares e por meio do preenchimento de uma ficha específica, realizou-se busca ativa de casos de doença genética e/ou defeito congênito em uma amostra probabilística aleatória, representativa de uma Unidade de Saúde da Família de um município brasileiro de porte médio. Resultados: Foram investigados 295 domicílios, totalizando 1.160 indivíduos e 238 casais. A média de filhos por casal foi de 2,7, a frequência de consanguinidade foi 3,8% e de abortamento espontâneo foi 8,7%. Foram identificadas 29 pessoas (2,5%) com doenças congênitas, 11 (0,9%) com deficiências auditivas, 10 (0,9%) com deficiência mental e 6 (0,5%) com déficits visuais importantes. Atraso no desenvolvimento neuropsicomotor foi relatado em 8,8% das crianças e adolescentes. Doze indivíduos (1%) possuíam câncer e 9,6% relataram história familiar positiva para câncer. Conclusão: Os profissionais da APS estão em posição privilegiada para identificar e organizar uma rede de cuidados para indivíduos com doenças genéticas e/ou defeitos congênitos. A utilização sistemática de instrumentos que facilitem o reconhecimento de fatores de risco e de situações suspeitas pode ser uma estratégia útil a ser incorporada pela APS.

Haematological profiles after Intensive phase of Anti Koch Treatment with special emphasis on bone marrow changes

BackgroundTuberculosis remains a major public health problem in various parts of the world. It leads to various haematological changes. Study of these haematological changes will help better patient management. Objective & methodsIt is to evaluate haematological changes in tuberculosis patients and compare the result with special emphasis to bone marrow changes as active case search is sharply decreasing the miliary tuberculosis. It is also to evaluate the patients with before and after the Intensive Phase of Anti Koch Treatment. Sputum positive and sputum negative tuberculosis patients confirmed by other ancillary techniques were included into this study. It is conducted at a tertiary level hospital in rural area. ResultIn this study bone marrow hypercellularity was of erythroid series with only 1.92% patients showed granuloma in bone marrow aspiration. In addition to bone marrow changes, significant changes were evident in haemoglobin level, Erythrocyte Sedimentation Rate (ESR) Total White Blood Cell count and RBC count. DiscussionIn majority cases this study showed Erythroid Hyperplasia. It is sharp contrast with other study where myeloid hyperplasia was evident. This study also differs from other study where high number of bone marrow granuloma was reported. In this study only 1.92% cases showed bone marrow granuloma. This study also documented higher number of anaemic cases mostly because of the institute serves poor and tribal population. ConclusionIn our study the cases showing granuloma and hyperplasia of myeloid series were limited. With introduction of Directly Observed Treatment and house to house active case search helped to sharply decrease bone marrow granuloma by limiting multi-organ spread. This study showed, ESR level may be considered as prognostic parameters of tuberculosis.

Measles Outbreak Investigation in Nomadic Population Nasirabad, Balochistan, Pakistan February 2018

Introduction: On 14 February 2018, the District Health Officer of Nasirabad reported 16 suspected measles cases from the nomadic population of Dera Murad Jamali to the disease surveillance and response unit of Quetta and requested an investigation. A FELTP fellow was deputed by the Director of General Health Services, Balochistan to investigate the outbreak, evaluate risk factors and recommend control measures. Methodology: A purposive sampling technique was adopted and a case control study was planned and conducted. Case was defined as “acute onset of generalized maculopapular rash and fever with cough or coryza or conjunctivitis from 29 January to 20 February 2018 in a resident of Dera Murad Jamali”. Active case searches along with interviews were conducted through a semi structured questionnaire. Demographic, socioeconomic, clinical and epidemiological information was collected along with assessment of routine immunization. Five blood samples were sent for serology. Results: A total of 49 cases (AR= 0.17%), including five deaths (CFR=10.2%), were identified. Males, 61% (n=30), were more affected. The median age was three years (age range=1-10 years). The age-group 0-4 years, 69% (n=34), was most affected. The median age group of controls were four years (age range 1-11 years). Of the cases, 71% were unimmunized for any routine antigen while 32% of controls were unimmunized. Pneumonia, 42.8% (n=21), and diarrhea, 38.7% (n=19), were the most common complications. All five samples were positive for measles IgM. Significant statistical association was found between nomadic populations having zero routine doses of measles containing vaccines (MCV1) (OR 2.85; CI 1.83 – 4.42; p value <0.0021) and developing measles. Conclusion: Nomadic populations with low immunization was a probable cause of outbreak, resulting in the rapid spread of measles amongst susceptible individuals in the community. Laboratory tests confirmed the outbreak. As a control measure, measles mop-up vaccinations and six health education sessions were suggested and carried out. It was also recommended that proper outreach microplanning and regular pulse immunization should be adopted in future.

Factors responsible for the 2015 Cholera outbreak and spread in Ebonyi state, Nigeria

Background: Cholera outbreaks are frequent across Nigeria irrespective of season. Cholera outbreak began on the 17th January 2015 in a community in Ebonyi State. We carried out an investigation to confirm the diagnosis, identify the source of infection, determine the factors associated with its spread and carried out some interventions.Methods: Descriptive cross-sectional study was carried out in the affected communities during which active case search, environmental survey and key informant interviews were done. Stool samples were taken from cases for laboratory diagnosis. A cholera case was defined as any person that presented with diarrhoea and or vomiting with laboratory confirmation or with epidemiological linkage to the affected areas.Results: A total of 551 cases were recorded in 38 communities with a case fatality rate of 8.6%. Vibrio Cholera was isolated from 5 stool samples. Those who were 20 years or less and females were more commonly affected. Males and attendance at burial in another community within the two weeks preceding onset of outbreak was significantly associated with death (p<0.001). Inadequate safe water supplies, poor sanitation and hygiene practices were observed.Conclusion: The outbreak was caused by Vibrio Cholera. Socio-cultural practices surrounding burial such as overcrowding, ceremonial killing of animals and communal eating together may have contributed to its widespread. A system thinking approach such as behavior change communication and community dialogue are needed for Cholera control.

Protracted cholera outbreak in the Central Region, Ghana, 2016.

On 24th October 2016, the Central Regional Health Directorate received report of a suspected cholera outbreak in the Cape Coast Metropolis (CCM). We investigated to confirm the diagnosis, identify risk factors and implement control measures. We used a descriptive study followed by 1:2 unmatched case-control study. We reviewed medical records, conducted active case search and contact tracing, interviewed case-patients and their contacts and conducted environmental assessment. Case-patients' stool samples were tested with point of care test kits (SD Bioline Cholera Ag 01/0139) and sent to the Cape Coast Teaching Hospital Laboratory for confirmation. Cause of outbreak, risk factors associated with spread of outbreak. Vibrio cholerae serotype Ogawa caused the outbreak. There was no mortality. Of 704 case-patients, 371(52.7%) were males and 55(7.8%) were aged under-five years. The median age was 23 years (interquartile range: 16-32 years). About a third 248(35.2%) of the case patients were aged 15-24 years. The University of Cape Coast subdistrict was the epicenter with 341(48.44%) cases. Compared to controls, cholera case-patients were more likely to have visited Cholera Treatment Centers (CTC) (aOR=12.1, 95%CI: 1.5-101.3), drank pipe-borne water (aOR=11.7, 95%CI: 3.3-41.8), or drank street-vended sachet water (aOR=11.0, 95%CI: 3.7-32.9). Open defecation and broken sewage pipes were observed in the epicenter. Vibrio cholerae serotype Ogawa caused the CCM cholera outbreak mostly affecting the youth. Visiting CTC was a major risk factor. Prompt case-management, contact tracing, health education, restricting access to CTC and implementing water sanitation and hygiene activities helped in the control. This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana.

Geophysical monitoring of simulated homicide burials for forensic investigations

Finding hidden bodies, believed to have been murdered and buried, is problematic, expensive in terms of human resource and currently has low success rates for law enforcement agencies. Here we present, for the first time, ten years of multidisciplinary geophysical monitoring of simulated clandestine graves using animal analogues. Results will provide forensic search teams with crucial information on optimal detection techniques, equipment configuration and datasets for comparison to active and unsolved cold case searches. Electrical Resistivity (ER) surveys showed a naked burial produced large, low-resistivity anomalies for up to four years, but then the body became difficult to image. A wrapped burial had consistent small, high-resistivity anomalies for four years, then large high-resistivity anomalies until the survey period end. Ground Penetrating Radar (GPR) 110–900 MHz surveys showed the wrapped burial could be detected throughout. 225 MHz GPR data was optimal, but the naked burial was poorly imaged after six years. Results suggested conducting both ER and GPR surveys if the burial style was unknown when searching for interred remains. Surveys in winter and spring produced the best datasets, and, as post-burial time increases, surveying in these seasons became increasingly important. This multidisciplinary study provides critical new insights for law enforcement and families of the disappeared worldwide.

Implementation of a Drug Allergy Testing Service in the Dermatology Outpatient Clinic of a Public University Hospital

Background: Investigation based solely on clinical history background is not sufficient to prove drug allergy and may lead to search for more expensive and potentially less effective alternative drugs. There are too few health centers that perform such tests in Brazil. Objectives: The aim of the present work was to structure and to systematize a service for in vivo drug skin testing in a public university hospital. Methods: The project was structured as follows: a) Divulgation about the service among health professionals and also among patients; b) Active search for suspicious cases; d) Referral to the allergist consultation; c) Performance of skin prick, intradermal and/or epicutaneous tests when requested. Results: Disclosure about the service was done through informal talk, workshop, flyers, advertisement. Active search for suspicious cases was done at the Dermatology Outpatient Clinics, Walter Cantidio Hospital School, Brazil. Ninety patients were evaluated by the allergist, and from these, 68 were submitted to drug skin tests. Thirty-five patients out of 68 presented clinical manifestations up to 2 h after drug intake and 33, more than 2h after drug intake. The drugs most implicated were NSAIDS and β-lactam drugs. Seventy-seven tests carried out. For immediate reading, 41 puncture tests and 12 intradermal tests were performed. For delayed reading, 24 epicutaneous tests were done. Two patients presented positive prick test to dipyrone. Conclusion: For implementing an adequate and effective service for drug skin testing, technical and practical training of health professionals about drug safety is necessary, besides interdisciplinary collaboration and an adequate support by the hospital managers. Key words: Patient Care, Skin drug test, Drug hypersensitivity, Drug allergy tests, Public hospital.

Factors associated with cutaneous ulcers among children in two yaws-endemic districts in Ghana

BackgroundYaws is a chronic relapsing disease caused by Treponema pallidum subspecies pertunue, which can result in severe disability and deformities. Children below the age of 15 years in resource-poor communities are the most affected. Several non-specific factors facilitate the continuous transmission and resurgence of the disease. Endemic communities in rural Ghana continue to report cases despite the roll out of several intervention strategies in the past years. The objective of this study was to determine the factors associated with cutaneous ulcers among children in two yaws-endemic districts in Ghana.MethodsA community-based unmatched 1:2 case-control study was conducted among children between 1 and 15 years. Data on socio-demographic, environmental and behavioral factors were collected using a structured questionnaire. Active case search and confirmation was done using the Dual Path Platform (DPP) Syphilis Screen and Confirm test kit. Data were analyzed using STATA 15. Logistic regression was done to determine the exposures that were associated with yaws infection at 0.05 significant level.ResultsSixty-two cases and 124 controls were recruited for the study. The adjusted multivariable logistic regression model showed that yaws infection was more likely among individuals who reside in overcrowded compound houses (aOR = 25.42, 95% CI: 6.15–105.09) and with poor handwashing habits (aOR = 6.46, 95% CI: 1.89–22.04). Male (aOR = 4.15, 95% CI: 1.29–13.36) and increasing age (aOR = 5.90, 95% CI: 1.97–17.67) were also associated with yaws infection.ConclusionsPoor personal hygiene, overcrowding and lack of access to improved sanitary facilities are the factors that facilitate the transmission of yaws in the Awutu Senya West and Upper West Akyem districts. Yaws was also more common among males and school-aged children. Improving living conditions, access to good sanitary facilities and encouraging good personal hygiene practices should be core features of eradication programs in endemic communities.

Evaluation of the national tuberculosis surveillance and response systems, 2018 to 2019: National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Abuja, Nigeria.

IntroductionNigeria is among the countries with high Tuberculosis (TB) burden by global rating signifying the relevance of TB surveillance system evaluation in improving performance and capacity of the existing system. Hence, this evaluation was conducted in order to determine the gaps and proffer solution to enhance the TB surveillance system performance.Methodsquestionnaires were administered to eight key informants using face-to-face interview method; data obtained was analyzed. Total number of TB cases and estimated number of cases for year 2018 was obtained. Percentage of positive cases using the GeneXpert test for 6 months (January to June 2019) was obtained. Available documents and publications on the National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP) were also sought for information.Resultsthe NTBLCP has over 5,300 TB service points and 1,602 microscopy Centre’s distributed across the country. Acceptance for the standard TB case definition was 100%, forms used are easy to fill and diagnosis is laboratory-based requiring specialized trainings for laboratory personnel. The system had 25% sensitivity, high data quality with 100% timeliness. The TB surveillance system is representative of all ages. The system was first designed as TB and Leprosy Control Programme but later Buruli ulcer was incorporated into the Programme. First quarter supervisory visits are skipped due to late funding and delayed budget approval. Major share of the funding comes from donor partners.Conclusionthe system is useful, representative, acceptable, has good data quality, timely, and sensitive. The system is stable but needs to be funded more by the government. There is need for early funding and budget approval to avoid skipping of supervisory visits due to funding challenges. The system is not simple due the various test that need to be conducted before, during and after treatment to detect and verify that the patient is cured. We recommend continuous training of health workers, routine monitoring and evaluation, integration of TB care and prevention into other health services programmes like HIV/AIDS and active case search at all levels to increase the sensitivity of the system. Speed up the process of integration of NTBLCP surveillance system with IDSR for data harmonization in the country.

Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016.

Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya. Hospital records for the period 2010-2016 were reviewed and additional cases were identified through active case search. Clinical diagnosis of cutaneous leishmaniasis was made based on presence of ulcerative, nodular or papular skin lesion. The study enrolled 58 cases matched by age and neighbourhood to 116 controls in a case control study. Data was collected using structured questionnaires and simple proportions, means and medians were computed, and logistic regression models were constructed for analysis of individual, indoor and outdoor risk factors. Of the 255 suspected cases of cutaneous leishmaniasis identified, females constituted 56% (142/255) and the median age was 7 years (IQR 7-21). Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages. A continuous transmission pattern was depicted throughout the period under review. Individual risk factors included staying outside the residence in the evening after sunset (OR 4.1, CI 1.2-16.2) and visiting forests (OR 4.56, CI 2.04-10.22). Sharing residence with a case (OR 14.4, CI 3.8-79.3), residing in a thatched house (OR 7.9, CI 1.9-45.7) and cracked walls (OR 2.3, CI 1.0-4.9) were identified among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2-12.7), residing near a forest (OR 7.8, CI 2.8-26.4) and having a close neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8-16.0) were identified among outdoor factors. We identify a large burden of cutaneous leishmaniasis in Gilgil with evidence of individual, indoor and outdoor factors of disease spread. The role of environmental factors and rodents in disease transmission should be investigated further.

Epidemiological diagnosis of infections associated with provision of medical care at current state

The risk-based approach to the prevention of healthcare-associated infections (HAIs) is entirely based on the results of a well-organized epidemiological diagnosis, which is aimed primarily at identifying risk factors. The structure of the risk-based approach includes risk identification, risk identification and risk analysis. One of the important points of epidemiological diagnosis is epidemiological observation. For the organization of epidemiological surveillance, both passive and active methods are used. The active method is the most effective, since it is an active search and identification of cases of HAIs using the standard definition of cases and the results of laboratory examination of patients from risk groups. To organize such work, a commission is formed in each medical organization, which should include an epidemiologist, clinical pharmacologist, expert doctor, laboratory assistant, head nurse, and a pharmacy employee. The functions of each participant depend on the organization of the general system for identifying HAIs in this organization. The proposed model of a risk-based approach to the epidemiological diagnosis of HAIs allows timely identification of groups and risk factors both in the context of individual departments and the medical organization as a whole, and, accordingly, to develop effective measures for the prevention of infections associated with the provision of medical care.

Corona Virus Disease 2019 Pandemic: Encouraging Involvement of Community Workers in the Active Search of Cases

In the ongoing Corona Virus Disease-2019 (COVID-19) pandemic, the role of health care professionals and outreach workers is indispensable towards the prevention and control of the disease. Anticipating the risk that the disease might land up into stage 3, a wide range of interventions have been implemented. However, the most important strategy will be to spread awareness about the disease and intensify actively search for the suspect cases in the community and here comes the role of outreach community workers. As the doctors and other paramedical staff are overwhelmed with the COVID-19 related work and are also involved in the delivery of emergency services, the importance of the role discharged by these community workers is extremely vital. In conclusion, the role of outreach community workers in creating awareness about COVID-19 and the identification of the suspect cases in the community through active search is extremely crucial in containing the disease and interrupting the chain of the transmission.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015.

INTRODUCTION The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher’s exact, or Fisher-Freeman-Halton tests were performed.RESULTS A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015.CONCLUSIONS Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Measles Outbreak Investigation in Pweto Health Zone—Haut-Katanga Province, DR of the Congo, 2018

Background: Sub-Saharan Africa reports repeated outbreaks of measles, a vaccine-preventable disease, which is notifiable under the Integrated Disease Surveillance and Response (IDSR) strategy in Democratic Republic of Congo (DRC). DRC has reported several outbreaks of measles in the last three years. Poor immunization coverage and weak health systems have been related with measles and other vaccination-preventable diseases’ outbreaks. The DRC has committed to eliminating measles by 2020. In this respect, we investigated one of the outbreaks that occurred in Pweto health zone (HZ), Haut-Katanga province, to describe the outbreak and identify risk factors. Methods: A cross-sectional study was designed to investigate a measles outbreak in Pweto health zone (HZ), Haut-Katanga province. Data entry and analysis were performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel. Findings: In seven months’ time, four health areas affected by a measles outbreak in Pweto health zone reported 116-suspected cases and 13 deaths. The cumulative attack rate of 42.3/100,000 population and case fatality rate (CFR) of 11.2% were recorded. Of these, 112 (96.5%) cases were ≤15 years of age, and 93 (80.2%) were zero dose of measles vaccine. Although, all age groups were concerned, under five years old were the most affected with 84 cases (72.4%). In response to the outbreak, a response immunization was organized with the support of MSF at the week 25 of the epidemic, when the epidemic curve started to decline. A response immunization involving 46,205 children from 6 to 59 was implemented and overall coverage of 99% (range: 95% - 105%) was achieved. Case management with vitamin A supplementation, active case search, routine immunization improvement and health education were some of the activities carried out to curb the outbreak. Conclusion: This confirmed measles outbreak was caused by failure to vaccinate (80.2% unvaccinated cases). Poor surveillance sensitivity and the community attitude about measles contributed to its spreading. Strengthening routine immunization, improving surveillance system and communication for behaviour change are required.

Predictive ability of symptomatology in COVID-19 during Active case search in Lagos State, Nigeria.

In April 2020, a community-based active case search surveillance system of coronavirus disease 2019 (COVID-19) was developed by the emergency outbreak committee in Lagos State. This followed the evidence of community transmission of coronavirus disease in the twenty Local Government Areas in Lagos State. This study assessed the value of respiratory and other symptoms in predicting positive SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR). It is hoped that if symptoms are predictive, they can be used in screening before testing. Communities were included based on the alerts from community members through the rumour alert system set up by the state. All members of the households of the communities from where the alert came were eligible. Household members who declined to participate were excluded from the study. A standardised interviewer-administered electronic investigation form was used to collect sociodemographic information, clinical details and history for each possible case. Data was analysed to see the extent of agreement or correlation between reported symptoms and the results of PCR testing for SARS-COV-2. A total of 12,739 persons were interviewed. The most common symptoms were fever, general weakness, cough and difficulty in breathing. Different symptoms recorded different levels of sensitivity as follows: fever, 28.9%; cough, 21.7%; general body weakness, 10.9%; and sore throat, 10.9%. Sensitivity and specificity for fever, the most common symptom, were 28.3% and 50.2%, respectively, while similar parameters for general body weakness, the next most common symptom, were 10.9% and 73.2%, respectively. From these findings, the predictive ability of symptoms for COVID-19 diagnosis was extremely weak. It is unlikely that symptoms alone will suffice to predict COVID-19 in a patient. An additional measure, such as confirmatory test by RT-PCR testing, is necessary to confirm the disease.

MENTAL HEALTH NURSING EDUCATION IN BRAZIL: PERSPECTIVES FOR PRIMARY HEALTH CARE

ABSTRACT Objective: To analyze the limitations, strategies, importance and obstacles in mental health education in undergraduate nursing, focused on the role of nurses in Primary Health Care. Method: An exploratory descriptive study conducted with 103 professors in the mental health area of Bachelor/Postgraduate nursing courses from 89 public Higher Education Institutions in the five regions of Brazil. Results: Only 23.3% (24) of the professors teach mental health classes only in primary health care. Of the sample, the limitations to teaching in primary care education are few class hours (46.6%), faculty to expand teaching beyond specialty settings (38.8%), and prioritization of other scenarios (48.5%). When teaching, the strategies used are home visits (43.7%), educational actions (34.0%) and active search for mental health cases (29.1%). The professors consider them important to support mental health actions (58.3%); and the barriers are the lack of articulation between the Collective Health and Health disciplines to conduct teaching (87.5%). Conclusion: It is suggested that the institutions, courses and professors make the commitment and focus efforts to overcome the gaps, which hinder the nurse’s education process regarding primary knowledge in mental health, so that they can offer care to patients in psychological distress in the context of the community, as well as strengthen national mental health policy.