Acute Watery Diarrhea Research Articles

Syndromic Surveillance of Communicable Diseases in Mobile Clinics During the Arbaeenia Mass Gathering in Wassit Governorate, Iraq, in 2014: Cross-Sectional Study.

BackgroundArbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Outbreaks of communicable diseases are a significant risk due to overcrowding and potential food and water contamination. Syndromic surveillance is often used for rapid detection and response to disease outbreaks.ObjectiveThis study was conducted to identify the main communicable diseases syndromes among pilgrims during the Arbaeenia mass gathering in Wassit governorate, Iraq, in 2014.MethodsThis cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering. Six communicable disease syndromes were selected: acute watery diarrhea, bloody diarrhea, fever and cough, vomiting with or without diarrhea, fever and bleeding tendency, and fever and rash. A simple questionnaire was used to directly gather basic demographics and the syndromic diagnosis from the attendees.ResultsA total of 87,865 patients attended the clinics during the 10-day period, with an average of 219 patients/clinic/day. Approximately 5% (3999) of the attendees had communicable diseases syndromes: of these, 1693 (42%) had fever and cough, 1144 (29%) had acute diarrhea, 1062 (27%) presented with vomiting with/without diarrhea, and 100 (2%) had bloody diarrhea. The distribution of the syndromes did not vary by age or gender. Stool specimen cultures for Vibrio cholerae performed for 120 patients with acute diarrhea were all negative.ConclusionsSyndromic surveillance was useful in determining the main communicable diseases encountered during the mass gathering. Expansion of this surveillance to other governorates and the use of mobile technology can help in timely detection and response to communicable disease outbreaks.

2525 A Case of IgA Vasculitis Diagnosed With Small Bowel Biopsy

INTRODUCTION: Immunoglobulin A (IgA) vasculitis is an immune-mediated condition that primarily targets small vessels. Presentation may vary- colicky abdominal pain, palpable purpura, acute arthritis, or nephritis. Adult annual incidence is 0.8-1.8/100,000. In adults, abdominal pain is rarely the presenting symptom. We report a case that presented with abdominal pain and was diagnosed with IgA vasculitis via duodenal biopsy. CASE DESCRIPTION/METHODS: A 60 year old male presented with acute onset severe periumbilical pain and watery diarrhea for several days. Pain was associated with vomiting and worsened after meals. Physical examination revealed marked periumbilical and right lower quadrant tenderness. Other review of systems and physical exam findings were unremarkable. Laboratory tests were remarkable for mild leukocytosis with neutrophilic predominance and elevated C-reactive protein. CT scan of the abdomen/pelvis showed significant patchy small bowel thickening with surrounding inflammatory changes. Small bowel enteroscopy showed edematous, purpuric and friable mucosa in the duodenum and proximal jejunum with stigmata of recent bleeding. Biopsies were obtained. Immunostaining for IgA was positive in the lamina propria, suspicious for small bowel IgA vasculitis. Shortly after that, he developed palpable purpura on upper and lower extremities. Punch skin biopsy confirmed IgA vasculitis. He was started on taper of systemic steroids, which lead to the resolution of skin and abdominal vasculitis within a few days. Currently, patient is in remission on rituximab maintenance therapy. DISCUSSION: In cases of abdominal involvement, IgA vasculitis has a predilection for small intestine. The classic endoscopic findings are diffuse mucosal reddening with hemorrhagic erosions and hematoma-like protrusions. Treatment is dependent on severity of vasculitis activity. For moderate to severe disease, systemic corticosteroids and analgesics are the mainstay of treatment. The diagnosis of IgA vasculitis is challenging, especially if abdominal pain precedes other manifestations. This case highlights the diagnostic value of early endoscopy in patients suspected of developing IgA vasculitis.

Descriptive epidemiology of cholera outbreak in Nigeria, January\u2013November, 2018: implications for the global roadmap strategy

BackgroundThe cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country. Evidence on the current epidemiology of cholera required for the design and implementation of appropriate interventions towards attaining the global roadmap strategic goals for cholera elimination however seems lacking. Thus, this study aimed at addressing this gap by describing the epidemiology of the 2018 cholera outbreak in Nigeria.MethodsThis was a retrospective analysis of surveillance data collected between January 1st and November 19th, 2018. A cholera case was defined as an individual aged 2 years or older presenting with acute watery diarrhoea and severe dehydration or dying from acute watery diarrhoea. Descriptive analyses were performed and presented with respect to person, time and place using appropriate statistics.ResultsThere were 43,996 cholera cases and 836 cholera deaths across 20 states in Nigeria during the outbreak period, with an attack rate (AR) of 127.43/100,000 population and a case fatality rate (CFR) of 1.90%. Individuals aged 15 years or older (47.76%) were the most affected age group, but the proportion of affected males and females was about the same (49.00 and 51.00% respectively). The outbreak was characterised by four distinct epidemic waves, with higher number of deaths recorded in the third and fourth waves. States from the north-west and north-east regions of the country recorded the highest ARs while those from the north-central recorded the highest CFRs.ConclusionThe severity and wide-geographical distribution of cholera cases and deaths during the 2018 outbreak are indicative of an elevated burden, which was more notable in the northern region of the country. Overall, the findings reaffirm the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera in Nigeria.

Diarrhoea and Comorbidities Seen at University of Port Harcourt Teaching Hospital, Nigeria

Background: Diarrhoea illnesses continue to cause major sickness and death in children in developing countries. They often occur simultaneously in association with other illnesses as comorbidities, especially in children under five years of age. There is a dearth of literature on these comorbidities.
 Objective: To evaluate the pattern of diarrhoea and associated comorbidities in children with diarrhoea diseases at the University of Port Harcourt Teaching Hospital, Nigeria.
 Methods: This was a descriptive, retrospective cross sectional study carried out in the Department of Paediatrics, University of Port Harcourt Teaching Hospital, between January 2011 to December 2014. The case notes of all children with diarrhoea who presented to the Diarrhoea Training Unit (DTU) and children’s emergency ward were retrieved and studied. Information sought included the biodata, type of diarrhoea, presence and level of dehydration, year and month of presentation, outcome of illness and comorbidities.
 Results: There were 394 subjects, males were 215(54.6%), females 179(45.4%). Their ages ranged from 1 month to 168 months, mean age 17.1±2.8 months. Acute watery diarrhoea was the most common type 321 (81.47%), followed by dysentery 47 (11.93%). Two hundred and thirty nine (60.7%) patients had no dehydration, 37 (9.46%) mild dehydration, 107 (27.2%) moderate dehydration and 11 (2.8%) severe dehydration. Malaria was the most common comorbidity 66 (16.8%), followed by tonsillitis 65(16%) and pneumonia 45 (11.4%). Two hundred and eighteen (55.3%) were discharged following treatment and 14 (3.6%) died.
 Conclusion: The commonest type of diarrhoea found was acute watery diarrhoea and malaria was the most frequent comorbidity found.

Assessment of Knowledge, Attitude, Practices and its determinant factors towards Acute Watery Diarrhea Disease among Military Personnel Living in Harar, Ethiopia, July 2018

Assessment of Knowledge, Attitude, Practices and its determinant factors towards Acute Watery Diarrhea Disease among Military Personnel Living in Harar, Ethiopia, July 2018

Comparative Genomic Analysis of the 2016 Vibrio cholerae Outbreak in South Korea.

In August 2016, South Korea experienced a cholera outbreak that caused acute watery diarrhea in three patients. This outbreak was the first time in 15 years that an outbreak was not linked to an overseas source. To identify the cause and to study the epidemiological implications of this outbreak, we sequenced the whole genome of Vibrio cholerae isolates; three from each patient and one from a seawater sample. Herein we present comparative genomic data which reveals that the genome sequences of these four isolates are very similar. Interestingly, these isolates form a monophyletic clade with V. cholerae strains that caused an outbreak in the Philippines in 2011. The V. cholerae strains responsible for the Korean and Philippines outbreaks have almost identical genomes in which two unique genomic islands are shared, and they both lack SXT elements. Furthermore, we confirm that seawater is the likely source of this outbreak, which suggests the necessity for future routine surveillance of South Korea's seashore.

Evaluation of the trends in the incidence of infectious diseases using the syndromic surveillance system, early warning and response unit, Mongolia, from 2009 to 2017: a retrospective descriptive multi-year analytical study

BackgroundIn recent times, emerging and re-emerging infectious diseases are posing a public health threat in developing countries, and vigilant surveillance is necessary to prepare against these threats. Analyses of multi-year comprehensive infectious disease syndrome data are required in Mongolia, but have not been conducted till date. This study aimed to describe the trends in the incidence of infectious disease syndromes in Mongolia during 2009–2017 using a nationwide syndrome surveillance system for infectious diseases established in 2009.MethodsWe analyzed time trends using monthly data on the incidence of infectious disease syndromes such as acute fever with rash (AFR), acute fever with vesicular rash (AFVR), acute jaundice (AJ), acute watery diarrhea (AWD), acute bloody diarrhea (ABD), foodborne disease (FD) and nosocomial infection (NI) reported from January 1, 2009 to December 31, 2017. Time series forecasting models based on the data up to 2017 estimated the future trends in the incidence of syndromes up to December 2020.ResultsDuring the study, the overall prevalence of infectious disease syndromes was 71.8/10,000 population nationwide. The average number of reported infectious disease syndromes was 14,519 (5229-55,132) per year. The major types were AFR (38.7%), AFVR (31.7%), AJ (13.9%), ABD (10.2%), and AWD (1.8%), accounting for 96.4% of all reported syndromes. The most prevalent syndromes were AJ between 2009 and 2012 (59.5–48.7%), AFVR between 2013 and 2014 (54.5–59%), AFR between 2015 and 2016 (67.6–65.9%), and AFVR in 2017 (62.2%). There were increases in the prevalence of AFR, with the monthly number of cases being 37.7 ± 6.1 during 2015–2016; this could be related to the measles outbreak in Mongolia during that period. The AFVR incidence rate showed winter’s multiplicative seasonal fluctuations with a peak of 10.6 ± 2 cases per 10,000 population in 2017. AJ outbreaks were identified in 2010, 2011, and 2012, and these could be associated with hepatitis A outbreaks. Prospective time series forecasting showed increasing trends in the rates of AFVR and ABD.ConclusionsThe evidence-based method for infectious disease syndromes was useful in gaining an understanding of the current situation, and predicting the future trends of various infectious diseases in Mongolia.

The Clinical Efficacy of Multi-strain Probiotics in the Management of Acute Watery Diarrhoea of Children aged 2 Months to 5 Years-a Randomized Controlled Trial

Background: Acute gastroenteritis is considered as one of the most common causes of under-five morbidity and mortality worldwide. Standard treatment is the use of oral rehydration solution (ORS), intravenous fluid if indicated, and zinc supplement. Recently, the use of probiotics has been introduced as an adjunct to the treatment of acute gastroenteritis. The aim of this study is to determine the clinical efficacy of multi-strain probiotics as adjunct treatment of acute gastroenteritis.
 Methodology: A randomized controlled trial was done in 250 bed district Sadar Hospital, Brahmanbaria, Bangladesh from January 2016 to June 2017. After fulfilling the inclusion criteria, 507 children aged 2 months to 5 years were enrolled in this study. Those with dysentery, chronic diarrhea, diarrhea due to known genetic disorder, chronic illness, malnutrition, systemic infection, CNS disorder and congenital malformation were excluded. Children were divided into two groups randomly. One group was With Probiotic, zinc and standard WHO (ORS) as case and other group was Without Probiotic, zinc and standard WHO ORS as control.
 Results: Among 507 children, 257 were without probiotic while 250 were with probiotic. The mean difference in stool frequency between the two groups were 3.3 after 24 hours, 3.5 after 48 hours and 1.6 after 72 hours after hospitalization which was statistically significant (p=0.000). Reduction of stool frequency was highest after 48 hours of admission. Mean duration of hospital stay was 4.40±1.22 days in control and 4.03±.89 days in case group. Probiotic group children with exclusive breastfeeding had mean recovery time of 3.95±0.85 days and those who were not exclusively breastfeed had recovery time of 4.2±0.95 days (p=0.025).
 Conclusion: Probiotic is efficacious in reducing purging duration and frequency of acute watery diarrhea in children.
 Bangladesh J Child Health 2019; VOL 43 (2) :97-101

Cholera in selected countries in Asia

IntroductionAlthough the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam. MethodsData from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available. ResultsFrom 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases. Discussion and conclusionWe present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.

Preparation and characterization of a single-domain antibody specific for the porcine epidemic diarrhea virus spike protein

Porcine epidemic diarrhea (PED) is a diarrheal disease of swine caused by porcine epidemic diarrhea virus (PEDV). It is characterized by acute watery diarrhea, dehydration and vomiting in swine of all ages and is especially fatal for neonatal and postweaning piglets. The spike protein of PEDV plays an important role in mediating virus attachment and fusion to target cells, and recent studies also reported that the neutralizing epitopes of the spike protein were mainly located in the S1 subunit, which makes it a candidate for vaccine development and clinical diagnosis. In this study, we successfully constructed an immune phage display single-domain antibody library with a library size of 3.4 × 106. A single-domain antibody, named S7, specific for the spike protein of PEDV was identified from the phage display single-domain antibody library. S7 could be expressed in a soluble form in E. coli, bound to the spike protein of PEDV in ELISA and stained the PEDV virus in Vero cells, but it showed no neutralization activity on PEDV. These results indicated the potent application of the S7 antibody as an imaging probe or as a candidate for the development of a diagnostic assay.

Disease Profile Among Children Admitted in a Tertiary Care Hospital

Background: An understanding of epidemiological trend in hospital admissions, including diseases and death pattern, is critical for health care planning, appropriate resource allocation & improving existing services facilities. To evaluate the disease and death pattern of children admitted in the Department of Child Health, Bangubandhu Memorial Hospital. Chattogram.
 Materials and methods: This was a retrospective study. The case records of all patients admitted in the Department of Child Health from Jan 1, 2015 to Dec 31, 2016 were analyzed.
 Results: Total 3560 children were admitted during this study period. All the patients were distributed into three age groups. Infant, under five and more than five age groups constitute 35%, 33% and 32% respectively. Acute watery diarrhea (33%) bronchiolitis (21%) Bronchopneumonia (10.5%) hereditary hemolytic anemia (9%) and Enteric fever (4.3%) were the five top disease in two years of admission. Among them total 12 (0.34%) patient died. Highest case fatality rate was found in bronchopneumonia (75%). Other common causes of death include meningitis (17%) and heart failure (8.5%). Patient came from urban area was 63% and 37% came from rural area.
 Conclusion: Admission related findings of this study will help to evaluate the disease pattern of a hospital and planning for more effective case-management strategies.
 Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 31-35

Clinical Efficacy of Bacillus Clausii Probiotic in the Management of Acute Diarrhoea in Children

Background: Diarrhoea is the second most common cause of under five mortality especially in developing world. Very few studies have been conducted so far on bacillus clausii probiotic with inconsistent result. So, the aim of the present study is to determine the clinical efficacy of Bacillus Clausii probiotic formulation as adjunct treatment of acute diarrhoea.
 Materials and methods: This prospective single blind randomized controlled trial included 310 infants and children between 6 months to 6 years of age admitted in a tertiary care hospital Sylhet, Bangladesh with acute watery diarrhoea having varied dehydration status ranging from no to severe dehydration excluding shocked state. Cases were randomly assigned to two groups: Group A (n=150) comprised of children who were treated with standard treatment (According to WHO guideline) only as control group and Group B who received standard treatment plus Bacillus Clausii as probiotic. Clinical responses were evaluated in terms of improvement of outcome variables such as duration and frequency of diarrhoea and duration of hospital stay.
 Results: Mean duration of diarrhoea was 3.3(±1.1) days in Group A and 3.2(±1.3) days in Group B which was not statistically significant. Frequency of diarrhoea decreased significantly at day 4 of treatment in both study groups showing no statistical difference. Mean duration of hospital stay in both groups was 3.8 days showing no significance.
 Conclusion: Bacillus Clausii is ineffective in reducing the duration, frequency of diarrhoea and duration of hospital stay.
 Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 14-17

Disease Surveillance System of Bangladesh: Combating Public Health Emergencies

Disease Surveillance System of Bangladesh: Combating Public Health Emergencies

Evaluation of Risk Factors Associated with Rotaviral Diarrhoea among Under Five Children in Sylhet Region of Bangladesh

Retrovirus is the major cause of acute severe diarrhea in under five children and contributing 10,000 to 27000 deaths each year in Bangladesh. This cross-sectional study was designed to determine the risk factors associated with Rotaviral among under five children admitted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet and was carried out in the Department of Microbiology during the period from 1st January to 31st December, 2018. Total 184 under five children with acute watery diarrhoea were enrolled in this study by convenient sampling. Stool samples were obtained and assayed for rotavirus antigens by enzyme linked immunosorbent assay (ELISA). Rotaviral antigen was found positive in 86 cases.The Rotavirus infection was found highest in age group of 7 to 12 months (50.56%) and in male (59.30%) children. It was found significantly higher in patients from lower socio-economic condition (64.00%), those who were from rural area (48.75%) and children who were not exclusively breastfed (83.87%). Bottle feeding, lower educational level of mother and overweight of children may serve as predisposing factors of rotavirus disease in these children.
 Bangladesh Med J. 2019 May; 48 (2): 32-37

Oral Rehydration in Children with Acute Diarrhoea and Moderate Dehydration-Effectiveness of an ORS Tolerance Test.

Oral rehydration solution (ORS) is the mainstay of treatment of acute watery diarrhoea, but it is underutilized in many hospitals, resulting in children with moderate degrees of dehydration being unnecessarily hospitalized and receiving intravenous fluids. We aimed to assess the utility of an ORS tolerance test on initial presentation to an emergency department, and determine the volume of ORS a child with diarrhoea and moderate dehydration needed to tolerate to be successfully managed at home. One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration were given ORS and observed in a Children's Emergency Department (CED) over a period of 2-4 h. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgement of the treating health workers. Seventy-nine (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5-28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63/79 (79.7%) children had improved, were adequately hydrated and the diarrhoea had reduced. Sixteen of the 79 (20.3%) failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia and/or weakness. The 63 who succeeded had tolerated a median of 25.8 (IQR 18.4-30.0) ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 (IQR 9.1-23.0) ml/kg ORS (p < 0.001).

Knowledge, Attitudes, and Practice (KAP) from Baseline Data of Acute Watery Diarrhoea (Awd)/Cholera among Adults (15-49) in the Somali Region of Ethiopia

Knowledge, Attitudes, and Practice (KAP) from Baseline Data of Acute Watery Diarrhoea (Awd)/Cholera among Adults (15-49) in the Somali Region of Ethiopia

Apparent overuse of antibiotics in the management of watery diarrhoea in children in Abakaliki, Nigeria

BackgroundDiarrhoea remains an important cause of childhood mortality in Nigeria, with Rotavirus and Cryptosporidium reported to have the highest contribution. However, high use of antibiotics for treatment of paediatric diarrhoea has been observed, although World Health Organization guidelines discourage the use of antibiotics for treating acute diarrhoea. Here we investigated more closely management and treatment practices for acute paediatric diarrhoea, both in home and healthcare settings.MethodsChildren under 5 years of age (n = 199) presenting at healthcare centres in Abakaliki, Nigeria with acute watery diarrhoea were included in the study. Background information on the children was collected by questionnaire, including home treatments, and clinical information including symptoms and treatment were provided by the healthcare centres. Analysis of faecal samples from the children indicated that over 90% had Rotavirus infection and over 6% Cryptosporidium infection. Data were compiled in a spreadsheet and analysed for associations between variables and use of antibiotics using logistic regression analysis.ResultsAlthough most children were treated supportively (oral rehydration solution and intravenous fluids at home and in healthcare settings, respectively) over 15% were given anti-diarrhoea drugs at home and over 85% were also prescribed antibiotics at the healthcare centre, mostly ciproflaxin, but also metronidazole and gentamycin. The only variable positively associated with antibiotic prescription was diarrhoea more than three times per 24 h at admission.ConclusionsIt is clear that young children presenting with acute watery diarrhoea to healthcare centres in Abakaliki are likely to be prescribed antibiotics, despite there being no obvious reason that this treatment is appropriate. Our study results support the need for institution-based antimicrobial stewardship being implemented in Nigeria.

Feasibility of a Comprehensive Targeted Cholera Intervention in The Kathmandu Valley, Nepal.

.A comprehensive targeted intervention (CTI) was designed and deployed in the neighborhoods of cholera cases in the Kathmandu Valley with the intent of reducing rates among the neighbors of the case. This was a feasibility study to determine whether clinical centers, laboratories, and field teams were able to mount a rapid, community-based response to a case within 2 days of hospital admission. Daily line listings were requested from 15 participating hospitals during the monsoon season, and a single case initiated the CTI. A standard case definition was used: acute watery diarrhea, with or without vomiting, in a patient aged 1 year or older. Rapid diagnostic tests and bacterial culture were used for confirmation. The strategy included household investigation of cases; water testing; water, sanitation, and hygiene (WASH) intervention; and health education. A CTI coverage survey was conducted 8 months postintervention. From June to December of 2016, 169 cases of Vibrio cholerae O1 were confirmed by bacterial culture. Average time to culture result was 3 days. On average, the CTI Rapid Response Team (RRT) was able to visit households 1.7 days after the culture result was received from the hospital (3.9 days from hospital admission). Coverage of WASH and health behavior messaging campaigns were 30.2% in the target areas. Recipients of the intervention were more likely to have knowledge of cholera symptoms, treatment, and prevention than non-recipients. Although the RRT were able to investigate cases at the household within 2 days of a positive culture result, the study identified several constraints that limited a truly rapid response.

A Syndrome-Based Surveillance System for Infectious Diseases Among Asylum Seekers in Austrian Reception Centers, 2015-2018: Analysis of Reported Data.

BackgroundAustria has been among the main European countries hosting incoming asylum seekers since 2015. Consequently, there was an urgent need to predict any public health threats associated with the arriving asylum seekers. The Department of Surveillance and Infectious Disease Epidemiology at the Austrian Agency for Health and Food Safety (AGES) was mandated to implement a national syndrome-based surveillance system in the 7 reception centers by the Austrian Ministry of Interior and Ministry of Health.ObjectiveWe aimed to analyze the occurrence and spread of infectious diseases among asylum seekers using data reported by reception centers through the syndrome-based surveillance system from September 2015 through February 2018.MethodsWe deployed a daily data collection system for 13 syndromes: rash with fever; rash without fever; acute upper respiratory tract infection; acute lower respiratory tract infection; meningitis or encephalitis; fever and bleeding; nonbloody gastroenteritis or watery diarrhea; bloody diarrhea; acute jaundice; skin, soft tissue, or bone abnormalities; acute flaccid paralysis; high fever with no other signs; and unexplained death. General practitioners, the first professionals to consult for health problems at reception centers in Austria, sent the tally sheets on identified syndromes daily to the AGES.ResultsWe identified a total of 2914 cases, presenting 8 of the 13 syndromes. A total of 405 signals were triggered, and 6.4% (26/405) of them generated alerts. Suspected acute upper respiratory tract infection (1470/2914, 50.45% of cases), rash without fever (1174/2914, 40.29% of cases), suspected acute lower respiratory tract infection (159/2914, 5.46% of cases), watery diarrhea (73/2914, 2.51% of cases), and skin, soft tissue, or bone abnormalities (32/2914, 1.10% of cases) were the top 5 syndromes.ConclusionsThe cooperation of the AGES with reception center health care staff, supported by the 2 involved ministries, was shown to be useful for syndromic surveillance of infectious diseases among asylum seekers. None of the identified alerts escalated to an outbreak.

Political will: necessary but not sufficient for control of an outbreak of acute watery diarrhoea in the Sudan, 2016-2018

Background: During the period between August 2016 and April 2018, an outbreak of Acute Watery Diarrhea (AWD) spread all over the Sudan. The aim of this paper is to assess the role of political will of the government in institution of control measures. Methods: A total of 269 high-level decision-makers in the country were interviewed using detailed, adapted standardized tools with open-ended questions. Interviewees including selected Federal and five state Ministers of Health, parliamentarians, Country Representatives for selected UN agencies, senior officials in the government, media were conducted. Furthermore, many Focus Group Discussion (FGD) among others with healthcare workers, community groups, and partner organizations were held. Issues discussed during the interviews and focus group discussions included in-depth review of thematic and cross-cutting intervention areas; e.g., surveillance, case management, environmental health, health promotion, resource mobilization including funding, supplies and logistics; coordination and leadership in outbreak response. Results: High-level officials made containment of the outbreak a top priority, paid field visits to the affected areas, mobilized resources, closely provided sound stewardship for inter-sectoral activities and nurtured a collaborative environment for different stakeholders. The Humanitarian Aid Commission facilitated the activities of registered national and international NGOs and their international staff movement in the country, permitted easy and unlimited access to 92% of the country to ensure the safety of the international staff. Indicators reflected high political will of the government to respond to the AWD to its best ability. Yet, the outbreak continued for almost two years. Donors and UN agencies demonstrated flexibility to support response activities as they reprogrammed some ongoing activities to secure funds. Discussion: Inadequate transparency, primarily related to difficulties in sharing results of laboratory investigations during the AWD outbreak constrained and limited the potential benefits from partners. The Government needs to foster stronger coordination between water and health sectors; and explore information sharing portals e.g. website and Epi-bulletin; with partners. Partners and the government should jointly clarify their mandates and map their roles during outbreaks so as to avoid duplication, competition, and delays in response. Conclusion: Political will is a high level enabler which is necessary but not sufficient for control the AWD outbreak. "Health in All Policies" initiative offers a platform to address observed gaps both in financing of outbreak response and addressing underlying root causes for AWD outbreak.