Division Of Vector-Borne Diseases Research Articles

Assessing Thailand’s 1-3-7 surveillance strategy in accelerating malaria elimination

BackgroundThailand’s strong malaria elimination programme relies on effective implementation of its 1-3-7 surveillance strategy, which was endorsed and implemented nationwide in 2016. For each confirmed malaria patient, the Ministry of Public Health’s Division of Vector Borne Diseases (DVBD) ensures completion of case notification within 1 day, case investigation within 3 days, and foci investigation within 7 days. To date, there has not been a comprehensive assessment of the performance and achievements of the 1-3-7 surveillance strategy although such results could help Thailand’s future malaria elimination strategic planning.MethodsThis study examined adherence to the 1-3-7 protocols, tracked progress against set targets, and examined geographic variations in implementation of the 1-3-7 strategy in the programme’s initial 5 years. An auto-regressive integrated moving average (ARIMA) time series analysis with seasonal decomposition assessed the plausible implementation effect of the 1-3-7 strategy on malaria incidence in the programme’s initial 5 years. The quantitative analysis included all confirmed malaria cases from public health and non-governmental community facilities from October 2014 to September 2021 (fiscal year [FY] 2015 to FY 2021) (n = 77,405). The spatial analysis included active foci with known geocoordinates that reported more than five cases from FY 2018 to FY 2021.ResultsFrom FY 2017 to FY 2021, on-time case notification improved from 24.4% to 89.3%, case investigations from 58.0% to 96.5%, and foci investigations from 37.9% to 87.2%. Adherence to timeliness protocols did not show statistically significant variation by area risk classification. However, adherence to 1-3-7 protocols showed a marked spatial heterogeneity among active foci, and the ARIMA model showed a statistically significant acceleration in the reduction of malaria incidence. The 1-3-7 strategy national indicators and targets in Thailand have shown progressive success, and most targets were achieved for FY 2021.ConclusionThe results of Thailand’s 1-3-7 surveillance strategy are associated with a decreased incidence in the period following the adoption of the strategy although there is notable geographic variation. The DVBD will continue to implement and adapt the 1-3-7 strategy to accelerate progress toward malaria elimination. This assessment may be useful for domestic strategic planning and to other countries considering more intensive case and foci investigation and response strategies.

The Evolution of the Malaria Clinic: The Cornerstone of Malaria Elimination in Thailand.

Background: Malaria Clinics (MCs) have served communities in Thailand since 1965 and are still playing a critical role in providing early diagnosis and effective treatment of malaria. Methods: We reviewed six decades of published manuscripts, articles, strategies, and plans regarding MC operations in Thailand;,and analyzed national program surveillance data in both malaria control and malaria elimination phases. Results: MCs accounted for 39.8% of malaria tests and 54.8% of positive cases by the end of the 1980s. The highest number of MCs established was 544 in 1997. MCs contributed to 6.7% of all tests and 30% of all positive cases over the 2015–2017 period. Between 2017 and June 2019, during the malaria elimination phase, MCs continued to test an average of 67% of all persons tested for malaria, and confirmed 38.3% of all positive cases detected in the country. Conclusions: Testing and positive rates of MCs are on a gradual decline as the overall burden of malaria declines annually, which may reflect decreasing transmission intensity. Although the number of MCs in the last three years has been stable (n = 240), the attrition of MC staff poses a real challenge to the longevity of MCs in the absence of a human resource plan to support the elimination phase. It is necessary to identify and support capacity gaps and needs as MCs are absorbed into an integrated and decentralized program, while ensuring that the Division of Vector Borne Diseases (DVBD) maintains its necessary technical and advisory role.

Epidemiological Distribution of Reported West Nile cases in Houston, Texas, 2014-2017

ObjectiveTo demonstrate an overview of the epidemiological and clinical distribution of reportable West Nile cases in Houston, Texas, from 2015-2017.IntroductionWest Nile virus (WNV) is considered the leading cause of domestically acquired arboviral disease and is spread through mosquitoes. In general, the majority of the cases are asymptomatic. One in five people infected will display mild symptoms like fever, headache, body ache, nausea, and vomiting. Only about 1 in 150 people infected will develop serious neurologic complications such as encephalitis and meningitis. According to CDC, in 2017, there were 133 confirmed cases including 5 deaths and 14 presumptive blood donors reported in the State of Texas. Out of the confirmed cases, there were 85 neuroinvasive and 48 non-neuroinvasive disease cases.MethodsData were extracted from Houston’s Electronic Disease Surveillance System (HEDSS) from January 1, 2014, to December 31, 2017. A total of 45 confirmed cases are included in this analysis to examine the epidemiologic characteristics of the WNV cases.A confirmed case is an illness with onset of acute focal limb weakness and an MRI showing a spinal cord lesion largely restricted to gray matter and spanning one or more spinal segments.ResultsAmong the confirmed cases, 67% of were males. Age group 60 and above (47%) had the highest proportion of WNV cases. Whites (26%) represented the highest number of confirmed cases followed by Hispanics (24%).Seventy six percent of the cases were hospitalized. Non-neuroinvasive clinical presentations found among confirmed WNV cases were fever (94%), headache (76%) followed by chills and rigors (68%). Among the neuroinvasive presentations, altered mental status had the highest proportion (24%), followed by stiff necks (18%), Ataxia (12%), and seizure (9%).ConclusionsWNV is mostly prevalent in White male adults over 60 years of age, with majority of cases have common neuroinvasive symptoms like altered mental status, stiff necks, and Ataxia. For non-neuroinvasive cases clinical symptoms were fever, headache, chills and rigors.WNV infection is a markedly underreported disease as most of the infected people do not seek medical care due to mild or no symptoms. Currently there are no specific treatments available. Thus, continued monitoring and surveillance activities are warranted for prevention and control of WNV complications as well as decreasing the risk of infection.ReferencesCDC: West Nile Virus [Internet]. Atlanta: Center for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), and Division of Vector-Borne Diseases (DVBD); Last reviewed: September 19, 2018.Available from: https://www.cdc.gov/westnile/index.html

Successful intravenous heparin administration during coronary revascularization surgery in a patient with alpha-gal anaphylaxis history

Allergy to galactose-alpha-1,3-galactose (alpha-gal) presents as an immunoglobulin E (IgE)-mediated, yet delayed-onset hypersensitivity reaction to non-primate mammalian meat. 1 Commins S.P. Jerath M.R. Cox K. Erickson L.D. Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016; 65: 16-20 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Alpha-gal sensitization develops after tick bite exposure. 1 Commins S.P. Jerath M.R. Cox K. Erickson L.D. Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016; 65: 16-20 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar , 2 Commins S.P. James H.R. Kelly L.A. et al. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galacatose. J Allergy Clin Immunol. 2011; 127: 1286-1293 Abstract Full Text Full Text PDF PubMed Scopus (351) Google Scholar , 3 Fischer J. Lupberger E. Hebsaker J. et al. Prevalence of type I sensitization to alpha-gal in forest service employees and hunters. Allergy. 2017; 72: 1540-1547 Crossref PubMed Scopus (59) Google Scholar The lone-star tick (Amblyomma americanum) represents the North American vector, spanning a relatively vast southeast, midwest, and northeast geographic distribution. 4 Approximate Distribution of the Lone Star Tick. Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Disease. Division of Vector-Borne Diseases. https://www.cdc.gov/ticks/maps/lone_star_tick.pdfDate accessed: March 28, 2019 Google Scholar Allergic manifestations include urticaria/angioedema, abdominal pain/diarrhea, or anaphylaxis, occurring approximately 3 to 6 hours after ingestion. 1 Commins S.P. Jerath M.R. Cox K. Erickson L.D. Platts-Mills T. Delayed anaphylaxis to alpha-gal, an oligosaccharide in mammalian meat. Allergol Int. 2016; 65: 16-20 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Alpha-gal hypersensitivity is not limited to food-related consumption. Other potential alpha-gal exposures include bioprosthetic heart valves and vaccines or medications (porcine/bovine origin or gelatin-containing), such as heparin. 5 Commins S.P. Invited commentary: Alpha-gal allergy: tip of the iceberg to a pivotal immune response. Curr Allergy Asthma Rep. 2016; 16: 61 Crossref PubMed Scopus (27) Google Scholar , 6 Dunkman W.J. Rycek W. Manning M.W. What does a red meat allergy have to do with anesthesia? Perioperative management of alpha-gal syndrome. Anesth Analg. 2018; https://doi.org/10.1213/ANE.0000000000003460 Crossref PubMed Scopus (8) Google Scholar , 7 Mozzicato S.M. Tripathi A. Posthumus J.B. Platts-Mills T.A.E. Commins S.P. Porcine or bovine valve replacement in 3 patients with IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galactose. J Allergy Clin Immunol Pract. 2014; 2: 637-638 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar

Production of a Sindbis/Eastern Equine Encephalitis chimeric virus inactivated cell culture antigen

Eastern Equine Encephalitis virus (EEEV) is a medically important pathogen that can cause severe encephalitis in humans, with mortality rates ranging from 30 to 80%. Unfortunately there are no antivirals or licensed vaccines available for human use, and laboratory diagnosis is essential to differentiate EEEV infection from other pathogens with similar clinical manifestations. The Arboviral Diseases Branch (ADB) reference laboratory at the CDC Division of Vector-Borne Diseases (DVBD) produces reference antigens used in serological assays such as the EEEV immunoglobulin M antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA). However, EEEV is classified as a HHS select agent and requires biosafety level (BSL) three containment, limiting EEEV antigen production in non-select agent and BSL-2 laboratories. A recombinant Sindbis virus (SINV)/EEEV has been constructed for use under BSL-2 conditions and is not regulated as a select agent. Cell culture production of inactivated EEEV antigen from SINV/EEEV for use in the EEEV MAC-ELISA is reported here. Cell culture conditions and inactivation procedures were analyzed for SINV/EEEV using a recently developed antigen production algorithm, with the MAC-ELISA as the performance indicator.

Chikungunya virus outbreak expansion and microevolutionary events affecting epidemiology and epidemic potential

Chikungunya virus outbreak expansion and microevolutionary events affecting epidemiology and epidemic potential Ann M PowersArboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USAAbstract: Chikungunya virus (CHIKV) is a mosquito-borne virus that is associated with severe and prolonged arthralgia. Starting in 2004, CHIKV reemerged in a series of outbreaks along the east coast of Africa and on several islands of the Indian Ocean. Over the subsequent 10 years, the virus spread throughout the globe and caused over three million cases. Molecular characterization of the genomes over time revealed changes that were associated with changes in epidemiology and transmission patterns. Monitoring and exploitation of these changes may lead to better understanding of viral movement and potential options for prevention and control.Keywords: chikungunya, alphaviral evolution, molecular epidemiology, transmission, outbreaks

Secondhand Tobacco Smoke Exposure Among Hospitalized Nonsmokers With Coronary Heart Disease

Secondhand Tobacco Smoke Exposure Among Hospitalized Nonsmokers With Coronary Heart Disease

Development of an algorithm for production of inactivated arbovirus antigens in cell culture

Arboviruses are medically important pathogens that cause human disease ranging from a mild fever to encephalitis. Laboratory diagnosis is essential to differentiate arbovirus infections from other pathogens with similar clinical manifestations. The Arboviral Diseases Branch (ADB) reference laboratory at the CDC Division of Vector-Borne Diseases (DVBD) produces reference antigens used in serological assays such as the virus-specific immunoglobulin M antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA). Antigen production in cell culture has largely replaced the use of suckling mice; however, the methods are not directly transferable. The development of a cell culture antigen production algorithm for nine arboviruses from the three main arbovirus families, Flaviviridae, Togaviridae, and Bunyaviridae, is described here. Virus cell culture growth and harvest conditions were optimized, inactivation methods were evaluated, and concentration procedures were compared for each virus. Antigen performance was evaluated by the MAC-ELISA at each step of the procedure. The antigen production algorithm is a framework for standardization of methodology and quality control; however, a single antigen production protocol was not applicable to all arboviruses and needed to be optimized for each virus.

Multiplex Microsphere Immunoassays for the Detection of IgM and IgG to Arboviral Diseases

Serodiagnosis of arthropod-borne viruses (arboviruses) at the Division of Vector-Borne Diseases, CDC, employs a combination of individual enzyme-linked immunosorbent assays and microsphere immunoassays (MIAs) to test for IgM and IgG, followed by confirmatory plaque-reduction neutralization tests. Based upon the geographic origin of a sample, it may be tested concurrently for multiple arboviruses, which can be a cumbersome task. The advent of multiplexing represents an opportunity to streamline these types of assays; however, because serologic cross-reactivity of the arboviral antigens often confounds results, it is of interest to employ data analysis methods that address this issue. Here, we constructed 13-virus multiplexed IgM and IgG MIAs that included internal and external controls, based upon the Luminex platform. Results from samples tested using these methods were analyzed using 8 different statistical schemes to identify the best way to classify the data. Geographic batteries were also devised to serve as a more practical diagnostic format, and further samples were tested using the abbreviated multiplexes. Comparative error rates for the classification schemes identified a specific boosting method based on logistic regression “Logitboost” as the classification method of choice. When the data from all samples tested were combined into one set, error rates from the multiplex IgM and IgG MIAs were <5% for all geographic batteries. This work represents both the most comprehensive, validated multiplexing method for arboviruses to date, and also the most systematic attempt to determine the most useful classification method for use with these types of serologic tests.

Lyme Disease and the Heart

Lyme disease is caused by bacteria that are transmitted to humans by hard-bodied ticks found in temperate climates throughout the world.1,2 In the United States, the disease is caused by Borrelia burgdorferi sensu stricto and is endemic in areas of the Northeastern and Middle Atlantic regions, as well as the upper Midwest and northern Pacific Coast (Figure 1). Ticks undergo a 3-stage life cycle during which they acquire the Lyme disease bacteria from mice and other rodent hosts and transmit them back to these hosts and to humans. The most common clinical manifestation is an expanding red rash called erythema migrans that occurs in ≈90% of cases (Figure 2). Other disease manifestations can be seen when the bacteria disseminate from the site of initial deposition in the skin to the heart and other organs. Before the discovery of effective antibiotic therapy, more than half of all Lyme disease patients experienced joint manifestations, whereas ≤10% had neurological or cardiac manifestations. The number of people experiencing these complications has decreased markedly since the use of standard antibiotic therapy early in the course of infection. Figure 1. Reports of cases of Lyme disease to the Centers for Disease Control and Prevention (CDC), United States, 2010 (National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, United States). One dot is placed randomly within county of residence for each confirmed case. Although Lyme disease cases have been reported in nearly every state, cases are reported from the infected person’s county of residence, not the place where they were infected. Courtesy of Centers for Disease Control and Prevention. Figure 2. Erythema migrans rash. This rash can be uniformly red ( A ) or have a bull’s-eye appearance with central clearing ( B ). The rash usually is painless …

Morbidity in Schistosomiasis: Assessment, Mechanisms and Control

The workshop, held in Nyeri, Kenya, 3–6 November 1997, was organized jointly by the Danish Bilharziasis Laboratory (DBL) and the Division of Vector Borne Diseases (DVBD) of the Kenyan Ministry of Health, and funded by DANIDA and the INCO-DC programme of the European Commission. It arose as a result of a previous DBL/DVBD workshop in Mombasa in 1995, and an EC meeting in Senegal in early 1997. It was attended by 41 participants from six countries in Africa and nine in Europe or North America, who represented a network of collaborating research groups. The consensus was that much had been achieved since the last workshop two years earlier, and that such workshops had great value not only in the sharing of detailed scientific results but also in forging or strengthening collaborations between the various groups involved and discussion of future research needs. Participants at the workshop wished to record their appreciation of the late Kenneth Mott's contribution to the field of morbidity due to schistosomiasis.