Effective Surveillance System Research Articles

In this issue – April 2018

In this issue – April 2018

Shiga‐toxigenic Escherichia coli of cattle origin represents a surveillance priority and an important human health threat to public and travelers of the Indian Ocean islands

AbstractShiga‐toxigenic Escherichia coli (STEC), also known as enterohemorrhagic E. coli (EHEC) pose a significant threat to public health worldwide. Livestock animals are well known reservoirs of STEC. In this study, cattle were investigated in situ on the tropical island of Mauritius. This island is of economic importance as it has a consolidated tourism industry and possesses several attributes which are increasingly being experienced by other tropical oceanic islands. Throughout our research, STEC were recovered in 20.3% (146/718) of E. coli isolates screened from faecal, milk, and meat samples. Prevalence‐wise, non‐EHEC‐7 dominates EHEC‐7 (seven serogroups classified as most virulent) and accounts for 77.4% and 22.6% of data set, respectively. Different virulent profiles were observed, with eaeA and EHEC‐hlyA genes being more frequent. These virulent E. coli strains represents potential threats to both local and international travelers. Mauritius today may thus serve as an “overview” of the potential threat encountered by many other oceanic islands.Practical applicationsAs in any risk assessment procedures, there is a need for identification and characterization of potential threats. With the flourishing tourism industry and increasing population in the Indian Ocean region, a greater demand for safe food justifies the need for a more effective surveillance system approach. Given the gap in the Indian Ocean surveillance system and the presence of Shiga‐toxigenic Escherichia coli in cattle with potential for zoonotic transmission to humans resulting from this study, we believe that providing information to policy makers and public health decision makers will enable the setting up of an Indian Ocean Zoonoses Control Programme supervised by the WHO to help promote prevention, public health education, research, surveillance, and control of zoonoses in this part of the globe, most commonly associated with diarrheal disease among both local and international travelers of the Indian Ocean region.

Malaria in Southeastern China from 2012 to 2016: Analysis of Imported Cases.

.To study the epidemiological distribution and the incident trends of imported malaria from 2012 to 2016 in Zhejiang Province, southeastern China, we collected data on malaria from the Information System for Parasitic Disease Control and Prevention. A total of 1,003 malaria cases were reported during 2012–2016, and all of these cases were imported. Plasmodium falciparum was the predominant species (76.3%) in Zhejiang Province. The percentage of Plasmodium vivax decreased from 33.6% to 8.1%, whereas the percentage of Plasmodium ovale and Plasmodium malariae increased. Most cases were male (89.8%), mostly in the age group of 21–50 years (82.6%). Businessmen (33.0%), workers (21.0%), farmers (18.8%), and overseas laborers (11.7%) were at high risk. The origin of the largest number of imported cases was Africa (89.5%), followed by Asia (10.0%) and Oceania (0.5%). The time interval from illness onset to confirmation was found to be significantly associated with the complications of patients. Out of 3,461 febrile individuals tested during reactive case detection, 10 malaria-positive individuals were identified. Effective surveillance and response system should be strengthened to prevent the reintroduction of malaria.

Sensing Bacterial-Induced DNA Damaging Effects via Natural Killer Group 2 Member D Immune Receptor: From Dysbiosis to Autoimmunity and Carcinogenesis.

The human genome is constantly exposed to exogenous and endogenous DNA damaging factors that frequently cause DNA damages. Unless repaired, damaged DNA can result in deleterious mutations capable of causing malignant transformation. Accordingly, cells have developed an advanced and effective surveillance system, the DNA damage response (DDR) pathway, which maintains genetic integrity. In addition to well-defined outcomes, such as cell cycle arrest, apoptosis, and senescence, another consequence of DDR activation is the induction of natural killer group 2 member D ligands (NKG2D-Ls) on the surface of stressed cells. Consequently, NKG2D-Ls-expressing cells are recognized and eliminated by NKG2D receptor-expressing immune cells, including NK cells, and various subsets of T-cells. Recent pieces of evidence indicate that commensal microbial imbalance (known as dysbiosis) can trigger DDR activation in host cells, which may result in sustained inflammatory responses. Therefore, dysbiosis can be seen as an important source of DNA damage agents that may be partially responsible for the overexpression of NKG2D-Ls on intestinal epithelial cells that is frequently observed in patients with inflammatory bowel disease and other disorders associated with altered human microbiota, including the development of colorectal cancer. In this article, we discuss recent evidence that appears to link an altered human microbiota with autoimmunity and carcinogenesis via the activation of DDR signals and the induction of NKG2D-Ls in stressed cells.

Changing paradigm in the epidemiology of Japanese encephalitis in a non-endemic region.

Japanese encephalitis (JE) is a mosquito-borne zoonotic disease. The JE virus (JEV) does not cause any disease among its natural hosts and transmission continues through mosquitoes belonging to Culex vishnui subgroup. This study was aimed to investigate the prevalence of JEV in mosquitoes and humans in the Thanjavur district, a non-endemic region for JE, in Tamil Nadu, by using standard available assays. : A sero-surveillance study was conducted in Thanjavur district among the normal rural school children in the 5-12 yr age group, during the JE season (October) and post-JE season (February) from 2011 to 2013 for the detection of JEV infection. Vector abundance studies were carried out from 2011 to 2014. JE seropositivity and its association between the seasons were analysed statistically. : The occurrence of JE infection among children aged 5-12 yr was very high in the study area. The infection rates for JE in two consecutive seasons for 2011-12 and 2012-13 were 32.2 and 65.2%, respectively. The Cx. tritaeniorhynchus sp. dominated the catch, and was majorly responsible for the transmission. There was a significant difference in the human infection rate compared to the years 1991-92 and 1992-93; and a marked decrease in the cattle to pigs ratio (123 : 1) compared to the studies in 1991-93. : The study unearthed the prevailing situation of JE among children, who are at higher risk of developing the disease during the transmission season. The decrease in the cattle to pigs ratio might be the one of the reasons for increase in the JEV infection among the children population compared to 20 years before. This trend requires urgent attention as it could be prevented with effective surveillance systems and vaccines.

Crimean-Congo Hemorrhagic Fever (CCHF) in Pakistan: The "Bell" is Ringing Silently.

Pakistan is being hit by communicable and noncommunicable diseases over time. Among these, tickborne viral disease, Crimean-Congo hemorrhagic fever (CCHF) is one of the most fatal infections. Rapid climate change aroused by industrial, occupational, and agricultural activities to support ever-growing human population has been considered the single most causative basis for emergence or re-emergence of CCHF in Pakistan, where it has biannual peaks between the months of March-May and August-October. Many factors, including poor sanitation at farms, villages, and cities, unhygienic transportation and slaughter of animals at numerous sites within a city, inefficient tick-control programs, post-slaughter piles of animal remains other than meat, nomadic lifestyle, and lack of trained animal and human healthcare staff, are contributing to the spread of CCHF. Pakistan has confirmed cases of CCHF in almost every province: Sindh (Karachi), Punjab (Faisalabad, Multan, and Rawalpindi), Balochistan (Quetta) and Khyber Pakhtunkhwa (Peshawar). The root cause behind the spread of CCHF in Pakistan seems to be the absence of an effective disease surveillance system in the human as well as the animal populations. Most of the time, CCHF cases are not diagnosed, and if they are diagnosed they are not reported. If these cases are reported, there are not enough effective measures by the relevant provincial and district authorities. There is a need to educate the general public, farmers, and healthcare workers about the causes, transmission, and dangers of CCHF. An immediate plan for the implementation of a surveillance system, standard preventive measures, early detection, proper treatment, and timely response is urgently needed. Without such a plan, the accumulation of factors responsible for the sudden outbreak of CCHF may pose a serious threat to humans and animals in different geographical regions of the country.

Biomedical Text Analytics for Characterizing Climate-Sensitive Disease

Large-scale influx of scientific literatures in the biomedical domain, enriched with various biomedical entities like genes, proteins, drugs, diseases, symptoms, microbes, pathogens etc. embed many useful information that remains untapped due to unstructured nature of texts. Processing these texts using NLP techniques, and extracting embedded entities and their relations can provide useful information in creating disease knowledge base, which is a key enabler for the development of effective disease surveillance systems. In this paper, we present a biomedical text analytics approach to identify disease symptoms and relations from biomedical texts for characterizing climate-sensitive diseases. Four climate-sensitive infectious diseases, including Cholera, Dengue, Influenza, and Malaria are considered for experimentation, and it is found that the proposed approach is able to identify new disease symptoms that are even not listed on standard websites like Center for Disease Control (CDC), National Health Survey (NHS), and World Health Organization (WHO). In addition, it also identifies generic relations between diseases and their symptoms. The proposed approach could be useful for the development of climate-sensitive disease surveillance and prevention systems.

Case study: statistical monitoring for the moisture content of the cut tobacco

The moisture content of cut tobacco in Tobacco industry affects directly the quality of tobacco. To prevent the abnormal changes of the moisture content of cut tobacco, effective surveillance systems would be extremely helpful to give out-of-control (OC) signals as quickly as possible. The conventional statistical process control charts are not suitable to use due to complex structures, such as semiparametric trend, within-batch correlation in the moisture content data. In this paper, we propose a four-step procedure in which Semiparametric longitudinal model, time series analysis methods and normal transformation methods are utilized to eliminate the impact of the complex structures. And our procedure is demonstrated using the moisture content data of cut tobacco at the outlet (MCCTO) collected in Shanghai tobacco group co., LTD of China. The results show that our procedure is effective in detecting the abnormal changes of the MCCTO data.

Modelling the implications of stopping vector control for malaria control and elimination

BackgroundIncreasing coverage of malaria vector control interventions globally has led to significant reductions in disease burden. However due to its high recurrent cost, there is a need to determine if and when vector control can be safely scaled back after transmission has been reduced.Methods and findingsA mathematical model of Plasmodium falciparum malaria epidemiology was simulated to determine the impact of scaling back vector control on transmission and disease. A regression analysis of simulation results was conducted to derive predicted probabilities of resurgence, severity of resurgence and time to resurgence under various settings. Results indicate that, in the absence of secular changes in transmission, there are few scenarios where vector control can be removed without high expectation of resurgence. These, potentially safe, scenarios are characterized by low historic entomological inoculation rates, successful vector control programmes that achieve elimination or near elimination, and effective surveillance systems with high coverage and effective treatment of malaria cases.ConclusionsProgrammes and funding agencies considering scaling back or withdrawing vector control from previously malaria endemic areas need to first carefully consider current receptivity and other available interventions in a risk assessment. Surveillance for resurgence needs to be continuously conducted over a long period of time in order to ensure a rapid response should vector control be withdrawn.

Alternative to plating for calcaneal fracture treatment via sinus tarsi approach

Currently in China, the schistosomiasis control program has shifted its focus from transmission control to the elimination of the disease. Effective forecast and surveillance systems of schistiosomiasis are of great importance for issuing timely and early warnings on risk of infection, and therefore implementing preventive measures to avoid infection. There is great demand in more sensitive and specific methods to improve the surveillance system for early detection of S. japonicum infection in sentinel mice. In this study, we reported a sensitive nested-PCR assay targeting a 303-bp fragment from highly repetitive retrotransposon SjCHGCS19 to detect the S. japonicum DNA in sera of experimental mice. Meanwhile, detection efficacy of the nested-PCR was compared with two conventional methods for field monitoring schistosomiasis such as ELISA and IHA. The nested-PCR assay could detect the specific DNA at 3-day post-infection in sera of mice with 5 cercariae infection, while for ELISA and IHA, both show negative results even after 2 weeks post-infection in mice with 20 cercariae infection. Our results demonstrated the DNA-based assay was more sensitive to make early diagnosis of S. japonicum infection in sentinel mice models, which will improve the early-warning ability of schistosomiasis surveillance system.

Comparative genomic and phylogenetic analysis of a toxigenic clinical isolate of Corynebacterium diphtheriae strain B-D-16-78 from Malaysia

In this study, we report the comparative genomics and phylogenetic analysis of Corynebacterium diphtheriae strain B-D-16-78 that was isolated from a clinical specimen in 2016. The complete genome of C. diphtheriae strain B-D-16-78 was sequenced using PacBio Single Molecule, Real-Time sequencing technology and consists of a 2,474,151-bp circular chromosome with an average GC content of 53.56%. The core genome of C. diphtheriae was also deduced from a total of 74 strains with complete or draft genome sequences and the core genome-based phylogenetic analysis revealed close genetic relationship among strains that shared the same MLST allelic profile. In the context of CRISPR-Cas system, which confers adaptive immunity against re-invading DNA, 73 out of 86 spacer sequences were found to be unique to Malaysian strains which harboured only type-II-C and/or type-I-E-a systems. A total of 48 tox genes which code for the diphtheria toxin were retrieved from the 74 genomes and with the exception of one truncated gene, only nucleotide substitutions were detected when compared to the tox gene sequence of PW8. More than half were synonymous substitution and only two were nonsynonymous substitutions whereby H24Y was predicted to have a damaging effect on the protein function whilst T262V was predicted to be tolerated. Both toxigenic and non-toxigenic toxin-gene bearing strains have been isolated in Malaysia but the repeated isolation of toxigenic strains with the same MLST profile suggests the possibility of some of these strains may be circulating in the population. Hence, efforts to increase herd immunity should be continued and supported by an effective monitoring and surveillance system to track, manage and control outbreak of cases.

OUTBREAK OF CEREBROSPINAL MENINGITIS IN KEBBI STATE, NIGERIA.

Cerebrospinal meningitis (CSM), is a major public health problem still affecting tropical countries particularly in sub-Saharan Africa. Group A and occasionally group C account for large scale epidemics in many countries in the African meningitis belt. The study aimed to describe the pattern of cerebrospinal meningitis outbreak in Kebbi state in 2015. Information on cases and deaths was collected throughout the duration of the meningitis outbreak in all affected local government areas of Kebbi state. During this outbreak, we defined a suspected case as any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs and any toddler with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, or flaccid neck, bulging fontanel, convulsion or other meningeal signs. All the data was entered into SPSS statistical software and analyzed. A total of 1,992 suspected cases of CSM were seen within the 18 weeks that the outbreak lasted. 1127 (57.0%) were males and 865 (43.0%) were females with a case fatality rate of 4.0%. The highest proportion of cases was found among those above 15 years of age (31.0%), 1252 (62.9%) of cases were immunized against neisseria meningitides type A. Two-thirds (16) of the LGAs in the state were affected and Aliero LGA had about half (n=1106; 55.5%) of cases seen. Most (77.3%) of samples analysed were positive for Nm type C. Kebbi state experienced an outbreak of cerebro-spinal Meningitis in 2015 which was massive. Effective surveillance system and mass vaccination with polyvalent vaccines containing serogroup C will prevent future occurrence.

Evaluation of the Malaria Surveillance System in Kaduna State, Nigeria 2016

ObjectiveTo describe the process of operation of the system and assessits key attributes, to determine the effectiveness and efficiency ofthe surveillance system and make appropriate recommendations tostakeholders for its improvement.IntroductionMalaria is a parasitic disease caused by Plasmodium falciparum.About 3.2 billion people worldwide are at risk of malaria.1Childrenand pregnant women are particularly vulnerable to the disease. Sub-Saharan Africa carries a high share of the global malaria burden.2Effective malaria surveillance system is essential in the control andelimination of malaria. Worldwide, there were an estimated 198million cases of malaria in 2013 and 584,000 deaths.1,3,4MethodsThis study was conducted using the “CDC’s Updated Guidelinesfor Evaluating Public Health Surveillance System, 2001”. Keystakeholders and Malaria Focal Persons were interviewed. IntegratedDisease Surveillance and Response case summary data from Januaryto December 2014 was reviewed. Data analysis was done usingMicrosoft Excel 2016 and Epi-info 7.ResultsThe system provides information on malaria trends, morbidityand mortality. Case definitions are well understood by participants.All Malaria focal persons (MFPs) were willing to continue usingthe system. Standardized data collection tools are available in 91%of Health Facilities (HF). The system was rated flexible by 91%of MFPs. The system was however not representative because datawere essentially from public health facilities only. The system hasan average timeliness of 37.7% and completeness of 59.4%, bothparameters were below the State’s 80% target. About 91% MFPs hadrefresher training, while 78% MFPs received supportive supervision.Main challenges identified were lack of commodities in all HFs, andinadequate mobile facilities in 70% of HFs.ConclusionsThe Kaduna state Malaria surveillance system is meeting itsobjectives. However, challenges are observed in its timeliness,representativeness, and data quality. Efforts should be made tointegrate tertiary and private health facilities into the system. MFPsneed more training on malaria reporting to improve timeliness anddata quality. There is the need to improve on the supply of malariatreatment commodities to all health facilities within Kaduna state.

Assessment of hygienic conditions of live bird markets on avian influenza in Chittagong metro, Bangladesh

Live Bird Markets (LBMs) in Asian countries are considered as hubs for the spread and maintenance of different infectious diseases. In Bangladesh, LBMs are the major source of live and dressed poultry to consumers and until now only a few studies have been conducted targeting infectious agent status such as avian influenza virus (AIV) prevalence of LBMs in Bangladesh. Therefore, a cross sectional study was conducted using all 40 LBMs within the Chittagong Metropolitan Area (CMA) of Bangladesh targeting demographic information and hygienic status of LBMs in concurrence with AIV prevalence and its subtype distribution, as well as the associated risk factors for AIV. Pooled environmental swab samples were collected from 2 to 9 different sites per stall, with epidemiological data being obtained from a total of 290 stalls across 40 LBMs. The samples were evaluated by Real Time Reverse Transcriptase Polymerase Chain Reaction. The prevalence of AIV was 40% (95% CI: 20–60%; N=40) at a LBM level followed by 20.3% (CI: 10–30%, N=290) at a stall level. Specifically, the prevalence of H5, H7 and H9 subtypes at stall level were 2.8% (95% CI: 1–5%), 0% (CI: 0–1.3%) and 3.1% (CI: 1–6%), respectively. Generalized Estimating Equation model identified that the type of species sold (OR=2.5: Chicken and non-duck species versus Duck with other species), bird holding areas (OR=1.9: Cage versus Floor) and Hygienic score (OR=3.1: Score 3 or more versus score less than 3) as potential risk factors for the detection of AIV at stall level. These results suggest that housing chickens and ducks together in the stalls, birds kept on floors, and lack of adequate hygienic measures of the stall were the crucial factors for spreading AIV. This research outcome could be used to develop a proof-based program concerning environmental sanitation along with development of an effective surveillance system to reduce the AIV transmission through LBMs in Bangladesh.

Trajectory-based vehicle tracking at low frame rates

In smart cities, an intelligent traffic surveillance system plays a crucial role in reducing traffic jams and air pollution, thus improving the quality of life. An intelligent traffic surveillance should be able to detect and track multiple vehicles in real-time using only limited resources. Conventional tracking methods usually run at a high video-sampling rate, assuming that the same vehicles in successive frames are similar and move only slightly. However, in cost effective embedded surveillance systems (e.g., a distributed wireless network of smart cameras), video frame rates are typically low because of limited system resources. Therefore, conventional tracking methods perform poorly in embedded surveillance systems because of discontinuity of the moving vehicles in the captured recordings. In this study, we present a fast and light algorithm that is suitable for an embedded real-time visual surveillance system to detect effectively and track multiple moving vehicles whose appearance and/or position changes abruptly at a low frame rate. For effective tracking at low frame rates, we propose a new matching criterion based on greedy data association using appearance and position similarities between detections and trackers. To manage abrupt appearance changes, manifold learning is used to calculate appearance similarity. To manage abrupt changes in motion, the next probable centroid area of the tracker is predicted using trajectory information. The position similarity is then calculated based on the predicted next position and progress direction of the tracker. The proposed method demonstrates efficient tracking performance during rapid feature changes and is tested on an embedded platform (ARM with DSP-based system).

Early detection of circulating DNA of Schistosoma japonicum in sentinel mice models

Currently in China, the schistosomiasis control program has shifted its focus from transmission control to the elimination of the disease. Effective forecast and surveillance systems of schistiosomiasis are of great importance for issuing timely and early warnings on risk of infection, and therefore implementing preventive measures to avoid infection. There is great demand in more sensitive and specific methods to improve the surveillance system for early detection of S. japonicum infection in sentinel mice. In this study, we reported a sensitive nested-PCR assay targeting a 303-bp fragment from highly repetitive retrotransposon SjCHGCS19 to detect the S. japonicum DNA in sera of experimental mice. Meanwhile, detection efficacy of the nested-PCR was compared with two conventional methods for field monitoring schistosomiasis such as ELISA and IHA. The nested-PCR assay could detect the specific DNA at 3-day post-infection in sera of mice with 5 cercariae infection, while for ELISA and IHA, both show negative results even after 2 weeks post-infection in mice with 20 cercariae infection. Our results demonstrated the DNA-based assay was more sensitive to make early diagnosis of S. japonicum infection in sentinel mice models, which will improve the early-warning ability of schistosomiasis surveillance system.

External Quality Assessment for Rubella Virus RNA Detection Using Armored RNA in China.

Although tremendous efforts have been made to reduce rubella incidence, there are still 300 new cases of congenital rubella syndrome daily; thus, rubella infections remain one of the leading causes of preventable congenital birth defects. An effective surveillance system, which could be achieved and maintained by using an external quality assessment program, is critical for prevention and control of this disease. Armored RNAs, which are noninfectious and RNase-resistant, were used for encapsulation of the E1 gene of rubella virus and for preparation of a 10-specimen panel for external quality assessment. Thirty-two laboratories across mainland China that used nucleic acid tests for rubella virus RNA detection were included in the external quality assessment program organized by the National Center for Clinical Laboratories of China. Different kinds of commercial kits were used by the laboratories for nucleic acid extraction and TaqMan real-time reverse-transcription PCR for rubella virus RNA detection; 99.2% sensitivity and 100% specificity were achieved in this external quality assessment program. Most of the participating laboratories obtained accurate results for rubella nucleic acid tests, thereby achieving the quality required for regional rubella and congenital rubella syndrome elimination.

Non Communicable Disease Risk Factors and their Trends in India

Background:India is a populous country of about 1.3 billion. Non communicable diseases (NCDs) contribute to around 5.87 million (60%) of all deaths in India. Hence, the objectives of this paper are to find baseline information on different NCD risk factors coverage and to determine their trends in India.Methods:For this systematic review, PubMed, Google and different surveillance systems were searched. Of the search results, 41 papers/survey reports were eventually assessed for eligibility. National and state representative data on NCD risk factors (for the major NCDs like cardiovascular diseases, chronic respiratory disease, cancer and diabetes) having World Health Organization(WHO) indicator definitions, covering rural and urban population, were included in the study. Thereafter, state-wise population proportion was added and divided by the total Indian population to determine the percentage of population coverage for each risk factor by the surveys. Also, the old and current data of the periodic surveys were compared to assess prevalence trends.Results:Various national/state level surveys in India include single or multiple risk factors. Nationwide coverage is available for tobacco use, alcohol drinking, raised blood pressure and overweight and obesity. Periodic National Family Health Surveys provide information on selected risk factors during 2005-16 among adults aged 15-49 years. An overall significant increase was noted in overweight and obesity while decline was noted in tobacco and alcohol use during the same period. From GATS 1 (2009-10) to 2 (2016-17) also, the prevalence of tobacco consumption decreased in India.Conclusion:India has a much delayed response on NCD risk factors surveillance and information of the same are sporadic and incomplete. In order to increase information comprehensiveness, standard WHO NCD risk factors questions must be incorporated in the ongoing surveys. India should also plan for cost and time effective NCD surveillance system.

Technological solutions for an effective health surveillance system for road traffic crashes in Burkina Faso

ABSTRACT Background: In the early 2000s, electronic surveillance systems began to be developed to collect and transmit data on infectious diseases in low-income countries (LICs) in real-time using mobile technologies. Such surveillance systems, however, are still very rare in Africa. Among the non-infectious epidemics to be surveilled are road traffic injuries, which constitute major health events and are the fifth leading cause of mortality in Africa. This situation also prevails in Burkina Faso, whose capital city, Ouagadougou, is much afflicted by this burden. There is no surveillance system, but there have been occasional surveys, and media reports of fatal crashes are numerous and increasing in frequency. Objective: The objective of this article is to present the methodology and implementation of, and quality of results produced by, a prototype of a road traffic crash and trauma surveillance system in the city of Ouagadougou. Methods: A surveillance system was deployed in partnership with the National Police over a six-month period, from February to July 2015, across the entire city of Ouagadougou. Data were collected by all seven units of the city’s National Police road crash intervention service. They were equipped with geotracers that geolocalized the crash sites and sent their positions by SMS (short message service) to a surveillance platform developed using the open-source tool Ushahidi. Descriptive statistical analyses and spatial analyses (kernel density) were subsequently performed on the data collected. Results: The process of data collection by police officers functioned well. Researchers were able to validate the data collection on road crashes by comparing the number of entries in the platform against the number of reports completed by the crash intervention teams. In total, 873 crash scenes were recorded over 3 months. The system was accessible on the Internet for open consultation of the map of crash sites. Crash-concentration analyses were produced that identified ‘hot spots’ in the city. Nearly 80% of crashes involved two-wheeled vehicles. Crashes were more numerous at night and during rush hours. They occurred primarily at intersections with traffic lights. With regard to health impacts, half of the injured were under the age of 29 years, and 6 persons were killed. Conclusions: This pilot study demonstrated the feasibility of developing simple surveillance systems, based on mHealth, in LICs.

Leptospirosis: An Infectious Emerging Waterborne Zoonosis of Global Significance

Leptospirosis, caused by Leptospira interrogans, is a highly infectious emerging water borne zoonosis of global significance. It is an enigmatic life threatening disease, which results into high morbidity and mortality, particularly in poor resource nations. Disease is endemic in many countries of the world including India. Currently, over one million people are affected with leptospirosis worldwide annually. Leptospirosis presents an occupational hazard of the persons who have direct or indirect contact with the urine of infected animals. The common mode of transmission of the disease is exposure to and ingestion of urine contaminated water. Clinical signs in humans may vary from asymptomatic to severe stage with a range of non-specific symptoms. Rodents are the chief reservoir of Leptospira, and organisms are excreted in urine, thus contaminating the environment including water. Disease is endemic in tropical regions of the world with maximum cases in young male adults during the rainy season. Pollution of city water supply may result in outbreak of disease. Severe epidemics of leptospirosis are related to water recreational activities. The diagnosis of disease is confirmed by detection of serum antibodies against Leptospira and also by isolation of the pathogen from clinical specimens such as blood, cerebrospinal fluid and urine. Early treatment with antibacterial antibiotics may shorten the duration of fever and reduce the severity of the disease. As leptospirosis is attributed to physical contact with contaminated water supplies, environmental detection is important in the development of adequate control measures. There is a need to develop an effective surveillance system to monitor the trends of disease. Sincere attempts should be made to estimate the annual burden of cases and deaths due to leptospirosis. Additional studies on the epidemiology, diagnosis, chemotherapy and vaccines are required to control this life threatening zoonosis.