Endemic Controls Research Articles

O Médico Veterinário como capacitador de agentes comunitários de saúde e de endemias para a prevenção de acidentes por animais peçonhentos

O Médico Veterinário destaca-se na saúde pública, por atuar na promoção da saúde, na identificação de fatores de riscos e determinação de medidas de prevenção e controle de doenças e agravos. Com o objetivo de realizar um levantamento do conhecimento prévio dos Agentes Comunitários de Saúde e Agentes de Combate às Endemias (ACS/ACE), sobre a relação de vertentes de saúde pública com a Medicina Veterinária e assuntos relacionados às principais espécies de animais peçonhentos envolvidos em acidentes com seres humanos. O estudo compreendeu três etapas, a primeira consistiu na elaboração e aplicação de questionários. Na segunda etapa, foi realizado um curso de capacitação sobre a prevenção de acidentes por animais peçonhentos aos ACS/ACE. Por fim, foram reaplicados ao término de cada encontro do curso, os questionários relacionados ao assunto abordado no dia. Do total dos participantes, 58,70% (27/46) eram ACE e 41,30% (19/46) ACS. Dentre as perguntas dos questionários, os participantes foram interrogados antes do curso se sabiam como se prevenir contra acidentes por animais peçonhentos. Verificou-se que 84,78% (39/46) sabiam como se prevenir, e após as ações 100% dos entrevistados responderam corretamente. Em outra pergunta, sobre o que é animal peçonhento, antes do curso 43,48% (20/46) souberam definir, e após o curso 71,74% (33/46). O estudo demonstrou a importância da Educação em Saúde e a função do Médico Veterinário como capacitador de ACS e ACE para a formação de multiplicadores de informações em saúde.

Rapid in-country sequencing of whole virus genomes to inform rabies elimination programmes.

Genomic surveillance is an important aspect of contemporary disease management but has yet to be used routinely to monitor endemic disease transmission and control in low- and middle-income countries. Rabies is an almost invariably fatal viral disease that causes a large public health and economic burden in Asia and Africa, despite being entirely vaccine preventable. With policy efforts now directed towards achieving a global goal of zero dog-mediated human rabies deaths by 2030, establishing effective surveillance tools is critical. Genomic data can provide important and unique insights into rabies spread and persistence that can direct control efforts. However, capacity for genomic research in low- and middle-income countries is held back by limited laboratory infrastructure, cost, supply chains and other logistical challenges. Here we present and validate an end-to-end workflow to facilitate affordable whole genome sequencing for rabies surveillance utilising nanopore technology. We used this workflow in Kenya, Tanzania and the Philippines to generate rabies virus genomes in two to three days, reducing costs to approximately £60 per genome. This is over half the cost of metagenomic sequencing previously conducted for Tanzanian samples, which involved exporting samples to the UK and a three- to six-month lag time. Ongoing optimization of workflows are likely to reduce these costs further. We also present tools to support routine whole genome sequencing and interpretation for genomic surveillance. Moreover, combined with training workshops to empower scientists in-country, we show that local sequencing capacity can be readily established and sustainable, negating the common misperception that cutting-edge genomic research can only be conducted in high resource laboratories. More generally, we argue that the capacity to harness genomic data is a game-changer for endemic disease surveillance and should precipitate a new wave of researchers from low- and middle-income countries.

Remarkable genetic diversity of Trypanosoma cruzi and Trypanosoma rangeli in two localities of southern Ecuador identified via deep sequencing of mini-exon gene amplicons

BackgroundTrypanosoma cruzi, the causative agent of Chagas disease, and T. rangeli are kinetoplastid parasites endemic to Latin America. Although closely related to T. cruzi and capable of infecting humans, T. rangeli is non-pathogenic. Both parasite species are transmitted by triatomine bugs, and the presence of T. rangeli constitutes a confounding factor in the study of Chagas disease prevalence and transmission dynamics. Trypanosoma cruzi possesses high molecular heterogeneity: seven discrete typing units (DTUs) are currently recognized. In Ecuador, T. cruzi TcI and T. rangeli KP1(-) predominate, while other genetic lineages are seldom reported.MethodsInfection by T. cruzi and/or T. rangeli in different developmental stages of triatomine bugs from two communities of southern Ecuador was evaluated via polymerase chain reaction product size polymorphism of kinetoplast minicircle sequences and the non-transcribed spacer region of the mini-exon gene (n = 48). Forty-three mini-exon amplicons were also deep sequenced to analyze single-nucleotide polymorphisms within single and mixed infections. Mini-exon products from ten monoclonal reference strains were included as controls.ResultsTrypanosoma cruzi genetic richness and diversity was not significantly greater in adult vectors than in nymphal stages III and V. In contrast, instar V individuals showed significantly higher T. rangeli richness when compared with other developmental stages. Among infected triatomines, deep sequencing revealed one T. rangeli infection (3%), 8 T. cruzi infections (23.5%) and 25 T. cruzi + T. rangeli co-infections (73.5%), suggesting that T. rangeli prevalence has been largely underestimated in the region. Furthermore, deep sequencing detected TcIV sequences in nine samples; this DTU had not previously been reported in Loja Province.ConclusionsOur data indicate that deep sequencing allows for better parasite identification/typing than amplicon size analysis alone for mixed infections containing both T. cruzi and T. rangeli, or when multiple T. cruzi DTUs are present. Additionally, our analysis showed extensive overlap among the parasite populations present in the two studied localities (c.28 km apart), suggesting active parasite dispersal over the study area. Our results highlight the value of amplicon sequencing methodologies to clarify the population dynamics of kinetoplastid parasites in endemic regions and inform control campaigns in southern Ecuador.

Impact of capacity building interventions on individual and organizational competency for HPSR in endemic disease control in Nigeria: a qualitative study

BackgroundThe need to build capacity for health policy and systems research (HPSR) in low- and middle-income countries has been underscored as this encompasses the processes of decision-making at all levels of the health system. This implementation research project was undertaken in Southeast Nigeria to evaluate whether the capacity-building intervention improves the capacity to produce and use research evidence for decision making in endemic disease control.MethodsThree training workshops were organized for purposively selected participants comprising “producers of evidence” such as health research scientists in three universities and “users of evidence” such as policy makers, program managers, and implementers in the public health sector. Participants also held step-down workshops in their organizations. The last workshop was used to facilitate the formation of knowledge networks comprising of both producers and users, which is a critical step for getting research into policy and practice (GRIPP). Three months after the workshops, a subset, 40, of workshop participants was selected for in-depth interviews. Information was collected on (i) perceptions of usefulness of capacity-building workshops, (ii) progress with proposed research and research uptake activities, (iii) effects of these activities on evidence-informed decision making, and (iv) constraints and enablers to implementation of proposed activities.ResultsMost participants felt the workshops provided them with new competencies and skills in one or more of research priority setting, evidence generation, communication, and use for the control of endemic diseases. Participants were at different stages of planning and implementing their proposed research and research uptake activities, and were engaging across professional and disciplinary boundaries to ensure relevance and usefulness of outputs for decision making. Key enablers of successful implementation of activities were positive team dynamics, good balance of competencies, effective communication and engagement within teams, team leader’s capacity to innovate, and personal interests such as career progress. Lack of funding, limited decision space, organizational bureaucracies, and poor infrastructure were the key constraints to the implementation of proposed activities. Lack of mentorship and continuous support from trainers delayed progress with implementing proposed activities.ConclusionsThe capacity-building interventions contributed to the development of a critical mass of research scientists, policy makers, and practitioners who have varying levels of competencies in HPSR for endemic disease control and would require further support in carrying out their medium and long-term goals.

Application of intelligent family doctor model in community prevention and control of coronavirus disease 2019

The community is the first line of endemic prevention and control. Facing the challenge of epidemic outbreak, Fangzhuang Community Health Service Center applied the intelligent family doctor model to carry out joint community prevention and control of coronavirus disease 2019 (COVID-19) epidemic. The intelligent family doctor model is a people-centered, information-based approach, which integrates community resources to carry out health education, counseling and public opinion guidance. With this model the community health service center can effectively screen and follow up the key groups to strengthen the joint prevention and control of COVID-19; at the same time it also can manage the chronic disease and the elderly care. This article introduces the intelligent family doctor model, and analyzes its advantages and existing problems, to provide references for community epidemic prevention and control. Key words: Coronavirus infection; Coronavirus disease 2019; Community health service center; Internet +; Intelligence family doctors optimized coordination model

A First Plasmodium vivax Natural Infection Induces Increased Activity of the Interferon Gamma-Driven Tryptophan Catabolism Pathway.

The human immune response that controls Plasmodium infection in the liver and blood stages of the parasite life cycle is composed by both pro- and anti-inflammatory programs. Pro-inflammatory responses primarily mediated by IFN-γ controls the infection, but also induce tolerogenic mechanisms to limit host damage, including the tryptophan (TRP) catabolism pathway mediated by the enzyme Indoleamine 2,3-Dioxygenase (IDO1), an enzyme that catalyzes the degradation of TRP to kynurenines (KYN). Here we assessed total serum kynurenines and cytokine dynamics in a cohort of natural Plasmodium vivax human infection and compared them to those of endemic healthy controls and other febrile diseases. In acute malaria, the absolute free kynurenine (KYN) serum levels and the KYN to TRP (KYN/TRP) ratio were significantly elevated in patients compared to healthy controls. Individuals with a diagnosis of a first malaria episode had higher serum KYN levels than individuals with a previous malaria episode. We observed an inverse relationship between the serum levels of IFN-γ and IL-10 in patients with a first malaria episode compared to those of subjects with previous history of malaria. Kynurenine elevation was positively correlated with serum IFN-γ levels in acute infection, whereas, it was negatively correlated with parasite load and P. vivax LDH levels. Overall, the differences observed between infected individuals depended on the number of Plasmodium infections. The decrease in the KYN/TRP ratio in malaria-experienced subjects coincided with the onset of anti-P. vivax IgG. These results suggest that P. vivax infection induces a strong anti-inflammatory program in individuals with first time malaria, which fades with ensuing protective immunity after subsequent episodes. Understanding the tolerance mechanisms involved in the initial exposure would help in defining the balance between protective and pathogenic immune responses necessary to control infection and to improve vaccination strategies.

Expression and production of the SERPING1-encoded endogenous complement regulator C1-inhibitor in multiple cohorts of tuberculosis patients

BackgroundTo facilitate better discrimination between patients with active tuberculosis (TB) and latent TB infection (LTBI), whole blood transcriptomic studies have been performed to identify novel candidate host biomarkers. SERPING1, which encodes C1-inhibitor (C1-INH), the natural inhibitor of the C1-complex has emerged as candidate biomarker. Here we collated and analysed SERPING1 expression data and subsequently determined C1-INH protein levels in four cohorts of patients with TB. MethodsSERPING1 expression data were extracted from online deposited datasets. C1-INH protein levels were determined by ELISA in sera from individuals with active TB, LTBI as well as other disease controls in geographically diverse cohorts. FindingsSERPING1 expression was increased in patients with active TB compared to healthy controls (8/11 cohorts), LTBI (13/14 cohorts) and patients with other (non-TB) lung-diseases (7/7 cohorts). Serum levels of C1-INH were significantly increased in The Gambia and Italy in patients with active TB relative to the endemic controls but not in South Africa or Korea. In the largest cohort (n = 50), with samples collected longitudinally, normalization of C1-INH levels following successful TB treatment was observed. This cohort, also showed the most abundant increase in C1-INH, and a positive correlation between C1q and C1-INH levels. Combined presence of increased levels of both C1q and C1-INH had high specificity for active TB (96 %) but only very modest sensitivity 38 % compared to the endemic controls. InterpretationSERPING1 transcript expression is increased in TB patients, while serum protein levels of C1-INH were increased in half of the cohorts analysed.

Bovine respiratory disease — challenges and opportunities

Bovine respiratory disease (BRD) remains a significant issue to farming around the world. Technology is now available that can be used to improve the speed and accuracy of detection, and it is important that we consider how this technology can best be implemented to maximise its returns. The use of antimicrobials in farming remains high on the agenda and this article discusses some of the key things to consider when prescribing for BRD to maximise effect and reduce the potential for the emergence of resistance. To truly control BRD it is essential that we consider the farm and potentially the industry holistically. At a farm level it is essential that all potential risk factors are managed to reduce disease. Further opportunities for reducing the risk of disease are offered by closer working relationships between farms and integrated supply chains as these can reduce the stress around periods of transition and also enable better control of endemic diseases

Integrating evidence from research into decision-making for controlling endemic tropical diseases in South East Nigeria: perceptions of producers and users of evidence on barriers and solutions

BackgroundEndemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control.MethodsInformation on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually.ResultsCross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders’ focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units.ConclusionsEvidence-informed decision-making for controlling ETDs is limited by constraints in the interactions of some factors between the users (supply side) and producers (demand side) of evidence. These constraints could be solved through stronger research collaborations, institutionalisation of HPSR, and frameworks for getting research into policy and practice.

Rapid in-country sequencing of whole virus genomes to inform rabies elimination programmes.

Genomic surveillance is an important aspect of contemporary disease management but has yet to be used routinely to monitor endemic disease transmission and control in low- and middle-income countries. Rabies is an almost invariably fatal viral disease that causes a large public health and economic burden in Asia and Africa, despite being entirely vaccine preventable. With policy efforts now directed towards achieving a global goal of zero dog-mediated human rabies deaths by 2030, establishing effective surveillance tools is critical. Genomic data can provide important and unique insights into rabies spread and persistence that can direct control efforts. However, capacity for genomic research in low- and middle-income countries is held back by limited laboratory infrastructure, cost, supply chains and other logistical challenges. Here we present and validate an end-to-end workflow to facilitate affordable whole genome sequencing for rabies surveillance utilising nanopore technology. We used this workflow in Kenya, Tanzania and the Philippines to generate rabies virus genomes in two to three days, reducing costs to approximately £60 per genome. This is over half the cost of metagenomic sequencing previously conducted for Tanzanian samples, which involved exporting samples to the UK and a three- to six-month lag time. Ongoing optimization of workflows are likely to reduce these costs further. We also present tools to support routine whole genome sequencing and interpretation for genomic surveillance. Moreover, combined with training workshops to empower scientists in-country, we show that local sequencing capacity can be readily established and sustainable, negating the common misperception that cutting-edge genomic research can only be conducted in high resource laboratories. More generally, we argue that the capacity to harness genomic data is a game-changer for endemic disease surveillance and should precipitate a new wave of researchers from low- and middle-income countries.

Anti-lysoganglioside and other anti-neuronal autoantibodies in post-treatment Lyme Disease and Erythema Migrans after repeat infection

BackgroundMolecular mimicry targeting neural tissue has been reported after Borrelia burgdorferi(Bb) infection. Herein, we investigate whether antineuronal autoantibodies are increased and whether antibody-mediated signaling of neuronal cells is elevated in a cohort of symptomatic adults with a history of Lyme Disease (LD). MethodsParticipants (n ​= ​179) included 24 with recent Erythema Migrans (EM) without prior LD, 8 with recent EM and prior LD (EM ​+ ​prior LD), 119 with persistent post-treatment LD symptoms (PTLS), and 28 seronegative endemic controls with no prior LD history. Antineuronal immunoglobulin G (IgG) titers were measured by standard ELISA and compared with mean titers of normal age-matched sera against lysoganglioside, tubulin, and dopamine receptors (D1R and D2R). Antibody-mediated signaling of calcium calmodulin dependent protein kinase II (CaMKII) activity in a human neuronal cell line (SK-N-SH) was identified in serum. ResultsEM ​+ ​prior LD cases had higher antibody titers than controls for anti-lysoganglioside GM1 (p ​= ​0.002), anti-tubulin (p ​= ​0.03), and anti-D1R (p ​= ​0.02), as well as higher expression in the functional antibody-mediated CaMKII Assay (p ​= ​0.03). The EM cases with no prior history showed no significant differences on any measures. The PTLS cases demonstrated significantly higher titers (p ​= ​0.01) than controls on anti-lysoganglioside GM1, but not for the other measures. ConclusionThe finding of elevated anti-neuronal autoantibodies in our small sample of those with a prior history of Lyme disease but not in those without prior Lyme disease, if replicated in a larger sample, suggests an immune priming effect of repeated infection; the CaMKII activation suggests that antineuronal antibodies have functional significance. The elevation of anti-lysoganglioside antibodies among those with PTLS is of particular interest given the established role of anti-ganglioside antibodies in peripheral and central neurologic diseases. Future prospective studies can determine whether these autoantibodies emerge after Bb infection and whether their emergence coincides with persistent neurologic or neuropsychiatric symptoms.

Reproductive control of capybaras through sterilization in areas at risk of transmission of brazilian spotted fever

ABSTRACT: Groups of capybaras (Hydrochoerus hydrochaeris) are currently frequent inhabitants of urban areas. The species participates in the transmission cycle of Brazilian spotted fever (BSF), a zoonosis that is caused by the bacteria R. rickettsii and transmitted by vector ticks. This has led to discussions on strategies to decrease the presence of this rodent through contraceptive methods and euthanasia, thus reducing their capacity to carry and transport ticks, which would be an important contribution to public health. Two condominiums and one business establishment in the interior of the state of São Paulo were used as case studies in the present investigation. All areas were classified by the Endemic Control Superintendence as risk areas for the transmission of BSF and presented the specie of ticks A. sculptum and A. dubitatum The objective of this study was to carry out sterilization procedures with animals that presented seropositive results for BSF. A total of 85 surgical procedures were conducted on immune capybaras, with authorization from DeFau/SMA-SP. For all procedures the animals were anesthetized with ketamine hydrochloride combined with xylazine and morphine. Two alpha males isolated themselves from the group after the vasectomy procedure, returning to their hierarchical position after 5 to 14 days. Population monitoring in the areas should be maintained indefinitely and conducting annual serological management until the natural death of these individuals. Tubal ligation, vasectomy and salpingo-oophorectomy were demonstrated to be simple and low-risk procedures in capybaras. These techniques assist in the population control of this species in enclosed areas with risk of BSF transmission, thus decreasing the need for euthanasia.

Increased platelet distribution width and reduced IL-2 and IL-12 are associated with thrombocytopenia in Plasmodium vivax malaria.

BACKGROUND Thrombocytopenia in malaria involves platelet destruction and consumption; however, the cellular response underlying this phenomenon has still not been elucidated.OBJECTIVE To find associations between platelet indices and unbalanced Th1/Th2/Th17 cytokines as a response to thrombocytopenia in Plasmodium vivax infected (Pv-MAL) patients.METHODS Platelet counts and quantification of Th1/Th2/Th17 cytokine levels were compared in 77 patients with uncomplicated P. vivax malaria and 37 healthy donors from the same area (endemic control group - ENCG).FINDINGS Thrombocytopenia was the main manifestation in 55 patients, but was not associated with parasitaemia. The Pv-MAL patients showed increases in the mean platelet volume (MPV), which may be consistent with larger or megaplatelets. Contrary to the findings regarding the endemic control group, MPV and platelet distribution width (PDW) did not show an inverse correlation, due the increase in the heterogeneity of platelet width. In addition, the Pv-MAL patients presented increased IL-1β and reduced IL-12p70 and IL-2 serum concentrations. Furthermore, the reduction of these cytokines was associated with PDW values.MAIN CONCLUSIONS Our data demonstrate that an increase in MPV and the association between reductions of IL-2 and IL-12 and PDW values may be an immune response to thrombocytopenia in uncomplicated P. vivax malaria.

Evaluation of Patient IgM and IgG Reactivity Against Multiple Antigens for Improvement of Serodiagnostic Testing for Early Lyme Disease.

Serologic testing is the standard for laboratory diagnosis and confirmation of Lyme disease. Serodiagnostic assays to detect antibodies against Borrelia burgdorferi, the agent of Lyme borreliosis, are used for detection of infection. However, serologic testing within the first month of infection is less sensitive as patients' antibody responses continue to develop. Previously, we screened several B. burgdorferi in vivo expressed antigens for candidates that elicit early antibody responses in patients with Stage 1 and 2 Lyme disease. We evaluated patient IgM seroreactivity against 6 antigens and found an increase in sensitivity without compromising specificity when compared to current IgM second-tier immunoblot scoring. In this study, we continued the evaluation using a multi-antigen panel to measure IgM plus IgG seroreactivity in these early Lyme disease patients' serum samples. Using two statistical methods for calculating positivity cutoff values, sensitivity was 70 and 84–87%, for early acute and early convalescent Lyme disease patients, respectively. Specificity was 98–100% for healthy non-endemic control patients, and 96–100% for healthy endemic controls depending on the statistical analysis. We conclude that improved serologic testing for early Lyme disease may be achieved by the addition of multiple borrelial antigens that elicit IgM and IgG antibodies early in infection.

Expression of a rK39 homologue from an Iranian Leishmania infantum isolate in Leishmania tarentolae for serodiagnosis of visceral leishmaniasis

BackgroundKinesin-related gene diversity among strains and species of Leishmania may impact the sensitivity and specificity of serodiagnostic tests for visceral leishmaniasis (VL).MethodsIn this study, we report on the recombinant expression of this novel Iranian Leishmania infantum (MCAN14/47) homologue of rK39 (Li-rK39), in L. tarentolae. The diagnostic potential of the Li-rK39 antigen was evaluated in an ELISA, using sera from 100 VL patients, 190 healthy endemic controls, 46 non-endemic healthy controls and 47 patients with other infections.ResultsThe results showed a sensitivity of 96% and a specificity of 93.8%. A commercial rK39 immunochromatographic test (ICT) was 90% sensitive and 100% specific on the same cohort.ConclusionsHere, we show that the K39 gene from an Iranian L. infantum isolate is heterozygous as compared to the sequence of the Brazilian L. infantum (former L. chagasi), whose antigen is incorporated in most rK39-based immunochromatographic tests. Therefore, Li-rK39 has the potential to be used as an alternative for VL diagnosis in Iran.

Building the capacity of users and producers of evidence in health policy and systems research for better control of endemic diseases in Nigeria: a situational analysis

BackgroundThere is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors.MethodsData was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses.ResultsThe knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work.ConclusionThe high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.

Integrated Approach to Facilitate Stakeholder Participation in the Control of Endemic Diseases of Livestock: The Case of Peste Des Petits Ruminants in Mali.

In Mali, small ruminants (SRs) are an important means for enhanced livelihood through income generation, especially for women and youth. Unfortunately, opportunities for livestock farmers to tap into these resources for economic growth are hindered by high burden of endemic diseases such as peste des petits ruminants (PPR). A key component for the control of PPR is vaccination of SRs. However, low participation of farmers to vaccination was identified by stakeholders of the livestock value chains as a key constraint to successful vaccination programs. This study was implemented in the framework of a project which aimed at improving the domestic ruminant livestock value chains in Mali by upscaling proven interventions in animal health, feeds and feeding and livestock marketing. The objectives of the study were to review the context of livestock vaccination in Mali and evaluate the impact of innovation platforms (IP) as a means for engaging stakeholders in the vaccination process. Desk review, key informant interviews (KII) and net-mapping were used to understand the context of livestock vaccination, while vaccination coverage and sero-monitoring together with group interviews were used to measure the impact of the intervention. IPs were created in 24 communes in three regions: 15 IPs in Sikasso, 4 IPs in Mopti and 5 IPs in Timbuktu. They developed work plans and implemented activities focusing on improving interaction among key vaccine chain delivery stakeholders such as farmers, private veterinarians, vaccine manufacturers, local leaders and public veterinary services; involving them in the planning, implementation and evaluation of vaccination programs and fostering knowledge sharing, communication and capacity building. After 2 years of implementation of IPs, vaccination coverage for SRs increased significantly in target communes. During the first year, seroprevalence rate for PPR increased from 57% (CI95: 54–60%) at baseline to 70% (CI95: 67–73%) post-vaccination in Sikasso region, while in Mopti region, seroprevalence increased from 51% (CI95: 47–55%) at baseline to 57% (CI85: 53–61%) post-vaccination. Stakeholder engagement in the vaccination process through facilitated IPs was successful in fostering participation of farmers to vaccination. However, a sustainable vaccination strategy for Mali would benefit from consolidating the IP model, supported by Government investment to strengthen and adjust the underlying public-private-partnership.

Role of acute schistosomiasis control in facilitating the progress towards schistosomiasis elimination

Acute schistosomiasis is a clinical type of schistosomiasis with severe symptoms. The number of acute schistosomiasis cases is not only a sensitive indicator to assess the endemic situation and control effects, but also an important indicator to define schistosomiasis outbreaks and evaluate the achievements of infection control or transmission control. Acute schistosomiasis control is therefore of great significance to achieve the goal of schistosomiasis elimination in China. This paper analyzes the features and causes of acute schistosomiasis, and proposes some suggestions for future acute schistosomiasis control in China.

Serum and urine fluoride levels in populations of high environmental fluoride exposure with endemic CKDu: a case-control study from Sri Lanka.

Chronic kidney disease of uncertain etiology (CKDu) is a common health issue among farming communities in the dry zone of Sri Lanka where groundwater fluoride is known to be higher than recommended levels. Excessive environmental ingestion of fluoride is widely considered as a possible factor for the onset of CKDu. This study was carried out to evaluate the serum and urine fluoride levels in biopsy-proven, non-dialysis CKDu patients. Control subjects were selected from the same area without any deteriorated kidney functions. Serum and urine fluoride levels were determined by ion-selective electrode method. Higher content of serum and urine fluoride levels were observed in patients with chronic renal failures. In CKDu cases, the serum fluoride concentrations ranged between 0.47 and 9.58mg/L (mean 1.39 ± 1.1mg/L), while urine levels were varied between 0.45 and 6.92mg/L (mean 1.53 ± 0.8mg/L). In patients, urine fluoride levels showed a significant difference with the CKDu stage; however, no difference was obtained between genders and age. In endemic controls, serum and urine fluoride levels ranged between 0.51 and 1.92mg/L (mean = 1.07 ± 0.3mg/L) and 0.36 and 3.80mg/L (mean = 1.26 ± 0.6mg/L), respectively. Significantly higher fluoride in serum and urine was noted in CKDu patients compared to endemic control groups. Higher fluoride exposure via drinking water is possibly the reason for higher fluoride in serum, while excessive urinary excretion would be due to deterioration of the kidney, suggesting a possible nephrotoxic role of environmental fluoride exposure.

Endemic Disease Control Agents' perception on the fight against Aedes aegypti and the prevention of arbovirus infections in Brazil.

BackgroundArboviruses pose a serious and constant threat to public health, and have demanded surveillance efforts worldwide. The prevention of arbovirus transmission depends on effective measures to control vectors and promote health. The objective of this study was to examine the factors that enhance and impair the endemic disease control agents’ field work, based on their own perspective.Methodology and main findingsIn 2017, 65 ACE of seven municipalities participated in a series of seven focus groups in the Zona de Mata mesoregion (Minas Gerais, Brazil). The focus groups were organized aiming to broaden and deepen the discussion and analysis of ACE perception of their performance in relation to attributions, work processes, training, continuous education, and evaluation. All the workers, irrespective of municipality, recognize their role in disease prevention and health promotion, however they suffer from a reductionist stigma associated with their profession. Also, internal and external factors such as infrastructure, resources, administrative management, and the work process affect the quality of service delivered and job satisfaction. Practice challenges include incompatible demands such as refusal by residents and high sense of insecurity related to violence. The respondents reported that success of their activities depend on the population.Conclusions/SignificanceThe recurrence of epidemics demands effective vector control policies. Therefore, the performance of these professionals as regards surveillance needs to be reassessed. Public awareness and acknowledgement of the role of ACE in the identification of risk and health protection factors are indispensable for the improvement of this workforce.