National Control Strategy Research Articles

Evaluation of an automated insulated isothermal polymerase chain reaction system for rapid and reliable, on-site detection of African swine fever virus.

To evaluate the utility of an automated insulated isothermal PCR (iiPCR) system for rapid and reliable on-site detection of African swine fever virus (ASFV) in swine biological samples. Lymph node, tissue homogenate, whole blood, serum, spleen, and tonsil samples collected from swine in North and South Vietnam. Analytic sensitivity of the iiPCR system was determined by serial dilution and analysis of 2 samples (swine tissue homogenate and blood) predetermined to be positive for ASFV. Analytic specificity was assessed by analysis of 2 samples predetermined to be negative for ASFV and positive or negative for other swine pathogens (classical swine fever virus, porcine reproductive and respiratory syndrome virus, foot-and-mouth disease virus, and porcine circovirus type 2). Diagnostic performance of the iiPCR system for detection of ASFV was determined by analysis of the various tissue sample types. For all tests, a real-time PCR assay was used as the reference method. The iiPCR system was able to detect ASFV in swine blood or tissue homogenate at dilutions up to 106, whereas the real-time PCR assay was able to detect dilutions of up to 105 or 106. The iiPCR system had high analytic specificity for detection of ASFV versus other swine pathogens. Between 97% and 100% agreement was found between results of the iiPCR system for the various tissue samples and results of real-time PCR assay. The evaluated iiPCR system was found to be a rapid, reliable, and sample-flexible method for ASFV detection and may be useful for disease surveillance and quarantine in national strategies for early ASF control.

An Overview of Current Approaches and Challenges to the Control of Endemic Infectious Cattle Diseases in Albania.

Agriculture is an important production sector in Albania that makes a significant contribution to the gross domestic product (GDP) and employment. The livestock sector contributes more than half of the agricultural GDP. The Albanian cattle population represents 50% of the total livestock units and accounts for 85% of the national milk production, the rest being supplied by small ruminants. Cattle productivity, health and welfare are hindered by infectious diseases, some of which are also transmissible to humans (zoonosis). The aim of this manuscript is to provide an overview of the control of selected regulated and non-EU regulated cattle diseases in Albania and to highlight specific challenges for the Albanian cattle industry. The most important infectious cattle diseases in Albania for which national control and eradication strategies are in place are bovine brucellosis, bovine tuberculosis, and anthrax, which are all zoonotic. Additionally, lumpy skin disease recently emerged in the Balkan region and is currently subject to controls. Most of the available funds and European Union support are allocated to the control of EU regulated zoonotic diseases. For control of non-EU regulated cattle diseases, no funds are available resulting in the lack of national control programmes (CPs). Based on research, clinical investigations and laboratory results, several non-EU regulated cattle infectious diseases appear endemic in Albanian dairy farms. While no national CPs exist for any of them, regional initiatives are available on a voluntary basis to control infectious bovine rhinotracheitis and bovine viral diarrhea. In the voluntary CPs, there is no monitored requirement to prove disease freedom of purchased animals and to re-evaluate the herd's free status after the introduction of animals into a herd. Data on animal movements that are routinely collected could potentially be used to control the risk of purchase, but quality needs to be further improved to increase its usefulness in disease CPs. This overview aims to collate existing information on the CPs implemented in Albania and to evaluate these to highlight gaps and threats in disease control, as well as opportunities and strengths through a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, with the goal of providing a framework for the future implementation of animal disease control measures in Albania.

Knowledge, Attitudes and Practices toward Hepatitis B Virus Infection among Students of Medicine in Vietnam.

Background: Building capacity in hepatitis B virus prevention and management for medical students and health professionals is one of the pillars of the national viral hepatitis control strategy. Methods: A cross-sectional study was conducted at eight medical universities from the northern, central and southern regions of the country between May and November 2020 using a systematic random sampling technique. Results: Among 2000 participants, 84.2% reported they had been tested for hepatitis B and 83.9% had received the hepatitis B vaccine. The mean knowledge, attitude, practice score was 40.2 out of 54 (74.4%) with only 19.9% of the study participants obtaining a good score. In multivariate analysis, fifth year students, students from central universities, students who had tested positive for hepatitis B and students who had received hepatitis B vaccine or had encountered patients with chronic hepatitis B had significantly higher knowledge score (p < 0.05). The study showed lack of trust in the hepatitis B vaccine safety and lack of confidence in providing counselling, testing and management of patients with chronic hepatitis B. Conclusion: Findings from our research emphasized an immediate need to improve the medical schools’ training curriculum in Vietnam to enable students’ readiness in hepatitis B prevention and management.

Abstract 56: Landscape and Challenges of Cancer Registration in the Middle East, North Africa and Turkey (MENAT)

Abstract Purpose: National and regional cancer control strategies have been identified as essential tools for reducing and managing the growing burden of cancer in low- and middle-income countries. Cancer registration is an instrumental component of any national cancer control strategy. In the Middle East, North-Africa and Turkey (MENAT) region, cancer registration varies immensely across countries and faces multifaceted challenges including protracted conflict. This study maps out the present capacities and outputs of cancer registration in the MENAT region and identifying thematic barriers facing implementation and utilization of cancer registry data. Methods: We employed a mixed-method approach utilizing a self-administered online survey with open and close ended questions targeting national and institutional cancer registry managers in the MENAT countries. The questions focused on the country-wide and registry-specific status and challenges of cancer registration. Results: Data from 20 MENAT countries were collected through the online survey. MENAT registry managers reported the presence of 97 population-based registries, 48 hospital-based registries, and 24 pathology-based registries. Most population-based registries were well or partially developed. Lack of accurate death records, complete medical records, communication between stakeholders, and trained personnel were critical challenges. These challenges are more severe in conflict-affected countries (both active conflict zones and neighbouring regions affected by conflict). Cancer registration challenges in these countries included weak health care infrastructure, absence of legislation mandating cancer registration, and cessation or disruption of cancer registration due to active conflict and loss of funding. Furthermore, refugee host countries such as Lebanon, Turkey and Jordan, also reported conflict-related challenges including refugee mobility and lack of accurate data on forced migrants. Conclusion: This study provides a much-needed understanding of the current landscape and contextual challenges affecting cancer registration in the MENAT, especially in conflict affected settings. These data are important for identifying areas on which to focus regional capacity-strengthening initiatives. Citation Format: Zahi Abdul Sater, Ali Shamseddine, Ali Taher, Fouad Fouad, Ghassan Abu-Sitta, Ibtihal Fadhil, Raya Saab, Richard Sullivan, Salim M. Adib, Shadi Saleh, Deborah Mukherji. Landscape and Challenges of Cancer Registration in the Middle East, North Africa and Turkey (MENAT) [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 56.

Epidemiological analysis of classical swine fever in wild boars in Japan

BackgroundClassical swine fever (CSF) is a contagious disease of pigs and wild boars that is transmitted through direct/indirect contact between animals or CSF virus-contaminated fomites. When the disease re-emerged in 2018 in Japan, a CSF-infected wild boar was reported shortly after the initial pig farm outbreak; subsequently, the disease spread widely. To control the disease spread among wild boars, intensive capturing, fencing, and oral bait vaccination were implemented with concomitant virological and serological surveillance. This study aimed to describe the disease spread in the wild boar population in Japan from September 2018, when the first case was reported, to March 2020, based on the surveillance data. We conducted statistical analyses using a generalized linear mixed model to identify factors associated with CSF infection among wild boars. Moreover, we descriptively assessed the effect of oral bait vaccination, which started in March 2019 in some municipalities in the affected areas.ResultsWe observed a faster CSF infection spread in the wild boar population in Japan compared with the CSF epidemics in European countries. The infection probability was significantly higher in dead and adult animals. The influence of the multiple rounds of oral bait vaccination was not elucidated by the statistical modeling analyses. There was a decrease and increase in the proportion of infected and immune animals, respectively; however, the immunization in piglets remained insufficient after vaccination for 1 year.ConclusionsConditions regarding the wild boar habitat, including forest continuity, higher wild boar population density, and a larger proportion of susceptible piglets, were addressed to increase the infection risk in the wild boar population. These findings could improve the national control strategy against the CSF epidemic among wild boars.

Population structure and transmission of Mycobacterium bovis in Ethiopia.

Bovine tuberculosis (bTB) is endemic in cattle in Ethiopia, a country that hosts the largest national cattle herd in Africa. The intensive dairy sector, most of which is peri-urban, has the highest prevalence of disease. Previous studies in Ethiopia have demonstrated that the main cause is Mycobacterium bovis , which has been investigated using conventional molecular tools including deletion typing, spoligotyping and Mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). Here we use whole-genome sequencing to examine the population structure of M. bovis in Ethiopia. A total of 134 M . bovis isolates were sequenced including 128 genomes from 85 mainly dairy cattle and six genomes isolated from humans, originating from 12 study sites across Ethiopia. These genomes provided a good representation of the previously described population structure of M. bovis , based on spoligotyping and demonstrated that the population is dominated by the clonal complexes African 2 (Af2) and European 3 (Eu3). A range of within-host diversity was observed amongst the isolates and evidence was found for both short- and long-distance transmission. Detailed analysis of available genomes from the Eu3 clonal complex combined with previously published genomes revealed two distinct introductions of this clonal complex into Ethiopia between 1950 and 1987, likely from Europe. This work is important to help better understand bTB transmission in cattle in Ethiopia and can potentially inform national strategies for bTB control in Ethiopia and beyond.

Main sources controlling atmospheric burdens of persistent organic pollutants on a national scale

National long-term monitoring programs on persistent organic pollutants (POPs) in background air have traditionally relied on active air sampling techniques. Due to limited spatial coverage of active air samplers, questions remain (i) whether active air sampler monitoring sites are representative for atmospheric burdens within the larger geographical area targeted by the monitoring programs, and thus (ii) if the main sources affecting POPs in background air across a nation are understood. The main objective of this study was to explore the utility of spatial and temporal trends in concert with multiple modelling approaches to understand the main sources affecting polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) in background air across a nation. For this purpose, a comprehensive campaign was carried out in summer 2016, measuring POPs in background air across Norway using passive air sampling. Results were compared to a similar campaign in 2006 to assess possible changes over one decade. We furthermore used the Global EMEP Multi-media Modeling System (GLEMOS) and the Flexible Particle dispersion model (FLEXPART) to predict and evaluate the relative importance of primary emissions, secondary emissions, long-range atmospheric transport (LRAT) and national emissions in controlling atmospheric burdens of PCB-153 on a national scale. The concentrations in air of both PCBs and most of the targeted OCPs were generally low, with the exception of hexachlorobenzene (HCB). A limited spatial variability for all POPs in this study, together with predictions by both models, suggest that LRAT dominates atmospheric burdens across Norway. Model predictions by the GLEMOS model, as well as measured isomeric ratios, further suggest that LRAT of some POPs are dictated by secondary emissions. Our results illustrate the utility of combining observations and mechanistic modelling approaches to help identify the main factors affecting atmospheric burdens of POPs across a nation, which, in turn, may be used to inform both national monitoring and control strategies.

Rising Gold Prices Threaten the Feasibility of Malaria Elimination in Guyana

Guyana reported a significant rise in malaria nationwide between 2008-2014. The surge was attributed by public health authorities to a temporal increase in gold mining activity in forested regions, without evidence of impairment of national control strategies. However, systematic analysis of the association remains lacking due to the remoteness of both malaria and mining, and collection of reliable data becomes exceptionally difficult. To overcome this challenge, we investigated the relation between international gold price and falciparum malaria transmission in Guyana between 2007-2019, using statistical inference and time series analysis. We also evaluated the association between falciparum cases and the El Nino-Southern Oscillation pattern, previously suggested as a major malaria driver. The proportion of falciparum malaria cases among temporary residents was highest during the years of peak gold price, consistent with circulation of individuals related to mining activity. Further, cases among all demographics showed a strong positive correlation with gold price but only in regions with mining camps. The highest cross-correlation occurred earlier among individuals representative of mining laborers, suggesting that transmission in mining camps is followed by infections in the community. Upon these findings, we were able to reliably forecast falciparum malaria trends using only gold price as the predictor variable. Last, the La Nina climatic events showed an additional, smaller positive correlation with malaria transmission. Our analyses evidence that the 2008-2014 falciparum malaria surge observed in Guyana was mainly driven by an increase in gold mining, while climate factors might have contributed synergistically. We propose that international gold price is a useful indicator of future cases of malaria. We conclude that the feasibility of malaria elimination in Guyana and in other areas in the Amazonian where malaria and gold mining overlap should be evaluated against the challenges posed by rapidly rising gold prices. Funding: PMD was supported by the Ramon Areces Foundation fellowship. PMD and COB were supported by NIH/NIGMS, grant number 5R35GM124715-02. Declaration of Interest: None to declare. Ethical Approval: Ministry of Public Health, Guyana granted access to non-identifiable surveillance data obtained from the Malaria Program /Vector Control Services under Institutional Review Board exemption. Further, Institutional Review Board exemption was obtained from Harvard School of Public Health (Boston, US), Human Research Protection Program, Protocol number IRB18-1638.

Challenges to the Fight against Rabies-The Landscape of Policy and Prevention Strategies in Africa.

Nearly 59,000 human deaths worldwide are attributable to rabies annually, of which more than a third occur in Africa. In recent years, progress has been made in both action and collaboration including implementation of surveillance and prevention measures. In this review we assess the scale of surveillance, preventive, and control efforts of canine-transmitted human rabies in African countries. We reviewed literature published from 2014 to 2018, retrieved from electronic databases including MEDLINE, Global Index Medicus, BIOSIS, Science Citation Index, and EMBASE. WHO reports, national disease control program reports, and conference proceedings were also reviewed. The database search was conducted using keywords including rabies, control, and prevention. In forty countries (40/54), some level of rabies control and prevention strategy was available while in fourteen (14/54) countries, no specific national control and prevention strategy for human rabies could be retrieved. Thirty-four (34/54) countries utilized the Stepwise Approach towards Rabies Elimination (SARE) tool to monitor the national rabies control efforts—five of these countries were at the lowest tier (0/5) of the SARE scoring system while no country had achieved the highest score (5/5). High burden countries need to step up the implementation of context specific national rabies control, prevention, and monitoring strategies. As a zoonosis, rabies control and elimination require coordination between human and veterinarian health sectors under the “One Health” umbrella and with national master plans on the prevention and control of neglected tropical diseases ending in 2020, the time to act is now.

Prevalence of and risk factors for curable sexually transmitted infections on Bubaque Island, Guinea Bissau

ObjectivesComplications from sexually transmitted infections (STIs) can result in severe morbidity and mortality. To date, no STI population studies have been conducted on the Bijagos Islands, Guinea Bissau. Our objective...

Assessment of the Transmission Risk of Schistosomiasis after Flooding — North Poyang Lake, Jiangxi Province, China, 2020

What is already known about this topic? Over 90% of Oncomelania snails, the only intermediate host of Schistosoma japonicum, are distributed in the middle and low reaches of Yangtze River. Flooding can extend the distribution of Oncomelania snails and hence accelerate the transmission of schistosomiasis. What is added by this report? Although the dispersal of Oncomelania snails was negligible in north Poyang Lake after flooding in 2020, 2 samples of cattle feces with Schistosoma egg and 2 infected snails samples were indeed found. All four risk sites were distributed in Lushan County. Cattle feces were observed in the six out of seven field sites in Lushan County. What are the implications for public health practice? The present national control strategy focusing on control of infection source should be reinforced in Lushan and other schistosomiasis endemic areas. Overlaps of infected snails and cattle feces with Schistosoma egg were not observed, which called for intensive surveillance in Lushan County.

Effect of Cigarette Smoking on Peak Expiratory Flow Rate

Introduction: Cigarette smoking is an intractable public health problem that carries a threat to the health of the entire population. Smoking is a known risk factor for chronic obstructive pulmonary diseases, cardiovascular diseases, certain cancers especially lung cancer.&#x0D; Objectives:To assess the effect of cigarette smoking on peak expiratory flow rate (PEFR) among cigarette smokers and examine whether PEFR differs between cigarette smokers and non-smokers.&#x0D; Materials and Methods: This is cross-sectional comparative study was done for one year from July 2014 to June 2015. A total of 150 subjects were recruited from the medicine and allied outpatient departments of Mymensingh Medical College Hospital and Mymensingh locality. They are divided into 50 non-smokers (Group I) and 100 smokers (group II) with a duration of smoking 5-10 years (group IIA) and more than 10 years (Group IIB). PEFR was recorded by using Wright’s mini Peak flow meter. A questionnaire including demographic data was completed in all cases. The data were collected and analyzed using SPSS version 11.5.&#x0D; Results: Mean PEFR among non-smokers was 449.20±6.83 L/min whereas among smokers of 5-10 years duration(Group IIA) and above 10 years duration (Group IIB), it was 301.20±2.17 L/min and 297.80±2.54 L/min respectively. Mean PEFR values were significantly lower in smokers than non-smokers of both groups.&#x0D; Conclusion: Cigarette smoking has deleterious effects on lung function causing a significant reduction of PEFR in smokers compared to nonsmokers. Coordinated national strategies for tobacco prevention, cessation, and control are essential for the establishment of a smoke-free environment.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 165-167

Modelling the expected impact of cigarette tax and price increases under Vietnam’s excise tax law 2015–2020

BackgroundVietnam’s national tobacco control strategy aims to reduce the rate of smoking among male adults from 45% in 2015 to 39% by 2020. The aim of this paper is to...

Malaria vector species composition and entomological indices following indoor residual spraying in regions bordering Lake Victoria, Tanzania

BackgroundVector control through long-lasting insecticidal nets (LLINs) and focal indoor residual spraying (IRS) is a major component of the Tanzania national malaria control strategy. In mainland Tanzania, IRS has been conducted annually around Lake Victoria basin since 2007. Due to pyrethroid resistance in malaria vectors, use of pyrethroids for IRS was phased out and from 2014 to 2017 pirimiphos-methyl (Actellic® 300CS) was sprayed in regions of Kagera, Geita, Mwanza, and Mara. Entomological surveillance was conducted in 10 sprayed and 4 unsprayed sites to determine the impact of IRS on entomological indices related to malaria transmission risk.MethodsWHO cone bioassays were conducted monthly on interior house walls to determine residual efficacy of pirimiphos-methyl CS. Indoor CDC light traps with or without bottle rotator were hung next to protected sleepers indoors and also set outdoors (unbaited) as a proxy measure for indoor and outdoor biting rate and time of biting. Prokopack aspirators were used indoors to capture resting malaria vectors. A sub-sample of Anopheles was tested by PCR to determine species identity and ELISA for sporozoite rate.ResultsAnnual IRS with Actellic® 300CS from 2015 to 2017 was effective on sprayed walls for a mean of 7 months in cone bioassay. PCR of 2016 and 2017 samples showed vector populations were predominantly Anopheles arabiensis (58.1%, n = 4,403 IRS sites, 58%, n = 2,441 unsprayed sites). There was a greater proportion of Anopheles funestus sensu stricto in unsprayed sites (20.4%, n = 858) than in sprayed sites (7.9%, n = 595) and fewer Anopheles parensis (2%, n = 85 unsprayed, 7.8%, n = 591 sprayed). Biting peaks of Anopheles gambiae sensu lato (s.l.) followed periods of rainfall occurring between October and April, but were generally lower in sprayed sites than unsprayed. In most sprayed sites, An. gambiae s.l. indoor densities increased between January and February, i.e., 10–12 months after IRS. The predominant species An. arabiensis had a sporozoite rate in 2017 of 2.0% (95% CI 1.4–2.9) in unsprayed sites compared to 0.8% (95% CI 0.5–1.3) in sprayed sites (p = 0.003). Sporozoite rates were also lower for An. funestus collected in sprayed sites.ConclusionThis study contributes to the understanding of malaria vector species composition, behaviour and transmission risk following IRS around Lake Victoria and can be used to guide malaria vector control strategies in Tanzania.

Bibliometric analysis of highly cited Chinese science and technology papers in the field of schistosomiasis, 2010-2019

Objective To analyze the features and tend of highly cited papers in the field of schistosomiasis in China during 2010-2019, and we provide reference for the research direction of schistosomiasis after transmission interruption. Methods Academic articles published in China National Knowledge Infrastructure (CNKI) during 2010-2019 were selected using Schistosomiasis, Schistosoma or Oncomelania as subject terms, which the retrieval date was 2020-06–02. Highly cited papers (HCPs) in field of schistosomiasis were screened according to PRICE, and then analyze total cites, years, journals, authors and institutions. Results A total of 9 094 articles were retrieved, the maximum cites was 187, and papers whose cites higher than 11 were considered as HCPs. A total of 257 schistosomiasis HCPs were selected, with a total cites of 6 171 and an average cites of 24. A total of 222 HCPs (86.4%) were published from 2000 to 2014, and 35 HCPs (13.6%) were published from 2015 to 2019. The 257 HCPs of schistosomiasis were mainly published in the Chinese Journal of Schistosomiasis Control (163 articles, 63.4%) and the Chinese Journal of Parasitology and Parasitic Diseases (17 articles, 6.6%). The main participating institutions of schistosomiasis HCPs include the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention, Jiangsu Institute of Schistosomiasis Control, and Jiangxi Provincial Institute of Parasitic Disease Control, etc. Top 20 cited schistosomiasis papers were about annual national schistosomiasis annual epidemic notification (9 articles), prevention and control strategy (6 articles), monitoring (3 articles), goal and task(1 article) and molluscicide (1 article), which has an average cites of 104, 19 of which were published in Chinese Journal of Schistosomiasis Control. Among the top 20 schistosomiasis HCPs cited frequently, Zhou Xiaonong made major contributions. The National Institute of Parasitic Diseases, Chinese Center for Disease Control, and The Ministry of Health Disease Control Bureau were main contributing units. Conclusion The number of schistosomiasis HCPs has been declining year by year from 2010 to 2019. Articles related to annual epidemic notification, prevention and control strategies and monitor have attracted a high degree of attention and influence. 摘要：目的 分析 2010—2019 年血吸虫病领域中文高被引论文（highly cited papers, HCPs）特征及趋势，旨在为制 定传播阻断后血吸虫病科研攻关方向提供参考依据。 方法 以“血吸虫病、血吸虫或钉螺”为检索主题词，从中国知网 学术文献总库中的中国期刊全文数据库检索 2010—2019 年发表的学术论文（文章被引频次截至检索日期 2020-06- 02）。根据普莱斯公式，定义 HCPs 被引频次阈值，对筛选获得的血吸虫病 HCPs 被引频次、发表年份、载文期刊、参与作 者、研究机构等进行文献计量学分析。 结果 共检索到 9 094 篇文章，最高被引频次为 187 次，HCPs 被引频次阈值为 11 次。筛选获得 257 篇血吸虫病 HCPs，总被引频次为 6 171 次，篇均被引频次为 24 次。2000—2014 年累计发表 222 篇 HCPs（占 86.4%），2015—2019 年共发表 35 篇 HCPs（占 13.6%）。257 篇血吸虫病 HCPs 主要来源于《中国血吸虫病防治 杂志》（163 篇，63.4%）和《中国寄生虫学与寄生虫病杂志》（17 篇，6.6%）。血吸虫病 HCPs 的主要参与机构包括中国疾病 预防控制中心寄生虫病预防控制所、江苏省血吸虫病防治研究所、江西省寄生虫病防治研究所等。被引频次居前 20 位 的血吸虫病 HCPs 研究主题涵盖全国血吸虫病年度疫情通报（9 篇）、防治策略（6 篇）、监测（3 篇）、防治目标与任务（1 篇）、灭螺药（1 篇），篇均被引频次为 104 次，其中 19 篇刊载于《中国血吸虫病防治杂志》。被引频次居前 20 位的血吸虫 病 HCPs 中，周晓农做出了主要贡献，中国疾病预防控制中心寄生虫病预防控制所和卫生部疾病预防控制局是主要贡 献单位。 结论 2010—2019 年血吸虫病领域中文 HCPs 数量总体呈逐年下降趋势，年度疫情通报、防治策略和监测类 文章受关注和影响程度高。

Depression and Coping Among COVID-19-Infected Individuals After 10 Days of Mandatory in-Hospital Quarantine, Irbid, Jordan.

BackgroundIn-hospital mandatory quarantine of asymptomatic and symptomatic COVID-19-infected individuals was part of the national control strategy used to prevent the spread of the COVID-19 outbreak in Jordan. This study aims to evaluate depression, associated stressors, and various coping methods used among adult quarantined COVID-19-infected individuals.MethodsThis cross-sectional study included all COVID-19-infected individuals who were obligatorily quarantined at King Abdullah University Hospital, Irbid, Jordan from March 15 to April 20, 2020. Symptoms of depression were assessed using the 9-item Patient Health Questionnaire after 10 days of quarantine. In addition, several questions regarding the patients’ sights with the health-care system, and coping methods were added. Demographic characteristics, clinical presentation, and comorbidities were collected from the medical records.ResultsOut of 91 quarantined COVID-19 patients, a total of 66 completed the survey, with a participation rate of 72.5%. The majority were relatively young; the mean ± SD age was 35.8 ± 16.2 years (range 18–79), 59.1% were females and 47% were asymptomatic. A considerable proportion of patients (44%) reported symptoms of depression, with 21% were at high risk of major depressive disorder. Depression symptoms were significantly more common among females than males [PHQ-9 score ≥10: 13 (92.9%) vs 1 (7.1%), respectively; p=0.004]. The majority of patients (71.2%) reported having problems with health-care services. Insufficient involvement in making treatment decisions was the most commonly reported concern (59.1%). Patients who reported problems in maintaining privacy, reaching out to their physicians, or receiving conflicting information from the medical staff, had more symptoms of depression compared with the satisfied ones (p<0.05). On the other hand, those who were receiving sufficient support from the family, friends, or medical staff during quarantine, were less likely to have depression symptoms (p<0.05). Furthermore, symptoms of depression were less in patients who stayed in touch with others using phone calls, texting, or social media (p=0.024).ConclusionSymptoms of depression were common among both symptomatic and asymptomatic quarantined COVID-19 patients. The support of family, friends, and medical staff was an essential alleviating factor. Facilitating adequate communication may promote the mental well-being of COVID-19-infected patients and help in reducing the risk of depression during the in-hospital quarantine.

Drug metabolism and pharmacokinetics of praziquantel: A review of variable drug exposure during schistosomiasis treatment in human hosts and experimental models.

Schistosomiasis control is heavily reliant on the drug praziquantel (PZQ), which is used as preventive chemotherapy as part of national helminth control strategies. Given the heavy reliance on PZQ for mass drug administration, there has been considerable research on the potential of parasites developing resistance to the drug, resulting in decreased drug efficacy. However, there have been comparatively fewer studies of other factors that can potentially alter PZQ efficacy. Here, we investigate whether host PZQ metabolism contributes towards variable cure rates. We evaluate factors that can influence the metabolism of PZQ and the resultant effect on the efficacy of PZQ treatment to determine factors that potentially influence an individual’s response to the drug. The literature search was directed at published studies from three online databases: Web of Science, PubMed, and EMBASE. The search terms for the review comprised of ([praziquantel OR PZQ] AND [schistosom* OR bilharzia] AND [pharmaco*]) and included studies evaluating PZQ metabolism. Publications were categorised into pharmacokinetics, drug–drug interactions, pharmacogenetics, and metabolite analysis. Forty publications describing human and experimental studies fitted the inclusion criteria and were subjected to data extraction and analysis. The analyses showed that variable exposure to PZQ was associated with alterations in the liver’s capacity to metabolise PZQ and observed drug–drug interactions. Other factors influencing the efficacy of PZQ were brand, formulation, and co-administered food. Although some work has been performed on metabolite identification, there was minimal information on PZQ’s metabolic pathway, and no pharmacogenetics studies were identified. The study indicated that in both human and experimental studies alterations in the liver’s capacity to metabolise PZQ as well as drug–drug interactions affected systemic levels of PZQ that could result in variable cure rates. The study confirmed previous findings of higher antischistosomal activity of (R)-PZQ enantiomer when administered alone compared to the racemate at the same dose as well as improved efficacy when the drug is administered with food. The study also highlighted the need for more comprehensive studies of the PZQ metabolic pathway and PZQ pharmacogenetic studies in humans.

Policy framework for building integrated care for TB patients in Romania: setting up the scene

Abstract Problem Romania put many efforts for TB control, but despite a constant decreasing trend since almost two decades, TB remained a public health concern, due to the notification rate (highest in EU), the number of resistant cases and the mortality. A national strategy for TB control has been issues for 2015-2020, but its implementation was fragmentary. Description of the Problem Benefiting for a series of programs financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Romania performed a detailed analysis of the national context, on four pillars (governance and accountability, service delivery, organizational capacity, resources). Quantitative data collected through routine systems were combined to interviews with key informers and focus groups with medical staff, patients and NGOs active in supporting key vulnerable population. Results A national framework for strengthening the implementation of the strategy was set up under a Tailored to Transition Global Fund Grant. This framework put together the policy and the technical levels and the civil society sector. Main interventions aimed to strengthen the governance, to improve the procurement and supply mechanism, to develop the ambulatory patient-centered model of care and to create tools for improving the access of key vulnerable population to basic integrated medical and social services. Lessons Translating the good practice models developed by the NGO sector to permanent (governmental) structures was difficult due to more rigorous legislative framework for public systems. Key messages Multisectoral approach is essential for building integrated care for TB patients. Integration of services should focus not only to complex medical needs, but also to the social ones.

Early assessment of health impact of the population-based tobacco control interventions in Vietnam

Abstract Background Through the period from 2013 until now, Vietnam has achieved progress in tobacco control following the implementation of MPOWER in 2008 and the enactment of the comprehensive Law on Prevention and Control of Tobacco Harms in 2012. This study aimed to assess the cost-effectiveness of 6 population-based interventions including health promotion &amp; education program; smoke-free models; cessation program; graphic health warning on cigarette package; bans on advertising/ promotion/ sponsoring; raising tobacco tax. Methods An Excel-based Markov model was adopted based on the previous studies of HV Minh et al 2018 and Ngalesoni et al 2017. We estimated the potential health gain on Vietnamese population by using the empirical data on tobacco epidemic in Vietnam together with the reviewed intervention effects from the literature. Due to the rapid decline of risk of cardiovascular disease after the smoking behavior changed, the short-run heath impacts were mainly estimated based on the change of smoking-related health burden of cardiovascular diseases. Results All six population-based interventions on tobacco control that have implemented were considered to be highly cost-effective ranged from 1,405 VND - 135,560 VND per DALYs averted compared to the WHO recommended threshold at 1 GDP per capita. Raising tobacco tax was projected to the most cost-effective intervention due to its significant health gains and potential to work on in the long run. Besides, smoke-free model, as the best intervention on individual behavior change, should be continue invested together with campaigns on raising awareness. Conclusions The study results shown the potential health impact in tobacco control in Vietnam after 10 years' implementation of MPOWER. Also, the findings provided a strong message that more attention should be paid to developing the national tobacco control strategy in the next phase to make the best use of available resources. Key messages Adequate attention should be equally paid for both political interventions and individual behavior – aimed interventions (communication, cessation…) in the fight against tobacco harms. Aside from raising tobacco tax, further investigations and investments on cessation services as well as smoking bans in public places are needed in Vietnam to achieve the best compliance on MPOWER.

Tuberculosis treatment outcomes and associated factors in two states in Nigeria

To determine the treatment success rate among TB patients and associated factors in Anambra and Oyo, the two states with the largest burden of tuberculosis in Nigeria. A health facility record review for 2016 was conducted in the two states (Anambra and Oyo). A checklist was used to extract relevant information from the records kept in each of the selected DOTS facilities to determine TB treatment success rates. Treatment success rate was defined as the proportion of new smear-positive TB cases registered under DOTS in a given year that successfully completed treatment, whether with bacteriologic evidence of success ('cured') or without ('treatment completed'). Treatment success rate was classified into good (≥85%) and poor (<85%) success rates using the 85% national target for TB treatment outcome. Data were analysed using descriptive statistics and chi-square at P<0.05. There were 1281TB treatment enrollees in 2016 in Anambra and 3809 in Oyo (total=4835). An overall treatment success rate of 75.8% was achieved (Anambra-57.5%; Oyo-82.0%). The percentage cure rates were 61.5% for Anambra and 85.2% for Oyo. Overall, only 28.6% of the facilities in both states (Anambra-0.0%; Oyo-60.0%) had a good treatment success rate. More facilities in Anambra (100.0%) than Oyo (40.0%) had a poor treatment success rate (p<0.001), as did more private/FBO (100.0%) than public health facilities (60.0%) (p=0.009). All tertiary facilities had a poor treatment success rate followed by 87.5% of secondary health facilities and 56.5% of primary healthcare facilities (P=0.035). Treatment success and cure rates in Anambra state were below the 85.0% of the recommended target set by the WHO. Geographical location, and level/tier and type of facility were factors associated with this. Interventions are recommended to address these problems.