Overall Prevalence Of Disease Research Articles

Prevalence of Diseases Among Working-age Men of Altai Region Living Near the Rocket and Space Activity Zone

Part of the population of the Altai Region is exposed to rocket and space activities. In order to identify possible medical consequences of such exposure, within the framework of the state space program in the region, since 1999, medical examinations of residents of territories adjacent to the fall areas of the second stages of launch vehicles launched from the Baikonur cosmodrome have been conducted. This paper presents the results of a dynamic analysis of the prevalence of diseases in men of working age in Krasnoshchekovsky district in 2003, 2008, 2013 and 2018. The most significant diseases, levels of indicators for the most widespread diseases and trends in the dynamics of indicators have been identified. The dynamics of the overall prevalence of diseases in men of working age and the prevalence of certain classes of diseases and nosologies is not unambiguous.

A simulation study of sampling in difficult settings: Statistical superiority of a little-used method

Taking a representative sample to determine prevalence of variables such as disease or vaccination in a population presents challenges, especially when little is known about the population. Several methods have been proposed for second stage cluster sampling. They include random sampling in small areas (the approach used in several international surveys), random walks within a specified geographic area, and using a grid superimposed on a map. We constructed 50 virtual populations with varying characteristics, such as overall prevalence of disease and variability of population density across towns. Each population comprised about a million people spread over 300 towns. We applied ten sampling methods to each. In 1,000 simulations, with different sample sizes per cluster, we estimated the prevalence of disease and the relative risk of disease given an exposure and calculated the Root Mean Squared Error (RMSE) of these estimates. We compared the sampling methods using the RMSEs. In our simulations a grid method was the best statistically in the great majority of circumstances. It showed less susceptibility to clustering effects, likely because it sampled over a much wider area than the other methods. We discuss the findings in relation to practical sampling issues.

Dynamics of the Prevalence of Diseases Among Fertile Age Women in a Separate Territory of the Krasnoshchyokovo District of the Altai Region Adjacent to the Rocket and Space Activity Zone

Part of the territory of the Altai Region is covered by the contours of the fall areas of the separating parts of launch vehicles during launches from the Baikonur cosmodrome. This paper presents the results of a dynamic analysis of data on the prevalence of diseases among women of fertile age – residents of the Chineta village council of the Krasnoshchyokovo district, as living in the territory adjacent to the fall areas of separable parts of launch vehicles. The data were obtained based on the results of a medical examination of the population of this territory in 2003, 2008, 2013 and 2018 in order to identify the possible negative impact of rocket and space activities on the health of the population. The study revealed the most significant pathology, the overall prevalence of diseases and the frequency of the prevalence of diseases of certain classes in women of fertile age in dynamics.

S104 Rising Prevalence of Anxiety and Depression in Chronic Pancreatitis: A Nationwide Analysis

Introduction: Chronic pancreatitis (CP) is a complex progressive fibro-inflammatory condition that has been shown to have long-term sequalae including chronic pain and decreased pancreatic function. Previous associations between gastrointestinal diseases such as inflammatory bowel disease and psychiatric disorders have been shown to negatively impact disease severity and overall quality of life. Recent studies have shown that psychiatric conditions, such as anxiety and depression (AD), are commonly associated with CP and significantly affect quality of life, burden of disease, and can worsen disease progression. However, no long-term studies evaluating the association between CP and AD has been performed. Methods: This analysis utilizes the National Inpatient Sample (NIS) database between the years 2010 – 2014. This is the first and most representative analysis that utilizes a national database to identify the association of AD in patients with CP. The primary goal is to provide further information about national trends, overall prevalence of disease and associations between patient and hospital characteristics. Results: A total of 75,744 patients with CP were include in our analysis. Of those, 23,323 (31%) patients had a diagnosis of anxiety or depression. Patients with CP and anxiety/depression were likely to be younger, more likely to be female, white, have Medicare or Medicaid insurance and be from hospitals in the Northeast or Midwest. African Americans, Hispanics and patients in hospitals from the South or West were less likely to have a diagnosis of anxiety/depression. The prevalence of anxiety among C P-related hospitalizations has increased from 7.33% in 2007 to 20.02% in 2014. Depression has increased from 18.49% in 2007 to 23.89% in 2014. A diagnosis of Anxiety and Depression has increased from 23.79% in 2007 to 33.44% in 2014. Increasing age in years was associated with an increased risk of mortality, OR 1.07 95% CI (1.04, 1.09, p< 10-5). AD was not associated with an increased risk of mortality, length of stay or hospitalization charges. Conclusion: CP is a prevalent disease with a significant impact on patients’ quality of life and wellbeing. We found that by 2014, 33% of patients had a comorbid diagnosis of AD. These findings can assist clinicians to improve treatment and management by including a comprehensive approach that addresses psychological and social variables.Figure 1.: National Trends in Anxiety and Depression in Chronic Pancreatitis.

SECULAR TRENDS IN THE PREVALENCE OF DISEASES AMONG THE RESIDENTS OF THE TERRITORIES OF THE ALTAI REGION ADJACENT TO THE AREAS OF FALLING OF SEPARATING PARTS OF LAUNCH VEHICLES

Introduction: Health of the residents of the territories adjacent to the space launches have been shown to be inferior to the national average. However, the data from the Altai region are scarce. Aim: To assess health status of the residents of the territories of the Altai region adjacent to the areas of falling of separating parts of launch vehicles Methods: All residents of the affected territories were examined by medical teams in 1999 (n = 1 929), 2005 (n = 1 213), 2010 (n = 1 016) and 2015 (n = 843). Overall prevalence rates class-specific rates per 1000 population were calculated. Secular trends were analyzed and comparisons with the reference population were performed. Results: The overall prevalence decreased from 4 400,5 - 4 406,5 % in 1999 to 3 932,7 - 3 941,5 % in 2015 (p &lt; 0.001) with no clear trend. In 1999, the main contributors to the overall burden of diseases were diseases of the endocrine system (1 072,2 - 1 075,0 %), diseases of the circulatory system (526,9 - 572,1 %), diseases of the eye and its appendages (390,8 - 435,6 %), and diseases of the respiratory system - 318,0 - 361,2 %. In 2015, the most prevalent illnesses were diseases of the circulatory system (743,4 - 801,0 %), diseases of the respiratory system (668,3 - 731,5 %), diseases of the endocrine system (636,6 - 701,4 %), and diseases of the eye and its appendages (452,0 - 520,8 %). Residents of the study group had greater overall prevalence of diseases (3 932,7 - 3,941,5 %) than the reference (2 539,3 - 2,539,5 %), p &lt; 0.001. The same was observed for the most classes of diseases. Conclusions: The overall prevalence of diseases among the residents of the territories adjacent to the areas of falling of separating parts of launch vehicles significantly decreased from 2015 to 1999 with no obvious linear trend. Women had poorer health than men. The overall prevalence of diseases and the prevalence of the most classes of diseases in the study group is significantly higher than in the reference population.

1679. Brucellosis in rural Narok County, Kenya: A Retrospective Review

BackgroundIt is well-documented that the country of Kenya is confronted with a heavy burden of brucellosis, presumably related to consumption of unboiled or fermented milk products (maziwa lala). As a developing country, epidemiologic data defining the prevalence of brucellosis is incomplete and particularly lacking in rural areas of the country. The objective of this study was to establish the rate of brucellosis in patients seen in a rural health clinic in Narok County, an area which has not been previously studied.MethodsThis study was performed at the Ewaso Ngiro Health Center, Narok County, Kenya, which serves a catchment area of 6,573 citizens. A retrospective chart review was conducted for 241 patients seen in December 2018 for acute visits. Medical records were reviewed for evidence of joint pain and other symptoms of brucellosis at the time of presentation and for brucellosis antigen testing results.ResultsOf the 241 patient charts reviewed, 78 (71 adult, 7 pediatric) patients had joint pain. Of the 71 adult patients, 21 were male and 49 were female (1 with no gender recorded). 50 patients had Brucella testing performed via serum agglutination, and yielded 14 positive results (13 adult, 1 pediatric). Confirmed brucellosis accounted for 5.8% of all acute visits in December 2018, and 26% of patients presenting with joint pain. In patients with confirmed brucellosis, the average age was 50.2 years (ranging 15–80). There were 8 female cases, 5 male, 1 with gender not recorded. Generalized joint pain was the most common complaint (n = 14), followed by back (n = 6), knee (n = 1), and neck pain (n = 1).ConclusionThe prevalence of Brucella disease in rural areas of Kenya, specifically Narok County, is not well studied. This study provides insight into the prevalence of brucellosis and shows that over 25% of patients presenting with joint pain, have brucellosis. Furthermore, 5.8% of all patients seen at the Ewaso Ngiro Health Center during the study period had brucellosis and the overall prevalence of disease in patients who were tested specifically for brucellosis (n = 50), was 28%. This study provides preliminary evidence of a heavy burden of Brucella disease in Narok County and suggests that a follow-up study in this area is warranted to be defined the true prevalence of disease over a longer time frame.Disclosures All authors: No reported disclosures.

The dynamics of the prevalence of diseases of the circulatory system among the population of the Altai territory, living in the zone of infl uence of rocket and space activities

Introduction. On the territory of the Altai territory there are four areas of falling of separating parts of space launch vehicles. For many years, these territories have been exposed to negative factors of rocket and space activities. In order to assess the possible impact of rocket and space activities on the health of the inhabitants of the Altai territory, living near the areas of falling of the separating parts of the launch vehicles, their medical examination is regularly carried out.The aim of the study is to assess the possible impact of rocket and space activities on public health.Materials and methods. Th e results of dynamic analysis of the prevalence of circulatory disease among the residents of Novoaleysky and Ploskovsky village councils of the Tretyakov District of the Altai territory. In 1999, 1929 people were examined, in 2005–1213 people, in 2010–1016 people and in 2015–843 people. Extensive and intensive indicators of prevalence of diseases of the circulatory system were obtained.Results. Basing to results of the dynamic analysis, the peculiarities of the signifi cance and prevalence of the circulatory system diseases, as well as of separate nosologies of this class, were identifi ed. Th e most common circulatory system diseases were determined for the studied contingent. Th e prevalence of this pathology diff ers in men and women. Comparison of the results of the medical examination in 2015 with the data on the general morbidity of the population of the Altai territory showed that the level of detection of diseases of the circulatory system among the inhabitants of the studied areas is signifi cantly higher than the level of the general morbidity of this pathology. Th e obtained results of the analysis of the prevalence of the circulatory system diseases allow overtime monitoring the residents’ health of the territories boarding to the areas of rocket and space activities. Th is allows to evaluate the eff ectiveness of measures to optimize their health and provides sound information for management decisions.Conclusions. Th e overall prevalence of diseases in the study areas in 2015 was signifi cantly lower than in 1999, but the prevalence of diseases of the circulatory system in 2015 was signifi cantly higher than in 1999. In the study areas, the most signifi cant diseases of the circulatory system are hypertension, myocardiodystrophy, angina pectoris and atherosclerosis of the aorta. In all the years studied, the prevalence of circulatory diseases among women was signifi cantly higher than among men. Among women, the prevalence of myocardiodystrophy of various etiologies and hypertension is signifi cantly higher. Th e prevalence of angina in men and women was the same. Th e prevalence of aortic atherosclerosis is much higher in men.

An outbreak of strangles associated with a novel genotype of Streptococcus equi subspecies equi in donkeys in China during 2018.

Strangles is a highly contagious respiratory disease of equids caused by the bacterium Streptococcus equi subspecies equi. To identify the cause of an outbreak of strangles that occurred on donkey farms within the Shandong Province of China and determine the prevalence of the disease. Cross-sectional. Samples were taken from clinically affected animals to measure the prevalence of strangles within the population of donkeys at six intensive farms in China and identify the SeM type of isolate recovered from affected animals. Diagnosis was confirmed by bacterial isolation, biochemical tests and PCR. Epidemiological data were analysed using Chi-square test and a Fisher's exact two-sided test. The SeM gene of S.equi isolates recovered from affected animals was determined and compared with the SeM database PubMLST-seM. In July and August 2018, an outbreak of strangles occurred on six donkey farms within the Shandong Province of China. The overall prevalence of disease within the different donkey herds was 13.4%. Younger animals were worst affected with 40.3% (83/206) of donkey foals aged under 1year exhibiting clinical signs compared with 12.5% (191/1525) of donkeys aged one to 2years and 3.8% (17/442) of donkeys over 2years of age. Analysis of SeM sequencing data identified that the farms were affected by the same strain of S.equi, SD201807, which contains the novel 136 allele of SeM. Healthy donkeys were not sampled in this study. The number of intensive donkey breeding farms in China has risen recently. The higher numbers of animals that are in closer proximity to one another raise the potential for the transmission of infectious diseases such as strangles. This is the first description of a strangles outbreak among donkey herds in China. The Summary is available in Chinese - see Supporting information.

Experience of studying the health status of personnel of rescue military units of EMERCOM of Russia

Relevance.Health maintanance and professional longevity are primary objectives of medical and psychological support for personnel of EMERCOM of Russia. Information about the state of health of military personnel and civilian personnel of rescue military units of Emercom of Russia, as well as military units for radiation, chemical and biological protection was not found in the available literature.Intention. Clarify data on the state of health of military personnel and civilian personnel of rescue military units of Emercom of Russia for developing evidence-based preventive and rehabilitation measures in the future.Methodology.The health status of the personnel of rescue military units of Emercom of Russia was studied on the model of the Federal State-Owned Institution Nevsky Rescue Center of Emercom of Russia (Kolpino, St. Petersburg) based on the results of periodic medical examinations in 2015–2016.Results and Discussion.The overall prevalence of diseases revealed in military and civilian personnel during the annual medical examination was similar, including the main classes of diseases, and averaged 2 diseases per 1 person. The overall prevalence of diseases in the older age group (30–44 years) of military personnel 1.2–1.4-fold (p = 0.021) exceeded that of the younger (18–29) age group of military personnel as well as of both age groups of civilian personnel. No convincing impact of professional experience on the prevalence of diseases was revealed.Conclusion. The levels and structure of pathology revealed during periodic medical examinations in military personnel and civilian personnel of the Nevsky Rescue Center had no statistically significant differences, suggesting the fundamental similarity of the nature and intensity of occupational factors. At the same time, age rather than the duration of professional activities influenced the frequency of the revealed pathology in the studied sample. Weighted indicators of public health over a longer period of time (5+ years) will help eliminate stochastic effects and make reasonable conclusions about the prevalence of diseases in various military rescue specialists.

PREVALENCE AND RISK FACTORS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN ADULT KASHMIRI POPULATION

Objective: The study was conducted with the objective of studying the prevalence of gastroesophageal reflux disease (GERD) and to study various factors associated with it in adult Kashmiri population.Methods: It was a community based prospective cross-sectional observational study conducted by the Department of Medicine and Gastroenterology, GMC Srinagar over a period of 24 mo upon native Kashmiris from urban as well as rural areas as a study group. A total of 2600 subjects above the age of 18 y were studied and the overall prevalence of disease was calculated and also the associated (risk) factors were looked for.Results: The overall prevalence of 20.3% was seen in the study population with female gender being more prone to the development of disease (p&lt;0.001). Other factors of greater significance included body mass index (BMI), smoking, physical activity, intake of spicy foods, posture after meals, dinner to sleep time, non-steroidal anti-inflammatory drug (NSAID) intake and some underlying ailments like asthma and history of abdominal surgery.Conclusion: The overall prevalence of GERD in Kashmiri community is 20.3% with females being more prone with a definite role of factors like BMI, smoking, physical activity, posture after meals, dinner to sleep time interval, intake of spicy foods, drugs and also the co-morbidities.

Insights into the genetic epidemiology of Crohn's and rare diseases in the Ashkenazi Jewish population.

As part of a broader collaborative network of exome sequencing studies, we developed a jointly called data set of 5,685 Ashkenazi Jewish exomes. We make publicly available a resource of site and allele frequencies, which should serve as a reference for medical genetics in the Ashkenazim (hosted in part at https://ibd.broadinstitute.org, also available in gnomAD at http://gnomad.broadinstitute.org). We estimate that 34% of protein-coding alleles present in the Ashkenazi Jewish population at frequencies greater than 0.2% are significantly more frequent (mean 15-fold) than their maximum frequency observed in other reference populations. Arising via a well-described founder effect approximately 30 generations ago, this catalog of enriched alleles can contribute to differences in genetic risk and overall prevalence of diseases between populations. As validation we document 148 AJ enriched protein-altering alleles that overlap with "pathogenic" ClinVar alleles (table available at https://github.com/macarthur-lab/clinvar/blob/master/output/clinvar.tsv), including those that account for 10–100 fold differences in prevalence between AJ and non-AJ populations of some rare diseases, especially recessive conditions, including Gaucher disease (GBA, p.Asn409Ser, 8-fold enrichment); Canavan disease (ASPA, p.Glu285Ala, 12-fold enrichment); and Tay-Sachs disease (HEXA, c.1421+1G>C, 27-fold enrichment; p.Tyr427IlefsTer5, 12-fold enrichment). We next sought to use this catalog, of well-established relevance to Mendelian disease, to explore Crohn's disease, a common disease with an estimated two to four-fold excess prevalence in AJ. We specifically attempt to evaluate whether strong acting rare alleles, particularly protein-truncating or otherwise large effect-size alleles, enriched by the same founder-effect, contribute excess genetic risk to Crohn's disease in AJ, and find that ten rare genetic risk factors in NOD2 and LRRK2 are enriched in AJ (p < 0.005), including several novel contributing alleles, show evidence of association to CD. Independently, we find that genomewide common variant risk defined by GWAS shows a strong difference between AJ and non-AJ European control population samples (0.97 s.d. higher, p<10−16). Taken together, the results suggest coordinated selection in AJ population for higher CD risk alleles in general. The results and approach illustrate the value of exome sequencing data in case-control studies along with reference data sets like ExAC (sites VCF available via FTP at ftp.broadinstitute.org/pub/ExAC_release/release0.3/) to pinpoint genetic variation that contributes to variable disease predisposition across populations.

Study on prevalence of bovine diseases at sadar upazila in dinajpur district of Bangladesh

The study was conducted to investigate the status of cattle diseases with relation to seasonal variation in Dinajpur district of Bangladesh. A total of 11402 clinical cases were registered for the clinical diagnosis and therapeutic purposes at sadar upazila veterinary hospital in Dinajpur district of Bangladesh during the period of March, 2016 to February, 2017. Disease diagnosis was made on the basis of owner’s statement, general examination and clinical signs. Diagnosed diseases were categorized as general clinical disorders, parasitic diseases, viral diseases, bacterial diseases, venereal disease, and metabolic disorders. According to study the highest (64.15%) prevalence was by parasitic disease followed by bacterial diseases (10.67%), viral diseases (8.97%), metabolic disease (7.61%), and venereal disease (6.60%). In respect of seasons, the prevalence of both bacterial diseases and viral diseases were significantly (p&lt;0.01) higher (13.88%) and (12.10%) in summer season respectively. Whereas the parasitic diseases were significantly (p&lt;0.01) higher (68.65%) in winter season. On the basis of season, it was found that the overall prevalence of diseases was highest in summer season (47.87%) followed by rainy season (30.10%) and comparatively lower in winter season (22.03%).Asian J. Med. Biol. Res. December 2017, 3(4): 446-453

PREVALENCE OF CLINICAL DISEASES OF PET DOGS AND RISK PERCEPTION OF ZOONOTIC INFECTION BY DOG OWNERS IN BANGLADESH

A case control study was conducted to ascertain the prevalence of clinical diseases and/or clinical conditions of 3670 sick pet dogs presented to the Central Veterinary Hospital (CVH), Dhaka during the one year period from January to December 2009. A total of 57 types of diseases and conditions in 17 categories were recorded in these pet dogs and their variation in prevalence were analyzed on the basis of age, gender, season and breeds of dogs. The prevalent diseases and/or conditions from low to high rates included glaucoma (0.05%), babesiosis ( 0.08%), sinusitis (0.08%), tetanus (0.08%), spaying (0.14%), nail injury (0.19%), nephritis (0.19%), cataract (0.25%), metritis (0.25%), poisoning (0.33%), orchitis (0.35%), rabies (0.35%), pus in antrum (0.41%), purulent cough (0.46%), alopecia (0.52%), pharyngitis (0.52%), transmissible venereal tumor (0.54%), cystitis (0.52%) phimosis (0.52%), paraphimosis (0.60%), stomatitis (0.63%), pneumonia (0.63%), mastitis (0.71%), otitis (0.73%), taeniasis (0.74%), abscess (0.82%), anal gland disease (0.82%), dystocia (0.84%), conjunctivitis (0.90%), lice infestation (0.90%), lameness (0.95%), ottorrhea (1.06%), uterine prolapse (1.31%), posthitis (1.31%), dental disorders (1.34%), metabolic diseases (1.36%), protrusion of eye ball (1.44%), canine distemper (1.61%), liver disease (1.72%), nutritional deficiency diseases (1.77%), infertility (1.80%), coccidiosis (1.93%), toxocariasis (1.93%), urinary tract infection (2.10%), accidental wounds (2.32%), haematuria (2.34%), bronchitis (2.81%), arthritis (2.94%), dermatomycosis (3.30%), aspiration pneumonia (3.32%), mange (3.76%), echinococcosis (3.92%), dermatitis (4.99%), diarrhea (5.21%), ancylolostomiasis (6.20%), flea infestation (9.84%) and tick infestation (11.88%). Age-wise overall prevalence of clinical diseases revealed significantly (p &lt;0.05) highest in age group above 36 months (48.12%) compared to that in 7 to 36 months (34.33%) and up to 6 months (17.55%) age groups of pet dogs. The significantly (p &lt;0.05) highest prevalence of diseases and/or clinical conditions was recorded in local (33.35%) and German shepherd (22.53%) breeds of pet dogs in comparison to that in their counterpart breeds of Lhasa-Apso (7.57%), Greyhound (7.11%), Doberman (6.34%), Samoyed (6.23%), Dachshunds (5.20%), Spaniel (3.37%), Spitz (3.07%) and Poodle (3.18%). Results from season-wise analysis of overall prevalence of diseases and/or clinical conditions in pet dogs did not differ significantly (p &gt;0.05) among spring (21.53%), summer (25.80%), autumn (22.83%) and winter (29.84%). The highest prevalence of arthropode infestation (22.62%), followed by intestinal parasitic diseases (14.80%) and diarrhea (5.20%) suggest a poor husbandry of these pets in Dhaka. Results of this study indicate that the risk of zoonotic infection by canine intestinal parasite may be high in Bangladesh.DOI = http://dx.doi.org/10.3329/bjvm.v8i2.11201 Bangl. J. Vet. Med. (2010). 8 (2) : 163-174

Prevalence of restless legs syndrome in the rural town of Cassia dos Coqueiros in Brazil

To estimate the prevalence and evaluate the characteristics and severity of restless legs syndrome (RLS) in an urban Brazilian community. A transversal study was conducted over an 18-month period. A neurologist conducted 1155 interviews using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The lifetime prevalence of RLS was found to be 6.40%. Prevalence during the last year, the last month, and the last week were found to be 5.71%, 5.36%, and 4.15%, respectively. A greater proportion of women met diagnostic criteria for RLS compared to men (OR: 2.63, CI 95%: 1.54-4.51). Furthermore, participants with low monthly family income (<$1575 USD) had a lower prevalence of disease compared to those with a high monthly family income (>$1575 USD) (OR: 2.91, CI 95%: 1.41-5.98). This is the first epidemiologic study of RLS conducted in a Brazilian population. The overall prevalence of disease and the greater proportion of RLS in women found in this study are similar to the findings of other studies conducted in western countries. The association of RLS with high family income is unpublished and should be confirmed in subsequent studies.

Zoonotic And Infectious Disease Surveillance In Ecuador: Ehrlichia Canis, Anaplasma Phagocytophilum, Borrelia Burgdorferi, And Dirofilaria Immitis Prevalence Rates In Canines

Vector-borne diseases (VBD) make up a large number of emerging infectious and zoonotic diseases. Ticks, fleas, and mosquitoes are effective vectors parasitizing canines, making dogs adequate reservoirs for zoonoses. The U.S. military deploys personnel and government-owned animals around the world with possible risk of exposure to VBD. Canine VBD have veterinary and public health significance for the host nations as well as for the U.S. troops and its working animals deployed in the theater of operations. These factors make disease surveillance a great importance. The objective of this work was to survey canines from the cities of Manta and Guayaquil in Ecuador to determine prevalence of heartworm disease (D. immitis), ehrlichi os is (E. canis), Lyme disease (B. burgdorf eri), and anapl asmosis (A. phagocytophilum). Canine blood samples (1-3ml) collected from the cities of Manta (n=50) and Guayaquil (n=50) were tested on site using a SNAPR 4DxR Test Kit. Prevalence for single or multiple disease status was calculated for each city. In the city of Manta the overall prevalence of diseases was 78%; 52% for E. canis alone, and 26% for co-infection with E. canis and A. phagocytophilum. The overall prevalence for the city of Guayaquil was 88%; 40% for E. canis alone, 22% for A. phagocytophilum alone, and 26% for co-infection with E. canis and A. phagocytophilum. Neither heartworm disease nor Lyme disease was detected in any samp le. In conclusion, this study showed the extensive presence of E. canis and A. phagocytophilum in both cities in Ecuador, emphasizing the value of surveillance for zoonotic diseases to determine disease prevalence and risk assessments, as well as to implement control measures.

Authors’ Response

To the Editor: We thank Ms. Daniels for her comments1 on our analysis of late diagnosis of human immunodeficiency virus (HIV) among young men in North Carolina (NC) published earlier in this journal.2 Although the Centers for Disease Control and Prevention classifies late diagnosis in the manner suggested by Ms. Daniels, which includes a 1-year postdiagnosis window for acquired immunodeficiency syndrome (AIDS) progression,3 there are various categorizations to identify persons testing late. In a recent review of studies of late diagnosis of HIV and late presentation into care in industrialized counties, Girardi et al.4 documented that the definitions of late diagnosis used in the reviewed studies included concurrent diagnosis of HIV and AIDS,5,6 as well as an AIDS diagnosis within a month7 or 6 months8 of HIV diagnosis. Different classifications of late diagnosis answer different research questions and have different biases associated with them. We recognize that our conservative categorization of late diagnosis as persons with an AIDS diagnosis at first HIV test identified those persons most disenfranchised from testing. Although this classification may have missed some persons who progressed to AIDS soon after diagnosis, it also eliminated loss to follow-up and the resulting misclassification bias. For example, some persons relocate to different states after an HIV diagnosis.9,10 For persons who moved from NC after HIV diagnosis, we would not have access to their HIV disease status 1 year later. Consequently, for those who progressed to an AIDS diagnosis within the next year, we would have falsely categorized them as having an early diagnosis. It is possible that persons who had the desire and means to move from NC were different from those who stayed, by demographic characteristics and risk behaviors. If so, this would have biased our results. Additionally, because disease progression after HIV diagnosis is partially dependent on HIV treatment, classifications of late diagnosis that include a follow-up period answer research questions about access to testing and access to care. Using our stringent classification, our research eliminated any heterogeneity in HIV treatment and focused on HIV testing. We echo Ms. Daniels’ call for increasing access to HIV testing for all populations. However, as communities implement the Centers for Disease Control and Prevention’s revised guidelines for HIV testing of adults, adolescents, and pregnant women,11 it will be essential to monitor late diagnosis to ensure that testing opportunities are both reaching and being accepted by all populations. As we noted, targeted testing interventions can reduce specific health inequalities. Universal testing policies will take steps toward reducing the overall prevalence of disease and morbidity of late diagnosis. For those interested in reducing health disparities, identifying and reaching out to disenfranchised populations is imperative.

Serological survey of Leishmania infection in dogs from the municipality of Peso da Régua (Alto Douro, Portugal) using the direct agglutination test (DAT) and fast agglutination screening test (FAST)

Leishmaniasis caused by Leishmania infantum is a prevalent disease in dogs and humans. A serological survey of Leishmania infection in dogs was carried out in the endemic region of Alto Douro (north Portugal). Two hundred and ninety-four dogs from the municipality of Peso da Régua were examined for clinical signs of canine leishmaniasis (CanL), and sera samples were evaluated by the direct agglutination test (DAT) and the fast agglutination screening test (FAST). The sero-prevalence of infection was 20.4%, after screening the study population by FAST and subsequent confirmation by DAT. The overall prevalence of disease was 3.1%. Only 15.0% of the sero-positive dogs had clinical signs of CanL. A high degree of agreement (88.4%; κ value=0.71) was found between DAT and FAST. This study further demonstrates that FAST can be used as a simple, rapid and sensitive screening test for canine Leishmania infection in areas of high endemicity and, together with DAT, is a valuable tool in the assessment of CanL.

Sero-epidemiological study of canine Leishmania spp. infection in the municipality of Alijó (Alto Douro, Portugal)

Visceral leishmaniosis caused by Leishmania infantum is a zoonotic disease in the Mediterranean basin. We report an epidemiological survey carried out in dogs from the municipality of Alijó in the endemic region of Alto Douro (north Portugal). Performance of the direct agglutination test (DAT) was assessed in 205 matching samples of blood collected on filter paper and serum. A high degree of agreement (97.6%; κ=0.83) was found between the results obtained from both types of samples. DAT was then used to test more blood on filter paper (B-FP) samples from other dogs of the same municipality. The detected sero-prevalence was 18.7% (288/1540), with values ranging from 0.0 to 81.1% in each of the 19 parishes of Alijó. Three distinct geographical zones of mean sero-prevalence could be defined: northwestern (2.5%), intermediate (11.4%) and southern (49.9%). No statistically significant difference was observed between male (19.1%) and female (17.8%) sero-prevalences ( P=0.560). Dogs of 9–11 years of age showed the highest sero-prevalence (28.4%), but all the other age-intervals (0–2, 3–5, 6–8 and 12–17 years) presented values (15.0–22.3%) not significantly different from the mean of the whole study population. Risk factors for canine Leishmania infection were age and geographical zone. Only 5.9% of the sero-positive animals had clinical signs of canine leishmaniosis and the overall prevalence of disease was 1.1%. This study validates the use of B-FP samples and confirms DAT as a simple and sensitive serological test to evaluate the level of canine Leishmania infection in areas of high sero-prevalence.

Mycobacterium tuberculosis in zoo and wildlife species.

Tuberculosis caused by Mycobacterium tuberculosis and M. tuberculosis-like organisms has been identified in a wide range of species, including non-human primates, elephants and other exotic ungulates, carnivores, marine mammals and psittacine birds. Disease associated with M. tuberculosis has occurred mostly within captive settings and does not appear to occur naturally in free-living mammals. Mycobacterium tuberculosis probably originated as an infection of humans, but from the zoonotic standpoint, non-human primates, Asian elephants and psittacine birds have the potential to transmit this disease to humans. However, the overall prevalence of disease in these susceptible species is low and documented transmissions of M. tuberculosis between animals and humans are uncommon. Mycobacterium tuberculosis causes progressive pulmonary disease in mammals and a muco-cutaneous disease in parrots. In all cases, the disease can disseminate and be shed into the environment. Diagnosis in living animals is based on intradermal tuberculin testing in non-human primates, culturing trunk secretions in elephants, and biopsy and culture of external lesions in parrots. Ancillary testing with deoxyribonucleic acid probes and nucleic acid amplification, and enzyme-linked immunosorbent assays have been adapted to some of these species with promising results. Additionally, new guidelines for controlling tuberculosis in elephants in the United States of America, and programmes for tuberculosis prevention in animal handlers have been established.

Transplant coronary artery disease in pediatric heart transplant recipients

Background Transplant coronary artery disease (TxCAD) contributes to a large percentage of late morbidity and mortality among adult heart transplant recipients. Intracoronary ultrasound (ICUS) is a sensitive tool in the diagnosis of TxCAD in adult patients and has allowed analysis of factors contributing to disease development. Experience with ICUS in pediatrics, however, has been limited. By using ICUS we sought to determine the overall prevalence of TxCAD in pediatrics and to characterize factors associated with its development in this population. Methods Eighty-six studies were performed in 51 pediatric patients a median of 3.4 years after heart transplantation. Evaluation included angiography and ICUS in 83 and angiography alone in 3 studies. Donor and recipient characteristics were obtained. The ICUS images were analyzed for intimal thickening and compared with coronary angiograms. The presence of any intimal thickening on ICUS was considered TxCAD. An intimal index and point of maximal intimal thickening (MIT) were measured. Vessel disease was graded 0 to 4 based on these results. Results Four patients had evidence of vasculopathy by angiography, whereas 32 patients (63%) had evidence of intimal proliferation by ICUS. Grade 2 or greater disease was present in 19 (37%) patients. A positive correlation was found when comparing time from transplant with intimal index and MIT ( p < 0.001). No other factors were found to predict the development of disease. The overall prevalence of disease was 74% in patients studied at least 5 years after transplant. Conclusions Intracoronary ultrasound can be performed safely in pediatric patients. Transplant coronary artery disease is common in infants and children after heart transplantation, although its prevalence appears to be less than in adult recipients at similar time intervals. We found no factor other than time from transplant was associated with development of disease.